To complete residency or not?

[docdoc17]

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Okay, so I was one of the unfortunate souls that did a full GMO tour for the Army. Completed internship and then went straight into a general practitioner position. Initially my intent was to complete an Army residency; however, that didn't work out and I just completed my military obligation.

Thankfully I landed a state job that pays decent and is very, very flexible. So flexible in fact that I am also able to pickup about 8-12 hours extra each week at a clinic I did some temporary locums work with. I have a good relationship with this clinic and they don't care that I am not board certified or board eligible.

My whole intent was to work for 1-2 years to build up some cash reserves then start residency (likely IM). The question now though is, is it worth it to complete a residency? Without giving out too much information my current annual salary is right around $180k working 48-52 hours a week and taking only home call. My job is not stressful and I do enjoy primary care.

So with that little bit of information, any opinions? I would be doing residency for the extra knowledge and expertise. I already know how to manage patients and be a good physician. I don't need residency to teach me the intricacies of primary care. It is partly a pride thing and knowing that having that board certification allows me more opportunites in the future if I decied I wanted to change my career.

 

[ThoracicGuy]

Okay, so I was one of the unfortunate souls that did a full GMO tour for the Army. Completed internship and then went straight into a general practitioner position. Initially my intent was to complete an Army residency; however, that didn't work out and I just completed my military obligation.

Thankfully I landed a state job that pays decent and is very, very flexible. So flexible in fact that I am also able to pickup about 8-12 hours extra each week at a clinic I did some temporary locums work with. I have a good relationship with this clinic and they don't care that I am not board certified or board eligible.

My whole intent was to work for 1-2 years to build up some cash reserves then start residency (likely IM). The question now though is, is it worth it to complete a residency? Without giving out too much information my current annual salary is right around $180k working 48-52 hours a week and taking only home call. My job is not stressful and I do enjoy primary care.

So with that little bit of information, any opinions? I would be doing residency for the extra knowledge and expertise. I already know how to manage patients and be a good physician. I don't need residency to teach me the intricacies of primary care. It is partly a pride thing and knowing that having that board certification allows me more opportunites in the future if I decied I wanted to change my career.

The longer you are out from medical school, the harder it will be to get a residency spot. Yes, that is a reasonable salary right now, but how stable is that job. If you end up losing it for some reason, what are your options for other jobs? Most will want you to be BC/BE.

I wouldn't be so sure about yourself not needing training to teach you the intricacies of primary care. You don't know what you don't know.

As you said yourself, completing a residency and getting certified gives you much more in the way of opportunities in the future. If you don't want to try IM, you could consider Occupational Medicine training. Your job opportunities wouldn't be as wide as IM, but it would be something to consider.

 

[docdoc17]

Well written and to the point. It actually mirrors a lot of my thoughts and concerns.

Regarding my current job and its stability; it is a state job and thus is inherently stable. Am I guaranteed to work for them for 20 years, not really, but I would rate the stability as a 9 out of 10. All that being said, nothing is preventing me from completing residency and then starting back where I left off, but with the added benefit of being able to ask for more money 🙂

 

[DeadCactus]

You have an internship done. You can likely finish a residency in 2 years and you've already finished the most painful part of the training. You have 9 years of training invested in this career, just do the last 2 and put yourself in a much more stable and profitable position. Never underestimate life's ability to f*** you and build a safety net accordingly. One of the worst aspects of our medical training system is your complete vulnerability to whims of others from the moment you step into medical school to the moment you become board eligible, now's not the time to take a pit stop.

 

[tdram]

You have an internship done. You can likely finish a residency in 2 years and you've already finished the most painful part of the training. You have 9 years of training invested in this career, just do the last 2 and put yourself in a much more stable and profitable position. Never underestimate life's ability to f*** you and build a safety net accordingly. One of the worst aspects of our medical training system is your complete vulnerability to whims of others from the moment you step into medical school to the moment you become board eligible, now's not the time to take a pit stop.

The 9 years is a sunk cost. Really what he should be comparing is his future earning potential with and without the investment of two more years and the opportunity cost of those two years.

 

[DeadCactus]

Economics aren't everything. Spending 9 years to be a fraction of a physician and treated like one compared to 11 years to be the "real deal". There are quality of life, stability, flexibility, and personal satisfaction issues that go beyond calculating Net Present Worth of presumed income streams...

 

[tdram]

Economics aren't everything. Spending 9 years to be a fraction of a physician and treated like one compared to 11 years to be the "real deal". There are quality of life, stability, flexibility, and personal satisfaction issues that go beyond calculating Net Present Worth of presumed income streams...

It all still boils down to basic economic principles. I agree with what you advised him to do though.

 

[docdoc17]

I appreciate all the responses.

