? of the day: What happens after MD/PhD?

[collinsc]

K here is my curious question. What happens after your MD/PhD education? Do you people usually go in to their post docs or do they go into their residency for their specialties? You have to do both at sometime right? Anyone know?

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[Neuronix]

>95%, approaching 100% these days, do residency. It always makes you a much more competitive and marketable individual to be board certified in a clinical specialty, regardless how you structure your career. As research funding has dwindled and the world of 100% research has become extremely competitive and unstable, almost nobody would gamble their career by not doing residency these days.

The concept of post-doc does not include clinical duties, and most MD/PhD do not do this.

Some MD/PhDs do spend an extended time doing research as part of fellowship or as a new faculty, and these typically include some amount of clinical duty. Only a certain amount of MD/PhDs (well less than half by my the ubpublished data I've seen) will make academic research a majority part of their career, and thus even that is optional.

 

[collinsc]

>95%, approaching 100% these days, do residency. It always makes you a much more competitive and marketable individual to be board certified in a clinical specialty, regardless how you structure your career. As research funding has dwindled and the world of 100% research has become extremely competitive and unstable, almost nobody would gamble their career by not doing residency these days.

The concept of post-doc does not include clinical duties, and most MD/PhD do not do this.

Some MD/PhDs do spend an extended time doing research as part of fellowship or as a new faculty, and these typically include some amount of clinical duty. Only a certain amount of MD/PhDs (well less than half by my the ubpublished data I've seen) will make academic research a majority part of their career, and thus even that is optional.

So are there few MD/PhDs do their residencies (get in their specialties), then usually open up their own labs as a PI? or is it the contrary?

In my perfect world, I would finish my MSTP program, go into my residencies and fellowships for pediatric cardiac surgery, then be a PI afterwards doing part surgery part research... I understand this may be quite hard for surgeons?

 

[Neuronix]

So are there few MD/PhDs do their residencies (get in their specialties), then usually open up their own labs as a PI? or is it the contrary?

I don't understand your question.

The vast majority of MD/PhDs do residency. Some open up their own labs as a PI, some do not. Most do stay in academics, which could mean anywhere from 0-100% research. Some go into industry, private practice, etc...

In my perfect world, I would finish my MSTP program, go into my residencies and fellowships for pediatric cardiac surgery, then be a PI afterwards doing part surgery part research... I understand this may be quite hard for surgeons?

Pediatric CT surgery is what... 10 years of residency and fellowship? It's extremely grueling training, on top of an already long and grueling MD/PhD program. Then you're expected to operate most of the time to be a very experienced technically proficient surgeon. It's not impossible to run a lab on top of this, just extreme and not very feasible.

 

[collinsc]

Pediatric CT surgery is what... 10 years of residency and fellowship? It's extremely grueling training, on top of an already long and grueling MD/PhD program. Then you're expected to operate most of the time to be a very experienced technically proficient surgeon. It's not impossible to run a lab on top of this, just extreme and not very feasible.[/quote]

Yeah its 5 yrs general, 3-4ish years for fellowship in CT, 1-2 yrs peds ct. so yeah I'd be looking at probably 20+ years studying. which would land me in my early 40s. Everyone thinks I'm insane and I know I am. The years don't really bother me. I just know thats something I'd really want to do with the internships and shadowing that I've done I know I would want both at least partially in my life.

 

[Neuronix]

You'll almost certainly change your mind. But that's not the issue here.

Do MD/PhD because you see yourself running a lab at least 80% of the time. If you don't see yourself doing that, don't do MD/PhD. The degree is meant to train researchers. The plan you're proposing would not make you a researcher. But I'm not the one you care about. If you interview for MD/PhD programs with this plan you will likely be shut out, because they will not think you are serious about a majority research career. I think you're just extremely naive.

 

[itsallthesame]

if you think getting into an mstp is hard, then you probably think getting an f30 is hard. well, i think the national rate of acceptance to peds surgery fellowships each year is ~= to the f30 rate (~20%).

Now, there's no limit on fellowship hours and there is such an excess of people wanting the job, 100 hour weeks for all of those years of fellowship is restful. Now, 80 hr weeks during residency leave some time for clinical research, but none for basic science.

If we follow your plan... last two years of med school, 5 years surge, 3 yrs CT, 2 yrs peds CT, then it will have been about 12 years since your last science publication when you get hired. how do you expect to a) get funded b) get people into your lab? c) have any knowledge of the litterature from the last decade? d) remember how to do everything in your lab from what equipment to buy to reagents, training techs, etc.

