Is going to a "top" program worth the extra research years?

[gsurg2011]

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Having a hard time deciding if it's worth 2 years of my life doing research so I can match at one of the "top" programs. I don't mind research but I really don't want to do it full time unless it's gonna be worth it. Not sure if I will end up academic or not. Is it better in the long term for job prospects, fellowships, etc... to just bite the bullet and go to a 7 year place like UCLA or Michigan? Or, can you do just as well without a big-time research background?

 

[Buzz Me]

Do you know what type of fellowship you're interested in? Many residents will go into the lab if they're planning on applying to a competitive fellowship (e.g. Peds Surg or Plastics).

 

[Guile]

Having a hard time deciding if it's worth 2 years of my life doing research so I can match at one of the "top" programs. I don't mind research but I really don't want to do it full time unless it's gonna be worth it. Not sure if I will end up academic or not. Is it better in the long term for job prospects, fellowships, etc... to just bite the bullet and go to a 7 year place like UCLA or Michigan? Or, can you do just as well without a big-time research background?

What makes you think you're ranked at those places??

I kid. I kid. In all honesty, IMHO you should not go to a 7-year program unless you want to do the time in the lab. You're not going to (or at least you're not likely to) get more excited about lab time as your residency goes on. If you're not looking forward to going into the lab then you probably won't enjoy it, won't be productive, your PI will be disappointed, it could get back to your PD or chair...all not good. (But hey, even some of the ones not excited about it end up loving it...they see it as a nice break and often moonlight and pay down loans, buy a car, etc.) If you're not dead set on doing peds or surg onc, then you can get a spot in fellowships without research. Matching in peds or surg onc is very difficult (near impossible) without it. That said, you can do research at almost all programs, even 5-year ones. So if you change your mind, you can do the time in the lab. Also to consider is your likelihood of going into academics. Unless you're completely sold on it, then you're probably not going into it. I think few people change their mind from PP to academics in training, maybe I just haven't seen it though. If you're not sold on academics, then pedigree really doesn't matter. You can match in really great fellowships even out of community programs (look at the match list at some strong community programs and university programs outside the "top 20"--they go to some good places) so really it just comes down to where you're going to be happy, regardless of the name. Since you're hesitant about 2 years of research, if I were you, I'd look elsewhere. Ideally you could go to a place where about equal numbers of people go into the lab as go straight through so you could figure it out when you're in training.

So bottom line, for the reasons you've stated, I wouldn't go to a 7-year program. Only go if doing two years is something you want to do, and not something that's a means to an end.

 

[ESU_MD]

In retrospect........
2 years isnt that long if you can moonlite and/or can afford the break. You are only young once. For me, gen surg was like college, only better. I wish i couldve prolonged the good times by spending a few years in the "lab"

 

[gsurg2011]

In retrospect........
2 years isnt that long if you can moonlite and/or can afford the break. You are only young once. For me, gen surg was like college, only better. I wish i couldve prolonged the good times by spending a few years in the "lab"

If I hadn't already taken a few years off before medical school I think I would agree with you. At this point for me, it is only worth doing if it will make a big impact careerwise. I'm probably not interested in peds or surgonc so that's why it's a harder choice.

 

[filter07]

There are a few things to consider.

Re: fellowship goals, those can change. Might end up loving ped surg, onc, or plastics along the way. If you do, then research might help.

Re: uncertainty about research. If you aren't into research at this point I think it is unlikely that you will come to like it later. If you somehow find yourself in a lab you might enjoy it, but even then I still think it's unlikely that you will run a lab in the future, get NIH funding, etc. So if you look at the lab time as an investment for academics, I would argue that is probably not a good investment. I never met anyone who was only sorta kinda into research actually go into research oriented academics... seems they were all pretty gungho about this stuff, but that's just anecdotal.

Re: time off. I took some time off in college. It is annoying watching my friends become attendings and my co-interns going on job interviews, but I was able to pay off some of my student loans and basically just waste a ton of time, which I love to do. Time enjoyed is never time wasted in my book. I'm in no hurry to be a real adult; being an adult sucks.

