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Physician Scientist Residency - Students' Advice

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Physician Scientist Residency

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“Thanks! I enjoyed that MD/PhD so much, I think I’ll have another one.”

Class of 2009

This guide is designed as a supplement to the significant amount of residency advising provided by the Office of Student Affairs. In particular, its goal is to introduce the added complexities of applying for physician scientist track programs in Internal Medicine and Pathology, largely because they are the most established. Additional comments are provided on applying with a research focus in other fields. This guide is limited to the experience of the graduating class of 2009, but we sincerely hope that the following classes will find it useful enough to expand it and keep it up to date.

Internal Medicine:

Most major academic IM residencies offer a Physician Scientist Pathway (referred to below as a PSP, even though every institution calls it something different). Like MSTPs, no two are exactly the same. However, they tend to share common attributes: Generally, these programs start with the goal of attracting medical students with significant research background to an institution for residency, typically using the ABIM research pathway (a.k.a., the short track). For non-MD/PhD applicants, they often will also offer the opportunity for formal graduate training. Of particular interest to the applicant is the extent to which these programs may ease access to fellowships at the same institution. This is a huge point of variation, with some programs offering guaranteed fellowship slots and some offering no preferment at all (or a guarantee of some fellowships but not others). Most programs also provide mentorship and molecular medicine oriented seminars, to help keep the science part of the brain working during residency.

How to Apply:

Here is another major point of variability. Some programs have their own ERAS listing (a separate box to check when you apply), while at others applications are sorted through after they are received and students who seem likely to be interested are contacted. For these institutions, there seems to be little to lose in also contacting the PSP administrator to let them know that you are interested.

More generally, it’s a good idea to get acquainted with the PSP of interest’s website pretty early in the game. Often, they will ask for things like extra letters (beyond the 4 through ERAS) or statements of research interest. Particularly for the extra letters, it’s nice to get a jump on these early.

Interviewing:

Most PSPs have a second interview day, typically with a normal IM interview day first. Some places only have a limited number of days on which PSP applicants interview, so it’s not a bad idea to know when those are before you start scheduling trips. As a PSP candidate, you will end up interviewing with some combination of these 4 types of people: IM residency interviewers, fellowship program interviewers, PSP administrators, and potential post-doc mentors. Not surprisingly, each group is looking for something slightly different in an applicant, and it is probably important not to be overly unidimensional. Also, pretty much everyone who is clinically active will ask you about short-tracking. People seem comfortable with intent without certainty (ie, “That sounds like the kind of thing I might want to do, but I’d like to try to make it as an intern for a bit before I commit.”)

On this vein, many clinical interviewers are wary of MD-PhDs being overly devoted to research and not being good clinicians, and they will ask probing questions to see whether you'd blow off residency, especially if you short-track. It often helps to let them know up front that you enjoy clinical work (if that is the case) and plan on taking residency seriously, as this could be your last chance at a rigorous clinical training. Similarly, a lot of programs will arrange your "scientific" interviews with people in your field, so they will ask detailed questions about experiments, hypothetical future projects, etc, not unlike a thesis committee member. You'll want to come across as the expert and have thoughtful answers ready. Know your research cold.

Things to think about:

PSPs share a backbone (IM residency followed by some advantage for fellowship), but there are a number of things that make the programs quite distinct. Both for the shared and distinct aspects, there are a fair number of things that you will probably want to have a good handle on before you show up.

