Thanks, Gfunk6. I went through each of those threads before I posted. They are mainly related to the structure of the Holman Pathway, whether it is a good choice to enter, what places are supportive of it, etc. I am already Holman, so that decision is done for me (which I am very happy with). Of course I've talked to a lot of physician-scientists whom I know personally, but I just wanted to crowdsource some info on what it takes to land that first position, especially in the current medical/economic environment, and what aspects people thought were most important in doing so.
I did not do Holman. I think anyone who trains in the Holman pathway should be 100% committed to a research pathway when they start residency. I was not. However, I am still trying to pursue an academic career with a significant research component. I have been NIH funded under a training grant in the past and have identified other sources of funding for my niche area of research.
We can talk about our feelings and isolated anecdotal evidence all day long, but here is some actual data on research funding in RadOnc departments. It doesn't paint a positive picture.
You asked in your original post for opinions/anecdotes. The articles you posted have been discussed previously on this forum. Yes, the reality is grim for NIH funding. In the current environment, I doubt any current residents will ever be multi-R01 funded like the good old days of the 90s. Fortunately, most PIs get funding from other sources than large individual NIH grants. I agree that in the end, the physician-scientist pathway is a difficult pathway, career stability and salary are less, and nobody should portray positively our scraps of funding.
So do you expect to make the same salary as your full-time clinician colleagues who are working to bring the institution money
No. I don't know where that line should be though. To me, post-doc salary is insulting after 8 years of MD/PhD (including essentially a post-doc year) and a residency that was heavy in research, but I'm not expecting to make private practice numbers either. Somewhere on the order of low end academic salary seems reasonable to me, but it depends. If you're doing 80% research with no external funding, you may have to work for even less. However, if you are promising enough, there are startup packages out there that include support for your salary while you try to get significant grants.
there are very few positions across the country that align with your desires (I would estimate there are <10 of these positions at present).
These positions are never advertised so we never know how many there are. RadOnc-A-Donk, this is where you have to network. You have to identify investigators at other institutions in your area of research who might be able to find funding for you and/or get you in the door. A lot of these potential supporters may not even be in the radiation oncology department. If you can make a compelling case to the institution, institutional, state, or private startup money might be forthcoming.
Failing to support scientific innovation in our field will lead to our (further) marginalization from a modern scientific understanding of cancer biology and lost opportunities to integrate emerging therapeutics into our treatment protocols. Physician scientists are already working two jobs, and if you force them to take less salary, you will increasingly drive people away (to say nothing of the increasingly grim NIH funding line). Supporting these endeavors should be part of the mission and overhead costs of academic institutions that aspire to lead the field forward.
I agree. What is the point of academics otherwise? Without investment in research, our treatment modalities will become stale. Other specialties will innovate and take patients from us. Reimbursements for increasingly routine treatments will go down. Other countries (mostly Europe for now) will produce the new technologies instead of the USA, and this weakens our economy overall. I understand that we've all trained a long, grueling time and taken on either years in the lab or high amounts of med school debt and we want a comfortable lifestyle for our time invested and hard work. But, someone has to stay in the lab and/or perform clinical trials that drive our future as a specialty. I'm not saying that researcher support needs to come directly out of a clinician's private practice pocket. But, I am saying that the mission of academic medicine has to be to continue to support those endeavors. If academic medicine doesn't continue to produce research ourput, then it's bad for our specialty and society as a whole.
What's ironic is that rad onc each years gets more MD/PhDs than almost every specialty just based on pure numbers, and probably as a proportion of total residency spots max out out of all specialties.
Sluox, If this were Politifact I'd give you a pants on fire rating. You should know better from years in the MD/PhD forum where we harp on these numbers repeatedly. If we look at Dr. Paik's article in JAMA (
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2778489/), radiation oncology is only the #6 most common specialty among MD/PhD graduates (6% overall, IM takes 25%). You're right that Charting Outcomes 2014 (
http://www.nrmp.org/wp-content/uploads/2014/09/Charting-Outcomes-2014-Final.pdf) demonstrates that rad onc has the highest percentage of matched applicants with a PhD, 23%, but pathology is a close second at 22%. Pathology is a much larger specialty.
