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ALERT - NIGMS request public comment on Strategies to Enhance Physician-Scientist Training

Discussion in 'Physician Scientists' started by Fencer, Jun 18, 2017.

  1. Fencer

    Fencer MD/PhD Director Physician PhD Faculty 10+ Year Member

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    NIGMS, the NIH institute that funds MSTPs and many other NIH training grants, has issued a public REQUEST FOR INFORMATION (RFI). They are planning on creating a new MSTP funding opportunity announcement (FOA), and this RFI is an attempt to help them craft a more innovative FOA.

    There are a lot people with strong opinions in this webforum as to what MSTPs should be doing or not. This is your chance... you can submit anonymously.

    NOT-GM-17-009: Request for Information (RFI): Strategies to Enhance Physician-Scientist Training through the NIGMS Medical Scientist (M.D.-Ph.D.) Training Program (MSTP)

    Purpose
    "The National Institute of General Medical Sciences (NIGMS) seeks input on NIGMS’s institutional Medical Scientist (M.D.-Ph.D.) Training Program (MSTP). This Request for Information (RFI) will assist NIGMS in identifying, developing and potentially implementing strategies that will catalyze the modernization of physician scientist training at the national level to ensure that trainees gain the skills and knowledge needed to be leaders of the biomedical research enterprise of the United States in academia, industry, and government settings."

    How to Submit a Response
    Responses to this RFI will be accepted through August 9, 2017. All comments will be anonymous and must be submitted via a web form at Request for Information (RFI): Strategies to Enhance Physician-Scientist Training through the NIGMS Medical Scientist (M.D.-Ph.D.) Training Program (MSTP) Survey.
     
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  3. phonyreal98

    phonyreal98 7+ Year Member

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    Should this be stickied?!
     
  4. Neuronix

    Neuronix Total nerd Administrator Physician PhD Faculty SDN Advisor 10+ Year Member

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    I sure had a lot to write on that survey...

    It's not a good thing to train all these MD/PhDs for jobs that don't exist. When I finished training with an extensive research CV and what I thought was a really cool research direction, I could find no jobs or fellowships that were willing to support me to do research.

    Now I'm clinical faculty with essentially zero resources or protected time. My smarter friends are in private practice now.

    So what's the point of training MD/PhDs like me?
     
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  5. sluox

    sluox Physician 10+ Year Member

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    I also wrote quite a bit. In particular, I suggested that they should create "matched" speciality spots that guarantee salary support for a period of time (say 10 years) after training for academic development regardless of ability to secure research project grants. I.e. the idea is to make the physician scientist track attractive, similar to a dermatology spot using a "matching" process that begins immediately after clinical training. One way to do it is to minimize paperwork burden for K23/K08 applications, and set a time limit for application (the year prior to completion of all clinical training), speed up processing like an NMRP application, and make them renewable for once, kind of like the current K24 system. This would especially enhance recruitment of women and minority, who bear disproportionally the financial burden of having to succeed in a lower paying career without significant existing resources for a prolonged duration "limbo period".

    I also suggested that the core of the issue is a wider gap in compensation between physicians and scientists, and this issue is not easy to address given dwindling research budget and escalating healthcare budgets. One way to solve this problem is to create hard salary spots backed by federal line budgets specifically for physician scientists, i.e. in essence to trade higher salary for absloute security. However, I suspect this will never happen since PhDs will resent it. Frankly I think using R01s to budget for PI/postdoc salary should be a banned practice. Using soft money to fund PI salary causes significant perverse incentive: instead of rewarding good science, institutions now reward whatever science that will generate the most grant dollars, which is often influenced by fad, connections, cronyism and politics, and peg PI salary essentially as a commission. These are issues that people didn't think through during the budget doubling and rapid transition to a soft money system.
     
    Last edited: Jun 29, 2017
  6. gbwillner

    gbwillner Pastafarian Moderator Emeritus 10+ Year Member

    ...That was therapeutic. thanks for providing the link.

    Echo some of what Sloux said above.... Clearly we have discussed this in detail before, and it is nice to see that we have similar perspectives with our professional hindsight.
     
