Physician-Scientist dream... what should be done? Residency/PhD/Fellowship?

[spikedoc2]

Hi!

I'm a 2nd year medical student in a tough spot. I want to have a future doing translational research / clinical on spinal cord injury repair and neural plasticity - a post-neurology fellowship offered in very limited locations.

Now I am left to decide a few options:
A) The neurorehabilitation/plasticity fellowship I'm looking to sub-specialize in is extremely limited in options. Should I do my neurology residency at the same place where the fellowship is available? - the fellowship I want to do is on the west coast but I plan to return to reside back on the northeast. This makes me wonder if it would be better to keep my residency on the east coast, then apply to do the 2 year research focused-fellowship on the west coast?

B) Should I take 3 years off to do a PhD? My school offers that as an option, but I don't know if it is needed. The fellowship I want to do is already very research driven (50% time spent in basic science). I want to have a career that focuses on neurological clinical work (~70%) and also pioneering research (~30%) and/or development for bringing spinal cord injury restoration therapies from the bench to the patients.

Thank you so much!

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[dl2dp2]

This depends on too many factors. For example, do you need the money and how much do you really care about the science. In general, a strong location specificity, especially for a smaller location with few academic centers, in a niche field is a kiss of death for a career in biomedical research. 30% FTE in the long run probably means you'll exit science in about 10 years. I wouldn't aim to commit to a PhD if that's the case. NINDS K funding rates are dropping from the high 30s to below 20 in the last five years, and this is typically for people with >80% protected time during the fellowship. The clean track if you want to commit to a research career is do the fellowship, commit at least 80% of time, and continue to do so for the next decade.

It's possible to sustain a longer career with 30% FTE, however, keep in mind that your role will be primarily being a study physician for someone else's clinical trial, or part time work for someone else's basic science project. If the project succeeds, you'll receive very little scientific recognition, and typically the main paper you will only be a middle author. It's difficult but not entirely impossible to transition from that kind of role into a full time PI role by raising a lot of money on your own free time, but the odds are very much stacked against you. Some people like this kind of role, you just need to be aware of the headspace before going into this.