What is the fesibility of matching years after graduating medschool?

[inep]

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I'm going to graduate next year from a highly regarded US med school. I'm currently planning on applying to a highly competitive residency as a pretty uncompetitive applicant. For various reasons, I have serious doubts about my ability to get through residency and be happy with my life. I've had a hard time with med school and have contemplated quitting at multiple times. I have a sleep disorder combined with anxiety issues and other problems.

Before med school, I started working from home and throughout med school have built this into an enjoyable and profitable business. I am seriously debating walking away from medicine after graduating and pursuing the opportunities I have created for myself with my home business. I think I would have a much more comfortable and enjoyable life at least in the short term if I did this. Obviously, the security with this form of entrepreneurship isn't there as it is in the medical field, so I could envision the possibility of being in the position in 5-10 years or so when my work dries up and I can no longer support myself.

My question is, if I have graduated with an MD, but never went further after graduation, would I still have a reasonable chance of matching into a residency position somewhere? Would I need to take USMLE step 3 after graduating to leave this door open? Realistically, how far out could I go before the door to getting a residency spot is effectively shut?

I understand that the competitive field I am intending on applying to is probably only open to me next year and it is unlikely I would ever be able to match as anything as a US senior. However, the only other field I am interested in is FM. Given the dearth of FM applicants currently, I'm hoping that this would still be an option if I were to be out of medicine for 5-10 years and want to get back into it and jump straight into a FM residency.

If I walk away, I want to make it an informed decision and need to know if I will ever be able to come back if things don't go the way they have been going and I need a 'real job.' What I think mostly is going on, is that I am burnt out and the prospect of going into a 5 year residency with so much more work and responsibility, being forced to abandon the awesome business I've built for myself, and need a year or two to relax and calm myself and think about what I want to do. Of course, doing this kills my residency chance, so realistically I think what's going to happen is that I'm going to apply and probably will not match and end up with a year off anyway.

So, what do people do who pursued options other than residency after getting the MD who want to come back years or even decades later?

 

[Ronin786]

For what its worth, I believe most states have a 7 year expiration date on your USMLE scores.

 

[inep]

For what its worth, I believe most states have a 7 year expiration date on your USMLE scores.

Hence my question about about taking step 3. I suppose you're saying I would have to re-take all of those steps 7 years out unless I did an intern year and became licensed? Am I going to have to complete an intern year to leave the option of eventual residency open?

Another thing I have thought of is completing a 3 year residency that would leave me enough time to keep my side business going and then bail after becoming BE. But I don't know what kind of residency that would be possible in. Even in FM it looks tough. PM&R perhaps. In my current choice, it's probably impossible and definitely impossible to finish a residency program and not practice and leave the option of coming back one day to practice open. It's too specialized and I'd be out of date instantly if I left.

 

[smq123]

My question is, if I have graduated with an MD, but never went further after graduation, would I still have a reasonable chance of matching into a residency position somewhere? Would I need to take USMLE step 3 after graduating to leave this door open? Realistically, how far out could I go before the door to getting a residency spot is effectively shut?

I understand that the competitive field I am intending on applying to is probably only open to me next year and it is unlikely I would ever be able to match as anything as a US senior. However, the only other field I am interested in is FM. Given the dearth of FM applicants currently, I'm hoping that this would still be an option if I were to be out of medicine for 5-10 years and want to get back into it and jump straight into a FM residency.

- You should be aware that, as Ronin pointed out, some states will not license you if there is too long a gap between Step 1 and Step 3.

- Many residency programs, including in Family Medicine, will not consider applicants who have been away from clinical medicine for several years. My own program, which was a small, pretty non-competitive community FM program, would not consider applicants who were more than 5 years out from graduation, and had not done any meaningful clinical work in the interim.

- There is a "dearth" of FM applicants CURRENTLY. Given how may US seniors went unmatched this year, though, and that the number of med students entering the match each year goes up (but they haven't added many residency spots), I would not bank on this being the case in 10 years.

If you want to take a year off, that may be fine. But decades, like you were talking about, is not at all feasible.

 

[Winged Scapula]

Echoing smq here: unless you have no desire to ever practice medicine, taking years off (let alone decades) is a mistake.

The match rate for physician candidates is low compared to 4th year students. It's ok to take time off especially in the case of competitive candidates, but a less than stellar application coupled with extensive time off is not likely to help you.

If you can, consider taking a year off while in medical school, as that becomes less of a problem for the match.

 

[Top Gun]

If you planned to take only one or two years off before applying, matching into a residency would be feasible. But if you're talking about years and years, forget it. Many residency programs have a 5-year cutoff, sometimes even a 3-year one, for good reason. The longer you are out of med school, the more your clinical skills atrophy.

 

[inep]

I think there is some confusion regarding this as a plan to come back to medicine in x number of years.