  7. Fencer

    Fencer MD/PhD Director Physician PhD Faculty 10+ Year Member

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    There are five links in this announcement. The most important is the summary report, which synthesizes the great response by the MSTP community about the T32 training programs and their outcomes. The council can be seen in a webinar at NIH at: NIH VideoCast - NIGMS Advisory Council - January 2018 . The discussion about MSTP occurs about 2:30 hours into it.

    NIGMS Council Discusses the Medical Scientist Training Program

    The NIH’s National Institute of General Medical Sciences (NIGMS) council January 18-19 convened, during which it approved the revamping of the MSTP mechanism (concept clearance for a MSTP T32 FOA). The MSTP T32 remains a priority, with plans to issue a Funding Opportunity Announcement by September 2018 and earliest award date by July 2020. An NIGMS Feedback Loop blog post discusses the summary report (which included comments from people in this SDN community) of the Community Input on Enhancing the Medical Scientist Training Program, which asked the community to give comments on four main themes: trainees, finance/funding, dual-degree training, and NIGMS management of MSTP grants. The AAMC also submitted comments to the original Request for Information.

     
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  8. Neuronix

    Neuronix Total nerd Administrator Physician PhD Faculty SDN Advisor 10+ Year Member

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    The summary report essentially ignored the theme of my response and did not quote anything I wrote.

    Simply put: there are no opportunities for physician-scientists in my specialty. There was absolutely no option for me to continue in research. I was willing to go just about anywhere for just about any pay. Despite this, I could not find a research fellowship or research faculty position. I have extensive research training, a lengthy CV, and my area of interest is hot in my field. None of that mattered. I am now a clinician. I had no choice.

    I can give several anecdotes from friends of mine who are in the same position.

    So why train people for jobs that simply do not exist? All this focus on how to best train people is moot if there are no opportunities for people to use their training.
     
  9. sluox

    sluox Physician 10+ Year Member

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    LOL i think they got the gist. Esp. the last section of the selected. Pretty apropo. Sadly NIGMS's power is limited.

    The fundamental issue is the "tournament" nature of this job, highlighted in the last paragraph of the summary. Unless that's solved all the other issues will remain. Someone else also suggested "permanent physician scientist" jobs (that you can presumably "match" into). Right now these are called K24s or MERIT and each IC has a handful. If one can get at least 2 R01s I think at least one academic center in your area would tenure you. But they may still end up making you do clinical work while your grants are on hold.
     
  10. Neuronix

    Neuronix Total nerd Administrator Physician PhD Faculty SDN Advisor 10+ Year Member

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    With what startup package? Yeah right and good luck.
     
  11. tr

    tr inert protoplasm Physician PhD Faculty 10+ Year Member

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    Gee it sounds like a lot of people had the same opinions I do because I feel like they quoted me all over the place? Unfortunately I didn't keep a copy of my responses so can't figure out which are actually verbatim. But I'm pretty sure I wrote that bit about the tournament scheme. I think I might have written the part about the research scientist job too, but I didn't mean like a K24 or Merit. I actually meant more like a clinical position with some baseline amount of protected research time to be underwritten by the institution or department.

    It was sort of an analogy to something I think we need more of for straight PhD's, which is like a salaried research scientist position that isn't grant reliant. Basically I think the whole soft money system for salaries is ridiculous and needs to be scrapped. NIH grants for specific research proposals should go to materials and resources, and salaries should be institutional. If NIH wants to support the salaries of researchers in academia they can give the academic institutions block grants for salaries, separate from the individual projects that are being funded. That way everyone could have their salaries planned out ahead and there wouldn't be this mad dash for how to pay everyone's rent (from the PI to the RAs) every time an R01 runs out. RAs, techs, and postdocs - like many/most grad students are already - would be salaried by the department/university and placed in labs/research groups according to need. Like ridesharing for science. I think I said more about this but they only took that very elliptical quote that didn't really illustrate the point well (or maybe it was someone else's quote, duno).
     
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  12. JETER

    JETER Smarter than Spock 10+ Year Member

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    Hey Neuronix - admittedly I've not been on these boards much over the past decade, but I'm curious to your experience and some of these anecdotes. I'm just now starting to interview for staff positions, and several places seem interested and willing to support "protected time" and fairly decent start-up and personnel assistance. What were your circumstances in negotiating your faculty position? Is this just a ruse? My goal, at least early on, is a 60-40ish clinic/research split, with what my area of research is in, is probably sufficient to be productive in the lab and the OR/clinic. Any words of wisdom?
     