Note: this is only if everything goes perfect. You might have to take research years in residency depending on where you match or you might not get into fellowships the first time you apply.

 

[mercaptovizadeh]

Agree with Neuronix here:

Practically the only basic science research that might have a major impact for a surgeon is in transplantation immunology. Even the big people in that field so far did not have PhDs: Christiaan Barnard, Joseph E. Murray, Thomas Starzl, E. Donnell Thomas (although that was BMT, not solid organ).

The other great innovators in surgery and perioperative care were far more practical, i.e. people like Michael DeBakey.

If you want to be a highly specialized surgeon, you DO NOT NEED a PhD. You can do a lot more by fiddling around in a physiology lab and tinkering around with blood pumps, artificial vessels, etc. and then come up with something new rather than going through a basic science PhD.

If you want to work on stem cells for heart tissue repair, go into IM and cardiology. If you want to develop imaging to visualize messed up circuitry in the heart, do radiology.

I repeat, for (almost any) surgeon a PhD is a waste of time.

 

[mercaptovizadeh]

Also know that a pediatric CT surgeon has practically no personal life. A recent case of a high profile physician suicide is of Jonathan Drummond-Webb. Pediatric heart surgeon, very good success rate, felt unrecognized by his colleagues, decided not to have children because of his career, killed himself at age 45.

http://en.wikipedia.org/wiki/Jonathan_Drummond-Webb

 

[Vader]

In general, the more procedure-intensive specialties leave less time for running a basic research lab. That is the main reason most MD/PhDs flock to medicine, path, neurology, etc.

I was interested in neurosurgery and loved the rotation I did and loved working with the residents (who were awesome, extremely hardworking, and witty people, btw!). However, I realized that I could reasonably dedicate more effort towards running a lab and still see my family if I did neurology. I also realized that clinically, I enjoy the diagnostic aspects immensely (including the history and neurologic exam, labs, neuroimaging and electrophysiology). I also liked the longitudinal aspects of patient care found in neurology.

There are many aspects to clinical specialties that you don't get exposed to until medical school, especially during your time on the wards. While it is fine to have interests, be sure to get exposed to as much variety as possible to ensure that you're making the right choice. I.e. you may find that cardiology is more compatible with a goal of both seeing patients and running a basic research lab. There are also certainly many interventional opportunities within cardiology (cath, electrophys) that may satisfy your "hands on" interests, but these do require extra training.

 

[collinsc]

In general, the more procedure-intensive specialties leave less time for running a basic research lab. That is the main reason most MD/PhDs flock to medicine, path, neurology, etc.

I was interested in neurosurgery and loved the rotation I did and loved working with the residents (who were awesome, extremely hardworking, and witty people, btw!). However, I realized that I could reasonably dedicate more effort towards running a lab and still see my family if I did neurology. I also realized that clinically, I enjoy the diagnostic aspects immensely (including the history and neurologic exam, labs, neuroimaging and electrophysiology). I also liked the longitudinal aspects of patient care found in neurology.

There are many aspects to clinical specialties that you don't get exposed to until medical school, especially during your time on the wards. While it is fine to have interests, be sure to get exposed to as much variety as possible to ensure that you're making the right choice. I.e. you may find that cardiology is more compatible with a goal of both seeing patients and running a basic research lab. There are also certainly many interventional opportunities within cardiology (cath, electrophys) that may satisfy your "hands on" interests, but these do require extra training.

Yeah I know that being in med school I will be exposed to a lot and I've always been open minded. Like I said before I got flamed for being naive, in a PERFECT world I could do both but in reality I probably couldn't. I actually was interested in pediatric cardiology itself for a while and like you I shadowed cardiac surgeons and loved it and I've also shadowed pediatric cardiologist as well and loved it too. I'm sure I'll find out what works for me and i know that I really really really want to run a basic research lab while still remaining in a clinical specialties which would undoubtedly be easier if I were just a ped cardiologist. As much as interests change in med school I would think that you would have to be open minded to begin with.

 

[greg12345]

What happens after MD/PhD? Most people become jaded.

 

[Tradewind]

I'm not jaded (yet), but I'm older.

 

[reine1jb]

I'm not jaded (yet), but I'm older.

do you still feel as "geeked" and excited about research and the ideal 80/20 split compared to when you first started?


if you don't mind me asking of course...