What I am interested in knowing is what are the options for somebody who graduates from a good med school in good standing with good grades and a decent performance on the usmle and pursues another career, but then decides to come back to medicine 10 or 15 years down the road? I want to clarify that when I said I was a relatively uncompetitive applicant, I meant that as for the ultra-competitive specialty I have been thus far pursuing. My step 1 and 2 scores are above average for less competitive fields.

I.e., the only red flag being that the person never applied for residency and pursued non-clinical/alternate career paths instead. It's not like I had repeats through med school, failed usmle, bad third year grades and am coming from a Caribbean program. Otherwise a solid applicant as a senior. Would this person be able to apply land a prelim position and then springboard from there into a categorical?

I fully understand that this is not a desirable position to be in, and I want to emphasize that if I go down this path, my plan is not to come back. My question is can I view my MD as a backup should my entrepreneurial endeavors fail?

I know that it is common for board certified physicians to quit medicine and pursue other career paths, namely entrepreneurial career paths or simply early retirement, and then come back years later when they run into financial trouble. What makes it different for a non-licensed, non-BE MD? Clearly the physician's skills have atrophied vs. the MD grad who never really developed his skills in the first place and has the opportunity to train anew vs. the physician who jumps straight back into practice without the luxury of a protective and educating residency program?

Hypothetically, say there is a guy right now who graduated 10 years ago in good standing and completed all 3 steps and never entered the match and has been doing other non-medical but productive things in the interim. He now, for whatever reason, wants to use his MD to pursue family medicine. What are his options to do this? If he cannot directly enter a categorical FM program, what can he do with his decade old MD? Complete a prelim year and find work once licensed? Or will prelim spots still fill crappy foreign grads or failed usmle us applicants over him?

 

[Winged Scapula]

I'm not sure we misunderstood your query.

Whether or not you plan on coming back or not, I am confident that we all agree that your chances of obtaining a training position are very slim. As noted above, many if not most programs will not take residents more than 5 years after graduation if they have not been in clinical training elsewhere.

Some states also have the same requirements for physicians who leave practice: besides CME update, they may require additional licensing examinations. This may vary from state to state.

 

[inep]

This isn't encouraging at all. It kind of sucks that I just dumped $150,000 on an MD if it's pretty much worthless unless used immediately, even in the least competitive fields.

Do things change if I complete an intern year and then walk away, or use my license to do 1 or 2 shifts a week at an urgent care type of facility while focusing on my other work full-time? Or is it still worthless unless I complete a residency?

What I am afraid of is giving up my side job which thus far has paid for my med school and provided me with a comfortable standard of living in med school working from home for about 30 hours a week, and entering residency, then washing out/burning out/failing out of residency and being left with nothing.

It's a lot easier to look forwards to the hell of residency when you have nothing else going for you and hundreds of thousands in non-forgiveable loans. For me, I have something else I enjoy that I am good at and pays very well with minimal stress, which granted may not last, but I have it for the time being. I've never been nuts about medicine in the first place and was encouraged not to quit halfway through in order to leave my options open. Now I'm finding out those options aren't there unless I complete a residency?

If I were your son, what advice would you give me? It's an incredibly unusual position to be in, and I feel like I'm in uncharted waters. I'm afraid of ending up with nothing either way I go, and the ability of being able to do both concurrently will end with the responsibilities of intern year. It would be more comforting to be able to walk away to know that I could use my MD for at least something professional years down the road (albeit not the ultra-competitive route I originally intended) instead of having to accept the possibility of being a 4.0 college grad turned MD working at wal-mart or selling cars.

Surely there is somebody out there who walked away after graduation and found a way to come back? Shotgunning every single FM program in the country wouldn't even produce a few hits?

 

[michaelrack]

Or will prelim spots still fill crappy foreign grads or failed usmle us applicants over him?

yes

 

[NotAProgDirector]

I'll add my agreement. PD's will see any long absence as either a lack of commitment to medicine, a sign that you'll bail at the first problem/issue, or a personality problem. In addition, you'll get seriously rusty in your skills, and medicine will move on without you. Even the MD/PhD's at my school that come back after 3-4+ years in the lab are seriously behind when they re-enter training, and you won't have a school supporting you. When you match into an internship, they expect you to be able to do your job (i.e. be a beginning intern) on day 1. If you arrive and look less skilled than the 3rd or 4th year student on the team, a program is unlikely to be pleased.

You are MUCH better off training now, then doing your business work (with or without continuing your practice), and then coming back to full time practice if you want -- at least if you're looking for the least risky plan. Whether this will make you happy, only you will know.

