Should i do Residency to help my research career?

[xcavier]

---

Members don't see this ad.

dear all,

Long time reader, first time poster. First a bit of b/g. I am in a MD/PhD program in Oz at one of the top med schools here. I have nearly finished med school and now am committed to a research career. I can't decide b/w trying to pursue a residency in the US, most likely pathology as the physician tracks look really appealing since they only require 15-18mths fo clinical work with 2.5 years devoted to research/post-doc equivalent.

OR

completing the PhD and only going for competitive post-docs.

My main concerns are:

1/ does doing a residency (eg pathology) help with getting a tenure track psn later on?
2/ How competitive is it for a IMG like me to land one of these phyisician track psns
3/ Is it worth it, or does doing a pure post-doc will allow me to concentrate more on the research; so there won't be much advantage to the residency for my future research career?

Just to make things clear, i am set on research. If i have the opportunity to do clinical work I will enjoy it but it is not a must for me. I am considering residency (a short one such as clinical pathology) primarily to help boost my research career in finding tenure track positions/grant money- maybe my understanding is not correct so I wanted to ask those in the know 🙂 thx for the feedback!

 

[K31]

My main concerns are:

1/ does doing a residency (eg pathology) help with getting a tenure track psn later on?
2/ How competitive is it for a IMG like me to land one of these phyisician track psns
3/ Is it worth it, or does doing a pure post-doc will allow me to concentrate more on the research; so there won't be much advantage to the residency for my future research career?

1) Being residency-trained will make you more attractive for tenure-track positions. This is mainly for financial reasons--clinical income is the main source of revenue for medical schools, and you can contribute to that if you're a licensed physician. It also has financial advantages for you--you'll make more as a 90% research, 10% clinical faculty member than as a 100% research PhD-only faculty member.

2) I can't really speak to research track residencies, but pathology in general is not very competitive and of course value research highly. As a MD/PhD from an English-speaking country, I'd say you'd have a good shot. Do you happen to have taken at least Step 1 yet?

3) See number 1; being a physician-scientist won't help much with getting grants, but will help landing a job. Pathology in particular is very amenable to research-intensive careers.

 

[Ombret]

As a pathologist, I would tend to say the exact opposite. No residency will directly help you reach your goal of becoming a tenured faculty member. At research-intensive universities, appointment to tenure-track positions is going to be based pretty much entirely on your basic science research background--pubs, funding, and whether your plan fits with the institution's priorities. Not whether you completed a residency. This is ESPECIALLY true in pathology departments where, for historical reasons, the research side tends to be very much like a basic science immunology department (i.e., high standards which you are most likely to meet if you are not distracted/slowed down by your clinical training).

Clinical revenue from your CP activities is not going to make you more attractive to the institution, mainly because the professional component of CP billing is minimal. The technical component is what pays, and the hospital is already collecting that whether you work there or not.

And anyway, in any tenure track job, the university's plan is to give you the can (or the sack as you guys may call it) if you are not covering your own expenses with external funding by the time you come up for promotion. Think about it, if clinical revenue could be used to justify tenure, the surgeons and radiologists would all be tenured from day one. Instead they are not typically on the tenure track at all. It just is not relevant to their activities.

Exceptions that I've seen--and this may seem contradictory--are that tenure is awarded rather more liberally in very clinical departments (say, ENT) where scientific standards are lower; or it can be used as a recruiting tool, usually by lower-tier institutions, to bring in or retain famous names. I suppose you could game this by aiming low, in terms of the caliber of your eventual institution.

If you are intent on a biomedical basic science career, the benefits to you from doing a CP residency, or any other, are (1) more awareness of clinically relevant research areas--this may help you direct your research more wisely; (2) lower overall risk of failure, as your clinical skills give you a backup plan if the lab goes south. You may also just enjoy clinical medicine. So I don't think it's the wrong thing to do. But when you are up at 3 a.m. preparing your fiftieth lab medicine case conference, you may wonder what you are doing in residency instead of in the lab.

