Taking a year off after IM residency before fellowship?

[nope80]

How hard is it to get a research position (paid) after residency before fellowship, for one year? I know that funding has been cut back quite a bit in research labs and am wondering how many people get paid positions after residency to do research for one year. How about working part time as a hospitalist (so that one could spend the other time doing research)? Any help would be appreciated🙂🙂

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[dragonfly99]

I think the issue with most research gigs is that they usually want you to stay for 2-3 years, if it is in someone else's lab, which is usually the case. It can be hard to find a research gig for just 1 year.
If you really want to do something like that, maybe check the NIH web site and see if there are any special 1-year programs?

 

[nope80]

Can we bump this thread to get more replies?

I'm wondering in all honesty how much taking time off between IM residency and fellowship will hurt my application? The only reason i would take off is for personal reasons (family) but I would try to make it a productive time by doing research. I have heard that they prefer if people go direct - how true is this?? Any insight on this issue would be really helpful.

 

[HoldTheCoffee]

I'm still just a medical student but this sounds like potentially a bad idea, at least if you are planning on 100% research. At the very least, you should probably still be seeing patients part-time because even the most academic/research-heavy fellowships will have some expectation that you participate in patient care.

 

[nope80]

Yeah I completely agree. But lets say I did part time clinic work with the research. Is the concept in general of taking time off looked unfavorably or is it okay? I have heard that its kind of not a good idea but I want to confirm or disfirm this.

 

[gutonc]

Yeah I completely agree. But lets say I did part time clinic work with the research. Is the concept in general of taking time off looked unfavorably or is it okay? I have heard that its kind of not a good idea but I want to confirm or disfirm this.

I have changed my opinion on this during the past application season.

I used to think, based on the number of my colleagues who I saw doing and still matching, that it wasn't a big deal.

This year, I was part of my former fellowship program's application committee and I have to say that I was kind of shocked to hear my (older, established) colleagues summarily dismiss otherwise excellent (IMHO) candidates because they had taken a year to be a hospitalist or do a BMT or pall care fellowship. In their minds, the only reason someone would do this was because they failed to match the first time around. Taking a year off to do research (in the one instance that we reviewed as a group) was well received, however this person got 4 first author papers out of the year so that's probably an outlier.

Chief residents of course are excluded from this bias.

Bottom line...if you can avoid it, don't wait a year. If you fail to match and have to find something else to do for a year, expect that your stock will be lower and you'll be less likely to match as well as you would the year before.

I don't agree with, or condone this attitude, and I'm sure it's not universal...but you need to be aware of it.

 

[nope80]

Thanks for the reply! Thats really helpful to know. I have indirectly heard people make comments hear and there like this but I wasn't sure if this thought was set in stone. Any other comments on this?

The only reason I would take off is for family reasons (maybe to have a baby) but more so to establish connections in a particular geographic region, that I am currently not part of, so I would have a better chance for fellowship. I guess maybe its a different story when you are trying to target a particular area but I don't want to wait a yr or two and be brandished because of it.

 

[nope80]

bump

 

[Syncity]

bump

I'm also interested in this.

If anyone has any input into the best time to take a PhD also, this would be greatly appreciated, i.e. before, during or after Fellowship? I don't mean to hijack the initial thread, but if anyone could also comment on this, I'd greatly appreciate it.

 

[gutonc]

I'm also interested in this.

If anyone has any input into the best time to take a PhD also, this would be greatly appreciated, i.e. before, during or after Fellowship? I don't mean to hijack the initial thread, but if anyone could also comment on this, I'd greatly appreciate it.

Between M2 and M3.

 

[Syncity]

Between M2 and M3.

I did an MSc between M2 and M3 - wasn't thinking ahead to PhD and didn't really decide until that year that I'd like to do one. Regrettable that I didn't just do one at that point. Do you realistically see any other opportunity to get one done? Appreciate the input.

