How serious are department chairs and search committees in hiring new physician scientists? If they are not able to find a MD with good enough research potential, how likely will they opt for the PhD who has a KO1 in hand? Or will chairs simply hire a PhD with his/her own funding to do basic research and hire a MD to staff clinics with requirements to consult with that PhD?
Physician-scientist hiring
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Depends on the particular department and institution. Nationwide, there is a shortage of MD/PhDs (i.e. well-trained, bright, enthusiastic physician-scientists) compared to jobs available. This does not necessarily apply to the big research-heavy institutions/departments in coveted locations. In general, it helps to bring current grants (i.e. K award) or at least a track record of successful individual grant funding. It is also important to have shown success in both graduate school and post-graduate research training, with quality publications to show for it. There are a couple of recent articles on ScienceCareers that relate to these issues, which have been referenced on SDN, the most recent of which was authored by Skip Brass from Penn.
What I have seen at my institution in terms of surgical departments is the hiring of MDs who staff the OR/clinic and PhDs who do the basic research, with very, very few MD/PhDs who do both. Whether this is a result of department preference or the paucity of well-qualified MD/PhDs who go into surgical fields remains unclear. I would wager that some department heads believe that high-quality research can be accomplished more efficiently by faculty who focus 100% of their time on it. However, it should be noted that there are very few PhD scientists trained to understand clinical problems, biomedical research and translational approaches. You are also only one person to pay versus having to hire two separate faculty. So I think as an MD/PhD, you would have a leg up on the competition.
What I have seen at my institution in terms of surgical departments is the hiring of MDs who staff the OR/clinic and PhDs who do the basic research, with very, very few MD/PhDs who do both. Whether this is a result of department preference or the paucity of well-qualified MD/PhDs who go into surgical fields remains unclear. I would wager that some department heads believe that high-quality research can be accomplished more efficiently by faculty who focus 100% of their time on it. However, it should be noted that there are very few PhD scientists trained to understand clinical problems, biomedical research and translational approaches. You are also only one person to pay versus having to hire two separate faculty. So I think as an MD/PhD, you would have a leg up on the competition.
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Correction. There is a shortage of physicians holding sizeable research grants. I've heard the statement that there's a shortage of qualified MD/PhDs many times from a certain department chair, but there are absolutely 0 incentives given to bring research MD/PhDs into the department. Several MD/PhD faculty or fellows who have since left this department have told me the environment at the institution is setup for failure. No startup money, little protected time, not enough time for you to get grants before being forced out of research.
As long as you bring in big grant money, institutions are more than happy to have you. There is and will always be a shortage of R01 funded scientists to a chairman. If there were still well funded investigators who wanted to work at your institution, they would build more buildings to house them. If you are successful to the 10th percentile of funding in bringing in money, you're set. These arguments about shortages make it seem like if there were more MD/PhDs there'd automatically be more funding for them. I wish that were true.
In summary, it's all about money. You bring in big grants, everyone wants you. You don't bring in money, you're out the door or switched to clinical. What shortage?
In talking to faculty in procedure heavy fields it seems that it's a choice on both sides. For a procedure heavy department that brings in a lot of revenue, the PhDs typically bring in much less revenue to a department. An MD/PhD who does 80%+ research work would bring in that level of revenue. The research MD/PhD takes on all the career instabilities, increased demands by way of clinical work on top of research work and the need to bring in grants, and for this are given worse hours and much (2x-3x) less pay, on the order of what the PhD was being paid.
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Note I commented about big money, procedure heavy fields. Subspecialties that are not bringing in big money clinically, typically that do not involve procedures a majority of the time, stand to gain equal or more money from grants than they do from clinical revenue. Thus there's little to no salary difference for the MD/PhD and more benefits from the department for the MD/PhD to do the research.
There are also MD/PhDs who say the heck with all that and keep doing research anyways. There are also those within the procedure heavy fields who buck the trend. I know a MD/PhD guy at a smaller-name institution who is 50/50 and still pulls in $300k/year in Radiology at 60 hours/week (you know, 50/50, i.e. 20 hours clinical, 40 hours research). He's one of a handful of 50/50 research guys I'm aware of the whole field, but if you get lucky you might find a department that's willing to host you and still pay you well. I don't know what's going to happen when his K08 runs out though.
If I mention 80% research within Radiology, I get laughed at. This includes by that same 50/50 guy I mentioned earlier 😉. This is why my program tries to steer me towards other fields. But the reality is everything comes back to $$$$$. Believe me, I never had any idea things were this way before starting my program, and I wish I had known. But it doesn't mean I'm going to pick something that isn't in my clinical interests, and all my interests are very procedural.
