Some questions

[Dor DP]

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Good evening everybody. Recently I have come to new decisions about my future career goals. but I still have some questions.

I am considering applying to Med school this year. In my country (Israel) Med school is 6 years long (you come with no former academic knowledge) and it includes 3 years of pre-clinical studies (when those end you get Bsc.Med) and later you have 3 clinical years and 1 year of internship (when those end you get an M.D).
Hopefully if I have high grades, during 3rd year I could apply to MD-Ph.D program which is my goal.

I am currently a biology undergrad (Freshmen) and I want to do Medical research (mostly interested in Translational/applicative basic research) and to be a lab PI when I am older. I am considering going to Med School because I also love Medicine, because I want to have a backup option of clinical work if research doesn't work, and because I think the MD knowledge and options (accessibility to patients) can help me to conduct meaningful applicative biomedical research.

After this background I have a few questions: (if 3 and 4 are more relevant to the international subform I'll ask them there)

1. How do I even become a PI after residency? to my understanding (from reading a lot) traditional Post-doc, the one biomed PhD (only) graduates do, isn't recommended for MD-PhD (low salary, long, most post docs never become PIs) and I heard that there is a thing called research fellowship that is the recommended option for MD-PhDs. I googled it and I am still very baffled. What is Research fellowship and how is it different from regular fellowship (eg. Hematology, Rheumatology or Immunology if we are talking Internal medicine)? how do you get to such programs and how long it takes before you become a PI in the Academia?

2. Is it harder for MD-PhD to get labs of their own (compared to PhD only)? because MD-PhD doctorate is 3 years long here compared to 4.5-5.5 years long for regular PhD, and there is a long break from research until after residency (so less research experience overall).

3. I personally want to migrate to the USA when I get my MD (after internship). I understand I'll have to take the USMLE, but how likely is it for me to get matched for residency in the USA? If I know myself well enough I believe I'd like to do internal medicine residency. My understanding is that it's very challengeable for foreign students to get matched in the USA. Is it easier if I have a green card (permanent residency)?
I am definitely going to try to do electives in the USA (if possible) during the clinical years and internship.

4. I am planning to take a year off after internship and before residency (there is this something I want to do for a while that requires a year off and I can't do now because of school continuity). Is taking a year off going to significantly damage my chances of getting matched to IM residency (hopefully in the USA)?


those are my main questions.
Thanks in advance.

 

[MannyManny]

Dor DP,

All of these questions have been answered ad nauseam on SDN, but I will give you a head start on your numbered questions. Please search through individual questions here on SDN for more thorough explanations:

1. Here in the US, K08 awards are an amazing thing to have during residency to get protected research time under a mentor so you can eventually start a lower level faculty position after residency/fellowship depending on how your research and other funding goals go. Basically, it comes down to how are you going to read papers, write grants and get your residency done? There are a few PSTPs around here for that goal specifically. I recommend looking them up. There are a million different ways to skin a cat, but that is one. Research fellowship is basically someone funding you to do research (e.g. HHMI fellowships, NRSA fellowships, etc.). A clinical fellowship follows clinical residency training mainly to further subspecialize (e.g. fellowship in nephrology after your IM residency)

2. It depends. For the vast majority, it's super difficult for anyone (PhD or MD/PhD). harder for physician-scientists overall because as faculty, you'll have to rake in those RVUs for the hospital in the mean time trying to be a self-sustainable and funded researcher--the money has to come from somewhere. Straight PhDs might have some sponsored start-up money the department gives them, but usually these people fight tooth-and-nail during their post-docs to bridge themselves to a faculty position via external funding.

3. Have you considered immigrating now and doing med school in US? Even though our stable genius president is impeached, matching as an foreign medical graduate is not a trivial task. I can't understate this. FMGs have a very tough time in the match on average.

4. Maybe there's some misunderstanding here: when we say "internship" we usually mean the PGY1 year of a medical specialty (i.e. IM, neurology, derm, etc.). That is to say, intern year IS part of your residency. If that's what you mean, I am unclear what goals that would accomplish in your situation.