 

[gutonc]

I did an MSc between M2 and M3 - wasn't thinking ahead to PhD and didn't really decide until that year that I'd like to do one. Regrettable that I didn't just do one at that point. Do you realistically see any other opportunity to get one done? Appreciate the input.

If you do a ABIM research pathway residency/fellowship you could tack on 2-3 extra years and get one...it will make your residency/fellowship 8-9 years though.

Why do you want/need one?

 

[Syncity]

If you do a ABIM research pathway residency/fellowship you could tack on 2-3 extra years and get one...it will make your residency/fellowship 8-9 years though.

Why do you want/need one?

The biggest reason is to tick a box in the list of things I want to do in my lifetime.

The second biggest reason is to move one step closer to being like my hero, gutonc.

 

[gutonc]

The biggest reason is to tick a box in the list of things I want to do in my lifetime.

Dumb. Get a puppy.

The second biggest reason is to move one step closer to being like my hero, gutonc.

That's an even worse idea.

 

[nope80]

i've heard a lot of people say for admissions purposes its better to go direct but i definitely know of a handful of people that took a year off. I would love to be able to take a year off, a nice little break, maybe start the family and use the time to work/do research but don't want to do anything that will hurt my chances in such a competitive market. I still don't have a clear sense on this.

 

[IMvrach]

I can understand why a gap before residency would be undesirable, as it likely means a year away from clinical practice. But with a fellowship, even if one did not match, why do you care about the gap and don't review the app, if he is otherwise an excellent candidate and spent this year/s doing something relevant? And there are many legitimate reasons for not applying straight after the residency, besides failing to match (such as waiting for a Green Card to be allowed to apply, which looks like a Catch 22 on the West Coast.)

In their minds, the only reason someone would do this was because they failed to match the first time around. Taking a year off to do research (in the one instance that we reviewed as a group) was well received, however this person got 4 first author papers out of the year so that's probably an outlier.

 

[Instatewaiter]

I can understand why a gap before residency would be undesirable, as it likely means a year away from clinical practice. But with a fellowship, even if one did not match, why do you care about the gap and don't review the app, if he is otherwise an excellent candidate and spent this year/s doing something relevant? And there are many legitimate reasons for not applying straight after the residency, besides failing to match (such as waiting for a Green Card to be allowed to apply, which looks like a Catch 22 on the West Coast.)

I think that's the point Gutonc was trying to make. He was surprised that others were looking at a gap year with disdain. So while it may seem innocuous, it is often not viewed favorably. Unfortunately in residency and fellowship applications negative things hurt a lot more than favorable things help

 

[IMvrach]

I understand this was Gutonc's point and I'm curious what was their explanation. I don't know their statistics, but I don't think those with gap make a large fraction of their pool to make reviewing their applications unmanageable.

The argument would probably be "we have enough applicants for 3 positions", but there is (seems to me) a very strong counterargument: those who took a gap, have more clinical and research experience under the belt. And this is something that can be easily inferred from their application, before the decision to interview them or not.

I think that's the point Gutonc was trying to make. He was surprised that others were looking at a gap year with disdain. So while it may seem innocuous, it is often not viewed favorably. Unfortunately in residency and fellowship applications negative things hurt a lot more than favorable things help

 

[gutonc]

I understand this was Gutonc's point and I'm curious what was their explanation. I don't know their statistics, but I don't think those with gap make a large fraction of their pool to make reviewing their applications unmanageable.

The argument would probably be "we have enough applicants for 3 positions", but there is (seems to me) a very strong counterargument: those who took a gap, have more clinical and research experience under the belt. And this is something that can be easily inferred from their application, before the decision to interview them or not.

Their argument was "we have tenure and endowed chairs, you can either follow our rules or you can go f**k yourselves." Ignore this (bulls**t) attitude at your own peril.

 

[Syncity]

Their argument was "we have tenure and endowed chairs, you can either follow our rules or you can go f**k yourselves." Ignore this (bulls**t) attitude at your own peril.

