MD-PhD>Postdoc>Basic Science Faculty

[Waiting4Ganong]

Have any recent/almost MD-PhD grads considered doing a postdoc right after med school with aim of getting basic science faculty position?

Obvious disadvantages to this route include that it doesn't give you a clinical career to fall back on, and limits options regarding clinical research.

Advantages as I see them is:

1) Being 35 rather than 40 when getting first faculty job,
2) Doing one thing well rather than two things badly (or less well )
3) Starting with research career from day 1 rather than spending 3-5yrs+ doing clinical residency/fellowship requirements.

Given the most a NIH funded physician-scientist can realistically hope to practice clinically is 20% anyway (1day/week) is it worth hoping off the treadmill early?

Anyone researched this option though? Does someone want to post a summary of the Strengths/Weaknesses/Opportunities/Threats associated with a MD-PhD picking this route?

Basic science salary is low I'm told (starting assistant prof salary as low as 60K in some places(!), typically 90-100K as a medical school basic science assistant prof to start though I'm told) - would this be supplemented for a MD-PhD not doing clinical work? (not all MD-PhDs are loan-free....). What is the success rates for MD-PhDs getting these positions? I know there is a massive mismatch between PhDs/postdocs and faculty positions but does the same hold true for MD-PhDs? (I thought there was a shortage of physician-scientists??).

I know the default setting for medical school is go to residency, do a fellowship - then decide. We have all been primed for that career path. I want to hear from anyone who has thought outside this box!

Please state what stage of training you are at when answering. I'd prefer to hear from those who have personally thought this through as an option for themselves or even better actually taken this route rather than pre-meds with strong ideas though.

Thanks,

W4G.

---

Members don't see this ad.

 

[Bluntman]

While certainly a small minority (<10% i think), people do successfully follow the route that you're considering. I see it as more of a contingency plan, however, rather than something that you'd plan to do from the start. After all, if you know from the get-go that you never want to deal with clinical aspects of research or treat patients, then why get the MD at all? It'd be more efficient to go straight for the PhD and supplement it with some physio/path/clinical/etc. courses if you need the boost. The main (only?) reason I see for people skipping residency is if they realize their gravitation towards only basic science research after they have already started their training.

If you're looking for an example, Kelsey Martin (Co-Director at UCLA) skipped hers and went straight to a post-doc.

Also, here's a good link to a 1998 study by the NIGMS on where their MSTP trainees end up.

 

[Waiting4Ganong]

Thanks. I should have said that I'm coming to the end of my MD-PhD (finished PhD, finished core clinical rotations, just doing electives and pondering future now!).

When I started I imagined doing 50% clinical and 50% research. Now I'd be happy to do somewhere in between 20:80 to even 100% research. It'd be a bonus to be able to do a couple of half day clinics in a subspeciality - I'm just not sure it is worth 4-5yrs extra of my time to have that option given basic science research is my main goal.

I'll check out the study you provided,

Thanks again,

While certainly a small minority (<10% i think), people do successfully follow the route that you're considering. I see it as more of a contingency plan, however, rather than something that you'd plan to do from the start. After all, if you know from the get-go that you never want to deal with clinical aspects of research or treat patients, then why get the MD at all? It'd be more efficient to go straight for the PhD and supplement it with some physio/path/clinical/etc. courses if you need the boost. The main (only?) reason I see for people skipping residency is if they realize their gravitation towards only basic science research after they have already started their training.

If you're looking for an example, Kelsey Martin (Co-Director at UCLA) skipped hers and went straight to a post-doc.

Also, here's a good link to a 1998 study by the NIGMS on where their MSTP trainees end up.

 

[gutonc]

In thinking about the time issue consider that, these days, a single, 3-year post-doc leading straight to a faculty position is more the exception than the rule. Even post-docs doing great work in great labs with great funding and great publications are having a hard time getting faculty slots. I know plenty of people who have had to hang out in their post-doc lab as a Research Asst. Prof. for a year or 3 after completing the formal post-doc.