 

[collinsc]

UPDATE:

Ok guys n gals. I took it upon myself to find someone who had an MD PhD and was a Pediatric Cardiac Surgeon like I want to be and is active in research and I found one. See his credentials here:

http://www.cincinnatichildrens.org/research/div/cardiothoracic/fs/fac/pirooz-eghtesady.htm

I decided to shoot him an email to ask him some questions on how he did it an how he kept his balance... I figured this would be very interesting for you guys to see (especially if there are newbies out there who are MD PhD wannabe wanting to be in a very specialized field. The following are my questions and the responding answers

Q. Approximately how much time are you able to devote to research as opposed to surgery?

A: It varies from week to week or even day to day. I would say at least 50 to 75% of my time is devoted to taking care of patients or matters related to that.

Q. Pediatric cardiac surgery seems like a very demanding (but rewarding) field, do you feel that during your training that you have been able to balance both your career and outside life or do you feel enveloped in your career. (I.e. if you have a family of your own, do you feel you are able were able to balance both your family life and career)?

A. Yes, it is very demanding, but so is anything that requires intense and extensive training. Do you think Michael Phelps or Tiger Woods spent/spend much time in their profession? How about a successful businessman or say a restaurant owner who can practically never take a vacation (unless the business gets so big that they can hire others, etc.) and has to go in early in the morning and stay late until closing. It is challenging to balance and at times I can and at other times I have not succeeded. Definitely during training it was not balanced, but again, ask the same of olympic atheletes or concert pianists, etc.


Q. Do you feel that it was hard to establish your own lab after your training for pediatric cardiac surgery? or did you establish your lab while you trained in your field?

A. I established my lab after training and it was very hard/challenging, but obviously doable. If one has the opportunity to work on establishing their lab during training, it would be ideal, but a lot has to happen to make it possible.

Q. I am completely uplifted by your ability to be both a pediatric cardiac surgeon and a researcher in both basic and clinical science. What do you feel helped you in your success?

A. Not sure. Luck, hard work and having supportive and understanding friends and family (which then goes back to question of luck). More and more, however, I believe that for success (depending on how you define success) to become feasible, to some extent one has to be focused (and know what it is they want so they can focus on it).

Good luck to you. You are already on the right track.
Pirooz

Pirooz Eghtesady, MD, PhD
Assoc Prof, Cardiothoracic Surgery
Surgical Director, Pediatric Heart Transplantation
Pediatric Cardiac Surgery
Cincinnati Children's
Hospital Medical Center
MLC 2004, 3333 Burnet Ave
Cincinnati, OH, 45229-3039
Phone 513-636-4770
Fax 513-636-3847
Cincinnati, OH, 45244


So there are people out there who have done it all through hard work and focus it IS possible without complete destruction. So keep dreaming kids!

 

[smoke47]

OP, the physician you found began med school in 1987, probably about the time that you were born (assuming you are applying to MD/PhD programs soon and haven’t taken any significant breaks). In fact, that physician has likely been a student for longer than you have been alive.

I just wanted to put some physical meaning into the numbers that are being thrown around. There is nothing wrong with dreaming big, but try to have realistic expectations for yourself. Keeping an open mind (like you said) is a great start.

 

[Neuronix]

I give collinsc an A for effort on that one. If you think that's what you want to do, go do it. My advice is to just tell the MD/PhD interviewers you're thinking about Cardiology and don't even bring up Cardiothoracic Surgery.

 

[collinsc]

I give collinsc an A for effort on that one. If you think that's what you want to do, go do it. My advice is to just tell the MD/PhD interviewers you're thinking about Cardiology and don't even bring up Cardiothoracic Surgery.

Yeah that's my main plan because 99.9% of the interviewers will think that I'd switch to straight MD since is really is hard to set up your own lab in the field I wish to be in. PS thanks for the A for effort lol.

 

[collinsc]

OP, the physician you found began med school in 1987, probably about the time that you were born (assuming you are applying to MD/PhD programs soon and haven't taken any significant breaks). In fact, that physician has likely been a student for longer than you have been alive.

I just wanted to put some physical meaning into the numbers that are being thrown around. There is nothing wrong with dreaming big, but try to have realistic expectations for yourself. Keeping an open mind (like you said) is a great start.