  • Things to think about early:
    • Do I actually want to keep going as a physician-scientist? There is no question that PSP programs are helpful, but they can also be limiting (see below). If you are strongly considering a career as a practitioner, you should be very careful not to commit to something that might limit your training options
    • Do I actually want to do residency and fellowship in the same place? For many a thirty-ish MD/PhD, the idea of a fixed location for the next 6+ years is quite appealing. But it does somewhat limit your prospects – if you want an extremely hard-core residency followed by fellowship in a basic science heavy institution, this may be more easily accomplished in two steps. It appears that no PSP would block you from leaving after residency, but this might cause hard feelings. Also, if you’re planning to short track, consider how you’d feel about applying for fellowship in the fall of intern year.
    • How sure am I that I know what I will want to do as a fellow? PSPs offer differing degrees of flexibility in when you have to commit to a fellowship. If you want time to think about it as a resident, make sure you’ll get it. Similarly, it’s always a bit dangerous to go to an institution with one mentor in mind – you never know if that person might leave or your interests might change.
    • What does physician-scientist mean to me? Different people have very different ideas of what it means to be a physician scientist. Generally, most agree with the 80/20 model (i.e., in the end 80% of your time will be spent in the lab), but the importance of having a close connection between research and practice can be varied. Have a sense of this for yourself, because some programs are more strongly in favor of “disease-oriented” research as a goal for physician-scientists than others.
  • In the application:
    • The OSA gives a formula for writing the personal statement that seems to work out well. Just as they suggest mentioning your subspecialty field of interest, it’s probably a good idea to highlight that you have research interests. But just as it’s best not to seem totally obsessed with a subspecialty, it’s probably best to discuss research interests briefly, and only in how they might inform your perspective on medicine.
    • It’s not a bad idea to keep in mind that not every program has a PSP, and that you may be invited to interview for residency at institutions where you are not also invited to interview for the PSP. Make sure that your application is appealing to residency program directors. (note: it is possible to send different personal statements to different programs)
  • Program-by-program questions:
    • Will your clinical training be limited? Many of these programs, in a not-unreasonable attempt to speed the path to starting your postdoc, will limit your options as a fellow (for example, some heme/onc programs do not allow their “lab fellows” to double board).
    • How does the residency program help you find your way into fellowship/the lab? Residency and clinical fellowship are both full time jobs, so it’s helpful to have people making sure you stay on track.
    • Are physician scientist fellows valued at the institution? You’ll be rusty after your clinical time, so you want to make sure that the labs you’d be excited about will want to take you. Sometimes programs sweeten the deal for PIs by giving funding your salary for a couple of years in the lab.
    • Can PSP fellows work in any lab in the institution? What about affiliated nearby institutions?
  • Interview questions:
    • Can’t overemphasize the importance of having an answer prepared about short tracking.
    • For the residency interviews –
      • Consider that most advising/mentorship for residents is focused on helping them find a subspecialty and do research during residency. You probably won’t want/need either of these things. What does the program offer for a candidate like you?
      • A lot of residency programs have cool components that you won’t participate in (primary care tracks, international health programs, etc). Will you be able to benefit from the diversity in your residency class?
      • Elective time during residency can be particularly helpful if you are trying to figure out what your subspecialty will be. If you already know, can you use the elective time for to get a little bit more rigorous training, if you’re only going to be there for two years?
    • For the fellowship interviews –
      • Most of these issues have been discussed above, but it’s important to keep an eye on how welcome physician scientists are in your area of interest, and how academic the program is overall.
      • As mentioned before, if your sub-specialty choice has further sub-sub-specialization (EP vs. cath vs. heart failure, etc.), find out if your research interests limit your access to areas outside of your focus, or require you to accelerate your decision of what to focus on.
      • While you don’t want to give the impression of avoiding work, you probably want to know out if your lab time is pretty well protected.
      • All of the other typical questions apply here – clinical mentoring, junior faculty outcomes vs. percent going into practice, etc…
    • For the scientific interviews, most of what you will probably want to think about with your scientific interviewer is already discussed above.
      • If this is someone you might be considering for a postdoc mentor, it’s helpful to find out if they have any connection with the department you’ll be a fellow in (and if that’s necessary).
      • If you’d like to have a translational component to your research, but are looking mostly at basic science labs, it’s helpful to make sure that collaborations have occurred in the past, and that the PI you’re considering is comfortable with it.


Pathology:

The majority of research-oriented residents seem to decide to do either AP-only or CP-only residency as this cuts residency by 1 year and lets you go back to lab earlier. Fellowships after or during residency seem to be optional, however clinical duties would be limited if subspecialty fellowships are not done.  For instance, clinical duties as an attending would be limited to autopsy if doing AP-only residency and no fellowship.   Note:  residents thinking of private practice should do combined AP-CP residency as jobs opportunities in private practice seem to be limited for AP-only and CP-only residents.

The majority, if not all, clinically-oriented residents seem to apply to combined AP/CP residency followed by fellowships of interest.  Jobs opportunities in private practice seem to be limited for AP-only and CP-only residents or for residents that have not done fellowships.  Combined AP-CP residency length: 4 years total (2.5 years of clinical requirements as specified by the AP Boards +  1.5 years  of CP requirements).  4th and 5th years would be used for fellowships.