 

[xcavier]

hey guys, thx for the replies. The research i'm doing is pretty computationally intensive and is more of a theoretical/quant nature so not much wetlab (though i've done plenty of gels b/f and wouldn't mind collaborating later on). I feel the med degree has already given me a lot of scope in terms of directing my research/interests towards fruitful areas.

The biggest attraction i saw from pathology residency was a) the short clinical time needed (so the non physician-scientist track residencies wouldn't be of great interest to me as they do not have built in research time) b) the impression that docs with residency seem to find faculty positions easier. However in the latter case it is based purely on anecdotal evidence and a sample size of 4 🙂

I should point out that the faculty positions i'm talking about are the basic research (though more directed towards solving medical challenges) academia posts with departments that do interdisciplinary research such as systems biology and related stuff. Which is why I'm more interested in the scientist track residencies as they are usually at the large academic institutions that provide these kind of research networks that i can tap into- understandably they are a lot more competitive, but is it realistically out of the league of an IMG? Otherwise going to a small county hospital is not going to provide the kind of opportunities i'm looking for.

I'm currently at the point of considering whether i should take the plunge and commit significant time (and a big wad of cash) towards taking the USMLE next year and getting on the interview circuit. So thanks for the feedback its really helping me make an important career decision- my main contention is whether the residency would add value towards securing a research post at a university doing the kind of research i mentioned above? (Note, i'm not concerned about fall back- if worse comes to worse i can always come back to oz and do training here) Or is it all about publications? Will a research department doing systems biology/modelling be impressed by a pathology residency or will the clinical time (albeit 15-18mths) detract from the critical task of greater research output?

Thx for the responses btw!

 

[gbwillner]

My advice (from a pathologist at a major academic center with a top CP training program): If you love computational work/working in collaboration with others, and don't really want to practice clinical medicine, don't do residency. Or you can start, and if you don't like it, quit.
We get 2-3 CP-only residents every year at our program. I have known 4 people with a similar background as you (computational or statisitcs), and of them, 3 quit residency to do research full-time. One quit after only 1 year, and another never actually started residency. They are all currently faculty and successful. The neat thing about computational biology is that it is really in demand, particularly right now. It is one of the few fields where you can get a faculty position without even doing a post-doc. I work on next-gen sequencing, and like a lot of other people, need help in analyzing the vast amounts of data. I NEED computational support. It would be relatively easy for you to come in with that specific skill set, and get put on several grants, and your own space (computers). I don't think any of the people I mentioned earlier have R01s, but they are heavily involved in large projects in the department and are well supported and regarded.

I can't speak for salaries, but they were all made instructor. They have roles in developing clinical projects, but obviously are not attendings and have no hospital privileges.

Like Ombret said, advancement is dependent on your research, not clinical work. And why would you waste 15 months when you may be able to get what you want with doing 0? Now, if you want to have a "back-up" career, than go ahead and do CP. Just know that your clinical role as a CP-only physician are EXTREMELY limiting- pretty much just blood banking.

 

[xcavier]

hey guys, thx for the great discussion. So if i understand correctly doing CP only pathology is really an all-in play as there's not much scope for clinical practice unless its coupled with anatomic path as well?

I'm leaning towards going for post-docs and see how things work out from there b/f applying to residencies. This way i'm not as restricted in terms of the number of research labs that i can apply. Its great to know that quant skills are in high demand 🙂

On a more practical issue, I understand that applying in the US USMLE step 1, LORs, med school grades (3/4 yr) are important. To clarify how important in pathology are US LORs, and do i need to submit med school grades seeing as its a foreign medical school? I mean, its a bit hard to compare with a different curriculum and scaling systems?

Btw, how have you guys found academic path? Has it turned out the way you envisioned, how much time would you split b/w research and clinical work?

 

[gbwillner]

hey guys, thx for the great discussion. So if i understand correctly doing CP only pathology is really an all-in play as there's not much scope for clinical practice unless its coupled with anatomic path as well?