 

[Dor DP]

Dor DP,

All of these questions have been answered ad nauseam on SDN, but I will give you a head start on your numbered questions. Please search through individual questions here on SDN for more thorough explanations:

1. Here in the US, K08 awards are an amazing thing to have during residency to get protected research time under a mentor so you can eventually start a lower level faculty position after residency/fellowship depending on how your research and other funding goals go. Basically, it comes down to how are you going to read papers, write grants and get your residency done? There are a few PSTPs around here for that goal specifically. I recommend looking them up. There are a million different ways to skin a cat, but that is one. Research fellowship is basically someone funding you to do research (e.g. HHMI fellowships, NRSA fellowships, etc.). A clinical fellowship follows clinical residency training mainly to further subspecialize (e.g. fellowship in nephrology after your IM residency)

2. It depends. For the vast majority, it's super difficult for anyone (PhD or MD/PhD). harder for physician-scientists overall because as faculty, you'll have to rake in those RVUs for the hospital in the mean time trying to be a self-sustainable and funded researcher--the money has to come from somewhere. Straight PhDs might have some sponsored start-up money the department gives them, but usually these people fight tooth-and-nail during their post-docs to bridge themselves to a faculty position via external funding.

3. Have you considered immigrating now and doing med school in US? Even though our stable genius president is impeached, matching as an foreign medical graduate is not a trivial task. I can't understate this. FMGs have a very tough time in the match on average.

4. Maybe there's some misunderstanding here: when we say "internship" we usually mean the PGY1 year of a medical specialty (i.e. IM, neurology, derm, etc.). That is to say, intern year IS part of your residency. If that's what you mean, I am unclear what goals that would accomplish in your situation.

Here internship is the last year of Med school. You technically work as a doctor (100% clinic sometimes 26 hours shifts) but you can’t work unsupervised and you don’t have your MD yet. It’s a year that follows the 3 clinical years but it’s before you match residency.

I wish I could do MD-PhD in the USA but Getting into MSTP program in the states is going to be 100 times harder as it is funded by the NIH and I am a foreign student.
Even If I get a green card by the time I am done with my Bachelor degree (lets say I am lucky enough to win the green card lottery which I filled this year) my degree will still be from Israel and even if we are talking about a University that is ranked in the top 150 in the world (and we are) , I am pretty sure they would give me hard time.

And I am quite disappointed to see it’s harder for MD-PhD graduates to get into Academic tenure track. MSTP= medical scientist!! Where do they want us to do the science?

I am really baffled with what I should do with my life. Quite my bio bachelor And move to Medicine? Finish bachelor (and do as much research as I can) and try to apply in the USA?

I am just lost. Thank you very much for your reply. If you have some extra information I would be happy tor read.

 

[Lampstrike]

1. A traditional postdoc is fairly common among MD-PhDs who stay in research, however like you said it is generally avoided if possible. The best way to avoid it is by doing a residency that provides you with a fair bit of research time, so that you can help develop your scientific career to the point that you are competitive for faculty positions. By develop your scientific career, I mean publish papers. Doing that requires protected research time (several months within your residency where your only job is to be a scientist). Special research fellowships/PSTP programs are formal ways to get this protected research time, however most academic research hospitals will offer some form of research track for residents (especially within IM). If by the end of this residency, you are still not competitive for faculty posts (but you still want to have a research-oriented career) you would probably turn to a postdoc so that way you could get more protected research time to publish papers.

2. Getting a lab comes down to your publication record. At good MD-PhD programs, the body of work that an MD-PhD should produce to complete their PhD should equal that of a pure PhD candidate. The fact that the MD-PhD finished a bit faster is mostly irrelevant when it comes time to compete for faculty jobs. What may hurt the MD-PhD most is that their publications are likely a bit older than a fresh PhD student because the MD-PhD took a several year long break from research to finish med school and do residency. Some schools may be looking to hire faculty trained in a hot new field and that type of position will always favor the young PhD who was just in that field vs. an older MD-PhD who hasn't worked in that field for 5-6 years.

3. From what I've heard, foreign student matching to the US is very rare and very difficult. You would need to have excellent STEP scores just as a baseline. Electives in the US will certainly be helpful. I have heard that the Sackler School of Medicine in Tel Aviv offers a program that is particularly good at getting students into US residencies. You should look into it if you haven't already. Other than that, I can only say try and find mentors in the US who have taken the path that you are trying to take and get their advice on the matter. I really don't know a lot about foreign matching, so I can't much help here. Sorry.

