PSTP_experiences
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- Jul 26, 2023
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I am starting this thread in an attempt to help young MD/PhD trainees, PSTP applicants, or PSTP trainees.
My goal is to impart some key principles, perspectives, and concepts that I learned along the way. Much of this advice originally came from other physician-scientists. I wish that many of these concepts had been conveyed to me earlier in my training.
I am a successful physician-scientist with an active clinical program, multiple R01s, and a track record of training PhD students and postdocs. My lab is thriving.
I’m a graduate of a very large and prestigious internal medicine PSTP at an institution with one of the largest MSTPs, and I am grateful for the training I received at that institution. However, based on what I know now, I would never recommend that institution to anyone else. I do not regret my training experience, but I do regret that I did not learn how to navigate institutional politics and priorities at a high level as a junior faculty member. I also regret that I initially chose a junior faculty job working for people who did not have the courage to do the right thing when they had the opportunity. It has been an adventure, and not without extremely rough times, most of which were at the junior faculty stage. This is why I am hoping to share insights with younger trainees so that you can make good decisions when choosing your training programs and first faculty jobs.
Your mentor and your boss are the most important factors in your training and career, and your consideration of local environment should outweigh institutional track record, institutional prestige, or even institutional scientific environment.
Things I have learned along the way:
To end on a positive note: There are many great places to work. After some difficult times, I landed at a great institution where I have been extremely happy and supported. I feel lucky. Having a lot of papers and grants made it easier for me to land somewhere good, so please remember that your productivity can be a golden ticket to move when needed. Institutions and leaders evolve over time. When searching for your own best fit, always be prepared to leave if your workplace becomes intolerable. Write. Write a lot. Papers and grants. Remember that words per minute x time spent writing = number of words on the page. And don't be a snob about the institution's name or perceived prestige. Many people will tell you that every institution has problems. This is true. But you should also remember that not every workplace has the same problems. There is a national shortage of physician-scientists, and you can choose to work at an institution without the kind of problems would derail your career. Moving to another university, or at least being willing to move when necessary, is an important part of succeeding in academia.
You're a physician-scientist, and you're in great demand. You must remember that working very hard is absolutely required, but not sufficient. You also need to do whatever it takes to find the mentor, boss, and/or institution that will truly appreciate you and help you thrive.
My goal is to impart some key principles, perspectives, and concepts that I learned along the way. Much of this advice originally came from other physician-scientists. I wish that many of these concepts had been conveyed to me earlier in my training.
I am a successful physician-scientist with an active clinical program, multiple R01s, and a track record of training PhD students and postdocs. My lab is thriving.
I’m a graduate of a very large and prestigious internal medicine PSTP at an institution with one of the largest MSTPs, and I am grateful for the training I received at that institution. However, based on what I know now, I would never recommend that institution to anyone else. I do not regret my training experience, but I do regret that I did not learn how to navigate institutional politics and priorities at a high level as a junior faculty member. I also regret that I initially chose a junior faculty job working for people who did not have the courage to do the right thing when they had the opportunity. It has been an adventure, and not without extremely rough times, most of which were at the junior faculty stage. This is why I am hoping to share insights with younger trainees so that you can make good decisions when choosing your training programs and first faculty jobs.
Your mentor and your boss are the most important factors in your training and career, and your consideration of local environment should outweigh institutional track record, institutional prestige, or even institutional scientific environment.
Things I have learned along the way:
- Mentors matter most. I learned the most from my mentors, who were great. The mentor is more important than the program or the institution where you train. It’s good to go to a strong academic program, but the most important thing is great mentorship.
- Institutions don’t love you back. Don’t prioritize the institution over your own well-being. A program might even treat you great until you graduate. After you graduate, no matter where you go, you will get to learn all about university politics! Some of the people—including leaders—might even start to treat you badly even though you are successful and doing everything you can to support the institution. There are lots of various issues at play, including politics / competition. Some leaders will even feel threatened by your success.
- Don’t be afraid to leave the place where you trained. Take your time looking around. Moving can be energizing. If you are working under bad leadership, then leave. People who aren’t willing to move often end up in a rut.
- Once you finish your PSTP training, the most important considerations are your: (1) Division Chief, and (2) Department Chair. Are they truly committed to physician-scientists? Are they members of ASCI? Are they the kind of people who do the right thing? Do they value achievements? Do they prefer to support their personal friends at all costs, even when it's the wrong thing to do? Remember to look at their achievements AND their actions—not just at their words. You might have to ask around nationally to understand your local environment.
