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b&ierstiefel
Let's discuss.
Pathology residents interested in basic science research...a dying breed?
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b&ierstiefel
So here's an article I stumbled on a year ago...
The numbers are striking. Over the past generation, the age at which American biomedical researchers with PhD degrees succeed in obtaining their first R01 award from the National Institutes of Health (NIH) has increased from 34.2 to 41.7 years of age. As a consequence, the biomedical community in the United States lives with the prospect of relying on an aging cohort of researchers to direct its research projects. The reasons for this are surely complex, but the long-term trend is ominous for the future of the American research enterprise. Why are R01 grants becoming so difficult to obtain? And what does this portend for future innovation and discovery by NIH-supported researchers?
The history of the last half-century demonstrates in a compelling fashion that much of the innovation in American biomedical research comes from young researchers working in relatively small, highly mobile, creative research groups. These groups operate opportunistically to exploit new research findings and to catapult our understanding forward, often doing so with stunning rapidity. These younger researchers, ranging from predoctoral students to principal investigators in their 30s and early 40s, have time and again delivered on the promise that unfettered imaginations and boundless energy are uniquely suited to generate new conceptual paradigms in biology. These young people represent the cadre of researchers whose vitality we must preserve at all costs. These people are the last who should suffer from a flat NIH budget.
Those who lead the U.S. Federal research agencies in Bethesda, Maryland, have lost sight of this simple truth. As a consequence, American biomedical research is increasingly reverting to models of research organization that have held back scientific progress in many other parts of the world. In these models, researchers acquire their scientific independence only when in their 40s and even 50s, long after the peak of their scientific creativity has passed.
The failure to recognize and halt this trend is compounded by another problem. As time goes on, ever-larger proportions of NIH funds are diverted to funding research collaboratives of various sizes to the detriment of small, investigator-initiated projects. Perhaps those in power have been influenced by the obvious successes of the Human Genome Sequencing Project and the bounty of useful information that it has yielded. Those who control the scientific purse strings seem to have lost sight of the fact that this undoubted success does not provide a useful template for how most discovery research is conducted. In the case of the National Cancer Institute, this vision of grand projects and their utility has caused this particular Institute to invest large amounts of funds in proteomics, nanotechnology, and a massive software development program that aspires to make the data systems of American research hospitals intercompatible. Implied in the launching of these large-scale projects is the notion that if small-scale projects yield relatively small advances, much larger projects will yield proportionately more.
Stated differently, some live with the notion that the era of small-scale discovery research has passed and that the time has finally arrived to organize large research consortia to move things forward more effectively. The truth is otherwise: the vast majority of recent leaps forward have come, as they did in the past, from relatively small research groups that have been given the license to venture out and explore the outer boundaries of existing understanding. Large-scale projects surely have their place, and technology advances made over the past decade dictate that some of these must be supported in order for science to be moved forward. But in the end, the viability of small research groups and investigator-initiated research should be paramount and must be protected; indeed, it must be the number one priority for those who invest in biomedical research. Large collaborative research programs tend to stifle discovery research rather than expediting it.
Woven into the thinking of some in positions of power and influence is yet another issue, which is equally pernicious: that the research process involves too much competition, and that scientific output would increase immeasurably if only researchers were induced (or even forced) to collaborate with one another more frequently. The reality is that successful laboratory researchers are highly opportunistic, continually forging new collaborations when they are deemed advantageous and dissolving these collaborations as soon as they have outlived their utility. Ignoring this dynamic, the NIH has contrived numerous funding devices for encouraging scientific collaborations, by bringing multiple research groups under a common funding umbrella; often, these research collaboratives are funded for periods that extend far beyond the time when their utility has ceased.
As a consequence of these trends, small-scale discovery research is under siege, yet it is precisely such small-scale science that attracts the best and the brightest of our young people. Many of those who are training for careers in research do not look forward to working as members of large research consortia, in which they will only serve as small cogs in very large wheels.
Compounding this is the current deplorable state of funding investigator-initiated research: pay lines in which only 10% of submitted grant applications are funded constitute profound disincentives for researchers. Why should a young person invest in the laborious task of writing an NIH grant application that has only a minimal chance of being funded?
These factors, when taken together, have made careers in biomedical research increasingly unattractive for many young people. Imagine the prospects of predoctoral students starting out in their early 20s, who confront a wait of two decades until they can procure their first R01 grant, become scientifically independent, and flex their scientific muscles for the first time.
Increasingly, these factors dictate that the best and the brightest are not entering our ranks. As a consequence, those of us who conduct discovery research are confronting the prospect of a lost generation, a wide gap in our ranks, as bright young people look elsewhere to discover their career paths. The marvelous engine of American biomedical research that was constructed during the last half of the 20th century is being taken apart, piece by piece. We will all pay for this destruction for decades to come.
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deleted113029
very good article 
it would be interesting to know who wrote the article; R01 funded vs. nonR01 funded researcher. i would give it more weight if it were the former.
i especially like the comment of people becoming fully independent by their 40s/50s, long after their peak creativity has passed. just from my experience, it's uncommon for people later in their careers to revolutionize science when compared to their earlier years. e.g. most nobel winners are recognized only decades after their initial discovery was made. another thing is that young researchers are inherently more energetic than their older counterparts...so why not award their energy and creativity.
