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Dilemma: top-25 md vs low-tier md/phd

Discussion in 'Physician Scientists' started by Kashue, Apr 19, 2004.

  1. Kashue

    Kashue No longer a USMLE JUNKIE!
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    I'm currently being faced with a dilemma and I would appreciate your guys opinions. I got accepted to Case School of Medicine regular MD program, Stony Brook MD program and also to my state school, SUNY-Buffalo MD/PHD program. In addition to their 17k stipend, Buffalo has offered me an extra 3k Dean's fellowship to attend, which equals 20k(which is plenty to live on). I'm currently confused as to which school to attend. I'm interested in academic medicine so I'm wondering if I should I go with Case MD or with the MD/PHD at Buffalo which is ranked lower but is a solid and well-coordinated program.
     
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  3. Gfunk6

    Gfunk6 And to think . . . I hesitated
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    IMO this is an absolute no-brainer. If you are truly interested in a career in academic medicine then go to SUNY-Buffalo. BTW, Case just barely ekes it's way into the top 25. We are not exactly talking about Harvard or Johns Hopkins.
     
  4. coldchemist

    coldchemist Biowulf
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    In total agreement. An MD/PhD with full funding is simply too good of an opportunity to miss--especially if you already want to do academic med.
     
  5. hockebob

    hockebob Member
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    i disagree here... i tend to think that the opportunities for research as an MD-only at case are probably going to be as good as at suny-buffalo mstp. have you considered contacting the case western mstp office to determine whether they accept students from the M1 or M2 classes? no offense to suny-buffalo students, but case is a much better clinical medical school no matter how you cut it. plus, the translational research opportunities at the cleveland clinic should be more than sufficient to satisfy your academic medicine leanings. finally, md-only isn't a dead-end... you could always try for one of the NIH payback scholarships after residency and/or do some sort of research fellowship. as we've discussed many times on this forum... MDs are certainly not disadvantaged if they are really serious about academic medicine.

    my thoughts,
    aaron
     
  6. Kashue

    Kashue No longer a USMLE JUNKIE!
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    Any more opinions?
     
  7. jjmack

    jjmack Senior Member
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    It's a tough decision. How do the research at case and buffalo suit your interests? Is money a big issue? If not then it would make the decision almost more diffucult. I would definately talk to the case director and see about trying to transfer in during M1 and M2. If I remember correctly from my interview this is something you can do. I'm not sure how many people actually do it though.
     
  8. Neuronix

    Neuronix Total nerd
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    Kashue, before I tell you my opinion it is very important for you to find out your chances of joining the MD/PhD program at Case. ASAP, I would write to the director of Case's MSTP or call their office and talk to someone about this. If it is very likely that you could join their MD/PhD after the first year, the decision would be difficult. If on the other hand it is unlikely you could join their MD/PhD program, I would say to go with the MD/PhD route. You could also consider Case's financial aid, to see exactly how much debt you would be in if you did end up at Case, if this is a factor for you.
     
  9. ATLien1224

    ATLien1224 Member
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    Yo in this case I would say go with Case (pun intended). If you really want to do basic research in conjunction with practicing, in general I would say definitely do the MD/PhD. However, I think that in this situation you have to take your whole career into account...in which case, the name recognition of Case with an MD and research during your time there will probably take you a lot farther than an MD-PhD from UB, even if you do want to do basic research. Plenty of MDs do basic research...not that it's the easiest, but you can make it happen. Of course the loans will be a pain in the ass to pay off if you just do MD...but I think that in terms of your career it would be better to go to Case, do research when you're there (between 1st and 2nd year, maybe a year off after 3rd for research/HHMI scholar), and go forth and conquer. Many more doors will open for you.
     
  10. chirurgeon

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    I agree with ATLien1224's take.

    2 questions/points:

    1) What type of research are you interested in? Basic, clinical, translational, or epidemiologic? Which institution is stronger in this area? From your visits/interviews, which school's peers did you feel more in sync with?

