Residency programs with a physician scientist training pathway

[Aljoufi]

Hello,

I'm looking for a list of Internal Medicine residency programs that have a physician scientist training pathway. I earned my MD a few years ago, currently doing a basic research at epigenetic and planning to apply for next match season.

Thank you

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[debateg]

What do you mean by physician scientist training pathway? The dirty little secret is that the PSTP really doesn't exist.

The American Board of Internal Medicine has a set research pathway (http://www.abim.org/certification/policies/research-pathway-policies-requirements.aspx). The majority of academic residency programs will allow you to go through this pathway in which you do an PGY-1 and PGY-2 as a resident and then do a PGY-3 as a fellow ("short tracking") in exchange for doing an extra year of fellowship.

What programs advertise as the PSTP varies dramatically. The MSTP offers I received seemed to be really straightforward. It was my experience that most PSTP programs were not at all honest about what they offered. At the bare minimum, they offered the possibility of short tracking, but I think most academic programs would be amenable to you doing this even if they don't have a formal pathway. That being said, I interviewed at one place with a "research pathway" where pulmonary/critical care refused to accept short trackers and heme/onc strongly discouraged it. I had to probe to find this out.

Many "guaranteed" fellowship admission with lots of string attached (e.g you can't switch fellowships during residency, the guarantee can be revoked at any time, it only applies to certain subspecialty fellowships, etc). None of this was volunteered to me during interviewing. Some guarantee you funding for that extra year of research and some do not, and sometimes it depends on the fellowship you're in and can change from year to year depending on the funding of the fellowship and the whim of the director. Some even force you to do that extra year of research as a PGY-3. Some programs offer you an extra bonus as a fellow to deter moonlighting. Most do not.

So when you say you want a PSTP, what do you want out the program? That will help answer the question.

 

[Neuronix]

Are you an FMG? If so, keep in mind that PSTPs are extremely competitive for even US grads and only offered at top programs. These programs may not be feasible for you.

 

[ratherbefishing]

What do you mean by physician scientist training pathway? The dirty little secret is that the PSTP really doesn't exist.

The American Board of Internal Medicine has a set research pathway (http://www.abim.org/certification/policies/research-pathway-policies-requirements.aspx). The majority of academic residency programs will allow you to go through this pathway in which you do an PGY-1 and PGY-2 as a resident and then do a PGY-3 as a fellow ("short tracking") in exchange for doing an extra year of fellowship.

What programs advertise as the PSTP varies dramatically. The MSTP offers I received seemed to be really straightforward. It was my experience that most PSTP programs were not at all honest about what they offered. At the bare minimum, they offered the possibility of short tracking, but I think most academic programs would be amenable to you doing this even if they don't have a formal pathway. That being said, I interviewed at one place with a "research pathway" where pulmonary/critical care refused to accept short trackers and heme/onc strongly discouraged it. I had to probe to find this out.

Many "guaranteed" fellowship admission with lots of string attached (e.g you can't switch fellowships during residency, the guarantee can be revoked at any time, it only applies to certain subspecialty fellowships, etc). None of this was volunteered to me during interviewing. Some guarantee you funding for that extra year of research and some do not, and sometimes it depends on the fellowship you're in and can change from year to year depending on the funding of the fellowship and the whim of the director. Some even force you to do that extra year of research as a PGY-3. Some programs offer you an extra bonus as a fellow to deter moonlighting. Most do not.

So when you say you want a PSTP, what do you want out the program? That will help answer the question.

This is very helpful information and what concerns me about doing the IM Research Track. It all seems like more hurdles to cover on the way to having a career as a physician-scientist - and more ways we lose people along the way.

I'd be interested to know which programs do as advertised. In the ideal world, you would be guaranteed a fellowship after 1 intern year and 2 IM years, with some kind of plan to hire you on as faculty at the end (is lab space contingent on secured funding from postdoc?). I can understand why they wouldn't want you switching fellowships because of the need for planning. From what I gather, WashU and Northwestern PSTPs seem to emphasize their ability to get their people through this track and into faculty spots. Or at least they are one of the few that have moderately useful websites with updated information on the program. More "inside" info is appreciated.

 

[debateg]

Here are the questions you need to ask, preferably before you apply. If you can, get in contact with current fellows. When you go interview, ask the PSTP and fellowship directors. When the fellowship directors start to waffle or sweat, you can tell they're not being honest with you.