- A people hire A people. B people hire C people. Once you finish PSTP training, you need to choose your institution largely based on your future boss, and whether you truly have the support of the people to whom you report. Do those leaders want to improve the environment? Are they just talking or do they act? Are they leading with a growth mentality? Or are they defensive? Do they want to hear your feedback? When you give feedback, do they act positively in response to it?
- No matter how egregious a situation might seem, you should not expect leaders to do the right thing. You should speak up, but only ask a leader for help once. If they don’t respond properly and promptly, especially to harassment concerns, then you need to leave. Don't keep asking. It won't help. You already know where that leader stands. Either ask someone else for help or leave. At dysfunctional institutions, retaliation does happen. HR offices sometimes protect the institution even at the expense of good people who are trying to do the right thing. At some institutions, HR will do the wrong thing because they think it will protect the institution. So you need to be careful when you choose who to trust.
- Whether you are choosing an environment for MD/PhD training, for PSTP training, or for your first faculty job, be sure to prioritize the following:
- The PSTP track record is not the most important thing. The mentor is more important. Choose mentors carefully. Look for capability, productivity, and character. I was lucky to have had great mentors all along the way.
- Reach out to recent graduates and especially to former trainees—no matter what stage of training. Don't overly rely on one person's opinion including mine. Ask many current and former people what is the reaction when they raise a concern or problem. Avoid working for people who engage in gossip, and also watch what leaders do—not just what they say. Choose to work for people based on their actions, achievements, integrity, and character. Gather as much info from unbiased sources who can speak freely. As an example, I worked for some leaders who never gossiped about others, and then there were leadership changes followed by constant gossip and toxicity. I recommend choosing to work for leaders who focus on achievements, and to avoid leaders who engage in gossip.
- Carefully identify institutional priorities based on facts and actions. If fully NIH-funded, successful physician-scientists are being mistreated and pressured to generate clinical revenue, then go somewhere else. Don't even think twice on this.
- Hire a lawyer to go over your contract before signing. Do not sign with institutions that pressure you to sign a non-compete. If their priority is to make the institution a desirable place to work, they will not try to trap a physician or a physician-scientist with a non-compete.
- Find out what is a nationally competitive salary.
- Find out what is an institutionally competitive salary. Example: I have worked at an institution where senior NIH-funded physician-scientists with many grants were earning $110-30K, while grantless investigators of the very same specialty with few publications were being offered $170-190K to come in do exactly the same job that a more senior investigator was already doing—even though the senior investigator had a lot of NIH funding, and even though the junior investigator had little to nothing in terms of funding or papers. Inequitable treatment of two people with the same job and same specialty should be a major red flag. You can read more about equitable / equal pay for equal work on government web sites. So make sure to carefully investigate what an institution claims their policy to be, and also what their actual policy is—and whether they follow it. At some institutions, salaries are completely negotiable and vary wildly even for two people with the same specialty, the same training, doing the very same job. My impression, based on limited information, is that state institutions and institutions on the coast are more likely to abide by equal pay for equal work. Based on what I have observed, certain institution(s), perhaps in the middle of the country, might not always abide by equitable / equal pay for equal work.
To end on a positive note: There are many great places to work. After some difficult times, I landed at a great institution where I have been extremely happy and supported. I feel lucky. Having a lot of papers and grants made it easier for me to land somewhere good, so please remember that your productivity can be a golden ticket to move when needed. Institutions and leaders evolve over time. When searching for your own best fit, always be prepared to leave if your workplace becomes intolerable. Write. Write a lot. Papers and grants. Remember that words per minute x time spent writing = number of words on the page. And don't be a snob about the institution's name or perceived prestige. Many people will tell you that every institution has problems. This is true. But you should also remember that not every workplace has the same problems. There is a national shortage of physician-scientists, and you can choose to work at an institution without the kind of problems would derail your career. Moving to another university, or at least being willing to move when necessary, is an important part of succeeding in academia.
You're a physician-scientist, and you're in great demand. You must remember that working very hard is absolutely required, but not sufficient. You also need to do whatever it takes to find the mentor, boss, and/or institution that will truly appreciate you and help you thrive.