    2) Are you ready to commit an additional 3-5 years of graduate work on top of 4 years med school, 3-5 years residency, and 2-4 years fellowship? The MD/NIH Cloisters track seems to be an excellent path for getting the research record necessary for an academic medicine career. Gauge where you are in life and figure how much time you are willing to devote to this endeavour.
     
  11. Kashue

    Kashue No longer a USMLE JUNKIE!
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    Thanks everyone for your opinion(s).

    I'm leaning towards Buffalo for the following reasons:

    1. Strong basic science faculty, especially in the neurosciences, in particular at the Toshiba Stroke Research Center.

    2. Excellent Match list: Dermatology at Upenn, Optho at Mayo, etc.

    3. Location - I have family in Toronto and the cost of living is really cheap in Buffalo. I can finally have a car!

    4. Their graduates have gone on to hold positions at prestigious universities(Stanford, Mayo, Cleveland Clinic, etc).

    5. Full funding is hard to pass up when you have a wife and I don't want to go into debt which I will(~160-200k on top of 40k loans I have now) if I go to Case.

    6. Program is well coordinated.
     
  12. Neuronix

    Neuronix Total nerd
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    Kashue, your reasoning is sound. MD/PhDs from ANYWHERE do better in the match, so I wouldn't worry about that difference. For example, my old PI was a MD/PhD at MUSC and went on to do his residency (neuropath) at Stanford. I've seen their updated match lists, and they put people into all kinds of competitive stuff.

    Does that leave any pros to going to Case? Reputation difference? If SUNY-Buffalo is strong in your area of interest, it becomes a no-brainer to me.
     
  13. Kashue

    Kashue No longer a USMLE JUNKIE!
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    Thanks Neuronix. I took your opinion and emailed the MSTP recruiting coordinator at Case and asked if I could join as an MS2. She said its possible, but I have to go through the admissions review, etc. I'd rather not risk it and end up with 200k+ worth of debt in case I don't get in (no pun intended). I think I'd be happy at Buffalo and I already know who I'd like to work with.
     
  14. Neuronix

    Neuronix Total nerd
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    Make sure there are others there you could work with. You never know what could happen to someone in the next couple years... Not that I'm wishing bad things, it's just good to cover yourself.

    About Case, if you're still interested, I would talk to someone who actually has a say on your application, like the director. You want to know specifics... Like, why weren't you accepted and what you would have to do to prove yourself to them next year. More things like what your odds are of being accepted, etc... You won't get that out of the office staff, and if you can't get it out of the adcoms, I would agree that it is too risky. Of course you would also owe that first year; there's almost no way to get it repaid.
     
  15. Kashue

    Kashue No longer a USMLE JUNKIE!
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    Thanks Neuronix. I'll email the director Dr. Cliff and see what he can mention about my application.
     
  16. Elixir6

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    I am totally necro bumping the hell out of this, but Neuronix, do you remember writing this. It may have been true back then, but practically comical now, especially after everything you've written over the years. At least now this applicant would have been better off going to Case, taking a year leave of absence to do a mini-research project (and kill Step 1 at the same time) and come out with an AOA. Nowadays the ol' PhD is slowly dropping from its status as a huge red carpet rolled out at any program your little heart desires (like my MSTP kept telling us ad nauseum) to almost toilet paper to wipe your.... Ugh... the pessimist I've become.

    I wonder what happened to @Kashue

    @Neuronix @mercaptovizadeh
     
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  17. gutonc

    gutonc No Meat, No Treat
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    At first I was going to scold you for bumping this, but now I want to quote you for posterity.
     
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  18. Elixir6

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    We do it for the kids right?

    ... (and maybe a bit of neuroticism/OCD related to online medical forums)
     
  19. mercaptovizadeh

    mercaptovizadeh ἀλώπηξ
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    Truth, the PhD is a worthless rag, it might actually be worse these days than no PhD. Just suck up, publish a rack of garbage/noise clinical papers from 1 year of research and get AOA.
     
