Do MD/PhD Directors Talk?: Disclosing Where You've Applied/Interviewed

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Future MD/PhD

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We see each other in meetings, but not about specific applicants. The system would so much better if we had a MD/PhD match. The problem is that about ~100 withdraw to medical school. Eventually, those slots are filled with other applicants, ending up with ~ 650 first-year MD/PhD students.
 
We see each other in meetings, but not about specific applicants. The system would so much better if we had a MD/PhD match. The problem is that about ~100 withdraw to medical school. Eventually, those slots are filled with other applicants, ending up with ~ 650 first-year MD/PhD students.

Emphasis mine; is that the purpose of the "where else are you looking/waiting on" question? To gauge interest in MD/PhD vs. MD only?
 
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It is broadly... Some people have connections to the city or region that might not be apparent from their applicant. For example, a significant other nearby. Keep in mind that when we are asking why MD/PhD or what do you want to do with your life, we are evaluating whether you would be worth the $500 - 1000 K expense (for the 7-9 years) from our part. Each of you costs us that much, and we will be justifying your future decisions, in our training grant renewals, endowment justifications, etc. I rather have someone quit MD/PhD at application state as compared to 2-3 years later, after paying for the first 2 years of medical school. Bottom line, although this is the wrong time to say this (given our current environment :laugh: - I can only laugh, 1 year done), believe me when I say, "there is no collusion between PDs regarding specific applicants".

We actually meet nationally to help work out issues regarding your future careers like leveraging our group to push for research-track residencies in every specialty.
 
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We actually meet nationally to help work out issues regarding your future careers like leveraging our group to push for research-track residencies in every specialty.

Our specialty's research track is disappearing. At one point it was probably the largest normalized for the size of our specialty.

Everyone realizes that once you're done the track, the odds of you getting significant grants or even a research job to start or sustain a real research career is so slim that there's no point to even bother training the residents in research. It doesn't help that academics is less and less about research every year and more about RVUs and revenue generation, so even the faculty are being disincentivized to do research.
 
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Academic centers are becoming the haves/have nots for the research enterprise. The margins in the clinical enterprise is what helps offset paying for the research mission of the institution. The problem that Neuronix's specialty (Rad Onc) is facing is that we all have to produce our salaries. Some specialties are more desirable because they have a greater salary. The problem, your cost to buy your research time is much higher than in traditional low paying specialties like IM, Peds, Neurology, Path.
 
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Academic centers are becoming the haves/have nots for the research enterprise. The margins in the clinical enterprise is what helps offset paying for the research mission of the institution. The problem that Neuronix's specialty (Rad Onc) is facing is that we all have to produce our salaries. Some specialties are more desirable because they have a greater salary. The problem, your cost to buy your research time is much higher than in traditional low paying specialties like IM, Peds, Neurology, Path.

It's not just salary. My salary is a reflection of the "professional" billing component of what I do, which is only about 20% of the revenue generated from each patient. 80% of the revenue is the "technical" component, which goes to the institution. So the losses are magnified even more than just my salary. Technical specialties lose a ton any time a physician is not treating patients. That money goes to support the money losing departments within the institution.

The other issue is that a lot of research is industry funded. Medical oncology trials generate a ton of money per patient. Industry funding is very common in medical subspecialties even for basic research. Even surgeons have device trials. Rad onc and radiology get almost no vendor funding because of the way radiation and radiology devices are regulated. It's to the point where many cancer centers don't even care about NIH funding anymore. Industry pays several times more per patient for clinical trials, so why bother with the NIH at all?

Still, people love to just point fingers and say "oh that's rad onc's problem" or "that's X specialty's problem" or "you weren't good enough" or whatever it is. I'd like to see the real data--for grads coming out in 2000s -2010s, how many are actually getting majority research positions? Just being in "academics" with one "academic day" a week is a joke. In my specialty you pretty much can't avoid becoming an "academic" physician because the academic institutions are taking over or building next to the private centers. So even if you're 100% clinical, you still get to be in academics with a meaningless academic title. I'm sure MD/PhD directors are claiming victory in these cases because all they seem to care about is that you aren't in private practice. But that's a farce.
 
