Options after completing an MSTP

[Gfunk6]

I am currently at the tail-end of my MSTP (Core Clinical Clerkships) and have been doing some serious thinking about what type of training I would like to pursue as a post-graduate.

It seems to me that a lot of MSTPers are using their PhD and considerably broad, deep academic strengths to muscle their way into hyper-competitive fields like Derm, Optho, and Orthopod. However, most of them choose to do a regular residency which will lead, presumably, to a mostly clinical practice (e.g. little or no research).

There are relatively few students going into IM fast-tracks or choosing research-oriented residency tracks (such as the Holman Pathway in Diagnostic Radiology and RadOnc). These student seem more genuinely interested in integrating basic or clinical research into their profression.

So, I'm just throwing this question out:

Where do you all stand on this issue?

Are you using your MSTP status as a springboard to obtain a mostly clinical residency that you might not be able to obtain as a straight MD?

Or are you more interested in research tracks tailored specifically for MD/PhD grads?

Just a note, I'm not interested in making value judgements -- as a MSTP grad you've certainly earned the right to do anything along the continuum from pure basic research to 100% clinical. I just want to hear opinions and generate some interesting discussion.

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[GeneGoddess]

I'm starting my fourth year in two weeks (after being out for years getting the PhD part) and plan to go into either Pedi/Med Genetics or a straight Pedi residency followed by a fellowship in Medical Genetics. I want to do mostly clinical (lab burn-out), but maybe have a lab or be part of a lab studying a specific genetic illness (probably neurological). I'll admit that Pedi/Med Gen is pretty competitve (there aren't many programs), but I went in to med school not knowing exactly what I wanted to do (my top choices were ob/gyn, neurology, and just straight med gen - I didn't expect to like pedi so much). The graduates of our program tend to lean more towards clinical research (I think ONE graduate in recent memory did a post-doc before a residency). We have one person who went into Derm, one or two into Surgery (one plastic), and one girl wants to do Optho after she graduates in 2006 (she's doing retinal research). Quite a few of our grads go on to "high powered" places (IM at MGH, Pedi Neuro at UCSF, etc etc), but I doubt any of them were MD/PhD just to get in somewhere "good". I've known a few people like that, but they've either dropped out or didn't get in. Most of my classmates are just the "I like research AND medicine" types.

 

[Gfunk6]

I'm starting my fourth year in two weeks (after being out for years getting the PhD part) and plan to go into either Pedi/Med Genetics or a straight Pedi residency followed by a fellowship in Medical Genetics. I want to do mostly clinical (lab burn-out)

This seems to be a really common phenomeon among MSTPers. After finishing lab, I admit to to having the "fire in my belly" quenched as well.

Quite a few of our grads go on to "high powered" places (IM at MGH, Pedi Neuro at UCSF, etc etc), but I doubt any of them were MD/PhD just to get in somewhere "good". I've known a few people like that, but they've either dropped out or didn't get in. Most of my classmates are just the "I like research AND medicine" types.

I agree with you that virtually nobody enters a program solely with the idea of procuring a good residency. But mostly b/c of the burnout you cited, I think a lot of students feel compelled to go into competive fields with little or no research.

Now that I'm on the topic, could I solicit your opinion on fast-tracking residencies? They are the ABIM Research tracks where you do 2 years of Internal Medince, 1-2 years of fellowship and you get 3 years of protected research time. They sound pretty compelling to me.

 

[b&ierstiefel]

At the school where I am at, there are a mix of students. Some of my friends decide after the PhD phase that they're burned out from research and want to do more clinical. And I can understand that. Job security is so much better in clinical vs. basic science research. When you're purely a physician, there are always jobs out there and no worries about the tenure and grant funding. For them, then the issue of money, lifestyle, clinical interests, etc. come into play when they pick a residency field.

Where do I personally stand on this issue? I am on the other side of the fence. Some people drop out of our MSTP program and finish med school and go do whatever they set out to do. For me, if I would drop out of the program, I would NOT finish the medical school training. I absolutely loved research before med school and became even more addicted to it during the PhD phase. On the other hand, during my 3rd year clinical clerkships, I thought about dropping out of med school on many occasions as I disliked almost every minute of it. I ended up deciding not to drop out because the MD confers many advantages for a person interested in an academic research position (more grants one can apply for, increased competitiveness when competing against straight PhD's for tenure track positions). In terms of long-term career goals, I definitely see myself doing purely research. If it's translational research, great! If not, I'm not gonna fuss about it.

Originally, I was thinking of going into short-track or fast-track IM programs. My PhD adviser (who was an MD) said researchers who are Internal Medicine clinicians are the best respected. Hence, I was set of going into IM and undergoing the shortest residency training as possible (hence, short-track/fast-track). Then I figured I would put in my research time, hopefully I would be lucky/serendipitous/productive, and I could settle in on a faculty position where my clinical duties would be minimized (just like my PhD adviser who only works 1 inpatient month per year and one half-day clinic per week). Then as I went through IM, I clearly wasn't enjoying the work and I decided not to do IM thinking, "Why go into IM when all i'm gonna do is try to minimize my IM clinical duties?" And I'll say this, the IM lifestyle is very difficult. Based on my desire to do research, an IM residency would be a very painful distraction. Anyways, I've ranted on related issues in the Pathology forums; if you're curious to take a look as I won't repeat the whole rant here.