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  20. Neuronix

    Neuronix Total nerd
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    No.

    Agreed. It's more of a liability these days than an asset. Nobody cares about your PhD, but they assume you want to do great things with it. Very few places at the residency, fellowship, or faculty level will allow you to do the research that the MD/PhD was designed for. Even academic programs, most of which don't allow for significant research, assume you want to do real research and don't want you around. They assume things like you're not a good clinician or that you won't be a "team player" or that you'll leave and go somewhere else with more research as soon as you get the chance.

    The research positions out there are more about connections and clinical metrics than anything. Funding is more about politics. A PhD doesn't hurt, but why waste 4 years of your life on something you probably can't use?

    No idea. I will say that @Gfunk6 is now in private practice. I'd love to join him.
     
  21. Lucca

    Lucca Will Walk Rope for Sandwich
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    This thread is pretty depressing lol I wish I didn't like doing science so I wouldn't feel so conflicted every time I see posts like the above.
     
  22. Neuronix

    Neuronix Total nerd
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    You and me both.

    Something I have said repeatedly is: you can always keep doing science. It's just a question of how much you're willing to give up. I could take a fellowship for $60-100k/year, live somewhere I don't want to live, have no job security, no independence, but have significant protected research time. At age 35 I'm not willing to do that when I can make triple that within academics, have more location choices for jobs, and have some level of independence and security.
     
  23. Lucca

    Lucca Will Walk Rope for Sandwich
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    The thing is, it is hard to know what I'll be willing to give up at 35. I feel I would more deeply regret the decision to skip the PhD, amass debt and then finish residency knowing I won't be satisfied without the lab and spending extra time obtaining research training at a decreased reimbursement level anyway only this time with more debt. I'm probably just very naive but even though I enjoy interacting with patients in the clinic and look forward to doing it professionally, I just look at what the docs are doing and think: "that's it?". They just seem too complacent. If you're not at least trying to advance knowledge and make things better for patients then what is the point. Maybe I should just learn to love outcomes research lol
     
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  24. Sir William Osler

    Sir William Osler Senior Member
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    if you like doing research then its worth pursing the phd, but dont believe for a second that you have to have a phd in addition to an md to do high quality research. if you go the md/phd route, then be savvy. Try to figure out in which specialty you want to train early, so you can make the best of your phd time. i see alot of people who do yeast research and then wish they would have done something more human and translational once they finish their clinical training. Also, remember that there are many "levels" of research. Some labs do very incremental work thats fundable but likely wont ever change patient care. Other labs may be more cutting edge and higher impact. There may be institutions that have your preferred type of investigator so look closely. Overall, my advice is to enter either pathway with all eyes open. For me, I did straight MD, a research fellowship, and a short track IM residency into a specialty. I'm 36 now, and starting my own lab as assistant professor with 10% clinical time and a nice package/salary. My colleagues who did md/phd are 2-5 years older and are feeling the time crunch. Many md/phds dont even attempt to do research after clinical training and its nearly a waste of time except for "the experience" factor. Best of luck. The environment for physician research is very difficult now.
     
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  25. Lucca

    Lucca Will Walk Rope for Sandwich
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    5 years seems significant but it's hard for me to imagine the difference between your path and 2 more years. Do external pressures at that age rise that steeply? I imagine it really depends from person to person: whether they have a family, cost of living, family wealth, etc. I don't think you need a PhD to do meaningful research but I feel having structured training generalizable to any kind of research project is beneficial.
     
  26. snowonkey

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    A slightly different question- is this challenging environment for physician scientists just as applicable across programs?

    From what I've seen of graduate students at the institutions that I've been at, those at so called "higher tier" schools are having (comparatively) less issues with finding jobs with potential for advancement than those at so called "lower tier" schools.

    Does the same hold true for MSTP? i.e.- how much difference in experience would someone graduating from a top program (i.e.Harvard, Hopkins, UCSF, Stanford, WUSTL, Penn) have vs someone graduating from a lower ranked program (i.e. most state schools, smaller private)?
     