I'm leaning towards going for post-docs and see how things work out from there b/f applying to residencies. This way i'm not as restricted in terms of the number of research labs that i can apply. Its great to know that quant skills are in high demand 🙂

On a more practical issue, I understand that applying in the US USMLE step 1, LORs, med school grades (3/4 yr) are important. To clarify how important in pathology are US LORs, and do i need to submit med school grades seeing as its a foreign medical school? I mean, its a bit hard to compare with a different curriculum and scaling systems?

Btw, how have you guys found academic path? Has it turned out the way you envisioned, how much time would you split b/w research and clinical work?

I believe CP-only is pretty much an "all-in" play. There will be disagreement here, but CP-only trained faculty have only a handful of roles in healthcare: as director of laboratories for a hospital/medical center, pure administrator in the department of pathology, running managing the blood bank (may include pheresis centers), a "backdoor" residency into hematopathology, or director of clinical chemistry or microbiology labs. The first couple of jobs I mention are filled by senior people (you can't typically shoot for these out of residency), and the latter two are virtually always filled by PhDs who did clinical fellowships in micro or chemistry. Why would they hire you to do their job for twice the salary? That really only leaves 2 viable clinical prospects for you- blood bank or hemepath. Both would require additional training in a subspecialty fellowship. Hemepath is competitive, and you would be at a pretty big disadvantage without AP. I don't think they would let you sign out lymph nodes without AP training, and that is a big part of it. That pretty much leaves blood bank. If you like this, then there is a pretty big market for it. But you have to know in advance that this will be your job up front if you rely on clinical duties. If you can get an 80/20 or 90/10 research type job in academia, you clinical duties can be entirely administrative, so no biggie. In private gigs the small amount of CP administrative duties or call are given to AP/CP trained pathogists (probably 95% of all pathologists are AP/CP). I gues I should add you may also be able to do a molecular fellowship and direct that lab as well, which can also be done by a PhD.

If your research is outstanding, I have no doubt you will get a spot in the US provided you take the USMLE exams and do well in them. LORs are a must, and will document your level of interest in the field. It's not good for a program to have residents start programs and then quit.

I love academic path in that it does give you the freedom to do both clinical and research. Particularly if you are at a major academic center with a good path department that is supportive of research. I am at the end of a research track (PSTP) program, and currently doing a post-doc after doing AP-only. I currently have no clinical responsibilites, so I can focus on my research, get 2-3 papers and a K award. At that point I expect to be made Asst. Professor, and would like a 70/30 or so type job. Unlike CP, I can do administrative roles, autopsy service, molecular pathology (my subspecialty fellowship), or practically any subspecialty within surgical pathology for my clinical work. Also unlike CP, AP training is rigorous, and unless you definitely want to have a clinical component to your job, is not worth it.

 

[xcavier]

(probably 95% of all pathologists are AP/CP). I gues I should add you may also be able to do a molecular fellowship and direct that lab as well, which can also be done by a PhD.

If your research is outstanding, I have no doubt you will get a spot in the US provided you take the USMLE exams and do well in them. LORs are a must, and will document your level of interest in the field. It's not good for a program to have residents start programs and then quit.

I love academic path in that it does give you the freedom to do both clinical and research. Particularly if you are at a major academic center with a good path department that is supportive of research. I am at the end of a research track (PSTP) program, and currently doing a post-doc after doing AP-only. I currently have no clinical responsibilites, so I can focus on my research, get 2-3 papers and a K award. At that point I expect to be made Asst. Professor, and would like a 70/30 or so type job. Unlike CP, I can do administrative roles, autopsy service, molecular pathology (my subspecialty fellowship), or practically any subspecialty within surgical pathology for my clinical work. Also unlike CP, AP training is rigorous, and unless you definitely want to have a clinical component to your job, is not worth it.

That was a great in-depth look at how CP residency would work out. I totally appreciate my clinical roles would be limited. (I was struck by the number of CP only programs in the US- over here there is no distinction path is a straight 5yr residency after a 1yr internship).

The main reason I am considering CP is really your third last sentence- would I be offered a Ass. Prof. position out of residency if I only did CP? I mean, it sounds like a more sure fire way of acquiring a faculty position. I don't want to sound like I'm totally turning my back on clinical work. I actually quite like it but I've discovered my passion for research far outweighs what I'm getting out of clinical duties. Which is why my post-doc/residency considerations are geared towards maximising my chances of landing a good research job.

