Residency or Research?

I got a note today from a medical student who asked: "If I'm deeply interested in research and I don't see myself practicing clinical medicine, what should I do? Pursue residency? Get a PhD?"

This can be tough to answer because it really depends on so many variables. First, how do you know that you won't enjoy some type of clinical medicine? Have you considered all the options, or only the most common ones? Towards the end of the clinical clerkship years, medical students have gotten exposed to most of the common medical specialties, but they probably haven't rotated through specialties like pathology, PM&R, preventive medicine, and several others.

If you're absolutely certain that you don't want to pursue residency, then step back and look at your long-term career goals. For instance, if you want to do clinical research in pharma, then you probably should do a residency, publish some papers, become an academic faculty, and then make the transition. You don't need an MBA to be a researcher for industry.

If you want to work in hospital administration, then you'll need to have practical clinical experience. Hence, you need to do a residency to really understand the nuts and bolts of managing a hospital system.

My advice is always to try residency first. If you give it a fair chance before you pursue other options, because it's often very difficult to go back to clinical medicine.

The road to a PhD can be a very long one, so if you know that you want to focus on basic science research, then you may want to start down that path earlier than later. However, I would still encourage you to give residency a chance (and try to look for some creative options).