  27. Neuronix

    Neuronix Total nerd
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    I graduated from a top program. Nobody cares. When getting hired as faculty, it's all about who you know and where you went to residency/fellowship. Getting a top residency/fellowship is more about clinical metrics (AOA, step score, letters/connections) than where you did your MD/PhD. Don't believe me? We had 4 students not match at all in one year at my MD/PhD program!

    I also did very specialty-applicable translational PhD research. There are just no opportunities out there for me regardless. I think Osler had the better approach. Doing an MD then tailored research at a big name residency seems to be the right way to go these days. That helps you get the connections and do the politicking you need to get a position. That is far more important than actual ability. Research novelty in my experience is similarly frowned upon. If you get things going in an established lab and established area, you are much more of a sure bet.

    Another good reason to go the MD only approach these days is: the research fellowship/instructor time is almost mandatory in a lot of specialties. The MDs spend more time there than MD/PhDs, but in the long-run they spend less time. An MD/PhD program is on average a 4 year PhD. I haven't seen an MD spend more than 4 years in post-graduate research limbo land. They either do special PhD programs that give 3-4 year PhDs or something equivalent, and then get the job. Meanwhile you have PhDs who spend 4,5,6 years or more on PhD being told they need to spend at least a year in a research-oriented fellowship position. It's less efficient. Sure, there is a money issue there where the PhD at least has no debt. However, the MDs can moonlight. One guy I know was making more money moonlighting earning his PhD as a resident than some junior FP attendings I know!

    Here's a great anecdote for you. My dream job came up recently. I had spoken to that institution previously about the job, and they buttered me up for it. Told me lots of nice things about how I was perfect for the job and they didn't know anyone else with my qualifications. Great. So when the time came to hire, they hired a current resident there who has never had more than a year out for research. What qualifications did they have? They know that guy, they like that guy, and they're going to send him away for a *year* to get more training before he starts the physician-scientist position. Plenty of people out there I know like that. "Oh you have your PhD in this area?? That's nice, we have someone who did their *bachelor's* in a related area, he did residency here with clinical research in that area, so that's the guy here who does your area of research. So you see, no position is available for your research." That's been the line at a number of places for me.

    Getting a PhD that you have no idea if you can use just seems like a dumber and dumber idea to me in the real world.
     
  28. Lucca

    Lucca Will Walk Rope for Sandwich
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    Man, that really, really blows. I hope it works out for you in the end, and if it's not science I hope it pays banker money lol. It's like you decide to go into science to skip some of the BS of the corporate world in exchange for the Bs of the academic world but then it turns out that they are both there.
     
  29. Doctor&Geek

    Doctor&Geek 25 > 5 / 15 < 8
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    MD PhDs don't let other MD PhDs do radiation oncology if they want to do research.
     
  30. Sir William Osler

    Sir William Osler Senior Member
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    I agree with Neuronix that politics matters. That is life, for better or worse. While it may not seem like alot of time, 2-5 additional years can significantly influence your decisions re: research track vs private practice. When you are 40 and your wife is looking for you to pay bills while she is taking care of two children, one year can be infinity. Of course, this is not a rule just an observation of my md/phd colleagues. While harsh, I think the NIH's investment in MSTP was a terrible decision. Better to fund people on the back end of their careers with loan repayment and paid instructorships than fresh college grads who often have no clue what they want to do.
     
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  31. Lucca

    Lucca Will Walk Rope for Sandwich
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    I don't have the physical book on me so I cant quote it but this reminds me a lot of the last bit of Lewis Thomas' "The Governance of a University" essay where he talks about the founding of the NIH and, not much later, MD/PhD programs. In it, he talks about how medical faculty were originally totally unpaid and fully expected to fund themselves (and their research, if they had it) through their private practice; the faculty position was more of a professional distinction. Later, after the NIH was founded and government dollars were shoveled into science the number of schools and students increased dramatically, every faculty member was expected to have an NIH grant and manage their own laboratory. At the end he laments that science and medical education together were becoming so incredibly expensive and rising at a rate that no one involved ever really expected. Not totally related but when I'm not a science geek I'm a history nerd and I like to figure out how we arrive at the issues we worry about today.
     
