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Burnout
- Thread starter littlestar71
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I'm really sorry you are feeling this burnout and career regret. I'm still early on in my program, but what you have described has been voiced by many MD/PhD attendings I've spoken with on faculty or in industry who no longer participate in academic research, so I definitely don't think you are alone or that there is anything wrong with you. The problems you listed with research and academia are real problems with the work.
I dont think theres any shame in going private practice if you no longer want to do science. There's no point in continuing to do something or follow a path that is making you unhappy or has become incompatible with your life goals. Sure, not doing a PhD would've been a more direct way there but life is filled with many twists and turns and very few have truly linear paths.
I can't help much for career alternatives besides listing the typical "industry or full-time clinical" but for what its worth Ive also spoken to mentors who were completely burnt out from research at the end of their PhD and "re-discovered" a passion for science later in residency or fellowship. Maybe that will be you or maybe not, but there's definitely no reason to feel ashamed.
I dont think theres any shame in going private practice if you no longer want to do science. There's no point in continuing to do something or follow a path that is making you unhappy or has become incompatible with your life goals. Sure, not doing a PhD would've been a more direct way there but life is filled with many twists and turns and very few have truly linear paths.
I can't help much for career alternatives besides listing the typical "industry or full-time clinical" but for what its worth Ive also spoken to mentors who were completely burnt out from research at the end of their PhD and "re-discovered" a passion for science later in residency or fellowship. Maybe that will be you or maybe not, but there's definitely no reason to feel ashamed.
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Fear not as you are not alone in feeling this way.
Be aware, at the end of the day, you have more options that a straight MD or PhD graduate. You mention private practice, but that is only one small sliver of options available to you. I'm sure more well read folks like @Neuronix could give you a comprehensive list, but I see the following paths as the most common for people in your current position:
- Being a straight clinician in academia: this basically is like never having done the PhD but still being an "academic professor" in the clinical setting. See basically most physicians in academic medical centers. They do some teaching and some research, but the majority aren't heading research groups, clinical trials/studies, etc.
- Being a straight clinician in the community: You mentioned private practice already, but what about being the vast 90% of physicians in this country who literally work at a hospital that is like 30 miles from your house? Not academic or anything, but literally a job in a hospital?
- Being a clinician who still messes around with research: whether it be basic science and/or clinical research. You can explore and putz around a little in your residency and experiment (no pun intended) on what you want your life to be like. Maybe you'd love writing grants and getting rejected until you hit pay-dirt... then you might be bringing a K-award to your fellowship institution? Maybe you find out you love research, but literally only as a hobby by helping others out while focusing on your medical practice (and getting co-authored pubs just for fun and CV building, etc. I feel like this is the most common route for those that feel like you do... and do not want to sign away their lives doing something they're not happy with
- all other options involving hard-core science: many different options but ones that don't involve residency or not using your MD (which doesn't seem like you, so I'll stop writing here)
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If you think you won't enjoy writing grants (and the process thereof, which involves politics and dealing with egotistical collaborators) there's really no future in academic research for you as a principal investigator who takes credit for the results, but you could take a variety of supporting roles. The core job of the PI is fundraising. Everything else is window dressing. If you don't like the core job there's no point in continuing, IMO. Some people like tinkering, but in my experience people who *only* like tinkering and never learned to enjoy the craft of fundraising die a very bad career death in academia.
My experience is that people who go into private practice (or industry, for that matter) never ever regret going into private practice--people usually tell me the mistake was to hang on for longer than they should have. Indeed, by conventional standards, principal investigators actually are much bigger losers for reasons you've already listed. Most owners of successful private practices are kind of #winning and people around them collectively breathe out a big sigh of relief. Physicians in general enjoy a level of prestige and monetary reward that is simply unattainable as a scientist, on average. So no, this is a nonsensical concern.
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I felt the same way you did finishing MD/PhD. I let myself dive into intern year with no more thoughts of being an academician. I killed that idea off completely in my head.
Start of 3rd year into residency I had a good opportunity and good support/mentorship in my program to get back into it. They knew I had the background and actually wanted to have more residents do bench research (believe it or not). I decided I would do it, but completely on my terms (meaning, I was developing my own research program within the auspices and mentorship of the department-- not working strictly on someone else's project). Fast forward, I'll be starting a lab this year right after completing residency, 75 lab /25 clinic with excellent startup/salary (same as full time clinicians). Didn't think I would be doing this at all at the end of MD/PhD.