 

[Ombret]

xcavier, no pathology department in the U.S. is going to make you a tenure-track assistant professor straight out of CP residency. That type of appointment is for people who have done a postdoc. The postdoc shows that you have developed a coherent research program and gives you a chance to prove that you can do research without your PI holding your hand. Remember, the institution is about to give you $250,000 of startup funds with no strings attached. They are not going to hand that kind of money to you as a residency graduation present.

Now, doing CP residency might help you OBTAIN a postdoc position, as it could buy you some time to find funding and/or let you figure out exactly what it is you want to do, and your residency might let you spend some time in the lab at their expense as part of the program. However CP residency is no bowl of cherries (trainees are normally bored out of their skulls, when not being berated for the quality of their educational conferences, or studying themselves silly for the ludicrous board exam) so there may be a less painful way to achieve the same goals. Having CP training, much less certification, will not in itself have any relevance to your postdoc.

To answer a couple of other points that you raised, your LORs for residency application would not need to be from the U.S. However you need to read up on something called the ECFMG. FMGs do land U.S. residencies but usually not straight out of med school, in part due to the time needed to get the ECFMG certificate lined up.

Anyway, it sounds like your current plan leans more toward going directly into a postdoc. If you really want a basic science career, that is probably more efficient AND more likely to give you the desired result.

 

[xcavier]

ur answers have been awesome and I think its really helped me clarify what each path(no pun intended) was leading towards. I mean the reason I figured a residency 'might' help with securing research positions was because of articles like this:

http://sciencecareers.sciencemag.or...rticles/2003_10_31/noDOI.15775442586127585725

It gave me the impression that the above individual was able to successfully leverage his residency training to secure research post/grants (I understand he's probably rather an exception than the rule, hence my posts on this website!)

And I think I was quite excited with the following from

http://www.med.upenn.edu/mstp/PhysicianScientistResidency.shtml

Clinical Pathology, CP-only applicants:
Length: 3 years total (1.5 years of clinical requirements as specified by the Pathology Boards + 1.5 years of research elective). Research-oriented programs may let you fudge these requirements and do only 1 year of core clinical requirements. Second and third year could then be used entirely for research, or for completing a clinical subspecialty fellowship during second year before a formal post-doc in third year and beyond. Note: Hemepath fellowship requirements are changing and it may be worth checking them before applying. For instance, Hemepath will require passing of general AP or CP boards before entering into this fellowship, which would mean 3 yrs of residency + 2 yrs of fellowship.
Salary funding during a formal Post-doc after the 3 years of residency/fellowship at the corresponding PGY level is similar to the description for AP-only residents mentioned above. Note: the writer was an AP-only applicant, and details for combining CP-only residency, fellowship and research should be double checked for each program.

This definitely conveyed a very research friendly residency that was short and did not detract from research. However, I now understand quite clearly that the CP residency allows a good opportunity for locking down the post-doc; while future faculty appts are very dependent on actual research generated (ie publications) during the post-doc. I had hoped that the CP residency might have given me a leg up in obtaining faculty positions. But i think i've sufficiently clarified this that ultimately its going to come down to the research output 🙂

Btw, slightly off topic how did you guys countenance with juggling research with clinical rotations? Because on some rotations such as obs or surgery it really posed a problem trying to juggle b/w the lab and hospital. Which means that most of my marks were average/mediocre in the sense of the 70's range. (Except for obs, which i just did not appreciate and had a paper to finish- i got absolutely slaughtered in the final exam and came in the low 50's , but still passed). As these marks are going on the transcripts did you guys ever go through similar experiences and if so how did you explain them to PD? Would a low 50 rule you out of the top academic programs or would they give leeway because they'd understand research was being done and sometimes its hard as a MD/PhD juggling b/w the two?

 

[Ombret]

Mmmyeah. David Engman is a nice guy, I met him when I was an MD/PhD applicant back in 1999 or so. The path he describes would be very atypical, especially today when rules are more rigid. The deal he got sounds like the sort of thing where you would have to really be the right person in the right place at the right time.

