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Physician Scientist Residency - Student Advice

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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.

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.

Pediatrics for MD/PhD Applicants:

Pediatrics is a field that has traditionally been very enthusiastic about research, but its residency programs do not tend to have as many MD/PhD applicants as Medicine or Pathology. Therefore, you will be a big fish in a small pond, and you should certainly use this to your advantage. Many programs are eager to have MD/PhDs, and it is likely that you will be heavily recruited. In general, much of the advice listed above for Internal Medicine applicants applies to Pediatrics. The application and interview process for the physician scientist is not as well established and streamlined and as in Medicine or Pathology. However, several of the large academic programs do have special scientific interview days, during which you will have an opportunity to hear about a program’s research, get tours of the labs, and meet with investigators of your choice. Even if there is not a special scientific interview day then you will likely be interviewed by at least one physician scientist.

Accelerated training pathways (e.g. fast-tracking) are available to Pediatrics residents, though fewer MD/PhDs in Pediatrics tend to take advantage of these pathways when compared to those in Internal Medicine. This may be due to the fact that there is a strong emphasis on the importance of outstanding general clinical training when dealing with children, a patient population that traditionally warrants special safeguards. However, the American Board of Pediatrics does support three special/accelerated pathways for physician scientists during residency training. It is important to note that support for these pathways varies considerably at different programs, so if the ability to follow one of them is important to you then you should make a point to ask about them during your interviews.

1) Special Alternative Pathway (SAP) – This is traditional fast-tracking, which allows you to shorten your residency to 2 years and enter fellowship early. This pathway is not very popular, as it requires special permission and a high score on in-service exams during your internship year, and a number of residency directors are not in favor of it. You must also be prepared to apply to the fellowship of your choice during the fall of your intern year.

2) Accelerated Research Pathway (ARP) – This is similar to the SAP but you exchange one year of residency for an additional year of fellowship. This extra year is usually primarily research, which you would probably need anyway before applying for a faculty position, though you may have some clinical responsibilities during this year as well (likely to be very variable based on the fellowship program). Like the SAP, this pathway requires you to apply to fellowship in the fall of your intern year. However, it has the advantage of not requiring an exam and seems to be much more popular.

3) Integrated Research Pathway (IRP) – This allows you to do up to 12 months of research in place of inpatient clinical work during your residency, usually during your 3rd year. Some residency programs (especially smaller ones) do not have adequate flexibility to support this pathway.

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.