MSTPs and academic medicine...a must?

[superdevil]

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Hello, all.

I've been in a particularly reflective mood lately, and this crossed my mind.

Having both an MD and a PhD gives one incredible flexibility as far as career choice goes. One could go into private practice exclusively, research exclusively, a combo of the two, work in industry, teach, or the ever-popular academic medicine route.

I realize that some of those options are frowned upon by many in the MD/PhD-MSTP community ("Private Practice? Oh, the humanity!!"), as the goal of these programs is to produce basic science researchers.

Is it wrong if someone gets both degrees and then decides, "You know, I really don't want do be tethered to a med school all my life, researching in academia." Of course, the adcoms would want you to say that academic medicine gets you all hot-and-bothered in an essay or interview setting, because that's tantamount to saying (in a trembling voice of longing admiration), "I want to be just like you when I grow up."

Should a person just tow the line and acquiesce?

The impetus behind this thread is that, until now, I have wanted very much to go the academic pathway and be involved in med school research (and I still do). Now though, I'm left saying, "As of this minute academic medicine is attractive to me, but what if that changes...?"

Would the MSTP mafia hunt someone down and break their legs if they don't conform? 😀

What are alternative, "acceptable" uses of the degree besides academia? Your thoughts?

Thanks.

 

[Neuronix]

There's always industry. MD/PhDs are highly sought after in industry, and a certain percentage every year will go that way. I don't think anyone really argues that industry goes against the MSTP ideals.

Originally posted by superdevil
Should a person just tow the line and acquiesce?

For interviews, yes. Do it. You want to get into programs and to do that you want to say the things they want to hear. Sound highly entusiastic about medical research, academia, etc.

Would the MSTP mafia hunt someone down and break their legs if they don't conform? 😀

Nope, you can do whatever you want when you graduate. You're also never even locked into the MSTP pathway. Keep that in mind. Flexibility is key.

I do think alot of this process is "I wanna be just like you!" Med schools, especially MD/PhD programs, are run by academics and there's a number of reasons they think that is the only or best pathway for MD/PhDs. You'll run into the ones who think pathology is the only good residency for MD/PhDs (and yes they are pathologists), and on down the line. It's just a matter of playing the game. Once you're in, you're in. Nobody is going to toss you out if you change your mind. They do get more flexible once you're in. For interviews, tow the line, stand out in the good ways, and keep your goals in mind.

 

[Spacekat]

Thank you! This thread just made me stop and remember how incredibly lucky I am to live in a free society - something I don't do nearly often enough.

There are many places we could have been born where the secret police really DO come and break your legs if the government educates you (probably in a discipline of THEIR choice) and you fail to comply with their life-plan for you.

We are a few of the tiny handful of human beings who have ever had this much choice. I say, once you get admitted, do what makes you happy! It's your duty to not waste all the hard work it took to get you this much freedom.

 

[Bad Mojo]

Does anyone know the percentage of MD/PhDs that actually end up in private practice? I've heard the statistic many times, but always forget it. If I remember correctly, though, it seemed like either the majority or considerably large amount (>33%) get both degrees annd either never do research again or don't do it until a long time down the road. Does anyone know the exact numbers?

 

[Neuronix]

I have seen the stats for Penn graduates, but now I have to quote from memory. There is no significant difference in the numbers between programs, no matter how the various programs try to select applicants or influence minds one way or another.

Basically, it's under 10% that end up in private practice. It's also under 10% that end up in industry. Of the remaining 80-90%, it's split about half and half of academic physicians (doing how much research?) and basic science researchers.

 

[Newquagmire]

Originally posted by Neuronix
Basically, it's under 10% that end up in private practice. It's also under 10% that end up in industry. Of the remaining 80-90%, it's split about half and half of academic physicians (doing how much research?) and basic science researchers.

These must be recent stats. One of my colleagues is a WashU grad (from the mid-80s or early-90s?) who repeatedly tells me how there are only 2 people in his graduating class still doing anything remotely related to research.

 

[superdevil]

thanks for the insight as always, guys.

i'm glad to hear that academic medicine doesn't have such a strangle-hold monopoloy on MD/PhD's. for a moment there, i felt like i was the only person on EARTH having reservations about that route! 😀

please, keep the suggestions/info coming!

 

[Newquagmire]

Originally posted by superdevil
i'm glad to hear that academic medicine doesn't have such a strangle-hold monopoloy on MD/PhD's

But note that my colleague also considers his class a bunch of MSTP "failures." The adcoms want to admit people who are certain that they want to do academic medicine.

From their (and the government's) point of view, if they're paying a considerable sum of money to put you through school, they want to know you're going to give something back to them.