Overall, MD/PhD training takes up a big chunk of time in one's life. 6 years for a few, 7-8 years for some, 8+ years for others. People grow during these long arduous years of training. And it's a wonderful thing to have more options than straight MD's or straight PhD's at the end of the day. Heck! We deserve it! That was the big draw for doing MD/PhD 7 years ago when I applied to med schools. I thought I wanted to be a doctor (in retrospect, the desire to be a doctor was quite superficial). I loved research (this was already deeply rooted). I didn't want to commit to a certain path before experiencing both the physician and scientist side of things. Of course I didn't say that during interviews

 

[Vader]

I am a year into the PhD phase and am enjoying research very much. However, I do miss the clinical side of things. For specialty, I am interesed in neurology, which tends to a fairly academically-oriented specialty, so a career combining clinical medicine and research is quite feasible.

I'm interested to see if I will experience PhD burn-out as well... sounds scary.

 

[b&ierstiefel]

I am a year into the PhD phase and am enjoying research very much. However, I do miss the clinical side of things. For specialty, I am interesed in neurology, which tends to a fairly academically-oriented specialty, so a career combining clinical medicine and research is quite feasible.

I'm interested to see if I will experience PhD burn-out as well... sounds scary.

that's cool man. definitely be open minded in terms of research and clinical stuff...at your stage, there's no reason to be narrow-minded. when i was at your stage, i felt the same way; however, my exposure to clinical medicine was what i read in books and studied and not to actual hospital/clinic work.

best of luck with your phd training...enjoy grad school

 

[GeneGoddess]

Now that I'm on the topic, could I solicit your opinion on fast-tracking residencies? They are the ABIM Research tracks where you do 2 years of Internal Medince, 1-2 years of fellowship and you get 3 years of protected research time. They sound pretty compelling to me.

I know one graduate who did a fast track (pedi for two years, then a pedi neuro fellowship for two years). He's now faculty (after only four years of post-grad training). This guy is brilliant, and it was right for him. It's not right for me. I want to be a GREAT doctor, not a merely adequate one, and I don't want to "fast track" my way through general peds before doing a fellowship. But that's just me. The guy I mentioned is a great doctor (really), but what he did is not for me. Just MHO.

 

[Gfunk6]

And it's a wonderful thing to have more options than straight MD's or straight PhD's at the end of the day. Heck! We deserve it!

Damn straight!
But I think you are a rare breed, my friend. It seems that most people want to stay in contact with the clinical side. However, there are handful of people in my MSTP who, like you, choose to focus on research. That's the beauty of the dual-degree.

I'm interested to see if I will experience PhD burn-out as well... sounds scary.

I was surprised that I was burned out myself. Though, I'm sure (I hope) the urge to run Westerns and PCR will re-manifest itself over the next couple of years.

It's not right for me. I want to be a GREAT doctor, not a merely adequate one, and I don't want to "fast track" my way through general peds before doing a fellowship.

A very interesting comment and it makes sense. Though, technically speaking, you could make the same argument about the MD degree in MSTPs. In our program we are required to do about 14 months of clinicals whereas the straight MD student requires around 20 or so. These 6 months are taken up as "research electives" for the MSTP student. I suspect fast tracking is doing something analagous.

 

[b&ierstiefel]

Damn straight!
In our program we are required to do about 14 months of clinicals whereas the straight MD student requires around 20 or so. These 6 months are taken up as "research electives" for the MSTP student. I suspect fast tracking is doing something analagous.

Damn Gfunk6, you guys are lucky! Only 14 months of clinicals? Shoot, we gotta do 16 here. Man I should've gone to your school, I'd be done by the end of summer and host my white coat burning ceremony 2 months earlier!

 

[GeneGoddess]

A very interesting comment and it makes sense. Though, technically speaking, you could make the same argument about the MD degree in MSTPs. In our program we are required to do about 14 months of clinicals whereas the straight MD student requires around 20 or so. These 6 months are taken up as "research electives" for the MSTP student. I suspect fast tracking is doing something analagous.

We do our third year clinicals with our class before starting the PhD (which I REALLY like - it's bad enough being on call when you KNOW your classmates!). And we get credit for 2 months of clerkships as a MSIV (it used to be 3), meaning we only have to do 7mo our fourth year (versus 9 for the regular MD). So that's 12+7 = 19mo for MD/PhD versus 12+9 = 21mo for regular MD. So we get MUCH more clinical than you do (interesting). I think that there are plenty of people out there (both MD and MD/PhD) who would make great doctors doing a fast track residency. I'm just not one of them. I want to have a good strong base and not JUST a narrow field of expertise (and I need the "extra year" not included in fast track).