  13. Fencer

    Fencer MD/PhD Director Physician PhD Faculty 10+ Year Member

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    When you are off-clinical, approach it with the same urgency as if you were doing a complex operation. Block the time to accomplish the research task at hand. Find a good mentor. Prepare a K23 application, which gives you 50% protected time for surgeons, and depending upon institute, more time. Read, the chapters of negotiating your lab, time management, etc. in the HHMI book for transitioning to faculty: https://www.hhmi.org/sites/default/files/Educational%20Materials/Lab%20Management/Making%20the%20Right%20Moves/moves2.pdf
     
  14. Neuronix

    Neuronix Total nerd Administrator Physician PhD Faculty SDN Advisor 10+ Year Member

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    The job market in my specialty is terrible. There was no negotiation possible and there were no research jobs available. My contracts were "take it or leave it". I was offered no resources such as space, support, or funding. The jobs were "clinical assistant professor" on a "clinical-educator" track. I was willing to go anywhere in the country or even take a research fellowship but I had very few job interviews or offers. Some of the biggest name places laughed at me when I told them I wanted to write a K award--it simply wasn't permitted because that is a money loser. Those were informal meetings and I was never invited to interview with them after sharing that I wanted a majority research position.

    60/40 ends up being 100% clinical. I'm supposedly 70/30 but my RVUs are 50th percentile for someone full time in my specialty. Most weeks I work about 60 hours a week just in the clinic. Having a resident helps me to divert some of that 60 hours into an hour here or there of academic time. When I don't have a resident, I'm 60+ hours a week just on patient care including charting.

    I don't think anything less than 50% true protected time allows one to have a sustainable funded lab.

    My CV was extremely strong. Private groups laughed at me for even thinking about leaving academics. My "less successful" MD/PhD counterparts are now mostly in private practice now making a lot more money for probably the same amount of work.

    I continue to publish clinical research papers frequently. I use my vacation time to work on them.
     
  15. sluox

    sluox Physician 10+ Year Member

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    Block grants system has its own issues. Think about Medicaid (fee for service vs. block grants). Block grants basically means centrally managed resources, which can result in random budget cuts. And how do you determine which institution gets how many slots? Ends up being driven by cronies. But I agree with you the current system is hopelessly complex and inefficient.

    Permanent positions do exist--the real tenure track jobs, which would guarantee you a salary even without having grants after tenure. Problem is 1) the said salary is low, and almost meaninglessly low in high cost areas. 2) grossly unbalanced number of those job vs. number of trainees, often in the single digit percentile. For example, with your stipulation of a "protected research time" job, how would you feel if I tell you that you can do clinical work and have protected time, but the protected time you won't get paid for it? Would you still do it? Right now that's basically what the institutions are doing, as they make overhead from your clinical revenue and give you a very low salary compared to private venues for the same amount of work.
     
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  16. tr

    tr inert protoplasm Physician PhD Faculty 10+ Year Member

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    Look, basically the scientific system is currently using low-paid trainees to perform the grunt work of science. Only a minority of these trainees will ever end up in the jobs they ostensibly trained for, i.e. running research labs. Most of them will get siphoned off into industry or sometimes government (for PhDs), or to clinical work (for MD/PhDs). This is a waste of people's experience and training. It also results in scientific inefficiency because all the people doing the actual benchwork are graduate students and postdocs, who will necessarily make rookie mistakes.

    The reason it works this way is because of the soft-money system. A PI who is successful at writing grants can have as many grad students and postdocs as he can convince the NIH to pay for. But the soft-money system has nothing to do with these trainees once they are done with their 12-20 years of training and no longer willing to work 70 hours a week for $45K. And the little single-PI fiefdoms are often in competition with each other, which is a waste of time and money.

    In order to remedy this, the large number of 'trainee' spots within academia should be consolidated into a smaller number of permanent positions at all levels: from lab tech through a number of 'research scientist' pay grades, just like there are in industry. There should be a place and a value for experienced scientists who want to continue to do benchwork. The levels should be populated about equally. An experienced research scientist would be much more productive than a postdoc, and would be paid commensurately more. There would be many fewer people doing this work than there are today, but they would be better people, because there would be increased selectivity at the trainee level (fewer grad student spots) and more accumulated experience at the upper levels. These people would not be wasting their time writing grants, but would actually be doing the work of science.

