After MD/PhD training, what do you do? The world is in fact your oyster 🦪, but in this post I’ll outline how you can continue on the physician-scientist pathway while also continuing your clinical training.

First, a note. You do NOT need to continue to practice medicine as a physician-scientist. Aka you do not need to go to residency. You go to residency if you actually want to provide care to patients as a physician. If you just want to have your current level of medical training (MD/DO/MBBS) inform your work as a researcher or in another space (i.e., academia, industry, government, or elsewhere), you do NOT in fact need to go to residency (save yourself the time – this is already a long road 😫).

This is a post for if you do want to practice clinical medicine and the next step of your journey is residency. In this case, there is a division of paths based on the specialty you plan to practice. I am going into internal medicine, so that is my bias, but here I will try to link to resources that can be helpful for hopeful physician-scientists in other areas of medicine, though my advice and experience is coming from the perspective of internal medicine.

Typically, you apply to residency at the beginning of the 4^th year of medical school. Applications are due in September through the Electronic Residency Application Service (ERAS) and interviews are scheduled from October through January. To further explore specialties in general, check out the AAMC Careers in Medicine resource (link).

Research in Residency

If you’re interested in wet lab research (e.g., biology, chemistry) or other research that is more time consuming, you may want to look for a program that has dedicated time for research. These come by many names. Depending on your chosen specialty, I recommend searching residency program websites for how they describe their research opportunities during residency.

In internal medicine, I found programs titled “Physician Scientist Pathway”, “Physician-Scientist Track”, “Science in Residency Program”, “ABIM Research Path”, “Physician-Scientist Training Pathway”, “Resident Research Path”, for example. Basically, there’s a lot of different names, so a google search for one of these terms will not bring up all the programs that fit the same description.

Despite the variances in names, these programs often followed a similar format. In internal medicine, that format is based on the American Board of Internal Medicine’s (ABIM) requirement for internal medicine training. There is a specific research pathway approved by the ABIM that is recommended only for physicians who intend to seriously pursue a career in basic science or clinical research. Within this pathway, there is an option to “short track” residency training to 2 years of internal medicine training instead of 3, with a required subspecialty fellowship training of 12-24 months of clinical requirements (length depends on subspecialty) plus 3 years of protected research time. This protected research time is really the important part of this training because this is setting the basis for your future research/lab. It is possible that other specialties have similar policies that dictate how residency programs may be able to shorten your physician-scientist journey.

The Long Road

This certainly sounds like a long time, especially after 8-9 years of MD/PhD training (some people can get into these pathways without the PhD but they have usually spend a number of years doing research outside of medical school that yields publications, so that is often almost a similar amount of time). Let me put this into perspective:

I can go through the ABIM research pathway, where I do 2 years of internal medicine training, 1-2 years of subspecialty fellowship clinical training, and 3 years of protected research training, for a total of 6-7 years of postgraduate training as a physician-scientist trainee. I may need 1-2 more years of research to get funding/papers that would make me competitive for a research position, but then I’m still on the track for an academic research position.

Alternatively, I can *just* complete my clinical requirements of 3 years of internal medicine training and 2-3 years of fellowship training, for 5-6 years of postgraduate training as a physician.

Or I can opt not to practice medicine but I still want to do post-doctoral research in a lab with hopes that I can get an academic faculty position. As an example, one of my grad school professors once shared the length of time applicants considered for faculty positions in our department had spent in their post doc training. These varied from 4-10 years, with an average of 7 years (n = 5).

Thus, you are looking at 5-6 years if you *just* want to practice medicine in a subspecialty, 6-7(+2?) years if you want to do a subspecialty and research, and 7 years on average if you want to *just* do research. It may be longer than some alternate options, but it may be more bang for your buck to do the physician-scientist route.

How to Learn More

It can be hard to know where to begin. So here’s a few of the main resources I used when preparing to apply:

• AAMC Physician-Scientist Training Program info page. Here you can find links to more specific info about different specialties including internal medicine, pediatrics, emergency medicine, and psychiatry, and pathology. Specifically within the archives, there are webinars on preparing your PSTP or research residency application, broader discussions of what is a PSTP, and many specialty-specific webinars (expanding beyond internal medicine).
• The American Physician Scientists Association has hosted many useful webinars including PSTP and RiR, Physician-scientist Residency training, and Ins and Outs of Physician Scientist Training Program Applications.

If you have any further questions about this next phase of training, feel free to reach out via the contact tab. I’ll try to continue producing this kind of content and it is helpful for me to know what is helpful for you!