Another "options after MD/PhD" thread

[okemba]

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Hey guys. Undergrad here. Still considering whether or not to do MD/PhD.

I've been digesting something that was said in the "how to fix MSTP" thread. (Also, is it just me or can we not go to the 2nd, 3rd,..., nth page of the forums anymore?)


It was something along the lines of pointing out that after getting an MD/PhD and finishing a residency at the age of 34...are you really going to want to go back to earning $40k as a postdoc when you could be earning an order of magnitude more as a physician?

And that got me to think more specifically. What are typical research career routes for MD/PhDs? Maybe it sounds like a stupid question, but how exactly do MD/PhDs who have done residencies go about shooting for tenure-track positions? Do they commonly get positions right after residency, or are post-docs frequently necessary? Etc etc.

And what sorts of research options are available for MD/PhDs who do clinical work on the side but don't want to run their own lab?

Thanks. I've just been thinking more about what exactly choosing MD/PhD would imply as far as what I do for the rest of my life. Because no, I do not care enough about research to be a post-doc after residency. But I would like to still do research. Eh?

 

[uniqenam]

Hey guys. Undergrad here. Still considering whether or not to do MD/PhD.

I've been digesting something that was said in the "how to fix MSTP" thread. (Also, is it just me or can we not go to the 2nd, 3rd,..., nth page of the forums anymore?)


It was something along the lines of pointing out that after getting an MD/PhD and finishing a residency at the age of 34...are you really going to want to go back to earning $40k as a postdoc when you could be earning an order of magnitude more as a physician?

And that got me to think more specifically. What are typical research career routes for MD/PhDs? Maybe it sounds like a stupid question, but how exactly do MD/PhDs who have done residencies go about shooting for tenure-track positions? Do they commonly get positions right after residency, or are post-docs frequently necessary? Etc etc.

And what sorts of research options are available for MD/PhDs who do clinical work on the side but don't want to run their own lab?

Thanks. I've just been thinking more about what exactly choosing MD/PhD would imply as far as what I do for the rest of my life. Because no, I do not care enough about research to be a post-doc after residency. But I would like to still do research. Eh?

Could we get that pinned, mods? Neuronix? (I know you're a big proponent of prospectives reading that thread)

 

[okemba]

I really just don't understand.

Lets say that I am program-funding-director guy (of many) at the NIH, and I'm on a panel (or whatever they're called) to come up with a new combined degree program to train physician-scientists.

Now, one of my underlings strolls up and presents to me his plan of a fully-funded combined MD/PhD degree. His idea is that after MD/PhD + residency (at the age of 34), its hoped that trained candidates will either start assistant professor jobs (which is great if you get offered one, but GFL) or go back to being post-docs in hopes of landing such a job.

I would LAUGH AT THE FOOL, and kick him out of Bethesda.

Am I missing something?! Is it actually relatively common for MD/PhDs who've just completed residency to land assistant professor jobs? I can't imagine this to be the case. We can't *all* be Karl Deisseroth.

Serious topic is serious. I don't mean to be seen as joking. This just seems like such a grandiose oversight in the planning of these programs that I don't understand at all what actually goes on.

 

[Spacedman]

Hey guys. Undergrad here. Still considering whether or not to do MD/PhD.

I've been digesting something that was said in the "how to fix MSTP" thread. (Also, is it just me or can we not go to the 2nd, 3rd,..., nth page of the forums anymore?)


It was something along the lines of pointing out that after getting an MD/PhD and finishing a residency at the age of 34...are you really going to want to go back to earning $40k as a postdoc when you could be earning an order of magnitude more as a physician?

