research years in gen surg

[MilesDavisTheDoctor]

if you want to do a competitive fellowship after general surgery residency are you pretty much required to do a few research years during residency?

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[DOVinciRobot]

if you want to do a competitive fellowship after general surgery residency are you pretty much required to do a few research years during residency?

Define competitive fellowship.

 

[MilesDavisTheDoctor]

well really like any of them lol. i guess competitive would be plastics but i'm most interested in thoracic

 

[deleted50541]

We've talked about this many times, but in general yes.

I can speak for CT since I did that training. Given how competitive it's become in the last few years and having reviewed fellowship applications, pretty much every applicant has some research. Whether that's dedicated time off taken during residency (I did a year between 2nd and 3rd year), doing research throughout schooling and residency without a defined break, or even having a PhD, I've seen all comers.

More research heavy programs with built in research time are going to want applicants with prior research experience. You don't have to take years off during residency, but the research you do should be substantive enough to at least get you a few publications and trips to national meetings for poster/oral presentations. You can also co-author a book chapter or two, a pretty common thing for residents to do with an attending.

 

[MilesDavisTheDoctor]

That is a pretty brual training length for CT if you really are pretty much required 5+2+3=10 years post med school. That's two ortho residencies lol. I guess why that started I6

 

[DOVinciRobot]

The only fellowships where research years are functionally a requirement are Peds and Surgical Oncology. My programs sends people to really strong programs in all of the other specialties and we don’t really have research years except in specific circumstances.

 

[MilesDavisTheDoctor]

So you're saying if you go to a decent gen surg residency it shouldn't be a problem matching something like CT *somewhere* (not necessarily at a top place)?

 

[DOVinciRobot]

So you're saying if you go to a decent gen surg residency it shouldn't be a problem matching something like CT *somewhere* (not necessarily at a top place)?

From what I’ve seen at my program, yes.

 

[Surgeon D.O.]

So you're saying if you go to a decent gen surg residency it shouldn't be a problem matching something like CT *somewhere* (not necessarily at a top place)?

I'm just a 3rd year med student with similar career aspirations but have heard the same thing as what @DOVinciRobot posted.

The fellowships you tend to see fellows who did the 7 yr surgery residencies with research years are peds and surg onc.

Research will always be a plus, but I'm not sure if dedicated YEARS are necessary for CT. At least what I have been told.

 

[Lem0nz]

Peds and surg-onc have unspoken mandatory research requirements at present. Peds is actually probably spoken but surg-onc is still kind of lowkey about it but 90% of the fellowships will not interview you without two years of dedicated research time and of the remaining 10% you are rarely as competitive as the people with the dedicated research time.

 

[deleted50541]

Peds and surg-onc have unspoken mandatory research requirements at present. Peds is actually probably spoken but surg-onc is still kind of lowkey about it but 90% of the fellowships will not interview you without two years of dedicated research time and of the remaining 10% you are rarely as competitive as the people with the dedicated research time.

Being as competitive as peds surg is, taking dedicated time off for peds research was common in my residency. Some people even did peds research fellowships after residency if they didn't match. One of our grads spent two years as a peds research fellow before she finally matched. We had a peds surgery fellowship at my program, so I was very familiar with how much time and effort these folks spent to finally match.

Two to three years of dedicated research is not uncommon for surg onc. From what my colleagues going into surg onc told me, it takes at least that long to devise and get a study going, followed by getting enough results to have something meaningful to analyze/publish/present. They were often doing bench research/animal studies, which is a whole other skill set and requires a lot of manpower, funding, and patience.

 

[ChordaEpiphany]

I can speak for CT since I did that training. Given how competitive it's become in the last few years and having reviewed fellowship applications, pretty much every applicant has some research. Whether that's dedicated time off taken during residency (I did a year between 2nd and 3rd year), doing research throughout schooling and residency without a defined break, or even having a PhD, I've seen all comers.

How common would it be for a resident with a PhD to skip the research years voluntarily? Basically MD/PhD --> 5 years GS --> 2 years CT (or 4+3 with no research years). I've checked out some faculty profiles of MD/PhD thoracic surgeons and it seems like a lot of people have done MD/PhD --> 7 year GS --> 2/3 years CT. I'm extremely interested in the thoracic wing of CT, but that training pathway is simply untenable for me. I couldn't stomach it. Some people from my program have matched into the i6 residencies, even if they are interested in thoracic over cardiac. At a lot of programs with fast-track 4+3, it seems like they still have the residents take research years. 9 years hardly feels "fast" to me.

