fw5tape6kq

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TL;DR: Deciding to do a dedicated year of research at MSKCC halfway into my MS4 would be a huge life-changing decision involving geographic relocation and postponing my graduation from med school. It's a decision I would be totally happy with however, if only I knew more about whether or not its even possible, and if so, how to go about it, and if its truly a worthwhile exercise in the long run.


I am currently doing an away rotation at a very large and well-reputed Rad Onc program for four weeks. This particular institution has a number of medical students rotate through their service each year, and sees a large volume of diverse and interesting cases.

However, we meds students were told at the beginning of this rotation that due to time constraints, there simply is no way to successfully engage in research with any of the residents or faculty here during our 4 weeks. Nor is there an option to engage in any longer research remotely, off-site. Our only choice then, would be to dedicate an actual additional block of time to live in the city and work at the hospital on a research project for an extended period (e.g., months to a full year).

Here's the background about why I am wondering so much about research. Number one: I love this program. Everything about it is amazing, and coming here for residency would be an absolute dream. Number two: every resident here has extensive research/publication experience as either an MD/PhD or MD who took a year off for research here or elsewhere (HHMI). Number three: Due to ****ty luck with inconsequential data, I have absolutely no Rad Onc publications at this point, despite having worked on three projects during my medical student career. The rest of my statistics are good, but lack of publications is a serious flaw in my candidacy. If I am being frank, there is little to no chance that I will get accepted here for residency right now because of that deficit.

Basically what I am getting at are these questions.
1) Is doing a year long research project as an MS4 a good idea? The obvious reservations I have about this proposition involve postponing graduation and residency application for another year. I have heard of students taking time between 3rd and 4th year, but never in the middle of fourth year.

2) If so, how do I even begin to try to do that at this away institution? Just randomly email someone? Is there a process or precedent for this?

3) Does anyone on here have any personal experience with this?
 
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RSAOaky

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If you have your heart set on obtaining a residency at said institution then have a frank conversation with the PD about what it would take for you to do so. That aside, some better advice would be to not have your heart so absolutely set on a specific place because you may be setting yourself up for disappointment. There are many fantastic radonc programs and there are many less well known places that have happy residents and provide excellent training/research opportunities. If you think you can get into residency without taking a year off then you should do that. Even with a year of research like you're proposing some places are just very difficult to get into and it wouldn't guarantee you anything.

As an anecdote, I considered taking a year off for research. I decided not to, interviewed at a bunch of middle tier programs, matched farther down my rank list than I expected in a city that I knew no one and didn't really want to be at and felt like the sky was falling. I'll be graduating in less than a year and it's been one of the best experiences of my life. I've loved the program, the people, the city, and will almost certainly be staying here after graduation. I'm sick of being an apprentice and ready to be done with residency and the thought of having an extra year tacked on makes me want to throw up. As a medical student it's really difficult to have perspective. Research and prestige are shoved down our throats and we think that's all that matters. It's not. Rather than stressing about taking a year off to do research to have a small chance of getting into a specific program that is for obvious reasons very difficult to get into, do your best on your away rotations and continue to try get some research done in the next few months. There are many programs around the country that you would be happy at.
 
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fw5tape6kq

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If you have your heart set on obtaining a residency at said institution then have a frank conversation with the PD about what it would take for you to do so. That aside, some better advice would be to not have your heart so absolutely set on a specific place because you may be setting yourself up for disappointment. There are many fantastic radonc programs and there are many less well known places that have happy residents and provide excellent training/research opportunities. If you think you can get into residency without taking a year off then you should do that. Even with a year of research like you're proposing some places are just very difficult to get into and it wouldn't guarantee you anything.