Maybe if the applicant was first author on a paper published in a journal with an impact factor > 18 they wouldn't have been so quick to judge!

 

[IMvrach]

Programs frequently make hard to comprehend admission policies and then adhere to them without exceptions, to maintain "purity of the match". As GutOnc says, ignore this attitude at your own peril.

Maybe if the applicant was first author on a paper published in a journal with an impact factor > 18 they wouldn't have been so quick to judge!

 

[nope80]

hmmmmm....are most places like this?? Logically I think there is a lot of value to a year of research or a year of working as an attending. And I would love a little break but I don't want to engage in irreversible harm...

 

[mercaptovizadeh]

Their argument was "we have tenure and endowed chairs, you can either follow our rules or you can go f**k yourselves." Ignore this (bulls**t) attitude at your own peril.

Just goes to show that medicine is full of narrowminded fools.

Seriously, pump out all the training you want, you can always choose to practice general IM or do research after the fellowship, if you find you enjoy it equally or more.

 

[gutonc]

hmmmmm....are most places like this?? Logically I think there is a lot of value to a year of research or a year of working as an attending. And I would love a little break but I don't want to engage in irreversible harm...

I have no idea. This is an N of 1. As I've pointed out, I think it's a completely ridiculous attitude but nobody really asked me what I thought (although I offered my opinion).

There is, frankly (from the side of the program hiring you at least), almost no value to a year of research or working as a hospitalist/PCP. You might think there is, but you're wrong. Those people are harder to deal with than the fresh grads.

I'm not arguing that it wouldn't be nice for you (you either work a lot less or make a lot more money, both of which are nice) but unless you score a first author NEJM/Nature/Cell paper or a K99/R00 out of the experience, it means nothing to your fellowship program.

 

[jdh71]

That's an even worse idea.

Agreed.

I mean I understand the impetus. Who wouldn't want to be that smart, that clinically gifted, to have that hair and THOSE abs . . .

But people gotta understand you can't just be gutonc. It took 100's of 1000's of years of evolution to produce just ONE gutonc, and according to the governmental studies, he's apparently the only human being capable of handling that much awesome in one place without spontaneously combusting (oddly enough it also allows him to consume enormous amounts of jello without going into liver failure; the science isn't sure yet what survival or selection advantage this is yet, but it is speculated that the gutonc genome is actually prescient on a level unheard of and is preparing for a mad-max style zombie apocalypse scenario where, apparently, there is a lot of jello and not much else . . . at least that what the computer models say . . .)

So basically what I'm saying is that you shouldn't want to be gutonc because this is a contradiction is many terms as well as unselfpreservating.

 

[gutonc]

Agreed.

I mean I understand the impetus. Who wouldn't want to be that smart, that clinically gifted, to have hair and THOSE abs . . .

But people gotta understand you can't just be gutonc. It took 100's of 1000's of years of evolution to produce just ONE gutonc, and according to the governmental studies, he's apparently the only human being capable of handling that much awesome in one place without spontaneously combusting (oddly enough it also allows him to consume enormous amounts of jello without going into liver failure; the science isn't sure yet what survival or selection advantage this is yet, but it is speculated that the gutonc genome is actually prescient on a level unheard of and is preparing for a mad-max style zombie apocalypse scenario where, apparently, there is a lot of jello and not much else . . . at least that what the computer models say . . .)

So basically what I'm saying is that you shouldn't want to be gutonc because this is a contradiction is many terms as well as unselfpreservating.

QFT.

In case jdh sobers up and deletes this.

 

[jdh71]

Can you still find your way back into a clinical fellowship somewhere following a "year off"? Probably, assuming you don't suck.

Can you find a top academic fellowship spot with a gap year? No.

Those of you who imagine yourself getting enough research nuts done in a year to make any kind of difference in anything are stupid, foolish, or ignorant.

Also, no one cares if you spend a year admitting gomers and finding them nursing home placement.