Basically, if I could become a full-fledged attending in 7 years and still leave myself competitive for some kind of academic or hybrid position, I think this could be the path for me. If that's some kind of uphill battle and I'll be fighting with PDs I bet I could be just as happy in another specialty. My PhD is directly related to surgical oncology/thoracic surgery, if that helps put it in context.

 

[mikeGR]

How common would it be for a resident with a PhD to skip the research years voluntarily? Basically MD/PhD --> 5 years GS --> 2 years CT (or 4+3 with no research years). I've checked out some faculty profiles of MD/PhD thoracic surgeons and it seems like a lot of people have done MD/PhD --> 7 year GS --> 2/3 years CT. I'm extremely interested in the thoracic wing of CT, but that training pathway is simply untenable for me. I couldn't stomach it. Some people from my program have matched into the i6 residencies, even if they are interested in thoracic over cardiac. At a lot of programs with fast-track 4+3, it seems like they still have the residents take research years. 9 years hardly feels "fast" to me.

Basically, if I could become a full-fledged attending in 7 years and still leave myself competitive for some kind of academic or hybrid position, I think this could be the path for me. If that's some kind of uphill battle and I'll be fighting with PDs I bet I could be just as happy in another specialty. My PhD is directly related to surgical oncology/thoracic surgery, if that helps put it in context.

In your case, I think you should be able to go straight through, but you will likely not be among the most competitive candidates for fellowship. I followed a similar path with surg onc (lots of research before residency - no PhD, no dedicated research years) and matched in a pretty good fellowship (but not MSK/MD Anderson). It also depends on how you perform during residency, whether you will continue doing research (w/o dedicated time), what connections you will foster etc. Also, some residents get so burned out that they take 1-2 research years off for a change/break. Who knows how you will feel in a few years.

 

[ChordaEpiphany]

In your case, I think you should be able to go straight through, but you will likely not be among the most competitive candidates for fellowship. I followed a similar path with surg onc (lots of research before residency - no PhD, no dedicated research years) and matched in a pretty good fellowship (but not MSK/MD Anderson). It also depends on how you perform during residency, whether you will continue doing research (w/o dedicated time), what connections you will foster etc. Also, some residents get so burned out that they take 1-2 research years off for a change/break. Who knows how you will feel in a few years.

This is good to know. Thank you for spelling it out this way. I do wonder if the PhD will be weighted more heavily than a heavy research background, but who knows. I also wonder if it's as important for CT as it is for surg onc. Probably though, you're right.

It's funny because they created the MD/PhD to foster physician scientists, but it turned out kind of like endless student loan availability, all it did was make things more expensive for everyone.

In classic specialities like heme/onc or ID the standard line is, "Now everyone has a PhD, what sets you apart? Keep post-doc'ing after fellowship and come back to me once you have a K grant."

In surgery the line is, "It's been so long since you did any dedicated research, who cares if you spent 4 years on it and published 10 basic science manuscripts?"

It's really just become a race to the bottom. Attrition through exhaustion, and unless you're willing to keep eating what they feed you for long after your MD only colleagues have gone off to private practice, the PhD is pretty useless.

FWIW, I don't really care if I'm competitive at MSKCC or MDA. I just want to know if I can match at a place that will train me well on the timeline I want. At this point I'm in it for an interesting career and a chance to live a good life. I also know that even if I did match a top, top program, once I get there someone will be waiting with an open palm saying I haven't done enough of X, Y, or Z if I want a top faculty position. I'll be 33 when I finish my MD/PhD and 40 when I finish residency and fellowship if I do the 7 year path. If that's not enough, then I simply didn't have it in me to be the best. Very few do, so I'm fine with that.

 

[Medstart108]

That is a pretty brual training length for CT if you really are pretty much required 5+2+3=10 years post med school. That's two ortho residencies lol. I guess why that started I6

Yeah but research years are at a bit of a break from clinical work, its also GS+CT, you basically are qualified to do surgery of almost all the internal organs of the body which is pretty badass.

 

[SurgDoc95]

Yeah but research years are at a bit of a break from clinical work, its also GS+CT, you basically are qualified to do surgery of almost all the internal organs of the body which is pretty badass.