Just for the record I was the tender age of 2 when he started lol. Like I said above, I know this is a 20+ year track for me if I choose to take it and that it would be and the odds would be against me but look around at the surgeons you see that are really successful. Would you really want a 28 year old surgeon working on your heart let alone your kid's? I think not. A lot of things can happen from now till then so yeah my mind is still open. I'm sure a lot of people who are/were in the shoes of this doctor were told they were naive and crazy too 😉

 

[martindoc]

Of the 9 people that were in my MD/PhD class, only 1 (maybe a 2nd who is earlier in residency) are still doing anything involving real bench research; most people are still in residency or fellowship and planning an academic career, but an academic clinical career (myself included). I'd rather be doing hard bench research but i am too much a coward and sick of being poor. If i could be paid the same money, and have the same career stability, in the lab, i would do it in a heartbeat. Basic science is far more interesting than clinical science. The question i have, is the MSTP program funding 8-10 people per year per program across the US worth it when only 10-25% end up using their PhDs (directly) once they graduate. I wonder if we would be better off with diverting that funding to post-MD fellowships and K08's for people without PhDs

 

[dl2dp2]

Of the 9 people that were in my MD/PhD class, only 1 (maybe a 2nd who is earlier in residency) are still doing anything involving real bench research; most people are still in residency or fellowship and planning an academic career, but an academic clinical career (myself included). I'd rather be doing hard bench research but i am too much a coward and sick of being poor. If i could be paid the same money, and have the same career stability, in the lab, i would do it in a heartbeat. Basic science is far more interesting than clinical science. The question i have, is the MSTP program funding 8-10 people per year per program across the US worth it when only 10-25% end up using their PhDs (directly) once they graduate. I wonder if we would be better off with diverting that funding to post-MD fellowships and K08's for people without PhDs

That's a good thought except straight PhDs tend to have a even smaller success rate. I don't think a simple re-distribution is going to help because the system is set up in a pyramid scheme--you need the low level people to do all the work, but you can't have too many upper level people because that's constrained by the resources. Unless something changes systematically you won't see the condition dramatically improve. As you said, basic science seems more fun--but not everyone is willing/able to do it, and this is dictated purely by logistics.

It seems to me that the PhD is primarily being "used" for credentialing, because in a less-competitive specialty, the better the program, the better your chance of getting into academia, and MD/PhD--regardless of the program tend to give you a much better shot at top programs than a straight MD. Of course the lifestyle specialty option is always there...

 

[Tradewind]

do you still feel as "geeked" and excited about research and the ideal 80/20 split compared to when you first started

I was much less informed when I started relative to many of you premeds these days. Partly because of that, I don't think I was ever really as "geeked." I had every intention of finishing the program, which I did. But I didn't set unusually high expectations for myself. At this point, I'll be ecstatic if I become a translational scientist, but if I go all 'all clinical,' that can be rewarding, too.

That being said, I want to make sure I give the research track all I've got before giving up on it. Because, yes, I enjoy research! (maybe that's what you mean by geeked..) Hence, my desire to give you younger students some advice based on my experience. Which is more than some, but I'm certainly not a PI - I'm a PGY.

 

[reine1jb]

I was much less informed when I started relative to many of you premeds these days. Partly because of that, I don't think I was ever really as "geeked." I had every intention of finishing the program, which I did. But I didn't set unusually high expectations for myself. At this point, I'll be ecstatic if I become a translational scientist, but if I go all 'all clinical,' that can be rewarding, too.

That being said, I want to make sure I give the research track all I've got before giving up on it. Because, yes, I enjoy research! (maybe that's what you mean by geeked..) Hence, my desire to give you younger students some advice based on my experience. Which is more than some, but I'm certainly not a PI - I'm a PGY.

Thanks for the reply! Don't quite know why I decided to use the term "geeked" but yes basically I was just wondering if you still enjoy research and still have a positive outlook on it which obviously you do, which is great!

 

[martindoc]

That's a good thought except straight PhDs tend to have a even smaller success rate. ...

Perhaps i should have been clearer. It seems to me that only 10-25% of MD-PhDs are even doing advanced post-docs. (and i was in a top 10 NIH MSTP, funded since the 70s) More PhD students do postdocs(that i have seen). The chances of becoming and independently funded PI are of course worse.

It just makes me wonder why the PhD education if so many of the people in the end don't even want to use it, or for other reasons, take a straight clinical career. Would we be better off with residency-PhD programs? If i were 4 years younger, and with all the clinical experience i have now, i think i could do much more in a research setting such as in graduate school, and the technologies change so rapidly. Systems biology was hardly mentioned when i was a graduate student, and i would love to re-train in genomics, computational biology, etc.