 

[smq123]

If I were your son, what advice would you give me? It's an incredibly unusual position to be in, and I feel like I'm in uncharted waters. I'm afraid of ending up with nothing either way I go, and the ability of being able to do both concurrently will end with the responsibilities of intern year. It would be more comforting to be able to walk away to know that I could use my MD for at least something professional years down the road (albeit not the ultra-competitive route I originally intended) instead of having to accept the possibility of being a 4.0 college grad turned MD working at wal-mart or selling cars.

If you were my son, I would tell you to do a residency, any residency. All you need to be is board certified (even board eligible is not enough at some places nowadays), and you have a lot more to offer than someone with an MD and no residency. Whether that means that you do Preventative Medicine or Nuclear Medicine or find the cushiest Family Medicine residency you can find, at least you will be more marketable than someone who washed out of medicine after graduation.

 

[NotAProgDirector]

I was typing while you were posting.

This isn't encouraging at all. It kind of sucks that I just dumped $150,000 on an MD if it's pretty much worthless unless used immediately, even in the least competitive fields.

Do things change if I complete an intern year and then walk away, or use my license to do 1 or 2 shifts a week at an urgent care type of facility while focusing on my other work full-time? Or is it still worthless unless I complete a residency?

This is definitely better than doing no clinical training after medical school. Still, options for physicians who are not board certified are drying up quickly -- not to mention that you might not actually be competent to do it. Many of these very simple urgent care shifts get filled with NP's and PA's.

What I am afraid of is giving up my side job which thus far has paid for my med school and provided me with a comfortable standard of living in med school working from home for about 30 hours a week, and entering residency, then washing out/burning out/failing out of residency and being left with nothing.

It's definitely a concern. I agree that running a 30hr/week business and being an intern at the same time is a great way to have your business crash, get fired as an intern, or both. Perhaps someone can help the business run while you're an intern?

It's a lot easier to look forwards to the hell of residency when you have nothing else going for you and hundreds of thousands in non-forgiveable loans. For me, I have something else I enjoy that I am good at and pays very well with minimal stress, which granted may not last, but I have it for the time being. I've never been nuts about medicine in the first place and was encouraged not to quit halfway through in order to leave my options open. Now I'm finding out those options aren't there unless I complete a residency?

Believe it or not, residency can be fun. Sure there are really long days, and really busy blocks. But being a physician is a great job for some of us. You seem to not like it, which is certainly your perogative / option. In that case, I don't think you're going to find it a good "backup" just in case. You might want to consider fields that are more shift based -- ED, or hospital medicine. Those allow much more flexibility regarding part time / decreased work load.

If I were your son, what advice would you give me? It's an incredibly unusual position to be in, and I feel like I'm in uncharted waters. I'm afraid of ending up with nothing either way I go, and the ability of being able to do both concurrently will end with the responsibilities of intern year. It would be more comforting to be able to walk away to know that I could use my MD for at least something professional years down the road (albeit not the ultra-competitive route I originally intended) instead of having to accept the possibility of being a 4.0 college grad turned MD working at wal-mart or selling cars.

Life is tough, and you need to decide which of these dreams to follow. Both could be very rewarding. Both could end with you being miserable.

Smart creative people can always find a use for their education. What you've asked is whether the standard, usual pathway will be open for you if you walk away from clinical medicine for more than 5 years. The answer to that question is "No". Can the right person, via force of will, personal salesmanship, and sheer effort overcome this? Of course. But that's not a "safe backup plan".

The safest option is to complete a residency, preferably in something that lends itself to part time work. FM isn't easy to do part time -- your patients will still get sick on your "days away", and finding partners that are willing to cover you for large swaths of time is not easy (but not impossible). Anesthesia, ED, Hospital medicine (although that tends to be 1-2 weeks of work at a stretch, not sure if that fits for you) might be a better fit.

The next safe option is to complete an internship, take Step 3, get a license, and then try to keep some clinical activity while doing your business. Again, clinical options for those without board certification are drying up.

Least safe option is to do no clinical training. Take Step 3 anyway -- get it done and passed. If too much time goes by, you may find your options very limited.

Nothing in any of these options stops you from being creative. Your business fails? Start another. Try to work in a pharmaceutical company. Or an EMR company. Etc. However, all of these positions are easier to get with full clinical training.

Surely there is somebody out there who walked away after graduation and found a way to come back? Shotgunning every single FM program in the country wouldn't even produce a few hits?

I'm sure there are. But in 5-10 years, if your business fails, will you be willing to move? Uproot any family you might have? Live in the "middle of nowhere" (not that those places aren't nice to live)? And there is a real risk that programs will pass you by for new fresh grads -- as mentioned above, it's unlikely that you'll be able to keep pace with changes in medicine while you're on the sidelines.

 

[StarbucksMD]

Might i ask, have you sought help for your "sleep disorder combined with anxiety issues"? If you can find a solution, perhaps you can find the confidence to do your training now.... This is really your best option. Also, how feasible would it be to leave your side-business while you train? I think your decision really needs to reflect your dedication to medicine.. Only you know for sure how you feel about making this your career vs something else. 5-10 years is going to limit you tremendously, not to mention the medical aptitude you will likely lose in that amount of time.

