Academic medicine mentor thread

Finding a personal mentor can be a challenge, but the hard work is worth the reward. Mentors can serve as a source of personal and career guidance, be a role model and provide their mentees access to learning and career resources.

Some questions to ask yourself as you search for a personal career mentor
Am I comfortable with this person?
Do I admire this person professionally?
Would I be able to discuss my career candidly and confidentially with this person?
Is this person's career one I would like to emulate?
Is this person well-respected by peers and colleagues?
Is this person part of a well-established professional network?
Is the person positive, enthusiastic and helpful?
Am I personally ready to commit my time and energy to developing a mentor-mentee relationship?


Best of luck!


Adapated from the American Journal of Health-System Pharmacy Volume 64, Number 12 by All4MyDaughter. No copyright infringement of any kind is intended.

maia said:

mentors?

Any advice on doing that in school? online?

how do we approach them? or introduce ourselves?

What if we don't know yet what we are looking for in a mentor? Or what we want to do later?
Is it okay to ask someone to be a mentor with those 2 questions?

Click to expand...

Here are some ideas that may be of help:

1. Finding a mentor(s) is the responsibility of the student at every level. It's nice if the institution helps, but it isn't the institution's responsibility to find you a mentor.

2. Mentors who look like you are not ALWAYS the best mentor. I've seen way too many people disappointed when a person of the same gender or ethnicity or religion turned out to be an ineffective mentor. Sometimes it's the person, sometimes they may be trying to mold the student excessively to their own vision.

3. Mentors should be willing to distribute the students to others to talk to about their needs. If someone comes to me interested in a different specialty, I'll send them to a person in that area to talk to, not BS my way through the pros and cons. So, start with the person you think can help you FIND the best mentor, not necessarily the person in your field. If they think you should be "sent onwards", they will.

4. Mentors should be willing to share of their own personal life. Few if any folks spend time with me and don't learn about my family. Mentoring is about the person, not just the career.

5. I realize in looking at this answer that I didn't respond to your "how to approach them?" question. Any reasonable method will do. A simple call or email that says "Hi, I'm maia and I wondered if you had some time to talk with me about career issues" will work. Try twice - if no one answers, move on....Always arrange a personal meeting to start. You need to judge their interest and they need to judge your suitability to be guided by them. Also, I really mean it that true mentoring (not just a quick piece of career advice) is a personal relationship with someone. So, be prepared to share a bit about yourself. Nothing "too" personal, but, if you want someone to help you along, is it unreasonable to tell them a bit about yourself beyond your Step 1 score?

Hope these ideas help.

A few more thoughts on this topic:

1. It is easy for mentors to focus on having their advisees work with them - stay at their institution, do research in their lab, etc. It is tougher for them to send you away. Keep this in mind and try to have multiple inputs into big career decisions. Mentors may genuinely believe it is in your best interest to stick with them, even when it is time to move on.

2. In general, this is a one-way relationship. Unless you are working FOR your mentor in a lab, etc, then they are giving you time, insight and valuable counseling and you have little you can give back. That's okay, but be respectful and understanding of this. Your success is the mentors reward. A very nice reward I might add.

3. Don't let a mentor take advantage of you to babysit, copy articles, etc unless you really want to do these things and even then, keep it to a minimum. I've seen too much of this sort of thing, especially among grad students. See #2 above. This isn't a balanced relationship and you don't owe this sort of thing to your mentor. That doesn't mean you can't help out at times, but don't let yourself be used.

4. What you do for your mentor is to listen, say thanks occasionally and then return to others one day the helpful mentoring that you received. And in an emergency watch their kids for 30 minutes....

5. Take every chance you can to use your mentor to network. Go with them to meetings, etc. Don't be a pest, but always think about how you can learn more from your mentor. Don't expect them to always "lead" you to insight and experiences.

I think it would be helpful for those who have worked with a mentor to comment about their experiences both good and bad. Please add the comments on this thread and they can be reviewed and added to the thread.

This thread is for those at any level who are thinking of a career in academic medicine, especially those looking to combine research, teaching and patient care (and administration) in some mix.

I have done this for a while and serve on the faculty promotions and tenure committee at my school so I have some idea of how academics at a research-oriented medical school works.

Questions about salary and specific institutions I'll pass on, but questions about the practical side of an academic career I'll try to answer. I'm trying to get a few "younger" academics to participate too.

Questions once they have one answer will be deleted per protocol...however, other mentors should feel free to quote and continue the discussion!

Here is a FAQ about what academic medicine is.

DoctorPardi said:

Are there limitations to the scope or cost of medical research performed by MDs?

What I mean to say is, without a PhD, are MDs as likely to receive grants and other funding for their research projects?

Also generally what is the highest percentage of an MD's work week that can be devoted to research vs clinic?

Click to expand...

These are a couple of great questions and commonly asked. I'll answer them in multiple responses to make it easier for ultimate indexing of this and other threads. Also, as the answers are a bit longer than usual for this forum, I may need to go back and edit and add to my answer over the next few days.

First, who am I and what do I do? I am an MD without a PhD. However, after doing my clinical training I spent three years at the NIH intramural program (as an NRSA for those familiar with the program) basically doing an additional research post-doc. My research/clinical breakdown is about 75/25, but that is very misleading as I'll discuss later. My research is about 90% funded via federal sources and about 10% via private or foundation. I would characterize my research as "translational" with a stong clinical component and collaboration with some basic scientists. I run my own laboratory and on occasion actually do lab work.

My lab group includes MD and PhD post-docs as well as research associates and study coordinators for the clinical studies. I do not have any graduate students or medical students working in the lab full-time at the moment but have had them in the past. I have lots of college students and post-bacc type students who work for me part-time in the lab however and always have.

DoctorPardi said:

Are there limitations to the scope or cost of medical research performed by MDs?

What I mean to say is, without a PhD, are MDs as likely to receive grants and other funding for their research projects?

Click to expand...

I serve on grant review panels for the NIH occasionally although I have never been on an established study section.

Investigator initiated research grants (R01 and similar) are reviewed for the "science", but the review includes an evaluation of the investigator and the facilities available for the proposed research. These evaluations are to be based on training, productivity and ultimately the likelihood that the investigator will do the project that they propose. As such, it is a bit like medical school admission in that the reviewers have a range of opinion on what they might think of the investigator. However, it is very different in my experience from medical school admission in that it tends to be more "fact based." That is, reviewers will count up the number of peer-reviewed papers produced from the invesigator, consider how they used previous grant funds, etc. In my experience, personal biases are relatively low. I suspect this is very variable.

Training grants contain a much larger evaluation of the individual. These grants, such as K08 grants given to starting faculty are mentored and the funding is primarily to support the individual with only a small amount fo the project itself. Furthermore, these grants usually go to people with a very short track record to go on. As such, the evaluations are more subjective and include a strong component of evaluation of the mentor and their laboratory, etc.