I recently received some path info about Hopkins and how they actually increased funding for their dept despite the hostile climate of funding. They explicitly stated that the MAJORITY of funds came from very senior researchers...again supporting the article written. even though most depts support young investigators, it puts undue burden on the dept finances and the senior researchers not to mention the young ones.
we will lose our coveted place in the scientific community if NIH funding is not rectified. what BRIGHT person, as the article states, wants to voluntarily suffer for science?
it would be interesting to know who wrote the article; R01 funded vs. nonR01 funded researcher. i would give it more weight if it were the former.
i especially like the comment of people becoming fully independent by their 40s/50s, long after their peak creativity has passed. just from my experience, it's uncommon for people later in their careers to revolutionize science when compared to their earlier years. e.g. most nobel winners are recognized only decades after their initial discovery was made. another thing is that young researchers are inherently more energetic than their older counterparts...so why not award their energy and creativity.
I recently received some path info about Hopkins and how they actually increased funding for their dept despite the hostile climate of funding. They explicitly stated that the MAJORITY of funds came from very senior researchers...again supporting the article written. even though most depts support young investigators, it puts undue burden on the dept finances and the senior researchers not to mention the young ones.
we will lose our coveted place in the scientific community if NIH funding is not rectified. what BRIGHT person, as the article states, wants to voluntarily suffer for science?
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I think it's always been a minority of Residents that's truly interested in basic sci. However, the natural barriers have been increasing, in part due to:
1. Increased focus on clinical efficiency.
While I have no hard data, it seems to me that the average attending has a much higher clinical workload than say 15-20 years ago. Even if that might not be true of Residents, it will leave less time for the Attending to mentor Residents in research.
2. More complex diagnostics.
The body of knowledge that must be mastered in any medical field is ever-increasing, so to stay on top of your game, you need to spend more time updating and maintaining your dx skillz, taking away time spent in research.
3. Paperwork.
Seems mundane, but increased use of complex protocols, HIPAA requirements, and a general requirement to document what you do eats away research time too.
4. More complex and expensive research projects.
Research projects are getting vastly larger and more complex. The sole attending and a couple of bright residents/postdocs have a hard time competing against multi-center labs with armies of postdocs. This directly affects:
A. Funding. Even with increased funding, a larger chunk is taken by very expensive projects, like SPOREs, leaving less money for the smaller projects. Also, funding agencies are increasingly geared towards evaluating the complex projects.
B. PI requirements. If you as a funding agency is about to commit a multi-million dollar grant, you want to be pretty sure that something will come out of the project. So you're much more likely to give R01's etc, to highly experienced PI's with hundreds of publications under their belts, solid tenures and administrative/marketing skillz, rather than younger and more inexperienced PI's.
Of course, the repercussions of these developments are likely to be severe. Many great medical discoveries are made through coincidence, and the track record of the mega-projects are mostly mediocre. Down at the J. Craig Venter Lab in MD they have 100 of the newest ABI machines (each costing the equivalent of a nice house) doing resequencing 24/7/365. However, so far there's not really been any tangible results that can be used in clinical medicine. Likewise, big pharma and biotech companies have increasing difficulty in developing new meds, despite research budgets that are larger than ever.
Unfortunately, I believe that it will be increasingly difficult to combine clinical and basic research work. Either field simply requires so much time and energy to stay on top, that it simply becomes too difficult to do both. Personally, I have given up on basic sci almost completely, but continue to do translational and clinically relevant research. If I look at melanomas every day, it makes sense that I'll try out some new IHC stains or molecular techniques on them to try to find better diagnostic markers, but I really can't find the time to start examining pathways and the molecular biology of the lil' critters.
I also note a distinct grouping among Residents (although I don't think there's anything new in that):
Group A: Research? No way.
Group B: I gotta do Research. To get that great Residency/Attending spot. But once I'm there, goodbye research.
Group C: Academic medicine is cool. And I believe it's called "Medical Science" for a reason, so I'll like to do my part as a physician-scientist.
Group D: Yeah, I've got that MD, but I never want to see the inside of a hospital. I'm pure research.
Don't want to give percentages, but it's fairly obvious that A are the most common, and D the rarest. It would be nice to have a lot of C's, but, for reasons cited above, I think they're the group likely to decrease the most.
1. Increased focus on clinical efficiency.
While I have no hard data, it seems to me that the average attending has a much higher clinical workload than say 15-20 years ago. Even if that might not be true of Residents, it will leave less time for the Attending to mentor Residents in research.
2. More complex diagnostics.
The body of knowledge that must be mastered in any medical field is ever-increasing, so to stay on top of your game, you need to spend more time updating and maintaining your dx skillz, taking away time spent in research.
3. Paperwork.
Seems mundane, but increased use of complex protocols, HIPAA requirements, and a general requirement to document what you do eats away research time too.
4. More complex and expensive research projects.
Research projects are getting vastly larger and more complex. The sole attending and a couple of bright residents/postdocs have a hard time competing against multi-center labs with armies of postdocs. This directly affects:
A. Funding. Even with increased funding, a larger chunk is taken by very expensive projects, like SPOREs, leaving less money for the smaller projects. Also, funding agencies are increasingly geared towards evaluating the complex projects.