I don't expect to only have to do 2 more years of training though. Since it has been 4 years since I completed an internship I will likely have to repeat part of my internship year. Honestly this doesn't bother me all that much. The stress of residency is something I am prepared to deal with, the working hours I do not view as being all that difficult. If I can survive being thrown into a position where I supervise 4 PA's and oversee the primary care of 1800 soldiers from day one out of internship, then I can manage a few "extra" months as an intern and then 2 years to finish out residency.

 

[gutonc]

I think the most important question is: how stable really is that job? I know working for the gummint' seems pretty stable, until it's not. So what you really need to consider is whether you're willing to give up 2-3 (likely 3 full but you might get lucky) years to improve your marketability/job security or just go for it with what you've got and see what happens.

 

[SouthernSurgeon]

The other thing to consider with the government job...will you qualify for a full pension for your retirement? Because that changes the value proposition of going back to residency if you could potentially stay in your current job, retire at around age 55 and draw a guaranteed 6 figure income for life...

 

[docdoc17]

With my current job and my military service I could retire when I am 57 and my pension would be 66% of my highest salary. So yes that is something to consider. While nothing is guaranteed, I could probably get something in writing from the medical director about keeping my current position open for me. Everything is negotiable after all 🙂

 

[SouthernSurgeon]

With my current job and my military service I could retire when I am 57 and my pension would be 66% of my highest salary. So yes that is something to consider. While nothing is guaranteed, I could probably get something in writing from the medical director about keeping my current position open for me. Everything is negotiable after all 🙂

Yeah that's what I was assuming. 180K per year (plus hopefully some promotions/raises over time) for 50 hrs a week plus retirement at age 57 w/ 120K+ per year pension sounds pretty sweet to me...and I'm a diehard workaholic surgeon. Having the pension to fall back on is like having a multi-million dollar retirement savings.

 

[MedicineMan99]

At all costs, finish residency as quickly as you can. There is no more useless degree in the world than a MD or a DO without a license and board certification.

 

[docdoc17]

At all costs, finish residency as quickly as you can. There is no more useless degree in the world than a MD or a DO without a license and board certification.

I have a license, otherwise I wouldn't be able to practice on my own. I just don't have board certification.

I do agree that I need to finish a residency as soon as I can though.

 

[MedicineMan99]

I have a license, otherwise I wouldn't be able to practice on my own. I just don't have board certification.

I do agree that I need to finish a residency as soon as I can though.

What I meant was, you need to have a state license and board certification for your MD/DO to have any practical value.

Just finish your residency as soon as you can, the longer you wait, the less likely it is to happen.

 

[SouthernSurgeon]

What I meant was, you need to have a state license and board certification for your MD/DO to have any practical value.

Just finish your residency as soon as you can, the longer you wait, the less likely it is to happen.

He has a stable government job as a practicing clinician, earning close to 200K which is as much or more than many PCPs. I'd say that his MD has practical value. He's not exactly working at Walmart.

 

[MedicineMan99]

He has a stable government job as a practicing clinician, earning close to 200K which is as much or more than many PCPs. I'd say that his MD has practical value. He's not exactly working at Walmart.

For now, but no job lasts forever. If the OP ever finds himself moving, or looking for another job, he'll probably be out of work, especially in a big city. I live in Chicago for instance. And if you are a physician, unless you are board certified, you'll be working at WalMart.

 

[DeadCactus]

He has a stable government job as a practicing clinician, earning close to 200K which is as much or more than many PCPs. I'd say that his MD has practical value. He's not exactly working at Walmart.

Maybe I'm just jaded, but I would have a hard time considering my job stable when my employer is well aware that I have limited to no other job prospects. It's almost like being a resident for the rest of your career. Sure, better pay and hours, but that ever present knowledge that your employer can tank your career if you piss off the wrong person...

 

[Law2Doc]

Even if the OP never changes jobs, things can change. It wouldn't be a stretch for organizations to decide they only want BE/BC people working there, or insurers only want to cover BE/BC people. OP is also in an area that is very susceptible to midlevel encroachment - i could easily see at least his locums role going away in favor of a cheaper NP.

You walk a very dangerous path thinking you can eek out a career without being boarded.

 

[docdoc17]

All above points are legitimate. Regarding my job, it is a state position and not a very glamorous one at that. It pays well and the hours are incredibly flexible. The state won't suddenly decide they only want BE/BC people because they cannot fill all the positions they need anyway. I know things can change, but this aspect of the job will not change.

At my locums job, they already have two NP's in place and they actually needed an MD there because that is the way their hospital hierarchy is setup. I have a very good relationship with the hospital administrator and all the staff. They actually offered me a full time position paying more than $200k plus all the usual benefits. The only reason I didn't take it was due to the commute compared to my state job (20 minutes round trip versus 2 hours round trip).