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  32. solitude

    solitude Senior Member
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    I agree with this and have stated a similar opinion on here previously: MSTP should be de-funded and the money should be re-allocated to loan repayment and start-up grants for physician researchers. I started another thread about this re: the Canadian NIH apparently defunding their MSTPs but nobody commented.

    I do think the MSTP can have value in encouraging people to go into research but only if the PhD is quick. With a 3 year PhD, you can have absolutely NO debt and psychologically, I think that extends your "wife clock" a bit. However, even most optimistically, you are looking at being mid-30s when finishing your clinical training, so if there is still any amount of substantive time of research training to be done before getting your position it gets to be ridiculous.

    Like Neuronix, I am still hopeful to get my "dream position" but despair that it does not exist or I will not get it for some other reason. Overall though, at this point in my life (and the retrospectoscope view does change over time), I am actually still glad I did MSTP, for a few reasons:
    1) no debt, which makes me feel better psychologically, even though the rational side of me knows that it was not a financially sound decision
    2) I will have no regrets if I am never able to make a research career work, because I now know how much of succeeding in research is bulls***
    3) I feel "smarter" than my co-residents. Many of us, if we are honest with ourselves, will admit that this is one reason we did it in the first place, even if this feeling is not justified.
     
  33. tr

    tr inert protoplasm
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    The no debt thing has been huge for me personally. I spent 3 years tooling around in a postdoc/fellow position. I know many posters here view those as some kind of prison sentence but I had a great time, with 80% protected research time, lots of freedom and very little pressure. The only downside being the low salary relative to a full-time clinician. Those were great years and there's no way I could have afforded to have them if I'd been carrying a debt burden like many of my MD-only co-residents. (Well, maybe with an LRP but there's no guarantee of getting that.)

    The other main value of the PhD has actually been (surprise, ha) the knowledge itself. All those years being submerged in basic neuroscience gave me a huge fund of knowledge that has shaped my clinical work and my research directions in really important ways.

    What the MD/PhD is not is some kind of magic golden prestige ticket to the career you want. Nobody really cares about the letters after your name.
     
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  34. Neuronix

    Neuronix Total nerd
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    Had to roll my eyes here. You act like there isn't a legion of physician-scientists in other specialities going through the same things. I'll spare you the medical oncology anecdotes--we already have a medical oncologist in this forum writing similar things.
     
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  35. Fencer

    Fencer MSTP Director
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    Honestly, every single medical specialty "can" benefit from physician-scientists translating science into practice. Indeed, it is harder to do that in highly-paid procedural specialties because if you want to be an equal in salary you must produce it (plus the overhead). Nevertheless, you still play a role while one ends up hiring PhDs to do the actual research. This situation contributes to the perception of "dilettante scientist" for those physician-scientists, despite its valuable role helping drive translation and discovery in the specialty.
     
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  36. Doctor&Geek

    Doctor&Geek 25 > 5 / 15 < 8
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    MSTP to K08/R01 success rate is still low across all specialities, but at least when examining specialities of K08/K23 and other career development awards recently in oncology, I saw many were many in medicine, pathology, and pediatrics (and surprisingly neurosurgery and urology).

    There are 4 currently funded radiation oncologists with an NIH career development award in the entire country. That's five years worth of applications folks.

    Jingsong Yuan - Columbia - K22 (trained at MDAnderson)
    Steven Shiao - Cedars Sinai - K08 (trained at UCSF)
    David Kirsch - Duke - K02 (trained at MGH)
    Jay Dorsey - Penn - K08 (trained at Penn)

    Methods: NIH reporter, actively funded grants, full text search radiation (and similar terms), K08, K23, other K awards, manual review of departmental association and qualifications. Note that I did not limit to NCI or Departments of Radiation Oncology.