B. PI requirements. If you as a funding agency is about to commit a multi-million dollar grant, you want to be pretty sure that something will come out of the project. So you're much more likely to give R01's etc, to highly experienced PI's with hundreds of publications under their belts, solid tenures and administrative/marketing skillz, rather than younger and more inexperienced PI's.
Of course, the repercussions of these developments are likely to be severe. Many great medical discoveries are made through coincidence, and the track record of the mega-projects are mostly mediocre. Down at the J. Craig Venter Lab in MD they have 100 of the newest ABI machines (each costing the equivalent of a nice house) doing resequencing 24/7/365. However, so far there's not really been any tangible results that can be used in clinical medicine. Likewise, big pharma and biotech companies have increasing difficulty in developing new meds, despite research budgets that are larger than ever.
Unfortunately, I believe that it will be increasingly difficult to combine clinical and basic research work. Either field simply requires so much time and energy to stay on top, that it simply becomes too difficult to do both. Personally, I have given up on basic sci almost completely, but continue to do translational and clinically relevant research. If I look at melanomas every day, it makes sense that I'll try out some new IHC stains or molecular techniques on them to try to find better diagnostic markers, but I really can't find the time to start examining pathways and the molecular biology of the lil' critters.
I also note a distinct grouping among Residents (although I don't think there's anything new in that):
Group A: Research? No way.
Group B: I gotta do Research. To get that great Residency/Attending spot. But once I'm there, goodbye research.
Group C: Academic medicine is cool. And I believe it's called "Medical Science" for a reason, so I'll like to do my part as a physician-scientist.
Group D: Yeah, I've got that MD, but I never want to see the inside of a hospital. I'm pure research.
Don't want to give percentages, but it's fairly obvious that A are the most common, and D the rarest. It would be nice to have a lot of C's, but, for reasons cited above, I think they're the group likely to decrease the most.
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b&ierstiefel
It was written by a very eminent RO1 funded investigator at MIT.very good article
it would be interesting to know who wrote the article; R01 funded vs. nonR01 funded researcher. i would give it more weight if it were the former.
Although I was cognizant of this, this fact is quite unsettling, especially in the context of the relative paucity of NIH funds now.
Seriously, I'm starting to think that being a martyr and a representative for a dying breed just isn't worth it. We only live once. We might as well be happy. I love science. I would be happy to do science but with all that is going on now with decreasing incentives to go into science, I'm not sure if I would still be happy.
The folks who advocate a career in science invariably say that people who go into science do it because they love it. Yeah, but we need a little more incentives here...and they're vanishing!
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b&ierstiefel
It has always been difficult to effectively combine clinical and basic research work. There are a special rare breed of folks who have been successful at this. And they are praised not because of how good of clinicians they are but they are praised for mainly two things: (a) their research accomplishments and (b) how they were able to balance their professional lives with their family lives. Most of us who go through MD/PhD programs are told that it is more feasible to focus on one or the other as we don't want to be doing half-assed jobs in both. Hence, the whole notion of doing 50% clinical and 50% research is laughable. Many MD/PhD students envision doing 90% research and 10% clinical (i.e., minimizing clinical duties so that they can stay on the top of their game in research and compete with all the PhD folks who do 100% research). But as you say, PathOne, even this will get harder, especially in pathology. Perhaps that is why I was told by multiple folks, during the interview trail, that it is essentially impractical to think that I would be a researcher and a general surgical pathologist diagnostician at the same time.
Hmm...the group B is the one that intrigues me the most. Are there really people out there like this? I haven't encountered this group of people.PathOne said:
The funny thing about your group stratification is that the MD/PhD folks in pathology I've run into are quite polarized. They're either in group A or group D.
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deleted113029
I'm only an MD and would love to do basic science research, but i have a wife and $190K of debt i need to think about. i've heard that MDs have a relatively easier time receiving funds since one needs to acquire a new skill set...i just hope this is the case.
i would love to do immunology research and i will apply for a K08 in the future. But if that doesn't pan out, then it's no real sweat off my back. (rationalizing sucks...i would be sad if it didn't pan out.) worse comes to worse, i do my best to become the best diagnostician in my specialty of choice...hemepath. Oh well, we'll see how things pan out...i haven't even matched yet and i'm thinking a little too far into the future. i need to excel in path first
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Bob Weinberg indeed knows of what he speaks (the author of the poignant article posted at the top of this thread). We are truly at a remarkable time in biomedical research in that never have such opportunities existed for individual investigators, be they straight MD, PhD, or MD-PhD, to derive science-based approaches to the treatment of complex diseases. The myth of single-agent therapy is beginning to fall away, particularly in oncology and endocrinology, straightforward commercially-available kits are now on-line to assay many cellular activities once only accessible to the biochemist, and we are increasingly limited only by the rarified pool of imaginative and well-read physician-scientists in terms of harnessing the exponentially growing knowledge base we have of human physiology. Science has never been more accessible to MDs. Unfortunately, we are stuck in the quagmire of current NIH funding levels at a time when we most need MDs to move the ball down the field and into the clinic.
I just have to think that the money is going to come back. Otherwise, we will never be able to spend all the scientific capital we have been accumulating.