I'm in a similar position to you. Finishing up 4th year after completing the PhD, wanting to have a research career, etc. I'm going to do a Research Residency in IM/Onc which should be 6 years, assuming all goes well. So, best case scenario it'll take me 3 years longer than the best-case of post-doc alone. In real-life it's probably an extra year or two.

The other thing to consider is the job security issue. If you're employable as both a physican and a researcher, you'll never be without a job. With the vagaries of research funding the way they are, if you're only employable as a researcher, if you lose your funding, most places will give you a year or so of slack but then you're SOL. Everybody wants to think that they'll always have good funding but **** happens and, since you've already taken the time to do the MD, why not finish it off. At the very least, do an intern year so you can get your license but I'd suggest doing a full residency.

The director of our Neuroscience PhD program is an MD/PhD who went the post-doc only route and says it was the biggest mistake of his career.

My $0.02.

BE

 

[MasonPrehealth]

I'm going to dispel a few things.

There are many different ways to get a basic science faculty position. I will admit for the biomedical sciences, you have to do a postdoc if you want any shot at getting a faculty position. Having an MD/PhD may help, but sometimes having an MD will also suffice. It depends a lot on the area of your research and the level of clinical interaction you require. In fact you can do basic science research in a clinical department (my PI did that, and she was only a Ph.D. in a division full of M.D.'s).

On the aspect of age in getting your first faculty job, the median age of a first tenure-track appointment is 36. The problem is the median age of a first NIH R01 recipient is 42. (Bridges to Independence report 2005, National Academies). Also the time expectation for you to go from MD/PhD to tt faculty position is about 5 years of postdoc "training." Overall, imagine that you took 12-15 years of MD, Ph.D, and postdoc life as a trainee. That's over 1/4 of a 40-year career.

I cannot really respond to salary expectations for basic scientists versus clinical scientists, though the numbers you throw probably aren't far off (though I really don't think a clinical assistant prof is paid THAT much).

That said, there are surveys about what most MD/PhD's do with their careers (misplaced the most recent survey PDF that I had about that). I think that some do make that successful transition, and with both degrees it is certainly easier to do.

 

[Waiting4Ganong]

Thanks brooklyneric, I'm presuming you went the 2+1+3 ABIM route. Congratulations - that is a great option if you can get it. I actually considered that too (also interested in Onc, both clinically and research-wise) but didn't know if I could face three more years of being a trainee for the clinical portion when I could be getting on with research (which I enjoy - and am much better at!). Your point that if the postdoc doesn't go well I'm not sure of a faculty job anyway is well taken (I always hear urban myths about the PhDs who couldn't get a grant and now works in a shoe shop etc.- I don't want to be the first MD-PhD in that situation).

Thanks for the stats Masonprehealth. At least if I did gamble and go the basic science route I won't be much/any older than the straight PhDs. As for salary - if anyone could direct me to salary surveys of MDs in basic science faculty jobs I'd appreciate it (even 100K is 33-50% of what I'd earn clinically -and I doubt I'd be able to service loans is earning much less than that). Not a priority for me obviously (or I'd be over in the plastic surgery forum ) but still a gritty fact of life....

Really useful advice so far. Keep 'em coming...

 

[Nuel]

Even post-docs doing great work in great labs with great funding and great publications are having a hard time getting faculty slots.

Is this really true?

 

[MrMunkily]

I don't doubt it.

 

[Waiting4Ganong]

I hear two contradictory things:

1) There is a shortage of medical academics and physican-scientists.
2) It is very difficult to get an medical school assistant prof job.

Both, individually, seem plausible and are backed up by anecdotal evidence.

Anyone got any idea of how we can get some objective evidence on this?

 

[venevite]

I think this is a very interesting question. I am an MD PhD who will be completing residency next year and I have been looking at my options-that is 1 reason I started lurking on these forums! My sense is that if you do a postdoc, no residency you will essentially be competing with PhDs, despite your MD degree-you are not being hired for clinical work. If, however, you complete a residency and almost certainly fellowship, depending on the specialty you are a "physician-scientist" and can do some clinical work, maybe 80/20, this would make life easier for you. I flirted briefly with the idea of just doing a postdoc, but I was told this would be too risky.