"Walk away" from it mentally. And then it's your choice whether or not to do it from that point (not someone else's expectation).
Start of 3rd year into residency I had a good opportunity and good support/mentorship in my program to get back into it. They knew I had the background and actually wanted to have more residents do bench research (believe it or not). I decided I would do it, but completely on my terms (meaning, I was developing my own research program within the auspices and mentorship of the department-- not working strictly on someone else's project). Fast forward, I'll be starting a lab this year right after completing residency, 75 lab /25 clinic with excellent startup/salary (same as full time clinicians). Didn't think I would be doing this at all at the end of MD/PhD.
"Walk away" from it mentally. And then it's your choice whether or not to do it from that point (not someone else's expectation).
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Not really. As usual your views are colored by certain superficial assumptions, which imply that everybody enjoys the same things in life, and are incorrect. This person already grabbed a bunch of grapes and ate them and didn't like how sour they tasted and decided to not eat a bunch more. That's not what sourgraping means.
Yes, top schools are saturated with #BornRich types, but the average university faculty is #NotDoingWell...just pick up the Chronicle of Higher Education any day. Higher ed, including med ed, is in a state of secular contraction. Becoming an average university research faculty is also not particularly competitive or #winning (for the average MD), as it lacks prestige, freedom and money (usually 3 constrain each other). What's competitive is getting *grants*, and that's only because they have too many people chasing after too few dollars--has nothing to do with the actual desirability of the job itself. In fact, the more competitive it is, the less desirable the job is. In real life you want to *avoid* the state of applying to Harvard every year--this is why relationships become much more important. In real life people care a lot more about *actual* revenue growth and value add. If you can find mechanisms where you can raise a lot of money very quickly without any competition, THEN you win. Competition for the sake of competition is rarely value-add, and I wouldn't do it even if I was #BornRich.
I know these things are confusing and seemingly contradictory, but hopefully one day you'll understand.
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Meh. Writing grants is the way to facilitate doing the research you want to do. Wealth and prestige are (or at least should be) irrelevant. By definition of being a doctor... you are wealthy.
I'm paid the lowest among my academic clinical colleagues, have higher expectations and pull more hours because of the research track... but I like it cause I get to do research. Clinical medicine is kinda boring and "could be done by monkeys" an old critical care attending once told me. She wasn't wrong in the slightest which is why you see such outsourcing/encroachment of physician jobs... its because they really aren't that hard. So there it is.
But to the OP, there's literally no point in pursuing something you don't want to do.
I'm paid the lowest among my academic clinical colleagues, have higher expectations and pull more hours because of the research track... but I like it cause I get to do research. Clinical medicine is kinda boring and "could be done by monkeys" an old critical care attending once told me. She wasn't wrong in the slightest which is why you see such outsourcing/encroachment of physician jobs... its because they really aren't that hard. So there it is.
But to the OP, there's literally no point in pursuing something you don't want to do.
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This is really encouraging to hear, congrats!
psychacad
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Just wanted to add that some of the PIs I've worked were very involved in the day to day science work. They weren't holed up in their offices writing grants. They actively supervised students and postdocs, problem-solved, suggested new ideas and projects..etc That's probably more science than running the 100th pipetting experiment. Not to say that there aren't bad aspects about the job.
I feel all of this #winner #loser calculations is a waste of everyone's time. At the end of the day what matters is your fulfillment, life satisfaction; people have different values and there are many ways to get there. It's normal to feel burned out after this kind of training. Take a break from science. See how you feel about it. You don't owe anything to anyone. If you want to 'walk away', you're perfectly entitled to do this.
I feel all of this #winner #loser calculations is a waste of everyone's time. At the end of the day what matters is your fulfillment, life satisfaction; people have different values and there are many ways to get there. It's normal to feel burned out after this kind of training. Take a break from science. See how you feel about it. You don't owe anything to anyone. If you want to 'walk away', you're perfectly entitled to do this.
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Everybody goes through phases. It's ok. Maybe you do just need a vacation or maybe this is how you will feel forever. That's your choice, and there's nothing wrong with what you choose.