I just have to think that the money is going to come back. Otherwise, we will never be able to spend all the scientific capital we have been accumulating.
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I guess I'm a idealistic C wannabe, but we'll see how it turns out when I'm face to face with the real world. Most faculty members I've spoken with seem to think the funding situation can't get much worse than it is now (knock another 10% off the success rate for R01 apps and no one gets funded at all!) My solution: tax lawyers more.
Seriously though, I think a lot of pathology departments could do more to support faculty members who want to combine dignostics with real research. I think the movement to more sub-specialized surg path signout systems will help. I see basic science reseach faculty members at my home institution who sign out part-time on subspecialty services and do a pretty decent job, but might not cut the mustard if they were expected to handle all of surg path.
Most faculty members I've spoken with seem to think the funding situation can't get much worse than it is now (knock another 10% off the success rate for R01 apps and no one gets funded at all!) My solution: tax lawyers more.Seriously though, I think a lot of pathology departments could do more to support faculty members who want to combine dignostics with real research. I think the movement to more sub-specialized surg path signout systems will help. I see basic science reseach faculty members at my home institution who sign out part-time on subspecialty services and do a pretty decent job, but might not cut the mustard if they were expected to handle all of surg path.
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i would have to agree with celiac...these things go in cycles i think. i think the money will come back someday and when it does, there will only be so many people who will be qualified to use it.
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I'm a MD/PhD student staring path residency in a few months. I still cling to the idea that I want to combine clinical practice with basic research. But, it has been interesting to see my perspective change over the years - the altruistic view is fading. The research I did for my PhD is not what I would want to do as a pathologist. So, I'll need to learn a new field of basic science in addition to the clinical field.
I think part of the problem is the way that the education from undergrad to faculty position is structured. Nothing has changed except the fact that everyone is subspecializing (no matter what field of medicine). The MD/PhD pathway is so disjointed that it makes it difficult to do significant basic science research. For instance, you do 7-8 years in MD/PhD, then 3-6 years in residency (minimal research), then you almost have to do some type of basic science-intensive fellowship (post-doc). By the time you get to this place in your life, you've been on full-throttle for so long, playing the game, that you just get worn out and need a break.
I think part of the problem is the way that the education from undergrad to faculty position is structured. Nothing has changed except the fact that everyone is subspecializing (no matter what field of medicine). The MD/PhD pathway is so disjointed that it makes it difficult to do significant basic science research. For instance, you do 7-8 years in MD/PhD, then 3-6 years in residency (minimal research), then you almost have to do some type of basic science-intensive fellowship (post-doc). By the time you get to this place in your life, you've been on full-throttle for so long, playing the game, that you just get worn out and need a break.
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Personally, I didn't go into medicine or med school in particular to do basic science research. If I wanted to do basic science research, I would have gone to grad school. While I understand that combining MD and PhD is a great route to research success, that's not what I did and I am certainly not prepared for such a career now.
Health care is in such a weird place in this country. Everything is too expensive, costs are increasing, things are highly specialized. Costs have to be justified and accounted for, but everyone is expected to be more productive than is possible based on those limitations. The money is in specialization yet the country needs generalists, but the pathway to both is the same (med school). The insurance industry is 90% bureaucracy and paperwork, yet makes seemingly all the decisions. Politicians have no clue except to keep throwing money at niche issues and interest groups.
Research money is vitally important to the medical community in this country, yet many major donors and funding organizations send their money overseas because results are more dramatic and tangible.
Do we as a country really want our future researchers and scientists to be forced to jump through such hoops and play such games to be able to perform groundbreaking research? Many many potential successes are going to be eliminated before they get started because money continues to go to the haves, and departmental funding, prestige, and glory are shunted from those with potential until they become established, at which point they don't really need it anymore.
Health care is in such a weird place in this country. Everything is too expensive, costs are increasing, things are highly specialized. Costs have to be justified and accounted for, but everyone is expected to be more productive than is possible based on those limitations. The money is in specialization yet the country needs generalists, but the pathway to both is the same (med school). The insurance industry is 90% bureaucracy and paperwork, yet makes seemingly all the decisions. Politicians have no clue except to keep throwing money at niche issues and interest groups.
Research money is vitally important to the medical community in this country, yet many major donors and funding organizations send their money overseas because results are more dramatic and tangible.
Do we as a country really want our future researchers and scientists to be forced to jump through such hoops and play such games to be able to perform groundbreaking research? Many many potential successes are going to be eliminated before they get started because money continues to go to the haves, and departmental funding, prestige, and glory are shunted from those with potential until they become established, at which point they don't really need it anymore.
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One of the things I like about path is that the distinction between good translational research and basic science research is fairly blurry. I think there are elements in pathology that are hostile or indifferent to anything that isn't morphologic diagnosis, but the fact is, if pathologists don't find ways to bring new research and new technologies into practice, someone else will. The H&E slide may not be going anywhere in the next 100 years, but academic path needs to keep pushing the envelope if they expect to keep attracting good people to the field, and you can't do that without solid basic science programs.
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b&ierstiefel
I agree with this. One of the advantages to pathology is that we bank tissue and can use it for research. This is invaluable for pushing science forward.
