Surgery residency and PhD

[tiedyeddog]

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I have a feeling this will go unanswered, but here goes my shot.

I am contemplating taking an MSTP acceptance my school's program just extended to me (I am an MS2). I want to go into academic medicine for absolute sure and I am almost positive I want to go into surgery, specifically neurosurgery.

Is it feasible to skip the MSTP and do a PhD during a surgical residency, or at least enough research to get a K01 funded? I love research but I am tearing myself up trying to decide if I should take this and what is best for my future career.

 

[debateg]

I know a guy who joined research as an MS3 and is very passionate about neurosurgery. He initially planned to do a one year's masters degree but stayed in lab for longer. When he realized that he was going to do 2+ years, he negotiated with the neurosurgery program to split his PhD between his current time in medical school and residency. They were super enthusiastic about attracting someone interested in science and promised him nearly guaranteed residency admission and tons of research time during residency. He stayed in lab for a year longer to get to a good stopping point in his PhD. He was gushing about all the opportunities the neurosurgery program was showering on him.

Fast forward 2 years later, and the neurosurgery program completely backed out of the deal. I'm not entirely certain the circumstances, but the guy I know is not so happy about what happened. The program frankly lied about his research prospects in residency. They told him they want him to finish his research during medical school, and he had to transfer officially into the PhD program. His PhD is now dragging out for longer than he anticipated, and the MD/PhDs who he started med school are mostly matching into residency.

I would be very wary of promises of research from neurosurgery programs. It can be done, but like other surgical specialties, it's very institution-specific, and I would try an institution which has a track record of supporting such things.

 

[Watson104]

At some point you have to spend the time doing research on the ground floor - ask any MD-only PIs to get an idea. In the MSTP, it's paid for and you do it early and you enter the rest of your medical training with a well-honed research eye. Plus, research does help for residency placement and will help you ask the right questions to identify a research-friendly program.

If you do it later (ie residency), your funding is less certain (who is paying for you to mess around in lab for 2 years? you've got no prelim data on day 1 and you're more expensive now), and your time is less protected (ie sure, a research month here and there, but a research 2 or 3 yrs? you better have an awesome department chair and a big enough department not to miss your hands in surgery). From what I understand you'll never truly be free of clinical demands once you finish the MD and depending on the location, getting real research time can be difficult and involves a lot of negotiation.

If you do get 2 yrs of dedicated research time . . . I'm sure one can pull off a K award with a year or two of prelim data and as much research experience. More likely it will require 4 yrs or so, despite your best intentions. But with the variable funding climate, I'm sure it's a lot easier to get a K award with a PhD behind your name, a publication record, an early grant or two, and 2 yrs worth of prelim data circa residency.

 

[solitude]

To add to those good points that have already been made...some things you should consider.

I am contemplating taking an MSTP acceptance my school's program just extended to me (I am an MS2). I want to go into academic medicine for absolute sure and I am almost positive I want to go into surgery, specifically neurosurgery.

I admire your zeal, but you may change your mind in MS3. Nearly everybody does, no matter how gung ho they were about a particular field.

Is it feasible to skip the MSTP and do a PhD during a surgical residency, or at least enough research to get a K01 funded? I love research but I am tearing myself up trying to decide if I should take this and what is best for my future career.

There are a few surgery programs that do this. As I understand it, they are typically in Gen Surg and not Neurosurg. Like debateg says, if the Neurosurg program does not have an established track record of doing this successfully, caveat emptor! As Watson mentioned, oftentimes the "research years" of surgery residency is a euphemism for a decreased clinical caseload along with the time to write some case reports and do a few case-control studies.

You'll notice that most community and lower academic Gen Surg programs are 5 years. Then at a few of the "top" schools the residencies are 7 years, no exceptions. Two are "research years". I have a hunch that these "research years" were added onto these programs as a way of mandating an additional two years of indentured servitude to these departments. They are now taken as indispensable at these programs. I'm skeptical. An alternative hypothesis is that the two "research years" were introduced into these programs because burn-out and all the associated issues was so high that they provide a more reasonable work-life balance to keep people from dropping out. Who knows.