How does that relate to your question? Well, in general, I don't think that the actual degrees a person has are considered as much as what they have done with their education. An MD who did a 2-5 yr mentored training grant and has been productive will not get "dinged" on the investigator evaluation of an R01 because they don't have a PhD. On the other hand, a PhD and post-doc can be a time in which careers are started with publications, etc are produced which enhance early grant applications.

On the whole, there is no area in which MD-only researchers cannot work and be funded. There are benefits in terms of being able to demonstrate your training background to being a PhD or an MD/PhD, but there are other options for getting the research training needed to be successful in the grant application process for MDs. I know numerous surgeons (non-MD/PhDs) doing basic science so it is certainly possible to do basic science and clinically intensive work.

The MD/PhD, etc forum has many debates about the relative benefits of going MD/PhD and I don't want to recreate that here, only to say that all training is beneficial. If it works out to go MD/PhD and get research training that way, great. If not, MD-only folks can and do perform all types of basic science research as well.

DoctorPardi said:

Also generally what is the highest percentage of an MD's work week that can be devoted to research vs clinic?

Click to expand...

I have seen every value from 0 to 100% of an MD's work week and funding that is research. But these numbers are misleading for a lot of reasons.

The problem is both with the use of a % to determine time spent in one area and with the impossibility of dichotimizing ones time in this way. Here's what I mean:

First, everyone wants the label of % time. It's needed on grant applications, it's a fundamental part of training grants ("No more than X, where X usually is 20-30%, can be spent on clinical activities") and of course, is commonly talked about in career counseling.

The problem is that what matters more is how much time you spend on one activity and how it relates to your other activities. If I am on the clinical service for a month everyone would count that as time spent 100% clinically. That is ridiculous - I still run a lab, handle emails related to my research, revise manuscripts, etc. I may spend MOST of my time at the hospital, but not 100%. Even if traveling, I'm still doing that. When on the clinical service I work MORE hours to make this all work. Pct time calculations don't take this into account.

Also, as we move along in our career, we tend to spend more time at home doing things like reading the medical literature, editing papers, reviewing papers, etc. Does this count? What if I'm watching a baseball game at the same time? My kids multi-task and I can too, although I have trouble watching the game, writing a paper, and listening to my iPod at the same time like they can. I never can figure out how many hours/week I work (the denominator for the % time calculation) because I can't even figure out IF I'm working (am I working now?).

The other side is true too. Time listed as "research time" is often, for practicing physicians, not nearly as pure as one might think. Post-call need to go home early, clinics, telephone calls from patients, and of course, endless clinical meetings, CME conferences, etc, fill up any academics "protected research time."

An equal problem is that academic medicine has 4 aspects, not just two or even three. The other two are of course "education" and "administration." The amount of time spent on these goes up as one advances in the career pathway in academics. These are generally "unfunded" activities as well. If I spend one hour/month or one hour/day teaching, mentoring and posting on SDN it is all compensated the same (essentially not at all) for me and most folks on research/clinical career tracts.

Administration means attending hospital-based committees and running programs. Hard to tally this up, but it increasingly takes up time. Not simple to categorize these activities as research or clinical or even teaching. Not nearly as much fun as teaching, but can't be avoided either.

Well, you get the idea....

bottom line, clinical time often ranges from about 20-80% for typical academic faculty (if there is such a thing), but it's a nearly-meaningless number in most cases! What matters is how much TIME you spend on each activity and how important it is to you.

Pemberley said:

When I shadowed academic physicians (a team of pediatric subspecialists) for a few months, they all told me that academics afforded a doctor great latitude to choose his own clinical/research/teaching mix. However, none of them ever did more than 10% clinical, and all of them were starting from a viewpoint that 75-90% research was the key element of a "good" mix.

What sort of positions are there for people who love to teach and want to stay heavily involved in patient care, but don't want to spend most of their time running a lab, soliciting grants, etc.? Would such a job (if it exists) be considered part of academic medicine at all?

Click to expand...

Absolutely! In many medical schools lots of the "Academic faculty" do very little research. In some cases they can be called "non-tenure track" and in other cases, there can be a clinical-educator "tenure track."

This is true for almost all fields. Some subspecialty fields, especially those at large academic hospitals, may be nearly all primary research faculty. You probably were shadowing some of those folks. Even in those areas, however, the clinicians are around to carry at least some of the burden of patient volume. Remember that academic institutions need both clinical patient $$ AND research $$ to thrive. For another time, we can consider how clinicians and researchers relate to each other in that setting!

GTsquirrel said:

I am a biology major, and I have been working in a lab for a professor for almost a year now. I took a class with him last spring, and I guess I did well enough for him to ask me into his lab. I have been doing research this semester and last semester as well. Although I think that the research has allowed me to apply what I have learned from classes, I don't think I really enjoy doing it. My goal of course is to go to med school, but unfortunately I did not score well enough on the last August MCAT to get accepted into medical school this year. Back in January, I talked with my mentor to ask for his advice on what I should do in the event that I don't make it in this year. He suggested that I take on a master's degree with him and then try medical school again in one year. Although I did appreciate his offer, I am just not sure doing a masters will help me out. I will have to go through classes and worry about my GPA all over again, and it is not required to have a master's in order to get into medical school. I feel that I already have a solid undergrad GPA (3.93), but my MCATs are the only thing holding me back right now. I was a little concerned about what the post above mentioned: the fact that my mentor may be keeping me in the lab for his best interests and not mine, but I don't want to believe that is true, but it is still a possibility. I am not sure yet of what I am going to do for the next year, but my plans are to get as much clinical experience as I can because medicine is what I want to do and getting clinical experience will be more helpful to my career than a master's in biology. I am just not sure if admissions officiers will see my gap year as "productive" if I only volunteer a few days of the week.

Click to expand...

Unlikely that the mentor was trying to "use you" in this situation, but, if in doubt, ask another faculty their thoughts.

kanzure said:

For students without access to university campuses quite yet, what are the standards for hunting down mentors of any calibur, such as students or professional mentors? Maybe some AIM, YIM, MSNM, emailing, or web-forum discussion setup.

Just wondering. I guess this stems back to the age-old "Adopt a Newbie" program that even the (online) computer scientists have been pondering, at least in the beginning programming forums.

- Bryan

Click to expand...

SDN is the best overall internet site for mentoring I've found, although as with anything, one has to be careful. I suggest hanging around a while and getting the sense of different boards and deciding who to PM, etc. When you get to campus, if there's a med school nearby, it'll become a lot easier.

Sorry, I'm a big believer in personal mentoring, not the on-line stuff. You can start on-line, but...I like to see folks face-face.

My dog (see avatar) likes to check potential advisees out by licking them and seeing if they feed him. No food for Tildy = no mentor relationship.