 

[Treg]

Although I am not doing a traditional MD/PhD, I thought I would toss in my 0.02. I will be defending my PhD thesis <1 yr, starting med school fall 2005. I am looking to do a part time postdoc during med school (I know a few people who have done this) in translational/semi-clinical research. Afterward, I hope to do the fast-track IM/Post-doc 4 year option. I am going to be shadowing a successful doc I know here who has 20% clinical/80% research in GI next month to see how I like the schedule.

I think it takes a long time to see if you really have a true passion for research. Good luck with your decision

Treg

 

[tr]

I'm going into my fifth year in the program, so headed into my third year of research.

I'm sort of the same type as AndyMilonakis; my primary interest was always research, and in fact my alternative to MD/PhD would have been straight PhD, not straight MD.

I think I will probably do a residency because I admit to being a little sick of the bench, although not of research in general. I am still interested in research but not necessarily the kind I'm doing now. My clinical interests are neurology and psychiatry, and patient-centered research in these areas sounds interesting to me.

Fast-tracking sounds like a good option. I guess I'll see what's available when I get to that point.

 

[tr]

1) A senior researcher and attending at our school specifically recommended that we *not* fast-track. He had done this himself and regretted it, suggested that there was no other time to really get a superb grounding in the basics of clinical care.

I don't think I'm going to take his advice against fast-tracking because I don't ultimately want to focus on clinical duties. I sort of agree with those who say that it's very difficult to do both things well. Although I think having done the residency will be useful to me in my future academic life, I see myself as being mainly research-oriented after that.


2) About research burn-out: I think that there are two phenomena here. One is definitely straight research burn-out. I've seen that a lot among MD-PhDs in my program. The other thing that sends people away from research is that it is HARD. There really are very few people who make it to the top, and I think a lot of MD/PhD's decide it's just not worth it. For myself, I'm in a very competitive field right now, and I just don't like the environment. I still want to do research, but I'd rather move into something where there aren't fifty high-powered labs snapping at my heels.

 

[b&ierstiefel]

As posed by GeneGoddess, fast-track/short-track programs will not give you as good training as a non-fast-track program. It's simply a matter of learning medicine over an extra year. Clinical medicine is so broad and there's a lot to learn so for people who mainly want to do clinical duties, fast-tracking may not be the way to go.

When I told my adviser that I wanted to devote myself to basic science research related to medicine, his overall advice was to do the shortest residency possible. Why do a residency? Credential inflation. Academic jobs are becoming more competitive to get given that there are many PhD's and postdocs out there. An MD in addition to a PhD as well as board certification in a field will surely make you more competitive in the job market. Hence, the impression I got was that fast-trackers are really for people like myself and tr...those who want to do mainly research in the long run.

Then I went through the internal medicine rotation and I saw how many of the residents were not happy. Maybe it's just a Michigan thing...I have heard from others outside of Michigan that our internal medicine residency program is considered "malignant." Initially I was interested in internal medicine and I figured I'll just suck it up for 2 years. But I really didn't like the work. I hated clinic. I hated rounding. I didn't like requesting a bunch of consults and following up on a bunch of tests. I wanted to be the one consulted. I wanted to be the one doing the tests. That would make my life easier and simpler on the clinical side of things such that I can then spend the rest of my brain doing research, writing grants, etc. I don't mean to talk smack about internal medicine docs. I have a profound amount of respect for them because they're really smart and know a hell of a lot.

BTW, I didn't know neurology and psychiatry had fast-track or short-track programs. Oh well, 5 weeks of subI's left and I need a drink.

Peace and good luck to you all. I'm sure all of you will succeed in your endeavors and end up doing something you will enjoy very much.

 

[tr]

I don't know that much about it (not anywhere near that point yet), but it seems a lot of it depends on the particular institution.

Neurology residencies in general seem to be fairly clinical, but there is a good deal of support out there for psychiatrist-researchers, who seem to be in short supply right now:

http://books.nap.edu/books/0309090717/html/37.html#pagetop

This is actually pushing me towards psychiatry rather than neurology as a residency option. Since my primary focus is still research, I'd rather be in a field where this is welcomed.

 

[GeneGoddess]

I don't want anyone out there to think that I believe that people who fast-track are bad doctors! They aren't! It's just not for me. I WANT to get the extra year of training because I think it would make ME a better doctor. There are others out there who will be even better than me who have fast-tracked. I just think that *I* will be better if I do a regular residency...

 

[b&ierstiefel]

I don't want anyone out there to think that I believe that people who fast-track are bad doctors! They aren't! It's just not for me. I WANT to get the extra year of training because I think it would make ME a better doctor. There are others out there who will be even better than me who have fast-tracked. I just think that *I* will be better if I do a regular residency...

It's not a question of fast-trackers being bad doctors. However, an extra year of residency (in non-fast-track programs) can only make a doctor better. It's awesome that you are willing to do that extra year to further improve your clinical skills and further hone your knowledge.

My implication in my previous post was that people who fast-track tend to have more interest in research. I fall under that category.