This is the beauty of MSTP. You can do whatever you want with your degrees. You will not live in a bubble of shame if you go to private practice. The only bubble is the one you live in. Nobody will care what you're doing 5+ years after graduation. Sure the program generally wants their grads doing some amount of research, but there's always going to be some attrition into private practice. There is no consequence for the MSTP grad in PP except their own feelings about it--and some people who go into PP come out relieved they tried the MD/PhD path, realized it wasn't for them, and live a content life knowing that's what they want to be doing.
As far as other opportunities... Academic mostly clinical, private practice, industry. Those are the big ones. Your opportunities will vary a bit based on the specialty and may evolve over time. If you're going to do clinical residency, pick which specialty you like best and keep your eyes open for whatever options interest you over the years.
Sure I'm junior faculty with an MD/PhD student of my own now living on a K grant, a start-up package, and a dream. But it wasn't always like this for me, and it's not for everyone.
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This has changed... There is increasing focus on outcomes during MSTP T32 renewals. The T32 MSTP FOA instruct reviewers to examine whether the program outcomes contribute to careers involved or supporting biomedical research.
From the Review Criteria regarding the Program's Training Record
On Training Outcomes for Trainees
- "Are the trainees (or individuals in the training grant eligible pool) transitioning to careers in the biomedical research workforce (i.e., the breadth of careers involved in the conduct and support of biomedical research in areas that are relevant to the NIH mission; Training Table 8A)?"
- "Does the training program have an appropriate plan to track trainee outcomes and make the data publicly available (e.g., on the institution's website)?"
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Indeed. So for you running an MD/PhD program it's a problem to have grads go into private practice. For the graduate it's not a problem at all. Even if (god forbid) I become a program director someday, I'm not going to try to convince people to do things they don't want to do or feel bad about not continuing in a research career.
When I bail to private practice if my MSTP program says anything to me about it I will tell them $#@%@#^$%#$^, and I would advise the OP the same way.
When I bail to private practice if my MSTP program says anything to me about it I will tell them $#@%@#^$%#$^, and I would advise the OP the same way.
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I just corrected your [quoted] statement from the standpoint of the program. My interest and commitment to all of my trainees is for them to discover the path that best suits them. This is a hard career, and I give a lot of though love to them, starting in the recruiting trail, during training, and after graduation. This career is not for everybody... despite of being qualified or having the aptitude. There is a reason why about 100 (out of 800+) applicants withdraw AFTER receiving a MD/PhD acceptance. After matriculation, about 10-15% of MSTP trainees withdraw and the majority of them, just complete their MD training.
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I wish NIH would actually dynamically allocate spots based on the success of individuals achieving the stipulated goals of the program. As of right now they simply track them, write a paper or two bemoaning how the outcomes are bad, and then leave it at that.
When was the last time MSTP was pulled due to bad trainee outcomes?
When was the last time a PhD T32 was pulled?
So I think you didn't correct anything. Neuronix is right. "Trainee outcomes" don't matter to you me or anyone at NIH or else half of the PhD programs would have been eliminated.
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I respectfully disagree... people do care about this, including PDs care about the outcome of their trainees. Now, in your opinion what constitutes enough "bad trainee outcomes" to pull away funding from a program as you suggests?
Long-term career outcomes from PhD programs include 23% of graduates in academic medicine (w 18% NIH funded). Many PhD graduates contribute to many other careers that support our biomedical research enterprise (such as patent law, science journalism, etc.) For MD/PhD programs, it is about 75% in academic medicine, government or research institutes (w 43% NIH funded), 6% in industry, and 15% in private practice. Some in PP actually contribute enrolling into clinical trials. Long-term outcomes for MD-only program show that <10% stay in academic medicine (w <1.5% NIH funded). IMHO, if a program overperforms compared to those national benchmarks, then their good outcomes overmatch their bad outcomes.
Long-term career outcomes from PhD programs include 23% of graduates in academic medicine (w 18% NIH funded). Many PhD graduates contribute to many other careers that support our biomedical research enterprise (such as patent law, science journalism, etc.) For MD/PhD programs, it is about 75% in academic medicine, government or research institutes (w 43% NIH funded), 6% in industry, and 15% in private practice. Some in PP actually contribute enrolling into clinical trials. Long-term outcomes for MD-only program show that <10% stay in academic medicine (w <1.5% NIH funded). IMHO, if a program overperforms compared to those national benchmarks, then their good outcomes overmatch their bad outcomes.