For those of us looking at doing a year or two of research to boost our CT apps, are there any formal CT research fellowships? I found one purely thoracic research fellowship between PGY2-3 but no true CT or Cardiac surgery ones. Just an intern, but trying to get my game plan together! Thanks

 

[HighwayVagabond]

For those of us looking at doing a year or two of research to boost our CT apps, are there any formal CT research fellowships? I found one purely thoracic research fellowship between PGY2-3 but no true CT or Cardiac surgery ones. Just an intern, but trying to get my game plan together! Thanks

Plenty. Search 'cardiac surgery t32' and that will pull up several NIH funded ones. There are others, too. If you have a specific interest, for example transplantation or ECMO, there are some programs geared toward those specific things. I'm a little surprised STS doesn't have a list of them on their website as a resource for trainees. I'm now appreciating how awesome the SVS resources are!

 

[Medstart108]

How common would it be for a resident with a PhD to skip the research years voluntarily? Basically MD/PhD --> 5 years GS --> 2 years CT (or 4+3 with no research years). I've checked out some faculty profiles of MD/PhD thoracic surgeons and it seems like a lot of people have done MD/PhD --> 7 year GS --> 2/3 years CT. I'm extremely interested in the thoracic wing of CT, but that training pathway is simply untenable for me. I couldn't stomach it. Some people from my program have matched into the i6 residencies, even if they are interested in thoracic over cardiac. At a lot of programs with fast-track 4+3, it seems like they still have the residents take research years. 9 years hardly feels "fast" to me.

Basically, if I could become a full-fledged attending in 7 years and still leave myself competitive for some kind of academic or hybrid position, I think this could be the path for me. If that's some kind of uphill battle and I'll be fighting with PDs I bet I could be just as happy in another specialty. My PhD is directly related to surgical oncology/thoracic surgery, if that helps put it in context.

I think if you want to continue the research you did in your PhD as an attending, you might want to take a few years for research, especially if its basic science. It'll be hard to be away from research for 7 years and come back to it as an attending.

If your goal is community, and you focus on operating, I could see you landing a job in 7-8 years no problem.

All in all, I'd budget 7-9 years if you want this path. If you don't want to do any more than 7, I wouldn't expect an academic position per say and I would steer clear of the more research/academic focused programs.

 

[ChordaEpiphany]

All in all, I'd budget 7-9 years if you want this path. If you don't want to do any more than 7, I wouldn't expect an academic position per say and I would steer clear of the more research/academic focused programs.

I think it would be insane to look at someone who spent 4-5 years doing full-time research and then knock them for not taking an extra two, but then again academic medicine is a little bit insane. I'm not saying you're wrong. I'm just... aggravated. Why do a PhD at all if two years of comparatively trivial work means just as much if not more? That said, I know at least one MD/PhD who did not take research years who is now running a lab at a top, top academic center. So it must be possible.

I'm a bit hesitant to consult my primary mentor (a prominent CT surgeon) on this. Essentially, I recently secured them a lot of grant money. I'm in their good graces, and I think I could get a spot in their program, which is top-tier academic, but I have a feeling the price will be an expectation that I go back to the lab to keep the data coming. If I take the 2 years, I'll be 42 by the time I'm an attending. I'm not married, but unless I marry someone a decade younger than me, I'd probably miss my kids' younger years almost entirely. Tough choices.

Thanks for your input.

 

[Medstart108]

I think it would be insane to look at someone who spent 4-5 years doing full-time research and then knock them for not taking an extra two, but then again academic medicine is a little bit insane. I'm not saying you're wrong. I'm just... aggravated. Why do a PhD at all if two years of comparatively trivial work means just as much if not more? That said, I know at least one MD/PhD who did not take research years who is now running a lab at a top, top academic center. So it must be possible.

I'm a bit hesitant to consult my primary mentor (a prominent CT surgeon) on this. Essentially, I recently secured them a lot of grant money. I'm in their good graces, and I think I could get a spot in their program, which is top-tier academic, but I have a feeling the price will be an expectation that I go back to the lab to keep the data coming. If I take the 2 years, I'll be 42 by the time I'm an attending. I'm not married, but unless I marry someone a decade younger than me, I'd probably miss my kids' younger years almost entirely. Tough choices.

Thanks for your input.

I think the main question when they hire you at the end is do they think you can do it. I think if you maintain some presence in the lab during your residency whether that be through research rotations or through research years, it would help if you are on the academic track. Ultimately, people are just going to hire people they think can do the work, if the work you are doing allows you to step away from research for years and come back to it then by all means. Its the same thing with surgery and medicine, a surgeon walking away for 7 yrs and coming back to operate would have a harder time than a physician doing the same.

