how to fix MSTP

[Fencer]

My general advice is to get the BEST possible academic training, but pursue a career in the location with the BEST match for your career goals. 50/50 is not something that you will find in top 20 institutions, because their promotion and tenure policies are geared to push you for a 90/10 or 10/90 career.

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[texan2009]

Guys/Girls the solution is simple. We all go through medical school. Just find a girl going into Derm or guy going into Ortho and marry them. Then they can make real money and you can spend your career doing what you like and not worry about how much salary to make. It's a pretty simple solution.

 

[miz]

Guys/Girls the solution is simple. We all go through medical school. Just find a girl going into Derm or guy going into Ortho and marry them. Then they can make real money and you can spend your career doing what you like and not worry about how much salary to make. It's a pretty simple solution.

indeed, I''ve often found that orthopedic surgeons are impressed by my academic qualifications and enjoy constant, earnest conversations about my research

 

[gbwillner]

Guys/Girls the solution is simple. We all go through medical school. Just find a girl going into Derm or guy going into Ortho and marry them. Then they can make real money and you can spend your career doing what you like and not worry about how much salary to make. It's a pretty simple solution.

Clearly that is too complex and requires a lot of work. A far simpler solution would be to win the lottery, and fund yourself.

 

[erikreinertsen]

indeed, I''ve often found that orthopedic surgeons are impressed by my academic qualifications and enjoy constant, earnest conversations about my research

haha

 

[Vader]

Guys/Girls the solution is simple. We all go through medical school. Just find a girl going into Derm or guy going into Ortho and marry them. Then they can make real money and you can spend your career doing what you like and not worry about how much salary to make. It's a pretty simple solution.

And see how long THAT one lasts...

 

[Vader]

Another one of the "dirty little secrets" that those contemplating or just starting this pathway is that clinical fellowship is:

1) a form of extended residency i.e. indentured servitude

and

2) becoming virtually "required" in certain fields or job markets.

MSTPs obviously need to be streamlined to the extent possible, but a major extension/prolongation of the training pathway is found in residency -> fellowship +/- postdoc. This is really the "holding" pattern which is lengthening most dramatically in recent times (concomitantly with the increase in length of standard postdoctoral fellowships), and in my mind is a major barrier to MD/PhDs continuing in research.

I would propose:
1) Clincial fellowship salary support to $80-100k/yr level, with yearly increases for level of training, and adjustment for cost of living and total family income. This could come from a combination of clinical revenue generated by the fellow, departmental or institutional support, and NIH funding. The R25 grant was supposed to focus on this bridging period, but only provides 50k per year support and no support for equipment, travel, meetings, etc. PSTPs do better, but are far and few between.

2) Housing and child care assistance benefits, particularly in high-cost-of-living markets. This would ensure that these basic necessities are addressed.

3) Offer federal income tax waiver for MSTP trainees and tax incentives (i.e. credits/deductions) for fellowship trainees.

4) Formal support programs offered during/integrated with fellowship to provide grant writing, statistical analysis, and career mentoring support. There is a new NIH grant program that does just this, but isn't clear to me how widespread this will be implemented.

5) A requirement for department chair and program director to outline in advance an individualized "career roadmap" that contains specific goals/milestones and funding mechanisms to get the trainee from point A to B to C, etc.

Why do you folks think? Are some/any of these feasible? At what level(s) should the requirements exist?

 

[Neuronix]

Another one of the "dirty little secrets" that those contemplating or just starting this pathway is that clinical fellowship is:

1) a form of extended residency i.e. indentured servitude

and

2) becoming virtually "required" in certain fields or job markets.

Yes, and residents and clinical fellows are viewed as cheap, relatively unprotected labor similar to grad students and post-docs. The difference is that there's almost always a clinical job waiting for clinical residents and fellows.

2) Housing and child care assistance benefits, particularly in high-cost-of-living markets. This would ensure that these basic necessities are addressed.

I find this part particularly funny. My residency specifically prohibits us from using the child care facility for faculty and staff right next door. We are also not able to enroll in the retirement plan and have no dental or vision coverage.

I just don't see many of your proposals happening. It seems that departments are losing faith in their residents/fellows becoming serious researchers, and most don't feel the need to invest in us. In the past, an investment in a research oriented resident was an investment in a potential large grant earner down the road. But nowadays so many MD/PhDs are going clinical only and grants are so hard to come by, that few institutions really feel the need to seriously support MD/PhDs.

 

[gbwillner]

Another one of the "dirty little secrets" that those contemplating or just starting this pathway is that clinical fellowship is:

1) a form of extended residency i.e. indentured servitude

and

2) becoming virtually "required" in certain fields or job markets.

MSTPs obviously need to be streamlined to the extent possible, but a major extension/prolongation of the training pathway is found in residency -> fellowship +/- postdoc. This is really the "holding" pattern which is lengthening most dramatically in recent times (concomitantly with the increase in length of standard postdoctoral fellowships), and in my mind is a major barrier to MD/PhDs continuing in research.

I would propose:
1) Clincial fellowship salary support to $80-100k/yr level, with yearly increases for level of training, and adjustment for cost of living and total family income. This could come from a combination of clinical revenue generated by the fellow, departmental or institutional support, and NIH funding. The R25 grant was supposed to focus on this bridging period, but only provides 50k per year support and no support for equipment, travel, meetings, etc. PSTPs do better, but are far and few between.

2) Housing and child care assistance benefits, particularly in high-cost-of-living markets. This would ensure that these basic necessities are addressed.

3) Offer federal income tax waiver for MSTP trainees and tax incentives (i.e. credits/deductions) for fellowship trainees.

4) Formal support programs offered during/integrated with fellowship to provide grant writing, statistical analysis, and career mentoring support. There is a new NIH grant program that does just this, but isn't clear to me how widespread this will be implemented.

5) A requirement for department chair and program director to outline in advance an individualized "career roadmap" that contains specific goals/milestones and funding mechanisms to get the trainee from point A to B to C, etc.

Why do you folks think? Are some/any of these feasible? At what level(s) should the requirements exist?

Yes, this is pretty much what I said at the beginning of my rant- that particularly salaries must be supplemented to keep people in the game.

BTW- the PSTPs pretty much do almost all of these things (minus the tax stuff). But you are right in that they are not only rare, but limited to certain specialties. And salaries are not quite as high as you mentioned (at least, not for me).

 

[dl2dp2]

1) Clincial fellowship salary support to $80-100k/yr level, with yearly increases for level of training, and adjustment for cost of living and total family income. This could come from a combination of clinical revenue generated by the fellow, departmental or institutional support, and NIH funding. The R25 grant was supposed to focus on this bridging period, but only provides 50k per year support and no support for equipment, travel, meetings, etc. PSTPs do better, but are far and few between.

2) Housing and child care assistance benefits, particularly in high-cost-of-living markets. This would ensure that these basic necessities are addressed.

