Physician scientists in industry

[convolutional]

I'm at a mid-low tier MD/PhD program, on track for several 1st authors, won a grant from a foreign government. My work is 100% dry lab, computational/AI stuff, so not exactly high start up costs. I am increasingly unsure about pursuing a life in academia. The tedium of grant writing and the limited impact that academic research has is making me rethink things. I know people in biotech and arguably they're doing cutting edge work with higher upside. Ultimately, I want my work to be impactful in terms of: (a) generating revenue for myself, (b) helping people. (a) is principally motivated by the fact that I have the constraints of supporting my immigrant parents and want to give them a better life.

I was wondering if anyone had any experience with working with industry or doing your own start up, and what a good path for this might look like? I was thinking the best personal situation would be to try to ball out in my PhD, work more on the CS side if possible, get into a good residency/PSTP that's in an area with biotech activity so I can build connections, and then work in clinical medicine while I try to get my venture off the ground. I was thinking a residency in something with good labour:revenue ratio would be ideal, e.g. rads/derm/psych or something research heavy like IM. Does this sound wholly unrealistic?

Thank you so much!

---

Members don't see this ad.

 

[tr]

What are careers like going from academic heme/onc to pharma?

I'm an MD/PhD student at an upper mid-tier school. COVID ran a bulldozer through my PhD and it's looking like I'll graduate with 6-7 basic science papers to my name, 3-4 first author, nothing in super high impact journals. My chances of being a PI at a high-tier institution without extra...

forums.studentdoctor.net

 

[tortuga87]

I have encountered some nuances with this area. In general, pharma research positions do not pay that well compared to clinical work, even computational scientist positions in pharma. Pharma is also not used to MD/PhDs working in AI/ML in general. They are used to MDs helping with clinical trials. There is therefore little to no overlap between AI/ML teams and MDs. If you go into AI/ML in pharma, then you will in general take a 100% PhD salary, and your MD will not be used even after fellowship. You will have a harder time getting the computational scientist positions as well because people will be skeptical that you will even want to work for them at 140K/year in San Francisco.

If you want to make money in AI/ML, the carved out path in general is to work in big tech working on image recognition, ad optimization, etc that is not related to clinical work. These jobs are very competitive and reserved for the best people in computer science; there is only a small chance that you will get them by the way. You will in fact likely have a lower chance of getting them with the same skillset because you "wasted time" doing an MD. There is a lot of bias against MDs in tech basically claiming that they cannot do math, even the ones who can.

You can also work in management, in which case you will not be doing much research beyond big picture direction.

OP, most people who are in your situation just go 100% clinical.

 

[convolutional]

I have encountered some nuances with this area. In general, pharma research positions do not pay that well compared to clinical work, even computational scientist positions in pharma. Pharma is also not used to MD/PhDs working in AI/ML in general. They are used to MDs helping with clinical trials. There is therefore little to no overlap between AI/ML teams and MDs. If you go into AI/ML in pharma, then you will in general take a 100% PhD salary, and your MD will not be used even after fellowship. You will have a harder time getting the computational scientist positions as well because people will be skeptical that you will even want to work for them at 140K/year in San Francisco.

If you want to make money in AI/ML, the carved out path in general is to work in big tech working on image recognition, ad optimization, etc that is not related to clinical work. These jobs are very competitive and reserved for the best people in computer science; there is only a small chance that you will get them by the way. You will in fact likely have a lower chance of getting them with the same skillset because you "wasted time" doing an MD. There is a lot of bias against MDs in tech basically claiming that they cannot do math, even the ones who can.

You can also work in management, in which case you will not be doing much research beyond big picture direction.

OP, most people who are in your situation just go 100% clinical.

Thank you for sharing your experiences! Personally, I do believe in the substance of my work and want to continue it. It’s very cutting edge, especially in my area of medicine. My dream would be to spin it off into my own company. I have some friends who have found success with their own start ups, more in fintech. I don’t think I would want to work in pharma for someone else unless I was at a very high management level, I just want to launch my own venture while working clinically in the meantime to bring in money for my family. Is that a pipe dream?

Match into PSTP environment, continue publishing in my field -> get some K award -> take position in a T2 university -> continue working while I try to launch out?

I am not drawn to the idea of constantly fighting for grants and ladder climbing. I can do it for a while, given that I enjoy writing, and given that I wouldn’t need a lot of resources aside from paying for a few staff and a university computing core. A 60/40 or even 80/20 clinic/research model could be effective.

 

[convolutional]

What are careers like going from academic heme/onc to pharma?