Dont get me wrong. We need MD PhDs, we need more. Especially in fields like genetics and laboratory medicine (CP). Too many PhD and MD only in these fields either dont understand the medical or techical well enough, respectively. So there still are advantages even if you dont use it directly.

I am just bitter by a system that didn't work for me, and i think i would have been much better of with 4 years of medical school, 4 years of residency and fellowship (and be 29 instead of 33) and then pursue a PhD in advanced genomics relevant to my clinical work (and with hopefully payment at the PGY level). Maybe a system like this would train more and physician scientists that the 75+% of NIH MSTP that dont

I have always been disgusted by the two people who told me that they only did the MD-PhD program to be more competetive to get in to dermatology (not from my program). That NIH money can more certainly be better spent

 

[Doctor&Geek]

I have always been disgusted by the two people who told me that they only did the MD-PhD program to be more competetive to get in to dermatology (not from my program). That NIH money can more certainly be better spent

I met a senior administrator of a west coast medical school at a recent conference and he was incredulous when this allegation was mentioned. I told him it was probably more prevalent than he thought.

 

[mercaptovizadeh]

I met a senior administrator of a west coast medical school at a recent conference and he was incredulous when this allegation was mentioned. I told him it was probably more prevalent than he thought.

I'd say at least half of the people in my program have matched or plan to match in lifestyle residencies. There's nothing that's so much more fascinating (scientifically speaking) about the fields of ophtho, ENT, rads, rad/onc, uro, and derm that is not equaled if not trumped by the breadth and depth of medicine, peds, and path.

On the other hand, I wouldn't want to (all) accuse people who went into such a specialty that it was entirely due to the money:hours ratio rather than things like a good fit, patient population, interest in procedures, personal connections, etc.

There is something broken with the MSTP system; I think it's actually a pretty worthless way of producing superb researchers. If medical school tuition wasn't so outrageously high, we wouldn't have as much of an issue with recruiting people to primary care AND basic science research. True, many people are insatiable and will always go for more money but a good number of people would be content with the 150k-200k salary in primary care or academia (or is it lower in academia? ) if they weren't saddled with enormous debt. Students often go in thinking debt's no big deal, but then they get married and have two children and suddenly (and reasonably) life priorities change and career interests need to be sacrificed for the comfort and security of loved ones.

 

[gbwillner]

It seems to me that only 10-25% of MD-PhDs are even doing advanced post-docs. (and i was in a top 10 NIH MSTP, funded since the 70s) More PhD students do postdocs(that i have seen). The chances of becoming and independently funded PI are of course worse.

I agree with this. The system is broken- every year it seems there are more and more MSTP programs and slots. Why? I think the actual number of people who are seriously committed to the program is actually pretty small. However, having an MSTP has become a prestige issue for medical schools and is a source of federal $$ so it makes sense that they would try to expand their programs. But it also seems that fewer and fewer graduates go on to research careers.

On the other hand, I do understand the interest in "lifestyle" residencies for MSTPS for reasons other than cash and family. If you have low clinical demands you also have more time for research. These are not all competitive. Is Pathology a lifestyle career? Ask any internist and he'll say yes.

 

[Vader]

I'll second (or third) what the others have said. I have seen a surprising (and apparently increasing) number of MSTPs go into anesthesia, derm, rads or ophtho recently. Many of these people started out very science-oriented, and some still are, but I am sure the lure of a big salary in practice will prove seductive for at least some of them.

I get the feeling that some applicants are really doing the MSTP pathway for the credentialing effect, but most do it out of genuine interest in science and discovery. It is only later, when dealing with all the trials and tribulations over the course of many years with little in the way of support, do they change direction. Or at least expand their career options for earning potential if science ultimately doesn't work out for them.

From the perspective of academic medicine, it's a tragic loss of talent and truly a waste of money. However, for those who do go on in academic careers, the program I believe is more than worthwhile. We really need more hard data on career pathways to truly assess whether the programs are a success or failure.