3) Offer federal income tax waiver for MSTP trainees and tax incentives (i.e. credits/deductions) for fellowship trainees.

4) Formal support programs offered during/integrated with fellowship to provide grant writing, statistical analysis, and career mentoring support. There is a new NIH grant program that does just this, but isn't clear to me how widespread this will be implemented.

5) A requirement for department chair and program director to outline in advance an individualized "career roadmap" that contains specific goals/milestones and funding mechanisms to get the trainee from point A to B to C, etc.

Why do you folks think? Are some/any of these feasible? At what level(s) should the requirements exist?

(1) The T32 fellowships in psychiatry actually pays 95k+ for research fellows, with ~10% clinical work.

(2) This maybe a hidden benefit for many dept. You need to ask your dept chair for help.

(3) NEVER GONNA HAPPEN. Moonlighting might be more feasible if $$ is a concern.

(4) - (5) There are often internal start-up grants for exactly the sorts of things you are talking about prior to writing the K. You really need to talk to your dept chairman about these things. Also, in terms of mentorship team, the unfortunate reality is that there's very little hand holding at this level. You really just have to be a door-to-door salesman to get support from senior people and basically start your own panel. Call their secretaries. Set up the meeting. Book the conference room. If one guy says no, pitch it to another guy. Change your pitch to cater to their antiquated brains, then pitch it to a guy from a different department. If there's no existing program for this in your dept, you basically have to BUILD it on your own. If there's no money, you have to PITCH for money and even develop new mechanisms for funding. Go to pharma. Apply to EVERYTHING. DO WHATEVER IT TAKES TO GET MONEY. Ask everyone. Be polite but persistent.

One of the star young faculties told me that at the fellow stage he applied to 21 grants in 1 year and got 9. That's basically what we are shooting for, I think. You basically have to write so many grants that you lose track.

I prefer to think senior research track residents/fellows as basically at the point very similar to early-stage entrepreneurs. You need to get your elevator pitch ready and convince other people in the SHARK TANK that your research is worth doing every step of the way. Is it supposed be this hard? I'm not sure, but with NIH funding rate in the single digits and there's just nothing like this before our generation, and we really don't have a choice.

Also I notice that things appear more difficult for neurology than psychiatry. Neurology has a lot of attitude about how everything needs to be done old school. In my opinion, NICU months need to be CUT for research track residents because it's not ACGME required. Anything not ACGME required should be cut for research track--like in psychiatry, and that's how the MDPhD psych residents pushed it--back in the days all the top programs are super old school about "oh we want to be clinically intense", "oh let's put in 4 months of CL just to torture you". Then all the MDPhDs stopped going to a certain program in Boston and a certain program in New York, and 5-8 years ago a competition of how much clinical time can be cut during residency was started. And oh how the mighty has fallen since then. Being hardcore about clinical is not producing the next Karl Deisseroth.

 

[Vader]

Yes, and residents and clinical fellows are viewed as cheap, relatively unprotected labor similar to grad students and post-docs. The difference is that there's almost always a clinical job waiting for clinical residents and fellows.
I find this part particularly funny. My residency specifically prohibits us from using the child care facility for faculty and staff right next door. We are also not able to enroll in the retirement plan and have no dental or vision coverage.
I just don't see many of your proposals happening. It seems that departments are losing faith in their residents/fellows becoming serious researchers, and most don't feel the need to invest in us. In the past, an investment in a research oriented resident was an investment in a potential large grant earner down the road. But nowadays so many MD/PhDs are going clinical only and grants are so hard to come by, that few institutions really feel the need to seriously support MD/PhDs.

Whether there is a clinical job waiting depends largely on what type of work you are looking for, whereabouts you are looking, and whether this matches with availability. Depending on the field and geographical location, this can be nearly as competitive as finding a research job, particularly at an academic institution.

I am surprised that you have no dental or vision offered. My residency program has plans offered for both; perhaps my program is more an exception than the rule? We also have family housing available, though there is a waiting list. Child care is not subsidized for housestaff or fellows, however.

Yes, this is pretty much what I said at the beginning of my rant- that particularly salaries must be supplemented to keep people in the game.
BTW- the PSTPs pretty much do almost all of these things (minus the tax stuff). But you are right in that they are not only rare, but limited to certain specialties. And salaries are not quite as high as you mentioned (at least, not for me).

The tax stuff could make a significant impact for someone earning in that bracket, a difference potentially of a few to several thousand dollars a year. I don't think this is necessarily impossible, particularly if we had a strong lobby. In addition, benefits such as vision, dental, child care and housing can add up to make a significant impact of thousands of dollars per year. The problem is that most of us physician-scientists are not very politically savvy and have no political organizing body to represent our interests at the national, state, local or institutional levels.

Unfortunately, there is no PTSP in my specialty, as far as I know. This was one of the discouraging things I didn't know ahead of time and only found out after I had already decided on specialty. Would I have done a different specialty had I known? --absolutely not! In retrospect, I'm glad I didn't decide on specialty based on this, as I very much enjoy the clinical aspects of my field. That being said, it has left me begging for scraps for support and having to piece together aspects of training. Despite not being a big fan of "hand holding", I would have appreciated a well-organized training pathway that offered good support.

(1) The T32 fellowships in psychiatry actually pays 95k+ for research fellows, with ~10% clinical work.
(2) This maybe a hidden benefit for many dept. You need to ask your dept chair for help.
(3) NEVER GONNA HAPPEN. Moonlighting might be more feasible if $$ is a concern.
(4) - (5) There are often internal start-up grants for exactly the sorts of things you are talking about prior to writing the K. You really need to talk to your dept chairman about these things. Also, in terms of mentorship team, the unfortunate reality is that there's very little hand holding at this level. You really just have to be a door-to-door salesman to get support from senior people and basically start your own panel. Call their secretaries. Set up the meeting. Book the conference room. If one guy says no, pitch it to another guy. Change your pitch to cater to their antiquated brains, then pitch it to a guy from a different department. If there's no existing program for this in your dept, you basically have to BUILD it on your own. If there's no money, you have to PITCH for money and even develop new mechanisms for funding. Go to pharma. Apply to EVERYTHING. DO WHATEVER IT TAKES TO GET MONEY. Ask everyone. Be polite but persistent.
One of the star young faculties told me that at the fellow stage he applied to 21 grants in 1 year and got 9. That's basically what we are shooting for, I think. You basically have to write so many grants that you lose track.
I prefer to think senior research track residents/fellows as basically at the point very similar to early-stage entrepreneurs. You need to get your elevator pitch ready and convince other people in the SHARK TANK that your research is worth doing every step of the way. Is it supposed be this hard? I'm not sure, but with NIH funding rate in the single digits and there's just nothing like this before our generation, and we really don't have a choice.
Also I notice that things appear more difficult for neurology than psychiatry. Neurology has a lot of attitude about how everything needs to be done old school. In my opinion, NICU months need to be CUT for research track residents because it's not ACGME required. Anything not ACGME required should be cut for research track--like in psychiatry, and that's how the MDPhD psych residents pushed it--back in the days all the top programs are super old school about "oh we want to be clinically intense", "oh let's put in 4 months of CL just to torture you". Then all the MDPhDs stopped going to a certain program in Boston and a certain program in New York, and 5-8 years ago a competition of how much clinical time can be cut during residency was started. And oh how the mighty has fallen since then. Being hardcore about clinical is not producing the next Karl Deisseroth.