 

[atsai3]

From the perspective of the government agency funding your M.D. and Ph.D. degrees, the MSTP program is an investment that will hopefully produce academic physicians. Taking an MSTP fellowship with the intention of going into private practice is basically a side transfer from the public to private sector. Of course, many students complete the MSTP with the intention of going into academia but then change their minds later. I guess the only the government can do is hope for a bit of decency and honesty.

Cheers
-AT.

Originally posted by superdevil

Is it wrong if someone gets both degrees and then decides, "You know, I really don't want do be tethered to a med school all my life, researching in academia." Of course, the adcoms would want you to say that academic medicine gets you all hot-and-bothered in an essay or interview setting, because that's tantamount to saying (in a trembling voice of longing admiration), "I want to be just like you when I grow up."

 

[pathdr2b]

Originally posted by Neuronix
You'll run into the ones who think pathology is the only good residency for MD/PhDs (and yes they are pathologists), and on down the line.

😛

 

[wgu]

If you search on Pubmed, people conduct research on the utility of MSTP all the time.

Here's an abstract for starters:

Acad Med. 1996 May;71(5):484-7. Related Articles, Links


Career characteristics of graduates of a Medical Scientist Training Program, 1970-1990.

Bradford WD, Anthony D, Chu CT, Pizzo SV.

Department of Pathology, Duke University School of Medicine, Durham, North Carolina, USA.

PURPOSE: To describe the career characteristics of the graduates of the Medical Scientist Training Program (MSTP) at Duke University School of Medicine. METHOD: Surveys and information at administrative offices were used to collect data on all the 1970-1990 MSTP graduates in the summer of 1995. Of the 147 graduates, all but three had completed postgraduate training. In addition, data were available for 35 recent graduates (1991-1995), most of whom were in transition from training and fellowship positions to career positions. RESULTS: Of the 144 graduates from 1970 through 1990, 84 (58%) had selected careers in internal medicine or pathology. A total of 106 (74%) were involved in careers in academic medicine or research. Of these, 87 (82%) held full-time faculty appointments and devoted major efforts to basic or clinical research. Of this group, 59 (68%) were primary investigators receiving grant support from the National Institutes of Health (NIH). Of the 12 women graduates, 11 had careers in academic medicine or research, and seven were primary investigators on NIH grants. At the present time, 11 of 43 (26%) of the matriculating MSTP students are women. Five of the seven underrepresented-minority students in the MSTP have entered in the last five years. CONCLUSION: This study reinforces and extends previous conclusions concerning the success of federally funded MSTPs in producing physician scientists who compete favorably for NIH funding.

 

[wgu]

There's also a nice figure here:
Journal of Orthopaedic Research
Volume 19, Issue 4 , 2001, Pages 505-510

Fig. 1. Diagram showing the numbers of MSTP graduates in each stage of training or career. This report describes a group that has graduated with both degrees, and the boxes on the right represent the components of this group. The upper box indicates the group of 277 graduates who took no postdoctoral clinical training and are in some non-clinical position, usually involving biomedical research. Fifty of these were still in postdoctoral fellowships, 31 held jobs in industry and 76 were university faculty members in basic science departments. One hundred and twenty others in that group could not be classified, because their title was listed as "fellow". The lower boxes represent those graduates who pursued postdoctoral clinical training. Of these, 593 were still in residency, 566 held tenure-track faculty positions and 130 were in private practice at the time of the survey. Forty-nine held the position of "assistant" or "instructor" in a clinical department and are represented by the box labeled "I". It is unclear how many of these were junior faculty and how many were in advanced clinical training, when fellows are often listed as instructors and assistants.

 

[Vader]

Originally posted by atsai3
From the perspective of the government agency funding your M.D. and Ph.D. degrees, the MSTP program is an investment that will hopefully produce academic physicians. Taking an MSTP fellowship with the intention of going into private practice is basically a side transfer from the public to private sector. Of course, many students complete the MSTP with the intention of going into academia but then change their minds later. I guess the only the government can do is hope for a bit of decency and honesty.

Cheers
-AT.

I wouldn't necessarily compare this as a "side transfer from the public to private sector". After all, the NIH is granting money to both public and private institutions to run their MSTP programs.

I do agree though that taking the MSTP fellowship with the intention of going into sole private practice is somewhat of a misuse of the system.

 

[noy]

I've heard mixed messages.

One prof, who did the MD and PhD separately, now does research and has probably not taken a pulse in 10 years. He says the MD was a waste of time. I say there is no way he would get the research funding without the second degree, and that it helps him know what is a good direction to take.

Another prof said this: that the combined programs dont help you become a better researcher or physician, and that most people go into it for the wrong reasons. His basic idea is that you have kids who graduate after having done very well as undergrads, and now want to to 'the best thing'. So they look around, everyone knows physicians are respected, same with PhD's, and these programs have maybe 300 slots around the nation, less than 100 at top schools, so its the most competitive thing out there, and will let the kids stay 'the best'. Of course they can do it, but does it accomplish anything?...