Suck it up. Like the rest of us, and just do it, if you really want it. If you're not willing to either do a chief year or start right out of residency, you probably don't really want it badly enough.

 

[IMvrach]

For the program the gap is another year based on which to judge an applicant. Besides, the point was not just that the year/s off bring huge benefit to the program, but that it's something that should be considered rather neutral.

But the reasoning that recent grads are easier to manage provides at least some explanation. Not that I agree with it, but still it's better than "This is how I want it and who the f..k are you to question me".

I have no idea. This is an N of 1. As I've pointed out, I think it's a completely ridiculous attitude but nobody really asked me what I thought (although I offered my opinion).

There is, frankly (from the side of the program hiring you at least), almost no value to a year of research or working as a hospitalist/PCP. You might think there is, but you're wrong. Those people are harder to deal with than the fresh grads.

I'm not arguing that it wouldn't be nice for you (you either work a lot less or make a lot more money, both of which are nice) but unless you score a first author NEJM/Nature/Cell paper or a K99/R00 out of the experience, it means nothing to your fellowship program.

 

[nope80]

I'm going to be making a mandatory move and need to match into a certain geographic area..was hoping that the year off would allow me to build connections in that area.

 

[gutonc]

I'm going to be making a mandatory move and need to match into a certain geographic area..was hoping that the year off would allow me to build connections in that area.

Connections aren't as big of a deal as you think they are. The top 15 people on our rank list this year had no connections (personal, professional, geographic) to our program. They were ranked highly because they were good candidates. There were two candidates who had gone out of their way to "make connections" at our program but were otherwise poor candidates. They were at the bottom of our list.

Make yourself a good candidate. The end.

 

[Bostonredsox]

Is this universal of all fellowships? I took a job as the Critical care hospitalist at my current communtiy shop for 3 years. Was hoping at the end of those 3 if everything is going well financially and with homelife to apply and squeeze in a 2 year pure CC fellowship so I can get more advanced training and actually be boarded in the field that I will have been practicing for the past 3 years. While I didnt think running a Community MICU for 3 years wwill be a huge plus on my fellowship app such as say a few first authors in CHEST, I surely did not think it would HURT saying I have 3 years experieince practicing as an attending running a 20 bed community hosptial MICU. From what I am reading from you guys, it seems I am wrong...

 

[nope80]

can we talk about exactly making one a good candidate? I know it sounds basic but what exactly were the traits those candidates had that you called them strong candidates?

One of my biggest hangups right now is my research - wish I had more of it. It takes time to publish and by the time this july comes around i wouldn't have made the type of progress I hoped for...

 

[C5toC9]

Is this universal of all fellowships? I took a job as the Critical care hospitalist at my current communtiy shop for 3 years. Was hoping at the end of those 3 if everything is going well financially and with homelife to apply and squeeze in a 2 year pure CC fellowship so I can get more advanced training and actually be boarded in the field that I will have been practicing for the past 3 years. While I didnt think running a Community MICU for 3 years wwill be a huge plus on my fellowship app such as say a few first authors in CHEST, I surely did not think it would HURT saying I have 3 years experieince practicing as an attending running a 20 bed community hosptial MICU. From what I am reading from you guys, it seems I am wrong...

As a critical care hospitalist, are you essentially a critical care attending? What is the difference in scope between CC hospitalist vs CC-boarded staff?

 

[Bostonredsox]

As a critical care hospitalist, are you essentially a critical care attending? What is the difference in scope between CC hospitalist vs CC-boarded staff?

the level of care is different. I am at a community shop with often less ill patients. No transplant patients, no trauma pts, no neurosurg patients. I dont have all the same resources. I also cant bronch, but after a 2 year CC only fellowship I probably still wont be able to bronch and thats ok there are some pulm guys around who are semi retired who come and do the bronchs here. If I want to stay here, and they dont hire a replacment boarded CC doc, my scope and job are the same, just a bit less intensive, no pun intended, as our capabilities are less (no ECMO, no HFOV, No CRT though that should change soon hopefully) But I will never be able to get a job at a larger academic instituion without the boards.