 

[inep]

I have sought help for my issues but only recently. SSRIs and stimulants have worked minimally to control my symptoms, and the field of medicine is unforgiving to things like this anyway (well, it seems unforgiving for just about anything personal with the exception of woman who want to have children). It would be better to find work in a field that allows the opportunity to periodically rest and get the sleep I need.

With regard to part time work, I thought FM had a lot of flexibility in it. Obviously it's a full-time job if you are a solo with no partners, but I was under the impression plenty of part-time opportunities were available. I'm not really interested in completing an IM residency. I hate being in the hospital, esp on the wards, and prefer outpatient clinics.

Another option, which I am not sure if possible, if it really is important to complete a residency, no matter what it's in, is to choose a residency that will give me 3 hours a night or so free to do the minimal amount of work I need to keep my business going and continue to run it through residency as I did through med school. Obviously surgical fields are out. What residencies would give me enough time to allow for this and lead somewhat of a semblance of a normal life? I feel that intern year would preclude it no matter what I did, except possibly for a TY, which is what my present path would require anyway.

 

[inep]

it's unlikely that you'll be able to keep pace with changes in medicine while you're on the sidelines.

That's what I'm not getting. As an MS-4, I haven't really been trained to do anything, and my knowledge base is more on concrete fundamentals. What are MS3s and MS4s going to be learning in 10 years that would put me behind the ball? It seems like everything is really learned on the job in residency. Either that, I'm in much worse position now than I think I am, because I don't really know anything beyond what can be learned from a few step 1 and step 2 books in a few months + the interviewing and clinical skills I picked up along the way.

 

[p30doc]

1. Do a cush FM residency.
2. Hire someone part-time to help keep the business going.
3. ????
4. Profit!

 

[smq123]

That's what I'm not getting. As an MS-4, I haven't really been trained to do anything, and my knowledge base is more on concrete fundamentals. What are MS3s and MS4s going to be learning in 10 years that would put me behind the ball? It seems like everything is really learned on the job in residency. Either that, I'm in much worse position now than I think I am, because I don't really know anything beyond what can be learned from a few step 1 and step 2 books in a few months + the interviewing and clinical skills I picked up along the way.

You know much more than you think you do. But after 10 years away from medicine, will you remember how to pick up murmurs? Will you remember how to do a basic musculoskeletal exam? Will you remember what the cranial nerves do? Will you remember what the various lab tests mean? Doubtful. Having you come back as an intern after 10 years away would be like teaching a lay person off the street how to take care of patients.

 

[Top Gun]

I'm curious. Why did you apply to med school in the first place if you have a successful business from home which you seem to enjoy? You said that you don't like medicine that much.

 

[inep]

I'm curious. Why did you apply to med school in the first place if you have a successful business from home which you seem to enjoy? You said that you don't like medicine that much.

Your comment implies most people go to med school for the money and lifestyle, which I think is mostly true, and I probably was no exception. I hadn't fell into my niche when I took the MCAT, and by the time school started it was only a hobby that was generating cash at that point. It wasn't until after I started school that I realized I could make a living from it. Up until then, it was, hey, I could use this to pay for med school. Why I wanted to go to med school was because I didn't want to do the rat race every other college grad seemed to do and was compensated squat for it and I hated wasting away in a corporate office/lab. The medical system, as you are aware, pushes you through it once you start without giving you much time to stop and think about it. Once I started the premed process, I just kept on going and wasn't sure why. I also grew up a lot along the way and learned how much money I needed to be happy in life (around $100k ait) and that there were other (although far less documented and/or socially respected) ways to earn a living in life besides going to professional school or working for a large corporation.

Besides my tech heavy specialty choice, I liked FM. Anesthesia also to some extent seemed tolerable as a job. Everything else, not so much. Don't get me wrong, if I match into my #1 (and that's a big if), I will make far more money as an attending that I probably will in my other line of work. But it stopped being about the money once I realized my life needs and goals, and money has zero to do with my residency choice at this point. They all would comfortably meet my financial needs. Whether they would meet my needs for rest and diversity in my life is a different story.

 

[inep]

You know much more than you think you do. But after 10 years away from medicine, will you remember how to pick up murmurs? Will you remember how to do a basic musculoskeletal exam? Will you remember what the cranial nerves do? Will you remember what the various lab tests mean? Doubtful. Having you come back as an intern after 10 years away would be like teaching a lay person off the street how to take care of patients.