Your points are well-taken, as always. Believe me, I've personally had many discussions with my chairman, mentors, and the such. There are certainly resources available if you dig for them, are willing to compromise your goals (or at least what you state as your goals), and are willing to spend years writing boatloads of grants with the uncertainty of whether you will have anything to let you thrive, let alone eat 3 square meals a day. Let's just say this isn't the most efficient pathway, and I'm looking for something more "high-yield" at this point. If the process was made easier by a smoother, established training pathway with decent startup and grant funding, and good job prospects, it would be a different story.

It is funny... I did consider psychiatry as a specialty and it probably would have allowed for much more research time overall. However, I enjoy neurology and as I mentioned above, am certainly glad I chose the specialty. In general, I would not advise prospective physician-scientists to choose clinical specialty for residency or fellowship based mainly on research interest or availability of research time, particularly if there is a good chance they will want to practice clinical medicine as at least a small part of a career. As we have heard, a good portion of these folks end up doing pure clinical medicine eventually, whether in academics or private practice.

 

[prometheus1]

This thread should be required reading for anyone starting out in an MSTP. I'm now more than a decade out from starting medical school. I've got plenty to post but no time to do it. I will be back.

 

[Neuronix]

Whether there is a clinical job waiting depends largely on what type of work you are looking for, whereabouts you are looking, and whether this matches with availability. Depending on the field and geographical location, this can be nearly as competitive as finding a research job, particularly at an academic institution.

In the high income clinical specialties, finding a position outside of fellowship that is 50% or more "protected" research time is far, far more difficult than finding a clinical position. That may not mean that there would be a short partnership track private practice position or cush clincial academic gig exactly where you want to be. But the difference is nearly night and day for me.

 

[Vader]

Absolutely.

On a side note, what's up with this "Emeritus" status? Makes me feels even older...

 

[prometheus1]

Some advice from an old man:

1. Go to a residency program that wants you to have an academic career and is willing to go to bat for you for this. Straight up ask the program director and chairman (if you can) if they are serious about supporting a resident/fellow who wants an academic career. They need to tell you yes. Maybe will not cut it. They need to tell you yes, and you will have time/support for research during residency and fellowship to make this happen. If you have the background to make them believe this, they might be on board with you. You need at least 2 protected research years. If they won't give it, then move on. Someone else will.

2. Choose a strong lab mentor. This is someone with multiple RO1’s or similar, is likely at least 50+ years old, has a track record of graduates going on to be faculty at places you want to be faculty at. This is also someone you “click with” and can get along with. They have to be doing research that you can see yourself doing as well. They DO NOT have to be in your department or even your field. And this should be OK with your program director and chair. Key points: track record of excellence, full support for you, and you need them to be active for the next 5-10 years or so while you build your own career. The exception is a young upstart with fire in their eyes who you KNOW is going to succeed. If you can be their first "protege" then their success will also be yours, and they will bet big on you to make that happen.

3. Make a plan to apply for K or similar by the end of your residency/fellowship. This should be an explicit goal and people need to know this. You need the strong backing of your mentor and your program director and your chair for this. It has to be explicit. You need their letters and these letters of support need to give explicit support for you no matter if you get the K etc or not. They have to know that you are applying for a lot of grants and will get something hell or high water.

4. YOU need to be serious. Work hard clinically. You need to be as good if not better than your peers. You need to publish: a few papers is good enough if they are high impact. Basically, you need to get the data to support your own grants. You have to prove to the world you are “fundable.”

5. This is a game of attrition to some degree. People will get discouraged about the 100+ pages of grant writing, the endless letters to collect, the constant positioning, taking call, endless crap, etc. Use this to your advantage. For every MD/PhD or research-track MD who starts out wanting a serious academic medicine career, very few will make it to the end, and many will drop out simply due to laziness. Carry on and don’t get discouraged. Just persevere and be imperturbable like Osler said to be.

6. Network network network. Say yes to things. Go to conferences and make friends. Always say “yes” to giving talks and writing papers. Connect people to each other. Be the link between the clinic and the lab. Be positive.

7. Apply apply apply for grants. By your end of residency/fellowship, be prepared to submit half a dozen career development style grants. Expect to get rejected by most for ridiculous reasons. Grants are a crap shoot. It’s like Vegas. Who cares. You only need to get one. You don’t have to tell anyone about all the failed grants you wrote! They will forget anyway. If you can bring money in grants up front when applying for a job, everyone will want to hire you!

8. Good luck.

 

[lazygun247]

A lot of what everyone has said centers on the idea that you MUST do research immediately coming out of residency. Is it required? Is it easier to build up a career or establish a solid foundation using 5-20 years of clinical work and then go back to pursuing what most of us love doing: research? The idea of doing research immediately goes one or two ways. If you get funding, you succeed. However, for a lot of people, if you don't get funding, you are forced to do post-doc (where there is little money to support yourself much less a family) or clinical medicine (where you end up doing no research). I hear all these stories about people dropping the PhD aspects of their careers and going into private practice, but has any of them ever returned back to academics after a period of time? What kind of issues do you foresee happening in this type of situation?

You would obviously take a pay cut when you return, but you shouldn't be in dire need of money (to pay off loans, or buy house, etc...). That was what the clinical years were for, to establish a foundation to allow you to go back.

... just an idea.

 

[Neuronix]

A lot of what everyone has said centers on the idea that you MUST do research immediately coming out of residency. Is it required?

Essentially yes. The pathway to becoming a physician-scientist is extremely long and arduous. You need to work on that K08 as a resident/fellow, get that K08, and then use it and any other small grants towards getting an R01. Nobody is going to hire you if you're not on that pathway. Nobody is going to fund you outside of such a pathway. Even research fellowships are only open to young investigators. The pathway is too long. What, you want you first major grant at the age of 50 or 60? Most people are looking for retirement by then.

Is it easier to build up a career or establish a solid foundation using 5-20 years of clinical work and then go back to pursuing what most of us love doing: research?

Why the heck would anyone do that? You'd be completely starting over as a trainee and cut your salary in an eighth. Maybe if you lost your medical license or something. Even then you'd have to be truly desperate.

I hear all these stories about people dropping the PhD aspects of their careers and going into private practice, but has any of them ever returned back to academics after a period of time? What kind of issues do you foresee happening in this type of situation?

