Non-MSTPers in Path

[mnf1985]

Hey folks - I was just wondering how common it was for traditional medical students (i.e. those who are not in an MD/PHD program) to go in to pathology. Also, perhaps for those who did enter pathology without an MD/PHD - did you find people (faculty? students?) giving you a hard time for entering the field? I know there are some less informed people who will say, in horror, - "oh, so you won't be seeing patients?!" but there are likely many who are supportive. Thanks!

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[MudPhudHopeful]

Hey folks - I was just wondering how common it was for traditional medical students (i.e. those who are not in an MD/PHD program) to go in to pathology. Also, perhaps for those who did enter pathology without an MD/PHD - did you find people (faculty? students?) giving you a hard time for entering the field? I know there are some less informed people who will say, in horror, - "oh, so you won't be seeing patients?!" but there are likely many who are supportive. Thanks!

I am still just a student, so I cannot comment on your second question, but in response to your first question, if you look at the stats, the vast majority of students that match into pathology do not have a PhD. Looking at the list of residents at particular pathology programs, especially at bigger, more well-known programs, may give the impression that most students who enter pathology are MD/PhD, but I think that is more a reflection of the research-oriented MD/PhD students being drawn to those research-heavy programs and also perhaps those programs wanting to recruit students who are interested in research.

 

[mlw03]

Most pathologists in practice at MDs (a few DOs); some MD/PhD, but they are by far the minority.

 

[path12]

Hi, I'm applying this year to path and I only have an MD degree, but I did 9 years of research and the programs that are calling me only are big on research.

 

[2121115]

There is a common myth out there among medical students that pathologists do research more than other specialties. Not true. There is likely the same percentage of MD/PhD's in pathology as there is in other specialties. Most of us are "just" MD's.

 

[lipomas]

Yeah MDPHds are pretty uncommon. Some end up in private practice but most stay in academics. I would guess not more than 10-15% of total residents are MD Phd but I may be off on that. A good percentage are foreign grads.

 

[Enkidu]

Yeah MDPHds are pretty uncommon. Some end up in private practice but most stay in academics. I would guess not more than 10-15% of total residents are MD Phd but I may be off on that. A good percentage are foreign grads.

Although the data indicates that pathology has the second highest density of MD/PhDs, after radiation oncology.

 

[LADoc00]

MSTPers entering a clinical field in my opinion is a total waste. As a former MSTPer myself, I can say without a doubt, the track was meant for true basic science with only a minimal amount of clinical work (like <25% time), typically in internal med or related subspec.

I have not seen any former MSTPer who actually benefited from the experience and was doing anything more than babysitting an autopsy service in a Path dept.

I just really dont think an MDPhD does much in Pathology aside from reducing student loan debt?

Even at the highest levels of academic pathology, the Joes actually doing service work almost never had their own basic science labs. This makes me seriously question the value of doing a Path residency if you are a true MSTPer scientist.

Im sure there are very rare example of Path residents going down the:
K01-->K22-->R03-->R08 track but man they are RARE. Rare.

I think the MSTP program itself is good but I dont think its even remotely accomplishing the goals it laid out for itself at its creation.

 

[thebouque]

Although the data indicates that pathology has the second highest density of MD/PhDs, after radiation oncology.

That's because a lot of IMGs are in pathology, and a lot of them do research while waiting for a residency spot.

 

[gbwillner]

That's because a lot of IMGs are in pathology, and a lot of them do research while waiting for a residency spot.

Citation needed

Lots of US MD/PhDs go into path- but they almost universally go to a top tier program, so they are heavily concentrated in those programs. Don't forget that there are relatively few path residents compared to IM, so although more MSTPers go to IM, proportionally there more in path (#s wise path is usually 3rd behind IM and Peds).

I think one of the main reasons is the perception that one could run a lab and sign out pathology in a more streamlined schedule than an IM or Peds doc who has to abandon lab for a week or a day or a month at a time. You also have access to all the samples, and can do studies focused on diagnostics vs. clinical trials, which can take decades. In practice, however, path doesn't really work this way, and I have to agree with LAdoc to some degree (SOME) that it is very difficult to maintain your expertise in surgical pathology and run a basic science lab. Most end up giving up the lab and taking on more clinical projects, or taking a niche field to sign out or autopsy for 20% of their time. Unlike LADoc, however, I know LOTS of MSTPers in path that still run a lab (or are attempting to do so)- but the number is getting smaller and smaller all the time. This is primarily a result of the terrible NIH funding situation.

Then there is CP-only, which is almost entirely made up of MD/PhDs. It's a fast track to full-time research with some administrative duties (basically).