I think if your'e earning 40k as a postdoc after residency, you're doing it wrong, or else the career option is really, really worth it. after residency, you'll have the option to do clinical work some fraction of the time, and if you're that serious about science you'd most likely have made some attempt at applying for funding as a resident. the latter need not be a K/R NIH grant- even getting on a T32 should help to augment your salary. My overwhelming impression is that the "40k postdoc after residency" scenario becomes a reality only after an extensive series of decisions starting with what city you move to, clinical department you join, institution, research focus, etc etc. it's not a foregone conclusion.

there are some situations that i've come across in my cohort (those MSTPs finishing residency or finished within the past few years) where doing a post-residency postdoc on a PGYx salary is reasonable, if a bit painful - for example, top lab, top department, very well compensated part-time clinical opportunities afterwards. definitely not for everyone.

spaced

 

[Spacedman]

Am I missing something?! Is it actually relatively common for MD/PhDs who've just completed residency to land assistant professor jobs? I can't imagine this to be the case. We can't *all* be Karl Deisseroth.

Serious topic is serious. I don't mean to be seen as joking. This just seems like such a grandiose oversight in the planning of these programs that I don't understand at all what actually goes on.

Deisseroth is clearly in a class of his own, but for what its worth, he did do a bona-fide postdoc. also, his first appointment was in psychiatry (a clinical department) -- so, even though the conventional wisdom is that "there's no path" and "everyone does it their own way", I think the broad career strokes are not so different among post-residency MSTPs going into basic science. and options are far better than straight phds attempting the same--

 

[gbwillner]

Thanks. I've just been thinking more about what exactly choosing MD/PhD would imply as far as what I do for the rest of my life. Because no, I do not care enough about research to be a post-doc after residency. But I would like to still do research. Eh?

You don't HAVE to do a PhD to do research. I would leave the MSTP program only for people who are ABSOLUTELY SURE they want to do research. Primarily do research. Otherwise, IT IS A GODDAM WASTE OF TIME.

To respond to your individual points:

1. It was something along the lines of pointing out that after getting an MD/PhD and finishing a residency at the age of 34...are you really going to want to go back to earning $40k as a postdoc when you could be earning an order of magnitude more as a physician?

A: No. That's why a majority of the few that actually make it to this point flame out nowadays. You don't HAVE to take a $35-45K postdoc position. Good institutions will augment your salary to PGY salary ($50-60K), and great ones will do you better ($75+). But that is still a pittance when you could be out in private practice making $250K+, depending on your specialty, of course.

2. Maybe it sounds like a stupid question, but how exactly do MD/PhDs who have done residencies go about shooting for tenure-track positions? Do they commonly get positions right after residency, or are post-docs frequently necessary? Etc etc.

A: Yes, that is a stupid question. Just kidding, it is a great one. Do MSTPs get Asst. Prof jobs in tenure track right out of training? YES. ALL THE TIME. However, they do NOT typically get secured research time or space or money, at least not significant amounts of those things without the post doc. People who bail on the post-doc after the MSTP and residency typically say something like "I still love research, but the funding rates are so bad right now, and the opportunity cost so high, I am going to get an academic clinical job now and do science on the side. If it works out, I will buy back protected time with grants." It almost never works out that way, but you CAN do it. Departments will still love you, since you will be better at clinical research than most MDs.

3. And what sorts of research options are available for MD/PhDs who do clinical work on the side but don't want to run their own lab?

A: There are lots of opportunities in clinical departments to do clinical research. You can collaborate on large projects, and act as an advisor. You can also go into industry. But you don't really NEED a PhD for any of those things.

 

[VitaminVater]

You don't HAVE to do a PhD to do research. I would leave the MSTP program only for people who are ABSOLUTELY SURE they want to do research. Primarily do research. Otherwise, IT IS A GODDAM WASTE OF TIME.

To respond to your individual points:

1. It was something along the lines of pointing out that after getting an MD/PhD and finishing a residency at the age of 34...are you really going to want to go back to earning $40k as a postdoc when you could be earning an order of magnitude more as a physician?

A: No. That's why a majority of the few that actually make it to this point flame out nowadays. You don't HAVE to take a $35-45K postdoc position. Good institutions will augment your salary to PGY salary ($50-60K), and great ones will do you better ($75+). But that is still a pittance when you could be out in private practice making $250K+, depending on your specialty, of course.

2. Maybe it sounds like a stupid question, but how exactly do MD/PhDs who have done residencies go about shooting for tenure-track positions? Do they commonly get positions right after residency, or are post-docs frequently necessary? Etc etc.