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Ohhh, you have no IDEA how valuable that tissue will truly become. Currently, tissue banks are mostly cubic zirconia, with a few rubies here and there (main problem is the tradition of soaking everything in paraffin, which makes RNA and DNA extraction a bit*h, or even impossible.)
HOWEVER, if everybody started a comprehensive frozen fresh tissue bank, as we're currently planning to do, then you'd have a pure goldmine on your hands, and every molec guy/gal wanting to be your friend.
Heck, if I could charge for access to -my- fresh tissue bank, I'd be looking for that fourth vacation home in no time. Unless you've tried it, you have no idea how bad the vast majority of molecular labs really need tissue. (actually, I've already started a pilot fresh frozen bank, and FedEx is very happy, due to the requests already pouring in).
HOWEVER, if everybody started a comprehensive frozen fresh tissue bank, as we're currently planning to do, then you'd have a pure goldmine on your hands, and every molec guy/gal wanting to be your friend.
Heck, if I could charge for access to -my- fresh tissue bank, I'd be looking for that fourth vacation home in no time. Unless you've tried it, you have no idea how bad the vast majority of molecular labs really need tissue. (actually, I've already started a pilot fresh frozen bank, and FedEx is very happy, due to the requests already pouring in).
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deleted113029
another thing is that young researchers are inherently more energetic than their older counterparts...so why not award their energy and creativity
Say what?
chillax dude. i don't have the energy to discuss this with you. Don't you know this is match week?!
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IMO, pathologists should be consultants only. They shouldnt be pipeting crap, running gels or blotting poo proteins. Thats what grad students are for. They also shouldnt be designing experiments, that what postdocs are for.
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Yeah, I remember that piece from Cell...and it is very true. I think there are several problems. First, there are way too many scientists for the amount of available funding. Getting into a PhD program and getting a PhD used to be alot tougher than it is today. Now, they are given out like candy at alot of institutions, and then many of these so called scientists go do post-docs at big time, well funded mega labs that produce Cell and Nature papers virtually every time they publish. They all go on to get faculty positions. Now, instead of three people studying some oncogenic pathway there are 30 people working on it. The funding has not kept up good enough with inflation let alone this rapid spike in scientists over the past 1-2 decades. This not only makes it harder to get noticed as a young researcher in this vast pool of people, this also puts many incompetent people on grant committees that reject good grants (and papers) by young PIs out of sheer ignorance or spite.
Second, everything is getting super specialized in medicine as mentioned by others in this thread. This means that in order to both practice and do research, now you have to superspecialize in both. For instance, you do your research on your favorite lymphoma, and all you sign out clinically is some heme and nothing else. However, in pathology this road puts you in a particularly bad situation because you basically pigeon hole yourself into a corner that you cannot escape. By soley focusing on whatever super-specialty you choose, you lose your general path diagnositic skills and/or your CP covering abilities. So, if you flunk at research, don't get tenured, etc, you are utterly screwed because you'll never be able to find a job outside of academics, where you have already been fed to the lions. I think many residents realize this and it scares them off, rightfully so.
I think one way to go is to really focus on your diagnostic skills during the first 3.5 years of residency and nothing else other than trying to keep up with science in your spare time. You've GOT to be able to practice, I don't care if your dead set on research or not. The MD is a perfect fall back option, but you have to be able to use it. The last 6 months of residency should be transitioning into whatever lab you want to do your K08 generating research for a post-doc research fellowship. This can't be just any lab, this has to be a superstar lab with a super sexy project that will not take more than 1.5 years to accomplish (granted you know how to walk in a lab and start generating data from the get go). Finally, it would be optimal that this 1yr post-residency research be combined with path fellowship training. Of course this would be a 2 year rather than a 1 year fellowship, but if the research is not working out you will have this fellowship to fall back on and go out and practice, and it would be a guaranteed (rather than having to apply for fellowships after the research). Several insitutions have these programs. The clincal are research portions could even be split up for mouse breedings, etc, and you could be doing the research in a field very closely related to the clinical fellowship where you could use some the aforementioned tissue banked samples (e.g. studying colorectal cancer and doing a GI fellow). If it works out, you are then competent to practice and you have sparked a research career closely related to your clinical field of interest.
Finally, in getting a faculty position you should only look for places that will not pigeon hole you into only signing out only specialty cases. Find a place that will allow you to do some general sign out (time should be roughly 70lab/30signout), at least during the beginning of your career. That way if the **** hits that fan it academics, your skills are still there. Now, if you end up striking it big with the research, etc, then this becomes less important and is phased out as your career progresses. But in this day and age, you HAVE to have a backup plan early on and that is practicing path in a general setting. Right now funding is 7 percentile.
This is the way I see it, and it seems really, really difficult. I think it is also possible and much more feasible to have a very satisfying career in pathology being part of program project grants, development of molecular assays, etc, that does not depend on securing R01 grant funding. This could be a gratifying substitute for basic science while maintaining the ability to practice, without all the headaches. In fact, I would be willing to bet that these "typeC" applicants are what alot of academic residencies are looking for. People who are confident enough that they will succeed in pure research should just do a post-doc, no reason to go into residency IMO (exception being CP-only).