SuperMentor said:

Hello, I have been interested in an academic career in medicine for probably greater than 10 years, love teaching aspect and ability to do translational research, however, I would like to practice half time in a developing country out of the year, and the other half of the time in an academic setting in US. Obviously financial planning and viability are an issue, but in terms of finding half-time employment in the US say a pediatric sub-specialty are there centers that support this? Also, if I am willing to do clinical work in an underserved area, such as in Africa 5-6 months of the year and do research as well, are there grants for this? Thank you for any information you could provide me with

Click to expand...

In general, the academic world will work with people who want to spend time internationally. The arrangement you have in mind is rarely done however due to the difficulty of fitting a whole years work into 6 months. It can be done, but is hard to arrange at the start of a career. Pediatrics is likely to be among the areas most willing to do this, especially for those with public health training, but, you would almost certainly be looking at one of the larger children's hospitals with whom to come to an agreement.

If what you want to do is take a group of folks overseas twice a year for a few weeks to do primary care health, it won't register on the radar of most places. In academics you have a lot of control (usually) over your schedule and a few weeks for something like this is easy to arrange. If you are collaborating on some clinical projects overseas and go over a few weeks each year to work on them, go to conferences, etc, it'll similarly not pose any real obstacles.

For longer-term arrangements, such as you are interested in, you'll need to find money to support this. I know academic medical folks who spend a good bit of time fund-raising for their clinic overseas. If it's research-related you'll have to go after grants, etc. This has the same issues that it would in the US. These grants can come from foundations, from companies, or from governments.

If you have a background in public health, this will help. Keep in mind that research-related grants, especially from governments are not that easy to get and ARE competitive. US funding sources will focus on the needs of the underserved in the US and overseas agencies may not be enthused to fund an American. You need to find a niche, a unique research area that people want to work with you on supporting. These exist (tropical medicine, HIV, nutrition, etc), but you need to have a track record of research or work for someone who does. Consider how you feel about working on pharmaceutical trials. Even if you are willing and can make the arrangements, your research has to be done under "Good Clinical Practice" guidelines, which isn't easy to arrange.

AMPed said:

I am a non-trad applicant who has been working in research for about 9 years after graduating from college. I have a solid record, include 15 papers (4 1st author), abstracts and a patent. I had been working towards applying to MD/PhD programs over the last year, but was recently advised to apply MD instead. The logic is that with my wealth of research experience, the PhD would be superfluous for my ultimate goal of becoming a physician scientist. I am concerned about applying to the right MD programs, however. I have a good amount of clinical experience shadowing doctors in several specialties but little volunteer experience and no hands on clinical experience. I was comfortable applying MD/PhD because my credentials lend themselves well to their mission of training physician scientists. However, I am concerned that AdComs at traditional MD programs may be looking for students with more clinically oriented goals. How can I find MD programs which are interested in training future physician scientists? Should I just use the US News Research rankings? NIH funding? Published mission statements? I appreciate any advice. Thank you.

Click to expand...

I believe that your background would be perceived very favorably by most medical schools including those not at the top of NIH funding lists. If you have a clear reason for going for the MD degree and a reasonable enough shadowing background, then "volunteer" or "hands-on" experience isn't needed for MD-only either. Be prepared to explain both why you did research for 9 years before applying to medical school and some idea of how you think you'll be using this knowledge in your career.

I suppose there may be a few medical schools that would be less inclined to accept someone who expresses an interest in research-oriented academic medicine. I believe these will be a small minority and you'll be able to identify these from the application process, including their websites and interview feedback, etc. Most will welcome you, as long as you express yourself and your goals in going into medicine clearly.

You could try to identify schools that have research years intrinsic to their program (Duke and CCLCM come to mind) or have a strong program of allowing and arranging extra research years, but I'm not sure that's necessary.

HarveyCushing said:

I am just wondering if you could comment on the salary and work hours at a academic setting vs. private practice. I know that this will ultimately depend on the physician, but could you make generalizations. Is it true that PP you make more and will have more free time, i.e. not as many committee meetings and other responsibilities (teaching/research) as you would have in an academic setting?

Click to expand...

The differences between academic and private practice in both salary and work time are so variable by specialty, place and academic rank that it is extremely difficult to make generalizations. Furthermore, the lines between academics and private are increasingly being blurred in many, but not all, medical and surgical specialties. I can only speak to my own experience and I've asked others in different areas to hopefully comment when they can. This is important as the gross oversimplication that academics get paid terribly compared to private practice is common among those in early stages of their career.

In my area, it is true that people starting as attendings now in private practice can and do make on the average a salary relatively comparable to what I make as a tenured full professor. They work (clinical care) more hours/week by far and do all clinical time, whereas I do only about 20-25% clinical time and the rest as research and teaching/administration.

The "paycheck" salary can also be a bit misleading. For example, as tenured faculty I receive a stipend that helps cover my children's college tuition. I also have a substantial educational and travel allowance (both directly and via my research). I don't worry about billing, arranging malpractice insurance, hiring office or other staff, etc. These all happen, but I don't have virtually any of the headaches of doing it. A am aware of a number of veteran attendings in my field who have left private practice to do academics (clinical faculty) for less salary largely so they don't have to deal with these issues.

Most importantly is that I love the job that I do. I like teaching and research as much or more than clinical care. I've been fortunate to be continuously funded by the US government for all of the last 19 years for my research and currently am very involved in a medical journal and do a large amount of mentoring at all levels of the academic world. This diversity allows me to remain enthusiastic about medicine as a profession. I'm not sure I'd be "as" enthusiastic if I was working 50% more hours for 100% more salary and driving a 200% more expensive car living in a 300% more expensive house.

Hope this helps. Academics isn't for everyone or even for most, but, it has been great for me, even though at first glance the money isn't as good as private practice. In the future, for those interested in research, the NIH loan repayment program may make the differences even smaller for many new faculty.

Chulito said:

Dr. Tildy-

Thanks for being so thorough in your responses and so clearly dedicated to being a good e-mentor. It's much appreciated.

My question has been almost asked already, and thus almost answered, but I want to hone in on it a bit. I'm a soon-to-be MS1 and very interested in academic medicine, teaching, mentoring--I've been a teacher in one capacity or another for ten years and love it--and leadership, but not in basic research. I could easily see myself pursuing a position as a residency director. I also love and am excited about clinical work. There are three details that you may be able to help me sort out.

1) Are positions of leadership in academic medicine more limited for people who do not wish to engage in research? I.e. is a position as a residency director out of the question if I don't publish in my field (or at all)? Would it make a difference if I were to engage in scholarship and publish in pedagogy and medical anthropology, but not bench or clinical medicine as they are traditionally conceived?

2) Leaving aside the question of leadership, can you give a rough estimate of the percentage of people in academic medicine who find a niche as clinicians and teachers but not researchers? Is it more difficult to get these positions as a newly minted physician than for those who are later in their career and who are easing up on formerly vigorous research activity? Is it even possible for someone still wet behind the ears?