Hard to comment on life sacrifices, but look at what drives you. If your passion for research drives you, you'll find a way to make it work.

 

[ChordaEpiphany]

I think the main question when they hire you at the end is do they think you can do it. I think if you maintain some presence in the lab during your residency whether that be through research rotations or through research years, it would help if you are on the academic track. Ultimately, people are just going to hire people they think can do the work, if the work you are doing allows you to step away from research for years and come back to it then by all means. Its the same thing with surgery and medicine, a surgeon walking away for 7 yrs and coming back to operate would have a harder time than a physician doing the same.

Hard to comment on life sacrifices, but look at what drives you. If your passion for research drives you, you'll find a way to make it work.

I'll reassess in a year or so, but for now I could take or leave bench research. COVID steamrolled my PhD, and it really sucked the joy out of the process. If I wanted to do bench research, I'd need a K-grant, and I'd definitely need to get back in the lab. No question there. I'm just not sure that's the passion anymore.

What I wouldn't mind doing is something like a 90/10 clinical/research path in surgery. I don't need to run a lab. I could co-author grants with basic scientists and take a 5-10% effort position on the projects. I could get NIH grants for clinical work/studies or participate/run clinical trials. Any of these things would scratch that itch. I know I don't need the PhD to do these things. I also don't really care if the PhD ends up being nothing but a weird side quest.

So I guess my question is, is that a viable path? Let's say I graduate from my PhD with 8-10 basic science manuscripts, 3-4 patents, a whole slew of abstracts/talks, and 2-3 clinical papers during my MD. I do well clinically and manage to pull off a 5 + 2 or a 4 + 3 at a major academic center and try to publish clinical papers and present at a conferences along the way, but I never take any explicit research years. Would I be in a good position to establish myself as a professor in surgery doing a 90/10 split?

 

[Dr.LeoSpaceman]

I'll reassess in a year or so, but for now I could take or leave bench research. COVID steamrolled my PhD, and it really sucked the joy out of the process. If I wanted to do bench research, I'd need a K-grant, and I'd definitely need to get back in the lab. No question there. I'm just not sure that's the passion anymore.

What I wouldn't mind doing is something like a 90/10 clinical/research path in surgery. I don't need to run a lab. I could co-author grants with basic scientists and take a 5-10% effort position on the projects. I could get NIH grants for clinical work/studies or participate/run clinical trials. Any of these things would scratch that itch. I know I don't need the PhD to do these things. I also don't really care if the PhD ends up being nothing but a weird side quest.

So I guess my question is, is that a viable path? Let's say I graduate from my PhD with 8-10 basic science manuscripts, 3-4 patents, a whole slew of abstracts/talks, and 2-3 clinical papers during my MD. I do well clinically and manage to pull off a 5 + 2 or a 4 + 3 at a major academic center and try to publish clinical papers and present at a conferences along the way, but I never take any explicit research years. Would I be in a good position to establish myself as a professor in surgery doing a 90/10 split?

First, from your description of how you feel about basic science I can say that even if you tried, it's not going to work out. If you're aren't going ho, it's just wasted effort to keep the option open.

The 90/10 split is possible, but it will mean finding the right opportunity. Unfortunately there are a lot of people who have the same thought, so there isn't necessarily a shortage of people to fill that role. Which means you're going to have to find a way to set yourself apart. There are no shortage of people taking their academic development time to get an MS/MPH because "they want to do clinical trials", and you'll have to compete with all those people.

 

[ChordaEpiphany]

First, from your description of how you feel about basic science I can say that even if you tried, it's not going to work out. If you're aren't going ho, it's just wasted effort to keep the option open.

The 90/10 split is possible, but it will mean finding the right opportunity. Unfortunately there are a lot of people who have the same thought, so there isn't necessarily a shortage of people to fill that role. Which means you're going to have to find a way to set yourself apart. There are no shortage of people taking their academic development time to get an MS/MPH because "they want to do clinical trials", and you'll have to compete with all those people.

You're bang on with the assessment that basic science is out. It feels awful to write that because it's been my passion for years, but I'm unwilling to drag a family around the country deep into my 40s chasing an elusive 10-20% chance of getting R01-level funding to run a basic science lab.

That said, how would I compete? I have a 1.5 years left in my PhD, and I'm supported on my own F30, so I have no obligation to my PI and can easily divert my efforts. That's plenty of time for productivity beyond basic science, and I could probably swap the effort of a single first author basic science paper for 5-10 clinical pubs and/or substantial clinical trial involvement while still graduating.