Second, everything is getting super specialized in medicine as mentioned by others in this thread. This means that in order to both practice and do research, now you have to superspecialize in both. For instance, you do your research on your favorite lymphoma, and all you sign out clinically is some heme and nothing else. However, in pathology this road puts you in a particularly bad situation because you basically pigeon hole yourself into a corner that you cannot escape. By soley focusing on whatever super-specialty you choose, you lose your general path diagnositic skills and/or your CP covering abilities. So, if you flunk at research, don't get tenured, etc, you are utterly screwed because you'll never be able to find a job outside of academics, where you have already been fed to the lions. I think many residents realize this and it scares them off, rightfully so.
I think one way to go is to really focus on your diagnostic skills during the first 3.5 years of residency and nothing else other than trying to keep up with science in your spare time. You've GOT to be able to practice, I don't care if your dead set on research or not. The MD is a perfect fall back option, but you have to be able to use it. The last 6 months of residency should be transitioning into whatever lab you want to do your K08 generating research for a post-doc research fellowship. This can't be just any lab, this has to be a superstar lab with a super sexy project that will not take more than 1.5 years to accomplish (granted you know how to walk in a lab and start generating data from the get go). Finally, it would be optimal that this 1yr post-residency research be combined with path fellowship training. Of course this would be a 2 year rather than a 1 year fellowship, but if the research is not working out you will have this fellowship to fall back on and go out and practice, and it would be a guaranteed (rather than having to apply for fellowships after the research). Several insitutions have these programs. The clincal are research portions could even be split up for mouse breedings, etc, and you could be doing the research in a field very closely related to the clinical fellowship where you could use some the aforementioned tissue banked samples (e.g. studying colorectal cancer and doing a GI fellow). If it works out, you are then competent to practice and you have sparked a research career closely related to your clinical field of interest.
Finally, in getting a faculty position you should only look for places that will not pigeon hole you into only signing out only specialty cases. Find a place that will allow you to do some general sign out (time should be roughly 70lab/30signout), at least during the beginning of your career. That way if the **** hits that fan it academics, your skills are still there. Now, if you end up striking it big with the research, etc, then this becomes less important and is phased out as your career progresses. But in this day and age, you HAVE to have a backup plan early on and that is practicing path in a general setting. Right now funding is 7 percentile.
This is the way I see it, and it seems really, really difficult. I think it is also possible and much more feasible to have a very satisfying career in pathology being part of program project grants, development of molecular assays, etc, that does not depend on securing R01 grant funding. This could be a gratifying substitute for basic science while maintaining the ability to practice, without all the headaches. In fact, I would be willing to bet that these "typeC" applicants are what alot of academic residencies are looking for. People who are confident enough that they will succeed in pure research should just do a post-doc, no reason to go into residency IMO (exception being CP-only).
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Yeah, the tissue procurement folks are always circling like vultures. Heck, when a frozen hits the window, tissue procurement knows before I do. I like to make'em sweat by acting like I'm dunking everything in formalin. "Oops! You really wanted a piece of that super rare tumor that we get once a year?"
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b&ierstiefel
A quick comment about these mega labs. These labs are virtual postdoc factories where the PI is looking out for him/herself. Mentoring is minimal and you're basically on your own. In many of these labs, the PIs put a few postdocs on the same project and the postdoc who finishes the project first gets full credit. It's a kill or be killed kind of environment. So although, the # of postdocs may be excessive, these labs do foster "natural selection". A good number of postdocs will bite the dust and they will go nowhere. As for grant committes, I think the bigger issue is politics rather than the presence of incompetent people on these committes. Young PI's frequently get their first or first few grants rejected because they don't have enough experience writing grants and because of political associations (or lack thereof).
I've thought about this so many times. The MD gives us something to fall back on. And to maintain the clinical skills, we insist on doing more training and clinical responsibilities. This is a potential pitfall because whatever time we devote to clinical work, the research suffers. Hence, you're already starting off on a negative mindset...instead of thinking, "This is what I will do when I succeed at the bench", we think about what we will do should the research fail. The research world is quite interesting because of the inherent instability in the system. The investigator is always under constant pressure. Produce, produce, produce! Publish in high level journals. Get more grant funding (much of the overhead which goes to the department) to increase the legitimacy and likelihood for getting tenure. This puts increasing pressure to focus more on the research and negotiate a decrease on the clinical work. For instance, people who get Howard Hughes investigator awards use this as political leverage to say, in essence, "You know what? I want even less clinical responsibilities and because I'm a fancy pants HHMI investigator who's bringing in a lot of money, you can't make me do that much clinical work." But this whole thing only serves to add more fuel to our fire of insecurity because of the little annoying question that lingers in the back of our minds, "But what if all this research goes to ****?"
Absolutely! Residency is about learning diagnostic skills, no more or no less. If one is not going to take this duty seriously, one is wasting his/her time where he/she could or should have instead just gone straight into postdoc after med school. I've realized this about a year into residency...you're not gonna have any meaningful time to do research so focus on the diagnostic side and develop it to its fullest potential.
See, this abstract 70/30 split is good but comes at the WRONG time. When you start out as faculty, you need to recruit good people into your lab so that your own lab can be strong. Ideas and grants need to be developed. Establishing credentials to make the case for promotion from assistant prof to associate prof are of greatest importance here. In this context, 30% clinical work becomes too taxing and distracting.
