Academic Foundation

[Quad]

---

Members do not see this ad.

I am interested in pursuing an academic oncological career.

I was thinking, how does one go about constructing the perfect research career? I wouldn't mind doing a year out or a PhD or a few fellowships... 🙂

I am especially interested in knowing what are the essential milestones that one should reach within the first years or doing an MD, PhD and/or residency.

Any contributions will be received with utmost delight

 

[Gfunk6]

Please clarify, are you interested in a lab-based career (80% lab, 20% clinical) or a clinical academic career (designing/reviewing/enrolling on clinical trials)?

 

[Quad]

Please clarify, are you interested in a lab-based career (80% lab, 20% clinical) or a clinical academic career (designing/reviewing/enrolling on clinical trials)?

Lab-based >>>>>>>>>>>> clinical.

From my short experiences I have found lab work to be very calming and basic science thoroughly engrossing 🙂 Then again, I never had to apply for grants...

 

[Gfunk6]

I want to say one word to you. Just one word.

Sacrifice

This is what will be fundamentally required for an academic career. Sacrifice in income, sacrifice in location of practice, and sacrifice in clinical care. Your love of science must be ever at the forefront, eclipsing all other needs.

Here is the "ideal" path to a physician-scientist:

1. Go to a top-ranked research medical school
2. Do an MD-PhD program through an MSTP (preferred), a non-MSTP MD/PhD program, or an MD program with a significant research component (perhaps with a dedicated year of research between M2-M3)
3. Match to a top-ranked research Rad Onc residency program
4. Participate in the Holman Pathway and/or be prepared to do a research fellowship
5. In general, for a physician-scientist faculty position you must be prepared to go anywhere in the country that has a good opportunity for you personally
6. If you don't have a large grant, then you will be potentially forced to conform your research to your Department Chair's area of interest
7. Once you start as a faculty member, you will be given start-up funds and given lab space, and perhaps a lab tech. Then the clock starts.
8. You have essentially ~3 years or so to obtain independent funding. If you don't achieve this then you may be forced to go into a full clinical academic career unless your Chair is willing to support you for a few more years.

During your development as physician-scientist faculty you will likely run into numerous pitfalls:

1. Difficulty in obtaining funding (especially from the NIH) due to increasing competition and decreasing funding
2. Criticism from your clinical colleagues (e.g. "Why is the physician-scientist earning the same salary as me, when I see patients five days a week?? I generate far more revenue for the department so the physician-scientist should either get a salary cut or be forced to work more clinical hours!")
3. Pressure to work more clinical hours; this can be exacerbated if fellow faculty members unexpectedly go on disability, switch institutions, or go on maternity/paternity leave.

Most physician-scientists I know are extremely driven, single-minded folks who LOVE science. They put up with all the other crap because it affords them the opportunity to pursue their passion. It is exhilarating to make a breakthrough scientific discovery that significantly advances the field. However, you have to sacrifice much to get there.

 

[beemer]

I want to nominate this for "Best Post Ever" on SDN.

 

[Radbio22]

I second that

 

[Gfunk6]

As a follow-up to the post above, I'd like to post some additional commentary. I've been getting numerous PMs from nervous applicants asking how to order their rank lists optimally for the best shot at an academic career.

Nowadays, it's all "academics" this and "why do all the graduates go into private practice" that. In response, I will re-post a PM I sent to one user with private information redacted.

Every single MS-4 wants to pursue an "academic" career (including me, when I was in that position), if they know "what's good for them." In other words, the current training environment is heavily slanted towards academics as reflected in the admission criteria. Yet, each year 40-60% of graduating residents go into private practice so there is an obvious disconnect.

The question you should be asking is not, "why are 'academic' programs pushing their residents into private practice," but rather, "are academic programs where all/most residents go into academics preventing their residents from going into private practice?"

At some programs (which will remain unnamed), there is a heavy bias towards academics. So much so that residents are actively discouraged from going into private practice and if they do, the department "blacklists" them. At other programs they have a much more enlightened approach. Although the expectation is that you'll go into academics, the faculty bear you no ill will if you don't.

The reasons for choosing private practice > academics are numerous:

1. Better compensation
2. More flexibility in location of practice
3. Don't have to deal with academic institutional bureaucracy
4. You can publish at your leisure, rather than "publish or perish"

Personally, I was born to do academics. MD/PhD from an MSTP, research was Rad Onc based, went to a top residency and did Holman, yet I went into private practice. I could go into the reasons why, but the "tl;dr" version was that I wanted to stay in a competitive market more than I wanted an academic career. The major academic centers in the area weren't hiring so I took an awesome "hybrid" position and have a volunteer faculty position.

For a variety of reasons the majority of graduating residents gravitate towards private practice. I'd argue that this has more to do with the individual and less to do with the program.

 

[thesauce]

I do believe, however, that it isn't misrepresentation so much as a change of heart that causes the majority to go into PP. Four years of residency is a long time and it isn't surprising that some might find that academics wasn't the holy grail that they thought it would be. For many, it was rotating at a private practice affiliate during their residency that gave them their first taste of that side.

In a small field like ours, research really drives it. And you are far more likely to enlist future academicians by selecting from a pool where everyone says that's what they want to do versus a pool where no one is saying that. 30-40% of graduates going into academics is a huge amount compared to any other field, so the strategy IS working. The "blacklisting" is unfortunate, however.

 

[deleted4401]

There is a huge disconnect. Part of it is willful deception on the part of both the applicant and the program, and part of it is that residency beats it out of you. The endless meetings, the pontification from people, the fact that you have a boss (or more than 1 boss), a total lack of control of hiring/firing of staff, the haranguing about meaningless crap and all the stinking memos. There is so much other crap to do before you can actually take care of your patients. Not to make a joke of it, but seeing what my attendings dealt with reminded me of Officespace. It's not the money any more (at least, that isn't the whole story) - as some academic people I know make more money than private practice docs.

It's just what you can tolerate. Private practice has its own headaches - non-evidence based practice from referrings/colleauges, a "yes, master" relationship with surgeons/medical oncologists, a lack of educational experiences unless you seek it out, little to no teaching (sometimes I get to teach my nurse something, ha or pimp my dosimetrist about staging as if he were a medical student). The benefits are that I am my own boss, I get to take care of patients solely, if someone screws up around here it is very easy to let them go, and in general nobody really bothers me. It works for me.

Honestly, though, I think most people are just playing the game on the interview trail. The disparity wouldn't be that huge, otherwise. It's more like a 3:1 ratio, not 1:1 or even 2:1.

S