Unfortunately, I have about a 2 month working memory for most things. Most from 1st and 2nd year is already gone.
There is no option to re-take step 1/2/3 later on down the road to prove currency of knowledge? In the world of aviation, you lose your currency after 'x' number of years, and depending on how many years out you'd been determined what you would have to do to regain your currency. Obviously this happens far less often to physicians than pilots, but still hard to believe there aren't options out there for an MD to brush the dust off and get back to where he was.

 

[Anon212]

I'm not sure why you can't just hire someone to run the business while you're in residency. I mean, if you were my son (and therefore my first priority was to make sure you have a stable, well-paid career) I'd tell you to hire someone while you do a residency in something you actually like, then figure out what to do later. Even after residency, if you take 10 years off as WS said, you'd have to retake boards etc, and I doubt too many groups would hire you after a decade of not practicing medicine. Maybe you could open up your own shop somewhere rural, but it depends on whether you want to do that or not.
But because you're not my son, my suggestion would be to quit and never look back. You're obviously not committed to medicine. You obviously didn't really like it. It's too bad you put the money into it, but here we are. Honestly at this point if I were you, I'd quit clinical medicine altogether, focus on what I actually love, then maybe 10 years from now get an MBA and go into consulting or something. You like business-y type stuff, no reason you can't just stick with that. To be fair I don't know how consulting works exactly and whether they'd really care that you graduated med school a zillion years ago, but it can't hurt to look into that.

 

[Top Gun]

Your comment implies most people go to med school for the money and lifestyle, which I think is mostly true, and I probably was no exception.

No, that is not what I meant. Quite the opposite, in fact. I would say most people choose medicine because they have a genuine interest in it. If it had been about the money and lifestyle, a better choice would be investment banking. My question was why you chose to do med school, because you had a business which you were more interested in, and you didn't seem to have much interest in medicine. But okay, at the time, your business was more of a hobby for you and you didn't see it becoming a potential long-term career. So I guess you changed your mind and decided you didn't want to do medicine after all.

Anyway, to answer your question, the odds of you matching into a residency 10 years after graduating from med school are virtually nil, for two good reasons. A PD would question whether an applicant in your situation is still sharp clinically, and also whether the applicant had sufficient commitment to medicine. I would suggest you at least consider doing the residency after a year, if you must take some time off, and that way you'll have something to fall back on if your business doesn't work out. Either that, or just drop out of medicine entirely.

 

[inep]

Suppose I decide to pursue my other career. Is there any benefit towards dropping another 40 grand (in cash, not loan money I can spread out forever) to finish up the last year of med school? The overwhelming consensus I am getting here is that an MD is a completely worthless degree by itself, both in the short term, and especially in the long term. Could anyone give me a compelling reason to pay up and stick it out?

 

[gutonc]

Suppose I decide to pursue my other career. Is there any benefit towards dropping another 40 grand (in cash, not loan money I can spread out forever) to finish up the last year of med school? The overwhelming consensus I am getting here is that an MD is a completely worthless degree by itself, both in the short term, and especially in the long term. Could anyone give me a compelling reason to pay up and stick it out?

You're correct that, in general, an MD who is not BC/BE is only marginally more employable than somebody with a BA or Masters degree. Outside of sales and marketing, even pharma is mostly looking for residency/fellowship trained docs.

If you're sure you don't want to be a doctor then no, it would be silly to drop another 40G just to get the degree. But you'd better be damn sure because if you bail now, that's it...it's over.

Alternatively, what about taking a leave of absence for a year or two and see how things go? If you're able to make a go of your other business and it becomes what you can see as a long-term/lifelong career for yourself, then I think you have your answer. If you get away from medicine for a year and find yourself missing it, then you can come back.

The LOA will still need to be explained on residency apps and every time you apply for a license, but it's not that big of a deal to explain. If you wait until after graduation, you'll have the same explaining to do but it will be a lot harder to get people to believe you.

 

[Winged Scapula]

You're correct that, in general, an MD who is not BC/BE is only marginally more employable than somebody with a BA or Masters degree. Outside of sales and marketing, even pharma is mostly looking for residency/fellowship trained docs.

If you're sure you don't want to be a doctor then no, it would be silly to drop another 40G just to get the degree. But you'd better be damn sure because if you bail now, that's it...it's over.

Alternatively, what about taking a leave of absence for a year or two and see how things go? If you're able to make a go of your other business and it becomes what you can see as a long-term/lifelong career for yourself, then I think you have your answer. If you get away from medicine for a year and find yourself missing it, then you can come back.

The LOA will still need to be explained on residency apps and every time you apply for a license, but it's not that big of a deal to explain. If you wait until after graduation, you'll have the same explaining to do but it will be a lot harder to get people to believe you.

This is excellent advice.

 

[inep]

Unfortunately I already cashed in that chip when I started med school and immediately took an LOA to start the next year due to some a benign, but personal issue I don't want to get into. Effectively it was a deferral since I never set foot on campus, but on paper it was an LOA.