Of course people do transition from private practice to academics. But REMEMBER, the vast majority of academics is mostly clinical medicine. The academic medical centers are happy to have you working full-time for them, generating them lots of revenue, they pay you less, and they pocket the difference. Oh, yeah and you can do research with your 20% "protected" time. That's the vast majority of academics. So sure, you can transition into that from private practice, and many people do for many reasons (easier jobs, practice goes under/gets bought out, location constraints, etc).

You would obviously take a pay cut when you return, but you shouldn't be in dire need of money (to pay off loans, or buy house, etc...). That was what the clinical years were for, to establish a foundation to allow you to go back.

Nobody is willing to go from 200k+/year working reasonable hours with a certain future of same to 50k/year with uncertain future, long hours, and no respect.

 

[Neuronix]

Some advice from an old man:

Indeed. Great advice for 15 years ago. There was a time when becoming a physician-scientist was merely challenging. Funding rates were 40%, and if you just applied a few times for grants, submitted a few grants around, and persisted in your efforts, you'd certainly get one. Now that funding rates are below 10%, the landscape has changed. It doesn't matter how persistent you are, grant funding is tenuous. Departments have a lot of failures, and are no longer willing to seriously support you to become an independent scientist. This is the new reality for physician-scientists who are trying to transition from residency. The advice from senior, successful faculty who developed in a better funding environment no longer applies.

1. Go to a residency program that wants you to have an academic career and is willing to go to bat for you for this. Straight up ask the program director and chairman (if you can) if they are serious about supporting a resident/fellow who wants an academic career. They need to tell you yes. Maybe will not cut it. They need to tell you yes, and you will have time/support for research during residency and fellowship to make this happen. If you have the background to make them believe this, they might be on board with you. You need at least 2 protected research years. If they won't give it, then move on. Someone else will.

Residency programs are getting very competitive. I actually wrote a paper about this that I couldn't get accepted, but is viewable here: http://www.neuronix.org/2012/06/effects-of-score-creep-trends-in.html . Because of this, there is no room for negotiation with residency programs. There are no repercussions if your position leaves you unable to do research--you literally cannot leave. You cannot negotiate a contract at any point. So what if they tell you yes, you come, and all of a sudden your research residency isn't really available. Maybe the chair changed and no longer supports a research residency. Maybe they lost a resident to pregnancy or whatever else and now you can't have your protected time. Maybe the faculty member you wanted to work with left or they won't support you to do the research you're good at and trained for in PhD. What are you going to do about it? There are all sorts of "research track" "short track" medicine programs, and they all come with a gigantic asterisk. * = Well only in certain fellowships. ** = Well only if we think you're good enough clinically. *** = Well only if we don't lose any residents out of our PGY-1 cohort. How many of these asterisks are you willing to accept?

But even if you are that type of person, like I used to be, who is hell bent on being a serious researcher. You will run into a serious problem. I see them every year. Adcoms hate them. The clinical program directors want the residents who will be easiest to train and aren't trying to go back to lab all day. "Patient care comes first", and there's always more patients. The most desirable residents are the ones who will do the most work for the faculty with the least complaint and least training required. The applicants who are the most serious about research and ask the serious questions get ranked low, while the people who are the most bubbly/friendly and agreeable get ranked high. Think I'm at a bad program? I didn't even get interviews at the big name research places in my specialty. I remember some advice from an "old man" who told me "don't worry about your clinical grades and step 1 scores, you're a top tier MD/PhD, you'll get whatever you want." HAHAHAHAHA. GOOD ONE.

2. Choose a strong lab mentor. This is someone with multiple RO1’s or similar, is likely at least 50+ years old, has a track record of graduates going on to be faculty at places you want to be faculty at. This is also someone you “click with” and can get along with. They have to be doing research that you can see yourself doing as well. They DO NOT have to be in your department or even your field. And this should be OK with your program director and chair. Key points: track record of excellence, full support for you, and you need them to be active for the next 5-10 years or so while you build your own career. The exception is a young upstart with fire in their eyes who you KNOW is going to succeed. If you can be their first "protege" then their success will also be yours, and they will bet big on you to make that happen.

Yeah, the only people with multiple R01s left are at least 50+ years old. I know a few junior faculty who couldn't get their R01s funded. Some are still working at it, some are 100% clinical now.

4. YOU need to be serious. Work hard clinically. You need to be as good if not better than your peers. You need to publish: a few papers is good enough if they are high impact. Basically, you need to get the data to support your own grants. You have to prove to the world you are “fundable.”

Great advice. You need to be the best at everything. You need to out compete your MD peers and your PhD peers at the same time. It's not possible. A "few" high impact papers. Yeah ok, you spend 4 years of grad school working on that Cell paper, but now that you're a resident you can just churn out a few more while you're working in the hospital 60+ hours a week. Sure. Seems reasonable.

5. This is a game of attrition to some degree. People will get discouraged about the 100+ pages of grant writing, the endless letters to collect, the constant positioning, taking call, endless crap, etc. Use this to your advantage. For every MD/PhD or research-track MD who starts out wanting a serious academic medicine career, very few will make it to the end, and many will drop out simply due to laziness. Carry on and don’t get discouraged. Just persevere and be imperturbable like Osler said to be.

You got it. Laziness. That's why we don't continue. It's not because there's no grant funding, and what little is left is soaked up by well established investigators who give meaningless feel good advice and then tell us we're lazy when we don't make it.

6. Network network network. Say yes to things. Go to conferences and make friends. Always say “yes” to giving talks and writing papers. Connect people to each other. Be the link between the clinic and the lab. Be positive.

Yes, be positive. 80+ hours a week for the rest of your life for little pay and a completely unstable future for yourself and your family. But don't complain about it.

7. Apply apply apply for grants. By your end of residency/fellowship, be prepared to submit half a dozen career development style grants. Expect to get rejected by most for ridiculous reasons. Grants are a crap shoot. It’s like Vegas. Who cares. You only need to get one. You don’t have to tell anyone about all the failed grants you wrote! They will forget anyway. If you can bring money in grants up front when applying for a job, everyone will want to hire you!

What half a dozen development grants? As a resident, I appear to be eligible for exactly zero development grants. K08s state that they are for fellows, but there are rumors that one resident at another program once got a K08 as a resident. There are a few other tiny grants worth a few thousands to maybe 20 thousand for which 100 people apply for 1 slot.

Of course everyone wants to hire you when you have grants. But nobody has them. The last guy I know who got hired for a serious 80% research position spent 4 years in post-doc. So let's see, that's 8 years of MD/PhD (13 if you're unlucky like one of my clinical faculty members), 5 years of residency, 4 years of post-doc, just to get your first job with 3 years of protected faculty time before you're forced to go clinical if you can't bring in at least $100k/year in salary support. AWESOME. SIGN ME UP.

