Background: I am 12 years out from matriculating in a top-10 MSTP. I have completed a research-track residency (PSTP). I have loved my experience, yet over time I have come to realize the MSTP system is fudamentally flawed. Every year there are more and more funded spots. Programs take pride in the number of positions they offer. I noticed in my time that the attrition rate during training was fairly high (definitely higher than the stated averages). I also noted that upon graduation, many of my colleagues, who after years of toiling away in lab, decided to pursue clinical work only, and used their status in the MSTP to improve their standing in the match process. They had given up the notion of research all together. For those that are left in the science-bent track, residency comes, and you are swamped with clinical work. Some are able to continue research during this time (I was) but most did not. I'm sure none of this comes as a shock to any of you. Those who are still interested in research can pursue it during fellowship, or even a post-doc. The real eye-opener comes after residency, when real-life intervenes. By this time you are likely to have a family and other commitments. You finish your fellowship and are given an option (assuming you still want to do research)- do a 3-year post-doc with little compensation and extend your miserable semi-professional state, just to have a shot at a decent start-up package with nothing guaranteed; or go into practice making more money in 1 year than in all your residency years combined. Most prefer the second option. In real life no one will hire you to a significant research position because of "potential." If you want protected research time, you need to provide your own funding. Anything less than a K08 and you are not likely to get any protected research time, meaning you need a post-doc to have data to apply for grants. And those are currently dwindling. Even with a K08 you are a risk to some degree- you will be given protected time but likely few start-up funds. You really need an R01 to punch your own ticket, which are nearly impossible to get now. Meanwhile your colleagues are vacationing in Europe or sailing their yachts. Most mentors will tell you that you can't be a successful scientist devoting less than 80% of your time to it. But you can't really get that job unless you've already been successful and got grants. It's kind of a catch-22. You are basically forced to do a post-doc if you want to get a GOOD job and have a chance, meaning you'll just be older and more cynical when you finally get there. This is why the average age for the first R01 is more than 40, almost 20 years after matriculating in medical school! By the time you enter the post-Doc, you probably do have a good chance at a good job and start-up. It's because you're in the small percentage of MSTP'ers who actually made it this far, and are a prized commodity- you will provide prestige and research funds to a department at less pay with more committments. I'm not complaining. I have been very successful in my career thus far and my future looks bright. I just don't think any of the younger folk here know the sacrifices they are going to have to make to have a successful career as a physician-scientist. Once they see it, most will flee. I had a large MSTP class in a large MSTP program. I honestly can't think of more than a handful of people who are still going strong on research and are writing substantial grants. Most are happy to take clinical jobs and tinker with science or forget it all together. This all seems so inefficient to me. I guess I was wondering what other senior MSTPs/residents/fellows/attendings thought about all this, and what could be done to make it better.