 

[itsallthesame]

the fact that few people become PIs and stay in science will never change and it is not about funding. there are simply a limited number of professorship slots.

think of it like this: pretend the average PI's career of active research is 25 years. The average training (science time in lab is about 5 years of PhD, roton year doesn't count, + 7.5 years of post doc) is only 12.5 years. That would mean that, keeping funding steady with inflation and professorships steady with number of GS's admitted, in order for every PI to have ONE person in their lab at any given time, 50% of science track people must quit/fail. now, have you ever worked in a lab with one post doc or grad student that was decent? if the average is four students/post docs, we're at a 12.5% PhD student becomes PI success rate.

everyone who clerks can't become a judge and if you work as an analyst you probably won't become a CEO, and because there are enough people who at least start out wanting to do research, it's simply not realistic to expect that there can even be CLOSE to a high success rate of ANY graduate student becoming a PI. and why should the gov't complain if, out of their investment, they get some people to become research MD/PhD's and the rest practice medicine with additional training? god forbid the USA foots the bill for a few MD's and gets 4ish years of research out of it...

 

[StIGMA]

It seems to me that only 10-25% of MD-PhDs are even doing advanced post-docs. More PhD students do postdocs(that i have seen). The chances of becoming and independently funded PI (as a PhD alone) are of course worse.

the fact that few people become PIs and stay in science will never change and it is not about funding. there are simply a limited number of professorship slots.

bla bla bla

it's simply not realistic to expect that there can even be CLOSE to a high success rate of ANY graduate student becoming a PI.

There is a difference in whether you go through the MD-PhD route or through the PhD route. There are different expectations. There are different career trajectories. You are not necessarily competing for the same jobs, and as an MD-PhD you certainly have more chance for becoming a PI than any random PhD graduate.

The problem is that MD-PhD graduates are not choosing careers in research, not that they cannot secure a tenure-track position.

 

[Spacedman]

From the perspective of academic medicine, it's a tragic loss of talent and truly a waste of money. However, for those who do go on in academic careers, the program I believe is more than worthwhile. We really need more hard data on career pathways to truly assess whether the programs are a success or failure.

There is a difference in whether you go through the MD-PhD route or through the PhD route. There are different expectations. There are different career trajectories. You are not necessarily competing for the same jobs, and as an MD-PhD you certainly have more chance for becoming a PI than any random PhD graduate.

The problem is that MD-PhD graduates are not choosing careers in research, not that they cannot secure a tenure-track position.

We can probably agree that there are almost no data showing long term career performance of MSTPs... so let's just be clear that most of this discussion is speculation. What we do have, though, is some published data on what MSTPs plan to do at the time of graduation. Contrary to the anecdotes posted above, it looks like most (>80%) of our brethren (and sistren?) claim that they will engage in research activities "significantly" or "exclusively" (selection bias, blah blah blah... it's the data we have). i think it's pretty interesting that the intent is about 3:1 clinical:basic, especially given that most phds are in basic science.

This "credentialing" argument for doing an MSTP is rather new to me. I'm really surprised to hear so many of your classmates are masochistic enough to do a basic science PhD solely to match into a highly competitive specialty. If these people exist, their time would be much better spent doing a one year Hughes fellowship and taking a couple months off to study hard and nail the boards. my MSTP classmates who have gone into ENT, rad/onc, diagnostic rads, dermatology and even EM are largely intending to carry on basic or clinical research. i think people should be careful about dismissing MSTPs going into "lifestyle" specialties - when i got back to the wards, i found out very quickly that if you enter any field with lots of clinical responsibility (ummm... any IM subspecialty) you will always be fighting for time to do research. on the other hand, a close friend went into rad/onc precisely because basic and clinical research are woven into the fabric of the practice- i.e. if your patient isn't in some chemo/RT trial, you're not doing your job. part of the "lifestyle" draw is that you can control your clinical duties enough to keep involved in academics.

Finally, even if only 20% of MSTPs go on to run labs, how tragic a loss of talent is it? as several posters have pointed out, it's probably better for the scientific community if MSTPs contribute to the PhD workforce and go on to clinical careers without competing for R01$ (which makes the MSTP expansion and recruiting only slightly less of a scam than PhD programs that way overadmit). in any event, if the NIH is sponsoring an ever growing number of clinically oriented physicians who stay at academic centers (even if they're not running labs) and have strong research backgrounds, isn't this part of the goal, to create a voice in academic medicine that's at least fluent in both research and clinical languages? one of my most depressing experiences was having to sit through a med student case conference on "siRNA therapeutics"- the blind leading the deaf, seriously. and it's a rare, rare pleasure when i meet an attending who's eyes don't glaze over at the mention of bench research.