Don't get me wrong, I am not "trying to get out of doing a residency". Despite being crazy busy I had a blast during my intern year and I was pretty disappointed when things didn't work out like I thought they should have with the Army. My ERAS application is pretty much done, only thing left is to contact the few doctors that will be writing LoRs for me.

I can see the pessimism in a lot of the posts and I understand it in part. Pay structure and work structure in medicine is changing and it seems like it is for the worse. I am just thankful that I was able to find my current job. Even at my locums position the medical director admitted that she was hesitant to hire me even on a temporary basis since I was not BE/BC. After me working for 2 weeks I was just having a casual conversation with her and she said that she respected my work ethic and was pleasantly surprised by my clinical expertise. That kind of caught me off-guard, but I guess that is the stereotype that non-BE/BC physicians receive.

 

[Law2Doc]

All above points are legitimate. Regarding my job, it is a state position and not a very glamorous one at that. It pays well and the hours are incredibly flexible. The state won't suddenly decide they only want BE/BC people because they cannot fill all the positions they need anyway. I know things can change, but this aspect of the job will not change.

At my locums job, they already have two NP's in place and they actually needed an MD there because that is the way their hospital hierarchy is setup. I have a very good relationship with the hospital administrator and all the staff. They actually offered me a full time position paying more than $200k plus all the usual benefits. The only reason I didn't take it was due to the commute compared to my state job (20 minutes round trip versus 2 hours round trip).

Don't get me wrong, I am not "trying to get out of doing a residency". Despite being crazy busy I had a blast during my intern year and I was pretty disappointed when things didn't work out like I thought they should have with the Army. My ERAS application is pretty much done, only thing left is to contact the few doctors that will be writing LoRs for me.

I can see the pessimism in a lot of the posts and I understand it in part. Pay structure and work structure in medicine is changing and it seems like it is for the worse. I am just thankful that I was able to find my current job. Even at my locums position the medical director admitted that she was hesitant to hire me even on a temporary basis since I was not BE/BC. After me working for 2 weeks I was just having a casual conversation with her and she said that she respected my work ethic and was pleasantly surprised by my clinical expertise. That kind of caught me off-guard, but I guess that is the stereotype that non-BE/BC physicians receive.

Everything you have described can change in an instant with tighter budgets. Your medical director and hospital administrator friends my change jobs leaving you to fend with new people who may see you as an under credentialed or too expensive option. I've seen it happen before. I know people who thought they were safe having to jump through hoops and hurdles to get certified very late in the game. They too thought they knew what the landscape would look like and that they'd still have a job. Just saying.

 

[docdoc17]

All true. Just waiting for September 15 to hit so I can officially apply to residency 🙂
I really hope me graduating from med school 5 years ago doesn't have a detrimental effect on my application.

 

[gutonc]

All true. Just waiting for September 15 to hit so I can officially apply to residency 🙂
I really hope me graduating from med school 5 years ago doesn't have a detrimental effect on my application.

It will. But there's nothing you can do about it now. Also, it's going to have less of an effect for you (having done your GMO and military duty) than it would for someone who just F'd off and worked in finance to make bank.... Apply and see what happens.

 

[Gastrapathy]

All anecdotal but I don't think it will hurt. In fact, apply for some reach programs, lots of xmil VA docs in academic depts.

 

[Law2Doc]

I know former military service is regarded as a big plus in residency applicants at the places I've been. I think you probably have a good shot if you apply broadly enough.

 

[docdoc17]

I know former military service is regarded as a big plus in residency applicants at the places I've been. I think you probably have a good shot if you apply broadly enough.

That is my plan, but can anyone give me an idea of what "broadly enough" would look like? I have read where some people are applying to 100 different programs. That seems excessive. Any thoughts?

 

[ThoracicGuy]

That is my plan, but can anyone give me an idea of what "broadly enough" would look like? I have read where some people are applying to 100 different programs. That seems excessive. Any thoughts?

The usual recommendation for someone that is a candidate with some red flags is to apply very widely. 100 programs would not be out of the question in this situation. If you are on good terms with your old intern location, you might see if you can talk to the PD and lay out your situation and see how competitive a candidate that PD feels you are. Yes, 100 programs is expensive, but its also cheaper than having to wait a year and the lost earning potential for that year.

 

[gutonc]

That is my plan, but can anyone give me an idea of what "broadly enough" would look like?

No, we can't. And not because we're being jerks about it. It's just that this scenario is rare enough that any experience with it will be anecdotal.

100 programs is a lot, but not ridiculous. Why not throw 50 apps out there and see what happens. If you get 20+ interviews, you're golden. If you don't get much love (<10 after 3 or 4 weeks of the MSPE going out) then apply to another 50.