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That escalated quickly 
I'm not saying that programs don't care about outcomes. Of course they do. From a cynical standpoint, they need to because of their grant. From a human standpoint, we run training programs so people can be successful with their degrees. Those of us who run programs and mentor students care about how their students do and want them to succeed in a physician-scientist capacity. We all want there to be physician-scientists, and we all recognize that there's more than one pathway and career to be a successful physician-scientist.
I thought NIH always cared about MD/PhD trainee outcomes, so it's not surprising to me that they're evaluating that. Heck when I was an MSTP student and still had a hairline, our leadership used to say "we need SOME OF YOU to stay in academics or we won't be an MSTP for very long."
Regardless of the above, I'll re-state my position. I'm here to advise the op on this thread, which is the same way I'd advise them if they PMed me, which is the same way I'd advise someone in real life. If your hearts not in it, don't do it anymore. That's your choice. What are they going to do to you otherwise? Nothing. That's all I meant.
I'm not saying that programs don't care about outcomes. Of course they do. From a cynical standpoint, they need to because of their grant. From a human standpoint, we run training programs so people can be successful with their degrees. Those of us who run programs and mentor students care about how their students do and want them to succeed in a physician-scientist capacity. We all want there to be physician-scientists, and we all recognize that there's more than one pathway and career to be a successful physician-scientist.
I thought NIH always cared about MD/PhD trainee outcomes, so it's not surprising to me that they're evaluating that. Heck when I was an MSTP student and still had a hairline, our leadership used to say "we need SOME OF YOU to stay in academics or we won't be an MSTP for very long."
Regardless of the above, I'll re-state my position. I'm here to advise the op on this thread, which is the same way I'd advise them if they PMed me, which is the same way I'd advise someone in real life. If your hearts not in it, don't do it anymore. That's your choice. What are they going to do to you otherwise? Nothing. That's all I meant.
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That’s not a fair comparison because the national MD pool and MD/PhD pool have different career goals (and both have different job prospects than PhD-only). If you killed all MD/PhD programs those now MD students would still go on to outperform (academics, clinical trials, grants) compared to the average MD applicant. A more fair comparison may be the long-term track record of MDs who go on to apply for fellowship awards or residency level PhD/research, compared to MD/PhD programs. I don’t think that comparison would be so favorable toward MD/PhDs.
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If you compare the outcomes to first R01 for Post-doc T32 awardees (in research intensive residencies), MD/PhD trainees have twice the subsequent grant success as compared to MD trainees.
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Is the glass 1/4 full or 3/4 empty? The rate is still less than 25% even for this highly enriched population of MD/PhDs who found research intensive residencies.
Still better than less than 10% though, I will give you that...
Still better than less than 10% though, I will give you that...
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I agree that MD/PhD is a good program. My opinion is the exact type of person going each route is different, and if you moved the MD/PhD population onto the MD track, that population would outperform the MD line in that graph because of their inherent interests/personality/traits.
Another factor is simple reviewer bias that could favor MD/PhD grants over MDs at the grant review process. I’ve seen grants awarded to those who put in “more years” of dedication to the career, over others who may have had a similar grant but didn’t “put in the years.”
There’s no good way to test/show some of these biases. Does MD/PhD training teach you enough by itself to be competitive for an R01? No way. But it does get you on the track perhaps better than some MD-only options. On the other hand, maybe MD/PhDs are also preferentially given better mentors/resources etc over MDs? I see this every year in my residency program— the MD residents with years of research before Med school but without PhD are not allowed by the program to join the research track. We award those who have been awarded previously. I’m not sure how much these things systemically favor MD/PhDs over MDs but it is not zero (with the postulate that the Md/PhD program do not value-add as much as we think, rather that systemic bias contributes a lot).
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Sounds ripe for an RCT 😂
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25% is really crazy when you think about it for more than a second. And yet somehow this deemed "acceptable". And this is 15 *years* after *T32 matriculation*. I really think a lot of people start asking themselves what the point of any of this is around 5 years after T32 matriculation.
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I started asking myself the point of any of this when I couldn't find anyone interested to support me on a T32 fellowship or equivalent.
Also I have no idea what this emoji is but I'm throwing it in for funsies
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Any highly specific benchmark is fraught with issues. For example, I count as a failure with R01 as the benchmark despite bringing in over $10 Million to my laboratory over a couple of decades, having being PI of VA Merit, program project, and several other grants. In the end, it is scholarly productivity and making contributions to science. In my career, I have produced >15 pubs with >100 citations, pubs in my area of expertise ranging from bench research, clinical observations, regulatory clinical trials, health care outcomes, and >10 patents including one that led to de-novo FDA clearance. Yes... I did not contribute to that 25%... There still are over 50% of MD/PhD graduates who do 50% or more of their time in research or research infrastructure time.