 

[Doormat]

Totally agree with LADoc. I was a MSTP MD PhD student. The federal government payed for my medical school tuition and gave me a massive annual stipend of 16K during my MD-PhD training.
I have no student debt. The goal of this federally-funded program is to encourage physician scientists to do science and write grants. As Nancy Andrews (chair of MSTP program at Harvard before she went to Duke) once told me, the idea is that when a student lacks a debt burden, they can pursue science and work in academics.

The biggest flaw with this that NIH funding rates for grants are abysmal, around 10%, How do you make your monthly mortgage payment or have a stable family when you are begging the NIH and private foundation for research dollars that are increasingly impossibly difficult to acquire? Even grants that are won must be renewed every 3 to 5 years. Even big shot scientists are not getting their grants renewed these days.

The only MD PhD students I know who run their own laboratories have a spouse who is a high-earner or love science so much they are willing to tolerate enormous uncertainty in their career and life. They also have supernatural confidence in their superiority over their peers that make them confident enough to compete in a game where 1 in 20 succeed.

I went into private practice.

 

[gbwillner]

The only MD PhD students I know who run their own laboratories have a spouse who is a high-earner or love science so much they are willing to tolerate enormous uncertainty in their career and life. They also have supernatural confidence in their superiority over their peers that make them confident enough to compete in a game where 1 in 20 succeed.

I went into private practice.

Why would you ever do an MD/PhD unless you loved science that much? That is part of the problem- too many people get who have no business doing it.

 

[lipomas]

That's because a lot of IMGs are in pathology, and a lot of them do research while waiting for a residency spot.

There's a difference between the people who do combined MD/Phd programs and those who do them at separate times. The IMGs are mostly the latter and aren't really the same kind of "physician scientist" as one who does the combined program. They are physicians who also happen to have PhDs.

Unfortunately for a lot of talented IMGs who otherwise should be considered for US resdidency spots, the combined IMG grads get the spots because their credentials are better.

 

[chalamilasidney]

Even at the highest levels of academic pathology, the Joes actually doing service work almost never had their own basic science labs. This makes me seriously question the value of doing a Path residency if you are a true MSTPer scientist.

Im sure there are very rare example of Path residents going down the:
K01-->K22-->R03-->R08 track but man they are RARE. Rare.

I think the MSTP program itself is good but I dont think its even remotely accomplishing the goals it laid out for itself at its creation.

How many NIH grants/ awards can you receive simultaneously? Do you anyone in residency or fellowship who got multiple grants?

 

[kchan99]

Do you anyone in residency or fellowship who got multiple grants?

Most NIH grants require experience (data and publications) and a faculty appointment. A few NIH grants are available to trainees, such as F32 for research fellows and R25 and T32 for residents and fellows. T32 is actually awarded to the program while for the R25, trainees apply individually in programs that are approved for the grant.

Depending on disease interest, fellows may be able to obtain private foundation training grants for salary support and research expenses.

 

[SetecAstronomy]

I went through the MSTP route and went into pathology. I was told by my program, that nationally, MSTP-ers match into 1. IM, 2. Peds, and then 3.Path in that order. Not sure if that's changed since I graduated.

I don't think my PhD helped me with pathology at all, except in one small part in one subspecialty service during residency. That's it.

As far as grants for residents/fellows, the K08 is the main vehicle for that since you can take that money with you when you leave.

As for multiple grants, this generally isn't possible since most entities that issue grants have a clause that they can be the only funders of a specific research project. So if you applied for won both a K08 and a American Cancer society grant for the same project, you'd probably decline the ACS grant and keep the K08 (although you can still list in on your resume!). While not impossible, it isn't likely that a resident/fellow could have different enough projects to warrant multiple grants. At least not without risking some ethical/legal issues.

 

[LADoc00]

I went through the MSTP route and went into pathology. I was told by my program, that nationally, MSTP-ers match into 1. IM, 2. Peds, and then 3.Path in that order. Not sure if that's changed since I graduated.

I don't think my PhD helped me with pathology at all, except in one small part in one subspecialty service during residency. That's it.

As far as grants for residents/fellows, the K08 is the main vehicle for that since you can take that money with you when you leave.

As for multiple grants, this generally isn't possible since most entities that issue grants have a clause that they can be the only funders of a specific research project. So if you applied for won both a K08 and a American Cancer society grant for the same project, you'd probably decline the ACS grant and keep the K08 (although you can still list in on your resume!). While not impossible, it isn't likely that a resident/fellow could have different enough projects to warrant multiple grants. At least not without risking some ethical/legal issues.

no. 3 Pathology? huh wha??? Where did you go?