In my personal case, I like research, but I don't really love it. What I like the most about lab time is the chance to show up to work when I want, leave when I want, turn off the pager for 2 years, and basically have control over my life again. The writing, pipeting, presenting, conferencing, and "getting my name out there" stuff is way less important to me, which probably does not bode well for an academic future. Previously I was pretty gungho research and academics, was looking at 7 year programs, and all that. Man, but that stuff doesn't get me up in the morning, which is probably why I show up to work at 10, about 4 times a week.

 

[winthug]

I agree with everything that has been said above so far. I'm looking for programs that are primarily optional research because it's impossible to say if I'm going to rule out peds/onc at this point. I only wanna do research if its going to further my career in terms of difficult fellowships or academics, which isn't the plan now, BUT it might change. I've heard of residents who do research as a means to an end, but like someone else said, it might be looked down upon.

As a side note, I think it's weird that other surgical specialties like urology, NS, ortho, direct plastics, CT, and vascular almost never have this "time off" component to their residency, yet the residents still go into competitive fellowships if they do any kind of clinical research during their clinical years. I don't know the full story though but regardless, I'm slightly envious.

 

[Guile]

As a side note, I think it's weird that other surgical specialties like urology, NS, ortho, direct plastics, CT, and vascular almost never have this "time off" component to their residency, yet the residents still go into competitive fellowships if they do any kind of clinical research during their clinical years. I don't know the full story though but regardless, I'm slightly envious.

This is a good point. I've never heard a good answer to it. I don't know anyone in urology or ortho who took time off to do research, but a lot of those guys, especially the ortho ones, do fellowships. Maybe because the programs are smaller it's harder to schedule it? But then why don't they just have 7-year programs?

 

[winthug]

My theory is that those specialties tend to be much more competitive than general surgery, so there's many more general surgery residents coming out of residencies vs. orthopaedics and such. However, the ratio of non-GS graduates to fellowship spots is probably closer to 1 compared to the ratio of GS graduates to GS-related fellowships. So, research is an artificial way to determine which GS-graduate is more competitive. If there were more fellowship spots or less graduating GS residents, you'd probably see less people doing research.

 

[Pir8DeacDoc]

Interesting point you guys bring up. Programs that really want to push research find a way in the subspeciality programs.
Our orthopedics program has half the resident go straight through and the other half obtain a masters in public health. In ENT, we have a four month research block, which I think is a requirement of our RRC, but it could be just my program? There is really no expectation that you do a ton of research to get a fellowship, at least in ENT.

Sort of a shame that you guys have to do at least one to two years in the lab to secure certain fellowships. It just makes the entire painful process that much longer.

 

[Encephalectomy]

This is a good point. I've never heard a good answer to it. I don't know anyone in urology or ortho who took time off to do research, but a lot of those guys, especially the ortho ones, do fellowships. Maybe because the programs are smaller it's harder to schedule it? But then why don't they just have 7-year programs?

Prevalence of required research time in residency among surgical fields is something like NS>Gensurg>>ENT=ortho=uro=gyn

I'm not sure if fellowships have anything to do with why certain fields have
more research built into residency than others. NS residencies almost always have 1-2 years of research time built in, and a relatively small (though increasing) percentage of them do fellowships. Probably just has more to do with the norms established in each field.

 

[SLUser11]

However, the ratio of non-GS graduates to fellowship spots is probably closer to 1 compared to the ratio of GS graduates to GS-related fellowships.

I've mentioned this before, but people often forget that there are a buttload of fellowship spots available for post-gen surgery training....and most of these are not that competitive.

The only fellowships that truly require research are Peds surg, and to a lesser extent surgical oncology. The rest absolutely do not require dedicated research years.

 

[Guile]

There is really no expectation that you do a ton of research to get a fellowship, at least in ENT.

