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[Thimble]

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[Neuronix]

Residencies are all different. With regards to the threads you linked:

1. I received no solicitations from residencies. After interviewing I received no special attention.
2. There are a few research tracks available. My advice: Pick your specialty, then consider a research track.
3. Research funding during residency is virtually non-existent. Again, pick your specialty, then consider later.

My advice: do well in medical school. Particularly, get high grades in rotations, try for AOA, and get a very high step 1 score. Even if you decide to go into a less competitive specialty, you will then get your pick of programs. From there, I found negotiating for research funding, time, and mentorship to be laughable. First off, I didn't even get a lot of interviews from places where I could do the research I am trained to do and want to do. I didn't have the clinical grades and step 1 score for top programs. Top programs are top because of their research, but these positions are still soaked up by a lot of MD only types with a little bit of research, AOA, and high step scores who want to go to the biggest name places. Even among the MD/PhD types, clinical things are more important than research things like number of publications or grant funding during graduate school. Where I did interview, I didn't match I believe because I tried to negotiate these things. Oh if I knew then what I know now... The MD/PhDs who come to a program and actually try to negotiate or seriously compare things between programs are the ones who get ranked lowly. The reality is that program directors are almost always MD only and want residents who will do the most clinical work, be the easiest to train, and create the least problems. Every faculty generally think their program is awesome and want their egos stroked at the interviews. This means being agreeable and smiley at residency interviews, not negotiating and seeming like you will run off to lab every minute you get (these are the problem residents who have a reputation for blowing off clinics and/or failing exams).

Again, funding is non-existent. Time is whatever the program wants to give you--it's non-negotiable. Mentors are hit or miss. If one leaves, it's not like you can leave with them. If they lose their funding/lab, you're stuck.

I do advise to consider doing MD/PhD research in the clinical area you're most interested in. If you go into a specialty like radiology after doing neuroscience research, you may think you are going to go do fMRI research or something, but the reality is nobody is going to care about your PhD. If you do your research in radiology, the clinical is still more important, but some places will actually consider your PhD valuable and you may get a bump.

Also, see my blog entry on this topic: http://www.neuronix.org/2011/07/nrmp-puts-out-charting-outcomes-in.html

 

[gbwillner]

I had a very different experience that Neuronix in basically every way. The differences are based on lots of factors, primarily what residency and where.

Specifically, I went on ~12 interviews- all top-tier academic places in my specialty (pathology). I got post-interview contact from the director or chairman at about 80% of them, typically telling me I was ranked to match. One program told me I could be ranked to match if I tell them in advance that I wanted to go there. I was invited for a second visit to most and elected to return for a second round of interviews at my top 3 programs. I spent about a week at each place to get to know them (and the residents) better. At these (and some of the others) I was told that I could have a year of dedicated research time in any lab that I wanted after or during residency. The amount of time and funds were variable based on institution.

At the program I matriculated into I negotiated (up front) a year of protected research time with no clinical service work at PGY + bonus that brought my salary up to the instructor level. That year could be extended for an additional year guaranteed and a second year with additional merit.

I do agree with Neuro that if you don't have these kinds of agreements up front then you should really expect absolutely nothing. There was another MSTP guy who came into my same department and expected the same treatment, yet he negotiated nothing up front and is pissed that he's gotten nothing in return. Yes, he could do a post-doc, but even getting bumped up to PGY level will be serious work for him.

I guess bottom line for the OP- first decide what residency you want to go into, then go to those specific forums for more advice. For me, the quality and quantity of research experience in the field was a HUGE determining factor on picking a specialty.

 

[Patros]

@gbwillner, what I take away from your post is that if your stats and CV put you so far ahead of the competition that you will be actively recruited, you will be able to negotiate. From what I can tell from Neuronix's post, if you are a strong applicant but not the best, you'll be walking a tight rope. Just out of curiosity gbwillner, what was your CV like?