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Neuronix points to an inconvenient truth. Certainly, much of this is determined by money. Departments with large amounts of clinically generated revenue tend to be more resistant to MD/PhDs leaning toward research, because the MD/PhD could be generated more revenue for the department by doing clinical work. These indeed are the more procedure-intensive specialties such as surgical fields, radiology, anesthesia, and others. Thus, if you are leaning toward one of these specialties, when applying for residency and fellowship is especially important to consider programs which have the tacit support of the department chair and program director for you to do research. It is also vitally important to nail down the specifics (i.e. how much protected research time).
I know a guy at my institution who worked out an arrangement to operate 1-2 days per week and spend the rest of the time doing basic research. He is taking a major pay cut compared to his earning potential, but has the support of the department chair, who considers the prestige of cutting-edge research in his department to be of high value.
I know a guy at my institution who worked out an arrangement to operate 1-2 days per week and spend the rest of the time doing basic research. He is taking a major pay cut compared to his earning potential, but has the support of the department chair, who considers the prestige of cutting-edge research in his department to be of high value.
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I wonder about this "shortage" theory as well. I think the spots are there -- i.e. depts are trying to get someone who can do both, but they aren't being filled. Why? (1) depts don't have start-ups. (2) academic salary is abysmal compared to private. The problem is, you won't get hired automatically if you are MD/PhD. They still want to see a track record, with preferably a K08. It sounds like 30% of K08s get funded. Since the majority of K08 applicants are MD/PhDs rather than MDs, I'd say whoever gets funded stay in academia--hence the 50% statistics thrown around.
So at the end of the day, the bottleneck for producing physician scientist still isn't the attrition--sure a few people go into rad onc, but still way too many aren't getting funded, and THEN leave.
but then again, what is life but taking a little risk? 🙄 It's just a matter of when you decide to quit.
If you look at the bright side though -- you'll always get a low-ish paying job where you want, and the job security is always there with great benefits. Private practice has its own set of headaches - insurance companies, trying to gain partnership, buying new boats, beating the Jones etc. The only draw back is that your spouse might have to make around the same as you in order for your to live at the level of your private practice peers. Be very careful and don't date a bimbo.
So at the end of the day, the bottleneck for producing physician scientist still isn't the attrition--sure a few people go into rad onc, but still way too many aren't getting funded, and THEN leave.
but then again, what is life but taking a little risk? 🙄 It's just a matter of when you decide to quit.If you look at the bright side though -- you'll always get a low-ish paying job where you want, and the job security is always there with great benefits. Private practice has its own set of headaches - insurance companies, trying to gain partnership, buying new boats, beating the Jones etc. The only draw back is that your spouse might have to make around the same as you in order for your to live at the level of your private practice peers. Be very careful and don't date a bimbo.
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In the following post, please consider reading films in the same catagory as procedures. Film reading is not a procedure. However, it's concrete like a procedure and it's a big revenue generator like procedures typically are.
It doesn't work that way. It's very hard to recruit clinical-only or mostly clinical physicians to academia in procedural departments. Thus, there is a chronic staffing shortage among procedural academic departments. In Radiology, the shortage is so severe that many academic hospitals have to outsource their Radiology to private practice groups. The section chief positions within departments go unfilled for many years. Many residency programs are "weak" in a subspecialty of Radiology because there's just one or none left in the department and so the films are being sent to a private practice group. The ABR has gone so far as to start forcing all residents to do fellowship to get boarded, so that there's still someone left in academics. Similarly, they allow foreign trained Radiologists to become board certified after 3 years training in the states. Again, this all helps to fill very sparse academic departments for the couple of years while they are "training" and also helps flood the market so the private practice positions might fill up and make private practice more competitive/less lucrative.
There are some incentives to academia. Such as that there is typically less responsibility because you can make residents and fellows do your scut and call. Thus mostly clinical academics can be more lifestyle and intellectually friendly even if the pay is less. The caseload tends to be less and the studies are often more interesting than a stack of normals. It's one place that tends to tolerate you almost entirely reading whatever films you were fellowship trained in, while private practice is much more general. That "lifestyle" goes out the window if you're competing for grants with serious research, however, since you're still expected to carry clinical load and run a full-time lab and obtain serious funding. These are all parts of the reasons why only about 50% of academic MD/PhDs are doing 50% or more research according to the survey.
