how to fix MSTP

[gbwillner]

What I'm criticizing, mostly, is this attitude that somehow people who are less academically accomplished (and poorer, and, implicitly, ethnic and culturally different from us) are some how having LESS demanding lives and don't have deal with as much in terms of work and family, and thus whatever we do is somehow HARDER than what the rest of society also has to deal with, and that you HAVE to have the lifestyle of rich doctors who make 400k, and that you "deserve" it, and that the fact that you can't have this is the fault of the institution that trained you. While I'm not dismissive to a particular individual's unhappiness, I am not at all convinced that the problem is existing at the level of the institution. The institution has problems, but the ones that are articulated, to me, are a lot of times the problems of the individual, and require addressing at an individual level via directed negotiation with the institution, individualized and specific psychological and career guidance/planning etc., and not necessarily at the level of the institution.

Dude, you are having this conversation with yourself. No one is arguing the point above. No one has come on this board and said we "deserve" anything. No one has posted that we have more demanding lives than anyone else. You are constantly accusing other posters, specifically me, of lying for some reason, saying things like:

Gimme a break here. Let's be honest. You hate it. You want to make 300k doing science...Face the reality. The world does not revolve around you..

..Despite the fact that I am one of the few MSTP'ers who HAVE made it this far and will CONTINUE to do research, and actually loves doing it. And the only sin I have committed was discuss what has led so many trainees to bail at the end of their training.

Any point you may have about introspection is lost in your numerous tirades accusing other posters of being bad with their finances (despite knowing nothing about their situation) or greed/envy of rich people or some twisted feeling of supremacy to other professionals without any evidence to support it. Yes, it is crazy to consider a career change after 15 years of training when you love what you do, and if you were to change would likely focus soley on your clinical profession. No, you cannot compare your situation to a teacher or whatever, because a teacher does not de facto have an additional certification in something that will pay them substantially more. And furthermore, the point of this entire thread was to discuss ways of making things better. Several things have been proposed, but you just dismiss them as impossible for some reason.

Please tell me why it is so wrong for a suggesting that system that is good at producing physician-scientists could also be good at ensuring funding for them to prevent attrition. Afterall, the point of MSTP is not just to hand out degrees.

And regarding people who love science but bail- I do know several. It's not JUST money, or envy as you would say. It has a lot to do with the uncertainty of the funding situation, stability of the institution, and the academic "clock". There are so many variables to consider, and you may not be in a financial position to handle such uncertainty. Then, you get an offer for clinical work that alleviates all those factors, and together supercedes your desire to continue a research track. But to you, those people were never serious about research, or they'd do it even if it caused cancer and killed them. That just shows your lack of empathy and insight.

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[dl2dp2]

No, you cannot compare your situation to a teacher or whatever, because a teacher does not de facto have an additional certification in something that will pay them substantially more ... Please tell me why it is so wrong for a suggesting that system that is good at producing physician-scientists could also be good at ensuring funding for them to prevent attrition. Afterall, the point of MSTP is not just to hand out degrees.

First of all, if you did well and went to an ivy league undergrad, you automatically have the leg up in terms of getting into either ibanking and teaching, and one makes a ton more than another. This "certification" idea is a straw man. You make a decision about your career based on a number of factors. I just don't see how any realistic change "at the systems level" would make any difference in terms of your personal decision making.

Secondly, it's not "wrong" to suggest ways in which the system may be improved upon, but I just seriously doubt that it'll help you in reaching your personal career goals and dissatisfactions, no matter what they are, and it's probably better to figure that out first if you intend to have them adressed. The fact of the matter is, there's NO WAY IN HELL that physician scientists would ever get paid more than pure clinicians no matter how you cut it. And even a modest financial assistance would involve aggressive lobbying and advocacy, which I'm assuming that you are not prepared to do. While perhaps some ideas proposed by the above (such as interest free loans as opposed to grants for tuition) may be useful policies, there's just no way to implement them. And as far as ensuring that people are getting funded--this again is mission impossible, unless you plan to become a scientific lobbyist to change the federal budget.

Thirdly, why do you assume that attrition is so bad? Do we really want a program that trains cookie cutter images of what an ideal "physician scientist" should be? I would argue that in many ways MSTP has brought into the clinical community a generation of clinicians who have strong basic science training and in many ways got involved shaping medicine that is practiced, which coincided with a radical shift in medicine from expert driven, experience guided practice to an evidence based, scientific discipline.

Fourthly, while I think it's probably good that you are directing your anger towards me (as opposed to your department chair) and I would indeed encourage you to use the internet as a way to release your frustration, I'm simply suggesting that perhaps you are not as "happy" and "successful" as you claim, and perhaps it's time to stop being defensive and figure out if there's some insight into looking into your own internal state and perhaps improve upon it.

 

[dl2dp2]

I think that we might all agree that it would be optimal if MSTP graduates were paid enough to not have to worry about keeping their families solvent. One of the problems is that salaries seem to be fairly uniform across the board, while living costs vary wildly. Another problem is that many research universities are located in areas with high living expenses.
One thing that the institutions I've seen have done a great job of doing is legitimizing and welcoming those who have children during the training period. That is something that is absolutely doable on the institutional level.

Except how much is "enough" and what do you mean by "solvent", and why would you move from one place to another with lower cost. These standards are clearly non-uniform not only between different individuals but also across different institutions. How do you expect the NIGMS to solve all these issues by reforming the way the training is structured?

Maybe we can restructure the discussion to take a different tack. These questions boil down to the following (1) how much money do we want and when do we want it. i.e. what do you think is a reasonable salary for a physician scientist both during and after residency? (2) other than money, what other barriers are to this career? What is a reasonable funding rate? What is a reasonable degree of mentorship or institutional support (3) how do we get the money and whatever else we want. There is a pervasive LACK of standard across the board with regard to the first two questions. And most importantly, without addressing the 3rd question, the first and second questions are to me, for lack of a better word, kvetching.

 

[Shifty B]

Thirdly, why do you assume that attrition is so bad? Do we really want a program that trains cookie cutter images of what an ideal "physician scientist" should be? I would argue that in many ways MSTP has brought into the clinical community a generation of clinicians who have strong basic science training and in many ways got involved shaping medicine that is practiced, which coincided with a radical shift in medicine from expert driven, experience guided practice to an evidence based, scientific discipline.

This is an interesting comment that many people do not consider. What if the attrition is satisfactory because people who complete MD/PhDs will bring a different perspective into their work, even if it ends up being 100% clinical work. It may not have been the perfect goal for that person, but that doesn't mean it won't end up being beneficial.

Is it all that bad to have a cohort of physicians doing clinical medicine who have considerably more training in research, interpreting the literature, and applying critical thinking to their practice?

 

[justgo]

This is an interesting comment that many people do not consider. What if the attrition is satisfactory because people who complete MD/PhDs will bring a different perspective into their work, even if it ends up being 100% clinical work. It may not have been the perfect goal for that person, but that doesn't mean it won't end up being beneficial.

Is it all that bad to have a cohort of physicians doing clinical medicine who have considerably more training in research, interpreting the literature, and applying critical thinking to their practice?

No, it is likely not bad. It is probably never bad to have individuals with more experience and broader perspectives involved in any substantive work.

However, the question is really if this is "important enough" to warrant the huge sums of federal money spent on training these broader folks.

These would be the people who could start an MD/PhD program, then after deciding to go clinical would have the money to pay off any costs incurred as a result of their MD training. Whereas the trainee who stayed in research would not have such funds.

This is the important point. The idea of MSTP funding is that you are allowing people to train for research careers at an academic frontier and remain debt free, as other research students do.

If we could find a way to pay MD/PhDs similarly to clinical MDs then we could stop funding MSTP programs at all. But, as that isn't happening we still need a mechanism to allow trainees not to incur debilitating debt.

Secondly, it's not "wrong" to suggest ways in which the system may be improved upon, but I just seriously doubt that it'll help you in reaching your personal career goals and dissatisfactions, no matter what they are, and it's probably better to figure that out first if you intend to have them adressed. The fact of the matter is, there's NO WAY IN HELL that physician scientists would ever get paid more than pure clinicians no matter how you cut it. And even a modest financial assistance would involve aggressive lobbying and advocacy, which I'm assuming that you are not prepared to do. While perhaps some ideas proposed by the above (such as interest free loans as opposed to grants for tuition) may be useful policies, there's just no way to implement them. And as far as ensuring that people are getting funded--this again is mission impossible, unless you plan to become a scientific lobbyist to change the federal budget.