    It would probably still be the case that the investigative decisions and grant applications would be undertaken by a relatively small number of people at the very top of the pyramid (ideally acting within larger consortia for greater effectiveness, group definition of important goals, and resource pooling). So the only people who actually submit grant applications are these super-PIs, who are reaching across labs, departments, and universities to achieve broad joint goals. Most resources, including personnel (lab techs, RAs, but also research scientists) as well as laboratory space and time on core facilities like sequencers, etc., should be centrally controlled and handed out on a temporary basis based on need. Like when you apply for an R01 to cover your materials, you also apply simultaneously to your institution for the necessary space, personnel, and use of core facilities.

    On the MD/PhD side I am imagining the 'research scientist' job to have a clinical component. Not too dissimilar to what Neuronix has for example, with the actual split to be determined, except that you might actually be able to get some research done with your 20-50% protected time if you weren't constantly using it to write unfunded grants.
     
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  17. Fencer

    Fencer MD/PhD Director Physician PhD Faculty 10+ Year Member

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    Great ideas... Some of these elements at the faculty level are used in a rudimentary manner at the NIH intramural program.
     
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  18. sluox

    sluox Physician 10+ Year Member

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    Agree with most of what you wrote. I'm trying to think what would be an alternative to this model that's more "American". The system you are talking about is basically how German institutes (i.e. Max Planck) work.

    I'm not sure writing grants is a "waste of time" per se. Grants are like blueprints. You write them so you can plan. There's nothing in principle wrong with tournaments of ideas, and in other areas (i.e. venture capital etc) tournaments works fine. The problem is one of degree/magnitude rather than quality. Hypercompetition and attrition due to lack of job security are adverse in an inequitable way. I think if we just clamp PhD programs by an order of magnitude everything else stays exactly the same we will basically have solved the problem. If you need RA level people just hire them ad hoc.
    You clamp PhD students by shutting T grants and forbidding R grants from paying grad salary.

    Tho there's still the issue of international postdocs. You can clamp American PhD programs but you can't really shut down everywhere. We are basically at square one with immigration reform on this issue. Basically postdoc funding has to be restricted. i.e. CMS GME style.

    Yup.

    In order to get an R01, you must be
    1) trained in the US or an equivalent
    2) graduate from a US or equivalent postdoctoral fellowship
    3) pass some exam (whatever, maybe, maybe not)
    4) match into a postdoc spot

    etc...

    That's literally what I said. Make physician scientist track like matching into derm...
     
    Last edited: Feb 7, 2018
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  19. tr

    tr inert protoplasm Physician PhD Faculty 10+ Year Member

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    Maybe. I agree with you that grantwriting is useful for research planning but I think the low funding rates are a huge waste of everyone's time and energy (and inequitably so to boot, as you say).


    If you forbade R grants from paying salary at *all levels*, that would fix the problem of excess postdocs. If universities want people to do science they should salary those people themselves. (This would result in exactly the type of gatekeeping you describe, because when spots become scarce they necessarily become more competitive to obtain.) If the federal government decides that would result in too few people doing science, and they want to subsidize people to do science, like I said it should be a block grant to the university for the purpose of salary - *not* linked to a specific project with a five-year time horizon.
     
  20. sluox

    sluox Physician 10+ Year Member

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    Sure. But how do you determine which university receives how much of the block grant? And what proportion of that block grant is allocated to PIs vs. postdoc salary support? You want more of a Soviet style where feds would micromanage individual institutions and allocate funds at an unthinkable level of detail. I say keep the American way where ideas get thrown to committees for review, and winner takes all, and the feds are only in charge of evaluating the science. Leave the actual administration of the science to the institutions. Just limit the number of people who are eligible to throw the ideas early once they get to childbearing age they don't have to fight so hard.
     
