residency vs postdoc

[dl2dp2]

Wow, that sounds like some kind of fantasy to me. $1M startup and 5 years of 80% salary support? My jaw is on the floor.
I guess I wasn't really paying attention to what the monetary arrangements were prior to five years ago so I can't say whether things have changed recently. I can say that where I am, getting your own funding has long been emphasized as a priority. Our fellowship seminar was basically a class in how to apply for a K award and I am pretty sure it was that way for a number of years before I got there.

A couple of points
1. I have heard through the grapevines that so and so (MD/PhD in our field) got a K99 and such and such dept chair (at a top 10 dept, though not top 5) decided to give 1.5 mil startup (though I think no additional salary) for 5 years. This still exists. I've also heard another so and so getting multi million startups at a top 15 dept after being a K08 funded jr faculty at a top 3 dept with soft money only. I plan to do a national job search (and this really only involves contacting dept chairs confidentially) after (making the assumption that I was lucky enough to get one) getting a K just to scout out the market and not necessarily to move, and I think all of us should do the same regardless of our geographical limitations--and this is told to me by so and so at your dept. You haven't been checking out the rumor mill at the happy hours I see . Even at your dept I know so and so and so and so at a prominent dept across town who got startups at a very similar scale.

That said, just because this and that happened to so and so doesn't mean that it will happen to you and I. So yes, to be safe, let's plan on living off soft money for the foreseeable future. This means ??writing one NIH grant every cycle...

2. This is the crazy part: I started a small private practice. I can tell you without a doubt that if one is somewhat savvy, and lives in the right place, and has the right credentials, one can make as much money in psychiatry as one could in rad onc, especially in subspecialty care... Maybe ceiling is higher in rad onc, but per hour really not so different. This aspect is unexpected and is going to affect (1) where I plan to work in the long run (2) how to best integrate clinical care with research. I'm not really sure how this is all going to transpire in the next 5 years... but I don't see how I can give up my private practice if I had to move to a lower tier geographical location that cannot support such a practice, especially when in a few years my practice will be full of full fee cash patients and doubles my academic salary, even with the dept tax. My current impression is that the psychiatrists who are in full time private practice coming out of the top 10 depts on the wealthy coast markets are making an amount of money that's wildly out of proportion to the "average" salary statistics. They just never advertise it.

I'm willing to take a pay cut to do research, but I don't know if I'm willing to take a pay cut, not see private patient AND live in a less desirable location just so that I can get a large(r) startup and more space for animals (or whatever).

All this stuff is really complicated in my head right now. In many ways I actually think that the K system is a fabulous contribution that NIH decided to make, because in someways now they are the centralized gate keeper for the existence of such jobs, where as in the past the wealthy academic depts were the gatekeeper. And NIH can transition much faster in terms of cutting down spots. It's much better to end your academic career (or at least figure out a way to hedge it) now if your K doesn't get funded than cutting it down 10 years down the line when your R-renewal is denied.

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[tr]

It's not as much money as you think. Because the term was 5 years, that's $200K per year. A technician will cost you 50-75K of that once all benefits come out. Add a couple of grad students and 1/2 to 3/5 of all that money is gone before you can even buy any reagents. It's enough for you to get by for 5 years.

No, that's fair. After I wrote that post I realized I am long out of touch with the realities of how much it costs to run a basic science lab. But to be fair, it was more the idea of 5 years of salary support than the laboratory startup funding that threw me for a loop. Especially the idea that that would be for someone coming out of a 1-2 year fellowship/postdoc and who didn't already have a track record of demonstrably independent research and ability to obtain funding.

Once you sit down and write NIH grants you will see how little else can be accomplished at the same time.

My suspicion is that it gets easier and easier the more often you do it. The first K submission took me months. The response/resubmission was far easier. If it gets rejected again I'm just going to fix it up in response to the comments and turn it around again as an A0 (since it's now permissible to do that again). Certainly an R01 would demand manyfold the level of intensity, but should I at any point be in a position to worry about that it will be years from now so I don't see the point in ruminating about that just yet. I'm working on developing an R21 which doesn't seem to be too much worse than the K, although it's early stages yet.

I will tackle the second part of your comment first, regarding the department's commitment to the candidate. I don't have to state that not all chairmen or directors are reputable people and will tell you whatever you need to say for you to qualify for the application. You want the grant, and they want you to get the grant. But sometimes there is an understanding that despite what is written in the promissory note, they have no intention of hiring you without the money.

I think we're on the same page here. Obviously the 'departmental commitment' to the candidate is not worth the paper it's written on if the grant is not funded. However you stated that people who were actually already funded were not able to remain either, which seems far more concerning.