Why do you think that loan repayment ideas would be impossible to implement? There are already numerous similar repayment programs in the academic world and several for MDs who go into research. Why could the MD/PhD program not follow an extant model or have administration through an existing office? What am I missing?

 

[miz]

I think that perhaps it is not possible to answer the third question without first answering the second question.

Except how much is "enough" and what do you mean by "solvent", and why would you move from one place to another with lower cost. These standards are clearly non-uniform not only between different individuals but also across different institutions. How do you expect the NIGMS to solve all these issues by reforming the way the training is structured?

Maybe we can restructure the discussion to take a different tack. These questions boil down to the following (1) how much money do we want and when do we want it. i.e. what do you think is a reasonable salary for a physician scientist both during and after residency? (2) other than money, what other barriers are to this career? What is a reasonable funding rate? What is a reasonable degree of mentorship or institutional support (3) how do we get the money and whatever else we want. There is a pervasive LACK of standard across the board with regard to the first two questions. And most importantly, without addressing the 3rd question, the first and second questions are to me, for lack of a better word, kvetching.

 

[Orbo]

Great post and discussion. As a somewhat senior MSTP (wrapping up PhD soon), I have a somewhat different take. I believe that the entire system of science is broken. MSTP is very inefficient but it's just a small component of the overall inefficiencies present in the scientific enterprise.

In my opinion, the incentives are all wrong. There is a moral hazard in that scientists are rewarded (in grants, jobs, salary, prestige, fame, etc.) for their papers rather than the quality of their papers. Yes, some papers are obviously bad, but many are ostensibly quite nice until you very closely interrogate the authors and discover all sorts of holes, many of which are ethically dubious. Even in the most well-intentioned scientists, the bias is ever-present and insuperable. As a consequence, it's my estimation that many if not most papers are, when you get down to it, essentially worthless.

We have to realign the incentives. Hundreds of years ago, scientists were motivated largely by curiosity and altruism. Monetary incentives were absent as most/all were gentleman-scientists. The focus was on getting the right answer. Think Darwin locking his manuscript in the drawer for 15 years.

It seems to me that the incentives in science are as perverse as fee-for-service in medicine. If you pay an MD to do things rather than maximize health of the patient, he will do the most number of things. But if you pay him to maximize health of the patient, he will do things most efficiently.

How to realign the incentives for science? I don't know. If I were omnipotent, the first thing I would do is axe about 75% of scientists, to cut the fat. This could easily be accomplished by mandatory retirement age (a la Britain), capping number of NIH grants per investigator, precluding PIs from paying postdocs off of NIH grants, and slashing training grants.

Then, cut the overhead costs. How many quarterly e-mails do you get about nominations for the Chancellor's Award for ____? You realize administrators are just sitting around making up these committees, spearheading nominations, ruling on this stuff, and hobnobbing at receptions? They all make way more than hardworking postdocs I can promise you that. IUCAC is largely a waste. IRBs are of course, needlessly complex. NIH grants have so much needless paperwork I want to pull a Santorum and barf in my mouth.

Once I've cut the number of scientists and the overhead, there are a lot fewer nincompoops and a lot more money to go around. Now, this relieves a lot of pressure and lifestyle improves, but I still haven't realigned incentives to maximize quality of the science. To do this, I promote large-scale collaboration. I'm talking everybody who's working in an area (say, chromatin remodeling) shares all of their data, both positive and negative data, on a daily or weekly basis. That removes a lot of the redundancy and inefficiency and enables fields to move faster. Of course this makes it more difficult to assess authorship contributions. That's fine because I abolish listed authorship of papers. Things become more like the Physics collaborations, where there is a Consortium of authors who publish hundreds of papers together. Except I would get rid of the Consortium and the enumeration of those authors altogether, and just have it authored by "Science Community, 2012". Of course there would have to be an executive committee and a tiered system of some sort to delegate authority for writing the manuscript, etc. etc. But removing authorship removes the perverse incentives for people to publish papers rather than maximize the quality of the science.

So what happens to the prestigious postdoc fellowships, the endowed professorships and the Nobels? Who cares? They fade away. Those do incentivize scientists, but for the wrong reasons and they lead to bad science.

Obviously, this is a pipe dream. But if you could fix science, you solve the financial and lifestyle impediments to keeping MSTPs in the fold.

I'm nearing the end of my PhD, and I think a little reflection on history might do us credit.

1.) Support. If you look at the great scientists of history, most were either "gentlemen" or relied on patronage. Patronage, which amounted to free reign to publish their scientific theories and funds to drive their research. And most importantly, patronage generally came from people who didn't dabble much in science.

Most of today's scientists are fighting for funding which will be issued at the decision of their peers, i.e. competitors or cronies, many of whom are entrenched in a particular understanding of the subject matter and favor material within that vein and disfavor stuff outside of it.

2.) Technical dominance/obstruction. Science is different today from what it was like 200 or 300 years ago. Back then, very simple instruments could help one or a few individuals discover fundamental phenomena and develop theories to explain them.

Today, the equipment and assays are becoming more demanding, requiring in depth knowledge by the investigator or extensive collaborations with many other individuals. Yet research - rather than being question focused and delocalized - continues to be driven by strong self-aggrandizing personalities who mix up the science with their desire for recognition and prestige.

There's also an issue of bureaucratization. I or the lab tech have lost countless hours - days even - dealing with IACUC protocol crap, IRBs, radiation safety forms, chemical hygiene, EHS, DEA, etc. They've given us grief (i.e. refused to allow it) about wanting to do a repeat experiment on 24 mice. This is absurd and a waste of time.

3.) Knowledge overload. Given so many scientists and labs, knowledge is being expanded at a greater and greater pace. This creates two problems:

a.) individuals are being required to assimilate ever-greater quantities of information and integrate it so as to better formulate their own ideas and understand the data; the individual's intrinsic capacity for this hasn't improved at all. If anything, scientists have less time to read broadly because they are dealing with the microdetails of their field all the time.

b.) lots of incorrect information/data is being put out there (including entire well-developed models, not phlogiston/spontaneous generation type nonsense), which lead science down incorrect paths and require threshing out at the individual level, followed by debunking (which requires higher and higher standards of experimental rigor (see the technical point in 2) the more entrenched the models are).

In other words, the science of the textbooks, the elegant little experiments we read about in our college textbooks that proved that DNA was the genetic material and not protein, or that calculated the charge/mass ratio of the electron, or demonstrated electromagnetic induction....that's all over.

Science itself has changed. The new "successful" scientist of our generation must read copious amounts of material related to the field and broadly outside of it. This provides the fertile germs for hypothesis/theory development. He or she must be very talented at socializing/networking with his colleagues (who will give him money) and must write well and persuasively. His or her name and lab must be marketed, show up in Science and Nature and Cell and PNAS. "Sexy" science is a plus, it's no longer enough to merely have consistent and well-conceived and -controlled experiments. He or she must be very technically adept, planting roots into a variety of collaborations and/or taking on new techniques and approaches as soon as they come out (as methods are dominating science today, I see how my mentor, who's perhaps 10-15 years off from the 'current trend' in techniques, is no longer getting funding).

And in the midst of all this, who has time to also see their family and friends, see patients in clinic, and take the odd vacation?

The 'have it all' dream (or is it nightmare?) was a lie.

These are excellent posts about the issues of research on the big-picture scale. Pretty much summed up the reason why I decided not to pursue a PhD after my bachelors, and have no real interest in pursuing research as a career now. Its funny because I had always thought PhD was a foregone conclusion up until undergrad because I loved the idea of being on the cutting edge of science and making exciting discoveries. But when I actually got to experience firsthand research in academia I realized that the massive bureaucracy in the research world sets up impenetrable red tape to do real life-improving research and instead shuffles incentives to merely pump out as many publications (good, bad, or UGLY [i.e. research with exaggerated findings, hidden findings, or unsupported conclusions]) as possible, as well as create slaves out of untenured professors to the grant-writing process.