Point is that it seems to me that these residents on their "research years" are very often doing relatively light research. Very, very few do hardcore basic science. Is this what you intend?

If it is not, Neuronix et al. have made a strong case here that there is no reason to get a PhD for clinical-oriented research*. And if it is, then you should think long and hard about whether a career doing both surgery and basic science is feasible. Certainly there are people who do it - and do it very well - but the vast majority do not. In a field with exceedingly long hours, exceedingly lengthy training, and exceedingly high reimbursements, the pull to do clinical medicine can be overwhelming.

Good luck.


*No pragmatic reason. Pure intellectual curiosity is not pragmatic but is a good reason, as long as you realize that from a career standpoint the PhD will likely be largely irrelevant to clinical-oriented research.

 

[tiedyeddog]

Thanks for the great replies, everyone.

It sucks how this system is set up. I have to predict more than a decade into the future what my career will be like. The amount of variables is astounding from my point of view as an MS2. Do I score well on step 1? 2?
Do I honor my clinical rotations?
Do I get into an academic residency with a strong research focus?
Do I manage to get enough research done to score a K award?
Do I get offered a spot at an institution that actually cares about my research focus, allowing me to become successful in research?
Do I have enough money to have kids and not make my wife suffer too much during this almost two decade learning extravaganza?

these are all rhetorical, I am just aggravated my future-seeing abilities aren't better than they are.

 

[solitude]

Thanks for the great replies, everyone.

It sucks how this system is set up. I have to predict more than a decade into the future what my career will be like. The amount of variables is astounding from my point of view as an MS2. Do I score well on step 1? 2?
Do I honor my clinical rotations?
Do I get into an academic residency with a strong research focus?
Do I manage to get enough research done to score a K award?
Do I get offered a spot at an institution that actually cares about my research focus, allowing me to become successful in research?
Do I have enough money to have kids and not make my wife suffer too much during this almost two decade learning extravaganza?

these are all rhetorical, I am just aggravated my future-seeing abilities aren't better than they are.

To keep your options open, I recommend doing well on Step 1 and 2, honoring as many clinical rotations as possible, and trying to match at an academic residency. At any point you can choose to jump off the train and do something less selective or academic, but you never want to limit yourself too early. As for the K award and getting a faculty job, those are so far in the future that there's no need to worry about them for now.

The more important thing now is whether to take the PhD position. Not sure how closely you've read this forum, but I would seek out a few of the lengthy threads "how to fix mstp" and so on, most of which are filled by reflections of graduating MD-PhD students. That isn't to say you shouldn't take the PhD spot, but you should think long and hard about it, especially in light of your interest in surgery, etc.

 

[tiedyeddog]

To keep your options open, I recommend doing well on Step 1 and 2, honoring as many clinical rotations as possible, and trying to match at an academic residency. At any point you can choose to jump off the train and do something less selective or academic, but you never want to limit yourself too early. As for the K award and getting a faculty job, those are so far in the future that there's no need to worry about them for now.

The more important thing now is whether to take the PhD position. Not sure how closely you've read this forum, but I would seek out a few of the lengthy threads "how to fix mstp" and so on, most of which are filled by reflections of graduating MD-PhD students. That isn't to say you shouldn't take the PhD spot, but you should think long and hard about it, especially in light of your interest in surgery, etc.

I do think the PhD would help me but I think the sacrifice is too much for me given the future unknowns. You're right, who knows how my wants will change by the time the match rolls around or even further down the road.

I guess I could always do a post-doc or a research fellowship later on to keep my options open.

 

[r1oid]

I think you have to really consider how much you love to do research. Honestly ask yourself if you are trying to convince yourself not to do the PhD (your gut says do it) vs. do the PhD (gut says don't miss the opportunity). If its to not miss out on some opportunity, then your time probably could be better spent even taking 1 year to do neurosurg specific research. It'll help your app and give you a good idea about what the work is like. A PhD is a significant endeavor you should not undertake unless you really have an enjoyment of the kind work that is done and intellectual curiosity about the subject matter. If you don't have these things the process will be a drag and you will have regrets about the time spent.