Transition from ABIM research pathway to private practice

[sallyhasanidea]

I'm currently a 4th year MD PhD student applying for IM fast track positions.

Can you directly go from ABIM research training pathway to clinical private practice after your fellowship training?

Standard pathway: 3 years IM + 3 years GI
Research pathway: 2 years IM + 1.5 years GI + 3 years research (free time)

If you just go through the research pathway and don't really care about your research output and don't take it seriously wouldn't it be just like free time to do whatever you want while avoiding an extra year of IM training? You end up with a total training time of 6 months extra but if it's research time/free time what downside is there apart from an extra 6 months of training?

At the end of the day you end up BE/BC in IM and GI, so what difference does it make? Am I missing something?

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[NotAProgDirector]

If you think that your research time in an ABIM research pathway is going to be "free time", you're in for a rude awakening.

If you don't produce adequate research output / don't put the time in required, your research mentor is likely to just drop you. You'll then not qualify for the ABIM research pathway any more, and need to complete an IM PGY-3 to continue. You'll be very lucky if your original program takes you back to do so. If not, another program may reuire you to restart at the PGY-2 level again.

So yes, you're missing something. Don't be a fool. If you don't want an 80/20 long term split research/clinical in the long term, don't even think about the research pathway.

#SallyHasABadIdea

 

[sallyhasanidea]

If you think that your research time in an ABIM research pathway is going to be "free time", you're in for a rude awakening.

If you don't produce adequate research output / don't put the time in required, your research mentor is likely to just drop you. You'll then not qualify for the ABIM research pathway any more, and need to complete an IM PGY-3 to continue. You'll be very lucky if your original program takes you back to do so. If not, another program may reuire you to restart at the PGY-2 level again.

So yes, you're missing something. Don't be a fool. If you don't want an 80/20 long term split research/clinical in the long term, don't even think about the research pathway.

#SallyHasABadIdea

So I thought you get board certified in internal medicine anyway after doing your PGY3 year regardless of if it is in IM or subspecialty (you sit for IM boards as PGY4 in August), wouldn't this leave open all IM pathways hospitalist/PCP? I.e. for example if you get kicked out of fellowship your 5th year wouldn't you still be able to work as a hospitalist because you're already IM boarded? Would you need to go back and complete another year of IM residency after getting IM board certified?

So looking at the website: Internal Medicine Policies | ABIM.org

"In addition, training as a subspecialty fellow cannot be credited toward fulfilling the internal medicine training requirements." So how do ABIM research track PSTP/fast track trainees become board certified in internal medicine?

Also historically do these programs ever drop fellows for not working? Just looking at research profiles of T32 fellows, many of them are not very productive at all and productivity is difficult to measure; clinical vs bench research, etc

Also, you say don't think about the research pathway if you don't want an 80/20 split; I hear stories of some fellows graduating and going to private practice, but wanted to know the logistics of this is it difficult to make that transition directly?

 

[gutonc]

I was just about to answer this question seriously, and then I realized who was posting. But here I go anyway.

So I thought you get board certified in internal medicine anyway after doing your PGY3 year regardless of if it is in IM or subspecialty (you sit for IM boards as PGY4 in August), wouldn't this leave open all IM pathways hospitalist/PCP? I.e. for example if you get kicked out of fellowship your 5th year wouldn't you still be able to work as a hospitalist because you're already IM boarded? Would you need to go back and complete another year of IM residency after getting IM board certified?

Yes

Also historically do these programs ever drop fellows for not working? Just looking at research profiles of T32 fellows, many of them are not very productive at all and productivity is difficult to measure; clinical vs bench research, etc

Yes, people get kicked out of research pathway fellowships not uncommonly for the behavior you're describing.

Also, you say don't think about the research pathway if you don't want an 80/20 split; I hear stories of some fellows graduating and going to private practice, but wanted to know the logistics of this is it difficult to make that transition directly?