The days of the truly great scientists has been all but over for decades now.

 

[echod]

because I loved the idea of being on the cutting edge of science and making exciting discoveries.

Maybe this is the real reason why you didn't undergo PhD training. It's not enough to like the idea, you need to like the process of doing research.

 

[mercaptovizadeh]

Maybe this is the real reason why you didn't undergo PhD training. It's not enough to like the idea, you need to like the process of doing research.

I don't think this is a fair response. There are aggravating things intrinsic to research, such as obtaining requisite (scarce?) materials, mastering techniques, troubleshooting failed experiments, and repeating experiments that were previously improperly controlled. That all requires patience and it's the "boring" aspect to science but arguably it's necessary.

What isn't necessary is to make obtaining funding the *central part* of the scientific process for the lead investigator. That was never the case in history. Investigators had their own funding already or depended on that of the benevolent wealthy, so they were intimately involved in their research from step A to step Z. How many PIs today have a grasp on all the techniques being done in their own lab, i.e. not only understand the concepts behind the techniques but also have done the techniques many times themselves and understand the pitfalls and how to troubleshoot?

What also isn't necessary is to enfold everything in a cloud of bureaucratic BS that slows everything down (and trust me, they do not have IACUCs in China).

And what also isn't necessary is having to slog from one journal to the next to get well-planned, well-controlled, and labor-intensive experiments that answer key questions, published. Publications are being evaluated not only on the consistency and integrity of the data and the *long-term prospects* opened up by the research and the quality of the writing, but on how "exciting" it will all be "for the rest of the community" in a very immediate fashion.

What will get published in a higher impact journal and faster? A "cure for cancer" paper with all sorts of holes and hidden data or a rigorously done paper on genetic engineering to induce disease resistance in crop plants? Which paper is more likely to have impact on human lives? The cancer paper? Guess again.

More people are alive today because of the work of agricultural plant biologists than because of half of the disease-oriented research out there. And I am understating that.

Well, here's a piece of news: by rewarding solely "exciting" and "cutting edge" research, we are handicapping nascent research that ultimately may be of greater importance than the next translational Nature Medicine paper, while tacitly encouraging fraud and overstated claims.

PCR would never have been possible had microbiologists not studied the archaebacteria that lived in thermal springs. Given today's funding environment, that early research would not receive the funding it merits and likely would not get published in a very high impact journal.

 

[justgo]

Given today's funding environment, that early research would not receive the funding it merits and likely would not get published in a very high impact journal.

Science had become (or maybe it always was but in a different way) a dynasty...getting published in high impact journals is a lot about if you have published in them before or if your department has...who you know. Which is why impact is a joke. Just ignore it and go on with your life! Maybe you won't end up as faculty at Harvard, but does that at all preclude one from having a solid career? Scientist are in control of who gets funded. I've sat in study sections and reviewed grants and there are a lot of solid opinions expressed that contradict the standard tomes in these arenas. The problem I think is that there is a lot of talk and then ultimate decisions are made by just a handful of very prestige driven folks at the top.

If we want more funding for science, we should first reduce the cost of science....supply prices are artificially hugely inflated. But if we want benevolent donors or we want federal funding to increase we need to get out and make people understand why science is beautiful. The gentleman scientists of old were much better at presenting public faces and in producing lectures that the lay elite could attend. We have made science exist within a cocoon via arrogance and now complain that our private game isn't being externally funded. We do all these things to ourselves in large part.

I think the PhD portion of the combined program is getting far too much attention in terms of expressing problems. I know few MD's that are completely happy in their professions these days either.

 

[Jorje286]

Most of those issues raised are merely the result of the fact that science is now more of a "mass" endeavor and not just the privilege of the inquisitive and fortunate few as it used to be. Is that really a bad thing? Certainly the biggest drawback is the conflict of interest.

The real issue imo is the disconnect between people's perceptions and the real world. A career in science/academia is not much different than a career in acting or singing. You have to be REALLY talented, really dedicated, or just lucky to be one of those few who make it and get their grants funded and approved. It doesn't suffice to "be there and do your job", and I think most people who get in the field aren't aware of that before they jump in, and that probably also applies to MSTP students. Which is why I also find the "400K attraction" argument a little bit silly - a career in science will not be as secure or as lucrative as one in the health field, and there's no reason for it to be so. If anything, that MD on the side should be more of an encouragement because at least you know that you have the security in case things don't work out.

 

[stevvo111]

I think what sluox was arguing and ranting about is that the amount of money that you are discussing is funny. Sure being an MD/Ph.D brings in less money, but $120-140K is still a lot of money (at least to me, more than enough to raise a family and have multiple kids, my parents did it with less than $40k for the most part of my childhood. They still make less than $100K, and I think we certainly live a fairly laid back, money is not that big of an issue, lifestyle). But I guess $400K is pretty incredible, I just don't see how doctors can spend this, considering to make this much I figure you must be in some specialty working many many hours, right? I mean yeah you have $400K, but so what? What are you going to do with that that you couldn't do with $140K. Buy a yacht? I don't see how you would have any time to actually enjoy this sucker to the fullest extent. I'd be comfortable working any job that paid $140K. I'd certainly be able to live comfortably, and raise a family, since my parents seem to have done so very well with way less. But overall I'd be extremely happy to do science and medicine and get paid $140K(as a base pay that can only go up with more grants won and administrative roles in the future)

^^ I think that is what sluox was arguing, at least I hope...

 

[erikreinertsen]

Hello from an incoming MSTP student. I really appreciate the thought-provoking discussion here. Mostly posts from fresh graduates and new attendings / faculty, right? I would be interested in hearing opinions on the state of MSTP from program directors, and what they think are the major hurdles. I think I will ask mine and relay any useful info.

Some of the issues brought up, especially funding and salary, seem out of MSTP jurisdiction - at least immediately so. MD/PhDs going into MSTP leadership positions is different than having MD/PhDs enter research and clinical leadership positions that handle funding. I'm sure it helps, but how much? The current system of peer review (and I am not familiar with how residency programs are funded so I won't make uninformed guesses) seems resistant to change for the better.

Being aware of these issues is an excellent starting point. Does anyone have suggestions for new students that will inherit what looks like many growing problems in a decade? Even at the earliest stages, we should take responsibility for our future careers as best we can. I think there is merit in carefully examining features that distinguish exceptionally successful MD/PhDs from those that are less successful (by what parameter is another question). How did they navigate the system? Is it time management? Networking with established faculty? We should try to understand what issues we will face, and preemptively attempt to develop necessary skills.

Sorry if this is vague, but I just wanted to start another area of discussion relevant for the newbies like me.

 

[Gfunk6]

But I guess $400K is pretty incredible, I just don't see how doctors can spend this, considering to make this much I figure you must be in some specialty working many many hours, right? I mean yeah you have $400K, but so what? What are you going to do with that that you couldn't do with $140K. Buy a yacht? I don't see how you would have any time to actually enjoy this sucker to the fullest extent. I'd be comfortable working any job that paid $140K. I'd certainly be able to live comfortably, and raise a family, since my parents seem to have done so very well with way less.

I'm sorry but this is just incredibly naive. However, I admit that when I was at your stage of training circa 1998 I was thinking the exact same thing. I had just finished undergrad and my MSTP had recently raised the stipend to $15,000 a year, I was so excited!

Between retirement funding, providing necessities for children (including saving for college), paying your home mortgage, paying for your car, and paying taxes you would be very surprised how quickly you blow through money. BTW, unless you are talking about a kayak, $400K is nowhere near enough to buy a yacht.

 

[Neuronix]

I'm sorry but this is just incredibly naive.

I was thinking the same thing. See: http://finance.yahoo.com/news/first-person-earn-more-100-000-still-feel-151200753.html

Absolutely this family could budget better, but 100k/year is not a lot of money for a family with multiple children to live well in most metro areas. I grew up poor, and while I ended up doing well, most of my friends didn't. I wouldn't want to subject my children to that.