Regarding the K08's.... although they ought to be a golden ticket to any department in the country, in reality, the money you get from such a grant is a small piece of the expenditures a department will spend on grooming a young clinician-scientist. The K will only cover your salary.

That's just not true. I just submitted one. About half the grant was salary. The other half was research (plus some travel and training) expenses. It's not enough to start a basic science lab, granted. But it's enough to fund some reasonable work if you have the facilities in place (which since the K is a training grant and you are still working with a mentor, you well ought to have).

 

[tr]

A couple of points
1. I have heard through the grapevines that so and so (MD/PhD in our field) got a K99 and such and such dept chair (at a top 10 dept, though not top 5) decided to give 1.5 mil startup (though I think no additional salary) for 5 years. This still exists.

This is post-K99 you are talking about. Someone who can land a successful K99 is rather different from what gbwillner seemed to be talking about, which was someone on the job market after a fast-tracked residency with small research component, plus 1-2 year fellowship/postdoc (plus outdated PhD). If anyone in that position is able to land a K99 more power to them. I think for most people it would take more time than that. There are a couple of powerhouses here who established innovative independent research programs as graduate students and were able to negotiate lab space and technical assistance as residents, then shot through to faculty status without passing Go. That's fantastic, but that's not most of us out there. (Also the people I'm thinking of got started pre-recession.)

I've also heard another so and so getting multi million startups at a top 15 dept after being a K08 funded jr faculty at a top 3 dept with soft money only. I plan to do a national job search (and this really only involves contacting dept chairs confidentially) after (making the assumption that I was lucky enough to get one) getting a K just to scout out the market and not necessarily to move, and I think all of us should do the same regardless of our geographical limitations--and this is told to me by so and so at your dept. You haven't been checking out the rumor mill at the happy hours I see . Even at your dept I know so and so and so and so at a prominent dept across town who got startups at a very similar scale.

I admit that I am and always have been woefully ignorant of whatever latest rumor is hitting the airwaves.

That said, just because this and that happened to so and so doesn't mean that it will happen to you and I. So yes, to be safe, let's plan on living off soft money for the foreseeable future.

That IS soft money. The two cases you mentioned were both people who had their salaries and some research expenses covered by K awards. In order to write a K you have to be (as stated above) within 4-6 months of finishing your fellowship. Most don't get funded on the first shot, so by the time you resubmit you may well be already done with your fellowship and in a temporary Instructor or Clinical Asst Prof position. I could well believe that someone who already has a K08 (much less a K99) would be appropriately funded by some department somewhere to get set up with space, equipment, and maybe some additional help for hires.

Gbwillner said 1) that people who already had these Ks were not able to stay in his department because the dept literally could not offer them the space and resources to do the work despite that they were fully funded. That's tragic. He also said 2) that at some time in the past there was this '80/20 track' where someone who did not yet have independent funding for salary and research expenses would nonetheless be afforded startup funds as well as five years of salary/research support, all on the department's tab, banking on the idea that in five years they were going to be able to compete successfully for an R01. That sounds, well, like I said, semi-mythical.

means ??writing one NIH grant every cycle...

****ing guess so. Or whatever you can crank out.

My current impression is that the psychiatrists who are in full time private practice coming out of the top 10 depts on the wealthy coast markets are making an amount of money that's wildly out of proportion to the "average" salary statistics. They just never advertise it.

I actually do know about this. One of our recent grads told me he is charging $800 (private pay) for an intake. That's with no fellowship training. It just rests on the sheer brass balls to look someone in the eye and request $800 for an hour and a half of your time. (I don't think I have it in me honestly.) But yeah, hence my feeling that I won't be horribly disappointed if I fail the funding bar and end up in practice. As I said, I really like clinical work. The idea that there's a very soft landing out there makes it hard for me to get super worked up about the prospect of not being able to cut it in science.

In many ways I actually think that the K system is a fabulous contribution that NIH decided to make, because in someways now they are the centralized gate keeper for the existence of such jobs, where as in the past the wealthy academic depts were the gatekeeper. And NIH can transition much faster in terms of cutting down spots. It's much better to end your academic career (or at least figure out a way to hedge it) now if your K doesn't get funded than cutting it down 10 years down the line when your R-renewal is denied.

I totally agree. (Although as gbwillner said, many people who get Ks nonetheless do not get R01s. But as I said, I just don't see the point in worrying about this yet.)

 

[gbwillner]

Just want to state for the record here that the job I ended up taking was outside of academia- in industry. I did get the offers I mentioned from academia, but ultimately I found a position in industry that was too good to pass up in terms of the dynamics and freedom of the job as well as compensation.