Thanks @thumper1 for your response! Do people planning for Phd usually prefer academically affiliated or it’s just a choice,.
High paying - high paying specialty later. I will wait for @WayOutWestMom’s response.
For me, “top residency” means one the student is after as a top choice. Different strokes for different folks otherwise.
My guy wants to go into med school teaching (I think), so being in a recognized top place for his specialty was important for him. He’s only finishing his 2nd year of residency now and it looks like he’ll be able to do what he wants to do. If he changes his mind, he has several other options open to him too. Actual location mattered to him too, so he didn’t apply to “all” the Top X options. Conditions within the residency also mattered. He loves a good, working team so paid attention in interviews and more to see what he felt about the vibe at each place. More didn’t make the cut after that.
For other future residents, different things matter and different residency locations are in the Top X even if that’s important.
I know some med students who want to stay local (to where they grew up or where family is), so for them location is top. They’re equally as thrilled when they get one of their top options.
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@hello06 are you talking about folks who have already done an MD/PhD program? Or are you asking about someone who wants to do a residency and then do a PhD?
Your question is confusing.
Top residency has several different meanings.
As @thumper1 alluded to, during the residency match process, med student apply to dozens of programs. Some programs will interview them; others won’t. After interviews are over, every individual will submit a ranked order list of programs they wish to train at. The programs likewise submit a ranked list of interviewed applicants they want to come to their program. A computer algorithm sorts all the lists and matches each applicant to one-and-only-one program. A program receive only as many matches as they have positions.
A video of how this process works is here: How It Works | NRMP
So someone who says they matched to a top program may be saying they matched to the #1 preference of all the places they interviewed.
But…
Residencies are also ranked in regional and national terms by various organizations such as Doximity or Becker’s which use factors like the the percentage of the teaching faculty who have publications, percentage of residents who go onto fellowships, percentage of faculty who are board certified in the specialty/sub-specialty, quality of education as ranked by current/past resident of a program, STEP scores of current/past residents, etc.
There are also reputation rankings among those within the same specialty. Most academic physicians will be able to tell you which programs are doing cutting edge research within their own field. Becker’s use this metric heavily for their rankings. Different specialty departments within the same hospital will have different national reputation
Residency rankings do not necessarily correlate with USNews med school rankings (which are trash…but that’s a whole separate discussion) or USNews specialty rankings (which are also trash). And top ranked residency programs aren’t necessarily attached to academic hospitals. For example, one of the top neurosurgery programs in the US is at Barrow Neurological Institute at St. Joseph’s Hospital and Medical Center in Phoenix. Denver Health Medical Center, Cooks County Hospital and U Cincinnati are among the top ranked emergency medicine residencies.
So there are lots of different ranking systems that people use when talking a “top residency”. Some mean their program is at a well known academic hospital like Yale or Mass General (which is where Harvard has some of its residencies). Some mean top ranked by peer reputation. Some mean best for sending its residents on to sub-specialty fellowships. Some mean top residencies as ranked by some ranking organization like USNews or Doximity. And some people mean top residency when they match to their #1 choice on their rank list.
tl;dr people use the meaning in all sorts of different ways, not always consistently
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Yes, when my guy looked at his Top X list to consider, he was using these - not US News or similar. Then he pared down that list based upon his preferences.
To earn PhD, one needs to be at a program that is part of a PhD granting university.
MD/PhDs earn their PhD as part of the educational process in med school. All MD/PhD programs are hosted by medical schools attached to a university.
Depending on their career trajectory, MD/PhDs will usually do a residency at an academic center that offers a research track. A research track residency has 1-3 extra years built in to the post-grad training to allow the young physician to start on their career-defining research. MD/PhDs will then usually go to sub-specialize in special research-oriented sub-specialties by doing research fellowships. Research fellowship programs usually have 1-3 years of additional time built in to the training process that will be devoted specifically to doing research projects.
Some MD/PhDs who plan to work in consulting, pharmaceutical, medical device, finance or other industries will do the shortest possible residency required to become board certified (typically in IM) then leave medicine to work elsewhere.
It’s possible to add a PhD after completing a MD. I know a young doctor doing this now. She completed an IM residency and started her pulmonology/critical care fellowship but became intrigued by an emerging systemic health problem she was seeing in her patients. She paused her fellowship to get a PhD at a nearby university not associated with her fellowship. Once her PhD is complete, she’ll return and finish her fellowship but likely won’t go into clinical practice. instead she’s headed for a career in public health policy and consulting.
Likewise, it’s possible to earn a PhD first, then attend med school. Both my daughters had at least 1 PhD in a biology-related field in their med school classes. Individuals with PhD can either pursue academic research residencies or purely clinical residencies, depending on what they want their careers to look like.
So there are lots of different ways to combine a MD and PhD. it depends on what an individual wants their final career to look like.
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Students in MD/PhD programs enter the match the year they are completing their Md/PhD programs.
As noted, if they have done the PhD part, they very well could desire an academic setting.
Since their rotations happen after the PhD part is completed usually…it’s also very possible that some of these folks desire to do more clinical practice…and that is reflected in their residency ranking choices.
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No residency is high paying. Residents get minimal pay for working very long hours.
Income post residency varies enormously. The differences are influenced by many factors including the specialty, the location of the medical practice, the type of medical practice (academic vs private vs large healthcare organization), the number of hours worked, etc.
Some family practice doctors earn more money than some orthopedic surgeons.
“Competitive residency” usually means a residency for a specialty for which there are more applicants than there are available training positions. Some are only modestly competitive; some are highly competitive.
The level of competitiveness for various specialties can fluctuate from year to year, though surgical subspecialties (neurosurgery, plastic/reconstructive surgery, vascular surgery, otolaryngology, urology, ophthalmology) tend to remain highly competitive because the of the length of required training and a lower number of available positions. These specialties require trainees to have years of intensive supervision which limits the number of possible training slots available.
There’s a lot data about the competitiveness of specialties to be found in thisreport: https://www.nrmp.org/wp-content/uploads/2022/11/2022-Main-Match-Results-and-Data-Final-Revised.pdf
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The match is out. Welcome to all those brand spanking new resident parents!
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Curious about this. Under what conditions do you see this happening?
FM locums.
FM hospitalist in smaller towns.
Recently saw an ad for a hospital in west TX/eastern NM offering over $400K for hospitalist. No nights, 4-6 weeks paid vacation, benefits including up to to $100k in loan repayments.
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anyway…
Congratulations to everyone who matched today!
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Matched IM in CA.
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Welcome back to CA 
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D matched at her #2 choice today! Her #1 and #2 kept switching places on her list as they both had features that were important to her. Needless to say, she is thrilled! We were with her during the match day event as were many other parents and family members. It was so much fun to see everyone so happy. D and her husband are leaving on Sunday for a well deserved three week trip to the UK and Europe after all of the parties/celebrations with classmates this weekend.
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My daughter is in the middle of an MD/PhD program, but shared their match list with me. 100% matched into academic medicine, with about a third choosing to do PSTP programs (more research than a normal residency).
As others have said, usually the PhD is completed before the rotations and the match year, so all of these new residents have already earned their PhDs.
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Congratulations to everyone who matched! What an exciting time!
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Sorry for the late update. SIL matched IM! He was disappointed to slide to #6, but happy for the US match. Being a Canadian/Irish med school grad made things much more complicated, but we are grateful and the kids are excited.
We are happy because he matched 90 minutes from home. We found an apartment and they are finishing the lease this week. Buying their tickets home next.
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@Boilerjoanne congratulations!!!
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