3) It's often taken for granted that landing a residency at a high-calibre academic institution requires that an applicant do research and publish. Is this true even if the ultimate goals of the candidate do not involve research? Can one not set him- or herself apart in other activities that reflect clinical and educational goals instead?

General answers are what I'm expecting, but if you happen to know anything particular about EM and hospitalst IM/Peds, I'm essentially certain that I will pursue a career in one of those areas, and am leaning strongly towards EM at this point.

Thanks again. You've been a tremendous help.

Click to expand...

No need for the Dr. Tildy bit. If there's food around, Tildy doesn't much mind any form of greeting.

First of all, don't be so sure you won't publish. Not all things that are published are large controlled trials or gene therapy studies. There are case reports, there are textbook chapters, etc, etc, all published by folks who don't do any lab work or run large trials. The emphasis on multi-centered trials leaves a lot of room for clinical collaborators at many locales to be involved too.

To answer your question, no, one doesn't need to be a researcher to run a residency program, etc. In fact, many of those jobs, like sitting on committees and deciding on care standards, equipment needs, and the like are readily delegated to clinical faculty.

I really can't give you a % of academic faculty who do basic/clinical/minimal/no research. It is highly dependent on institution and field. Physician faculty in genetics for example would be nearly all researchers. Physician faculty in many surgical subspecialties would be much lower. As a first approximation, the old medical rule of 1/3's might apply. That is 1/3 primary research, 1/3 clinical research and patient care and 1/3 virtually no research. Regardless, you can find a niche. It's nice to have some interest in supporting clinical invetigation at universities - even if you don't do much your colleagues may and need your help in it, but you don't have to do it. It's not necessarily harder to get these jobs right after residency/fellowship at all.

I think the premise of the "high caliber" academic institution is off. I don't know of any "low caliber" institutions. Each contributes to the development of the next generation of physicians and to the development of new ideas about patient care. As such, there are many ways to set oneself apart - these include developing new teaching strategies, improving patient care outcomes, etc.

I'll pass on discussing specific fields.

Hope this helps!

Let's think about what we can reasonably expect a mentor to do for an advisee. Lets assume for a minute that we're talking about a medical student advisee and a faculty mentor.

1. Meet with the advisee and discuss in detail their performance in medical school and any particular problems they've had. The purpose of a mentor is not to write your letters of rec so you don't need to "hide" the fact that one faculty member on a rotation said you were "dumb" and another one said that his grandmother sewed faster than you do. Lay it out there...the purpose is to guide you and that can't be done unless we know what your experiences really are as well as your strengths and weaknesses. If you can't share this stuff with a mentor, then find another. Faculty are aware than not all students honor everything.

2. Talk with you about career plans. Repeatedly and in a serious and all-encompassing way. This is obvious but it's amazing how uncommonly this is done for medical students. The usual thing is that on each rotation, the students are asked "Do you want to go into our field?" Most quickly learn to lie and say yes, or lie and say maybe. The mentor should be asking "What fields interest you?" Then listening to the answer and developing options that the advisee can test out.

3. Be available and understanding when things go wrong. No, they don't have to help you with your break-up with your S.O., but they should be there when you don't get the Step 1 score you expect, when your mother/father is diagnosed with cancer or when you are treated abusively on a rotation or in any setting. I'll deal with some of these (often multiple times) almost every year with someone. My reponse can be just an "it'll do" and that a "240 isn't that bad a Step 1 score" . Othertimes it is a "you should take a month off to spend at home" type advice. Rarely, it is "I need to intervene with a dean and get you out of this situation."

Your mentor is not just a friend to tell you "everything is okay" and "I'm sorry." These are often the right advice and may be given, but the mentor is there to advise you, in a professional capacity, on how to deal with significant problems that occur. Rarely, they should be prepared to advocate for you in more serious situations.

4. In the best of all worlds, a mentor is there for a long-time afterwards. They should be around, by email or phone, years and years later for questions. They KNOW you and can be a long-standing source of advice and support. Finding the right mentor is a bit like finding the right "life's partner" - once you have them, don't let go!

QofQuimica said:

Hi Tildy,

I am a PhD organic chemist now in medical school. Right now I am undecided about what direction I want to take, except that I know I definitely want to do research primarily. I also really enjoy teaching and working with patients. I'm less excited about doing administration. Do you have any insight about choosing among careers in academia versus industry versus government? How does a physician scientist-to-be decide where to go?

Click to expand...

Well, lets take on the "academia" vs "industry" one since it's not commonly thought about by medical students and is a different issue than "academia" vs "private practice."

I've never written this comparison up, but lets work through it. I've known a sizeable number of practicing physician-researchers who left academic life to work for industry. Why do they do it?

1. Money - huge difference is possible in pharmaceuticals. Especially with stock options. Pharm companies are always recruiting for physicians who understand research. At a more senior level, it's less to actually do the research (they'll hire PhD's for basic science and non-physician study coordinators for clinical study management), than to manage the medical side of the studies and provide product leadership.

2. Jobs being offered in pharmaceutical companies don't require you to get grants. Lots of folks are sick of the NIH grant system and I don't blame them. Award levels of 8-10% for R01's are very, very frustrating.

3. A chance to develop products both in basic science and clinical research that are directly applicable to human health. This can be a big motivator for some.

4. Tired of clinical night-call, etc. The grind of running a research lab and doing clinical practice is wearying after a bunch of years.

Okay there are the positives. To keep the post reasonable in length and make sure I don't lose it...I'll go to some negatives in the next post.

QofQuimica said:

Hi Tildy,

I am a PhD organic chemist now in medical school. Right now I am undecided about what direction I want to take, except that I know I definitely want to do research primarily. I also really enjoy teaching and working with patients. I'm less excited about doing administration. Do you have any insight about choosing among careers in academia versus industry versus government? How does a physician scientist-to-be decide where to go?

Click to expand...

Okay, now for the other side of the academia-industry discussion. I've also known more than a handful of physician-scientists who went to industry and hated it and either came back or retired or bounced between jobs. Some of the reasons I can identify are:

1 Above all, the culture of corporate America is vastly different that that of academic medical centers. It's a huge, huge culture shock. All of a sudden the big-shot researcher from the Ivy league school has a bean-counter as a real boss. They're expected to justify expenses, produce money-making results, etc.

2. Stock options haven't exactly been sky-rocketing in many companies over the last 6-8 years. Whoops, not getting as rich as we thought we would. Many companies use performance benefits, etc, even for senior scientists.

3. Without trying to put down industry/pharma here, lets just say that they don't always have the same view of public interest that an academic scientist has. Easy to get disillusioned. Hard to keep advocating only for one company or product.

4. Travel - and you go where and when the boss wants you to go. Not as much fun as academic travel many times.

5. Crisis management. I'm amazed how much time the corporate folks have to spend on this. A patient has a complication from your product, etc and you're up to your ears in pressure and headaches. Not what was expected.