Taking a year or two leave of absence would be ideal for me right now, but I don't see how it is doable before graduation. Firstly, my school wouldn't allow it for the reason of testing the waters, and if they did, I could get maybe one year max. They are very strict when it comes to time to degree. Second, I feel that doing so would blow whatever already slim chance I have at pretty much the only specialty I want to do. Oddly enough, the only way to really make this happen would be to apply for the match and go unmatched, requiring a delay of graduation with intention of reapplication the following year, giving me some breathing room.

From what I understand, sitting out the match and graduating and entering the following year or after as an independent applicant would kill any chance I had of matching. If I make it to match day next year and don't get a spot, I may be the only unmatched guy in the country whose heart doesn't drop when he gets the news.

The flip side of the coin is that, given how easy passing fourth year is, it might be worth finishing given that I can afford it (painfully, but I can do it) should I ever need to send out resumes for a real job again. I could see where I might have problems getting hired if I am labeled as somone who quit his previous career right after starting, and quit med school without finishing. On the other hand, they may look at someone with a random MD on his resume and see me as total loose cannon. I don't know.

 

[TexasPhysician]

I think you need to strongly consider residency programs that are shorter and require fewer hours.

You have gotten this far, but your time will be for nothing unless you complete residency. You may not love it right now, but you will probably hate yourself later for not completing it. Afterwards, you can pick up consulting, pharma, or whatever.

Seriously consider fields like EM, psych, occupational medicine, and family medicine. Start searching for the cushier programs now. Do them while doing your side job part-time.

 

[inep]

Do you think that it is possible to work part time like this while doing a FM residency? I understand they don't have an intern year per-se.

In my current field, which requires a TY, I am learning that while the lifestyle is good post-residency, during residency it's going to require a lot of after hours work in finishing up notes, working on projects, etc. I don't see it happening.

I don't see it happening during an EM residency either.

And further, do you have the flexibility when you finish residency in something like FM, or possibly EM, to say, I'd just like to pick up one or two shifts a week to stay current while I run my other business full-time? I.e., keep it as a legitimate fallback and not just totally bail on 6 years of premed and med prep + a quarter million dollars invested in it, that I could have used, to oh, you know pay off a house by the age of 30.

 

[BADMD]

My question is, if I have graduated with an MD, but never went further after graduation, would I still have a reasonable chance of matching into a residency position somewhere?

No. Every year without clinical experience makes it less likely you will match. It will get very tough after 3 and damn near impossible after 5.

Would I need to take USMLE step 3 after graduating to leave this door open? Realistically, how far out could I go before the door to getting a residency spot is effectively shut?

It would be a good idea. You want to complete all the Steps in 7 years to remain eligible for a license in all states.

I'm hoping that this would still be an option if I were to be out of medicine for 5-10 years and want to get back into it and jump straight into a FM residency.

Answered above. This is a bad plan, even for FM.

 

[BADMD]

Do you think that it is possible to work part time like this while doing a FM residency? I understand they don't have an intern year per-se.

It would likely be difficult. FM still has night call and in hospital rotations during residency.

It would be essentially impossible during an EM residency.

And further, do you have the flexibility when you finish residency in something like FM, or possibly EM, to say, I'd just like to pick up one or two shifts a week to stay current

With FM, if you are a sole practitioner, you can work as much or as little as you want. Many find EM to be very lifestyle positive. You could potentially run a business, working a reduced schedule, assume your business doesn't require set business hours.

 

[NotAProgDirector]

Although rare, it is possible to "share" a residency slot with someone else. You then work 1/2 the time, twice as long. Chances are you'd be one month on, one month off. ? if something like this would work for you. The spots are rare, but I think you can search FREIDA for "shared pairs" or something like that.

 

[dozitgetchahi]

Everything I've been told indicates that psych residencies tend to have the fewest hours and most flexibility. Obviously I'm sure this varies by program etc, but it seems like psych is worth looking at.

 

[inep]

BADMD,

Thanks for your response. That all makes sense. Another thought that I have had...residents often "moonlight" after they obtain their license. I could potentially run my other business on a skeleton crew for a year while I complete a (hopefully not grueling) prelim, complete step 3, and obtain a license. Wouldn't this allow me to effectively do the same thing (i.e., pick up a few shifts at an urgent care every week) and do this indefinitely to stay current thereby hopefully making it more feasible to actually get into a residency down the road if I want/need to?

Are residents who moonlight protected by their residency's legal umbrella for their moonlighting activities (i.e., is that the only way you can get a job as a licensed, but not BE physician)?

I understand these are all pretty crappy career moves for a physician, but I'm comparing this to dropping out during 4th year or having an MD without a license.

 

[Buzz Me]

Are residents who moonlight protected by their residency's legal umbrella for their moonlighting activities (i.e., is that the only way you can get a job as a licensed, but not BE physician)?