As an anecdote, I considered taking a year off for research. I decided not to, interviewed at a bunch of middle tier programs, matched farther down my rank list than I expected in a city that I knew no one and didn't really want to be at and felt like the sky was falling. I'll be graduating in less than a year and it's been one of the best experiences of my life. I've loved the program, the people, the city, and will almost certainly be staying here after graduation. I'm sick of being an apprentice and ready to be done with residency and the thought of having an extra year tacked on makes me want to throw up. As a medical student it's really difficult to have perspective. Research and prestige are shoved down our throats and we think that's all that matters. It's not. Rather than stressing about taking a year off to do research to have a small chance of getting into a specific program that is for obvious reasons very difficult to get into, do your best on your away rotations and continue to try get some research done in the next few months. There are many programs around the country that you would be happy at.
I have no doubt that many of those things are true, and that my perspective as a medical student is probably short-sighted, but if you really apply your logic firmly, then why should anyone ever strive for a top-tier residency program in the first place? I agree that it's definitely prudent to keep one's mind open to many opportunities, but shouldn't I strive to do the absolute best I can, and see what happens from there? To reach for the stars, so to speak. If I do everything I can possibly do to be a great candidate and still don't match at a fantastic place, ok. That's not the end of the world. But I do have a problem with an automatic sense of resignation that - "yeah, you wont match there or at any other great place, but you might be happy with what you get."
 

medgator

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I have no doubt that many of those things are true, and that my perspective as a medical student is probably short-sighted, but if you really apply your logic firmly, then why should anyone ever strive for a top-tier residency program in the first place? I agree that it's definitely prudent to keep one's mind open to many opportunities, but shouldn't I strive to do the absolute best I can, and see what happens from there? To reach for the stars, so to speak. If I do everything I can possibly do to be a great candidate and still don't match at a fantastic place, ok. That's not the end of the world. But I do have a problem with an automatic sense of resignation that - "yeah, you wont match there or at any other great place, but you might be happy with what you get."
In the same vein, knowing what you are coming in with, why not be realistic about where you will have a shot based on historical data of who matches to places like MDACC, Sloane Kettering, ucsf, Harvard etc
 
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fw5tape6kq

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In the same vein, knowing what you are coming in with, why not be realistic about where you will have a shot based on historical data of who matches to places like MDACC, Sloane Kettering, ucsf, Harvard etc
That's precisely my point. As of right now, I am not a good enough candidate for any of those places, and my odds of being accepted into them are essentially nil. I have no illusions about that. However, given the rest of my application, I feel like I could be a more viable candidate at such programs if only I had more research and publication experience under my belt. The question is: is it worth it, or even possible, to take time off to get to that position where my candidacy is stronger ?
 

medgator

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That's precisely my point. As of right now, I am not a good enough candidate for any of those places, and my odds of being accepted into them are essentially nil. I have no illusions about that. However, given the rest of my application, I feel like I could be a more viable candidate at such programs if only I had more research and publication experience under my belt. The question is: is it worth it, or even possible, to take time off to get to that position where my candidacy is stronger ?
From those of us who matched in and out of the match, I get the sense most would not take a year off. They would rather do what they can in MS4, take their chances and then try to get a spot out of the match during internship if they don't match their MS4 year.

You'd be amazed how many spots open up
 
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fw5tape6kq

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From those of us who matched in and out of the match, I get the sense most would not take a year off. They would rather do what they can in MS4, take their chances and then try to get a spot out of the match during internship if they don't match their MS4 year.

You'd be amazed how many spots open up
It's not that I think I wont match altogether. I'm fairly certain that I will get into most mid-tier programs and my home institution. The question is whether to do an additional to bolster my application and increase my odds of getting into a top 10 program.
 

medgator

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It's not that I think I wont match altogether. I'm fairly certain that I will get into most mid-tier programs and my home institution. The question is whether to do an additional to bolster my application and increase my odds of getting into a top 10 program.
Yet you posted this in your OP:

Due to ****ty luck with inconsequential data, I have absolutely no Rad Onc publications at this point, despite having worked on three projects during my medical student career. The rest of my statistics are good, but lack of publications is a serious flaw in my candidacy. If I am being frank, there is little to no chance that I will get accepted here for residency right now because of that deficit.
Getting into a mid tier place without even a single published retrospective case series or study seems a little dubious imo, although things may have changed since I applied over a decade ago
 
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fw5tape6kq

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Yet you posted this in your OP:



Getting into a mid tier place without even a single published retrospective case series or study seems a little dubious imo, although things may have changed since I applied over a decade ago
Yikes. Idk. Maybe you're right. In that situation I case I suppose I would be doing the year not for just top programs, but for any decent program in particular.
 

medgator

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Yikes. Idk. Maybe you're right. In that situation I case I suppose I would be doing the year not for just top programs, but for any decent program in particular.
Things may have changed for all I know given the shameless expansion in residency slots coupled with the deteriorating job market
 
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fw5tape6kq

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Things may have changed for all I know given the shameless expansion in residency slots coupled with deteriorating job market
No, I don't think things have changed that drastically since you were a resident. You're probably right. Unfortunately, this makes me feel even more despondent than before. Perhaps I should put it this way: if I had plenty of research with a decent number of pubs on my CV, I think the rest of my application is strong enough to at least make me a candidate for some really great programs in Rad Onc. The deficit in pubs that I have now, however, is likely significant enough to preclude me not only from the top tier, but perhaps mid as well. I guess this makes it even more imperative to consider research, unless I am open to some lower tier programs for residency.

This is all so depressing. I think you're initial point about lack of perspective as a medical students is definitely true, but I can't say that I still don't feel sad inside... especially when I'm willing to potentially remediate and take 1-2 years off to compensate for my deficits. I don't know if all medical students are willing to do that. I just feel so lost in this whole process, with very little guidance or luck, and having no sense of precedence for any of my decisions. I'm willing to do whatever it takes to do well, but its as if reality has just gotten in the way of that.
 

RSAOaky

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I have no doubt that many of those things are true, and that my perspective as a medical student is probably short-sighted, but if you really apply your logic firmly, then why should anyone ever strive for a top-tier residency program in the first place? I agree that it's definitely prudent to keep one's mind open to many opportunities, but shouldn't I strive to do the absolute best I can, and see what happens from there? To reach for the stars, so to speak. If I do everything I can possibly do to be a great candidate and still don't match at a fantastic place, ok. That's not the end of the world. But I do have a problem with an automatic sense of resignation that - "yeah, you wont match there or at any other great place, but you might be happy with what you get."
I'm sorry, was there somewhere in my post that I said you won't match match at any great place? I believe my exact words were that there are many fantastic radonc programs. If you feel so strongly that you should "strive for the stars and see what happens" why did you even make this post? Go take your year off and let us know where you match.
 

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Unfortunately, this makes me feel even more despondent than before.
Nobody is going to guarantee you a spot at a top tier rad onc program, or really any rad onc program, no matter how your CV looks. Get used to it. You need to be ready to commit to the field no matter where you end up. Maybe you should consider a less competitive specialty where you have a better shot at a top tier program. I have no idea why someone would do that, but I guess I could imagine someone is so dead set on academics or their ego is so fragile they can't stand to not be at a top place. That said, people from not top tier places do well in academics all the time.

I just feel so lost in this whole process, with very little guidance or luck, and having no sense of precedence for any of my decisions. I'm willing to do whatever it takes to do well, but its as if reality has just gotten in the way of that.
I don't understand the drama here. Yes you'll probably match better with a year off for research. None of us think it's particularly worth it to do that. There's your guidance.
 

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I can't imagine what the job market is going to be like in 5-6 years but don't forget that taking another year off is going to cost you at least another quarter million dollars (another year of making $50,000-$75,000 as a resident as opposed to $300,000+ as an attending) ... that is if you can even find a job when you graduate (delaying even one year means another 200-250 graduates flooding the market the year before you graduate).
 