Even CP only...what's the point of doing CP only, I wonder? CP only folks don't have much of a fallback option. I posit that some of these folks just do this residency just for the sake of doing a residency but they're not really into this and just can't wait to get back into lab. This subset of folks should not be in residency in the first place.
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Yeah, I've got this article hanging on my bulletin board too.. it's nice to know there are still some of us reading Cell.
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Are you sure you were MD/PhD????
It seems like most of them come out this way, although they don't intend to. They just get burned out by research and never want to see a pipet again. Of course, most of these folks don't go into Path. They seem to end up in surgical specialties.
/or were you being sarcastic???
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b&ierstiefel
I wasn't being sarcastic...and yes, I was a mudphud.
The majority of MD/PhD students I've encountered who decided not to do research in the long run didn't start out way. Yes, they may be "burned out" but they finish the program before coming to that realizaion. They go through grad school and say, "You know what? Grad school was cool and all but based on my experiences, I don't think I wanna do research for the rest of my life." For me, these people fall into Group A.
When I think of Group B, I think of people who enter MD/PhD programs for ulterior motives such as free tuition/stipend and being more competitive for residency. That may be true and that's unfortunate; I'll stress once again that both are not very practical reasons (especially the second one) to do MD/PhD. I think many people realize this...but maybe the current generation of MD/PhD applicants are thinking this way. That is unfortunate. As for getting that attending spot, it's the clincial training that matters, not one's remote history of having completed an MD/PhD program. Plus, the folks who do research/postdocs don't reach attending level to say "screw the research to hell".
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I've seen the data through my contacts at the NIH and this simply isn't true. A young PI who submits a quality project is more likely than anyone but a graduate and/or medical student to have their research funded. Most grad programs require their students take courses in grant writing, thus the success so many have in being awarded grants. Personally, I've never known an MD only student to take a grant writing class in medical school (not saying it doesn't happen) so I wonder where could MD only student learn how to write a good grant?
Just a couple observations from the 'trenches":
1) I can't think of one single program where PhD's are "given away". IMHO, if getting a PhD were so easy I think there would be more MD/PhD graduates.
2) Getting a post doc in a well funded lab at a big time University isn't easy from what I've seen either due in large part I think to the large influx of foreign PhD's who are more than willing to do twice the work for half the pay. That, and funding is way down too.
When you say young researcher, are you talking about a PhD, an MD, or and MD/PhD "young" researcher? My contacts at the NIH/NCI tell me the reason why many MD only's don't get funding is due to the poor quality of the projects they submit which honestly shouldn't be suprising. Medical school trains you to be a clinician not to conduct research.
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b&ierstiefel
Well that goes without saying. BUT, look through the data and see who gets their grants rejected more often...I've seen the data, and just due to sheer inexperience, the young investigator's grant gets canned. Why? Because grant writing workshops teach you the basic backbone of the grant application. But it doesn't teach you the "inside tricks". For instance, did you know that you can find out who is likely to be on review committees? All it takes is a phone call or two. The more established investigators who are familiar with many more investigators can twist things in their grant application increase the likelihood of getting a higher score. The younger investigator is not likely to know all these tricks and are therefore at a disadvantage. Sure, if there is a smoking gun application from a young PI, then fine, he/she will get it accepted. But more often than not, the young PI should be prepared to submit a few grants and going through more involved revisions before getting that first RO1. I think your bolded statement is true but bit idealistic. If X = # quality grants from young investigators / total # young investigators and Y = # quality grants from senior investigators / total # senior investigators, Y is greater than X. I'm making a relative statement.
Well, nobody actually GIVES PhD's away like candy, of course. But the attrition rate is quite low. For instance, take the grad student who works in the lab for 8 years without any publications. That student should not get a PhD. But graduate departments will frequently just give them the PhD just to get rid of them. Now, at the same time, the attrition rates for med schools are quite low...it takes effort to flunk out and not get the MD, it seems
Sure makes the supply : demand ratio wacked! You're right, it is harder (not impossible) to get into one of these power labs as an American PhD...because the quality of your graduate work is more likely to be scrutinized by these PI's (remember, they don't need you...you need them!). Hence, this furthers the "natural selection" a bit; i.e., the guy with multiple publications in a 4 year grad school stint is more likely to get accepted into one of these labs over the 8th year grad student without any publications. Then the game intensifies once you're in this power lab environment because then you put these smart people together and stick 3 of them on the same project...and then the little game ensues where the PI says, "look to your right and to your left...FIGHT!...morrrrtallll kommmmbatttttt!"
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Dork.
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There are far more programs with "seed money" for beginning investigators than there are for "established" ones. And the acceptance rates for young investigators is higher. I bolded the statement in my original post because even I with no Dr in front of my name, can't believe some of the things folks try to get away with in some of these grant proposals.
I don't know if I think a person who takes 8 years to finish a PhD shouldn't be allowed to finish because I getting 1) Getting a PhD is so subjective 2) Getting published is dam subjective. I also think the reason it takes 8 years has absolutely nothing to do with the "quality" of those who pursue PhD's. It's because the PI needs the cheap labor.Well, nobody actually GIVES PhD's away like candy, of course. But the attrition rate is quite low. For instance, take the grad student who works in the lab for 8 years without any publications. That student should not get a PhD. But graduate departments will frequently just give them the PhD just to get rid of them. Now, at the same time, the attrition rates for med schools are quite low...it takes effort to flunk out and not get the MD, it seems
I know, right?