A: Yes, that is a stupid question. Just kidding, it is a great one. Do MSTPs get Asst. Prof jobs in tenure track right out of training? YES. ALL THE TIME. However, they do NOT typically get secured research time or space or money, at least not significant amounts of those things without the post doc. People who bail on the post-doc after the MSTP and residency typically say something like "I still love research, but the funding rates are so bad right now, and the opportunity cost so high, I am going to get an academic clinical job now and do science on the side. If it works out, I will buy back protected time with grants." It almost never works out that way, but you CAN do it. Departments will still love you, since you will be better at clinical research than most MDs.

3. And what sorts of research options are available for MD/PhDs who do clinical work on the side but don't want to run their own lab?

A: There are lots of opportunities in clinical departments to do clinical research. You can collaborate on large projects, and act as an advisor. You can also go into industry. But you don't really NEED a PhD for any of those things.

In your opinion, could a Master's or 1-2 year off Med school for pure research put one of par with an MD/PhD in terms of research experience necessary to compete for these post-doc/tenure track positions in basic or translational science research?

 

[okemba]

Thanks for the replies guys.

A: Yes, that is a stupid question. Just kidding, it is a great one. Do MSTPs get Asst. Prof jobs in tenure track right out of training? YES. ALL THE TIME. However, they do NOT typically get secured research time or space or money, at least not significant amounts of those things without the post doc.

Okay. But what?! What does it mean to have a *tenure-track assistant professorship* without secured research time or space or money?! I seem to recall my newbie PIs starting off with their own lab space, and some small $100ks of seed money. And obviously they're all full time, since they're PhD.

How does this work?

/myignorance

 

[ratherbefishing]

Hey guys. Undergrad here. Still considering whether or not to do MD/PhD.

.... Because no, I do not care enough about research to be a post-doc after residency. But I would like to still do research. Eh?

If you fall in the category of just "wanting to do research on the side" then I think you probably 1) don't need the PhD and 2) will probably be unhappy during the PhD and/or drop out if/when things get hard. I may be a minority opinion on this, but I really think that the MD/PhD program is for people who want to spend of a majority of their time in research and have a lab. If you don't love the daily grind of lab life, its going to be tough going.

 

[nysw]

If you fall in the category of just "wanting to do research on the side" then I think you probably 1) don't need the PhD and 2) will probably be unhappy during the PhD and/or drop out if/when things get hard. I may be a minority opinion on this, but I really think that the MD/PhD program is for people who want to spend of a majority of their time in research and have a lab. If you don't love the daily grind of lab life, its going to be tough going.

Ha, I agree with the last statement wholeheartedly. If you cannot imagine splitting time at LEAST 50:50, and want to do research on the side, esp non molecular basic science-y research, don't bother. Underscore, all caps, what have you. An MD is enough to do a lot of research 'on the side', and is a much easier route.

 

[gbwillner]

In your opinion, could a Master's or 1-2 year off Med school for pure research put one of par with an MD/PhD in terms of research experience necessary to compete for these post-doc/tenure track positions in basic or translational science research?

No. The only way to be "on par" (not really, but as close as possible) is to do a post-doc as part, then additionally to, your clinical fellowship. That's it.

 

[gbwillner]

Thanks for the replies guys.



Okay. But what?! What does it mean to have a *tenure-track assistant professorship* without secured research time or space or money?! I seem to recall my newbie PIs starting off with their own lab space, and some small $100ks of seed money. And obviously they're all full time, since they're PhD.

How does this work?

/myignorance

It means you are clinical faculty with 50% or less protected time to do academic scholarly duties. As an MD/PhD, you may be able to secure more protected research time, but the space and start-up costs will be an issue. You may get some (and this does happen all the time as well), but it's just not typically enough for a young PI to get their bearings. It's typical in my field for MD/PhDs from top tier institutions and a successful record to get faculty positions with 50% protected time and about $200K without a post-doc. But this just isn't really enough in today's world with today's NIH R01 pay-lines. That means you have about 1-2 years to get a NIH funding or you will forfeit your protected time, and be 100% clinical. You would then have to get really lucky to buy back your time.