 

[stevvo111]

I'm sorry but this is just incredibly naive. However, I admit that when I was at your stage of training circa 1998 I was thinking the exact same thing. I had just finished undergrad and my MSTP had recently raised the stipend to $15,000 a year, I was so excited!

Between retirement funding, providing necessities for children (including saving for college), paying your home mortgage, paying for your car, and paying taxes you would be very surprised how quickly you blow through money. BTW, unless you are talking about a kayak, $400K is nowhere near enough to buy a yacht.

haha, yes, I guess my previous statement was a bit naive. But as Neuronix said, I also grew up poor( not homeless poor, or in debt up our heads poor, but mediocre wage poor), but I think I have lived a fairly good life up until now (and that's with my parents funding me through college, paying for extravagant trips, and allowing me a sizable monthly fund to spend on necessities and random things- with the stipulation that I will take care of them in old age- something I have no problem doing).

But I still think $400K is a butt load of dough, compared to my parents wage and my families lives that is. I guess my view of this is distorted by the incredible money management skills my parents have employed for my entire life. With around $75,000 a year (me in college and my brother in medical school, a morgage half paid, pretty terrible insurance coverage provided by their jobs), they still seem to save upwards of $25,000 a year (provided we didn't live in a metropolitan area, far from it actually. I actually tried to persuade my dad into giving me $1000 stipend every month so I could invest it for him in the stock market, etc, but he decline that offer haha). This is only recently though, back in the day, they were making somewhere near $40,000 and couldn't save nearly as much especially since we lived in a metro area.

But I see your point, I think the realization of how far money can actually go hits when you actually make it and have to use it yourself.

 

[Pow5F1]

I think what sluox was arguing and ranting about is that the amount of money that you are discussing is funny. Sure being an MD/Ph.D brings in less money, but $120-140K is still a lot of money.."

The point that a number of posters are ignoring is that the academic researcher career with the $120-140k salary is available to any MSTPer who wants it. I bought this line when I was applying, but it's just not true. As others have posted, it's only true if you get at least K08 funding, and then a steady stream of R01's. I've heard MANY current faculty say that funding lines will go back above the 8% or so they are now, but I'm not convinced. Academic facilities have been overbuilt in the last decade, and as soon as funding lines go up, PhD's will be hired for soft money positions from the glut of postdocs.

There's an arrogance that pervades people who ignore the long odds of entering this group of researchers who can compete for the steady stream of R01's. "I'm smarter/better/stronger than my competitors, and therefore I'll get funded even at 8%." Yes, some people submitting R01's aren't that smart. And some smart people will submit lousy grants. However, I've never heard a PI come back from a study section and say that any less than 20% of the grants were excellent.

I'm finishing my PhD this summer, and I have no intention of ever doing research full-time again. It's not that I don't enjoy science, I love it. One of the reasons I am good at it is that I am an obsessive planner. I just can't deal with the uncertainty of when will I be done with training, not being able to tell my wife how many years we'll be living in city X and where we'll be going next, or exactly what I will be doing. I know no matter how much I plan things will go differently, that's the lesson the PhD has taught me above all, but I can't live my life with the fog of not having any sort of defined endpoint of when my training will finish.

 

[Fencer]

Your career direction is unfortunate because you said that you love science. In the last 16 years, I have not been funded for 1.5 years. At all other points, I have been funded with small or big grants. I have had a K08, a VA Merit (equiv for R01), and been co-PI in R01. However, smaller grants (higher risk/reward) have been more productive. This is not because I am smarter than the other guys, but because I have persisted doing this despite been told many times that my science or research was "crap".

I can tell you that as long as you work hard, think out of the box, and truly enjoy doing research ... things will work out. Perhaps not in the ideal way of having 3 or 4 simultaneous R-01s and 10 post-docs in the lab. There might be a few years when you might need to do 60-80% clinical, but also years with 60-80% bench research. Persistence, creativity and thick skin are more important than intelligence. I outworked many other smarter than me...

Today, I found out something against dogma when reviewing results from a database. We need to recheck the assumptions, but that "this is funny" moment is what I enjoy the most.

Good luck on your career!

 

[gbwillner]

The point that a number of posters are ignoring is that the academic researcher career with the $120-140k salary is available to any MSTPer who wants it. I bought this line when I was applying, but it's just not true. As others have posted, it's only true if you get at least K08 funding, and then a steady stream of R01's. I've heard MANY current faculty say that funding lines will go back above the 8% or so they are now, but I'm not convinced. Academic facilities have been overbuilt in the last decade, and as soon as funding lines go up, PhD's will be hired for soft money positions from the glut of postdocs.

This is the important point that bears repeating. It's not that you can't live on $120-140K, and that why people are bailing on science. Most of us, when finishing fellowship, if given that option with a start-up and protected time would take it in a heart beat. All the examples I gave before were people who bailed because this was NOT an option. The real options (for most) are:
1- take a POST-DOC at 30-60 K/year, with no promise of future employment or advancement, so that you can be productive in lab again, and then once the grants come someone will take a chance on you with a start-up and protected time (the traditional 80/20).
2- take an academic job at $80-180K (instructor- asst. prof), with little to no start-up, and little to no protected time. Most of us realize you will likely not be productive scientifically without funds or time. You can have the option of "buying in" research time with grants. But it will be an uphill battle from day 1 given your clinical responsibilities. It's not IMPOSSIBLE to make it work this way, but the odds are against you.
3- cash in. Realize the funding environment makes a research career a constant struggle, realize few departments will just "take a chance" on you without post-residency publications and grants, and realize you've been trained in a career that pays a lot of money with good benefits.

Now, there are a few of us who have found a way to make it work. PSTP programs often have "built-in" post-docs at attending level pay- this is usually instructor level (~$80K). While it's not ideal financially, you can at least "bridge the gap" much more comfortably this way- it's at least something. You still have uncertainty in terms of future emplyment, but it makes the post-doc a time that you don't have to get a reverse mortgage on your house. When you are done you will theoretically be a highly prized commodity. But even given this option, many will bail because of thje uncertaintly of the grant situation and the pay difference. The other problem is that there just aren't that many PSTPs or other forward-thinking chairmen that offer this option.

 

[Pow5F1]

I can tell you that as long as you work hard, think out of the box, and truly enjoy doing research ... things will work out. Perhaps not in the ideal way of having 3 or 4 simultaneous R-01s and 10 post-docs in the lab. There might be a few years when you might need to do 60-80% clinical, but also years with 60-80% bench research. Persistence, creativity and thick skin are more important than intelligence. I outworked many other smarter than me...

If I could go back in time to tell my pre-MSTP self one thing is that "Be wary of advice from current academic professors. By definition these are the people who won the tournament." If you don't know what I mean by tournament, pick up Freakanomics and read "Why drug dealers live with their moms." In my time as a PhD I've seen:
1. My undergrad PI (full professor) lost his R01 funding, and had his lab space reduced and administrative duties increased to the point he left academia.
2. The lab across the hall (assistant professor) shut down because she couldn't get her only R01 renewed.
3. Two postdocs (PhD only) who wanted to get academic positions left and are now not doing any bench work.
4. The most recent postdoc to be offered a job is 44 years old and has been a postdoc for 8+ years.

Things CAN work out, no question, but they don't have to. Keep in mind, young MSTPers/applicants, the people you're talking to are the ones who it DID work out for.

 

[Jorje286]

I want to just add that what I think is the most critical component for success in science is whether you have that one question in your mind that you're willing to chase and pursue. It doesn't suffice to enjoy lab work and think of it as fun or something you can see yourself doing for the rest of your life - it has to be somewhat of a higher calling. Then the "practicalities" won't matter as much and you'll find a way to survive on a subpar salary after all those years of training, in addition to dealing with the emotional stress of lack of security. And even if you fail in that case, you probably won't regret it. As was previously mentioned, MD/PhDs have an advantage over PhDs in that at least they have a secure job on the side that they can turn to if things don't work out.

Ultimately, I don't think the "problem" is in MSTPs but rather in the research/academic enterprise. MSTP is part of the research world, and those problems are shared across the spectrum by scientists everywhere. And then what's really the "problem" here is the capitalist system. That's what you get when the product of your labor is not immediately marketable and needed by the public.