I'm not sure I understand the argument that I'll be struggling to compete for 90/10 academic jobs simply because I took 4 years of research time prior to residency instead of 2 years during. After all, my research is surgery-related anyway. It's not like I'm doing 4 years of investigating neuronal synapses and expecting that to vault me above people with more directed research. This seems especially confusing looking at a large number of clinical profiles of people with exactly these positions who went to residency programs that don't even offer development years. If nothing else I figured a surgery-related PhD would make me a more attractive candidate for an academic position, especially a position that involves collaborating with PhDs. In our lab we collaborate with a lot of surgeons who have never even picked up a pipette. What am I missing here?

 

[Dr.LeoSpaceman]

You're bang on with the assessment that basic science is out. It feels awful to write that because it's been my passion for years, but I'm unwilling to drag a family around the country deep into my 40s chasing an elusive 10-20% chance of getting R01-level funding to run a basic science lab.

That said, how would I compete? I have a 1.5 years left in my PhD, and I'm supported on my own F30, so I have no obligation to my PI and can easily divert my efforts. That's plenty of time for productivity beyond basic science, and I could probably swap the effort of a single first author basic science paper for 5-10 clinical pubs and/or substantial clinical trial involvement while still graduating.

I'm not sure I understand the argument that I'll be struggling to compete for 90/10 academic jobs simply because I took 4 years of research time prior to residency instead of 2 years during. After all, my research is surgery-related anyway. It's not like I'm doing 4 years of investigating neuronal synapses and expecting that to vault me above people with more directed research. This seems especially confusing looking at a large number of clinical profiles of people with exactly these positions who went to residency programs that don't even offer development years. If nothing else I figured a surgery-related PhD would make me a more attractive candidate for an academic position, especially a position that involves collaborating with PhDs. In our lab we collaborate with a lot of surgeons who have never even picked up a pipette. What am I missing here?

I'm not saying you'll struggle to compete. I'm saying you will compete. And PhD aside, those people that took the research time in residency may be just as competitive.

I've interviewed a number of resident applicants and fellowship applicants. Then I went through the job hunt. "I want to be the clinical collaborator for basic science labs" and/or "I want to run clinical trials" is a cliché. Whenever I hear this, I immediately probe about how people see that working, what kind of projects they're interested in, and what they've done in residency/fellowship to prepare them for that. Some people have good answers, and some people don't. Being able to provide a cohesive vision and explain how your recent efforts contribute to it are going to far outweigh a PhD you got before residency and aren't planning on "using".

 

[ChordaEpiphany]

I'm not saying you'll struggle to compete. I'm saying you will compete. And PhD aside, those people that took the research time in residency may be just as competitive.

I've interviewed a number of resident applicants and fellowship applicants. Then I went through the job hunt. "I want to be the clinical collaborator for basic science labs" and/or "I want to run clinical trials" is a cliché. Whenever I hear this, I immediately probe about how people see that working, what kind of projects they're interested in, and what they've done in residency/fellowship to prepare them for that. Some people have good answers, and some people don't. Being able to provide a cohesive vision and explain how your recent efforts contribute to it are going to far outweigh a PhD you got before residency and aren't planning on "using".

That makes perfect sense.

It's also not that I wouldn't be "using" my PhD. It's that I wouldn't be an independent, R01-funded PI. The latest data shows that only ~5-8% of all MD/PhDs obtain that career. The rest are mostly clinical, and some manage hybrid arrangements with 10-30% protected time.

With that in mind, I've never really thought of a PhD as a degree that you use. I think it's incorrect to do so. Everything you do in research, PhD or no, is so niche you'd never really bring the specifics to your next job. It's development time. It's just a more intense version of the two years that general surgery residents or IM sub fellows take, and from what I've seen they're not doing the definitive research that defines their career paths during those years either. They're just learning some skills. You learn to analyze data, to ask the right questions, and to effectively communicate.

So I guess I'm not sure why it's relevant that the PhD was obtained before residency or why you'd discount that experience. By the time you apply for attending positions, an MD/PhD without research years would be 6-8 years removed from 4-5 years dedicated research time (assuming the MD/PhD uses the latter half of 4th year to do dedicated research, which anyone with an F grant is obligated to do) while an MD would be 4-6 years removed from 2 years dedicated research time. The recency factor seems pretty irrelevant. Probably more important is that MD/PhDs usually don't do anything surgery-related whatsoever during their PhD.