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I'm trying to just consider the MD/PhDs in my own program.
Last year: One pure academician, one who went private for big money.
Current 4th years: Three of them. All going private. Two of them haven't even done any projects during their training.
Current 3rd years: One, who is CP only and research bound.
Out of this n of 7, only two academicians among them.
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There was a point in my not too distant past when that I thought that ANY MD/PhD who didn't spend some time doing research was a sell out. Not anyomore. There is no "loyalty" to anything anymore as far as I'm concerned, other than to your family.
Still I think in 20 to 30 years down the line, we're going "to pay" for not making a career in scientific research more attractive.
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b&ierstiefel
They are sellouts! Just kidding.There was a point in my not too distant past when that I thought that ANY MD/PhD who didn't spend some time doing research was a sell out. Not anyomore. There is no "loyalty" to anything anymore as far as I'm concerned, other than to your family.
Still I think in 20 to 30 years down the line, we're going "to pay" for not making a career in scientific research more attractive.
Yeah, if I don't do a postdoc, I will see myself as a sellout. I'm already looking at myself as a pseudo-sellout for even having doubts about my future as a research investigator
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b&ierstiefel
You two have to engage in verbal fistacuffs on SDN? But you guys are at the same institution, same department. Can't you just razz each other in person? Or perhaps you can resort to send prank pages, or maybe even email?
P.S. Do you guys actually run the bowel as in cleaning the ****? Or does someone else scoop the **** out and then you examine the cleansed bowel walls? Oh yeah, I heard some institutions require one to find all 4 parathyroids during the autopsy? Do you guys have to go through that miserable exercise?
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Well, some of us are actually working this month on surg path (me) and some of us are spending our days eating outside in the beautiful weather over on the Corner (not me), so I have to get my digs in whenever possible.
As for your other questions:
-Yeah, in general, the secondary resident on a case will take care of the bowel while the primary resident is paying attention to the in situ exam and pitching in with the evisceration. I've developed a pretty good system that allows me to have the bowel run in just a couple minutes, so it's not too big a deal.
-The director of Autopsy pays us 5 bucks for every parathyroid candidate that actually turns out to be a parathyroid. Personally, I still don't spend much (any) time looking for them, b/c I just want to get the case over as quickly as possible (so that I too can go for two hour lunch breaks over on the Corner).
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I hate when the original cyst measurements don't get noted down on the bucket.
Occasionally the TPFs come in useful. I couldn't find anywhere in the EMR notes if there was a previous tubal ligation, and she knew because the patient told her so.
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Frankly, as an interested eavesdropping vanilla MD, it's difficult enough doing "little r" research of the USCAP variety and attempting to get it published during residency, without taking on the basic science monster. The majority of residents I know who present at path meetings do it so that they can travel to conferences for free, and because they think it's important for fellowships, or maybe because an attending had a bee in their bonnet one afternoon - not necessarily out of the desire to do research.
Overheard: "If I wanted to work so hard, I would have gone into surgery."
Overheard: "If I wanted to work so hard, I would have gone into surgery."
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Descutes, the reason research leaves a bad taste in your mouth is because there is no mentorship at your University. If you have mentors that are enthusiastic and even (god forbid) help you out, then the clinical projects you speak of would probably be more fun.
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As a followup, how difficult is it to actually get abstracts accepted for posters and platform presentations at USCAP. As someone who had to bust his ass to get abstracts (especially for platforms) into American Society of Hematology meets, it would seem extremely difficult during residency to produce the same level of research.
Also, during my interview trail, especially at WashU, where almost every faculty member I met was MDPhD and were really very impressive people, they were of the opinion that basic research/diagnostics has to be a 80/20 or 90/10 ratio especially for the RO1 kind. This leaves me wondering if isnt better to do a post-doc stint rather than a residency (for the pure basic research kind). I know most people do a residency as a fall back option, but imagine having to revert back to diagnostics/morphology after say ten years of 90/10, wouldnt you feel seriously underprepared to take this on?
But, it seems like there is light at the end of the tunnel for the translational kind, especially now that there is a huge push at NIH to fund such research. I think that's the area pathologists can create a serious dent (and I whole-heartedly agree with all the good folks in this forum who support tissue banking). Also, according to my advisor, NIH is beginning to fund a lot of research involving information systems and creating easy searchable databases of patient clinical data integrating path/lab/molecular studies/radiology etc. etc.
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USCAP abstracts can be rejected, but it seems to me like the majority of well organized studies (even if the results aren't that significant) will be accepted at least as a poster. The other organizations (ASCP, CAP, some subspecialty areas) often are even easier, and will accept interesting case reports (or often even encourage them).
USCAP acceptance often, interestingly, depends on what subspecialty it is in, for some reason the breast abstracts get rejected a lot, but GI and GU all you have to do is submit it, it seems (I am exaggerating, obviously).
USCAP acceptance often, interestingly, depends on what subspecialty it is in, for some reason the breast abstracts get rejected a lot, but GI and GU all you have to do is submit it, it seems (I am exaggerating, obviously).