 

[gutonc]

Is this really true?

I'll give you one example of a friend of mine. Two years before I started my current program (that I'm finishing this year after 9 years) I was a tech at MSK. There was a post-doc in a Hughes lab next door who started that same year. 2 1/2 years ago she got her first faculty position. She had 7 papers in her post-doc (5 first author), 3 JBC, 1 MCB, 1 Cell, 1 Nature Med, 1 Cancer Cell and has 3 more in press left over from work she started in her post-doc. She's one of those scary smart people, works harder than most post-docs I know and had a K-award at the end of her 2nd post-doc year. Still, she had the hardest time finding a spot in the NYC area. Had she been willing to relocate I think she would have had an easier time of it but that's another big issue. By the time most people finish a post-doc (plus another year or two as a RAP or equivalent) they've got a family and are fairly settled in the area where they did their work so relocating may not be easy.

I realize this all sounds horribly pessimistic but I'm not trying to make it that way. I just think a lot of people (particularly those that come from an MD background) think that the pathway from grad/med school to research faculty position is a straight line with specific timelines. It still can be but to expect it to work that way will set you up for disappointment.

BE

 

[smugass]

wait, so

4yrs ...drunken coed
3yrs ...lab grunt
4yrs ...scut monkie
5yrs ...lab grunt
6yrs ...glorified lab/scut slob
3yrs ...expected sitting on of hands
total: 25 yrs ?!
+/- 1-3 more for additional post-docs???

age at first "job": 45?
pile of s*itty papers: priceless!

GIVE UP THE DREAM!!!

 

[MasonPrehealth]

Is this really true?

To be terse, yes.

We can post up a lot of anecdotes, but if you take a step back, a lot of times, you have to remember that it is a job search. There are many reasons why one could get or note get a job, but one very underrated aspect is the concept of collegial fit.

Relatively speaking, it is really easy to get into graduate school than it is to get into a tt faculty job. The pool for both is extremely competitive; smart people with great resumes and CV's are competing with others. The next step is dealing with communications skills and collegiality; is this person going to be able to work in our department? Even if this person has a grant, what is the likelihood that this person will be productive? There are many issues that push one person's application over another's... and "the big name" recommendation can only go so far.

 

[venevite]

To be terse, yes.

We can post up a lot of anecdotes, but if you take a step back, a lot of times, you have to remember that it is a job search. There are many reasons why one could get or note get a job, but one very underrated aspect is the concept of collegial fit.

Relatively speaking, it is really easy to get into graduate school than it is to get into a tt faculty job. The pool for both is extremely competitive; smart people with great resumes and CV's are competing with others. The next step is dealing with communications skills and collegiality; is this person going to be able to work in our department? Even if this person has a grant, what is the likelihood that this person will be productive? There are many issues that push one person's application over another's... and "the big name" recommendation can only go so far.

Yes, I think you are right "collegial fit" is probably the X factor. I have seen people where I went to grad school (one of the top biomedical grad schls in the country) get faculty positions without such a great publication list. I have often wondered why. But they usually have trained in the institution and are known to faculty, so I guess they are considered a good fit. Bottomline, I think it is easier to get hired where you train, so factor that in fellowship decisions and don't burn any bridges!

 

[pseudoknot]

Another big issue when hiring assistant profs is whether the candidate seems to have a coherent vision for the direction of his or her lab in the next 10+ years, and whether that vision matches where the department wants to go. This is another one of these things that can separate two otherwise "qualified" applicants.

 

[MasonPrehealth]

Yes, I think you are right "collegial fit" is probably the X factor. I have seen people where I went to grad school (one of the top biomedical grad schls in the country) get faculty positions without such a great publication list. I have often wondered why. But they usually have trained in the institution and are known to faculty, so I guess they are considered a good fit. Bottomline, I think it is easier to get hired where you train, so factor that in fellowship decisions and don't burn any bridges!