But private practice still earns on the order of double or more. You also have the satisfaction and independence of owning your own business, or being a partner in a practice. Of course this business side doesn't appeal to everyone, but the heirarchy, competitiveness, and often antagonistic behavior of academic hospitals doesn't fly in private practice. My point is there are positives and negatives to both sides. You have no idea about this as a pre-med student, and I still think it's ridiculous to expect a 22 year old fresh out of undergrad to have any sense of what the real world is like. Even if they did, saying you will have a research career 15 years from now is like saying you'll be a millionaire 15 years from now. It's a nice goal, but you may not get there for a variety of reasons.
I think it's silly to make it sound like private practice is automatically more work than academics in procedure heavy fields. Often it is, but it's because the attendings are raking in lots of money and directly see the fruit of their increased labor. In academics, it is often not this way thanks to a fixed salary. Though many departments are rewarding based on numbers of procedures done. This further removes the incentives for anyone to do research within academics and is one of many ways the pay gap is widened between researchers and clinicians.
Even so, I know a few private practice guys who left academics. They upgraded their vacation from 4 weeks to 4 months a year and tripled their salaries in the process. They would say they work about the same amount when they're on service as they were in academics. So, I guess Radiology is just a "bad specialty for research"? No. The research seems to be as good as anywhere else, maybe even better if you have the right technical skills and also since the field is so empty. It's just a great specialty for clinical work. If you want to follow the people and the talent, you just have to do what I said earlier, and follow the $$$$.
It doesn't work that way. It's very hard to recruit clinical-only or mostly clinical physicians to academia in procedural departments. Thus, there is a chronic staffing shortage among procedural academic departments. In Radiology, the shortage is so severe that many academic hospitals have to outsource their Radiology to private practice groups. The section chief positions within departments go unfilled for many years. Many residency programs are "weak" in a subspecialty of Radiology because there's just one or none left in the department and so the films are being sent to a private practice group. The ABR has gone so far as to start forcing all residents to do fellowship to get boarded, so that there's still someone left in academics. Similarly, they allow foreign trained Radiologists to become board certified after 3 years training in the states. Again, this all helps to fill very sparse academic departments for the couple of years while they are "training" and also helps flood the market so the private practice positions might fill up and make private practice more competitive/less lucrative.
There are some incentives to academia. Such as that there is typically less responsibility because you can make residents and fellows do your scut and call. Thus mostly clinical academics can be more lifestyle and intellectually friendly even if the pay is less. The caseload tends to be less and the studies are often more interesting than a stack of normals. It's one place that tends to tolerate you almost entirely reading whatever films you were fellowship trained in, while private practice is much more general. That "lifestyle" goes out the window if you're competing for grants with serious research, however, since you're still expected to carry clinical load and run a full-time lab and obtain serious funding. These are all parts of the reasons why only about 50% of academic MD/PhDs are doing 50% or more research according to the survey.
But private practice still earns on the order of double or more. You also have the satisfaction and independence of owning your own business, or being a partner in a practice. Of course this business side doesn't appeal to everyone, but the heirarchy, competitiveness, and often antagonistic behavior of academic hospitals doesn't fly in private practice. My point is there are positives and negatives to both sides. You have no idea about this as a pre-med student, and I still think it's ridiculous to expect a 22 year old fresh out of undergrad to have any sense of what the real world is like. Even if they did, saying you will have a research career 15 years from now is like saying you'll be a millionaire 15 years from now. It's a nice goal, but you may not get there for a variety of reasons.
I think it's silly to make it sound like private practice is automatically more work than academics in procedure heavy fields. Often it is, but it's because the attendings are raking in lots of money and directly see the fruit of their increased labor. In academics, it is often not this way thanks to a fixed salary. Though many departments are rewarding based on numbers of procedures done. This further removes the incentives for anyone to do research within academics and is one of many ways the pay gap is widened between researchers and clinicians.
Even so, I know a few private practice guys who left academics. They upgraded their vacation from 4 weeks to 4 months a year and tripled their salaries in the process. They would say they work about the same amount when they're on service as they were in academics. So, I guess Radiology is just a "bad specialty for research"? No. The research seems to be as good as anywhere else, maybe even better if you have the right technical skills and also since the field is so empty. It's just a great specialty for clinical work. If you want to follow the people and the talent, you just have to do what I said earlier, and follow the $$$$.