Oh and one more thing; why pathology? As someone hoping to go into cancer research, I was thinking about pathology or IM followed by heme/onc. But I've been told that the former deals largely with cell biology and mechanistic research, while the latter deals with therapeutics and outcomes research. Not sure if there's any truth to that, or just a way to pigeonhole the careers. I've also heard that the former has a poor job market, while the latter demands a pretty intense lifestyle. I guess there are no perfectly convenient careers.

I'll be matriculating into a MSTP shortly so it may be premature for me to even talk about this stuff, but since I'm not going to a top 10 MSTP like Neuronix, I'm a bit anxious that the residency-match odds are already stacked against me.

 

[gbwillner]

If you are interested in cancer research then I agree that the best two options will be either pathology (AP) or IM+ Onc fellowship. The specifics may get blurred more than stated in other threads, as serious researchers in both fields will do mechanistic work. The translational angle may be somewhat different with path being more on diagnostics and Onc being more therapeutics. And yes, it is premature for you, but it's good to be thinking about this. In retrospect, I feel I could have been happy either in Onc or path. I am happy with my decision.

Re: the job market- it's getting tight in all fields. Reimbursements are down across the board, and only continue to decrease. Path has gotten hit harder than most in the last couple of cutting binges by CMS, but I do think the worst is over. Personally, however, this has not been a problem for me. I was very forward thinking when choosing my research focus and fellowship and had more opportunities than I can count. But this is not typical and there are lots of anecdotal reports of good residents having a lot of trouble finding a good job. I am currently deciding between taking another academic position or going into industry.

Re: stats- I won't suggest my stats where any better than Neuronix's. They probably were not. I think it had more to do with my specialty being more research-oriented, and my specific goals and focus being very hot at the time.

 

[Neuronix]

@gbwillner, what I take away from your post is that if your stats and CV put you so far ahead of the competition that you will be actively recruited, you will be able to negotiate. From what I can tell from Neuronix's post, if you are a strong applicant but not the best, you'll be walking a tight rope.

Disagree.

I think it had more to do with my specialty being more research-oriented, and my specific goals and focus being very hot at the time.

Agreed. I don't know rad onc programs that are going to offer residents much of anything outside of some amount of protected time which is not guaranteed until you actually matriculate and hope it's still available. However, there are plenty of stories out there like gbwillner's colleague as well in all specialties--MD/PhDs promised or expecting something, and not getting it for various reasons out of their control. Remember, as a resident you have no negotiating power.

but since I'm not going to a top 10 MSTP like Neuronix, I'm a bit anxious that the residency-match odds are already stacked against me.

The USNews research rank of your MSTP is completely irrelevant to your future and this discussion.

 

[Patros]

Disagree.

Didn't mean to imply anything, I just saw this and assumed:

First off, I didn't even get a lot of interviews from places where I could do the research I am trained to do and want to do. I didn't have the clinical grades and step 1 score for top programs. l

I'm still pretty fresh-faced to this stuff, so when you describe the difficulties in residency apps and research, I'm guessing that's specific for radiology?

The USNews research rank of your MSTP is completely irrelevant to your future and this discussion.

I'm as big a critic of the USNWR rankings as anyone, but I think saying the rank is completely irrelevant is a bold claim, no? But I won't press the issue, especially because that's pretty reassuring if right.

 

[Neuronix]

I'm still pretty fresh-faced to this stuff, so when you describe the difficulties in residency apps and research, I'm guessing that's specific for radiology?

IMO, it's specific for all specialties. See post #12 in this thread where I discussed this recently http://forums.studentdoctor.net/threads/are-surgery-and-md-phd-incompatible.1065821/

I'm as big a critic of the USNWR rankings as anyone, but I think saying the rank is completely irrelevant is a bold claim, no?

I don't think it's a bold claim at all. For more of my thoughts on what matters for residency, see: http://forums.studentdoctor.net/thr...s-will-having-a-phd-give-you-an-edge.1067424/

 

[snobored18]

Residencies are all different. With regards to the threads you linked:

1. I received no solicitations from residencies. After interviewing I received no special attention.
2. There are a few research tracks available. My advice: Pick your specialty, then consider a research track.
3. Research funding during residency is virtually non-existent. Again, pick your specialty, then consider later.