    Last edited: Feb 7, 2018
  21. tr

    tr inert protoplasm Physician PhD Faculty 10+ Year Member

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    Not at all, I'd say the universities themselves would be best positioned to apportion those funds among people at all levels, from the research tech to the senior faculty. Hence 'block grant' rather than allocated funding. Ideally I'd say the universities should pay their people themselves vs depending on the feds to do it, but I recognize that would probably result in an unconscionably small scientific workforce.

    I just think it's inefficient for there to be all these little labs competing with each other. Fine to have ideas reviewed for funding, but I think they should more frequently be huge ideas involving multiple labs and sub-projects, like these P-level program project/center grants or whatever. Ideally I'm thinking a funding rate around 30-50% or something like that, would maintain competition but avoid excess waste of time and talent.
     
  22. sluox

    sluox Physician 10+ Year Member

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    Currently P level grant rates based on what I see probably exceed 50%. I in theory agree with the idea that small labs competing is inefficient. In practice, every PI who runs a small lab thinks he'll be next big cheese, and therefore resists consolidation. This is a detail though. The main issue is it's unclear how much block grants should be allocated to each university. In almost all cases where a block grant model is used, this allocation becomes extremely political...
     
  23. CheGuevaraMD

    CheGuevaraMD 7+ Year Member

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    You could restrict federal training funds for grad students or postdocs, but I don't think this would fully solve the problem.

    Look at the humanities -- the academic job market is terrible, and yet thousands of students still enter humanities graduate programs every year. Why? Because universities need TAs for freshman English.

    As long as PIs need armies of high skill workers, there will be grad students and postdocs. Universities will just pay them out of a different pot of money. How could it be any other way? PIs still need workers to conduct science. And it is most definitely unconstitutional to regulate the way that universities conduct graduate education. There's no way that you can ban universities from giving scientific workers degrees -- the government can't regulate speech. Medicine is different because cutting people up and giving them drugs are highly regulated activities.
     
  24. tr

    tr inert protoplasm Physician PhD Faculty 10+ Year Member

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    That's exploitative too.

    I don't see why it's inevitable that these workers should all be classified as trainees, and thus poorly paid and with minimal worker protections. Of course there is always pressure to do things as cheaply as possible, but society as a whole does not have to accept this. We used to have child labor too and I'm sure many people thought that was inevitable and inescapable at that time as well, but it's now been outlawed. I think if the graduate student unionization movements could get off the ground that would really improve things, because if the universities could be forced to provide pay and benefits commensurate with education, grad students wouldn't be such a bargain compared to more experienced people.
     
    Last edited: Feb 9, 2018
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  25. tr

    tr inert protoplasm Physician PhD Faculty 10+ Year Member

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    Do you mean funding lines for P level grants are at 50%, or do you mean that P level grants constitute 50% of all funding disbursed by the NIH?

    Because currently the allocation of grant funding is not political???

    I'm sure some kind of formula could be devised. Block funding for salaries could even be calculated on the basis of total project grant funding to a given university, so that there was a rough match. My point is that disbursing salaries centrally through the university, rather than having them depend on external funding sources, would permit the university to reshuffle workers more efficiently when specific projects came to an end.
     
  26. tortuga87

    tortuga87 7+ Year Member

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    What about the following idea? First, science is difficult but not very difficult. To be real, many reasonably intelligent people can do good science, just like many reasonably intelligent people can practice dermatology because dermatology is not that difficult either. Selective does not mean difficult to actually practice. Also, because science is not super difficult, you just need several years of training before you max out. That means that a 3rd year post doc is not that different from a 10th year post doc because skills are gained fast in the early years, but then the rate gradually tapers off.

    Second, because many people can actually practice science, this begs the question: how would you screen out people who "cant do science" at a young age before they have a chance to do science? GPA, GRE or MCAT scores seem insane. I think, if you are going to judge people based on their research, you have to see how well they do research. That means they need to be trained to do research (grad school), then actually have the chance to do research after training (post doc); otherwise you are just guessing


    Third, you can socialize research as much as you want but, even if you establish career scientist tracks, they will still be low pay in a capitalist society. That means that most intelligent people will avoid research like they do today. Science and money do not play well together - science needs money but money does not need science. This is just a fact of capitalism... the only exception I know from history is when two societies want to blow each other up (WWII, cold war race), then money needs science
     
    Last edited: Feb 9, 2018
  27. tr

    tr inert protoplasm Physician PhD Faculty 10+ Year Member

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    Wow. I could not disagree more with this. Have you never been in a lab with one of these very senior postdocs, or a career lab tech who has been there 10+ years? Those people are invaluable. They usually cannot be induced to work 60+ hours a week like graduate students can, but they are far and away more efficient with the time they have and they increase everyone else's efficiency due to their accumulated knowledge.