 

[dl2dp2]

Some advice from an old man:

1. Go to a residency program that wants you to have an academic career and is willing to go to bat for you for this.

While I can't say that I completely endorse Neuronix's little polemic and happen to agree with you in terms of most of your advice, I just have to say that your advice is very much biased toward the career in the career/non-career balance. Sometimes people have to go to residency programs that are sub-optimal for academic career development for a variety of other reasons, and it's not entirely fair to fault them to making such decisions. A lot of times a lot of people are trying really hard, but they just can't make it. I'm not sure what that says about the system. I'm of two minds about it.

And Neuronix is absolutely right in that department chairs LIE *ALL THE TIME*. Not to be paranoid or anything, but in this game the biggest piece advice, in my opinion, is to get multiple offers and know that things change very fast and everything in life is negotiable. Nobody is always reliable and your department chair will NEVER be fully supportive to you, because he has higher priorities. Do you really think he has the best interest of you, the young faculty, in mind when he has to deal with the financial burden of the department? Nobody is going to or expected to bend over backward to accommodate you unless you have leverage--could be grant money, could be external offers, could be papers, whatever it is. You can only count on mentorship and support if your interest and their interest align in a fundamental way.

 

[uniqenam]

"don't worry about your clinical grades and step 1 scores, you're a top tier MD/PhD, you'll get whatever you want."

This was the same wisdom that was repeated by one of our venerable clinician scientists at a recent match panel with our MS4s. After saying this, someone asked the MS4s how important they felt grades/step/letters were for matching, even for the 'not-competitive' specialties like Peds/IM; after hearing that position, it seemed that they were loathe to disagree publicly, but a lot of them insinuated that "maybe it's not as easy to match as an MD/PhD as we were led to believe", even though the MS4s at my institution all got their 1st/2nd choice (I think). It's definitely a "thing" that older PS love to talk about how easy it is to match with a PhD, but the facts seem to disagree.

 

[solitude]

"don't worry about your clinical grades and step 1 scores, you're a top tier MD/PhD, you'll get whatever you want."

This was the same wisdom that was repeated by one of our venerable clinician scientists at a recent match panel with our MS4s. After saying this, someone asked the MS4s how important they felt grades/step/letters were for matching, even for the 'not-competitive' specialties like Peds/IM; after hearing that position, it seemed that they were loathe to disagree publicly, but a lot of them insinuated that "maybe it's not as easy to match as an MD/PhD as we were led to believe", even though the MS4s at my institution all got their 1st/2nd choice (I think). It's definitely a "thing" that older PS love to talk about how easy it is to match with a PhD, but the facts seem to disagree.

Be careful with the "got their 1st/2nd choice". If you don't get an interview somewhere, you cannot rank it as a choice, so this information is heavily biased. I know multiple MSTPs from a top 5 school who were rejected from competitive residencies because of good, but not great, performance. I do think, however, that in some specialties like Peds and IM, it IS somewhat easier for MSTPs, not because they are highly valued by residency adcoms - they're not - but because there are a lot more spots.

 

[mercaptovizadeh]

Agreed that "1st/2nd choice" depends on who chooses to interview you. Lots of my friends did not even get interviews from a slew of places they most likely would have liked/wanted very much. Even after they begged for interviews by phone or email. Even when recommendation letter writers or other supporting faculty made calls to secure interviews. Even if it's someone's "2nd choice" on their rank list, it may have been their #8 choice prior to applying and getting all those rejections.

 

[prometheus1]

Indeed. Great advice for 15 years ago.

All your points are well taken.

I'm an old man by SDN standards only. I'm in my mid 30's. This advice is from my personal experience over the last couple years, not 15 years ago. But yeah you make good points. I have been very lucky in many ways and luck is probably the biggest factor here in addition to an almost foolish perseverance.

As a resident, I appear to be eligible for exactly zero development grants. K08s state that they are for fellows, but there are rumors that one resident at another program once got a K08 as a resident.

You are eligible for grants like the K08 as a resident in your last year (provided your next job is attending level) or as a fellow (if your next job is attending level). And there are a handful of other ones you can go for from the government and probably some private foundation ones related to your focus. Google for a couple hours and you will find them. When you apply you need a letter from the boss saying they are supporting you. You should be a clinical faculty level at the time the K style award kicks in, but you don't have to be when you apply for it. And you can apply and re-apply when you fail the first time if you want.

 

[Fencer]

All your points are well taken.

I'm an old man by SDN standards only. I'm in my mid 30's...

Wow! I'm ancient history, then... I'm 50.4 years young, but still publishing and having fun. Just saw the red moon eclipse with my telescope. It was pretty cool.

 

[Neuronix]

I'm an old man by SDN standards only. I'm in my mid 30's.

That's not old for the MD/PhD forums. Your advice did sound like the cheery, out of touch MD/PhD program faculty advice that I typically hear though, so I assumed you were older . There are plenty of posters with a resident tag hanging around here. That's almost a guarantee of being in the 30s for MD/PhDs.

You are eligible for grants like the K08 as a resident in your last year (provided your next job is attending level) or as a fellow (if your next job is attending level). And there are a handful of other ones you can go for from the government and probably some private foundation ones related to your focus. Google for a couple hours and you will find them. When you apply you need a letter from the boss saying they are supporting you. You should be a clinical faculty level at the time the K style award kicks in, but you don't have to be when you apply for it. And you can apply and re-apply when you fail the first time if you want.

I always love the "of course there are grants, you just need to look harder" argument. Please share where these grants are hiding, because I have done plenty of looking. Now I'm not in my last year of residency, but I am doing research on top of clinical work, so I'd love to have some funding. As for the private foundation grants, those are the tiny little non-career development grants that aren't meaningless, but again are small, and have a large number of applications per grant.

I'm not going to get 80% protected research time without a K award. I'd be lucky to even get 50% protected research time without a K award. So let's say that I don't get the K award the first time around, which is almost guaranteed given the funding rates. What then? Then the clock is ticking to get the R01 level funding when I start as faculty. That clock is on the order of 3 years, at 50% (at best) protected time... Or I could do fellowship/post-doc for at least one year, but likely several, and delay the R01 clock for who knows how long in hopes that I still won't fail to get an R01 or equivalent in a few short years even after the 15+ years invested in training. Alternatively, I can go into a clinical track (academic or otherwise), make good money, work reasonable hours, and have a stable career.

Hmm when you think about it logically... I'd almost have to be a lunatic to stay in research these days. Why are we losing MD/PhDs from research again? Oh yeah, because of laziness. I guess I'm just too lazy

 

[gutonc]

Hmm when you think about it logically... I'd almost have to be a lunatic to stay in research these days. Why are we losing MD/PhDs from research again? Oh yeah, because of laziness. I guess I'm just too lazy

I have only said "F*** You" to one faculty member at my institution. And it was the one who told me that the reason I couldn't get a TT position was that I wasn't working hard enough.