4. I don't think that it is recommended to take a year off between med school and residency. Residency programs really want students to plug and play from their med school hospital to their residency hospital. Taking a year off in the middle would be somewhat unappealing to residency directors. If you want to take a year off, the best times would be either between undergrad and med school and after residency. Obviously, you can take a year whenever you really want, but other than those two times, it will likely cause some amount of hardship in terms of your career path. Still, if the trip really is important to you, then you should still do it.

Hope this was helpful!

 

[Dor DP]

1. A traditional postdoc is fairly common among MD-PhDs who stay in research, however like you said it is generally avoided if possible. The best way to avoid it is by doing a residency that provides you with a fair bit of research time, so that you can help develop your scientific career to the point that you are competitive for faculty positions. By develop your scientific career, I mean publish papers. Doing that requires protected research time (several months within your residency where your only job is to be a scientist). Special research fellowships/PSTP programs are formal ways to get this protected research time, however most academic research hospitals will offer some form of research track for residents (especially within IM). If by the end of this residency, you are still not competitive for faculty posts (but you still want to have a research-oriented career) you would probably turn to a postdoc so that way you could get more protected research time to publish papers.

2. Getting a lab comes down to your publication record. At good MD-PhD programs, the body of work that an MD-PhD should produce to complete their PhD should equal that of a pure PhD candidate. The fact that the MD-PhD finished a bit faster is mostly irrelevant when it comes time to compete for faculty jobs. What may hurt the MD-PhD most is that their publications are likely a bit older than a fresh PhD student because the MD-PhD took a several year long break from research to finish med school and do residency. Some schools may be looking to hire faculty trained in a hot new field and that type of position will always favor the young PhD who was just in that field vs. an older MD-PhD who hasn't worked in that field for 5-6 years.

3. From what I've heard, foreign student matching to the US is very rare and very difficult. You would need to have excellent STEP scores just as a baseline. Electives in the US will certainly be helpful. I have heard that the Sackler School of Medicine in Tel Aviv offers a program that is particularly good at getting students into US residencies. You should look into it if you haven't already. Other than that, I can only say try and find mentors in the US who have taken the path that you are trying to take and get their advice on the matter. I really don't know a lot about foreign matching, so I can't much help here. Sorry.

4. I don't think that it is recommended to take a year off between med school and residency. Residency programs really want students to plug and play from their med school hospital to their residency hospital. Taking a year off in the middle would be somewhat unappealing to residency directors. If you want to take a year off, the best times would be either between undergrad and med school and after residency. Obviously, you can take a year whenever you really want, but other than those two times, it will likely cause some amount of hardship in terms of your career path. Still, if the trip really is important to you, then you should still do it.

Hope this was helpful!

I won’t get into Sackler. Their requirements are insane.

They way I see right now is to choose between living in the USA (where research and life quality are better) and between going MD-PhD and being stuck here for the rest of my life.
It’s just cruel and apparently education doesn’t make immigration easier, if anything harder.
And I thought doctors were appreciated.
Not only you can’t do residency in the satates they won’t recognize any residency from here. Same applies for Canada or Britain.
I can’t even do MD-PhD in America.
All of my options are impossible.
I’ll see where life takes me.

 

[Dor DP]

1. A traditional postdoc is fairly common among MD-PhDs who stay in research, however like you said it is generally avoided if possible. The best way to avoid it is by doing a residency that provides you with a fair bit of research time, so that you can help develop your scientific career to the point that you are competitive for faculty positions. By develop your scientific career, I mean publish papers. Doing that requires protected research time (several months within your residency where your only job is to be a scientist). Special research fellowships/PSTP programs are formal ways to get this protected research time, however most academic research hospitals will offer some form of research track for residents (especially within IM). If by the end of this residency, you are still not competitive for faculty posts (but you still want to have a research-oriented career) you would probably turn to a postdoc so that way you could get more protected research time to publish papers.