Actually that's the wrong thing to do for a tt position. In academia, you want to establish your independence and get a job as far away from your previous advisors as possible. Now there are a few people who somehow or another buck that trend, but that is a rarity.

On the other hand, RAP's (research assistant profs) are generally hired interally in this manner, but many of my colleagues in academia consider this a desperate move that should be avoided if at all possible.

 

[MasonPrehealth]

I hear two contradictory things:

1) There is a shortage of medical academics and physican-scientists.
2) It is very difficult to get an medical school assistant prof job.

Both, individually, seem plausible and are backed up by anecdotal evidence.

Anyone got any idea of how we can get some objective evidence on this?

For those of you with institutional subscriptions to JAMA: this link goes to the most recent article looking at the physician-scientist pipeline.

For the rest of us, this link goes to a study by NIGMS about MSTP students.

 

[venevite]

Actually that's the wrong thing to do for a tt position. In academia, you want to establish your independence and get a job as far away from your previous advisors as possible. Now there are a few people who somehow or another buck that trend, but that is a rarity.

On the other hand, RAP's (research assistant profs) are generally hired interally in this manner, but many of my colleagues in academia consider this a desperate move that should be avoided if at all possible.

I was thinking of getting an institution to sponsor you for a K8 - I believe that is the usual route for physician scientists. I think it is different if you are PhD only.

 

[dr.z]

wait, so

4yrs ...drunken coed
3yrs ...lab grunt
4yrs ...scut monkie
5yrs ...lab grunt
6yrs ...glorified lab/scut slob
3yrs ...expected sitting on of hands
total: 25 yrs ?!
+/- 1-3 more for additional post-docs???

age at first "job": 45?
pile of s*itty papers: priceless!

GIVE UP THE DREAM!!!

 

[Hard24Get]

Actually that's the wrong thing to do for a tt position. In academia, you want to establish your independence and get a job as far away from your previous advisors as possible. Now there are a few people who somehow or another buck that trend, but that is a rarity.

On the other hand, RAP's (research assistant profs) are generally hired interally in this manner, but many of my colleagues in academia consider this a desperate move that should be avoided if at all possible.

That's weird, it seems like Penn has a lot of "lifers" Penn Med--> Penn Residency/Fellowship --> Penn faculty. If you already were lucky to get a tt job offer from your current program, why would it hurt to stay in the department?

 

[MasonPrehealth]

That's weird, it seems like Penn has a lot of "lifers" Penn Med--> Penn Residency/Fellowship --> Penn faculty. If you already were lucky to get a tt job offer from your current program, why would it hurt to stay in the department?

That's a good question, but there are two major reasons though I am speaking more in the Ph.D./academic world than necessarily the M.D. world... though for higher administrative levels this will apply.

1) Independence. At least for Ph.D.'s and for promotion to professoriate rank in medical school, you very seldom have faculty from the same institution because the criteria for promotion and tenure is evidence of a productive and significant academic career independent of your previous mentors. People get dinged on lack of independence if they stay in the same institution as their advisors (how much did the investigator really come up with this project?).

2) Show me more $ (etc). Some academics know that sometimes getting too used to bureaucracy can stymie your own research program. It helps going to other places that can support the work you want to do, and that's why many academics move (or at least those who have very powerful and desirable research programs).

Staying place in medicine is more common, but that is probably because your value is measured by your collegiality with other doctors, patients, and administration. Having to move away and learn different chart systems or bureaucracies to do your job in the clinic is not always ideal.

 

[MasonPrehealth]

I was thinking of getting an institution to sponsor you for a K8 - I believe that is the usual route for physician scientists. I think it is different if you are PhD only.

Yes, the K08 is the best route, as are K23's for patient-oriented clinical research. There were also K22's but that is being phased out for the K99/R00 I think.

 

[1Path]

post deleted. Scientist turned premed opinions not desired!