    Bench work is complicated, sensitive to small perturbations, and often very dependent on technique. It's also always changing, and someone with a lot of experience troubleshooting techniques is better at making new ones work quickly.


    It's true of almost any new skill that the fastest rate of skill acquisition occurs early, but that doesn't mean that it doesn't continue to improve over time. I think the fact that inexperienced people do most of the benchwork in our current system may contribute to the false impression that they are equally as good at it as a more experienced person, but I'd say this is absolutely false. To take a downmarket analogy, think about the people you know who are the best cooks. Usually they are older women who have had to feed large numbers of people for many years. Someone who has been cooking routinely for five years is much better than someone who never cooks, but someone with 30+ years of cooking experience usually produces a far superior product to someone with 5 years of experience. I'd say the same applies to lab science, only more so.


    I completely agree, and I think that furthermore it is a huge waste of the selected talent and accumulated experience of people who have been through 6-10 years of hands-on training at the bench when they have to leave science/academia because they can't progress to the PI level.

    (*Also, please don't say 'begs the question,' which has a specific meaning within formal logic, i.e., assuming what you want to prove, when you mean 'raises the question.' Please. It kills me when I see educated people do this.)


    Of course they will be low pay, but people will still do them because they are interesting and engaging work, just like people will hang on for years in postdoctoral positions that provide extremely low pay compared to other work they could do outside academia. The problem is that eventually you can't be a postdoc anymore, and the only available options after that are up to PI or out of academia. I think a lot of these people would be happy to take research scientist positions with moderate salaries (better than postdoc but worse than PI) and reasonable benefits.
     
  28. tortuga87

    tortuga87 7+ Year Member

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    Thanks for the reply. I am still hesitant though about decreasing the number of research positions. This would basically just be maximizing precision (most ppl we select in will in fact be good scientists) at the expense of recall (lots of ppl we dont select could have been good scientists). I think we should instead be increasing the number of alternatives for scientists.

    For example, I think we should be encouraging more licensing (and also entrepreneurship) for discoveries. Universities should be forbidden to take a large cut. That way, a researcher can profit from his/her discoveries, or even be encouraged to leave academia to start a company. This means patents should cost more like $100 instead of 10K.

    Currently, if a scientist makes a discovery, he/she has a go through the technology transfer office which is always short on money and staff (except at Stanford). Then, even if a patent is filed, most of the tech goes nowhere because who knows what will be useful in industry. IMO, companies should be able to present their problems and ask for solutions from university scientists, so scientists know what it is in demand. Currently, scientists mainly ask the NIH for money, and the NIH helps decide what's useful (in terms of what will be funded). The NIH usually does not always know what is useful by a long shot.

    Allowing companies to present problems would help scientists get an idea of what is useful as well as help scientists establish working relationships with companies (perhaps even be hired by a company full time and therefore leave academia). Encouraging licensing (and entrepreneurship) would give more options to scientists outside of academia, increase scientist pay and probably also benefit the economy in general in the long run.
     
    Last edited: Feb 10, 2018
  29. tr

    tr inert protoplasm Physician PhD Faculty 10+ Year Member

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    The problem with market-driven solutions is that, as you noted above, what is useful is not always profitable and what is profitable is not always useful. That's why we haven't had any new antibiotic mechanisms hit the market in the past three decades but we have a billion variations on the same mechanism for antidepressants.

    The NIH and NSF are supremely important because they provide money for all the research that is useful but not likely to yield a profit, most of which is conducted within academic settings. It's already the case that scientists can find positions in industry (indeed this is where most of the ones that don't make it to PI level in academia end up) but I'm not sure that's to the benefit of society as a whole.
     
  30. tortuga87

    tortuga87 7+ Year Member

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    I think the NIH is very important, but I also think that the institutes are too important right now because they almost monopolize research funding. This means that there is little incentive for making career scientists or raising the pay.