 

[Neuronix]

By definition these are the people who won the tournament." If you don't know what I mean by tournament, pick up Freakanomics and read "Why drug dealers live with their moms."

This is a pretty good summary: http://articles.latimes.com/2005/apr/24/opinion/oe-dubner24

Academics is often compared to a pyramid scheme. I believe this analogy is not farfetched given so many low-paid individuals scrambling for limited funding with a low success rate of becoming a full and/or tenured professor.

Clinical medicine is much less of a pyramid. Yes, academic institutions need low paid residents to keep the academic institutions running their wards and clinics, but those residents will all have well paid clinical jobs at the end.

One of my favorites in cartoon form:

Note that there is incentive within the pyramid to recruit those under you. Of course those on the top of the pyramid would prefer for those more junior to be successful. But when the junior students or investigators are not successful, it is easy to simply blame them for not being focused and/or smart enough to make it.

 

[dl2dp2]

1- take a POST-DOC at 30-60 K/year, with no promise of future employment or advancement, so that you can be productive in lab again, and then once the grants come someone will take a chance on you with a start-up and protected time (the traditional 80/20).
2- take an academic job at $80-180K (instructor- asst. prof), with little to no start-up, and little to no protected time. Most of us realize you will likely not be productive scientifically without funds or time. You can have the option of "buying in" research time with grants. But it will be an uphill battle from day 1 given your clinical responsibilities. It's not IMPOSSIBLE to make it work this way, but the odds are against you.
3- cash in. Realize the funding environment makes a research career a constant struggle, realize few departments will just "take a chance" on you without post-residency publications and grants, and realize you've been trained in a career that pays a lot of money with good benefits.

I'm still not really sure what the point of this is. You are saying, someone who REALLY loved science, and wished for that 120k job couldn't get it because either he wasn't very good at it, or he wasn't very lucky and got shut down at the 8% funding line. OK....So then move on and cash in. Why would anybody care if you made a choice? And why is all the lamenting justified? If you want to cash in, cash in. NOONE IS STOPPING YOU (except yourself, and your guilty conscience, apparently...)

Going into research requires a certain degree of risk taking. If you can't handle the heat, get out of the kitchen. I just don't see how this fact in itself points to any specific way the system is not set up correctly. Given there is limited funding, we have to draw a line somewhere. Perhaps we should draw the line at high school. Perhaps we should draw it at residency matching, like dermatology. But it sounds like people can't even agree on where it should be drawn. If it was drawn at high school, perhaps you and I wouldn't even get INTO the game, let alone plotting how to fix the system 10 years later.

And to the poster who decided to quit science despite loving it so much. Ok. I'm not sure how to respond to it. A lot of people love being a movie star. Not every one can be a movie star. Good luck changing the system so everyone who loves being a movie star can be a movie star. Am I supposed to feel bad for you? Am I supposed to feel angry with you? Again, I reserve my pity and indignation for much bigger fish than your apparent unhappiness with not getting that 120k job that you didn't want in the first place.

I still think these arguments are just absurd, and so far no one has been able to articulate to me what exactly that he/she wants and how exactly he/she is gonna get it that's in any way realistic. And, maybe a decade ago a graduate student can claim to NOT know that the scientific research enterprise is a pyramid scheme. But, come on, who today enters into a MSTP not knowing how competitive this game is? You (i.e. the pleural you) did it on your own volition. You put the chips on the table. And now you are complaining the game isn't fair. You know what, LIFE ISN'T FAIR.

 

[Neuronix]

But, come on, who today enters into a MSTP not knowing how competitive this game is?

I think before this forum, most applicants had little or no idea about the realities of the physician-scientist training pathway. There's no other good source for this info written towards pre-meds out there, unless you're well connected to the academic world coming in (and few are).

This is why I think it's extremely important that we continue having these discussions now and into the future.

 

[dl2dp2]

I think before this forum, most applicants had little or no idea about the realities of the physician-scientist training pathway. There's no other good source for this info written towards pre-meds out there, unless you're well connected to the academic world coming in (and few are).

This is why I think it's extremely important that we continue having these discussions now and into the future.

That's fair. I agree.

 

[miz]

Isn't one of the big perks of the MD/PhD that even though it might not work out in academia for you in the end, you can pursue that dream and still have a solid backup plan?
It's true that pursuing an academic position is difficult, and with a low success rate. But if you complete residency, you are in theory as employable as any MD. I feel that pursuing a PhD is a much riskier path compared to pursuing an MD/PhD because I see many of my PhD only, postdoc friends feel the pinch of low pay and few career prospects, and at that stage, they have fewer options. I think we are very lucky to be able to pursue science in a relatively low-risk way. Ideally you don't do the MD/PhD for job security alone, but it is an important aspect. Hopefully you enjoy science such that the time spent on the PhD is not 'time lost' no matter where you end up- this may be a very naive sentiment, I don't have a PhD.

This is another way of viewing the trickle of MD/PhDs entering "just" clinical research- as a product of academic, scientific hierarchy rather than the fault of MD/PhD training process. We agree that academia seems to be a relatively saturated job market, yes? In this regard it is a problem of the structure of academic research rather than specific to the MSTP. You could even argue that the MSTP offers an imperfect solution in that the outcompeted graduate students have other options (clinical practice). I don't fully believe that but it is better than the alternative (PhD, no job prospects)

The reason there is incentive for professors to recruit graduate students and such is because the work you produce as a grad student or postdoc is significant. I don't think that it is a total waste to have very smart, medically informed students complete PhDs and then enter mostly clinical careers. They have spent around 4 years doing academic research for low pay which they most likely would not have otherwise done. Is it worth the 200,000$+ to train them? Probably not, but it's certainly not a total wash, even before you consider those who will go on to successfully enter research careers.

 

[Pow5F1]

I think before this forum, most applicants had little or no idea about the realities of the physician-scientist training pathway. There's no other good source for this info written towards pre-meds out there, unless you're well connected to the academic world coming in (and few are).

This is why I think it's extremely important that we continue having these discussions now and into the future.

Agree completely. At my school, there is an unwritten ban on discussing the realities of the current scientific enterprise, especially with applicants. As an applicant, I did intellectually know that not everyone makes it. I just didn't know how I would feel to be part of a system where you're invited to be cheap labor for going on a decade with no guarantee of advancement. It was something that I needed to experience for myself to know it's not actually what I wanted for my life.

However, I have not told my PI I feel this way. I have not told my MSTP program director. I don't think I will tell people on my residency applications. There's a persistent group think that we need to pretend everything would be fine if we could just get the NIH to give us enough money. What would I change if I could...almost everything, starting with the concept of a PI run lab, but that's pie in the sky. What would I realistically change, to have realistic conversations with students at EVERY stage of training, including applicants.

I don't want to discourage anyone who also needs to find this out for yourself. If you'll always wonder if you'll regret missing out on a research career, try it. I'm just sick of the "You can do everything and do it well" pitch. Life is compromise, be honest about the choices we're going to have to make. On a related note, thanks for starting this thread, it's been very cathartic.

 

[Neuronix]

I don't think I will tell people on my residency applications.

Good idea. You need to sell yourself to get a residency position. Community programs are never going to take an MD/PhD, even if you sell yourself as all clinical. But if you say you want to go mostly or all clinical to the academic programs, you will lose any advantage the PhD gives you to get a position. This is an easy way to fall into the MD/PhD trap I write about in my blog and fail to match.

It's unfortunate, because it cheapens the value of the MD/PhD. Every faculty member can now talk about an MD/PhD who talked a big academic game coming into the program who quickly changed their tune within residency. In my experience, most of the the big name academic programs out there really put little emphasis on the PhD in residency selection. But you still have to market yourself for what advantage the PhD is going to give you.

It's a game we have to play. And the reality is, we play it against every MD-only out there with a few months of research in medical school who swears up and down now that they want to go into academics (when in private they don't). Don't let yourself be beat by that person.

 

[gbwillner]

I'm still not really sure what the point of this is. You are saying, someone who REALLY loved science, and wished for that 120k job couldn't get it because either he wasn't very good at it, or he wasn't very lucky and got shut down at the 8% funding line. OK....So then move on and cash in. Why would anybody care if you made a choice? And why is all the lamenting justified? If you want to cash in, cash in. NOONE IS STOPPING YOU (except yourself, and your guilty conscience, apparently...)

