Well, speaking as a participant in this group that is not a scientifically collected cross-section of pathologists gathered in a non-biased manner and corrected for all of the typical skewing factors...
I think that Alois was just suggesting that the collection of viewpoints in this or any other discussion group are not necessarily representative.
it is my general observation (both in my colleagues and myself) that the decision to go private vs. academic often hinges on two important factors
Neither of the two factors you mention should come as news to you as you are finishing clinical training as a pathologist. Part of the responsibility of a PhD advisor is to ensure that her/his graduate students understand the financial aspects of running a lab (the difficulty in getting grants, the process of fund management, the details of hiring and supervising employees). If your advisor kept all of this hidden from you, then s/he did you a great disservice.
1. NIH funding is stagnant,
Those of us who have been around for a long time can tell you that grant dollars are cyclical. Yes there have been easier times (but even then the R01 pay line only rarely has crept above 20%) but there was also 1974 -- the year that Nixon impounded NIH money (no doubt, well before you were born). Overall, the system works well, rewarding insight and strong ideas; more money into the pot always make it better.
When push comes to shove, can you delay your material gratification any longer?
If you aren't getting the rewards you need, paired with an acceptable standard of living, then you need to seek a different career. As I sometimes tell students, science is about the search as much as it is about the answer. If you don't find the search rewarding in itself, then it isn't the career for you -- because far more of your time is spent searching than learning answers. Part of the education of a PhD student should be making sure that this is the way you want to spend you time. If your job isn't what excites you every day, what gets you moving in the morning, what keeps you thinking about things in the middle of the night, then you are in the wrong business. You can work in medicine while hating it, viewing it as glorified factory work, but you can't do science like that. Your lack of commitment to it ends up reflected in your productivity, in your thinking and in your work; and the people reading your grants can see this. On the other hand, if you love the work, pour your energy into it and have the intellectual power behind it, then you will succeed.
-----------------------
It is unfortunate that people start down a path as long and complex as a double degree without thinking about where they are going. It is hard to do without good advice at the start, yet many people come to these programs too young, fresh from college. MD-PhD programs don't encourage students to view the reality of the career they are choosing because any attrition looks bad on the next application for funding. Thus, students are coming to the end of 6,7,8 or more years of training unwilling to face the future for which they have been preparing.