Honestly, I think he is jealous that he did not make it - he was a pre-med and ended up as a PhD (who will do VERY well, btw). I never asked if he actually applied to med schools and did not get in...

Yet another I spoke to said the MD was just a way to get more funding from his research, and seeing patients was a waste of time better left to the MD only's.

A clinical MD/PhD I know said that the PhD is a 'union card' that lets him get respected in research, while he still plans on being clinical. This way he can branch out as he gets older...

I think the opinions vary greatly but of those I have spoken to the constant seems academia, ranging from seeing patients at a research institution to running a basic science lab like any other PI. To me, this seems like the unwritten rule of MSTP, and since my plans are to stay in academia, it fits very well for me.

 

[Primate]

Go into it for what you want. Do what you want. But....

The MSTP is a federally funded program that is designed to train physician scientists. It is not intended to train physicians for private practice. The money is given to schools to pump out researchers, not just clinicians (gifted or not). You may game the system and get your school paid for, but that is not what the government is spending your fellow citizens' tax dollar for.

Clinical research - fine. Research while in a surgical field - no problem. Private practice - no. Frankly, I wouldn't mind seeing the repayment clause reinstituted.

As to the utility of the degree, it's largely what you make of it. If you want to be 100% in the lab, the MD is probably not worth it. If you want a community practice with no research, go to med school.

You may disagree, but that's my $0.02.

P

 

[coldchemist]

I think Primate has a good point (sounds kinda funny...I'm taking advice from a monkey) that relates to the original post. Is there an ethical concern when a person accepts an MD/PhD offer and then runs with both degrees into a private practice? Yes, but a temporal distinction must be made.

A person accepting a position is stating, either explicitely or implicitely, a committment to research--how much time they devote to research is left up to them, but it is assumed that research will become a significant part of their post-training career.

If the person changes their mind at some point during or after their training, there really is no wrongdoing because, presumeably, nobody could forsee this change. If, however, the person accepted the position with no intention of fulfilling their committment to research, then in my humble opinion they have misled the institution that granted the position--unfortunate, but it happens (browse the CWRU MSTP student webpages for an exmple). I think we all probably mislead schools to some extent, either intentionally or unintentionally, but considering the amount of taxpayer dollars involved, this is a lie that should not be overlooked.

So when is it okay to make the decision not to pursue research and still remain in the program? Hell, who knows? Off the top of my head I would say that if you change your mind before the end of your second year you should probably drop out of the program. Otherwise stick with it.

 

[Primate]

Some people will, of course, change their minds as to what they want to do with their career. I don't think anyone would argue that this is unethical. However, if you've made the decision to bail on research it is incumbent upon you to similarly leave the MSTP funding behind as well. Never gonna happen, you say? Read on....

I had one classmate who did this after her first year of med school (at CWRU, oddly). She had the benefit of a year of free classes and then paid for the rest. No one was upset about the money spent in that case. I also had another classmate leave when she was about a year from getting her PhD (at UPenn) - two years of classes paid for, but she went back to med school on her own nickel. Again, no one was upset about the money. People were sad to see two good people leave research, but "everyone" agreed that they had to do what was right for them.

The problem, as implied, is when people stay in only either for $$ or in order to land a competitive residency. There is the ethical rub, even if it's post-PhD that the decision is made. I'm a bit of a stickler when it comes to ethics and doing the right thing.

P

(and who says a monkey can't make sense - if you sit a thousand monkies at typwriters for a thousand years . . . )

 

[superdevil]

thanks for the continued advice!

just to re-focus the thread though: it seems as though everyone here has kind of taken the "is it unethical to 'cheat' the system?" angle a bit too far. in my original post, i asked,

What are alternative, "acceptable" uses of the degree besides academia?

i was just curious as to what the NIH would see as kosher besides working in a lab in a medical school. any suggestions along these lines?

also, just for argument's sake, i am applying to at least a handfull of non-MSTP programs in case my reservations intensify.

as always, you guys rule! keep the advice comin'.

 

[Primate]

Threads do evolve. That's one of the things that keeps me checking back. 🙂

As to the OP, "acceptable" is pretty broad (per the NIH). It does not have to be bench research, regardless of what some might imply. Though these are the preferred careers, this is mostly because they are so easy to categorize when grant renewal time comes up (easier to justify the rather large investments).