    I think academia should struggle to keep its PIs. There is incentive to leave academia now but not enough. Post docs are more likely forced out because "they cant make it in academia." How many professors quit academia after making tenure? Very few, because the options outside of academia are not great. In computer science and engineering, PIs quit for industry much more frequently because their research is more clearly applicable to industry. I think this should happen to a greater extent. It should also happen in the medical sciences. If PIs worked on topics that were more pertinent to industry (I am not saying exclusively this, but moreso), then they would be more wanted outside of academia.

    Academia and industry should be competing to keep its personnel, or else people are just going to be exploited by whoever has the monopoly. Perhaps PIs are currently being exploited right now in the sense that they spend most of their time begging for money for the NIH instead of actually doing research. Grants are not bad; too much people competing for too few grants is bad.

    I think limiting the number of spots and creating more hierarchy as mentioned previously should be done after more competition is introduced.
     
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  31. SurfingDoctor

    SurfingDoctor "Hooray, I'm useful" Physician Faculty 10+ Year Member

    I think the problems with the pathway are rather obvious. In pretty much any other job (clinical, non-research academic, industry), experience leads to promotion and thus job security and pay down time. Except in the NIH-funded physician scientist, that pathway is absent. Thus one could spend a majority of ones career pursuing a concept that in the end, is a dead end and have little to show for it. Well, one could be a tenured professor who had a career of NIH funding, but to a department chair, “had” doesn’t help today. The uncertainty in usefulness to a department is a major long term hurdle that I’m not sure the NIH is designed to tackle. That is far more institutional based. However, I’m not sure institutions really care. They just want those indirects and patent dollars.

    I like the idea that an institute or specific directors fund a position to do research on topic “X” as far as certainty, but I think that also stifles innovation. I’m not sure there is a good mechanism. Maybe a longer funding period, but one that has more accountability (PRRPs are jokes honestly) where funding could be removed biannually if metrics aren’t met (I think that is more or less the intent of the R35 mechanism). Maybe the same approach to research as clinical enterprises withcenters of excellence in a specific topic or field. I don’t know though, the system is imperfect and the government oversight, or lack thereof, enhances that imperfection.
     
    Last edited: Feb 13, 2018
  32. sluox

    sluox Physician 10+ Year Member

    1,479
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    Jan 4, 2002
    Just want to preface by saying the discussion of this thread is overall pretty high quality, I imagine because people are a bit more experienced and not constrained. A few more thoughts...

    This is not factually true anymore. Industry funding now accounts for about half of total R&D budget in the US.

    There's gonna be a limit to this. No matter how much competition you introduce, the subject matter area is relevant. If you are a humanities professor, you just won't get as many relevant industry opportunities, unless it's in a specific niche area (international affairs, etc). Similarly, while overall CS profs do well in industry, if you specialize in computational complexity theory your work outside of academia is rather limited. So in order to make this work, you want to micromanage the labor market at very precise, subject specific level. In general, this fails miserably, mostly because of competing interests--typically the central agencies is responsible for both the training pathway, which typically favors increasing spots to get more cheap labor, and the professionalization, which typically favors limits on licensure. Examples of recent such regulatory failures within medicine include pathology, radiation oncology, and until recently, radiology. I can think of two specific instances where this micromanagement works, one is dermatology, one is economics. In both cases, there's a nationalized matching process, and a fairly informed and flexible central committee that matches training spots with professionalization. In particular, what also saves those two is a rising private demand. Invariably, if the central committee favors professionalization, the professionals in the field eventually benefit from the arbitrary monopoly. This really applies in EVERY SINGLE scenario: i.e. when labor is more powerful, the laborers get more out of the system. Ultimately though, the final arbiter is rising private demand. One might argue the only difference between derm and rad onc is the former has one.

    In the case of NIH funded research, there's a lack of rising demand, and during the funding doubling, training was decoupled from professionalization, causing a severe bottleneck. The rise of the K award process introduces some elements of "matching", but it's cumbersome, requires a multiple year tedious application process, evaluated by multiple committees and has limited geographical flexibility, causing problems for women and "the poor".