6. No patient care, no teaching, just meetings and meetings and meetings.

7. Broken promises - the corporate world isn't an R01 - you aren't guaranteed 5 yrs funding for your project. It can and is pulled away from you if it isn't going where the bosses (bean counters) want it to go....

What about government? I'm not entirely sure what you mean here. Lets first dismiss things like FDA jobs. Not many of these held by physician-scientists and who'd want them? A daily root canal would be easier and more fun.

Intramural NIH research positions (i.e. jobs at the campus in Bethesda, MD, where I spent 3 years) can and are held by MD and MD/PhD types. It has become a tough spot to be at though. Salary is very low and the rules associated with the job are frustrating. Travel and consulting rules are unbelievably restrictive. The research support money comes easily (relative to extramural grants), the scientific atmosphere is amazing (sometimes), but the lifestyle is lousy.

For the most part (there are exceptions to this), it's not possible to practice medicine while doing intramural research at the NIH. This hurts the $$ for the physician-scientist as well.

Bottom line, these are extremely presigious and tough jobs to get, but few make it a career once they discover that they need a living wage and get tired of the NIH hierarchy and politics. A long time ago I was offered the equivalent of a starting faculty job at the NIH and said no. It wasn't a difficult decision. I couldn't live off of what was offered.

There are a few other government-type jobs for physician scientists - CDC, USDA, USAID and I'm sure others I'm not thinking about will have some jobs. But these are rare and almost never starting positions. CDC has some excellent physicians, but there are not too many positions and I don't really know much about how one gets those jobs or how much they pay. I doubt it is much and they probably have rules similar to the intramural program.

To put it all together, I think that someone with a PhD who is in med school who has any real interest in patient care should do a residency and postpone the career decisions of this sort. Most folks will probably be better off if they want to do bench research in academics at least to start. With a true committment to academic research (for another day we'll talk about why academic careers go badly for some), many will be successful and make a career that way. Then you can decide about going with industry later on, with a clear view of what you expect to get and will demand from industry before making the move.

Hope this helps. I welcome your comments on this thread!

QofQuimica said:

Someone mentioned to me that if I'm only after a license, I really only need to complete an internship year. Is that true? What is the minimum amount of graduate training I need to get in order to be a licensed physician?

Click to expand...

This issue comes up occasionally on SDN - you might search it out. In the past, you could get a license after one year and that was useful for moonlighting and urgent care center work. My understanding is that this is not possible in all states anymore. I know of some researchers who a long-time ago did that so they could function as admitting doctors for research patients.

I believe that in the current era, it would be almost useless not to do a full residency. I don't think that hospital priveleges to do anything useful could be obtained without board eligibility, which requires 3 years in IM/peds/FM and I believe most ER residencies. Without that, you could use your MD as a way of getting into industry or government, but I don't think you could practice much medicine. There are others on SDN who know more about the state laws related to this issue.

I write about 30-40 letters of recommendation/yr for students going into medical school, residency or fellowship. I also write evaluations of people for various grants and other programs. All total I easily write about 60-80 or more letters or fill out some form FOR someone else each year.

The requests for this frequently come to me like this - I get an email sent at 2 AM saying:

Hi, Tildy, this is "summerstudent" who worked with you in your lab 4 years ago. I'm applying for a grant to go to X country for the summer from the "Association for ........ students." You know I'm committed to this, and it was great of you to encourage me when I worked with you. So can you write me a letter of support. It's due next week. Thanks!!!

I write back:

Dear "summerstudent": This is great and I'll be glad to help, but do you think you could send me:
1. A link to the program you're applying to so I can see what they are interested in supporting.
2. A copy of your current CV
3. A copy of the letter you are sending to get this grant
4. Anything else that will help me write this letter.

Now, you can laugh, but similar requests come to me for letters for ERAS (residency app) as well as med school applications. The writer may be sure I remember them well, but they don't realize that I'm more than a bit senile and may not really remember that their grandfather came from X country and that is why they are committed to going back there. Even if they are currently working for me, this information will help me make a non-generic letter.

I do not ever have students ghost-write their letters and I don't want them to do it. I do want them to help me make a letter that will actually be read. Since I read literally thousands of letters of rec each year (I am an adcom and a faculty promotions committee member, remember...), I know what makes a good letter. But it takes knowing the person a bit and it helps, a whole lot, to have this information. Send it with the request for the letter. Make sure, if it's something unusual you are applying for (e.g. a foundation grant), that you tell the mentor as much as you can about who and why this is suited for you.

In another post, we can talk about creating a CV as a "Student" and how to document your accomplishments!

strangeglove said:

I'm just about to complete an MD-PhD and am entering a residency in psychiatry. I published more than average during my PhD, including a first author Science paper, and also obtained a pre-doctoral NRSA. With these qualifications, will I be able to get a tenure track physician-scientist position (similar to Tildy's job) right out of residency, or will I be expected to complete a post-doc of some kind?

Click to expand...

Hi:

I don't have enough experience with psychiatry to give you a specific answer. In general, after completing the usual training in a field, most institutions will give someone the "assistant professor" title. At a few places, it may be an "instructor" slot that has be be moved up to a tenure-track assistant professorship.

In medicine and pediatrics, those doing research will usually enter these tracks after a specialty fellowship (e.g. endocrinology), whether they were MD-PhD or not. But, in some areas where fellowships are not commonly done then it might be directly after residency. I would defer to the MD-PhD board on how often folks do a traditional PhD post-doc, but I have not usually seen this done after residency as most folks are ready to make the money that comes from practicing medicine. There are alternative approaches within the funding hierarchy (various types of training and mentored grants) that can be used.

My guess is that with your background, you'll find an institution willing to support you with start-up funds right out of residency so you can do some clinical and establish a research lab. In looking for such a position, it can be very helpful to find somewhere that has a good match for a research mentor for you. This will help in the early aspects of getting grant-funding for your position. The real key will be for you to carefully, with the help of a trusted person in your field, evaluate the offers you get in terms of protected time and start-up funding as well as lab resources. It can be exciting to be offered a first job as an "assistant prof", but the devil really is in the details of the offer.

dbhvt said:

Hi, Tildy. I'm a first year medical student interested in academic medicine. I have heard that it is difficult for surgeons to get protected time for research because the hospital can take a big financial hit if you're not in the OR. Also, the surgeon-researchers that I know about are mostly basic science researchers. I'm interested in surgery and clinical research--outcomes, decision making, and the like. How difficult is it to get this to work?

Click to expand...

Hi - I've been trying to recruit a surgeon to answer that but they're all doing PCR's and high resolution mass spec these days. I think there are lots of such opportunities, especially in the specialty surgical areas, but I need to defer to the wise advice of a surgeon. I'm posting this to see if any come and have an answer for you better than this.

Tildy said:

In medicine and pediatrics, those doing research will usually enter these tracks [tenure track assistant professor] after a specialty fellowship (e.g. endocrinology)

Click to expand...

