Intentions upon joining an MSTP

[fizzlefizzlepop]

---

Members don't see this ad.

Hi All,

I'm a long-time lurker on the physician scientist threads. I'm very grateful to all the frequent posters here for sharing their experiences and providing their opinions about the MD/PhD training and beyond.

I'm lucky to have already been accepted into some great MSTP programs as well as some great MD-only programs, but a few things have been bothering me as I make my final choice. There are many threads on this forum about how difficult it is to make the physician-scientist career work nowadays. The particular reasons have already been discussed thoroughly in previous threads so I won't go into them here, but from what I've gathered, the short story is that even the brightest and hardest-working MD/PhD students have a very slim chance (<20%?) of sticking to the 80/20 academic research model touted as the end-goal of training. I'm a realistic person, and I'm not going to pretend I know that I'll be an exception to this trend...

Does this mean that I should expect a mostly clinical career after training? I don't think that would be the end of the world for me (heck, it's possible I'd even like it better, idk), but I feel like it might be slightly disingenuous to start and MSTP program knowing that I likely won't stick with research. Do any current applicants feel this way? What about current students? Graduates?

At least right now I'm excited about doing a PhD (i.e. I wouldn't drop the degree just because I don't think I'd use it). Just antsy about how uncertain the career prospects are haha...

 

[gutonc]

You're asking two different questions here.
1. "Is it dishonest of me to do an MSTP knowing that I may not be able to make an 80/20 career work?"
2. "Is it dishonest of me to do MSTP knowing that I don't want to do research and only do clinical work?"

The answer to the first one is "absolutely not". The answer to the 2nd questions is "maybe, but in the grand scheme of things, nobody really loses but you".

As down as I am on the whole MSTP thing at the moment, if you're starting now, you're looking at a 12-16 year timeline before the issues of career prospects are a major problem for you. Things will change in that time period. How, in what direction, and whether it will benefit you or not in terms of getting a TT research position are things you need a crystal ball to see. NIH funding is cyclical but if you plot the average of the peaks and troughs, there has been a clear downward trend over the past 30 years.

Now...you could argue that it's dishonest of programs to try to recruit you to train to fill a position that will be less common than a rainbow-farting unicorn 15 years from now. But that's not the question you asked.

 

[miz]

Is the reason that you think you likely won't stick with research logistical, or interest-based? If it is logistical, I don't think it's wise to prognosticate career-wise at this stage. If it's interest-based, then an MSTP might not be the best fit. It sounds like you like science and want to do a PhD but are worried about finding a job afterwards, in which case I agree with the poster above.

FYI, I'm a second year MSTP student and I had many similar concerns to yours. While browsing this forum I found it very tempting to be pessimistic about my career outlook before I started, but having arrived here, I am inspired every day by the science around me. I consider myself fantastically lucky to be here and able to pursue this dream job. I am enjoying my experience and try not to worry too much about the end goal while still preparing myself scientifically. I cannot predict the career market in 10-12 years from now (timeframe if I choose to do residency and fellowship and/or postdoc). Meanwhile I can choose a mentor carefully, study for boards, keep my eyes open to the amazing things that are being done scientifically at my institution and plan my project. And enjoy the company of my peers.

I guess what I'm trying to say is it's a personally satisfying pathway during the training phase, or at least it has been so far for me. I have the feeling that I am doing something worthwhile in the company of people with similar motivations to me- and I'm still living my life- it makes it a lot easier to feel like it's worth it.

 

[miz]

I should also add that I made very few or no tradeoffs to attend my institution, in the sense that I have family and a strong social network here, and this colors my overall satisfaction. I also do not have to pay off crippling amounts of college debt, which some of my friends are doing. I do think you have to continue living your life in order to think that this path is worth it, and in the future pursuing those things may make following this path more difficult. (This is a decision tree which I have deferred.)

 

[okemba]

Now...you could argue that it's dishonest of programs to try to recruit you to train to fill a position that will be less common than a rainbow-farting unicorn 15 years from now. But that's not the question you asked.

I too have been keeping up with discussions on this forum, and still don't understand how/why MSTP programs continue to be funded. Mysteries.

 

[fizzlefizzlepop]

Thanks for the replies gutonic and miz! At this point I think I can confidently say that I do want to pursue the 80/20 research model, but I guess I'm just feeling depressed at how bad the outlook for research is right now (poor job market, poor funding rates, huge amount of time/effort investment for an uncertain future).

As you said gutonic, 12+ years of training is a long time and who knows how things will look then. Maybe things will be better, but I don't want to put all my eggs in that basket (one of the main reasons I chose not to pursue a straight PhD). I believe that I am passionate about research, as much as any undergrad could claim I suppose, but will that carry me through my decade+ of training? I don't think there's any way to know for sure.