I'm not sure I understand why you don't get it- it's clear as day. The point is that the $120-$180K 80/20 job is a MYTH out of training. You need to put in time in a post-doc if you want it, with no further commitments from the university (in terms of time, promotion, or future employment). It may not be feasable for you to do one without some other support. Some departments will pay you PGY salary to do one, others will not. A few will supplement PGY salary, making it mouch more feasable, but these positions are rare. You are also likely to be in a stage of life where you need to support your family/parents/etc. Most human beings in this position weigh not only the lack of income but the uncertainty of the research world and decide to go into clinical practice. Even those who take the academic job will not successfully compete in science because of the restrictions on their time and buget (how can you buy more protected time with grants, when you have no space/time/funds?).
It's not my guilty concience that forced me to write this thread. It is my concern for the utility and future of a great training program whose goal is to produce physician-scientists. It is SAD that many trainees put a lot of effort in their training and would like to continue the research track, but ultimately decide against it for the above reasons.

It's also tells a lot about you that you have no ability to empathise with these people, who will ultimately become the majority of your peers. As to who cares? I believe most of us do. We don't feel bad people will now make better income, we feel bad that potentially great clinician-scientist are bowing out for preventable reasons.

 

[soundnin]

I still think these arguments are just absurd, and so far no one has been able to articulate to me what exactly that he/she wants and how exactly he/she is gonna get it that's in any way realistic.

you just argued our points exactly. people are being very clear about what they want. they want to have sustained careers as physician scientists. as for the latter, how we do it? we go through 8-10 years training, we do our residencies, maybe other training on top of that, and ... ? if this pathway doesn't result in a high likelihood of "how exactly he/she is gonna get it that's in any way realistic", doesn't that mean there is something flawed with the system (the whole point of starting the thread)?

(though i do agree with the recent posts saying that the main issue is the world of science, which physician scientists are a part of)

 

[dl2dp2]

It's also tells a lot about you that you have no ability to empathise with these people, who will ultimately become the majority of your peers. As to who cares? I believe most of us do. We don't feel bad people will now make better income, we feel bad that potentially great clinician-scientist are bowing out for preventable reasons.

This. None of the reasons you've specified are preventable. Furthermore, you don't even specific what exactly that you want. I'm not really sure with whom I'm trying to empathize. I don't think you understand what the word empathy means. As I said, people who quit are happier when they quit. Most people who don't quit are happy that they didn't quit. As to people who don't quit but can't help but whine and whine about not quitting, I understand perfectly why you feel so lousy (empathy), and sometimes I feel lousy too, but I'm suggesting a genuine solution to your (my) problems are not external but internal (i.e. fix your own perspective first--and if necessary, get therapy--so as to facilitate a change in your life so that you would actually become happier). Just because I refuse to whine with you and interpret it in a different way doesn't mean that I don't empathize (understand) your admittedly sad predicament.

 

[Jorje286]

are bowing out for preventable reasons.

And how are they preventable? The only way to prevent them is to increase the funding rate. Or are you proposing that they get paid better in the post-doc phase and then be booted out anyway when their grants don't get funded.

The real issue is that research is TOUGH ****. And this is what everyone in the field needs to come to terms with. Whether being an MD/PhD or a PhD you need establish a solid record of at least 8 years with several publications preferably in top journals before you get a shot. Funding is limited, competition is intense. There's nothing more to it. It's not easy, but at the same time, it's not tragic either to get paid 70k. You have to be ready for making compromises, and oh well, being an intellectual (which what academia is after all) never carried a light price.

Before I went into med school, my research advisor was very clear to the people in the lab. He said don't go into this if you have any doubts about your capabilities, and you need to work your ass off to have a shot. Maybe not all PIs are this frank with their students, but I think that's the realistic attitude.

 

[dl2dp2]

you just argued our points exactly. people are being very clear about what they want. they want to have sustained careers as physician scientists. as for the latter, how we do it? we go through 8-10 years training, we do our residencies, maybe other training on top of that, and ... ? if this pathway doesn't result in a high likelihood of "how exactly he/she is gonna get it that's in any way realistic", doesn't that mean there is something flawed with the system (the whole point of starting the thread)?

(though i do agree with the recent posts saying that the main issue is the world of science, which physician scientists are a part of)

Ok. Well, what is a "high likelihood"? I'm guessing 10% isn't high enough. How about 30%? How about 90%? Can we even agree on this? And where exactly is the hold-up? Is it the salary, or is it the sustained R01 award?

Let me show you why what you are asking for is not even close to being realistic. Let's say 500 MDPhDs graduate each year, and each of which needs a (guaranteed) "sustained career of 30 years" of R01 funded research. Given a modest yearly direct cost of 250k, at the end of the 30 year cycle, the NIH needs an increase of more than 3 billion dollars, which is about 30% of funding available for ALL of clinical research in the US. (The basic science budget is roughly the same.) In order to prop up the kind of system that you envision, we need to create a system that's around 1/3 the size of the entire clinical research institution. And this is just for MDPhDs, which comprises around 3% of the medical school students. And this is not factoring in indirect costs. And, in light of at least 100k salary differential, if NIH tries to fill in a supplement of salary for all the MDPhD graduates for 30 years, that's another billion. This kind of structural modification requires MAJOR MAJOR advocacy and policy changes at the Congressional level. Again this is only for MDPhDs, not PhDs or MDs, should the injustice of such a system not be immediately obvious. Despite the lip service that both parties are paying to scientific research, this is just NOT a priority to most elected official now or in the near future. We can barely advocate enough to get the NIH budget increased to meet INFLATION.

I'm sorry to report, but your 8-10 years of scientific training is BASICALLY WORTHLESS at the end of the day because scientific research makes NO MONEY. This is a sort of a hyperbole, but my point is, don't bet on your training giving you a significant gain in human capital, because the fields in which you are training are not that profitable. This is not an MBA from Wharton and you have absolutely no leverage in terms of sustaining a career around that. The value of your existence is that your PIs need cheap labor and they can't get it any other way. The sooner you realize this and figure out a way to make peace with it the better.

Someone tells me how my math is not right.

 

[gbwillner]

This. None of the reasons you've specified are preventable. Furthermore, you don't even specific what exactly that you want. I'm not really sure with whom I'm trying to empathize. I don't think you understand what the word empathy means. As I said, people who quit are happier when they quit. Most people who don't quit are happy that they didn't quit. As to people who don't quit but can't help but whine and whine about not quitting, I understand perfectly why you feel so lousy (empathy), and sometimes I feel lousy too, but I'm suggesting a genuine solution to your (my) problems are not external but internal (i.e. fix your own perspective first--and if necessary, get therapy--so as to facilitate a change in your life so that you would actually become happier). Just because I refuse to whine with you and interpret it in a different way doesn't mean that I don't empathize (understand) your admittedly sad predicament.

So what you are saying is that adding bridge funding, in the form of start-up funds to your institution from MSTP funds, would NOT be helpful in retaining physician-scientists who have completed their training? because that is what I've specifically stated. Or are you saying that nothing will ever change, so it's a waste of time to even consider it? And people who even discuss it are just a bunch of whiners? Why change anything?

Regarding empathy, you clearly don't have it.... (ps- it means to put yourself in someone's shoes and see the world through there eyes- not have pitty on them)

Obviously I understand people who decided against a career in science. ... I just don't know what's the logic behind all this kvetching over things that you have very little control over. If you are happy, why do you think the system is broken? If you aren't happy, then do something about it....
Am I supposed to feel bad for you? Am I supposed to feel angry with you? Again, I reserve my pity and indignation for much bigger fish than your apparent unhappiness with not getting that 120k job that you didn't want in the first place....
I still think these arguments are just absurd, and so far no one has been able to articulate to me what exactly that he/she wants and how exactly he/she is gonna get it that's in any way realistic. .. But, come on, who today enters into a MSTP not knowing how competitive this game is? You (i.e. the pleural you) did it on your own volition. You put the chips on the table. And now you are complaining the game isn't fair. You know what, LIFE ISN'T FAIR.