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Oh yeah. I remember feeling that way at the end of my basic science PhD.
Honestly I think the environment is a bit better in clinical/translational research. Things are more team-based and there's not so much of these little PI-based fiefdoms that are in competition with each other. Clinical questions always need replication so there's not nearly as much intensity around the possibility of scoopage. And the flexibility of being able to fill non-research time with clinical work also makes the endeavor less pressurized, which reduces the incentives to engage in unethical behavior in the pursuit of success.
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Another consideration regarding translational research is that our largely wet lab PhDs generally do not prepare you at all for a career in clinical research. Comparing experimental groups in Prism or Excel is not sufficient for design of clinical trials and downstream multivariate analysis of large clinical datasets. I find that MD trainees who focused on clinical research starting in medical school had a significant advantage on this career path over conventional MSTPs. As I currently go through the process of revising and re-revising a C/N/S manuscript (now almost 1.5 years from initial submission) my peers have published 10-20 clinical manuscripts in this time frame. This phenomenon is amplified in faculty, where those that are highly productive in clinical research are promoted and advance in national reputation faster than faculty pursuing high-risk basic science projects.
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There's a lot of garbage published as translational research though. I mean, I get it, the "publish or perish" manta exists everywhere in academia, but man has it created some rotten "science" along the way.
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I think you are just going up to finally getting out of level 1 in your soft skills.
If you are more advanced you'll realize that it's much better to actually get people to work with you than scooping their data/technique so there'll never be any future possibility with them ever again. In fact, you might get screwed in various settings (i.e. various annonymous reviews, etc)
If you change your mindset a bit, you'll realize that getting scooped is the LEAST of your concerns. It's not something to be afraid of at all. It's actually a *good* thing, because it means people care about your work enough to scoop it.
Scooping is a very unsophisticated management strategy--it's a sign of desperation. If you are more sophisticated you'd be able to convince people to willingly give you their data and let you take all their credit. If you don't know how to do this you should ask your mentor. The most important thing is relationship. Nobel Prize winners never get scooped. They get replicated. Know the difference. People who are good at this stuff can do literally exactly the same thing as everyone else and yet somehow convince 10 separate panels that their work is the most innovative.
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This is true but elides the fact that there is also a ton of garbage published in basic science. (Amyloid hypothesis anyone?) I find Sturgeon's Law pretty accurate for most situations.
Publish or perish is way stronger in basic science because people's careers and livelihoods are at stake. I just don't see that in clinical research because you're not going to lose your job if you don't hit that special h-index.
The crap in clinical research comes from the ethical and practical limitations to conducting well designed studies with appropriate controls on human populations. When doing it right is not an option, people just do something else, and it gets published somewhere, and lives to spawn a thousand breathless and hopelessly inaccurate headlines in Prevention magazine or whatnot.
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I would agree with that except that it is pretty easy to publish “research” in clinical/translational that has no hypothesis. It’s more collect patient data and discuss the correlation found by data mining for statistical significance. I suppose that could happen in basic science, one could put “omic” studies into that realm, but I still think there’s more hypothesis testing in basic science than clinical/translational research.
But either way, clearly the “publish or perish” model of acquiring funding and advancing ones career leaves a lot to be desired.
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I think we're mostly in agreement here that there's a lot of crap around. My point is that the garbage in clinical research is not as much driven by publish-or-perish, but more so by the fact that ideal science (hypothesis driven, with appropriate controls etc) isn't always feasible, so a lot of non-ideal work gets out there where the interpretation is murky due to unavoidably poor design.
I think the garbage in basic science often does come from publish-or-perish, where people are twisting their data or even making it up wholecloth to fit a sexy theory or claim a groundbreaking finding. The incentives towards that kind of thing are not nearly as powerful in clinical research. I'm not saying it's not there at all, just that it's not as overpowering.
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In particular, negative results get into NEJM on a fairly regular basis. In basic science, OTOH, labor deployment is really inefficient. You rarely have a large consortium of labs try strategy 1-10 together in a cohesive way. Instead, whoever gets to strategy 8 that worked gets the credit. It's quite a bit more malignant.