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Even in less procedure-oriented fields (such as neurology), one can expect to make 30-50% more in private practice. An assistant professor starting salary in academic neurology might be on the order of ~120k. A starting private practice general neurologist can make ~180k starting and beyond. Obviously, 30-50% more salary is less incentive compared to the potential of doubling or tripling your salary as in more procedure-oriented specialties. That is why many people in the MD/PhD community are worried about students headed toward ROAD specialties.
However, you could also look at an academic ROAD specialty as a good deal if you are intent on the physician-scientist track and can secure a super-majority (75-80%) research time (a big if, I guess): you still get paid more than your medicine colleagues and get to spend the majority of your time doing research. Yes, you could be getting paid much more to do private practice, but you are also getting to do what you love--research (supposing you still love research!).
While I'm all for increased grant funding, paying academics more, and increasing vacation time, I think the bottom line is that if you are primarily interested in making money, academics will virtually always be a losing pathway compared to private practice. However, if you are interested in continuing a research career, then academics is the place to be. That is unless you decide on going into industry.... (whoops--a whole other can of worms just opened! 😉 )
However, you could also look at an academic ROAD specialty as a good deal if you are intent on the physician-scientist track and can secure a super-majority (75-80%) research time (a big if, I guess): you still get paid more than your medicine colleagues and get to spend the majority of your time doing research. Yes, you could be getting paid much more to do private practice, but you are also getting to do what you love--research (supposing you still love research!).
While I'm all for increased grant funding, paying academics more, and increasing vacation time, I think the bottom line is that if you are primarily interested in making money, academics will virtually always be a losing pathway compared to private practice. However, if you are interested in continuing a research career, then academics is the place to be. That is unless you decide on going into industry.... (whoops--a whole other can of worms just opened! 😉 )
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I think there's a lot of talk of private practice in general being this "sell-out" plan of making a lot of money + less headache in applying for grants. I just want to caution people that private practice isn't always heavenly either. First of all, you are under much more pressure to produce the bottomline. Secondly, you have to be much more of a bussinessman, and worry about things like insurance coding, cost cutting, getting partnered, etc. etc. It's likely that reimbursement will get cut again, and private practice in ROAD may not be as lucrative in the future. There are a lot of unhappy private attendings, and they get really bitter over things like socialized medicine. I'm not sure I want to be in that position. Some people stay in academia or become staff at a hospital because of the axillary benefits--you don't have to deal with billing, staffing, getting yourself benefits, retirement planning, getting facility, etc. The academic hospital takes care of indigent populations and do certain cost containment measures--everyday you work for an academic hospital and getting paid less, you are in essence doing some charity work. There are intermediate arrangements between "academic 80/20" and "single specialty private practice group"--you can become primarily a clinical faculty, for instance, or teaching faculty, or you can get staffed at fancy, suburban hospitals with better payer ratio (i.e. private insurance vs. medicare). Certain specialties, like psychiatry, can allow you to do solo, non-insurance practice. The options are ENDLESS.
The jobs are out there to be had. Not everyone can get to become a 80/20. And it's important to remember that there's really no perfect job. Being happy is about finding what's right for you, and it's not NECESSARILY what makes the most money. And I suspect that anyone who graduated from an MSTP, if sufficiently committed, will be able to get a 80/20 job AT SOME POINT. You just end up asking yourself, is it worth it for me to get paid 80k applying for that K08 the third time, or is it worth it for me to make 120k or 180k (or 300k) as an attending. If you like research enough, you persist, and make ends meet with that 80k. Plenty of other Americans do it. If you think it's not worth it, go ahead and make more money--and be prepared to work for it.
Like OP i find myself worrying about this a lot. But I think at the end of the day, anyone who goes through an MSTP will be sufficiently trained that he will make enough money to not have to worry about money, in the sense that you will make enough so that your happiness won't depend on you making more. You might not be happy with how much researchers get paid, but this won't necessarily be addressed by quitting research 😛. I think a lot of people like the idea of research in principle, but are afraid of failure and unemployment--and I think MSTP is one of the best ways of insurance against this scenario.
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so, what constitutes a genuine commitment on the part of a department to developing an md/phd's research career? neuronix, you've posted quite a bit about what i assume is your home institution's rads department, and i'd really appreciate any details you'd be willing to share about the kinds of offers you've heard/seen - always valuable to see how different fields (and departments) compare.
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Don't assume. First it'll get me in trouble. Second, I'm drawing from multiple experiences from multiple departments and multiple schools. I'm working elsewhere right now and some of my info is drawn from there. Others is drawn from my interactions with faculty who have previously been at other institutions or who are currently at other institutions.