If you're planning to do PP, knowing that the research pathway is as long, if not longer, than the "standard" pathway, why would you bother to do it?

Is it possible go into community/private practice after the research pathway? Yes. Should you enter the pathway if your plan from the beginning is just to do that? No.

 

[sallyhasanidea]

I was just about to answer this question seriously, and then I realized who was posting. But here I go anyway.


Yes

Yes, people get kicked out of research pathway fellowships not uncommonly for the behavior you're describing.

If you're planning to do PP, knowing that the research pathway is as long, if not longer, than the "standard" pathway, why would you bother to do it?

Is it possible go into community/private practice after the research pathway? Yes. Should you enter the pathway if your plan from the beginning is just to do that? No.

Thanks for the reply - For the first yes, which question is it referring to? I.e. for example if you get kicked out of fellowship your 5th year wouldn't you still be able to work as a hospitalist because you're already IM boarded? Would you need to go back and complete another year of IM residency after getting IM board certified?

I'm aiming to do something similar to what you did, reading through your posts it looks like you fast tracked and are now in community practice? But why do you recommend not going through the ABIM research pathway to do this? It looks like you get an extra 6 months of total training time but the actual training itself would be much easier hours and lifestyle wise than the clinical pathway?

Is it true that after finishing the ABIM research pathway you are board certified in IM and your subspecialty of interest and can work as a community hospitalist/PCP if desired as well as community subspecialist if desired? For example if I finish the GI research pathway I would become board certified in both IM and GI? If 10 years down the line colonoscopy reimbursement for GI goes down, can I still practice as a hospitalist?

Maybe the argument may be more clinical experience prior to community practice, but it seems like a lot of the clinical training is unnecessary. And the total amount of subspecialty training for fellows remains the same regardless of standard pathway or research pathway. Especially for GI, maybe I'm missing something but do we really need to train for 3 years if our goal is to do outpatient screening colonoscopies all day long? There are several posts on this forum of attendings with the same thought process

 

[Osteoth]

I was just about to answer this question seriously, and then I realized who was posting. But here I go anyway.


Yes

Yes, people get kicked out of research pathway fellowships not uncommonly for the behavior you're describing.

If you're planning to do PP, knowing that the research pathway is as long, if not longer, than the "standard" pathway, why would you bother to do it?

Is it possible go into community/private practice after the research pathway? Yes. Should you enter the pathway if your plan from the beginning is just to do that? No.

So you don’t have to apply to fellowship and can stay at one institution for the whole time. It’s like applying GI with all the people applying surgical subsspecialty, you’re “done” with the rat race, and maybe you like research better than wards.

 

[NotAProgDirector]

Seeing gutonc's reply, I searched your post history. You're very clear that your plan is to make as much money as quickly as possible. Which is totally fine with me, although it's not the route I chose (or would choose if I had to choose again).

You seem to be the kind of person who just wants the cold, hard truth. So here it is:

Using the research pathway as some sort of shortcut to $$$ is insane and an incredibly bad idea. The research pathway is longer than standard training, and the best way to $$$$ is to get working with a full salary as quickly as possible. No, you will not be allowed to moonlight for lots of $$$$ during your research time -- if you try to do this you will get fired from the program for lack of productivity. And if you get fired, there's no guarantee that the clinical fellowship will continue your training -- so you might lose all specialty qualifications.

The ABIM is very clear on what happens if you drop out of the research pathway: Research Pathway Policies and Requirements | ABIM.org Last question on the page:

If you're tossed early enough, you'll need to make up the missed time which will likely be LONGER than traiditional training anyway. And that's if your fellowship doesn't just drop you in disgust, at which point you won't be able to bill for those colonoscopies any more and would have been better off just completing IM.

And last, all the research pathway does is short circuit your PGY-3 in IM for 1.5-2 research years. And the PGY-3 in IM is usually at least 50% elective anyway. During which time you could moonlight like crazy and start making your million.