This is the fundamental difference. I think most people applying in peds have 10+ papers. Even then, you apply to every fellowship, interview everywhere you get an offer, rank them all and pray you match. Surg onc is less competitive than peds to get a spot but if you want to go to MSKCC or MDACC then you better have the papers and time in the lab. You need quality research to even get a spot though. I think people get into good plastics programs without two years of research, and the rest are lower in competitiveness after that.

 

[Encephalectomy]

This is the fundamental difference. I think most people applying in peds have 10+ papers. Even then, you apply to every fellowship, interview everywhere you get an offer, rank them all and pray you match. Surg onc is less competitive than peds to get a spot but if you want to go to MSKCC or MDACC then you better have the papers and time in the lab. You need quality research to even get a spot though. I think people get into good plastics programs without two years of research, and the rest are lower in competitiveness after that.

Peds surgery is definitely hypercompetitive and none of the surgical subspecialties have an equivalently competitive fellowship that some people are gunning for (maybe Facial plastics for ENTs?), but I really doubt that anybody is getting a fellowship at MSKCC or MDACC in any field without a fairly impressive publication record whether they are shooting for surg-onc out of gensurg, Head and Neck cancer out of ENT, Orthopedic onc etc., but in gen surg, since most people who are on an academic track have taken 2 years out for research they probably have more people with basic science research in residency.

 

[Pir8DeacDoc]

Nothing in our specialty fellowship wise is even close to pedi surg or plastics. There is a certain amount of self-selection but generally speaking the most competitive is facial plastics (a handful more applicants than spots) and then otology (about the same # spots as applicants), and then it drops off from there.

It holds that you have to be top notch to get the very best fellowships in any field, but to just get in, generally isn't that hard for our fellowships.

 

[winthug]

This is the fundamental difference. I think most people applying in peds have 10+ papers. Even then, you apply to every fellowship, interview everywhere you get an offer, rank them all and pray you match. Surg onc is less competitive than peds to get a spot but if you want to go to MSKCC or MDACC then you better have the papers and time in the lab. You need quality research to even get a spot though. I think people get into good plastics programs without two years of research, and the rest are lower in competitiveness after that.

With that being said tho, ppl usually want to get into a top fellowship or one in a particular region. So research will definitely get you into the top CT, Vascular, Colorectal fellowship in a preferred location where you might not otherwise have an easy time obtaining without research. I still feel though that research should be done by people who have a passion for it and not be done as a means to an end. I'm sure a lot of ppl do the latter just to get their peds fellowship and never set foot in a lab again. These fellowships should use another way to rank their applicants other than who can postpone getting a REAL job the longest. Lets face it. There's not that many professions that have you do this much school until you're in your mid 30s before you finally can start paying off yout loans. 🙁

 

[JackADeli]

...deciding if it's worth 2 years of my life doing research so I can match at one of the "top" programs. ...unless it's gonna be worth it. Not sure if I will end up academic or not. Is it better in the long term for job prospects, fellowships, etc... to just bite the bullet and go to a 7 year place like UCLA or Michigan? Or, can you do just as well without a big-time research background?

Alot said throughout. I think a few big issues with the question....

1. It all depends
2. What do you want to do
3. What is your end game

Is it "worth it" for primary residency out of medical school.... i.e. ENT, Ortho, Uro, integrated x, y, & z? I don't know. The majority of folks I know in any of these programs did not do dedicated time-off from medical school in a lab.

Is it "worth it" if you are going into community practice? Probably not. A solid residency is a solid residency and doesn't need additional years of research or some big name.

Is it "worth it" for your pay-check? Probably not. Again, once in practice, they aren't going to pay much difference if a Harvard Grad or a "St. Someone's" grad.

Is it "worth it" for a fellowship? Alot said on this one. Some specialties will require research plus/minus big name to be competitive for additional fellowships. I know plenty that have entered Pede-surge, plastics, surge-onc, etc... via university affiliated community programs with and without time-off research. It just depends. For fellowship hopes, the best thing you can do is ascertain a primary residencies' track record of getting grads into the next fellowships. Then find out what their grads needed to do while in residency to get into the fellowships.