To answer your other question, clinical grades matter quite a bit for any residency application. Even CP. Trash grades could make it very difficult to get an interview at a U.S. program as a foreign medical graduate. FMGs who successfully match in the U.S. were usually at the tip-top of their programs at home and may have even already completed a residency in their home country, all of which assuage the program's uneasiness at taking an applicant from outside the familiar U.S. medical education system.

I think most of the people I went through MD/PhD with put lab work pretty much on hold while doing our clerkships. If keeping up with research seemed so much more appealing than clinical work during your clinical year, then that reinforces the point that going straight to postdoc would probably be the most appealing choice for you--and nothing to regret there as it is a totally respectable option.

 

[xcavier]

yeah, i think my mind's made up. I had already committed to the research route. I guess sometimes theres always a sense of residency opening more doors but sooner or later i'm gonna have to take the plunge.

Anyway, I'm >95% going to be aiming at post docs but I wanted to make sure I explored all avenues.

On a final note, I'm curious as to whether you or other physicians in academic program style residencies are supported by the residency program or the lab you choose to do the research portion of your training? Say you choose to work in lab A during your research component would you be supported by your residency program funds or the lab's? I ask because I'm wondering if it means that the residency gives you more leeway to go to labs that otherwise were not hiring for post docs?

 

[gbwillner]

On a final note, I'm curious as to whether you or other physicians in academic program style residencies are supported by the residency program or the lab you choose to do the research portion of your training? Say you choose to work in lab A during your research component would you be supported by your residency program funds or the lab's? I ask because I'm wondering if it means that the residency gives you more leeway to go to labs that otherwise were not hiring for post docs?

Depends. If you do AP or CP training independently or in a non-PSTP or research-friendly program you are not guaranteed a thing after training. You may be stuck with N0 post-doc salary ($39K). "Top" programs may offer you 1 guaranteed year of a post-doc at PGY salary- this is something that is to be negotiated up front before even accepting the residency position if possible. These funds are from the department, and YES it can help you get into a lab that is not actively recruiting since you will be free to the PI. While the quote you listed above may have been true (except for that bit about Hemepath fellowships being 2 years- they are only 1) at MGH or other top place, most programs are NOT going to pay you PGY do play in the lab when they need those funds to pay for more gross-room monkeys.

Then there are PSTP-type programs, that will pay PGY+stipend, and give you 2+ years. These are extremely rare. Maybe just 1-3 programs in the whole country ( I only know of 1 for sure, although there are "variations" on this theme and different programs call their research-track different things and offer different things). They will let you pick any lab in the institution, and the department will pay your salary.

PM me for more info into specific programs, although some of my knowledge is now 4+ years old.

 

[xcavier]

Depends. If you do AP or CP training independently or in a non-PSTP or research-friendly program you are not guaranteed a thing after training. You may be stuck with N0 post-doc salary ($39K). "Top" programs may offer you 1 guaranteed year of a post-doc at PGY salary- this is something that is to be negotiated up front before even accepting the residency position if possible. These funds are from the department, and YES it can help you get into a lab that is not actively recruiting since you will be free to the PI. While the quote you listed above may have been true (except for that bit about Hemepath fellowships being 2 years- they are only 1) at MGH or other top place, most programs are NOT going to pay you PGY do play in the lab when they need those funds to pay for more gross-room monkeys.

Then there are PSTP-type programs, that will pay PGY+stipend, and give you 2+ years. These are extremely rare. Maybe just 1-3 programs in the whole country ( I only know of 1 for sure, although there are "variations" on this theme and different programs call their research-track different things and offer different things). They will let you pick any lab in the institution, and the department will pay your salary.

PM me for more info into specific programs, although some of my knowledge is now 4+ years old.

Hey, thanks for that really detailed breakdown. Been really busy with some assessments. PM sent 🙂 All in all, I feel pretty happy about where i'm going; i guess there's always a sense of feeling a bit of under utilizing the med degree w/o residency of some kind even if i fully intend on a research career.