Rad Onc is not really a research specialty. It's more of an escape hatch for MD/PhDs who don't really want to do research. Yes exceptions do exist, but I don't think the vast vast majority of people going into rad onc is interested in an ongoing basic science (or even a translational science) career.
This is where the
smiley comes in. Personally, I chose radiation oncology because I have a PhD in physics and I want to use it. I work with a core of MD/PhDs who believe in themselves and in their basic science careers. I think people leave the research pathway for all sorts of reasons, but I'm not about to call a majority of MD/PhDs applying in this specialty liars about their goals for research.
Not only do I think it's insulting to imply that MD/PhDs apply in radiation oncology because they want to escape into private practice, that view is also not supported by the data. If we look at the data by Brass et al (
http://weill.cornell.edu/mdphd/bm~doc/are-mdphd-programs-meetin.pdf), only 15% of the identified MD/PhD graduates who went into radiation oncology were in private practice. This was #5 in their list of specialties for academic outcome, and compares very favorably to the other specialties in the list. I.e. there is a tight clustering among the best specialties, but even 16% of MD/PhD (MSTP) program graduates who went into internal medicine were later found in private practice.
Truer words have never been written in this forum
Let's be clear. What drives medical students into 'specialties' versus primary care?
Not every medical student in rad onc should go into research or academics. I want to make it clear that I'm talking about MD/PhD applicants and a handful of non-PhDs with very significant research background.
From that perspective, there's nothing wrong with primary care. MD/PhDs almost have to go into specialties where they can remain competent practicing clinically a small percentage of the time. It also benefits them to do research that directly applies to a small clinical focus.
Mainly $$ and lifestyle with a smaller element of prestige.
I do agree that this drives many. But I believe that someone who earned an MD/PhD and slaved away for extra years in a lab with a productive PhD has demonstrated their true ambitions to do serious academics. The surveys show that MD/PhDs do want real academic careers. Clearly, some fail for many reasons. That reflects a harsh reality, and I can't blame someone for wanting a specialty they enjoy clinically in case the research doesn't work out.
In a way, this is like NCAA football. Every student-athlete says they want to go to Alabama "for the education" but everyone knows that they have their eye on the NFL. The only difference is, in Rad Onc, the chances of 'making it to the NFL' are much higher 🙂
I'd turn this around the other way. Many MD/PhDs go into rad onc residency have their eyes on a real 80% research, heavily funded lab career. That's the NFL. Odds are they'll end up in mostly clinical practice instead. The strange thing here is that the mostly clinical practitioners make more money anyway. So at least if you fail in research, you can cry into your pillow full of money.
Also just to be clear: This is the view-point of only a couple of people on this board. Neither I nor Gfunk can speak for the specialty as a whole. But what I have seen is that the people least interested in an academic career are those with MDPhDs. Ironically the PhD really puts ppl off to an academic career.
PhDs know the reality. I certainly don't mince words about what people are getting into. I tell our MD/PhD applicants who want a Holman that "our program will support you to bang your head into the wall." It does annoy me quite a bit when bobble headed applicants with little real research experience talk about how great research is and how they are so interested in research.
Still, I have to respect the fact that come interview and match days, the faculty making the decisions at most programs are rarely researchers, but typically program directors who are focused on clinical measures like grades and step scores and personality. I disagree with that philosophy. I don't think you need to be in the top of your medical school class to be a competent clinical radiation oncologist. I believe that we should be taking the most research-minded MD/PhD applicants with the best ideas into the best academic residency programs. But that's not the way it works.
I think what gets patients to our clinic are the referring docs.
In the real world, most patients just follow a chain of referrals. i.e. The primary referred them to the urologist who sent them to you as the radiation oncologist.
What generates prestige and private, out-of-network referrals is reputation. Reputation is mostly because of research. The big name, nationally known places like Anderson or MSKCC draw referrals because they have subspecialists who perform the clinical and translational trials bolstered by bench research.
I can't even... This thread... 