I regret neither doing the PhD nor getting the hell out when I did. I currently work about half as many hours as I would in a TT research position and make 50% more than I would in that same job. I miss research like crazy but I don't miss the rest.

 

[okemba]

Tenable career goals to enter an MD/PhD program in 2015 for (not motivations, just a list of what actual jobs are possible with the degrees):

• Tenure-Track 80/20 or 50/50 Professorship
• Doing the PhD for fun, then riding the free MD into a 100% clinical position (academic or private)
• Using part-time clinical work to finance permanent Post-doc hood working in someone else's lab.
• Clinical-track professorships

I still don't understand why MD/PhD programs exist. It seems like academia needs to undergo large-scale remodeling. (I really like that phrase. lol).

I used to think that we were all just being pessimistic, and extrapolating a transient downward trend into the foreseeable future. But if TT positions are mostly unavailable to MSTP grads (which will probably be exacerbated by the higher rate of population/MSTP grad increase than of TT position increase), and perma-postdochood (even with a salary augmented by some clinical work) is undesirable to most people, the only remaining options seem to be pure clinical jobs that don't... benefit much from the PhD, or use your PhD knowledge/skills?

Just thought I would put this here.

As nice as the traditional academic track sounds, I'd much rather work as a hospitalist, transition into moonlighting work while doing a post-doc in what I'm really interested in, then switch into pharma or go abroad for greener pastures. The current model is dying a quick death, no thanks.

-Mercaptovizadeh

 

[uniqenam]

Tenable career goals to enter an MD/PhD program in 2015 for (not motivations, just a list of what actual jobs are possible with the degrees):

• Tenure-Track 80/20 or 50/50 Professorship
• Doing the PhD for fun, then riding the free MD into a 100% clinical position (academic or private)
• Using part-time clinical work to finance permanent Post-doc hood working in someone else's lab.
• Clinical-track professorships

I still don't understand why MD/PhD programs exist. It seems like academia needs to undergo large-scale remodeling. (I really like that phrase. lol).

I used to think that we were all just being pessimistic, and extrapolating a transient downward trend into the foreseeable future. But if TT positions are mostly unavailable to MSTP grads (which will probably be exacerbated by the higher rate of population/MSTP grad increase than of TT position increase), and perma-postdochood (even with a salary augmented by some clinical work) is undesirable to most people, the only remaining options seem to be pure clinical jobs that don't... benefit much from the PhD, or use your PhD knowledge/skills?

Just thought I would put this here.


-Mercaptovizadeh

You forgot "selling out" and going into biotech venture capital/investment banking or consulting, both of which are decidedly not goals of tax payer money.

 

[Fencer]

Tenable career goals to enter an MD/PhD program in 2015 for (not motivations, just a list of what actual jobs are possible with the degrees):

• Tenure-Track 80/20 or 50/50 Professorship
• Doing the PhD for fun, then riding the free MD into a 100% clinical position (academic or private)
• Using part-time clinical work to finance permanent Post-doc hood working in someone else's lab.
• Clinical-track professorships

I still don't understand why MD/PhD programs exist. It seems like academia needs to undergo large-scale remodeling. (I really like that phrase. lol).

Academia is undergoing large-scale remodeling... see: http://www.pnas.org/content/early/2014/04/09/1404402111.full.pdf+html

We, MD/PhD programs, need to be right-sized for the biomedical research enterprise. As a group, we already are. The wrong size component in training is the PhD growth fueled by the NIH growth. If you look at tables for SOM faculty, MD/PhD are replacing some of the MD faculty in clinical departments. I think that any PhD student going in is looking for a though situation, but MD/PhD graduates will have choices. For 2014 or 15 MD/PhD applicants, the world is not doomed. If policies discussed in the article are implemented at NIH, and I know Varmus is very serious about this, there will be a lot of PhD attrition over the next 15 years. Hopefully, the extra supply of PhD talent will push innovation in the private biomedical industry. Team science is not "post-doc hood", but a valid contribution to research and innovation.

 

[ABatOutofHeck]

"don't worry about your clinical grades and step 1 scores, you're a top tier MD/PhD, you'll get whatever you want."

This was the same wisdom that was repeated by one of our venerable clinician scientists at a recent match panel with our MS4s. After saying this, someone asked the MS4s how important they felt grades/step/letters were for matching, even for the 'not-competitive' specialties like Peds/IM; after hearing that position, it seemed that they were loathe to disagree publicly, but a lot of them insinuated that "maybe it's not as easy to match as an MD/PhD as we were led to believe", even though the MS4s at my institution all got their 1st/2nd choice (I think). It's definitely a "thing" that older PS love to talk about how easy it is to match with a PhD, but the facts seem to disagree.

The one thing I learned from going though the match process this year is that everyone lies about how they did, and I would take any self-reports of matching to their top choice with a whole shaker full of salt. Unless someone is headed to the absolute top/hardest to get into program in their field (Brigham/UCSF for IM, CHOP for Peds, Barrow Institute for Neurosurgery, etc., etc. ), it's probably safe to assume that they've had to recalibrate their expectations at some point in the process, whether it's in the programs they applied to, after they didn't get interviews, and so on. There are definitely exceptions (i.e. people who want to head to certain programs for geographic/personal reasons), but I've seen a lot of friends come up with such explanations after they failed to match at more desired programs.

 

[uniqenam]

Definitely possible; I didn't know any of the 4th years since they were so far from me temporally, so I couldn't really get a read on them. They seemed happy and I think they all matched well objectively (good academic medical centers etc), but it could certainly be the case as you say.

 

[okemba]

Academia is undergoing large-scale remodeling... see: http://www.pnas.org/content/early/2014/04/09/1404402111.full.pdf html

That pulled no punches. Probably the most interesting thing I've read in a while. I found this as well:

http://www.cancer.gov/aboutnci/director/speeches/science_interview_2013

Team science is not "post-doc hood", but a valid contribution to research and innovation.

Oh I agree. I think it has to be the future of science. I just meant that currently its seen more as "post-doc hood" than the latter by most people who are
considering career paths. I would love if/when things change...

Hopefully, the extra supply of PhD talent will push innovation in the private biomedical industry.

Hopefully...

 

[gutonc]

Team science is not "post-doc hood", but a valid contribution to research and innovation.

Oh I agree. I think it has to be the future of science. I just meant that currently its seen more as "post-doc hood" than the latter by most people who are considering career paths. I would love if/when things change...

The big problem is that many of those leading the teams do treat it like permanent post-doc-hood for their "team members". When done right, it's a great thing that will help advance the careers of many young scientists. Unfortunately, oftentimes it becomes a European/Rockefeller U style system where there's "Herr Professor" and his "team members" who, despite titles to the contrary, are basically scientific serfs.