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maruchan

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It's definitely possible to start your year off in the middle of 4th year. I know people who have done it. Just talk to your med school advisors. To arrange a research year at an outside institution is a hassle but can be done, email people until you find a PI who will agree to have you, preferably with funding to support you for a year.

My two cents for you:

1) Things will be fine no matter what you pick. Don't worry so much and don't be despondent. I repeat, things will be fine.
2) It comes down to what you value. If you really want to do academics (and be honest with yourself here) or prioritize getting into a high-ranked program for other reasons, then take a year off. If that's not the case, then don't take a year off.

I think what RSAoaky and others are saying is that medical students tend to feel that matching into a high-ranked program is more important than it actually is, which is probably true. But if you mull that over, and in your heart you still want to go for that, then follow your heart.
 
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DrfluffyMD

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First of all I am not a radonc so take this with a huge grain of salt, just want to chime in something I've saw about radiology.

When radiology jobs were hard to find a few years ago, people from UCSF, Columbia or BWH/MGH still did well. People from smaller programs were hurting, however.

To the wise posters of the board, would you say given the deteioritig radonc job market and overexpansion in residency, it's even MORE important to get a top 10 place rather than a mid tier program?

When radiology became less competitive, the recruitment in mid tier programs dropped significantly more than the top tier programs and so were their competitiveness for top job markets.

When law job became hard to come by, low tier law school grads were hurt the most while people from Yale always would have jobs.

Thoughts?
 

medgator

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First of all I am not a radonc so take this with a huge grain of salt, just want to chime in something I've saw about radiology.

When radiology jobs were hard to find a few years ago, people from UCSF, Columbia or BWH/MGH still did well. People from smaller programs were hurting, however.

To the wise posters of the board, would you say given the deteioritig radonc job market and overexpansion in residency, it's even MORE important to get a top 10 place rather than a mid tier program?

When radiology became less competitive, the recruitment in mid tier programs dropped significantly more than the top tier programs and so were their competitiveness for top job markets.

When law job became hard to come by, low tier law school grads were hurt the most while people from Yale always would have jobs.

Thoughts?
local connections and personality/fit matter way more imo for coveted pp positions in my neck of the woods.

It comes down to the "three A's"... availability, affordability and ability (some would joke, in that order). Patients/referrings want the above more than where you did your training.

An arrogant ivy league trained physician is going to have a tougher time than a down to earth clinically well-trained mid tier physician in a pp scenario. Remember pp is a very different beast than academics and unlike radiology (outside of maybe mammo), we do have a significant amount of patient contact and communication with referring physicians
 
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DrfluffyMD

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local connections and personality/fit matter way more imo for coveted pp positions in my neck of the woods.

It comes down to the "three A's"... availability, affordability and ability (some would joke, in that order). Patients/referrings want the above more than where you did your training, an arrogant ivy league trained physician is going to have a tougher time than a down to earth clinically well-trained mid tier physician in a ppl scenario. Remember pp is a very different beast than academics and unlike radiology (outside of maybe mammo), we do have a significant amount of patient contact
I mean no disrespect, but where is your neck of wood? In my field of IR, it's absolutely true that where you train lead to where you work with the exception of Southern California where the lesser known local programs seem to have trouble placing its grad into the local market while big centers from the opposite coast like the Harvards or big NYC programs seem to have no problem.

It made me wonder if name matters more in a more competitive, perhaps even more superficial market like socal. Again, it seemed to be an exception rather than role for the field of interventional radiology and the above came from fellowship interviews and conversation with fellows who have been looking for jobs.

I think the level of patient contact between IR and radonc is probably comparable.
 

medgator

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I mean no disrespect, but where is your neck of wood? In my field of IR, it's absolutely true that where you train lead to where you work with the exception of Southern California where the lesser known local programs seem to have trouble placing its grad into the local market while big centers from the opposite coast like the Harvards or big NYC programs seem to have no problem.