 

[gutonc]

can we talk about exactly making one a good candidate? I know it sounds basic but what exactly were the traits those candidates had that you called them strong candidates?

One of my biggest hangups right now is my research - wish I had more of it. It takes time to publish and by the time this july comes around i wouldn't have made the type of progress I hoped for...

Research is important but don't get super hung up on the publication issue. If you have a good project going and can get your research supervisor to write you a good letter, that's pretty good. Sure, pubs are nice but you're correct, they take time.

Honestly? Get good LORs. Improve on your Step 3 from 1/2. Be likable. Have a good answer for "why this specialty/program?"

 

[nope80]

Research is important but don't get super hung up on the publication issue. If you have a good project going and can get your research supervisor to write you a good letter, that's pretty good. Sure, pubs are nice but you're correct, they take time.

Honestly? Get good LORs. Improve on your Step 3 from 1/2. Be likable. Have a good answer for "why this specialty/program?"

Interesting, so if I apply in July I will have two outstanding projects. Hopefully this will be acceptable and they will "count" those two projects? I did fine on step 3, a little above average so I don't think will help or hurt me.
In terms of recs, how many will I need from the subsp I am applying to? Also does the title if person writing rec matter??

 

[Syncity]

If you do a ABIM research pathway residency/fellowship you could tack on 2-3 extra years and get one...it will make your residency/fellowship 8-9 years though.

Why do you want/need one?

Gutonc, would you know which programs offer this ABIM research pathway? Are they extremely competitive? Thanks in advance.

 

[gutonc]

Gutonc, would you know which programs offer this ABIM research pathway? Are they extremely competitive? Thanks in advance.

Most true academic programs either have it as a defined pathway or support it. Some are more supportive than others. You have to do your own homework on this one. Look on the website and if you don't find the answer, hit the "contact us" button and ask.

Some are competitive, others less so. In general, if you're competitive for that particular IM program, and you have the research background, you'll be competitive for the research pathway spots.

If you're asking about which programs would potentially let you complete a PhD, that's a different question and will vary widely. Obviously it would have to be a place that already had a PhD program in place as well as adequate funding (training grants, well funded PI, etc). You might also have to deal with getting paid as a grad student for that period of time which would be a roughly 50-60% pay cut from your fellowship pay.

 

[Syncity]

Most true academic programs either have it as a defined pathway or support it. Some are more supportive than others. You have to do your own homework on this one. Look on the website and if you don't find the answer, hit the "contact us" button and ask.

Some are competitive, others less so. In general, if you're competitive for that particular IM program, and you have the research background, you'll be competitive for the research pathway spots.

If you're asking about which programs would potentially let you complete a PhD, that's a different question and will vary widely. Obviously it would have to be a place that already had a PhD program in place as well as adequate funding (training grants, well funded PI, etc). You might also have to deal with getting paid as a grad student for that period of time which would be a roughly 50-60% pay cut from your fellowship pay.

Thanks a mil gutonc - you're the man!

I'll get on top of this in the coming weeks and hopefully will be able to find something. Thanks again for the info.

 

[VentdependenT]

Is this universal of all fellowships? I took a job as the Critical care hospitalist at my current communtiy shop for 3 years. Was hoping at the end of those 3 if everything is going well financially and with homelife to apply and squeeze in a 2 year pure CC fellowship so I can get more advanced training and actually be boarded in the field that I will have been practicing for the past 3 years. While I didnt think running a Community MICU for 3 years wwill be a huge plus on my fellowship app such as say a few first authors in CHEST, I surely did not think it would HURT saying I have 3 years experieince practicing as an attending running a 20 bed community hosptial MICU. From what I am reading from you guys, it seems I am wrong...

I did ZERO research.

 

[Bostonredsox]

I did ZERO research.