So, you're a complete idiot for considering the research pathway based upon what you've told us here. You'll end up financially ahead with the traditional schedule, and risk having your career implode if you half ass your research time in a research pathway.

But, you do you.

 

[gutonc]

Using the research pathway as some sort of shortcut to $$$ is insane and an incredibly bad idea. The research pathway is longer than standard training, and the best way to $$$$ is to get working with a full salary as quickly as possible. No, you will not be allowed to moonlight for lots of $$$$ during your research time -- if you try to do this you will get fired from the program for lack of productivity. And if you get fired, there's no guarantee that the clinical fellowship will continue your training -- so you might lose all specialty qualifications.

Just to comment on this: during my own time in the research pathway, I saw 4 fellows in 3 different programs let go from the research pathway for this specific reason. 2 of them were in cardiology and basically spent every night they weren't taking cards call moonlighting wherever they could. Both were removed from the fellowship program completely, offered the opportunity to complete their PGY3 IM year (one took it, the other left) and cards stopped supporting the research pathway because of this.

The other 2 were PCCM (just finished enough clinical time to get IM/CCM) and Hem/onc (went back and did essentially another first year of fellowship as a PGY6 and left with IM/Onc).

 

[AlbinoHawk DO]

You really think you're the first to think of gaming the system? Come on. Just accept there's no shortcuts in medicine

 

[Scottish Chap]

I'm currently a 4th year MD PhD student applying for IM fast track positions.

Can you directly go from ABIM research training pathway to clinical private practice after your fellowship training?

Standard pathway: 3 years IM + 3 years GI
Research pathway: 2 years IM + 1.5 years GI + 3 years research (free time)

If you just go through the research pathway and don't really care about your research output and don't take it seriously wouldn't it be just like free time to do whatever you want while avoiding an extra year of IM training? You end up with a total training time of 6 months extra but if it's research time/free time what downside is there apart from an extra 6 months of training?

At the end of the day you end up BE/BC in IM and GI, so what difference does it make? Am I missing something?

This is a terrible idea.

People I know have gone into private practice, yes, after the ABIM research pathway usually because they discover a career as a physician scientist is not for them, or they are not supported by their institution at the end, or they cannot win a career development grant.

There is something to be said for actually immersing yourself in clinical work if that is what you intend to do. Just as it is way harder (though not impossible) to forge a career as an investigator without extra time learning how to do it, you effectively are short changing yourself, and you will be at a significant disadvantage than your pure clinical peers at securing a high end clinical job.

You will also be way less prepared for your board exams and you will be sitting the medicine exam AT LEAST one year later than your peers who do a categorical IM residency.

Don't do it.

 

[dozitgetchahi]

Just to comment on this: during my own time in the research pathway, I saw 4 fellows in 3 different programs let go from the research pathway for this specific reason. 2 of them were in cardiology and basically spent every night they weren't taking cards call moonlighting wherever they could. Both were removed from the fellowship program completely, offered the opportunity to complete their PGY3 IM year (one took it, the other left) and cards stopped supporting the research pathway because of this.

The other 2 were PCCM (just finished enough clinical time to get IM/CCM) and Hem/onc (went back and did essentially another first year of fellowship as a PGY6 and left with IM/Onc).

Can confirm. At my IM program, there was a cards research fellow who was doing exactly this…he was moonlighting as a VA hospitalist as much as humanly possible, and it was well known among the residents that whenever he was on he basically just fell asleep in the call room and did nothing for his patients. So one lovely summer night, I was covering the VA residents’ services overnight while he was “covering” the hospitalist service. Long story short, he fell dead asleep as usual, ignoring all pages - and I coded one of his patients and then promptly had to admit several of his new patients that night (on top of those coming to my service) because the ER was overflowing and he was AWOL. My chief, PD, and dept chair became aware of this, and he lost his research position, was banned from moonlighting, and came very close to getting fired as a cardiology fellow.