Should I apply/interview for Internal Medicine Research Fast-Track positions?

[Valar144]

Hey y'all!

Thanks in advance for your help.

As the title suggests, I'm wondering if any of you have any advice/thoughts about applying into fast-track physician-scientist programs in Internal Medicine. I'm interested in Gastroenterology as my future career and would like to secure a fellowship spot in GI in my home area but I'm worried as applying into GI fellowship at strong institutions seems extremely competitive as a resident.

I've gotten just a handful of interviews from the programs I applied and am wondering if I should apply to the additional research fast-track pathways if the option is there to do so. I didn't apply to fast-track positions originally due to my lack of confidence in my research/not sure if I could compete with PhDs but seeing that there is an option to add fast-track interviews at some locations has got me thinking... I know most programs are basic-science related, but seems as though some fellows at certain institutions only have clinical research as well.

I definitely don't have a PhD nor basic-science research, but have some clinical research background throughout medical school. I'm at a T3 school with Step 2 of 257 and Step 1 Pass , though not sure if this matters much. I have a research LOR from a long-term research mentor in Heme/Onc who was previously the chair of the department and have other strong clinical letters with honors in my sub-Is.

Regarding my research, I currently have three first author publications: 1 large data/blockchain publication in a decent journal (IF: 5, top journal in its class, but am co-first author), 1 large publication in a smaller oncology journal (IF:3), and 1 short report in an well-known Internal Medicine journal (IF: 5). I also have 1 first-author case report.

I also have 2 first-author short manuscripts in GI that are currently being reviewed/accepted in smaller GI journals (IF:~3). I'm continuing to do research in GI in my fourth year and will hopefully have another first-author publication by graduation.

I feel confident about my chances of matching in IM residency at my home institution or a comparable program, but am nervous about my odds of matching to a strong GI program (or even my home program) once in residency due to the lack of spots (7 total) which mostly seem to go to fast-trackers anyways. I'm also not sure how much my research stands out in the sea of PhDs and students with big-name journals.

Is my research and general application competitive for fast-track positions? If so, do you think I should interview for the fast-track positions? Will this hurt my chances of matching into IM normally at the institution?

Thank you!

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[eteshoe]

I've been told that pick the "fast-track" option if you're really wanting to go down the research heavy pathway - e.g. 1-2 clinic days and remaining running a lab or whatever. You're only fast tracking the IM part but the GI part is still gonna be 4 years and typically the programs want you to be aiming for early career investigator awards by the end of fellowship. From your post it doesn't seem like you're the type of candidate that most of these programs would be looking for. Unless I'm missing something?

Having good productivity as a med student is great for residency apps but honestly if you wanna be a mostly clinical GI doc - then get into a strong IM program. Network w/ the GI division and get some publications out and apply widely. It's a competitive subspecialty but from my non-MD/PhD friends who are now attendings - it's not impossible to match into. Though I wouldn't put all your eggs in matching at your current home institution.

 

[ChordaEpiphany]

Not sure a fast-track is compatible with your goals.

First, you might not be that competitive. These programs are designed for MD/PhDs who will earn an early career award by the end of the program. At MGH I'm counting 1-2 residents per year that are MD only, and almost all of them have first author basic science papers in good journals (IF > 10), which usually means at least a full year of dedicated bench research (+ luck, + a very supportive PI). Spots are limited and reserved for those who are most likely to receive outside funding. Also, be advised some departments put you on the NIH post-doc pay scale instead of PGY.

Success in basic science research is usually about 1-2 big deal 1st author papers (IF > 10, preferably at least one > 20). To a committee awarding K or R grants you'd be pretty far behind. I know a post-doc now whose K grant wasn't discussed despite 30+ manuscripts and 10+ in top, top journals (IF > 20). His first author papers (3) were in good (IF > 10) but not great (IF > 20) journals. There's a lot of luck behind great papers, and top PSTP programs like to choose people who've already received a good dose of luck in their first foray into science.

Second, if your goal is to receive the best clinical training by going to the top fellowship in the area, spending several years out of the clinic and in the lab instead feels like a very bad option. You will definitely lose clinical experience and training time by going PSTP. If your goal is simply to maintain T3 status rather than potentially dropping to a non-brand name GI program, spending several years in a lab feels like a miserable way to go about it, especially since you may not be as well-positioned for the actual career you want afterwards compared to doing a clinical fellowship with some translational/clinical research on the side. I don't know if you are in Boston, New York, or the Bay Area, but with your goals I'd take the second or third best clinical program in those cities over a PSTP at the top program any day.

 

[NotAProgDirector]

You're being silly. You're going to match to a great univ program, and you're going to be very competitive for a GI fellowship as is. Do some more research and network with GI wherever you match. You'll be fine.