I didn't do a full gas residency before IM 😛

 

[redy]

the level of care is different. I am at a community shop with often less ill patients. No transplant patients, no trauma pts, no neurosurg patients. I dont have all the same resources. I also cant bronch, but after a 2 year CC only fellowship I probably still wont be able to bronch and thats ok there are some pulm guys around who are semi retired who come and do the bronchs here. If I want to stay here, and they dont hire a replacment boarded CC doc, my scope and job are the same, just a bit less intensive, no pun intended, as our capabilities are less (no ECMO, no HFOV, No CRT though that should change soon hopefully) But I will never be able to get a job at a larger academic instituion without the boards.

The one possible reason why it would hurt you or to put it another way a perceived negative of your application for CC will be that you have worked in the CC by yourself for 3 years and so will be set in your ways.So will you be willing to change your ways of working/dealing with things. Will you be flexible enough? I am not so sure I know how to address that concern (if it is a concern at all).

Having said that CC is not too competitive. But thats now. Who knows how its going to be in 3 years?

 

[VentdependenT]

I didn't do a full gas residency before IM 😛

Boh!

Dude youll be fine. It aint GI

Plus you talk the talk AND walk the walk!

Shieaut, Id want you as a co-fellow NOW damn it

 

[machomed]

Does a chief year help an application?

 

[gutonc]

Does a chief year help an application?

Usually.

 

[jdh71]

Does a chief year help an application?

I would go so far as to say almost always

 

[jdh71]

This thread is full of a bunch of too much whiney nonsense. Of course it's not fair. It is what it is.

You want to get into endo, or rheum, or renal, or pulm crit and want to take a year off, I think you'll still find fellowship, but not at Penn or UW or UCSF, etc. You've taken the top academic spots off of your list effectively taking a year off. Which may or may not be a big deal. Though it is also at the bigger academic places where they will being seeing the weirder cases and using the newest cutting edge therapies and doing the newest procedural stuff.

You want to get into cards, GI, or Heme/onc? You've probably given your career a death sentence as far as fellowship is involved taking a year off. Can I say unequivocally you won't find a spot somewhere, anywhere? No. Maybe you have a family member in the division somewhere? Maybe it's an odd year. Maybe a spot opens up and they know you as opposed to an unknown? Maybe, maybe, maybe. But if we're going to wager $100, I know where I'm putting my money.

 

[kjamess]

This thread is full of a bunch of too much whiney nonsense. Of course it's not fair. It is what it is.

You want to get into endo, or rheum, or renal, or pulm crit and want to take a year off, I think you'll still find fellowship, but not at Penn or UW or UCSF, etc. You've taken the top academic spots off of your list effectively taking a year off. Which may or may not be a big deal. Though it is also at the bigger academic places where they will being seeing the weirder cases and using the newest cutting edge therapies and doing the newest procedural stuff.

You want to get into cards, GI, or Heme/onc? You've probably given your career a death sentence as far as fellowship is involved taking a year off. Can I say unequivocally you won't find a spot somewhere, anywhere? No. Maybe you have a family member in the division somewhere? Maybe it's an odd year. Maybe a spot opens up and they know you as opposed to an unknown? Maybe, maybe, maybe. But if we're going to wager $100, I know where I'm putting my money.

That's interesting, I wasn't aware that time off would be a big problem. I know a couple guys who did a year as hospitalists, and one matched at MSKCC for heme/onc and the other at a mid-tier cards program. Neither were chief residents, but to be fair they came from great IM residencies.

 

[jdh71]

That's interesting, I wasn't aware that time off would be a big problem. I know a couple guys who did a year as hospitalists, and one matched at MSKCC for heme/onc and the other at a mid-tier cards program. Neither were chief residents, but to be fair they came from great IM residencies.

you roll your dice as you see fit . . .

 

[IMvrach]

Is there a difference in perception between staying for a year as a Chief Resident and staying for a year in the same hospital where one did residency as a "junior attending"?