Chulito said:

In response to the bolded sentence, within academic medicine is this need for fellowship-level subspecialization mostly only true for people who wish to be hired as researchers? Would you say that people looking to work in academic medicine as clinicians, teachers and administrators can apply for jobs after EM, IM or Peds residencies, for example, or would it be more normal (or at least prudent) to follow with fellowships a la EM + PedEM, IM + endocrinology, Peds + PICU, etc.? If the latter is the case, what about dual residencies such as EM/IM, EM/Peds, IM/Peds? Would these adequately take the place of a residency followed by a fellowship, or is the specialization not thorough enough?

Click to expand...

Those who are going to enter a clinical academic faculty track (most commonly referred to as a clinician-educator track these days), would need to be board eligible in whatever they were going into. In the past, it was reasonably common for people to finish residency in medicine or pediatrics and join the clinical faculty and work in a clinic setting. In some places these people would be "instructors" and non-tenure track. In other places, they might be "Assistant professors" and might or might not be tenure-track. For another time we can consider whether tenure-track has any meaning for non-research faculty.

Nowadays, non-subspecialty trained clinicians in medical school academics may have done other additional training as a hospitalist, in academic general pediatrics or some other form of additional training. Some such folks may have MPH or MBA or master's in education giving them a niche in the medical school. There are still folks going from residency to clinical faculty without these, but I believe this is less common nowadays with these alternatives.

In an of itself, dual residencies, such as med/peds wouldn't be the same as a fellowship, although a shortage of med/peds academic faculty would mean that med/peds graduates are needed for clinical and teaching work (and to develop and direct residencies). Combinations involving EM are best addressed to the EM threads.

strangeglove said:

It seems odd to me that someone who is interested in doing 75% or more time doing basic research should need to do a fellowship in a clinical area. I know that this is the usual path, but what purpose does this training serve if one is going to spend most of one's time in the lab? Is this because the only physicians in academic medical centers are sub-specialists? If not, couldn't one work in the lab most of the time and be a generalist in the clinic, even in a field with multiple subspecialties?

I have a feeling that the reason why physician-scientists are expected to do fellowships is that, historically, the fellowship is where most of them obtained their research training. However, for an MD-PhD, who has already obtained research training - arguably beyond that provided by a fellowship - it seems that a fellowship would be somewhat redundant.

Then again, I suppose that an MD-PhD who has been out of the lab for >4 years of residency may be considered to be in need of research refresher. Also, an MD-PhD usually won't have a grant in hand when applying for a tenure track job after residency, unless there was time in the residency to collect some data and write a grant, such as a K. Some residencies, such as psychiatry, do allow for a year or more of research time.

Click to expand...

Thanks for the thoughts. I think many of the clinician-scientists want to do specialty care in medicine or pediatrics. Fellowship training can serve as a form of post-doc for those with extensive research background. I've seen many change their area substantially.

swoop said:

Hi, I am starting med school in August. I believe I am interested in academic medicine. I have done bench research and don't particularly enjoy it. I think I might be more interested in clinical research, but truthfully don't have that much experience. What is a good way to go about getting involved in a project? While remembering I will be in school. I have read about the NIH Clinical Research Training Program, but have no idea what makes a competitive app and what I can do towards that during the early part of medical school. Thanks for the information.

Click to expand...

A lot depends on what school you are at and what the resources and experiences are for medical students to do clinical research. Some schools have the option of taking a year off and doing research fairly well built into the program. For others, you may need to do some arranging.

It isn't all that necessary to do such a year however at this phase of your training and decide about academics. It may be more effective to go through the first 2 years and even some rotations to determine where your interests are. Depending again on available faculty, you may be able to help out with a small project by helping recruit, enter and analyze data, review the literature or charts, etc. Some of these tasks are a bit like scut-work, but so is research at times! It can astound folks that even professors, after a lot of years and seniority, sometimes just have to sit down and enter data themselves to see what they are trying to find. I prefer to do most of my data analysis too, although of course consulting with a professional as needed.

If you have trouble finding a good mentor and project at your school, and really want a year to see if clinical research is for you, there are some programs out there. The NIH CRTP program is certainly worth looking at (link goes directly to listing of projects, you can get to the homepage from there).

So, I'd not worry about it too much right now and see how school goes and where you develop interests. As you meet profs, start asking them about clinical research and see where that takes you.

strangeglove said:

Given that academic positions usually pay less than private practice, some of us who are interested in research may want to spend a few years after residency in private practice before pursuing the academic route. Would this affect one's chances of getting a fellowship? How about later success at getting a tenure track job?

Click to expand...

It's usually seen as a positive. A bit of real world experience often makes for a better fellow. However, I've known many a person who planned to go back to fellowship after practicing for a few years and didn't do it. Hard to take that type of cut in salary and increase in hours, as well as back to "learner" status. Some do it though.

vkrn said:

Do you feel that MD grads who are nontraditional students, finishing residencies in their early forties, would not be considered for a serious academic position in clinical research?

What roadblocks would such MDs have?

Click to expand...

I have never seen that to be a problem and have known several people who fit that or a similar description.

southpawcannon said:

I've barely had the chance to read in detail what you all have said, but will check back again soon being that I am interested in doing some teaching along with practice, ideally with a university known for it's research. Will this thread remain up should I have any furthur questions once I have the chance to read more thoroughly your responses?

Thanks again

Click to expand...

Well, unless Lee deletes my account it should be around for a while...

anon1235 said:

I was curious if where you goes to medical school affects your career in academic medicine. I have heard many times that you should go to the cheapest med school possible, unless you want to go into academics. Is this accurate?

Your advice is a great help!

Click to expand...

I was waiting for this. I anticipate I'll be asked about affirmative action and academic medicine and whether DO's can do academic medicine soon.

Actually, this is my first ever true opportunity to use my favorite smiley.
I've always wanted that chance, so thanks.

Okay, on to your question...

First, as always with unanswerable questions, it's worth giving a couple of personal anecdotes. After all, if the question has no answer and there are no data, what else do we have but experience?

I graduated from a state medical school and a small-program, non-academic residency. When going for fellowship, I recieved a letter from one place that said basically (I'm paraphrasing here) "Tidly, you may be a loyal and good dog, but your breeding line is weak and you can't keep up with the big dogs here." What was interesting about that was that I had never actually applied there, just send them a letter asking about the program. I've saved that letter and I use it in career talks I give. Everyone has been told they don't belong with the "big dogs" at some point. So, remember these affronts and get even by proving them wrong.

On the other hand, I interviewed at arguably 2 or the 4 most well-known programs in the field, both offered me positions and I accepted one. I've always considered sending that place that turned me down based on geneology a copy of my xth peer-reviewed paper or my nth funded NIH grant, but I haven't.