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It's not just salary. My salary is a reflection of the "professional" billing component of what I do, which is only about 20% of the revenue generated from each patient. 80% of the revenue is the "technical" component, which goes to the institution. So the losses are magnified even more than just my salary. Technical specialties lose a ton any time a physician is not treating patients. That money goes to support the money losing departments within the institution.

The other issue is that a lot of research is industry funded. Medical oncology trials generate a ton of money per patient. Industry funding is very common in medical subspecialties even for basic research. Even surgeons have device trials. Rad onc and radiology get almost no vendor funding because of the way radiation and radiology devices are regulated. It's to the point where many cancer centers don't even care about NIH funding anymore. Industry pays several times more per patient for clinical trials, so why bother with the NIH at all?

Still, people love to just point fingers and say "oh that's rad onc's problem" or "that's X specialty's problem" or "you weren't good enough" or whatever it is. I'd like to see the real data--for grads coming out in 2000s -2010s, how many are actually getting majority research positions? Just being in "academics" with one "academic day" a week is a joke. In my specialty you pretty much can't avoid becoming an "academic" physician because the academic institutions are taking over or building next to the private centers. So even if you're 100% clinical, you still get to be in academics with a meaningless academic title. I'm sure MD/PhD directors are claiming victory in these cases because all they seem to care about is that you aren't in private practice. But that's a farce.
PDs at programs always talk about how their graduates end up in academic. How do we actually determine the proportion of an MSTP's students that end up in a tenure track position with dedicated research time/start up? It seems like the only way to find out is to individually google graduates and see where they are now....? That wouldn't yield a numerical percentage, but I suppose it would uncover who is in academic medicine and looks to be productive in research still?
 
PDs have been investigating this through surveys. The problem is that the published data aggregates from the good times such as for grads from the 1970s-1990s when more than a small percentage of people had proper circumstances to launch a research career.

It's hard to just look at websites and gather this sort of information. It's not like the website states that I'm a "clinical" professor on a "clinical-eductator" track. I mean, I still publish plenty of low impact clinical/chart review papers in my free time after work and on weekends that I didn't need a PhD for. Is that a success? I don't think so. But, I had no choice. At least I have full-time employment.
 
PDs at programs always talk about how their graduates end up in academic. How do we actually determine the proportion of an MSTP's students that end up in a tenure track position with dedicated research time/start up? It seems like the only way to find out is to individually google graduates and see where they are now....? That wouldn't yield a numerical percentage, but I suppose it would uncover who is in academic medicine and looks to be productive in research still?

There is no real tenure track position for physician scientists that is tenure in salary. There are jobs that are “tenured in title”, but it means if you don’t bring in grants they will make you do clinical work. Real tenure in salary is typically called endowed chair which doesn’t come much later in your career, if ever.

A reasonable measure is how many people graduated from 2000-2010 in the mstp cohort now have an R01 as a PI. I suspect that number is very very low...at best 10-15%. However, depending on how you look at things, a comparable cohort of PhD only might have a comparable number of 5% and MD-only might have a number of 3%.

So then you ask yourself the question what is the point of funding all the T32s for MSTPs for jobs that don’t exist. The answer is that the funding streams are controlled by senior steakholders who benefit from a large pool of lowly paid trainees. While this might seem weird and unfair, realize that this is how it goes very typically in the vast majority of corporate America. It’s just that academia is more hypocritical about it. Recent institutional battles against graduate student and postdoc unionization, for example, is a rare glimpse of that academic panties.
 
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There are many challenges in Academic Medicine. Despite them, we still have an annual $60 Billion expenditure for biomedical research ($36 B are from NIH, but other agencies and Pharma fill the rest) that is mostly managed by Physicians-scientists (data shows >60%) and a little more than half of these physicians are MD/PhDs.
 
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