I like your perspective miz. My current first choice for MSTP is at a school that I think would be a good fit for me from a location and community perspective. I'm also debt-free coming out of undergrad which makes the extended training somewhat more reasonable. I guess the best any of us can do is try to enjoy the journey, focus on obtaining the best training possible, and as you said, don't put the rest of your life on hold. I'll try to put my future-career qualms on hold for now...

I too have been keeping up with discussions on this forum, and still don't understand how/why MSTP programs continue to be funded. Mysteries.

This does seem odd when you candidly look at the outcomes haha... but if the government/school wants to pay me to train for my dream job (even if it's a pipe dream), I'm not gonna be salty.

 

[Patros]

Speaking of trends, medical school tuition is steadily increasing and physician salaries have been taking hits (and is evidently about to get worse). So as far as paying off debt is concerned, the MSTP route is looking better and better, even if your research career doesn't work out.

 

[miz]

Good luck with your decision!

This does seem odd when you candidly look at the outcomes haha... but if the government/school wants to pay me to train for my dream job (even if it's a pipe dream), I'm not gonna be salty.

I think this all the time 🙂

 

[dl2dp2]

I too have been keeping up with discussions on this forum, and still don't understand how/why MSTP programs continue to be funded. Mysteries.

I don't understand this point at all. PhD programs at lower tier institutions continue to be funded. The pyramid scheme is by design and benefit senior faculty members in charge. At least MD/PhD programs provides a cushion for students.

 

[mercaptovizadeh]

It's not dishonest to do the MD/PhD with the full knowledge that your chances of making an 80/20 career work are slim, not due to internal factors or interests so much as the funding climate.

I think there's also a question of how well you know yourself. Observe what people say during journal club and what your own thoughts are. Do you really feel that you think in a creative/unique way? I think many of us do, but observing that my own thoughts/critiques were fairly commonly held by other peers was sort of confirmation that there wasn't anything particularly unique in my thinking process. Now, some of us may find that when we get to our PhD our "out of the box" mind suddenly awakens and then we really bring something to the table. I do think that happens for some people, for some projects. I think when you find yourself in that situation you may have a little more confidence going into a research career when the odds are stacked against you. Even so, they'll still be very much stacked against you, just perhaps stacked a little lower.

 

[gutonc]

I don't understand this point at all. PhD programs at lower tier institutions continue to be funded. The pyramid scheme is by design and benefit senior faculty members in charge. At least MD/PhD programs provides a cushion for students.

Absolutely. When people ask me about doing MSTP, I have a frank discussion with them about what I see as the pros and cons. Same with med school in general. But when people talk to me about going to grad school , I actively try to talk them out of it.

Given the current funding environment , I think a 50% cut in MD/PhD spots and a 80-90% cut in PhD spots would be reasonable. It'll never happen of course, but it needs to.

 

[okemba]

I think many of us do, but observing that my own thoughts/critiques were fairly commonly held by other peers was sort of confirmation that there wasn't anything particularly unique in my thinking process.

How humbling. I'm sure you've seen this - http://en.wikipedia.org/wiki/Dunning–Kruger_effect. Perhaps you're too harsh on yourself. I've always been a big fan of the idea that a small but consistent amount of time spent each day solving new/creative math problems or lateral thinking puzzles can permanently add new items to your mental toolkit.

http://www.artofproblemsolving.com/Store/viewitem.php?item=ps:aops1&
http://www.amazon.com/How-Solve-It-Mathematical-Princeton/dp/069111966X
http://www.amazon.com/Mensa-Lateral...115300&sr=1-4&keywords=mensa+lateral+thinking

 

[okemba]

I don't understand this point at all. PhD programs at lower tier institutions continue to be funded. The pyramid scheme is by design and benefit senior faculty members in charge. At least MD/PhD programs provides a cushion for students.

Interesting, I'd appreciate an explanation then (I've been looking for one for a while). I understand that PhD over-enrollment fits into this pyramid scheme model of pushing forwards the gears of academic research, but *why* MD/PhD? *Why* throw an extra $200-300k at someone to go to medical school when their research is unlikely to be commensurately more impactful than a regular PhD? Why not just hire an extra 3 PhD students in their place?

Its said that MD/PhDs are more productive, but surely not so much better as to justify the cost. I'm curious.

 

[dl2dp2]

Interesting, I'd appreciate an explanation then (I've been looking for one for a while). I understand that PhD over-enrollment fits into this pyramid scheme model of pushing forwards the gears of academic research, but *why* MD/PhD? *Why* throw an extra $200-300k at someone to go to medical school when their research is unlikely to be commensurately more impactful than a regular PhD? Why not just hire an extra 3 PhD students in their place?