 

[Fencer]

The big problem is that many of those leading the teams do treat it like permanent post-doc-hood for their "team members". When done right, it's a great thing that will help advance the careers of many young scientists. Unfortunately, oftentimes it becomes a European/Rockefeller U style system where there's "Herr Professor" and his "team members" who, despite titles to the contrary, are basically scientific serfs.

You are correct that the proposition of Team Science require an overhaul of institutional policies including tenure & promotion guidelines to avoid the biomedical research "Sacred Cow" syndrome.

 

[prometheus1]

I always love the "of course there are grants, you just need to look harder" argument. Please share where these grants are hiding, because I have done plenty of looking. Now I'm not in my last year of residency, but I am doing research on top of clinical work, so I'd love to have some funding. As for the private foundation grants, those are the tiny little non-career development grants that aren't meaningless, but again are small, and have a large number of applications per grant.

K08, K99, K23, DOD career awards, AHA Early Career award, ACS research scholar, Conquer Cancer Foundation, BWF to name a few, and there are others.

 

[gutonc]

K08, K99, K23, DOD career awards, AHA Early Career award, ACS research scholar, Conquer Cancer Foundation, BWF to name a few, and there are others.

We're all aware of these and the issues with the current funding climate have been well described above and elsewhere. FWIW, a friend of mine (admittedly straight PhD) with first author post-doc papers in PNAS, Cell and Nature Cell Bio as well as 3 TT job offers got a non-fundable score on her first K app. It's not a walk in the park. As for the Foundation awards, I talked with one of the key reviewers on a CDA I'd applied for. They had 4 grants to give and got almost 500 applications for it.

It's not that the grants aren't out there, it's just that the chances of getting one are small and getting smaller.

 

[Fencer]

Fiscal / Year / Applications / Awards / Success Rate
2013 ... K08 .......... 346 .......... 124 ........ 35.8%
2013 ... K23 .......... 555 ........... 178 ........ 32.1%

Source: http://report.nih.gov/FileLink.aspx?rid=551

 

[DermViser]

You forgot "selling out" and going into biotech venture capital/investment banking or consulting, both of which are decidedly not goals of tax payer money.

Versus getting treated as an indentured servant with a vow of poverty.

 

[DermViser]

Indeed. Great advice for 15 years ago. There was a time when becoming a physician-scientist was merely challenging. Funding rates were 40%, and if you just applied a few times for grants, submitted a few grants around, and persisted in your efforts, you'd certainly get one. Now that funding rates are below 10%, the landscape has changed. It doesn't matter how persistent you are, grant funding is tenuous. Departments have a lot of failures, and are no longer willing to seriously support you to become an independent scientist. This is the new reality for physician-scientists who are trying to transition from residency. The advice from senior, successful faculty who developed in a better funding environment no longer applies.

Residency programs are getting very competitive. I actually wrote a paper about this that I couldn't get accepted, but is viewable here: http://www.neuronix.org/2012/06/effects-of-score-creep-trends-in.html . Because of this, there is no room for negotiation with residency programs. There are no repercussions if your position leaves you unable to do research--you literally cannot leave. You cannot negotiate a contract at any point. So what if they tell you yes, you come, and all of a sudden your research residency isn't really available. Maybe the chair changed and no longer supports a research residency. Maybe they lost a resident to pregnancy or whatever else and now you can't have your protected time. Maybe the faculty member you wanted to work with left or they won't support you to do the research you're good at and trained for in PhD. What are you going to do about it? There are all sorts of "research track" "short track" medicine programs, and they all come with a gigantic asterisk. * = Well only in certain fellowships. ** = Well only if we think you're good enough clinically. *** = Well only if we don't lose any residents out of our PGY-1 cohort. How many of these asterisks are you willing to accept?

But even if you are that type of person, like I used to be, who is hell bent on being a serious researcher. You will run into a serious problem. I see them every year. Adcoms hate them. The clinical program directors want the residents who will be easiest to train and aren't trying to go back to lab all day. "Patient care comes first", and there's always more patients. The most desirable residents are the ones who will do the most work for the faculty with the least complaint and least training required. The applicants who are the most serious about research and ask the serious questions get ranked low, while the people who are the most bubbly/friendly and agreeable get ranked high. Think I'm at a bad program? I didn't even get interviews at the big name research places in my specialty. I remember some advice from an "old man" who told me "don't worry about your clinical grades and step 1 scores, you're a top tier MD/PhD, you'll get whatever you want." HAHAHAHAHA. GOOD ONE.

Yeah, the only people with multiple R01s left are at least 50+ years old. I know a few junior faculty who couldn't get their R01s funded. Some are still working at it, some are 100% clinical now.

Great advice. You need to be the best at everything. You need to out compete your MD peers and your PhD peers at the same time. It's not possible. A "few" high impact papers. Yeah ok, you spend 4 years of grad school working on that Cell paper, but now that you're a resident you can just churn out a few more while you're working in the hospital 60+ hours a week. Sure. Seems reasonable.

You got it. Laziness. That's why we don't continue. It's not because there's no grant funding, and what little is left is soaked up by well established investigators who give meaningless feel good advice and then tell us we're lazy when we don't make it.

Yes, be positive. 80+ hours a week for the rest of your life for little pay and a completely unstable future for yourself and your family. But don't complain about it.

What half a dozen development grants? As a resident, I appear to be eligible for exactly zero development grants. K08s state that they are for fellows, but there are rumors that one resident at another program once got a K08 as a resident. There are a few other tiny grants worth a few thousands to maybe 20 thousand for which 100 people apply for 1 slot.

Of course everyone wants to hire you when you have grants. But nobody has them. The last guy I know who got hired for a serious 80% research position spent 4 years in post-doc. So let's see, that's 8 years of MD/PhD (13 if you're unlucky like one of my clinical faculty members), 5 years of residency, 4 years of post-doc, just to get your first job with 3 years of protected faculty time before you're forced to go clinical if you can't bring in at least $100k/year in salary support. AWESOME. SIGN ME UP.

Loved your blog where you say:

MD/PhD! Your ticket into top residencies anywhere!***

***Offer valid only in certain residency specialties. Offer not valid at community programs. Offer may only be used in conjunction with above average to excellent medical school performance. May not apply to residencies in competitive locations.

 

[gbwillner]

Fiscal / Year / Applications / Awards / Success Rate
2013 ... K08 .......... 346 .......... 124 ........ 35.8%
2013 ... K23 .......... 555 ........... 178 ........ 32.1%

Source: http://report.nih.gov/FileLink.aspx?rid=551

I agree with these numbers... but there is a lot of variability within the different institutions from the NIH. Also, these are for ALL applications- and most have to resubmit at least once before getting accepted. What is the success rate of first-time applicants for a K08? probably more like 10%.

