How are the job prospects in academic medicine?

[PlebeianObserver]

Hello,

I'm exploring different career options within medicine, and academic medicine has always been stuck in the back of my head. My primary concern is that it would be difficult to find a full-time position; I know the job prospects in other parts of academia aren't great. How difficult is it to land a tenure-track position in medicine? Does the difficulty vary by specialty? What should one be doing in medical school and residency to increase the likelihood of landing a position? Does completing a PhD dramatically increase the odds of finding a job?

Thank you!

(I used the search bar, but couldn't find anything addressing my questions directly. I apologize if this has already been answered.)

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[QofQuimica]

Depends on what you want to do. If you want to be primarily a clinician and do some clinical teaching, my experience is that you will have job offers left and right. A PhD is definitely not necessary in that case. If you want to do research, others have already discussed quite extensively how much more difficult a path that is to travel. Even then, a PhD is often not necessary.

 

[PlebeianObserver]

Depends on what you want to do. If you want to be primarily a clinician and do some clinical teaching, my experience is that you will have job offers left and right. A PhD is definitely not necessary in that case. If you want to do research, others have already discussed quite extensively how much more difficult a path that is to travel. Even then, a PhD is often not necessary.

Primarily a clinician and clinical teaching definitely describes my interest better than straight research. I would like to do research, but it is secondary to clinical practice and teaching.

 

[tr]

Typically there are two, quite different career trajectories that can be described as academic medicine.

Tenure track positions are majority or entirety research, and are extremely competitive to obtain. You're competing for spots against a huge pool of smart and hungry PhDs who have few appealing alternative options. Salary is very low compared to a clinician.

Non tenure line positions involve mostly clinical care, with some teaching and an optional amount of research. These are not very competitive and the salary is typically well below what you would get in a clinical position outside academia, but well above what you would get on a tenure line. Competition is minimal because most MDs prefer the higher reimbursements they can find outside academia.

Sounds like you are interested in option 2, which is very reasonable and attainable as long as you don't mind the salary hit. Best way to set yourself up for this job is avoid accumulating an excessive amount of educational debt such as would restrict your choices down the line.

 

[mercaptovizadeh]

Typically there are two, quite different career trajectories that can be described as academic medicine.

Tenure track positions are majority or entirety research, and are extremely competitive to obtain. You're competing for spots against a huge pool of smart and hungry PhDs who have few appealing alternative options. Salary is very low compared to a clinician.

Non tenure line positions involve mostly clinical care, with some teaching and an optional amount of research. These are not very competitive and the salary is typically well below what you would get in a clinical position outside academia, but well above what you would get on a tenure line. Competition is minimal because most MDs prefer the higher reimbursements they can find outside academia.

Sounds like you are interested in option 2, which is very reasonable and attainable as long as you don't mind the salary hit. Best way to set yourself up for this job is avoid accumulating an excessive amount of educational debt such as would restrict your choices down the line.

How difficult is the basic science track these days? What % of R01 applications is getting funded? My sense is that every year I've been in clinical training the basic science path is getting narrower, harder, nastier, etc.

 

[dl2dp2]

How difficult is the basic science track these days? What % of R01 applications is getting funded? My sense is that every year I've been in clinical training the basic science path is getting narrower, harder, nastier, etc.

Most ICs: 8-12%. NEI is higher around 20-30%

There is a lot of backlog of existing grants that are scored well but not funded being sent in over and over.

It is now more common than not to have a funding gap. Plan accordingly if you want to continue in this track...1) everyone should do a residency. 2) think about exit strategies from day 1.

 

[purplerainbow]

Most ICs: 8-12%. NEI is higher around 20-30%

There is a lot of backlog of existing grants that are scored well but not funded being sent in over and over.

It is now more common than not to have a funding gap. Plan accordingly if you want to continue in this track...1) everyone should do a residency. 2) think about exit strategies from day 1.

Sorry, newbie here. By "exit strategies" do you mean a return to clinical work if the basic science path does not work out? Is that why you suggest residency?

 

[eteshoe]

Sorry, newbie here. By "exit strategies" do you mean a return to clinical work if the basic science path does not work out? Is that why you suggest residency?

Yes or if you decide to go to industry or something else entirely.

 

[dl2dp2]

Sorry, newbie here. By "exit strategies" do you mean a return to clinical work if the basic science path does not work out? Is that why you suggest residency?

Not necessarily. If you did a residency then yes that's one of the exit strategies. There are other jobs that would leverage your skills as a physician scientist: pharma, startup, business, government, etc.

Within the range of clinical work, there is also a huge variety. Other than the famous "clinical educator track" as above, there are other tracks, administrative, education, clinical and any mix thereof.

Depending on the field of PhD, it may or may not be necessary to do a residency. For example, if you did a PhD in some branches of computer science/informatics, you may be able to get a job in research at a tech company right out of MD/PhD that pays MORE than a typical physician scientist. Similarly, it may be possible to secure a very well paid and stable research job at a policy institute or think tank if your PhD is in healthcare economics without doing a residency.

I'm just saying that at this particular point in time, it's useful to explore all these options as a MSTP from day one, and see if you are drawn to any of them. It's becoming clear that even if you are a full time NIH sponsored researcher, you may have to exit at any time during your career if your funding runs out, and this becomes more and more likely as time goes on. The department may or may not be able to float you for a period of time without grant support, but there's no "tenure", or the money protected by the tenure is so small that it won't really make a difference.

I would think about physician scientist careers now as more of a portfolio management problem. You train a long time to have a fairly diverse set of skills that can be applied to a fairly diverse set of jobs. Different jobs have different characteristics: some pay a lot more and are stable, others may be more intellectually engaging but pays little (or nothing), and yet others may be both but competitive. Other than pay and security and intellectual engagement, there are other factors such as availability of jobs in specific regions and cost of living in these regions, number of hours required to achieve a certain pay, flexibility of hours for childcare, other "lifestyle" considerations etc. People also to a certain extent move in and out all the time now.

 

[SurfingDoctor]

I will say, depending on the specialty or field of medicine, there may be a number of jobs or there may be relatively few and maybe highly competitive. For instance, our division is hiring currently, and there are about 30 applicants (last time I was updated) for 1 spot and this was for a clinician-educator spot, not a clinician-scientist spot which can be even rarer due to the upfront cost to the institute to support a clinician-scientist trying to develop their career. Either way, the more experience and skills you have, like @sluox mentioned, the better your chances of 1) getting hired to begin with 2) retaining your position if funding runs dry 3) networking with other colleagues to open up new avenues to pursue you may have not otherwise been exposed to. In the beginning of one's career as an academic faculty, you need to protect your time to get your career started and fine your niche, but once that has happened, maybe year 2 to 3, you need to get your hands in as many things possible. That's just my own experience, just again, the more you can do, the more marketable (and retainable) you are. It is hard to say what the future academic market will be, but again in my experience, academic centers are non-profit and don't have the capital to expand like private hospitals or practice groups, so the number of new jobs is less than the private sector.