My advice: do well in medical school. Particularly, get high grades in rotations, try for AOA, and get a very high step 1 score. Even if you decide to go into a less competitive specialty, you will then get your pick of programs. From there, I found negotiating for research funding, time, and mentorship to be laughable. First off, I didn't even get a lot of interviews from places where I could do the research I am trained to do and want to do. I didn't have the clinical grades and step 1 score for top programs. Top programs are top because of their research, but these positions are still soaked up by a lot of MD only types with a little bit of research, AOA, and high step scores who want to go to the biggest name places. Even among the MD/PhD types, clinical things are more important than research things like number of publications or grant funding during graduate school. Where I did interview, I didn't match I believe because I tried to negotiate these things. Oh if I knew then what I know now... The MD/PhDs who come to a program and actually try to negotiate or seriously compare things between programs are the ones who get ranked lowly. The reality is that program directors are almost always MD only and want residents who will do the most clinical work, be the easiest to train, and create the least problems. Every faculty generally think their program is awesome and want their egos stroked at the interviews. This means being agreeable and smiley at residency interviews, not negotiating and seeming like you will run off to lab every minute you get (these are the problem residents who have a reputation for blowing off clinics and/or failing exams).

Again, funding is non-existent. Time is whatever the program wants to give you--it's non-negotiable. Mentors are hit or miss. If one leaves, it's not like you can leave with them. If they lose their funding/lab, you're stuck.

I do advise to consider doing MD/PhD research in the clinical area you're most interested in. If you go into a specialty like radiology after doing neuroscience research, you may think you are going to go do fMRI research or something, but the reality is nobody is going to care about your PhD. If you do your research in radiology, the clinical is still more important, but some places will actually consider your PhD valuable and you may get a bump.

Also, see my blog entry on this topic: http://www.neuronix.org/2011/07/nrmp-puts-out-charting-outcomes-in.html

Similar to gbwillner my experience in IM (recent cycle) was almost the exact opposite of what Neuronix describes, which drives home the point that the residency application/selection is specialty-specific. At least for IM/ABIM research tracks:

1) Many programs (even in the "top ten") heavily recruit post-interview including all expenses paid re-visits and recruiting calls/letters/e-mails from PDs, division chiefs, department chairs, etc.
2) Most major academic medical centers support the ABIM research pathway and many offer a direct PGY-1 match into residency/fellowship/2-3 years of protect post-doc research time.
3) Even if you don't go the ABIM research track route, most of the big name IM programs (e.g. MGH, Duke, Hopkins, WashU, etc) have significant funds and protected months available for resident research. The vast majority of this is clinical, but you'll run into some folks during interviews (including MD only) who have figured out a way to do focused bench work with this allotted time. The ABIM route gives you protected research time and at most places PGY-X salary + a 15,000-25,000 bump during the research years.

Neuronix is spot on about doing well during medical school. Even in IM, which is getting more competitive, but nowhere near the level of Derm/RadOnc/etc, you have to prove you are a competent physician plus show some real research prowess for any of the above to come into play. Mediocre board scores, a PhD with a paucity of publications, and a mix of P and HP in M3 clerkships likely won't cut it at top programs. You will get a bit of lee-way when it comes to clinical performance if you've amassed a stacked CV during your PhD and my sense is that the research productivity is heavily weighted in the ABIM research track selection process. Lastly, the match process itself makes negotiation extremely difficult as you can't technically sign a contract until after match day unless you/your future program want to risk a match violation. I suppose one could do a "good faith" negotiation, but the program could change its mind without legal recourse and you'd be stuck.

Bottom line: when you figure out your specialty, seek out folks who recently followed a similar path for advice. Each specialty is different and the medical landscape has changed/is changing so you really need to talk to senior and junior faculty to get the best/most pertinent advice.