You sound like the CounterPoint guy from Airplane...
"they bought their tickets, they knew what they were getting into... I say, let 'em crash!"

Also, your obsession with trying to psychoanalyze me are off-base. If you disagree with me, fine. Tell us all you think the system is fine the way it is, and attrition is part of the game. That it's too bad for those who left (or good), but the system is better without them in it. That the money going into their training (and their lost time) is Okey-dokie by you. You have no idea what my circumstances are, where my happiness lies, or of my successes and failures. IF you would search all my previous posts on this forum (all thousands of them) you would see how off you were.

 

[Pow5F1]

I'm sorry to report, but your 8-10 years of scientific training is BASICALLY WORTHLESS at the end of the day because scientific research makes NO MONEY...The value of your existence is that your PIs need cheap labor and they can't get it any other way.
Someone tells me how my math is not right.

The issue is that this statement bothers most of us. We have been bombarded with statements like an MD/PhD going into PP is a failure. Yet, you even point out that it's impossible for all MD/PhDs to have careers that require their elaborate and expensive training! Don't all those wasted years of peoples lives bother you at all?

 

[Gfunk6]

I agree with sluox in that an MSTP is a zero sum game. There are a finite number of 80-20 positions that rely upon grant funding and cannot possibly be obtained by EVERY MSTP grad. Ergo, there will necessarily be graduates who do not pursue 80-20 careers.

However, there are alternate paths which allow you to use some of your PhD training. These include Clinical-Investigator/Translational-Scientist type jobs either in academia or industry. If all else fails and you want to stay in academics you could become a straight up Clinical-Educator.

These are not "ideal," but it is obviously impossible for everyone to achieve the ideal even they wanted to.

 

[dl2dp2]

I just want to apologize if I offended anybody here because my deliberate rhetoric devices of sarcasm. There is a bit too much back and forth going on. But I do think that one major component is to have a place and a setting for these "vents" on an institutional level. I.e. senior investigators may be at a better place to offer advice than an internet forum. I think a lot of macroscopic changes are probably much better implemented on a school by school, department by department basis.

In terms of big picture, and sarcasms aside, from my personal perspective I feel that despite of all its problems, I do want to express an enormous gratitude towards the MSTP system in general, and some of the newer initiatives to promote younger investigators, especially translational investigators. While my PhD wasn't as awesome or awful as some of my peers, it had its problems. But I still enjoyed working with some of the smartest people out there. And while I am having my share of uncertainties for my future, I remain optimistic and am prepared to do whatever I can to make the system more hospitable. People can feel free to PM me on an individual basis if they think they have any specific issue that's pertinent. While I'm by no means in a "position of power", I do know a few people especially along the lines of the new CTSAs and etc. and in concert we can perhaps reach some kind of consensus. Otherwise I just want to say that I feel very lucky in generally, and if any current student/perspective student has any questions I would also gladly answer them and if I can't answer them point them to the right people. In terms of "how to fix MSTP", my first instinct is I kind of loved it, and I have no complaints. But realistically I'm not really sure how it can be fixed, except to say that perhaps we should advocate the system to be more transparent, track alumni performance, and finding allies in institutional support. And in terms of specifics, things are very complicated.

 

[Neuronix]

These include Clinical-Investigator/Translational-Scientist type jobs either in academia or industry. If all else fails and you want to stay in academics you could become a straight up Clinical-Educator.

I personally don't see how this is any better than private practice. You don't need a PhD for these things, and the MD/PhD program typically doesn't give you any specific training for it.

I have always wondered why someone would choose a clinical-educator track at all over private practice. I have only ever heard two reasons that made sense to me.

1) The job was in a location where they couldn't get a PP job, but really wanted to be.
2) Residents to do your work for you makes your life easier.

Even in a clinical research position, the clinical investigation I see is so often such totally softball work. Personally, I've been an MD/PhD who has always been hardcore into high tech, engineering, basic science things. To do retrospective chart review work the rest of my life makes no sense. I feel like I might as well just go to private practice. I would be happy to receive more input into why a basic science trained MD/PhD would stay in academics and accept much lower pay just to do a small amount of clinical research.

 

[soundnin]

Ok. Well, what is a "high likelihood"? I'm guessing 10% isn't high enough. How about 30%? How about 90%? Can we even agree on this? And where exactly is the hold-up? Is it the salary, or is it the sustained R01 award?

Let me show you why what you are asking for is not even close to being realistic. Let's say 500 MDPhDs graduate each year, and each of which needs a (guaranteed) "sustained career of 30 years" of R01 funded research. Given a modest yearly direct cost of 250k, at the end of the 30 year cycle, the NIH needs an increase of more than 3 billion dollars, which is about 30% of funding available for ALL of clinical research in the US. (The basic science budget is roughly the same.) In order to prop up the kind of system that you envision, we need to create a system that's around 1/3 the size of the entire clinical research institution. And this is just for MDPhDs, which comprises around 3% of the medical school students. And this is not factoring in indirect costs. And, in light of at least 100k salary differential, if NIH tries to fill in a supplement of salary for all the MDPhD graduates for 30 years, that's another billion. This kind of structural modification requires MAJOR MAJOR advocacy and policy changes at the Congressional level. Again this is only for MDPhDs, not PhDs or MDs, should the injustice of such a system not be immediately obvious. Despite the lip service that both parties are paying to scientific research, this is just NOT a priority to most elected official now or in the near future. We can barely advocate enough to get the NIH budget increased to meet INFLATION.

I'm sorry to report, but your 8-10 years of scientific training is BASICALLY WORTHLESS at the end of the day because scientific research makes NO MONEY. This is a sort of a hyperbole, but my point is, don't bet on your training giving you a significant gain in human capital, because the fields in which you are training are not that profitable. This is not an MBA from Wharton and you have absolutely no leverage in terms of sustaining a career around that. The value of your existence is that your PIs need cheap labor and they can't get it any other way. The sooner you realize this and figure out a way to make peace with it the better.

Someone tells me how my math is not right.

right you just argued my point. i totally agree. as for what is high? 100%. it's a program where the goal is to train physician scientists. but it's not reality = whole point of thread. and because of this bottleneck, people end up going purely clinical AND get paid more for it = mstp system flawed. do you not agree we are saying the same thing here?

Sent from my LS670 using Tapatalk

 

[soundnin]

In terms of big picture, and sarcasms aside, from my personal perspective I feel that despite of all its problems, I do want to express an enormous gratitude towards the MSTP system in general... In terms of "how to fix MSTP", my first instinct is I kind of loved it, and I have no complaints.

and this here illustrates why this thread has been sort of a you VS us debate so far. no one here is really talking about "happiness level" except for you. gbwillner even explicitly stated multiple times that he is quite happy with his current position (see especially the post at the top of this page). i'm sure most md/phd graduates also enjoyed and appreciated their training. i'm sure most matriculating trainees are excited to begin their program. but we are trying to objectively criticize the mstp initiative in this thread. thus, the whole talk about external/internal solutions is kind of, well, irrelevant, since you seem to acknowledge the same problems we do. i'm glad we're all in agreement, and i really appreciate the ongoing discussion in this thread as an incoming MS1

 

[dl2dp2]

but it's not reality = whole point of thread. and because of this bottleneck, people end up going purely clinical AND get paid more for it = mstp system flawed. do you not agree we are saying the same thing here?

I don't really see how you equate the first two to the third. Just because there's a bottleneck doesn't mean the system is flawed, and the system may be flawed but for reasons other than the bottleneck. Again I disagree that drop outs are necessarily bad. I also disagree that the ongoing criticism of MSTP in this thread is "objective" as you call it. I maintain that a lot of such criticisms arising in these contexts come out not due to the systems per se but due to the individuals making the criticisms and their particular experiences and emotions. I don't think this particular caveat ought to be very controversial, but I do think it's a caveat that is rarely addressed.

In summary, I'm not convinced that the MSTP needs "fixing." And suppose that it does need to be fixed, I'm not at all convinced that the way to fix it is to increase salary or pouring more money for the young graduates, but I could be persuaded if you provide me with a concrete plan and solid evidence. Thirdly, I'm not convinced that such "fixes" should occur at the national level and not at the departmental level. Fourthly, one reason why I think the ways in which the previous proposals have been put forth are not the right way to go, as I've shown, is because these proposals are grossly unrealistic.

