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I know I want to have a non-clinical job. Do I need to do a residency?

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Q.I need some help in figuring out whether I need to do a residency. I’m an MS3 and need to start thinking about what programs to apply to if I want to match when I’m an MS4. The thing is I haven’t liked the clinical work that I’ve done or my rotations so far. I’ve been looking into nonclinical jobs and really think these are a better fit for me. I’m hoping to get a job in consulting, and have read that most companies don’t pay any better if you have done a residency or not. Is it ok to skip doing a residency? I don’t really see the point if I’m not going to have a clinical career and there are jobs for physicians without residency. I’m afraid I’d be really miserable the whole time, too.

A. In most cases, I strongly advise that everyone do a residency. I thought long and hard about not doing one myself, and I’m really glad I did one. The first reason I highly recommend residency is that the formal training legitimizes you in medicine.

Sure, there are jobs for physicians without residency. But having an ABMS board certification is a requirement for a surprising number of non-clinical jobs and, if not required, it’s often considered a plus for the applicant. It also gains you respect among physician peers. Depending on the nonclinical field you’re in, you may be working with other physicians. Whether or not it’s ‘fair,’ some of them would have a lower level of regard for your professional competency after finding out that you have an MD but no post-graduate training.

Second, I don’t advise that salary potential play a role in determining whether do a residency. (It’s reasonable for it to play a role in the type of residency you choose, but not whether to do one.) The salaries in clinical careers and in nonclinical careers both have such a wide range, it’s hard to know while you’re still in medical school where your particular salary will fall. Even if you don’t do a residency, you could still change your mind about wanting to do consulting and decide to work in biotech or another nonclinical role. These can all have very different salaries based on what your position is.

But let’s suppose for a minute that you continue to want to go into consulting. I’ll assume you mean management consulting for a company like McKinsey or BCG. You’re correct that, in general, a starting salary for an MD at one of these companies would be about the same whether you’ve done a residency or not. Despite that, though, don’t discount the experience, skills, and knowledge that you’d acquire during residency.

That extra 3 to 6 years of training can leave you with an understanding of certain topics and with expertise that could be a huge help to you and your team on certain consulting projects. Your success on these projects could lead to you being promoted quickly. With that promotion would come a salary adjustment and an increase in your value within the organization. See where I’m going with this? Your residency is likely to set you up for success in consulting.

Third, it’s hard to be certain during medical school that you want a career that’s 100% nonclinical, and to know without a doubt that you don’t want a clinical job in the future. Without intending to nitpick the way you phrased your question, I want to point out that you “really think” nonclinical jobs are a better fit for you. You’re not 100% sure, probably because you haven’t yet had the chance to try out a nonclinical role as a physician.

I know right now the thought of doing years of extra clinical work when you ultimately don’t want to be a clinician is an exhausting thought to have. But don’t let this get you down. You have almost two years of rotations left in med school. Use them to find some aspects of clinical medicine that you enjoy, and capitalize on those. Use them to assist you in finding a specialty in which you can stick with it for residency. You’ll be glad you did!

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