Anatomical Pathology, AP-only applicants:

Length: 3 years total (2.5 years of clinical requirements as specified by the AP Pathology Boards +  0.5 years of research elective).  Research-oriented programs may let you fudge these requirements and do only 2 years of core clinical requirements.  Third year could then be used entirely for research or for completing a clinical subspecialty fellowship before a formal post-doc.  Exception to the latter is subspecialties that require an additional subspecialty board examination besides the general AP boards (Dermpath, Neuropath, Hemepath).  These fellowships required 3 yrs of AP and passing of general AP boards before entering into these fellowships.  AP boards seem to be required before entering surg path fellowship, which means 3 years of residency/research before becoming a surg path fellow.  Note:  board requirements seem to change year-to-year and  it may be worth checking them when applying.

After 3 years of residency/fellowship, during a formal research post-doc, most research-oriented programs guarantee 1 to 3 years of salary support or until obtaining a KO8 grant at the corrensponding PGY level if the resident/fellow decides to do a formal post-doc.  This funding support seems to make residents/ fellows more attractive to join the  lab in terms of the PI's perspective. Some programs have formal names for this kind of pathway, and the number of years that are guaranteed depends on the program:

Clinical Pathology, CP-only applicants:

Length: 3 years total (1.5 years of clinical requirements as specified by the Pathology Boards +  1.5 years of research elective).  Research-oriented programs may let you fudge these requirements and do only 1 year of core clinical requirements.  Second and third year could then be used entirely for research, or for completing a clinical subspecialty fellowship during second year before a formal post-doc in third year and beyond.  Note:  Hemepath fellowship requirements are changing and it may be worth checking them before applying.  For instance, Hemepath will require passing of general AP or CP boards before entering into this fellowship, which would mean 3 yrs of residency + 2 yrs of fellowship. 

Salary funding during a formal Post-doc after the 3 years of residency/fellowship at the corresponding PGY level is similar to the description for AP-only residents mentioned above.  Note: the writer was an AP-only applicant, and details for combining CP-only residency, fellowship and research should be double checked for each program.

Other Fields:

2009 applicants in OB/Gyn and radiology felt that while the PhD was a useful academic credential, there was no specific component of the residency application/interview where it played a role. However, in other fields (listed alphabetically) it did:

Neurology:

Neurology is a field that is extremely welcoming to MD/PhDs, and for those starting with neuroscience PhDs, it is not a challenge to connect previous research with career goals. Most programs offer some elective time for research (3-6 months in the last year), but there were no specific subsections of programs to apply to. Most of these programs have funding for this built in to the program or the investigators' labs.

Psychiatry:

Psychiatry is another field that is very welcoming to physician scientists. An MD/PhD is heavily recruited, particularly if his/her stated goal is to return to basic sciences. Many of the interviews are done by physician-scientists, eager to talk to about your research and to try to recruit you to do theirs as well. Essentially all of the top programs offer some sort of research track, though there is a lot of variability. Some have a separate match number, others have a limited number of spots in their program, and others let anyone who wants to be on the track. Because there is no set track from a national level, there is also quite a bit of room for negotiation. Most research tracks offer a block of protected time during the second year (2-3 months), 20-30% research time during the 3rd year (spread throughout the entire year, so usually 3 half days each week), and anywhere from 50-100% time during the 4th year.

Radiation Oncology:

Radiation oncology has become an increasingly competitive field over the past 10 years. 6 months of research are required during residency. However, with the Holman pathway, the total number of clinical months required to boarded is 27 out of 48, with the remaining 21 months used for bench research.  Not every program sponsors Holman and there have been some discussions between departments whether two years in the clinic is sufficient clinical training to then go on to practice -- some programs have added one year fellowships, which could then be used to exclusively conduct research. There are also many possibilities of training in one place followed with fellowship/post doc in another which seems to have been a very popular path in the past for physician scientists.

Afterword:

Once again, please bear in mind the limitations of this guide. It comes from the experience of one MD/PhD class. There are no details on specific programs, as those are likely to change, and multiple fields are not covered. Hopefully it will be useful enough to future classes to be expanded and updated.