I currently review a lot of applications for grants as well as academic appointments and promotions. Never, ever have I seen anyone care about someones medical school. Really. Believe me or not, it doesn't matter, this is the way it is and I review across a fairly wide range of topics, not just my specialty. Some of the best research in certain fields is performed in places you would never think of as academic powerhouses. State schools, small private schools and the like are filled with tremendous academic faculty who contribute to every type of research.

So, bottom line, I can't resolve this endless debate for you or for SDN. This debate will go on forever. I can tell you that there are some academic centers in some fields that care about what medical school you went to. A lot more, however, give it very little if any importance.

So, pick the school that has the program you want in the place you want at the price you can afford. If it is a top academic center, well that won't hurt. If it is a place that has the type of faculty interests and programming that you are interested in - well that's even better. If it's a place that you are comfortable with and leaves you without a massive debt, well, that's the winning school to get your degree at.

strangeglove said:

You don't seem to differentiate between medical school and residency. While I would agree that where you go to medical school is probably not that important for an academic career, I wonder whether whether where you go for residency actually does matter. I've certainly heard many times as I've applied to residencies in psychiatry: "It doesn't really matter where you do a residency...except if you're interested in an academic career." I mean, if you go to completely non-academic residency (i.e residency at a place where there are no fellowship programs), wouldn't you miss out on getting letters of recommendation from people who are recognized in a given subspecialty field. Also, if you go to an academic residency, aren't you more likely to learn about how things work in an academic setting, such as what a fellow does?

Click to expand...

Despite the anecdote that merged the two, I thought I was otherwise clear that I was only referring to med school. If not, be assured that I was only referring to medical school. Residency is too variable to generalize - in some fields it matters where you go, in others it matters very little and in others, like psych, I have absolutely no clue as to whether it matters . Questions about that should be directed to specialty threads like the EM or pediatric thread. If you think a thread for psych should be started, suggest that in the suggestions thread.

Thanks

Taty said:

If I want to ask a person to be my mentor,what is the most appropriate way to do it? Should I ask in person? Send an e-mail? What if the person who I want to be my menor is actually a professor in another medical school? ( I think that she has enough medical students following her).

Click to expand...

A phone call or email is fine. Remember, you're not asking someone initially to be a "mentor" you're asking them to have a meeting with you about your career. Then, you'll see if they seem interested in continuing to advise you. If they are at another med school and that school is too far to just go for a visit to talk, I'd not use them as a primary mentor, but would set up a time to talk on the phone and see if they are interested in advising you.

Venom said:

I think it would be very beneficial to have an SDN mentor. How would I go about finding one?

Click to expand...

I'm unaware of any such program on SDN. I suggest posting your information and interest in being guided in the forum that most closely matches your career goals and see what happens. As always, SDN being an anonymous internet site, should not be the only or even the main source of career advice, at least until you get to know someone here well, and hopefully have met them.

In other words, I suggest finding someone you can talk to in person.

staup said:

I was wondering, does anybody really know the difference in salary between academic medicine and private practice. For instance, how much would an oncologist at a mid level academic institution like jefferson earn verses private practice? or how about at a more prestigious place like ucsf? I am very interested in academic medicine but also have a huge loan burden and worried about paying off my debt.

thanks for any help.

Click to expand...

The difference in salary is far too varied by field, location, experience, work hours, and other factors to generalize in a meaningful way. Sorry, I can't begin to answer this and I have no idea at all about oncology at Jefferson or UCSF. Perhaps suggest to the site suggestion thread here that heme/onc mentors be sought? Even if you get an answer, it may be very different in 8-10 years.

cardsurgguy said:

I'm interested in academic medicine since I love the environment of the academic teaching hospital for many reasons

1. It's usually the referral center with all of the specialties that see the most complex cases.

2. I love teaching and want to teach the rest of my life. I'd love to teach medical students and residents on the units and even give a lecture here and there to medical students.


HOWEVER, what you don't see on there is research. This is because I really can't stand research. Just not my thing to say the least.


Question is...Can one be a physician at an academic medical center who practices medicine and teaches, but doesn't do any research at all?

Technically it "can" be done obviously. After all, if you're the best _______ist in the country, then every center will want you regardless of if you want to do research or not.
But how common is it overall?

Click to expand...

You won't be the best _____ in the country the day you finish your training, no matter what your natural skills and ability. So, if you want to do academic medicine, you need to fit within the system while you develop into a great clinical track (teaching and patient care) academic doctor. This is common and a great route, but nonetheless, it is still a "developing" process, not a given based on clinical skills. A bit less common as the level of research at any given institution goes up, but there are plenty of those folks everywhere.

Still, consider that collaborating with academic colleagues doing clinical research is actually "fun" and quite worthwhile. Someone who demands to never be part of research is cutting off a possible important career aspect, even if they never go in a lab.

strangeglove said:

My sense is that the more prestigious the institution, the lower the salary and the harder it is to get promoted. This is a generalization, of course. Please correct me if I'm wrong.

Click to expand...

hmmm, I'd guess the r-value is about 0.3, with an R-sq of 0.09

But, I would love to see the data on this.

Location and specialty would be huge covariates here. Not sure about gender.

In other words, maybe it's slightly true, but not the major factor, especially among the top 30-40 research institutions.

Pemberley said:

That does sound like a good compromise position... can you elaborate a little more on how opportunities like this are structured, and how a newly-graduated-from-fellowship physician goes about finding them? I'd been under the impression that the research question was all-or-nothing: either live in a perpetual grant-proposal-writing purgatory as the head of a lab, or don't do research.

Click to expand...

First lets deal with the "purgatory" comment. There are multiple types of grants. The usual ones are "investigator-initiated" in which a scientist proposes an idea and goes out and tries to get $$ for it. The money can come from a federal source, a non-profit non-governmental source (i.e. a foundation or organization) or from a for-profit company. Sometimes these are "competing" and othertimes, especially when dealing with for-profit companies, they can be non-competing - that is, one contacts the company tells them what one wants to do and they say yes or no. Grants can be single site or multi-centered. If multi-centered there is almost always a single coordinating center and a single principal investigator. Usually the investigator has primary control over the conduct, interpretation of data and reporting of results.

The second type of grant is "non-investigator initiated" which usually means it originates from a pharmaceutical or similar company. These too can be single site or multi-centered. "Control" is variably given to the investigator in designing and changing the study design. Final reporting of data is generally done by a scientist not associated with the company, but this is variable as well.

For an academic physician, this variety of research modes gives them the opportunity to be involved in many studies without writing grants that are peer-reviewed. One can be the PI on a pharmaceutical grant, one can be the site principal investigator on a multi-centered investigator initiated trial, etc, etc. Overall, the majority of physicians involved in conducting clinical research are not the ones who struggled through writing the grant.

Of course, after a while, one might discover that one wants to ask ones OWN questions and it's worth it to write a few proposals and send them in for competitive review. Nothing beats getting a "yes" no matter who it comes from! If that is your WHOLE livelihood, it is high pressure, but for clinically practicing physicians, that usually isn't the case. There are the big NIH type grants, but also lots of small foundation grants.