I understand these are all pretty crappy career moves for a physician, but I'm comparing this to dropping out during 4th year or having an MD without a license.

If you're doing external moonlighting (i.e., outside your residency program's hospitals...and this would be your case since you'd only be doing one prelim year), you would need to provide your own full medical license, DEA number and malpractice/disability insurance.

Moonlighting during the residency research years is hard enough. Doing it after just one prelim year under your belt, and no residency options to fall back on? Even tougher.

 

[Cancer Man]

I've seen it done twice. However, it was less than 6 years between graduating and residency for both of them

 

[Taurus]

Why so secretive about this venture of yours? If it's so tenuous that you can't share any info on it, it probably won't survive long-term because technology changes and new competitors move in.

If you truly don't see yourself going back into clinical medicine for at least 10 years, then quit med school now. 3 years after med school graduation, you've hit your expiration date.

 

[michaelrack]

Suppose I decide to pursue my other career. Is there any benefit towards dropping another 40 grand (in cash, not loan money I can spread out forever) to finish up the last year of med school? The overwhelming consensus I am getting here is that an MD is a completely worthless degree by itself, both in the short term, and especially in the long term. Could anyone give me a compelling reason to pay up and stick it out?

I disagree with some of the other posters. I think that an MD degree IS worth 40k (and the time/effort spent doing cush 4th yr med school rotations).

True, an MD alone won't qualify you for many jobs (though it may enable you to teach at a jr college), but it can be advantage when combined with another skill set.
For example, an MD alone won't really qualify you for "consulting", but it would be of some help when combined with a solid business knowledge and/or MBA.

I advise you to complete your MD and apply through the match. You'll have to decide whether to apply for your dream specialty and/or something like psychiatry- You can always turn down the position and leave medicine at that point.

 

[vistaril]

Inep, I'd look at psychiatry, and I'd find the 10-15 most 'cush' psych programs in the country(they won't be 'top' programs) and go to one of them. I really think you could devote hours to your business at the same time as completing a psych residency. I think this would be possible because you're going to be a lot more efficient than some of the imgs(and otherwise really weak candidates) at some of these poorer(but also make sure it's cush) psych programs.

Now you may not have any interest in psych, but compared to family med it's going to be a lot less hours on average if you find a cush one. Additionally, although you may not have much interest in psych, it's pretty darn clear you don't have much interest in any field of medicine and so I'm not sure that would be an issue. It would also go well with your anxiety and sleep issues as psych doesn't have a lot of scenarios that should be particularly anxiogenic.

 

[Rothbard]

nm

 

[inspirationmd]

You need to do a residency. Medicine, for all its faults, is a safe way to guarantee a 6-figure income. Get yourself a TY year and then do an Occupational Med residency. This is the easiest way to give you the time you want while keeping your stress level low. Psych and PM&R are the next two you should consider since again their work loads and stress levels are much less than the other specialties while still giving you a bunch of time off for your outside pursuits.

FM will require a decent amount of your time and has a bunch of stress that I don't think you are considering. Someone with a severe anxiety problem is not going to do well with the stress of a complicated delivery, a septic shock patient, etc. I am guessing your specialty of choice is Rad-Onc and while I have heard that after residency it can be nice, the amount of reading you are going to need to do for residency is going to be prohibitive for the desired guaranteed 3 hours a night. If its not Rad-onc then consider carefully if your specialty of choice will let you have the time you feel you need.

 

[SmilingPolitely]

I have seen plenty of Residencies that you aren't working near the 80 hour a week limit and you could easily have 3 hours a night to work on your home business.

The Pysch residents are never doing anything it seems. My buddy who did it at another hospital had his first weekend of call in late SEPTEMBER, having started in mid-june.

I also have a few friends that are now 1-2 years out of med school who just matched this year and they did not at all enjoy it. Not that the match process is ever enjoyable, but there were many programs that didn't show any interest and for the most part the only options were family medicine or generic internal medicine. Maybe pysch too. You also didnt have the support of the school behind you, and probably don't have friends doing the same thing that you can bounce questions and frustrations off of..

There are plenty of cush residencies out there. And you could easily find a partner who could split the work with you...

I have to say, I am very curious as to what you have on the side. I have often said through med school and now even in residency that I wished I had some silly side business to fool around with on the side. Something that is a hobby buy better.
So if you are looking for a partner...