 

[Vader]

Absolutely--I should have prefaced my previous statements that they are largely anecdotal. From personal experience, I have seen several people who went through the MSTP choose a lifestyle specialty with absolutely no intention of ever doing research again. There have also been several people who have done so, but with every intention of doing research (but well-less defined whether it would be more clinical, translational or basic).

There is no one I know of in my MSTP program who is doing it purely to enhance their chances of getting into residency (what I was referring to as "the credentialing effect").

I agree that "lifestyle" specialties can facilitate a physician-scientists' career by providing more protected time for research. Folks who pursue these specialties may both keep the door open for doing research (as is borne out by the available data) and at the same time enhance their ultimate earning potential. IMO, this makes quite a bit of sense and is quite a reasonable path to tread. However, it would be interesting to see data on what these folks actually end up doing later in their careers, and how this compares to more "traditional" clinical specialties for MSTPs.

This sort of data is necessary to address the "justification problem". The MSTP program is extremely expensive and funded by taxpayer money. It should be subject to evaluation for concrete endpoints that allow the program to be judged for efficacy. If other training methods are found to better increase the number of physician-scientists doing high quality research--then those ought to be pursued. I strongly believe that the MSTP program will, in fact, hold up to such scrutiny. But to justify its existence, we do need hard efficacy data.

While I too believe that it is valuable to have people who are fluent in both science and medicine permeate the entire medical community, I also think that this cannot be the main justification for the MSTP program, which is designed for a fairly narrow purpose--to produce physician-scientists who will make discoveries at the bench and translate them into new therapies to help patients.

We can probably agree that there are almost no data showing long term career performance of MSTPs... so let's just be clear that most of this discussion is speculation. What we do have, though, is some published data on what MSTPs plan to do at the time of graduation. Contrary to the anecdotes posted above, it looks like most (>80%) of our brethren (and sistren?) claim that they will engage in research activities "significantly" or "exclusively" (selection bias, blah blah blah... it's the data we have). i think it's pretty interesting that the intent is about 3:1 clinical:basic, especially given that most phds are in basic science.

This "credentialing" argument for doing an MSTP is rather new to me. I'm really surprised to hear so many of your classmates are masochistic enough to do a basic science PhD solely to match into a highly competitive specialty. If these people exist, their time would be much better spent doing a one year Hughes fellowship and taking a couple months off to study hard and nail the boards. my MSTP classmates who have gone into ENT, rad/onc, diagnostic rads, dermatology and even EM are largely intending to carry on basic or clinical research. i think people should be careful about dismissing MSTPs going into "lifestyle" specialties - when i got back to the wards, i found out very quickly that if you enter any field with lots of clinical responsibility (ummm... any IM subspecialty) you will always be fighting for time to do research. on the other hand, a close friend went into rad/onc precisely because basic and clinical research are woven into the fabric of the practice- i.e. if your patient isn't in some chemo/RT trial, you're not doing your job. part of the "lifestyle" draw is that you can control your clinical duties enough to keep involved in academics.

Finally, even if only 20% of MSTPs go on to run labs, how tragic a loss of talent is it? as several posters have pointed out, it's probably better for the scientific community if MSTPs contribute to the PhD workforce and go on to clinical careers without competing for R01$ (which makes the MSTP expansion and recruiting only slightly less of a scam than PhD programs that way overadmit). in any event, if the NIH is sponsoring an ever growing number of clinically oriented physicians who stay at academic centers (even if they're not running labs) and have strong research backgrounds, isn't this part of the goal, to create a voice in academic medicine that's at least fluent in both research and clinical languages? one of my most depressing experiences was having to sit through a med student case conference on "siRNA therapeutics"- the blind leading the deaf, seriously. and it's a rare, rare pleasure when i meet an attending who's eyes don't glaze over at the mention of bench research.

 

[fairalexfield]

While I too believe that it is valuable to have people who are fluent in both science and medicine permeate the entire medical community, I also think that this cannot be the main justification for the MSTP program, which is designed for a fairly narrow purpose--to produce physician-scientists who will make discoveries at the bench and translate them into new therapies to help patients.

I recently had a conversation along these lines with an MD/PhD PI on my floor. I asked him if it would be better to spend the money on making research a more attractive career (aka more grant money and higher salaries) or throwing money into the MSTP and getting such a ****ty return of actual physician-scientists.

He is one of the few who actually went on to become a rather successful PI and he thinks the MSTP is still a great thing. I think we can all agree that it's great to have clinicians (even in private practice) that understand basic science and the process of discovery and researchers who have a knowledge of clinical medicine. The stated goal of the MSTP needs to be expanded.