 

[voxveritatisetlucis]

You’ll be able to get into BWH, MGH, JHU, or UCSF since one of those must be a home program. Then you’re pretty much set for GI fellowship. Why prolong it by applying research track?

 

[AlteredScale]

Hey y'all!

Thanks in advance for your help.

As the title suggests, I'm wondering if any of you have any advice/thoughts about applying into fast-track physician-scientist programs in Internal Medicine. I'm interested in Gastroenterology as my future career and would like to secure a fellowship spot in GI in my home area but I'm worried as applying into GI fellowship at strong institutions seems extremely competitive as a resident.

I've gotten just a handful of interviews from the programs I applied and am wondering if I should apply to the additional research fast-track pathways if the option is there to do so. I didn't apply to fast-track positions originally due to my lack of confidence in my research/not sure if I could compete with PhDs but seeing that there is an option to add fast-track interviews at some locations has got me thinking... I know most programs are basic-science related, but seems as though some fellows at certain institutions only have clinical research as well.

I definitely don't have a PhD nor basic-science research, but have some clinical research background throughout medical school. I'm at a T3 school with Step 2 of 257 and Step 1 Pass , though not sure if this matters much. I have a research LOR from a long-term research mentor in Heme/Onc who was previously the chair of the department and have other strong clinical letters with honors in my sub-Is.

Regarding my research, I currently have three first author publications: 1 large data/blockchain publication in a decent journal (IF: 5, top journal in its class, but am co-first author), 1 large publication in a smaller oncology journal (IF:3), and 1 short report in an well-known Internal Medicine journal (IF: 5). I also have 1 first-author case report.

I also have 2 first-author short manuscripts in GI that are currently being reviewed/accepted in smaller GI journals (IF:~3). I'm continuing to do research in GI in my fourth year and will hopefully have another first-author publication by graduation.

I feel confident about my chances of matching in IM residency at my home institution or a comparable program, but am nervous about my odds of matching to a strong GI program (or even my home program) once in residency due to the lack of spots (7 total) which mostly seem to go to fast-trackers anyways. I'm also not sure how much my research stands out in the sea of PhDs and students with big-name journals.

Is my research and general application competitive for fast-track positions? If so, do you think I should interview for the fast-track positions? Will this hurt my chances of matching into IM normally at the institution?

Thank you!

The PSTP shouldn't be used to just secure a GI spot. You need to know that you are wanting a career in research, because you are essentially doing the bare-bones clinical training which can actually hurt you in the long run. Additionally, it isn't a short track, it in fact extends your training period but at minimum 6 months. (2 IM, 3 research, 1.5 GI).

I am in this program. The training is more intense due to the 2 year IM training. I want to pursue a career that focuses heavily on basic science / translational science and this is the only chance I get to actually develop my techniques and data enough to submit grant proposals. It is plausible to do it focused on clinical research but at this stage you need to have a niche within your clinical research to really convince the committee that you are wanting to do this for the right reasons and not just getting the GI fellowship. Importantly, if you do this and bounce out into private practice, your institution may lose its T32 funding which pays for a big portion of PSTP.

You should pursue the categorical pathway, keep publishing, make connections with your GI department early, do clinical rotations in GI to show you will be a good asset to them, etc etc.

 

[srirachamayonnaise]

Given your background, I think you are already overshooting…. Just relax and enjoy the ride and you will get to scope for the rest of your life… lol

 

[srirachamayonnaise]

You’ll be able to get into BWH, MGH, JHU, or UCSF since one of those must be a home program. Then you’re pretty much set for GI fellowship. Why prolong it by applying research track?

Not necessarily. OP could be at NYU or VP&S, though traditionally speaking, these two programs are not considered T3.

 

[Valar144]

Thank you all for your comments! I appreciate the supportive and constructive feedback. I've taken some time to think about all that's been said and I definitely agree with the majority of the comments so far. I'm in a good position for top IM residencies from what I've been told by my mentors, and my ultimate goal is to practice medicine where I go to medical school now, which is also where I've grown up and my community of friends/family are.

As many other posters have said, I think fast-track wouldn't really align with my interests and I wouldn't necessarily be competitive for those programs, as they are usually geared for MD/PHDs with basic/translational science backgrounds interested in 80/20 research careers funded by R/K grants. I'll see where I end up for residency (hopefully my home program, which seems to take a few of their own) and get to continue my GI research through the same mentors. Hopefully my connections and research after two years in the IM program at home will enable me to be a strong candidate to match at my home institution for GI, though a chief-year might be necessary to guarantee that. I recognize that I'm in a privileged position already and will just take things as they come, and am flexible to move around in my career long-term as well if matching GI at my home institution doesn't quite work out.

I appreciate all of your comments so far! Excited for all the opportunities ahead.