 

[Lem0nz]

After reading all of this I feel like you've really answered your own questions buddy. You can be competitive for an academic or hybrid track without doing additional research years or a seven year program. You won't be as competitive as someone who did an MD/PHD + 7 year program. People do 12-15+ years of training because it is a safe pathway to a very specific career choice from 'the best' institutions. If you don't want that career that badly, don't do surgery and pick another specialty. If you do but you're willing to fail and find another path in surgery, go for it. If you really want that path absolutely no matter what and do not want to tolerate taking any chance of not succeeding and not throwing yourself completely at it, you have your answer.

Am I missing something? Your frustrations aren't wrong or invalid but this is just the reality of academic medicine and you seem to understand the game better than most. You just don't want to play it anymore. So... don't. I also feel like you (and others) are ignoring the really important fact that there are a lot of non academic jobs that allow you to continue doing research. You can interface with labs in the community, with industry, you can have dedicated teaching jobs, you can still apply for grants - there is nothing in the title of the professor that conveys a special ability to do that. If you are already self sustaining as an MD/PHD you'll be able to do so as an attending surgeon. Outside of academics the big difference is you'll generally get paid more to do it and you just have to be clear about what you're going to do with your time up front and justify why its important to your institution. There are a LOT of non-profit, non-university settings that still value education and research.

 

[Medstart108]

I'll reassess in a year or so, but for now I could take or leave bench research. COVID steamrolled my PhD, and it really sucked the joy out of the process. If I wanted to do bench research, I'd need a K-grant, and I'd definitely need to get back in the lab. No question there. I'm just not sure that's the passion anymore.

What I wouldn't mind doing is something like a 90/10 clinical/research path in surgery. I don't need to run a lab. I could co-author grants with basic scientists and take a 5-10% effort position on the projects. I could get NIH grants for clinical work/studies or participate/run clinical trials. Any of these things would scratch that itch. I know I don't need the PhD to do these things. I also don't really care if the PhD ends up being nothing but a weird side quest.

So I guess my question is, is that a viable path? Let's say I graduate from my PhD with 8-10 basic science manuscripts, 3-4 patents, a whole slew of abstracts/talks, and 2-3 clinical papers during my MD. I do well clinically and manage to pull off a 5 + 2 or a 4 + 3 at a major academic center and try to publish clinical papers and present at a conferences along the way, but I never take any explicit research years. Would I be in a good position to establish myself as a professor in surgery doing a 90/10 split?

I do think its a viable path. It doesn't sound like you want to run a lab, in that case your goal is to pivot towards clinical research, which is much easier to do without grants and can be done in your free time essentially. You don't need additional research years per say if you choose that path but you do need to remain productive. During your residency and fellowship and perhaps your remaining PhD years, you want to be starting to write and be involved in clinical research. If you are going to interview for a job and you can demonstrate that you understand how to do clinical research and you have several publications to your name, you will still be competitive from a research perspective. Plenty of people who have a basic science PhD have pivoted towards clinical research/surgical careers, but the most important thing is they actually started to publish clinical research and work on that. Overall this path is completely viable, just make sure you actually have clinical research work, you won't be able to rely on your basic science work to argue that you can do clinical research. I know plenty of people who have had some impactful basic science research that no pretty much only do low tier clinical research (think surveys, low quality SR/MAs) because they just haven't worked on that aspect of their career enough and I also know people who have pretty avg basic science work and are now running clinical trials and "experts" in their surgical field. TL DR you don't need those extra clinical research years, but you do need to show clinical research productivity, it is a whole different field and you'd be naive to think you can just walk straight into it and do it well.

But also, if your goal is 90/10, you are getting your job based on your surgical skills, not your clinical research, so you'd probably want to focus on surgical skills primarily if that is the kind of a job you want.

 

[Medstart108]

That makes perfect sense.

It's also not that I wouldn't be "using" my PhD. It's that I wouldn't be an independent, R01-funded PI. The latest data shows that only ~5-8% of all MD/PhDs obtain that career. The rest are mostly clinical, and some manage hybrid arrangements with 10-30% protected time.

With that in mind, I've never really thought of a PhD as a degree that you use. I think it's incorrect to do so. Everything you do in research, PhD or no, is so niche you'd never really bring the specifics to your next job. It's development time. It's just a more intense version of the two years that general surgery residents or IM sub fellows take, and from what I've seen they're not doing the definitive research that defines their career paths during those years either. They're just learning some skills. You learn to analyze data, to ask the right questions, and to effectively communicate.