Most important: Does every fellowship have a T32 training grant? Are any T32s at risk of not being renewed? Does every fellowship provide funding for the "extra" year of research on T32 grants? If not, where do the fellows get their funding for that year? What happens to them if they cannot secure a grant? Has there ever been a case in which a fellowship has not been able to fund a PSTP during their research years? If so, what happened?

Do you get guaranteed admission to every possible IM fellowship?

Does every fellowship accept people who short track? Do the majority of PSTP's short track?

Does the "extra" year of research always happen at the end of fellowship contiguous with the regular research?

What is the track record for the graduates? How many got faculty positions at their institution or another?

What benefits does the program provide to assist in achieving a faculty position?

In my experience, Wash U, Michigan, and Vanderbilt are as advertised. I don't know about Northwestern.

 

[Scottish Chap]

I completed residency and fellowship (each at different institutions) under the ABIM Research Pathway. Hands down, Vanderbilt is the best and most organized I saw on the interview trail and though I ultimately decided to go to a slightly less organized Research Pathway program for the clinical training, I think Vanderbilt has the right idea. Some trainees (like me) did the MD/PhD the expensive way, and so having a program understand the financial stressors and know that a slightly higher stipend in the research years makes a big difference says something.

It's true that some programs have been running an unofficial Research Pathway for years (Hopkins, Mass General etc.) since you only need 2 years of general IM training to be boarded. Make sure that the programs with less experience understand they will: 1. be accountable to the ABIM for making sure you meet clinical board eligibility in your sub-specialty (especially those that require procedural competence like GI, cards, and critical care), 2. understand that they MUST release you for your 1/2 day clinic each week while you are a researcher for three years, 3. understand that they are accountable for paying medical malpractice insurance for you while you serve this clinic in your research years (some of the big medicine programs--including the one where I did my residency--get into huge fights with the sub-specialty divisions who sometimes decide they don't want to foot the malpractice insurance bill for your research years).

Whoever mentioned the T32 is smart. Some programs forget that they must pay you for longer than a general fellow, and having the assurance of a T32 training grant which covers stipend, medical insurance, and an annual conference allowance can be a big deal. Also ask about how many of their current trainees are submitting a K08 and if they are successful (Vanderbilt awards their fellows more money if they take the time to submit the K08--it demonstrates that both parties are mutually serious and invested in research success).

I personally would avoid any program that 'forces' you to do the research years right after 2 years of IM and before fellowship (Emory insisted on this when I interviewed several years ago). Being away from clinical medicine for three years, then being expected to perform as a competent fellow (all while losing research momentum at the time when your start-up lab and grant applications should be most active) made zero sense to me, but it was a personal decision.

Good programs I saw advertized: 1. the willingness to reserve the clinical fellowship of your choice right out of medical school so that you don't have to waste time interviewing (I had to interview for fellowships as an intern), 2. the willingness and understanding to allow you to switch into another fellowship if you are better suited to it after gaining meaningful experience as a resident, 3. understanding the ABIM rules permit you to interview at other institutions for fellowship even if you have a fellowship reserved where you are a medicine resident, 4. a track records in having Research Pathway fellows be successful with the NIH Loan Repayment Program (LRP) grant to reduce debt.

Hope that helps.

 

[StilgarMD]

http://www.stanford.edu/~jcpaik/rr.html - seems relevant to those interested in this topic

 

[yoyopa]

As a current PSTP applicant, the advice above is spot on. Many of the top (but not tip top) have formal programs, almost all I've been fortunate to interview with will guarantee the fellowship of your choice and many now supplement your salary by 15-25k during the research fellowship years. Seems to be working to some degree at these places as a fair number of people are staying on for faculty with the support of Ks/private independence pathway awards.

The applicant pool appears to be small by IM terms, but very competitive. FWIW, I have yet to see a FMG on the interview trail, a couple years ago (at least at my home institution) I think this was a viable route for institutions to retain/train star foreign MD research post-docs, but I've got no anecdotal evidence to support that notion is viable now or in the future as US graduate medical education is getting more competitive at all levels.

 

[Doctor&Geek]

http://www.stanford.edu/~jcpaik/rr.html - seems relevant to those interested in this topic

Old data, and useless at that.

 

[Elixir6]

Old data, and useless at that.

Haha - don't diss your own work! It might be older, but I think its quite useful. Do you think things have changed that much in 3 years?