    What's also really funny when you think about "industry" competition is that this exists for physician scientists, it's called being a clinician. Lots more MD/PhDs drop out prior to the K award stage (and after) because clinical work pays more and often are less demanding. The Feds creates a pathway but underfunds it, causing severe salary disparity. This leads to worsened labor mismatch, where highly qualified candidates pursues different careers solely because of lack of salary support, and people who stay in the track often have outside financial support. This is really a microcosm of what happened in Soviet Russia.

    Rather than a block grant system, the government could just arbitrarily limit the number of grantees based on budgets, especially for training grants and institutions would then be responsible to acquire the training grants and demonstrate more spots are needed. Though in the current scenario, the large grant budgets are just too big for this issue to matter (i.e. for R01s, you'd probably prefer to just hire students, who are higher quality to begin with, than random RAs from the community). Most of the PhDs from lower tier programs go into industry anyway, though admitted a lot of skills they learn during PhD may be useful (i.e. writing and presentation). It would be impossible to create a match program for PhDs overall, as they often go to jobs that they over-qualify for, and there's a sharp difference between to top PhD programs and lower tier. The situation is closer to law school than medical school.

    There are disagreements (as shown in the present discussion) in whether more or less oversight is the right next move. Whenever this happens I think the right answer is that it depends--some kinds of research benefits from more oversight (especially large multi-lab collaborations), others don't. Creativity might come out of competition, but it might not. What IS creative is extremely subjective. A lot of work done by mid-range mid-career people are not "creative", but 1) are necessary foundations 2) I would hate to see them lose their jobs. Now I'm a medical doctor so I don't care as much, but it sucks a lot to be a PhD who had previous R01s who end up in a teaching position in his/her 50s. This happens not infrequently. This is also an issue that people aren't used to be aware of. To be fair, the situation really got this bad about 10-20 years ago, so the trickling is still going on.
     
    Last edited: Feb 14, 2018 at 6:32 AM
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  33. SurfingDoctor

    SurfingDoctor "Hooray, I'm useful" Physician Faculty 10+ Year Member

    I mean yeah, there's no easy answer. I like the idea of position advancement in research that is somewhat protected (which is what tenure is suppose to be but really isn't anymore), but that could also lead to pursuit of research hypothesis that are essential dead ends or not really impactful with little accountability. This already happens to some degree, tenure as I mentioned, but also current investigators who have played the politics of NIH-funding well and continue to receive funding for low impact ideas. I'm always reminded of a specific project that was funded initially about a decade ago (and continues to be so last time I checked) that initially discovered a new protein and this protein was thought to modulate all sorts of ill responses. Only fast forward 8 years, and the impact of that protein was found to be not as important because the initial protein isolates were contaminated with toxins. It wasn't deceitful in any regard, it was just poor quality control. But this person built there career on this protein and many people jobs depend on that. So there is continues to be some interest in funding that project, despite it's impact being low at this point (of course, impact is highly subjective as you suggest).

    I would also agree that for people with MD or MD/PhD, the fallback is far more palatable. There are always patient willing to pay money to see doctors. The life of a career PhD-only investigator is far more uncertain and my nextdoor colleague is a late-stage PhD-only investigator who has been without an R01 for about ~4 years. He got some small awards and was tenured, but was basically without support. He recently got an R01 which he probably can ride till retirement, but that amount of uncertainty in a late stage of ones career sucks. Had he not gotten it, the only thing he could claim was that he used to be funded... not a good way to end ones career.

    Like I initially stated, I don't think there is a good or easy answer. It would make sense to me that the extramural model be essentially P or U grants at dedicated centers. Kinda of like the intramural model, but spread over regions (more than the six they currently have, maybe instead 1 to 2 per state max). If someone wants to study cancer or sepsis or drug addiction, they go to a specific academic enterprise with that dedicated P or U grant and study that problem with some direction from the NIH. It would help eliminate some of the competitive aspect, ensure some job security and make a cohesive approach to tackle a problem. Similar to how the NHS tackles clinical treatments... if you have problem "X" you go to the center or few centers that offer dedicated expertise in that problem. I assume there would be some backlash to this, mostly via loss of independent exploration and the people who enjoy competition, but either want the system to be better, or they want the status quo. The latter though doesn't seem to be doing a great job though.
     
    Last edited: Feb 14, 2018 at 8:34 AM

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