To be acceptable, you need to somehow fit the word "academic" into the job description. Of note, this can be in a university or a drug company. Just as long as you're pushing translational research (of additional note, one can do just bench research and this is considered a win, but going too far in the other direction is not - just a curious asymmetry). So, even a clinician with no lab will look OK come grant renewal time (marginally), as long as they are actively involved in the academic activities of a university (teaching, clinical research, etc.). Private practice or going to the business side of industry (consulting, venture capital, investment banking, managerial functions of a drug company) is not considered OK.

The historical preference has been for running a wet lab and seeing a few patients, and this is where the current bias still leans. However, that does not mean that other activities are anathema to the MSTP grad (in the eyes of the NIH). There have even been some funding efforts recently in the areas of public health (NRSAs available from several NIH divisions - NINDS, NIMH for instance) that are pushing for CD's to do epidemiology rather than bench work (comments in a recent thread not-withstanding).

Stay within the spirit of pushing the frontiers of patient care and/or basic science and you'll probably keep the NIH satisfied, if not even happy.

No one will break your legs or career should you bail. They used to have you pay the $$ back, but not anymore.

If you want in to an MSTP, kissing a$$ may or may not help. Saying you want to go into venture capital (or even surgery, at some programs) definitely won't. So, yes, be discrete in choosing your words during the application cycle. But, getting back to the "slant" you mention, why would one need to be false if translational medicine is truly interesting to you? Ans: only if it's not. And we've come full circle.

Best of luck. These are important decision.

P

(Gotta go study for my Peds shelf!)

 

[xanthines]

Becuause the decision to accept one person over another often comes down to a matter of opinion of a few people of may or may not be so enlightened as you! 😉

-X

Originally posted by Primate
... But, getting back to the "slant" you mention, why would one need to be false if translational medicine is truly interesting to you? Ans: only if it's not. And we've come full circle. ...

 

[Primate]

Touche. Of course, we all try to present ourselves in the best light possible (I never mentioned my past interest in ortho during interviews). My point is not that we aren't selective in what say during interviews, but rather that applicants don't manufacture an interest in medical science in order to snag a spot in an MSTP.

If one really wants to be a physician scientist, then by all means play to the rules (and do what you need to to get a spot). My concern is more with people who go into the program for other reasons (mentioned above).

Enlightened.... Even with tongue planted firmly in cheek, I'm not sure I've ever been called that. 😉

P

 

[superdevil]

i know threads "evolve." sorry if i sounded rude by reasking the question😉

thanks for elaborating on "acceptable," primate. your advice is very appreciated. seriously, though, i'm not trying to be "fake" about anything. i am intrigued by academic medicine. i just wanted to hear if there were alternatives, since i'm not positive. the whole point of my recent reflection is that i want to have this thing figured out before i apply, so i know what programs are right for me (even if they're not NIH funded).

if anyone has any more advice, keep it coming🙂

 

[chef]

hey, it's your life, and u only live once. do wahteer makes YOU happy, why do u even care what other people think?

 

[dl2dp2]

I don'w know if i want to revive this thread, but I was recently checking out Columbia's MSTP graduates. I found a suprising number of people in the industry, primarily as founders/CEOs/chief consults. I found this somewhat disturbing but I think this might make sense in that MD/PhDs are probably highly sought after in private sector and can be (and probably have been) lured away from academia with very high salaries and stock options (think millions)...

I don't know if this is deemed "acceptable" though 🙂 Although as far as I know, the actual quality of research in the industry is as high, while the atmosphere is totally different. You'd have to make a judgement on your own.

 

[superdevil]

a lot of people wouldn't consider industry acceptable (at least those that i've spoken with). i believe academia even has an equation for this very matter:

(working in industry) + (making lots of money) = SELLING OUT


i personally could see how one could argue that industry also needs the knowledge of medical scientists (as full-time staff, consultants, or otherwise), but for every one of those points, someone on the "other side" could probably refute them. oh well. i still think its a good thread. 😉

 

[Primate]

Industry can be an "acceptable" option, even to the PDs, as long as the job is bench/translational in nature. The concern is that many scientists early in their career shoot themselves in the foot, in a way, by allowing the company to direct their research (which, though not ALWAYS the case, is by far the most common arrangement). One can end up having to drop a potentially important line of research if it doesn't look like it'll produce a product in an acceptable time frame or cannot be made public due to competitive concerns, and thereby keeping one from publishing and racking up career points.

Many scientists will go to industry after already establishing themselves and they take positions in which they are actually able to direct research. This is a more accepted course, at least by the powers that be.

Of course, there's variation to all this, but this is my take on the general lay of the land.

One last thing, the salaries/stock options are not uniformly huge in industry. They're good, and if you're VERY VERY lucky the options can hit (highly unlikely these days - may change), but the work load is also high. It's not the golden land that everyone seems to think it is (not sure why so many people think it's so sweet - probably a few anecdotes they've heard).

P