 

[itsallthesame]

I asked him if it would be better to spend the money on making research a more attractive career (aka more grant money and higher salaries) or throwing money into the MSTP and getting such a ****ty return of actual physician-scientists.

But what is the real cost of an MSTP to the gov't? I may be wrong... but at most schools, the school with the MSTP grant carries several non-MSTP full ride MD/PhDs. Also the MSTP grants generally only cover a portion of the full ride (typically ~3 years of support, no?).

Funding the career of a physician scientist is VERY expensive when you consider several R01s, and attending/professor salary vs. $27k stipend + MS tuition for 2 years. If you cut the MSTP for the same $$$ the gov't would probably only be able to fund a few extra labs, no? Hardly enough to make doing only basic science more attractive. And certainly not when you consider that more people would have debt when going into it.

 

[Slothrop]

The stated goal of the MSTP needs to be expanded.

What's your proposal?

 

[fairalexfield]

I'm not sure yet, I think you guys would have a better idea of what the training has done for you and your colleagues, but I'd suggest something rather broad: to train people with expertise in both the basic sciences and clinical medicine in an effort to bridge this gap in the clinic, the lab, education, policy, industry, etc.

 

[collinsc]

So I see a lot of you guys say that the main reason why some MSTP students don't usually become PIs is because of money issues and possibly credentialing. So I wonder for the people who actually go on to be PIs in basic science or translational science how they do it. Are they mainly getting academic jobs do you think? Any thoughts? For example, the doctor who wrote back to me said if he could have established his lab during training or residency he would have but he said I lot would have to happen for that to work. Is this possible to do? I know that there are residencies that have research intertwined too... Anyone know of MSTPs who went on to establish there labs while they were in residency or fellowship? I've seen some who have done it after...

 

[StIGMA]

This guy established a lab while simultaneously completing residency.

Excerpt:

"Northwestern had a particular strength in autoimmune disease research, and my visit included interviews with the investigators who worked in that area. At the end of the 2-day interview process, I was offered a unique opportunity to develop an independent molecular parasitology laboratory, while simultaneously pursuing residency training in clinical pathology and postdoctoral research in autoimmunity, in a flexible manner, over a five-year period."

 

[marctam86]

This guy established a lab while simultaneously completing residency.

Excerpt:

"Northwestern had a particular strength in autoimmune disease research, and my visit included interviews with the investigators who worked in that area. At the end of the 2-day interview process, I was offered a unique opportunity to develop an independent molecular parasitology laboratory, while simultaneously pursuing residency training in clinical pathology and postdoctoral research in autoimmunity, in a flexible manner, over a five-year period."

i met him at my NW interview. Nice guy.

 

[Doctor&Geek]

This guy established a lab while simultaneously completing residency.

Excerpt:

"Northwestern had a particular strength in autoimmune disease research, and my visit included interviews with the investigators who worked in that area. At the end of the 2-day interview process, I was offered a unique opportunity to develop an independent molecular parasitology laboratory, while simultaneously pursuing residency training in clinical pathology and postdoctoral research in autoimmunity, in a flexible manner, over a five-year period."

Pathology? Sure you can do this.

Forget it if you're doing most other things.

 

[StIGMA]

Yes- unusual circumstances, a lot of support, a lot of effort and skill. His career path is clearly atypical (ie: was able to use his PhD work as a foundation for his lab, the program sought him out for the opportunity). I posted it because it was asked for. Any evidence that his training route will become more common in some specialties?

 

[malchik]

This is not at all unusual in CLINICAL pathology. The ABP requires 18 months (!) of clinical training, three years total, for board eligibiliity in clinical pathology. So over 5 years, you have at least 3.5 years for 100% research time. And even those clinical training months have a lot of down time. Anatomic pathology is busier, with two quite busy years bare minimum, more like 3 if you want to actually sign anything out besides autopsies.

 

[Red Leader]

This guy established a lab while simultaneously completing residency.

Excerpt:

"Northwestern had a particular strength in autoimmune disease research, and my visit included interviews with the investigators who worked in that area. At the end of the 2-day interview process, I was offered a unique opportunity to develop an independent molecular parasitology laboratory, while simultaneously pursuing residency training in clinical pathology and postdoctoral research in autoimmunity, in a flexible manner, over a five-year period."

hmm yeah "that guy" is the NU MSTP director.