So I guess I'm not sure why it's relevant that the PhD was obtained before residency or why you'd discount that experience. By the time you apply for attending positions, an MD/PhD without research years would be 6-8 years removed from 4-5 years dedicated research time (assuming the MD/PhD uses the latter half of 4th year to do dedicated research, which anyone with an F grant is obligated to do) while an MD would be 4-6 years removed from 2 years dedicated research time. The recency factor seems pretty irrelevant. Probably more important is that MD/PhDs usually don't do anything surgery-related whatsoever during their PhD.

The reason people are skeptical about the whole MD/PhD -> Surgical resident thing is we've seen it all before. The keen bean superstar undergrad who absolutely must do it all, naturally aims for the most prestigious thing he/she can find, a MD/PhD. They get into a top tier MD/PhD program, naturally, they must get into the ultra prestigious surgical residency and become a world leading professor of surgery. You really hit your social peak right as you enter that MD/PhD.

6 years into their MD/PhD, they feel the burnout, life moves on, their MD friends are halfway through residency and yet they are still a student. Some realize they have no real interest in the academic life, but a few simply must press on to achieve their surgical dreams. I've met these guys in residency, most of them have families now and have absolutely no tolerance for the 80 hrs a week of clinical drudgery that is a surgical residency. Few of them want to publish any more papers, some barely publish at all. Most of them want to go straight into practice as a community surgeon.

 

[CABGpatch Kid]

The reason people are skeptical about the whole MD/PhD -> Surgical resident thing is we've seen it all before. The keen bean superstar undergrad who absolutely must do it all, naturally aims for the most prestigious thing he/she can find, a MD/PhD. They get into a top tier MD/PhD program, naturally, they must get into the ultra prestigious surgical residency and become a world leading professor of surgery. You really hit your social peak right as you enter that MD/PhD.

6 years into their MD/PhD, they feel the burnout, life moves on, their MD friends are halfway through residency and yet they are still a student. Some realize they have no real interest in the academic life, but a few simply must press on to achieve their surgical dreams. I've met these guys in residency, most of them have families now and have absolutely no tolerance for the 80 hrs a week of clinical drudgery that is a surgical residency. Few of them want to publish any more papers, some barely publish at all. Most of them want to go straight into practice as a community surgeon.

+1 about this. Someone from my program went into CT, he was an MD/PHD from top tier in both.

Went into community practice as soon as he was out of fellowship. Can’t blame him, he wanted to have more time for his family that he missed out on for many years.

No PhD here, but two years of research, and I’ll be in my 40’s once completing CT fellowship due to career before medicine. I still entertain academic practice following fellowship, but we’ll see how I feel 3 years from now and what training program I match to.

 

[ChordaEpiphany]

The reason people are skeptical about the whole MD/PhD -> Surgical resident thing is we've seen it all before. The keen bean superstar undergrad who absolutely must do it all, naturally aims for the most prestigious thing he/she can find, a MD/PhD. They get into a top tier MD/PhD program, naturally, they must get into the ultra prestigious surgical residency and become a world leading professor of surgery. You really hit your social peak right as you enter that MD/PhD.

6 years into their MD/PhD, they feel the burnout, life moves on, their MD friends are halfway through residency and yet they are still a student. Some realize they have no real interest in the academic life, but a few simply must press on to achieve their surgical dreams. I've met these guys in residency, most of them have families now and have absolutely no tolerance for the 80 hrs a week of clinical drudgery that is a surgical residency. Few of them want to publish any more papers, some barely publish at all. Most of them want to go straight into practice as a community surgeon.

While I 100% agree with this assessment, I do think it's important to mention that

1) This is not most MD/PhDs. Most that I know are still dead set on research by the time they get out of med school.

2) I think a lot of MD/PhDs that go into surgery specifically do so because it's not a traditional research field. As an MD/PhD, people push you to keep sacrificing for a chance to run a lab and no guarantee you won't get dropped at 45 years old with no funding and a resume fully geared towards lab work. Surgery becomes a nice environment, because research isn't the end-all-be-all.

I find this quote from a Vanderbilt MSTP alum absolutely hilarious: “Lab was more influential for me because I hated it much more, and I didn’t want to choose a specialty that was ‘friendly’ to research.” Pretty much sums up the surgeon you described.