Having been through the process and knowing many, many others who have also gone through it, the process of getting a grant accepted is in no way "fair". It only takes one reviewer to shut you down. And if you don't get a reviewable score from one of three reviewers the first time around, don't bother resubmitting- it's NEVER going to get through no matter how good your proposal actually is. Try getting a K08 in AML genomics without 1 of maybe 5 top researchers in the country as your mentor- the deck is definitely stacked against you unless you are already well entrenched in a field. And that doesn't happen during a clinical fellowship easily. The best way though this is to join the lab of a top researcher in whatever field you are considering submitting to and you really have an inside edge.

The essential problem we come to again is that you cannot submit these applications as a fellow. Well, technically you can, but you must be faculty by the time the reviewers meet. The reviewers expect you to have published in the stated field, and at least 1 aim of your proposal should already be complete with figures to show that you already know everything will work. This is not an easy task with clinical responsibilities. And departments in general will not hire you to a faculty position without the money unless you want a clinical track job. So the only real workaround is to either luck out and get the funding on your first shot, or be at an institution where they will hire you as instructor as a retainer until you get the funding for promotion to Asst. Prof. and allow you to resubmit your proposal. Those are definitely getting harder to find. Maybe some will still hire you to that level up front, but those departments are quickly disappearing or have a very limited number of slots to gamble on.

 

[gbwillner]

Loved your blog where you say:

MD/PhD! Your ticket into top residencies anywhere!***

***Offer valid only in certain residency specialties. Offer not valid at community programs. Offer may only be used in conjunction with above average to excellent medical school performance. May not apply to residencies in competitive locations.

Why should getting an MD/PhD help you in a community program? That makes no sense. The PhD does in fact help you if your intentions are to do research later on- there is no doubt about it. Especially at programs with established research programs. These are far more frequent in IM, Path, Neuro, etc.

 

[gbwillner]

You forgot "selling out" and going into biotech venture capital/investment banking or consulting, both of which are decidedly not goals of tax payer money.

I never would have considered industry in a better fiscal situation for MD/PhDs... but I am now looking into this option and liking it more and more. In the right situation, you still get to do science and/or clinical work. And you will have both (relative) stability and a more significant (1.5x-10x academic) paycheck.

 

[Fencer]

gbwillner, this is actual 2013 NIH data. The link gives you information about 2004-13, and the success rates are listed per institute. Clearly, there is variability of success rates across the NIH institutes. Regarding the first submission success, the data is not available by I suspect a higher number in the 17-18% (still under 20%) based upon my 10+ years of study section service.

 

[DermViser]

Why should getting an MD/PhD help you in a community program? That makes no sense. The PhD does in fact help you if your intentions are to do research later on- there is no doubt about it. Especially at programs with established research programs. These are far more frequent in IM, Path, Neuro, etc.

Did you not read the part that said, "Offer not valid at community programs"? How does that read to you as "help you in a community program".

 

[gbwillner]

Did you not read the part that said, "Offer not valid at community programs"? How does that read to you as "help you in a community program".

No, I got it. Neuronix's post originally was meant as a gripe that he initially (and naively) thought the MSTP was a "gold ticket" to any residency, anywhere. But it turns out it's really not. OK, that is a legitimate gripe in some regards. But why ever expect the MSTP help you if you never want to do science? I guess I was finishing a conversation we were having like 5 years ago.

 

[DermViser]

No, I got it. Neuronix's post originally was meant as a gripe that he initially (and naively) thought the MSTP was a "gold ticket" to any residency, anywhere. But it turns out it's really not. OK, that is a legitimate gripe in some regards. But why ever expect the MSTP help you if you never want to do science? I guess I was finishing a conversation we were having like 5 years ago.

Considering that many of the competitive specialties value research, and MD/PhDs have good quality research, I could TOTALLY see how someone would think an MD/PhD was a good to match into a competitive specialty. An MD/PhD who has done basic science melanoma research, for example, would be very much courted by our program. That's bc our field is pushed forward heavily with research discoveries.

 

[uniqenam]

I never would have considered industry in a better fiscal situation for MD/PhDs... but I am now looking into this option and liking it more and more. In the right situation, you still get to do science and/or clinical work. And you will have both (relative) stability and a more significant (1.5x-10x academic) paycheck.

Also, presumably a better work schedule, right? Seems like it could be a pretty sweet gig, pretty much just sacrificing some scientific independence for a better lifestyle, while still doing the PS thing.

 

[gbwillner]

Also, presumably a better work schedule, right? Seems like it could be a pretty sweet gig, pretty much just sacrificing some scientific independence for a better lifestyle, while still doing the PS thing.

Work schedule is debatable. Sure, you may not have as much overnight call or weekends, but you have essentially zero off-service time and 2-3 paid weeks vacation, max. In academia you don't have to answer to anyone on your off service time.

Also, it's a different culture that takes some getting use to and is not for everyone. In the end, it's all about the Benjamin's.

 

[gbwillner]

Considering that many of the competitive specialties value research, and MD/PhDs have good quality research, I could TOTALLY see how someone would think an MD/PhD was a good to match into a competitive specialty. An MD/PhD who has done basic science melanoma research, for example, would be very much courted by our program. That's bc our field is pushed forward heavily with research discoveries.

MSTP will help in SOME competitive specialties at SOME institutions. The trick is to know which ones.

 

[dl2dp2]

Try getting a K08 in...without 1 of maybe 5 top researchers in the country as your mentor- the deck is definitely stacked against.. best way though this is to join the lab of a top researcher in whatever field you are considering submitting to and you really have an inside edge.

I agree with you in essence. This is also another reason that the K process is becoming more like the academic job circus in general where pedigree matters more and more. This is the standard pathway -> top MSTP, top journals, top residency, top fellowship, top postdoc mentor, K, R, top or midlevel major R1 university clinical dept tenure or non-tenure faculty.

On the other hand, I'm not sure how people get jobs without having the kind of connections with which you and I are obviously familiar. But what is also obvious is that they DO. There's one group of people that we know who basically occupy about 30-40% (maybe more) of federal funding, cover most of the major journals, appear at most of the top end conferences and are "names" in a field. But there is a large unknown group of people who do research that gets published in IF <3 journals but still get their Rs competitively renewed all the time. Wonder what their lives are like... My suspicion is that they don't suck. I think it's POSSIBLE to sustain a career without a "name" but the process can be extremely random-walk with a high degree of attrition. I suspect that people who have a first R may not get a second R, and people may need to supplement salaries at various points.

The other factor that may be worth considering is that when you move down from the tippity top pathway, you become less enamored with the kind of research you end up doing because the tippity top people control the major journals and awards that set the tone for what is "important" research. You may hit a jackpot or two once a while, but your program will be less recognized by that particular community. Given the fact that your science is a social product, the lack of appreciation thereof may be in itself a reason to push someone out of doing science. I read the top journals in my field and 8 out of 10 articles come out of maybe a dozen labs, all of which I know. Small labs get their papers rejected by the editors unless they are referred initially by a name. I understand that the R process is actually less clubby in that sense.