And in terms of bridge funding, K-awards do exist to provide that, and there are other non-NIH sources for this. But, again, it's just not possible to give everyone an award. I just don't think this is necessarily a "problem" that requires a "fix." I kind of agree that the 10% funding rate for R01 is a "problem", but the "fix" is very complicated and complaints per se haven't helped so far. I also think that a system that gives 100% yield is neither desirable nor realistic. Many MSTP students don't know 100% when they go in that they want to commit to a life of 80/20. Many MSTP graduates or K-awardees don't know that. Perhaps the fact that the system allows for some leakage is an advantage. Suppose you are cherry picked from high school to be a research PI for the next 30 years, and the government gives guaranteed funds--but you can't do anything else...are you sure this is really a good thing? To me it sounds vaguely Soviet.

 

[soundnin]

Fourthly, one reason why I think the ways in which the previous proposals have been put forth are not the right way to go, as I've shown, is because these proposals are grossly unrealistic.

i was just pointing out that we are saying the same thing. it wasn't a proposal

 

[soundnin]

Perhaps the fact that the system allows for some leakage is an advantage. Suppose you are cherry picked from high school to be a research PI for the next 30 years, and the government gives guaranteed funds--but you can't do anything else...are you sure this is really a good thing? To me it sounds vaguely Soviet.

nobody is saying this? it's more the flip side of the coin - for those that want to do so, to have it be a more viable option than what is currently reality.

edit:
sorry. i probably wasn't clear before but when i said 100% i meant that that was the mission statement of mstp's.

 

[r1oid]

Again for the most part this is a great thread. A few thoughts.

Its not a stretch to say 100% clinical isn't the green field we are making it out to be. I'm sure at this point a lot of us know people on the other side and the issues they complain about. If you are lucky enough to have a clinical option that wouldn't be a miserable vocation then you have a legit backup. We have to remember those MD/PhDs that forgo residency each year to postdoc. The ones I've known saw no possible future for themselves in medicine (incuding path, rads, etc,,,) and had no regrets. Bringing in family responsibilities, location desires, etc.. muddies up the issues but they would do so in just about any career path.

For the group of us that actually get a lot of fulfillment from patient care there is something to be said about the way a physician scientist (no PhD required) approaches patient care. I think a lot of us have met these people and can appreciate what they do and offer to their patients. Becoming one of these docs isn't a cop out but probably not in the strict description of what the MSTP grant wanted to put out.

Then there is the group of us who can't help but see the scientific questions in a lot of the clinical medicine we are exposed to and can't get over that gnawing desire to try and answer those questions with the tools our PhDs gave us. Yes you probably have to pick one or two questions to tackle but it is true that we have a unique perspective that most of our PhD colleagues don't have. For all the cancer papers that start with X # people die of Y cancer every year and if we shut down Sexy gene we might treat those people, how many of those PI's have any real clue what % of patients have benefited from all the targeted therapies that we've come up with so far. NIH's investment is that someone like us will have the tools to come up with the HAART therapy equivalent for cancer from all drugs we have and drug targets out there.

One last thought. A lot of us are in or coming out of training during a low in the funding cycle and it is coloring our view of where academic research is going and where we might be able to fit in. We have to remind ourselves that Billions of dollars are still being given out each year in grants and that we are a very smart and talented cohort of people. We beat out a lot of other smart people to get where we are and for the most part it was with drive and raw brain power. The "competition" is using the same thing, there is no mystery mojo in their pocket. Luck splits some of the difference but that goes both ways.

 

[u2psalm40]

I think before this forum, most applicants had little or no idea about the realities of the physician-scientist training pathway. There's no other good source for this info written towards pre-meds out there, unless you're well connected to the academic world coming in (and few are).

This is why I think it's extremely important that we continue having these discussions now and into the future.

yes this thread so refreshing.
kids listen up b/c this is the truth you don't hear at school.
only among that group of senior students you don't want around the younger mstps.

Yes there should be some changes to better take care of the end products (people who want that 80/20 etc etc) instead of cramming more people down the chute. Unfortunately we're stuck between 2 broken systems which are both changing (science --> funding black hole, hard to publish cycle; medicine--->uncertain future of healthcare economy/reimbursement/ future of clinical specialties, something we haven't discussed here yet that affects academic medicine as well), so how to fix the system is not entirely clear.

So please if you're in college dreaming of that md/phd life (you know the one that starts 15 years from now) or you're at those Second Looks i'd find some time to bookmark this thread. minus the personal attacks, but what is SDN without that. filter that out and hear some truth for once instead of pandering scores/numbers, why md/phd? etc.

You have to look it in the face and decide whether you want it, warts and all. no guarantees. there is an element of masochism involved. at every stage of the game.

and if it doesn't work out, like LeBron you can always take your talents to south beach. it's ok to remember that. masochism doesn't pay or feed the kids.

 

[ChemMed]

.................

 

[vitalamine]

We will adapt, and the incentives for clinician scientist careers will remodel. The pipeline is leaky but not entirely broken. I agree with the idea that MD/PhDs might actively participate in Team Science. Read "The Vanishing Physician Scientist".

I was just reading through this thread again and curious if Fencer or anyone else would speculate in what ways you predict that "clinician scientist careers will remodel"?

For example, if "team science" will predominate, how will incentives change to promote this? And is this actually happening anywhere?

 

[Underarchiever]

You can be a collaborator for somebody's funding as far as you hold some resources the other people need. You can be a part of a drug trial grant, too. "team science" is a good name for working for a big PI (usually a program project). Your career starts when you get your first RO1. I don't see any way out unless you get your own RO1 and renew it, to be a physician scientist. Without it, there is no tenure possibility. When NIH launches so many program project RFAs, it eats away the funding pool for RO1 and really makes it hard for young people to make a career in science. Most MD-PHDs do not make it. If the funding situation continues to be like today, we will lose a generation of scientists, because it is difficult for a start-up to compete against well established PIs.

 

[Fencer]

I guess I am the optimist because I got promoted/tenured despite being inefficient with a 50/50 and competing against 100%s. I have had about 20 different grants including K-08, renewed K-08, VA Merit Award, co-PI a R01, local PI site for VA Coop study, a dozen clinical pharma studies, two pharma bench studies, several institutional/small foundation grants (including HHMI), added 4 questions to CRF of large clinical NIH trial ($ 40 M), section chair for HHS/NIH grant, etc. Some are bench, some clinical, and some are population (health care outcomes), but most are "teams" a few are just mine. The key is curiosity and trying to understand my area of research and clinical interest (they align very much). The other is to find the right location where the expectations match your interests. There are at least 60 research intensive universities in the country, for example the 60 CTSA institutions (http://ctsaweb.org). Despite being offered a job at a top 5 institution, I would NOT have been supported or promoted at any of those Top 20 institutions (perhaps, now with almost 4000 citations, I would). My family would have also not seen me there during the ride, and I would have been pushed into differentation 80/20 in either way (R/C or C/R). I chose and found the support of a chair at a Institution ranked 40-60 in NIH research and have thrived doing TEAM science while running a small funded bench lab and built a clinical powerhouse (now with 8 subspecialists). At one point, I looked at my longitudinal clinic as a research opportunity for my clinical fellows. Now I have several observational cohorts of over 500 patients. This month, I have collaborated with a group in health care outcomes (using a 90 million patient database), while I collaborated via skype weekly with a junior faculty working in zebrafish (replicating some of my bench stuff in rats). Read: TEAM science. Just need to be creative when you are having fun. I have been in doom scenarios a few times... This is why is so critical to understand the expectations of you chair and institution, and find mentors at all levels of academic development.

 

[vitalamine]

Interesting idea that the environment of a "top" institution could make it more difficult to realize one's goals (if those goals involve balancing clinical and research).

Would you agree that the best time to find a supportive department/institution is looking for that first job out of fellowship, or earlier?

If this should be a larger factor in selecting a fellowship, I imagine for those thinking of a PSTP type residency, such considerations might begin during medical school. Or all else being equal, is it better to train at a "top" place as long as possible and find a supportive department/institution later.