It made me wonder if name matters more in a more competitive, perhaps even more superficial market like socal. Again, it seemed to be an exception rather than role for the field of interventional radiology and the above came from fellowship interviews and conversation with fellows who have been looking for jobs.

I think the level of patient contact between IR and radonc is probably comparable.
Southeast. FL/TX/GA/Carolinas, etc. I've heard similar things
 
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Neuronix

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I agree with medgator. Regional ties are more important than prestige in my experience. There are always exceptions.

Even in academics, places like to keep their best residents. This can mean overruling others from bigger name places. My regional ties helped me to get my academic job.

Private practice is a really mixed bag. Personality and "fit" are most important. It's also very much a "who you know" and networking sort of thing. I've seen numerous examples where lucrative PP positions in good locations went to the local grad from a not so big name residency program because they knew that person well and that person had "ties to the community".

Just going to a big name program doesn't necessarily help you with networking either. It can actually be the opposite. I knew an attending from a big name program who felt stuck in academics after graduating because their residency program actively discouraged people from PP and refused to recommend them to PPs.
 
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evilbooyaa

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Lot of good advice in this thread.

OP - If you're dead-set on MSKCC, there is unfortunately nothing you can do to guarantee that you get in. Most people who do a full year of research at MSKCC don't match at MSKCC.

However, given your lack of published (do you have any posters or presentations?) Rad Onc research, I don't think you taking a year off for research is the worst idea in the world. I don't know the rest of your stats, so I can't gauge how competitive of a resident you would be without research. I'll take your word for it that you're competitive.

I think, that if you can't get at least 1 to 2 posters and/or case series done by the time ERAS opens, I'd certainly think about taking a year off. This would give you the research experience you need, along with, ideally, a good LoR from a big name, at a big institution. I don't know what your LoR status is, in regards to the size of the names that are currently writing for you, but PDs love seeing LoRs from names they recognize.

Yes, you could potentially go for it, end up unmatched, and have to find a spot outside of the match. Those are all possibilities, but they are not extremely common, despite what most current attendings (who are 5+ years from the residency application process and likely underestimate the competitiveness of the field, especially the focus on research) think.

I do agree that there is much more to Rad Onc than just research, but the powers that be seem to have deemed it to be pretty darn important for residency admission at least.
 

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I think, that if you can't get at least 1 to 2 posters and/or case series done by the time ERAS opens, I'd certainly think about taking a year off.
Would the posters or case series need to be radonc specific? Just wondering how general oncology research is viewed.
 

evilbooyaa

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Would the posters or case series need to be radonc specific? Just wondering how general oncology research is viewed.
Ideally, yes. Rad onc research >>>> General Onc research > Other research, IMO. However, I'm still a resident so most of this is second-hand info, perhaps @Chartreuse Wombat can elaborate what a PD would look at.
 
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Dare2Dream

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Ideally, yes. Rad onc research >>>> General Onc research > Other research, IMO. However, I'm still a resident so most of this is second-hand info, perhaps @Chartreuse Wombat can elaborate what a PD would look at.
Thanks for your insight, I can certainly see how that would be the case. With no home program and a non-research heavy school, it is certainly a challenge to do enough publishable research and away rotations before apps are due next Sept.
 

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Regarding the value of top-tier programs and private practice....

We are currently recruiting for our private practice and I can personally attest to the fact that performing residency at a top-tier program matters little by itself. We all know of excellent Rad-Oncs from smaller programs and ones you wouldn't trust to clean the break room from more well-known programs. However, one possible advantage that hasn't been mentioned yet is "top-tier" programs tend to be larger and thus have a larger network of graduates to tap into when searching for jobs.

Our group operates on the understanding that possessing strong clinical knowledge and skills are the bare minimum required to be considered for a position and we are heavily evaluating for the "extra-curriculars" that candidates may bring. For instance, skills in computer science may allow that physician to lead technology innovations/sub-committees within the group, etc...