For example, have an idea that would make the life of a person with a disease like rheumatoid arthritis, Crohn's disease or diabetes a bit better? Doesn't have to be a "curative" drug - could be nutrition-related, mobility related, pain-related, etc. These diseases have foundations that support relatively small grants to fund this type of research that the NIH won't touch. Sure it's competitive funding, but nothing like the NIH battle to get funded.

Hope this helps. Lots of folks finish fellowship, do academic medicine but don't run labs and still do research!

Magus said:

Hi Tildy,


My only question is...do you mainly see the rare cases in academia rather than the usual routine cases? If so, do you ever feel deficient in providing clinical care to patients compared to the care of private practitioners?

Thanks again, and keep up the good work.

Click to expand...

Academic docs see a ton of "routine" cases. We do so in several situations. First, when on the patient care services, we handle cases that come into what are variably called the "house" service or various different names. These are often cases where the patient does not have a regular doctor or is from out-of-town, etc.

We also do in-patient consults in various situations, many of which are not unusual cases but just situations in which the private physician can not or does not wish to take care of it or wants a second opinion that it really isn't something unusual

Although in clinics, academic docs see a disproportionate amount of unusual cases, we see tons of bread-and-butter cases too.

Finally, academic docs regularly supervise trainees in various settings in which they are seeing routine cases.

Bottom line. We see plenty of everything. I like the variety between ordinary cases and unusual ones.

sekem said:

Hi Doctor,

Do you mind me asking what is the philosophy behind the "It's a dog's life" below your user name on SDN?

Click to expand...

Tildy is my dog (see pic). Any other interpretation is projection.

Don't worry, Tildy is a happy, well-fed dog.

Hard24Get said:

Dear Tildy:

I am a MD-PhD student graduating next year, and I am really interested in translational medicine in EM. At this point I am trying to come up with an image of my future self interms of what type of research I will conduct. Since you mentioned you are doing translational medicine, I was hoping you could give me your take on what translational medicine is (since everyone has a different def), how you do it, and how it should be done in the future. Also, what is your opinion on the new CTSA grants? Any advice for us translational medicine hopefuls?

Thanks!

Click to expand...

I'm not the best person to go after definitions for on this sort of thing. In general, I think people are using the term to refer to studies done using the tools of molecular biology as applied to patient populations, although there is no doubt that others are using it in terms of some forms of animal research as well.

I think the increasing use of the concept is important in developing the transition of research to clinical applications, without using a drug company, etc. That is, it is a way of using federal dollars to move basic research to product/drug/nutritional development.

There are others more familiar with academic EM and they can answer here or you could post on the EM board, but I think this has lots of as yet undeveloped potential in EM. The new research into resuscitation with less than 100% oxygen, etc is a good example. But, I think it will take time and some work to make this become common in EM. Still, others may have more ideas and I'm certain that it is possible, perhaps especially at the interface of EM and trauma care, resuscitation, fluid management, etc.

The CSTA program of tranlational research centers is new and I don't have any direct experience with it. If it works, it will be very good for those who have an MD/PhD and an interest in this type of bench to bedside work. Let's see what happens!

meowkat444 said:

I am applying to MSTPs this year, and while I know it's a long way off and I might change my mind 32781 times, I'm wondering if people generally do a residency that lines up with their phd? I'm probably going to do a neuroscience PhD, so i guess it would make sense to do a neurology or psych residency. However, I'm fascinated by surgery (again, I know I don't have to decide for years). Is there a place for people whose residencies and PhDs might have slightly different foci?

Click to expand...

This is better addressed to the physician scientist forum. I'm sure there are lots of folks whose residency doesn't line up well with their doctoral thesis, but anything more than that should be addressed there.

Although it's nice and at times useful to consider your relationship with a mentor as a bit analogous to a "personal" relationship, in addition to the obvious, there is another huge difference. Your relationship with your mentor should NOT be exclusive. It's okay to cheat on them, with or without their knowledge.

What does this mean? This means that as the advisee, you have the right and obligation to obtain multiple opinions related to career decisions. Some may be part of long-term "mentoring" relationships and others from brief discussions held in the hallway. It is useful to get "outsider" opinions at times.

Most faculty understand this well. I will often be asked by a fellow in another area advice about getting a starting faculty job. I talk to them about the options and then will try to let the persons usual mentor (if I know who it is) know the basics of the conversation, while maintaining the fellows privacy about their plans and concerns.

When does this go "wrong"? Well, although I don't run into this often, it is certainly possible to have a jealous or possessive mentor. This usually happens in the context of a research laboratory situation. Some faculty will have trouble with fellows or trainees moving into a new area and can be upset by outside faculty "talking" to "their" fellow. I don't really see this much in the clinical area, but I suppose could happen.

Bottom line is that it's a trainees right to get multiple opinions and have multiple mentors. There doesn't have to be a "principal mentor" and the trainee is under no obligation to tell anyone about who else they are getting advice from. Open discussions are useful, but sometimes one needs to "cheat" a little to make sure the original "partner" is where you want to be.

It's okay!

Really

Anastasis said:

Earlier you posted that a mentor that looks exactly like you isn't always the best situation. So I have a question that is somewhat related in my mind. If you have no idea what speciality you want to pursue, would it be reasonable to just pick a mentor that you get along with personally and whom you respect to mentor you until you become more focused on what you want to do with your career? I worry that perhaps the mentor would perceive this as a waste since you aren't committed to their specialty.

I guess more generally my question is: For someone who isn't sure about what kind of medicine they want to pursue, how would you suggest they go about finding a mentor willing to work with them on that front?

Click to expand...

My answer on this might surprise you a bit. That is, I would advise you to be very cautious of getting too much mentoring from someone in a different field than you are interested in and thus I would delay identifying a real mentor until a bit clearer on your goals.

Let me explain a bit. In the past, most medical students didn't really get too much career advise until at least their 3rd yr and the start of rotations. Then they found a faculty in that area and talked with them a little. Many, including me, didn't really look for "mentoring" until residency when it was time to look at sub-specialties.

Nowadays, there seems to be a bit more of a push to identify areas of interest and get advice early in medical school. Some of this may be driven by more non-trads who have a clearer idea of both what they want and how to obtain and interpret career advice. Regardless, medical students want career counseling and mentoring from an early point.

The problem is not so much with wasting the time of someone not in your ultimate field, but of them giving you biased information. Although SDN isn't necessarily the best perspective on this, just look in any of the graduate forums and see what people, including attendings, routinely say about other fields. Unfortunately this is common in the "real world" as well. Legendary disputes between specialties become ingrained in the attitude of faculty and private practioners. Much of the information provided about other fields is simply factually wrong and outdated.

So, if you are really unsure, do a good of talking around your first 2 years but wait until third year at least to get too focused on advice from faculty. Then, make sure that any specialty you have any interest in is represented in your input database by a true expert!