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[Officer Farva]

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I was wondering, did any of you all have problems at medical school interviews discussing how you intend to incorporate research into your career. Did you either fake disinterest in your research, took a wishy-washy approach and say you want to do some research but not focus on it, or say I love research and want to focus on it?

I am saying after completing my interview season, since I encountered many MDs who were so split on the importance of science in medicine. Most had a "leave it to the PhDs" type of attitude, although at the school that admitted me the MD loved research and even used to run a lab.

How many of you had that experience?

 

[VlLLVGE]

I am saying after completing my interview season, since I encountered many MDs who were so split on the importance of science in medicine.

either you were interviewing at schools that embrace homeopathy or you grossly misunderstood your interviewers lol

 

[Fencer]

The greatest growth in medical school faculty for LCME accredited MD schools has been for Clinical MD faculty. Some of them get drafted as interviewers and many have the attitude described - "leave it to the PhDs". They are clinician-educators, and we need them to help leading the 95% of students in medical school who will never do research but become in compassionate competent physicians.

 

[Officer Farva]

either you were interviewing at schools that embrace homeopathy or you grossly misunderstood your interviewers lol

The greatest growth in medical school faculty for LCME accredited MD schools has been for Clinical MD faculty. Some of them get drafted as interviewers and many have the attitude described - "leave it to the PhDs". They are clinician-educators, and we need them to help leading the 95% of students in medical school who will never do research but become in compassionate competent physicians.

I consider myself more research focused than the average MD, but not as research focused as your typical MD/PhD. I did not apply to MD/PhD programs because I knew those programs are tremendous commitments.

However, there has to be some middle ground for the regular MD people. The MD school that accepted me, I was interviewed by an MD internal medicine subspecialist who used to run a lab but now does purely clinical research. That interviewer liked my commitment to research. However, at other interviews, I did face some resistance based on how much research I had, with the doctors telling me to go MSTP or pure PhD.

Has anyone with more knowledge than me noticed this in the university setting? With MDs either completely supporting research or being anti-research?

 

[QofQuimica]

I think sometimes interviewers ask rote questions because they're just looking for something to ask, not so much because they're thinking in great depth about how that question specifically applies to you as an individual applicant. I mean, I'm a PhD-to-MD (meaning I applied to medical school after already doing my PhD). Like you, I was very open about my interest in academic medicine and research. I had one med school interview where I was asked, "if you're so interested in research, why didn't you apply to the MD/PhD program?" Now I am not a person who is often at a loss for words, but I did go speechless for a couple seconds there. Then I told the interviewer, "well, it's been hard enough getting one PhD. I kind of figured one would be enough to last me a lifetime."

 

[tachycore]

I consider myself more research focused than the average MD, but not as research focused as your typical MD/PhD. I did not apply to MD/PhD programs because I knew those programs are tremendous commitments.

However, there has to be some middle ground for the regular MD people. The MD school that accepted me, I was interviewed by an MD internal medicine subspecialist who used to run a lab but now does purely clinical research. That interviewer liked my commitment to research. However, at other interviews, I did face some resistance based on how much research I had, with the doctors telling me to go MSTP or pure PhD.

Has anyone with more knowledge than me noticed this in the university setting? With MDs either completely supporting research or being anti-research?

You're referring to an age old rift between "real-world" vs. "academic" clinicians. It's contributed to outright divorce between institutions.

Yes, it's present at most academic settings. Members of one camp always view themselves as the workhorse / foot soldiers, seeing actual patients, practicing "real" medicine, bringing in the RVU's / money. They tend to view the other side as stuck up in ivory towers removed from patient care, occasional dictators trying to tell the rest of the medical world what to do. Those of the other view themselves as carrying out missions, such as expanding / improving medical science, raising prestige, etc. They tend to view the other side as unphilanthropic, corporate and self-interested, and less evidence-based.

Turns out the "real-world" clinicians are right on the RVU's / money front.

Since they easily make up the majority and bring in the bulk of ANY hospital system's income (not just university) ... well. You do the math and figure out who university hospitals really are going to support.

My favorite attendings learned how to exist between both worlds. But keeping both camps happy is definitely not easy.

 

[dl2dp2]

Since they easily make up the majority and bring in the bulk of ANY hospital system's income (not just university) ... well. You do the math and figure out who university hospitals really are going to support.

Turns out there is a lot of nuance to this. The profit margin for primary care, for example, is thinner than a typical indirect rate paid by a typical NIH grant. Hence, for an academic tertiary referral center, the approach is often to diminish primary care (and associated lower paying services) and increase research efforts. There is also a large and increasing revenue stream that derives from intellectual property and tech transfer at large centers. Philanthropy and state and agency support, consultation services, etc. have also become very important.

If anything, I would say clinical revenue at large tertiary center is becoming LESS important, except for very specialized areas such as subspecialty surgery and other lucrative procedural services. You need to plan ahead if you want to sustain a career in academic medicine.

 

[Neuronix]

Turns out there is a lot of nuance to this. The profit margin for primary care, for example, is thinner than a typical indirect rate paid by a typical NIH grant. Hence, for an academic tertiary referral center, the approach is often to diminish primary care (and associated lower paying services) and increase research efforts.

If you don't have primary care services, how will you get the subspecialty referrals? Self-referrals are a small and highly competitive market. Most patients generally go where they're referred. Many competitive markets are expanding primary care to make sure that they have a guaranteed referral base.

If anything, I would say clinical revenue at large tertiary center is becoming LESS important, except for very specialized areas such as subspecialty surgery and other lucrative procedural services. You need to plan ahead if you want to sustain a career in academic medicine.

Being in one of those other lucrative procedural services, it seems like there is heavy emphasis on clinical revenue. Tertiary referral centers are expanding radiation oncology services like wildfire. But, even at large tertiary centers, they are almost all entirely clinical positions with very limited resources or time for research.

 

[dl2dp2]

If you don't have primary care services, how will you get the subspecialty referrals? Self-referrals are a small and highly competitive market. Most patients generally go where they're referred. Many competitive markets are expanding primary care to make sure that they have a guaranteed referral base.

Turns out this is not an issue. For example, very few of our transplant surgery cases are referred through our own ambulatory care network (a perpetual money loser). Ditto for specialty ICU. That said, the hospital is trying to expand into adjacent suburbs where the payor mix is more favorable. This tension has gotten pretty bad--recently the hospital threatened to shut down the family medicine residency program, even though it more than finances its own salaries, because it wants to take over the space (a community hospital in a poor neighborhood) to build a state of the art spine surgery center.

Another example is something like this is MSKCC. Once you develop a national or even international reputation, self referral drives business.

Being in one of those other lucrative procedural services, it seems like there is heavy emphasis on clinical revenue. Tertiary referral centers are expanding radiation oncology services like wildfire. But, even at large tertiary centers, they are almost all entirely clinical positions with very limited resources or time for research.

Right, this is the nuance I'm talking about. Certain clinical services generate a huge amount and at a very good profit margin. In these departments research is de-emphasized, and clinical revenue really keeps the lights on. However, this is not true across the board. In fact, I would venture to say that most academic centers (though don't have sufficient data to back it up) main cognitive specialties (IM, neurology, path, etc.), the clinical profit margin is comparable or lower than the typical NIH indirect payment. This is why department heads in these departments have been very keen on bringing in more research dollars. Nevertheless, NIH grant $ is drying up, so sometimes depts have no choice but to expand the thinly profitable clinical services. NIH grant individual salary caps are lower for researchers, but that's a separate issue.