 

[Anon212]

To all of you who are throwing out random specialty ideas (and to the OP):

would you really consider doing a specialty like psych or pm&r if it's not what you like, just to be board eligible in something? I'm genuinely just curious, no accusation whatsoever. Not that I'm so naive as to think you should have one specialty "calling" or whatever. I get that medicine at base is a job. But I spent so much of my third year being bored to death and swearing "never again" that I can't imagine just picking a specialty because its residency is easy- that's a whole life of doing something you don't like. Like, regardless of the hours, I could never just do psych. It's....psych. It's just not what I do. I don't know. So for all of you who are making these suggestions, do you think you yourself could pick a specialty at random and learn to love it just to maintain a side business while still being board eligible in something?
I kinda figured everyone would tell the OP to quit medicine altogether since it sounds like it's not really what he loves to do anyway and it's a whole lot of time commitment for something you feel meh about....

 

[dozitgetchahi]

I liked almost all of third year except surgery and some elements of OB (and peds, to a lesser extent). PM&R wasn't super interesting, but I think I could rationalize doing it if I was in the OP's position. The only specialty that I really, really despised was surgery, but most of what makes surgery suck is the time commitment and the ongoing stress and monotony of being in the OR. I think it's a bit different if you're doing an easier specialty that requires less of a time commitment.

 

[cabinbuilder]

isn't encouraging at all. It kind of sucks that I just dumped $150,000 on an MD if it's pretty much worthless unless used immediately, even in the least competitive fields.

Do things change if I complete an intern year and then walk away, or use my license to do 1 or 2 shifts a week at an urgent care type of facility while focusing on my other work full-time? Or is it still worthless unless I complete a residency? Yes, they do change but there is only so long you can work urgent care on a one year training certificate. More and more urgent care require board certification to even be considered because those jobs are in high demand due to flexibility of scheduling.

What I am afraid of is giving up my side job which thus far has paid for my med school and provided me with a comfortable standard of living in med school working from home for about 30 hours a week, and entering residency, then washing out/burning out/failing out of residency and being left with nothing.You will only wash out of residency if you are a completely incompetant fool and cause danger to a patient. You are better off just doing the residency and be done. Trying to get back into the game after many years is very difficult if not impossible. You can continue your side job in residency. I didn't see residency any worse than a regular job most days with the exception of being on call but that's not all the time. I went to medical school and residency with 2 kids, I think you can deal with your business.

It's a lot easier to look forwards to the hell of residency when you have nothing else going for you and hundreds of thousands in non-forgiveable loans. For me, I have something else I enjoy that I am good at and pays very well with minimal stress, which granted may not last, but I have it for the time being. I've never been nuts about medicine in the first place and was encouraged not to quit halfway through in order to leave my options open. Now I'm finding out those options aren't there unless I complete a residency?Pretty much. You have already defeated yourself. Residency isn't hell, I actually had a great time in residency. You need to change your mindset and just do it. 3 years goes very fast and then you have lots of options.

If I were your son, what advice would you give me?GO TO RESIDENCY AND SECURE YOUR OPTIONS NOW

It's an incredibly unusual position to be in, and I feel like I'm in uncharted waters. I'm afraid of ending up with nothing either way I go, and the ability of being able to do both concurrently will end with the responsibilities of intern year. You will end up with nothing if you don't do residency. So your side job produces 6 figures? Medicine is essentially guaranteed income for the rest of your life. You are willing to blow that for a few years of a side business?

It would be more comforting to be able to walk away to know that I could use my MD for at least something professional years down the road (albeit not the ultra-competitive route I originally intended) instead of having to accept the possibility of being a 4.0 college grad turned MD working at wal-mart or selling cars.You will be the greeter at Wal-Mart. Do not count on anyone taking you 5 years out. I have a friend who could not pass step 2 until the 6th time. He is currently 8 years out of medical school and could not get a residency. He went to pharmacy school after that and is not working as a pharmacist.

Surely there is somebody out there who walked away after graduation and found a way to come back? Shotgunning every single FM program in the country wouldn't even produce a few hits?Seriously, seriously doubt it. Not a wise move

 

[cabinbuilder]

BADMD,

Thanks for your response. That all makes sense. Another thought that I have had...residents often "moonlight" after they obtain their license. I could potentially run my other business on a skeleton crew for a year while I complete a (hopefully not grueling) prelim, complete step 3, and obtain a license. Wouldn't this allow me to effectively do the same thing (i.e., pick up a few shifts at an urgent care every week) and do this indefinitely to stay current thereby hopefully making it more feasible to actually get into a residency down the road if I want/need to?

Are residents who moonlight protected by their residency's legal umbrella for their moonlighting activities (i.e., is that the only way you can get a job as a licensed, but not BE physician)?
I understand these are all pretty crappy career moves for a physician, but I'm comparing this to dropping out during 4th year or having an MD without a license.

NO, Moonlighting is ON YOUR OWN. You have to acquire your own malpractice policy, your own license, and your own DEA and/or pharmacy license depending on the state you are in. The residency does not cover you in any way. Urgent care jobs generally take you as a resident after you have completed 2nd year with the premise you are going to finish. To think you will be to work indefinitely on an intern year of training is naive and not practical.