Its said that MD/PhDs are more productive, but surely not so much better as to justify the cost. I'm curious.

The calculus is very complex. It has financial and ethical dimensions to it, and various interests are conflicting. When you say "productive", what do you mean by that? We could, in theory, fund 100 labs in India to conduct 100 times as much work with 1 R01, but we are not doing that. Instead we prefer to hire grad students from India and pay them 50% as much as a normal employee with his training to produce as much as he could. His boss is "more productive" in that with the same amount of money he can generate more data by clamping both the competitive option for his grad student and his salary simultaneously. But I still don't see how this is ethical and different from exploitation.

I'm making the argument that lower tier PhD programs should be shut down in the same vein that sweatshops in Asia should be shut down. You could make the claim that they shouldn't be because then the sweatshop workers would then be starving to death in the gutter, just as these grad students would then be stuck in the pitiful living standards of their home country. I'm not sure what to say to that other than to warn American students to never go into these programs, because they aren't meant for you. Indeed, perhaps these Indians who ended up in PhDs here that they hate could end up somewhere more productive and reduce poverty in their country, and the Americans who weren't doing that bio PhD at State U (because, god willing, they get shut down) might become a physical therapist or nurse, and actually help someone. Is that not "productive" enough for you? By shutting down bio PhD at State U we might actually DECREASE unemployment. By the way the same argument had been made many times in the Chronicles of Higher Ed for humanities PhDs.

MD/PhDs are getting a decent and fair deal. Options are open. The best and luckiest students are rewarded. The average and unlucky have a backup plan or two. This is why these programs are getting more competitive in general and for American students. Markets are very sensitive and not idiotic.

If you are a good student and have no interest in medicine and would want to do a PhD in biological sciences, make SURE it's from a top lab from a top school. Make DAMN sure. And make sure you do your postdoc at a top lab. The chance of you not ending well if you choose a middle of the road lab in a middle of the road school is very very high if you are only a PhD. The problem comes up when none of the "top" labs do things that you are interested in. What if you are interested in the obscure biochemical pathways of sea moss? If you were truly a star you'd be able to "pitch" your idea to a top lab and have them embrace your concepts as one of their own. But if not, your alternative is to find a good advisor who supports your work, and work hard, and pray that things would work out, but be psychologically prepared for a very high chance of failure and life of lower middle class--which, I suppose if you are truly the ascetic scientist, wouldn't faze you?

 

[okemba]

Sluox -

The calculus is very complex. [...] but be psychologically prepared for a very high chance of failure and life of lower middle class--which, I suppose if you are truly the ascetic scientist, wouldn't faze you?

I'm already completely on the same page as you on this point. My question is, why does the *NIH* continue to fund MSTP programs? It seems like such a small percentage of the people that they're throwing this $500k training grant (essentially) at are doing what they want them to do.

As I understand it, the NIH funds PhD students because they are cheap labor and whether or not they do research afterwards is not of huge import. But why spend all this money training MD/PhDs when the money/productivity ratio is so much higher?

???

I'm not sure what to say to that other than to warn American students to never go into these programs, because they aren't meant for you.

God, I have had this thought a hundred times. As a son of Asian immigrants (who had the foresight to jump ship from American bio PhD programs back in the 80s into CS), I want to shake all of the Americans I see going into Bio PhD programs and start yelling at them to reevaluate their career decisions. And I do try...


Trying to talk to my American professors about this point always creates a mind-boggling Selfish Gene moment. They all tell me that they went into a PhD because of their curiosity and desire to create new knowledge, etc., etc., and so they think that is sufficient justification for the current crop of students and advise them accordingly.

Then of the 100 or so PhD students entering bio-heavy BME/bio PhD programs with the mindset gleaned from this advice, the 10 or so that become TT professors will have their worldview incorrectly validated and pass it on to the next generation. Just-world phenomenon, etc.

 

[dl2dp2]

As I understand it, the NIH funds PhD students because they are cheap labor and whether or not they do research afterwards is not of huge import. But why spend all this money training MD/PhDs when the money/productivity ratio is so much higher?