I spent time at a program with the biggest most well developed MSTP element ever created and we had like 1 total into Path over I would guess a 40+ MDPhDs graduated. I dropped out so that would be another +1 into Path if you counted that, but IM, ENT, Ortho and Derm all had more matches in the final analysis. I also dont think I knew a single MSTP do Peds, that seems odd to me but this was also forever ago.

I also spent time in the 2 most research oriented Pathology departments in the country and number of the MSTP grads was astonishingly small and I even had Cotran personally tell me Path residency could derail an otherwise strong research bound student.

 

[BU Pathology]

The NIH just announced a new funding stream specifically to enhance research training during residency. The program is an R38, Stimulating Access to Research in Residency (StARR). More information can be found here:
RFA-HL-18-023: Stimulating Access to Research in Residency (StARR) (R38)

Pathology is well positioned to capitalize on this new program, since the ABP just approved the physician scientist pathway.

The number of MD PhDs in pathology, as a % of the workforce, is the highest of any specialty. More information about this may be found in this article.
Opportunity: Newly Created Physician-Scientist Research Pathway by the American Board of Pathology

You do not have to be an MD PhD in order to have a successful career as a physician-scientist. It is helpful, but not a necessity.

Daniel Remick, M.D.
Chair of Pathology & Laboratory Medicine, Boston Medical Center

 

[LADoc00]

Huh where the hell was this Physician-Scientist pathway when I was in training...I feel cheated now.

I will have to make myself feel better tonight by sleeping on stacks of money from my private practice work.

 

[gbwillner]

The NIH just announced a new funding stream specifically to enhance research training during residency. The program is an R38, Stimulating Access to Research in Residency (StARR). More information can be found here:
RFA-HL-18-023: Stimulating Access to Research in Residency (StARR) (R38)

Pathology is well positioned to capitalize on this new program, since the ABP just approved the physician scientist pathway.

The number of MD PhDs in pathology, as a % of the workforce, is the highest of any specialty. More information about this may be found in this article.
Opportunity: Newly Created Physician-Scientist Research Pathway by the American Board of Pathology

You do not have to be an MD PhD in order to have a successful career as a physician-scientist. It is helpful, but not a necessity.

Daniel Remick, M.D.
Chair of Pathology & Laboratory Medicine, Boston Medical Center

Good. I was lobbying MSTP and the NIH to fund this program for the last 10 years, and I'm glad they finally moved forward. Residency (really the residency - faculty transition) is the chokepoint for physician scientist training.

 

[dukeresident]

MSTPers entering a clinical field in my opinion is a total waste. As a former MSTPer myself, I can say without a doubt, the track was meant for true basic science with only a minimal amount of clinical work (like <25% time), typically in internal med or related subspec.

I have not seen any former MSTPer who actually benefited from the experience and was doing anything more than babysitting an autopsy service in a Path dept.

I just really dont think an MDPhD does much in Pathology aside from reducing student loan debt?

Even at the highest levels of academic pathology, the Joes actually doing service work almost never had their own basic science labs. This makes me seriously question the value of doing a Path residency if you are a true MSTPer scientist.

Im sure there are very rare example of Path residents going down the:
K01-->K22-->R03-->R08 track but man they are RARE. Rare.

I think the MSTP program itself is good but I dont think its even remotely accomplishing the goals it laid out for itself at its creation.

That’s my impression of MSTP in most areas. Think it’s a flop.

 

[dukeresident]

Totally agree with LADoc. I was a MSTP MD PhD student. The federal government payed for my medical school tuition and gave me a massive annual stipend of 16K during my MD-PhD training.
I have no student debt. The goal of this federally-funded program is to encourage physician scientists to do science and write grants. As Nancy Andrews (chair of MSTP program at Harvard before she went to Duke) once told me, the idea is that when a student lacks a debt burden, they can pursue science and work in academics.

The biggest flaw with this that NIH funding rates for grants are abysmal, around 10%, How do you make your monthly mortgage payment or have a stable family when you are begging the NIH and private foundation for research dollars that are increasingly impossibly difficult to acquire? Even grants that are won must be renewed every 3 to 5 years. Even big shot scientists are not getting their grants renewed these days.

The only MD PhD students I know who run their own laboratories have a spouse who is a high-earner or love science so much they are willing to tolerate enormous uncertainty in their career and life. They also have supernatural confidence in their superiority over their peers that make them confident enough to compete in a game where 1 in 20 succeed.

I went into private practice.

A lot of MSTP paths hitch a ride on other folks’ grants.