    EDIT: In a 5 year period 2004-2009, 84 MSTP trainees entered radiation oncology residencies; obviously considering that times periods are dissimilar, one cannot calculate a success rate directly based on data that I have.

    Similarly, I ought to check to see how many medicine residents and folks of other specialities have NIH CDAs. 367 MSTP trainees entered into Internal Medicine.

    Limitations also include not reviewing current awardees of ACS/DoD/Komen/Damon Runyan/Burroughs, etc. etc, R awards, etc.

    Burroughs Awardees:
    Gaorav Gupta - UNC (trained at MSKCC)
    Jay Dorsey - Penn (funding completed in 2012)
     
    #35 Doctor&Geek, Dec 23, 2015
    Last edited: Dec 23, 2015
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  37. Shifty B

    Physician 10+ Year Member

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    Well, this doesn't necessarily mean radiation oncology isn't conducive to research. It just means that it isn't that conducive to getting K awards. A significant problem in relatively high paid specialties (derm, radonc, radiology, surgical specialties) is that your department does not want to support you for submission of these awards because of low income support. They require 75% research and yet cap the salary support in the low $100s. If your base salary is $300k, your department is paying you $225 for that time the NIH will only give you $100 for.

    You might say that you could take a salary of $120k and go for a K. I guess you could, but many departments aren't interested in having that much income inequality because it tends to generate resentment. Plus, who wants to give up 70% of their potential income?

    It's one thing to say that you are willing to take a lower salary at some indeterminate time in the future to do research; it's an entirely different thing to choose a job with a salary of $120k when you have the skills to do work that you like and make $300k, starting tomorrow.
     
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  38. Fencer

    Fencer MSTP Director
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    100 K - 75%
    75 K - 25% time (at 300K FTE)

    The comparison is 175 K vs 300 K, still substantial difference but not 120K. Some of us took that ...
     
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  39. sluox

    Physician 10+ Year Member

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    Personally I don't think it's as simplistic. I could make 300k tomorrow (or a lot more in a few years) doing full time clinical practice, but there are aspects of the research job that are attractive. For example, flexibility in hours and vacation, mentorship (both getting and giving), possible future in administrative roles, etc.

    The more problematic aspect, to me, isn't lower salary, but the fact that the lower salary is PEGGED to a very unsteady/insecure grant stream. I think a decent number of rad oncs (or really any physician scientist), esp. MD/PhDs, would be willing to forgo the 300k salary if they can get slotted into hard money positions, when their salaries, however low, are decoupled at some baseline level from grant funding (let's call it $120k). This is not really feasible though, because the market is that there are way more people available to do research than hard money slots.

     
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  40. Neuronix

    Neuronix Total nerd
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    Shifty's post is right on.

    For me personally, the opportunity to do 80% research simply does not exist at any salary level. There are only a few departments that are interested in my area of research, and they are simply not hiring physician-scientists, nor are there research fellowships available.
     
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  41. Shifty B

    Physician 10+ Year Member

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    My point was that the gap between researchers and clinicians becomes greater as the salary becomes higher. As Neuronix says, most of these higher paying departments just don't have positions for a physician who is 80% research.

    On a side note, I'd be interested to know how OP's decision panned out.... it was more than 10 years ago.
     
  42. phdplusmd

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    Despite the constant drumbeat against the value of the PhD, I think I would have to agree with this: the knowledge from PhD training days and medical training days has been wonderful! There is a role for us dual trainees, as I see the only-MD's lack good research training/rigor. The only-PhD's lack any sense of what's clinically important. I've seen it being done, and while it's a struggle, you may have to compromise (being older, not live where you want exactly, take less salary, job title etc...), but if it's what you want to do: think, discover, see patients, do the science-medicine-translation, why not?
     

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