This isn't clear. Similarly, why is it that MDs get preferential treatment by having a restricted pot of "career development awards" that are not available to PhDs? And why is it that half of the research budget of NIH is dedicated to clinical research, and a third of the total budget is dedicated to administrative and other activities, such as funding private companies, etc., unrelated to scientific research? Basic PhD candidates cannot get money from these large pots, and thusly must rely on the ever so rare institutional start-ups to build their initial career. My sense is that NIH systematically prefers MD and MD/PhD researchers over PhD researchers, probably because PhD researchers do not conduct research that generally align with the mission of NIH. Furthermore, many if not most of the institute directors are MDs, and I suspect that there are a large number of MDs sitting on various study sections and strategic initiative boards. MDs bring a unique knowledge-base and perspective that PhDs don't have, especially in figuring out which questions are actually important and relevant to actual clinical entities and society at large. The hiring cost of MDs is far greater than that of PhDs, and therefore for NIH to at least retain even a small number of MDs, they have to make the deal sweeter. Even then, since the 60s the proportion of MDs going into research is decreasing. The system currently in existence at NIH is often a historical artifact and isn't necessarily the best or most optimal or well designed way to achieve what it's meant to achieve.

These subtleties create significant tension at the national level between basic, clinical and non-research staff at academic centers, both inter and intra institutionally. When funding is tight, and there are haves and have-nots, and everyone thinks what he/her's doing is worth more, how to divvy up that 21 billion a year so that one prostitutes ones scientific career more than what is required to get a grant, but not so much so as to lose ones vision, becomes an object of extreme obsession.

Trying to talk to my American professors about this point always creates a mind-boggling Selfish Gene moment. They all tell me that they went into a PhD because of their curiosity and desire to create new knowledge, etc., etc., and so they think that is sufficient justification for the current crop of students and advise them accordingly.

One important skill to learn as you get older is "empathy" or "mind reading" or "reading behind the lines". Your professors might understand exactly what you are saying, but imagine how it would look if they revealed to you the actualities of getting an academic job. They may even develop an adverse reputation that could prove to be a self-fulfilling prophecy. You are just getting the boilerplate answer, which would be one I would give you also if you asked me today in person. Doesn't mean I actually believe it, or that it's not as nuanced and complex as it in fact is. It's just a strategic omission of details. It's not simply a survivor bias.

One important thing to realize is that while you can make significant and meaningful impact as a biomedical researcher, more likely than not these "successful professors" careers would end up as a small piece that's more aptly described as some kind of "niche" job. Try not to be too narcissistic to think that if you win or lose the game it would in the end matter too much, and that might help you enjoy the game a bit more.

 

[okemba]

This isn't clear. [...] that might help you enjoy the game a bit more.

Sluox, that was a really helpful and interesting response. Thanks.

[...] especially in figuring out which questions are actually important and relevant to actual clinical entities and society at large.

I very frequently see statements like this when discussing the merits of MD/PhD programs. Could you provide a specific example (or specific enough, anyway) of a case where an MD's perspective was very valuable in shaping the direction of a basic science research project? I really would like to understand this better.

 

[ephemeralartery]

I very frequently see statements like this when discussing the merits of MD/PhD programs. Could you provide a specific example (or specific enough, anyway) of a case where an MD's perspective was very valuable in shaping the direction of a basic science research project? I really would like to understand this better.

The discovery of H. pylori and its involvement in ulcers/stomach cancer is an example of a discovery very much driven by physicians with physicians' perspectives. The nobel lectures can be viewed here http://www.nobelprize.org/nobel_prizes/medicine/laureates/2005/press.html

 

[uniqenam]

Sluox, that was a really helpful and interesting response. Thanks.



I very frequently see statements like this when discussing the merits of MD/PhD programs. Could you provide a specific example (or specific enough, anyway) of a case where an MD's perspective was very valuable in shaping the direction of a basic science research project? I really would like to understand this better.

http://www.pnas.org/content/110/37/14829.full

Sort of a classic that a lot of people know of.

 

[Neuronix]

Does this mean that I should expect a mostly clinical career after training? I don't think that would be the end of the world for me (heck, it's possible I'd even like it better, idk), but I feel like it might be slightly disingenuous to start and MSTP program knowing that I likely won't stick with research. Do any current applicants feel this way? What about current students? Graduates?

Just because you enter with your eyes open to reality and don't bury your head in the sand doesn't mean that you're being disingenuous. If you like research and clinical work and intend on a majority research career, you should do MSTP. If you don't end up actually being a physician-scientist, at least you got free medical school and you tried it rather than wondering what if. If you make it, awesome. We don't know what things will be like in 10 years. I feel like my generation of MSTP grads were cut off at the knees, but it might be better for your group. Or it might not. Who knows. As long as the fully funded MD/PhD pathway exists, someone has to fill those positions, so it might as well be you if you're interested in it and the stated goals, even if they're currently unrealistic.

At least right now I'm excited about doing a PhD (i.e. I wouldn't drop the degree just because I don't think I'd use it). Just antsy about how uncertain the career prospects are haha...

We're all antsy about it. If you're not, you're just not paying attention.