2. Getting a lab comes down to your publication record. At good MD-PhD programs, the body of work that an MD-PhD should produce to complete their PhD should equal that of a pure PhD candidate. The fact that the MD-PhD finished a bit faster is mostly irrelevant when it comes time to compete for faculty jobs. What may hurt the MD-PhD most is that their publications are likely a bit older than a fresh PhD student because the MD-PhD took a several year long break from research to finish med school and do residency. Some schools may be looking to hire faculty trained in a hot new field and that type of position will always favor the young PhD who was just in that field vs. an older MD-PhD who hasn't worked in that field for 5-6 years.

3. From what I've heard, foreign student matching to the US is very rare and very difficult. You would need to have excellent STEP scores just as a baseline. Electives in the US will certainly be helpful. I have heard that the Sackler School of Medicine in Tel Aviv offers a program that is particularly good at getting students into US residencies. You should look into it if you haven't already. Other than that, I can only say try and find mentors in the US who have taken the path that you are trying to take and get their advice on the matter. I really don't know a lot about foreign matching, so I can't much help here. Sorry.

4. I don't think that it is recommended to take a year off between med school and residency. Residency programs really want students to plug and play from their med school hospital to their residency hospital. Taking a year off in the middle would be somewhat unappealing to residency directors. If you want to take a year off, the best times would be either between undergrad and med school and after residency. Obviously, you can take a year whenever you really want, but other than those two times, it will likely cause some amount of hardship in terms of your career path. Still, if the trip really is important to you, then you should still do it.

Hope this was helpful!

If I get a green card (so I become a tax payer permanent resident) and I apply MD-PhD.
Will I have to redo my Bachelor degree in America or they would acknowledge my biology bachelor from here?

I know that most programs require at least one year of high education (premed?) in the USA which is going
a problem because how can you study for only one year.
Would doing a Master degree in the USA satisfy this requirement?
I’m just lost.

Also programs require 4 years Bachelor degree but all degrees here (but engineering) are 3 years long (including mine) so how am I supposed to fulfill this requirement?

 

[Seihai]

You can do a postbacc (enroll as a non-degree-seeking student and take classes) to get your year's requirement of education in the US. You should do primarily premed prerequisites as it's unclear as to whether they would accept prerequisites done abroad, but every school will vary slightly on this.

 

[dl2dp2]

Your best chance is to stay in Israel, finish your MD. Come here for a PhD/postdoc, then do your boards and apply for a residency. THEN apply for grants.

There's otherwise no viable alternative. In general US MD/PhD programs don't take foreign students (i.e. students who did college elsewhere). Exceptions exist, but if you can't get into Sackler I can say you have no shot.

 

[GrosslyUnremarkable]

Hello OP, and don't worry if you don't know quite what to do yet. Sometimes it takes awhile. I got sidetracked for about 33 years myself.

One of our PIs at Wake Forest University School of Medicine (Winston-Salem NC USA) is an MD-PhD in the cancer bio department. She did both of those degrees at Cairo University and is one of our more popular instructors. I don't know if that would be possible for you but maybe you can check it out.

I'm a mere biomedical science grad student so I can't be relied on for med school pointers. Many of my classmates are from other countries, although I don't know anybody from Israel. You sound like somebody we would be glad to have here at least in the PhD track. We have very few MD-PhD slots. Keep asking around and be prepared to take longer than you think you need.

 

[Dor DP]

Your best chance is to stay in Israel, finish your MD. Come here for a PhD/postdoc, then do your boards and apply for a residency. THEN apply for grants.

There's otherwise no viable alternative. In general US MD/PhD programs don't take foreign students (i.e. students who did college elsewhere). Exceptions exist, but if you can't get into Sackler I can say you have no shot.

I have talked to people and there is actually quite a good chance (the average for IMG was 43% in 2019 but for Israelis probably more) to get matched for Internal Medicine residency, especially if you have a PhD from a lab of a well known researcher (And we have more than few of them here).
Also many doctors here told me the USMLE should be quite easy for Israeli graduates as our tests are harder.
In addition I heard from some Americans that Israeli universities have good reputation worldwide and in the USA (are always among the top 150 universities worldwide).
It's not exactly black and white, many IMG get matched every year and I believe that I would be able to match when the day comes.
I wish someone here told me that before all the stress.
Thank you.