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I was just wondering if anyone had any experience with this sort of a path.
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Postdoc between MD/PhD and residency
- Thread starter Freak
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Bad. Very bad. There are lots of issues anywhere from licensure time limit to clinical proficiency. Just don't do it if you can get away with it.
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I would advise against a postdoc before residency. I have known a few people that have taken 1 year at most before applying for residency and come back to successfully enter a residency. Otherwise, it is just a disaster waiting to happen.
First, it will be much harder to apply for residencies. Every program that reviews your application is going to wonder what you were doing during that year. Even if it was a very good research opportunity, it's going to be meaningless to most program directors.
Second, there are time limits in many states about how long you can spend to complete USMLE steps 1-3, and in many cases this is 7 years. You can then apply for an extension if you were an MD/PhD, but even then the maximum amount of time then is often 10 years (http://www.fsmb.org/usmle_eliinitial.html). You really need to get these steps done in that amount of time or you're facing a bunch of stupid hurdles, including begging the state medical board to give you an exception. Nevermind the risk of failing step 3 as your clinical information gets 2+ years old in your mind.
Third, clinical proficiency was mentioned above. I think it's much harder to get back into clinical medicine than research. If you spend a couple of years out of research, you just go back for a postdoc for a year and you're back on track. If you are out of medicine for 3 years, you're going to feel like a starting M3 when you come back. If you're out for any longer, the difficulty just increases.
I think you really need to evaluate what would make you want to not do a residency immediately. There are a few things that I think would make it reasonable to do at most a 1 year postdoc.
1) You are sitting on some huge scientific development that is highly likely to pan out. I'm not talking about discovering some new protein or some new gene involved in a pathway. I'm talking about a huge finding that is likely to lead to changed clinical management, a new clinical treatment, or the clinical trials of a new drug. If you've discovered a new treatment for pancreatic cancer, then by all means defer your internship. Otherwise, think twice. Plus, it's unlikely that you did this during your M3 or M4 years. If you were so confident, you should have deferred going back to med school for a year.
2) You are pretty confident you don't want to do clinical medicine (>95% but not quite 100%) and want the option to change your mind. Then, after a year or so you can make up your mind for sure. Even if this is the case, I still think it would be better to do an internship to help you make up your mind. Then you can quit after your internship if you hate it.
3) Extremely difficult family situations. If you have a parent or sibling who is dying, consider a post-doc year that will make it easier for you to spend time with them. If you're having a baby, suck it up and match for a residency.
In short, you need a really good reason to forgo your residency for any length of time.
First, it will be much harder to apply for residencies. Every program that reviews your application is going to wonder what you were doing during that year. Even if it was a very good research opportunity, it's going to be meaningless to most program directors.
Second, there are time limits in many states about how long you can spend to complete USMLE steps 1-3, and in many cases this is 7 years. You can then apply for an extension if you were an MD/PhD, but even then the maximum amount of time then is often 10 years (http://www.fsmb.org/usmle_eliinitial.html). You really need to get these steps done in that amount of time or you're facing a bunch of stupid hurdles, including begging the state medical board to give you an exception. Nevermind the risk of failing step 3 as your clinical information gets 2+ years old in your mind.
Third, clinical proficiency was mentioned above. I think it's much harder to get back into clinical medicine than research. If you spend a couple of years out of research, you just go back for a postdoc for a year and you're back on track. If you are out of medicine for 3 years, you're going to feel like a starting M3 when you come back. If you're out for any longer, the difficulty just increases.
I think you really need to evaluate what would make you want to not do a residency immediately. There are a few things that I think would make it reasonable to do at most a 1 year postdoc.
1) You are sitting on some huge scientific development that is highly likely to pan out. I'm not talking about discovering some new protein or some new gene involved in a pathway. I'm talking about a huge finding that is likely to lead to changed clinical management, a new clinical treatment, or the clinical trials of a new drug. If you've discovered a new treatment for pancreatic cancer, then by all means defer your internship. Otherwise, think twice. Plus, it's unlikely that you did this during your M3 or M4 years. If you were so confident, you should have deferred going back to med school for a year.
2) You are pretty confident you don't want to do clinical medicine (>95% but not quite 100%) and want the option to change your mind. Then, after a year or so you can make up your mind for sure. Even if this is the case, I still think it would be better to do an internship to help you make up your mind. Then you can quit after your internship if you hate it.
3) Extremely difficult family situations. If you have a parent or sibling who is dying, consider a post-doc year that will make it easier for you to spend time with them. If you're having a baby, suck it up and match for a residency.
In short, you need a really good reason to forgo your residency for any length of time.