After reading all of this I feel like you've really answered your own questions buddy. You can be competitive for an academic or hybrid track without doing additional research years or a seven year program. You won't be as competitive as someone who did an MD/PHD + 7 year program. People do 12-15+ years of training because it is a safe pathway to a very specific career choice from 'the best' institutions. If you don't want that career that badly, don't do surgery and pick another specialty. If you do but you're willing to fail and find another path in surgery, go for it. If you really want that path absolutely no matter what and do not want to tolerate taking any chance of not succeeding and not throwing yourself completely at it, you have your answer.

Am I missing something? Your frustrations aren't wrong or invalid but this is just the reality of academic medicine and you seem to understand the game better than most. You just don't want to play it anymore. So... don't. I also feel like you (and others) are ignoring the really important fact that there are a lot of non academic jobs that allow you to continue doing research. You can interface with labs in the community, with industry, you can have dedicated teaching jobs, you can still apply for grants - there is nothing in the title of the professor that conveys a special ability to do that. If you are already self sustaining as an MD/PHD you'll be able to do so as an attending surgeon. Outside of academics the big difference is you'll generally get paid more to do it and you just have to be clear about what you're going to do with your time up front and justify why its important to your institution. There are a LOT of non-profit, non-university settings that still value education and research.

I'm not sure I had answered my own questions, but the replies here were great. I really appreciate the input. I've done some exploring at my own institution, and it seems like there's just a whole lot of grey area, and people get positions for all sorts of reasons. It'll be a toss up. Like you said, I'll have to be okay with other paths in surgery. To that end, I'm now going to weekly surgery clinics, and I'm submitting/presenting research I've done with surgeons at my institution. I'm just going to keep learning, keep publishing, find what I like clinically, and then just let it ride.

 

[Lem0nz]

While I 100% agree with this assessment, I do think it's important to mention that

1) This is not most MD/PhDs. Most that I know are still dead set on research by the time they get out of med school.

2) I think a lot of MD/PhDs that go into surgery specifically do so because it's not a traditional research field. As an MD/PhD, people push you to keep sacrificing for a chance to run a lab and no guarantee you won't get dropped at 45 years old with no funding and a resume fully geared towards lab work. Surgery becomes a nice environment, because research isn't the end-all-be-all.

I find this quote from a Vanderbilt MSTP alum absolutely hilarious: “Lab was more influential for me because I hated it much more, and I didn’t want to choose a specialty that was ‘friendly’ to research.” Pretty much sums up the surgeon you described.

I'm not sure I had answered my own questions, but the replies here were great. I really appreciate the input. I've done some exploring at my own institution, and it seems like there's just a whole lot of grey area, and people get positions for all sorts of reasons. It'll be a toss up. Like you said, I'll have to be okay with other paths in surgery. To that end, I'm now going to weekly surgery clinics, and I'm submitting/presenting research I've done with surgeons at my institution. I'm just going to keep learning, keep publishing, find what I like clinically, and then just let it ride.

Listening to your replies I feel like you would be pretty happy in many of the alternate pathways out of surgery and would find them pretty fulfilling. I would go for it and not look back, 5 years from now you will be a very very different person after surgical residency.

 

[YCAGA]

For those of us that are probably not competitive for I6 thoracic residency, what is a realistic path to CT surgery? Of course a lot can change in the 5-7 years until current med students apply for fellowship, but what is the current landscape? 5 gen surg years + 1 or 2 research years + 2 to 3 CT fellowship years?

8-10 years seems pretty brutal for "just" private practice CT surgery but I guess that amount of time is still an Eagle or Double Eagle for peds surg or surg onc.

 

[DOVinciRobot]

For those of us that are probably not competitive for I6 thoracic residency, what is a realistic path to CT surgery? Of course a lot can change in the 5-7 years until current med students apply for fellowship, but what is the current landscape? 5 gen surg years + 1 or 2 research years + 2 to 3 CT fellowship years?

8-10 years seems pretty brutal for "just" private practice CT surgery but I guess that amount of time is still an Eagle or Double Eagle for peds surg or surg onc.

You don’t need research years to match CT, but it undoubtedly helps for the heavy hitter academic programs. We place CT fairly regularly and we haven’t had dedicated research time in about 10 years. I might be wrong but I don’t think it’s the standard for CT like it is for peds or onc

 

[YCAGA]

You don’t need research years to match CT, but it undoubtedly helps for the heavy hitter academic programs. We place CT fairly regularly and we haven’t had dedicated research time in about 10 years. I might be wrong but I don’t think it’s the standard for CT like it is for peds or onc

Gotcha. It might be naive to say but my goal is to be a surgeon not the (academic demi-god) surgeon, if that makes sense. So MGH et al is not my end goal in life or career.