I'm an MD/PhD student at an upper mid-tier school. COVID ran a bulldozer through my PhD and it's looking like I'll graduate with 6-7 basic science papers to my name, 3-4 first author, nothing in super high impact journals. My chances of being a PI at a high-tier institution without extra...

forums.studentdoctor.net

Thank you for sharing this, I will take the time to read this over carefully

 

[tr]

Thank you for sharing your experiences! Personally, I do believe in the substance of my work and want to continue it. It’s very cutting edge, especially in my area of medicine. My dream would be to spin it off into my own company. I have some friends who have found success with their own start ups, more in fintech. I don’t think I would want to work in pharma for someone else unless I was at a very high management level, I just want to launch my own venture while working clinically in the meantime to bring in money for my family. Is that a pipe dream?

Match into PSTP environment, continue publishing in my field -> get some K award -> take position in a T2 university -> continue working while I try to launch out?

I am not drawn to the idea of constantly fighting for grants and ladder climbing. I can do it for a while, given that I enjoy writing, and given that I wouldn’t need a lot of resources aside from paying for a few staff and a university computing core. A 60/40 or even 80/20 clinic/research model could be effective.

OK so you don't want to work for industry, you want to start your own company. (I have no personal experience in this area but definitely have many friends/acquaintances who have attempted, and some who have succeeded.)

I don't think that's excessively unrealistic, although the overall success rates are no better than those for NIH funding and possibly worse. With the caveat that most people who get to the point of applying for NIH funding are already pretty serious/accomplished/committed, whereas there are tons of early-20s overconfident tech bros out there pitching their revolutionary new dry-cleaning app to anyone who will halfway listen to them, so the denominators for that success ratio are quite a bit different.

But if that's your goal I think your plan sounds good actually. Low-demand specialty training (I can recommend psych), aim to match in SF Bay Area or other area with strong academic/tech/industry interconnections if possible, and seek capital, e.g. via Y-Combinator or similar.

The only thing I have to say is that most people who are trying to launch new companies are running themselves into the ground 100+ hours/week, so I have some concerns about how realistic it is to try to do this at the same time as residency. On the other hand if you are willing to live cheaply post-residency such that you can support yourself on 1-2 clinical days per week (again, I can recommend psych for this) then that could be a reasonable time to attempt this. I'm not sure you would need the academic position in this scenario, and actually unless it provides a really clear advantage wrt your technology development (e.g., access to patient population for trials or whatever), it could be a handicap, given how much less money you would make (and hence how many more clinical hours you would need to support yourself) vs private practice.

 

[tortuga87]

Thank you for sharing your experiences! Personally, I do believe in the substance of my work and want to continue it. It’s very cutting edge, especially in my area of medicine. My dream would be to spin it off into my own company. I have some friends who have found success with their own start ups, more in fintech. I don’t think I would want to work in pharma for someone else unless I was at a very high management level, I just want to launch my own venture while working clinically in the meantime to bring in money for my family. Is that a pipe dream?

Match into PSTP environment, continue publishing in my field -> get some K award -> take position in a T2 university -> continue working while I try to launch out?

I am not drawn to the idea of constantly fighting for grants and ladder climbing. I can do it for a while, given that I enjoy writing, and given that I wouldn’t need a lot of resources aside from paying for a few staff and a university computing core. A 60/40 or even 80/20 clinic/research model could be effective.

This is possible. Would just make sure to plan everything well. I would develop the tech independent of the university as much as possible so they don’t try to sue you afterwards for money. Use the MSTP to become very good at AI ML and mature the tech very well. Make sure it can scale with minimal effort and you have access to the necessary data streams.

You likely will not have time for clinical work with a start up. The people who I know who did this did not do a residency. Most residencies are not open to people who will create start ups because program directors and clinical faculty are essentially the polar opposite of entrepreneurial people. You may be able to pull off clinical work plus start up but just keep these facts in mind

 

[tr]

This is possible. Would just make sure to plan everything well. I would develop the tech independent of the university as much as possible so they don’t try to sue you afterwards for money.

Oh yeah that too. You actually probably don't want to have an academic position when you launch your startup because the university will claim ownership of it. Given that, there's really no point in sweating it out trying to get a K or any other training grant during your early career. I'd cut the academic ties as early as possible.

 

[SurfingDoctor]

What are careers like going from academic heme/onc to pharma?

I'm an MD/PhD student at an upper mid-tier school. COVID ran a bulldozer through my PhD and it's looking like I'll graduate with 6-7 basic science papers to my name, 3-4 first author, nothing in super high impact journals. My chances of being a PI at a high-tier institution without extra...

forums.studentdoctor.net

Honestly, that thread should be stickied. I don't know who needs to make that happen, but it needs to happen.

 

[solitude]

sounds like you are burned out on research already. I recommend picking a lucrative specialty. You can then do private practice or academics and either way still make enough to support your lifestyle and your parents. What you are proposing is not compatible with clinical practice and very high risk, i.e. you may not end up making enough money to accomplish your (a) objective.

 

[dl2dp2]

Just read that thread. I've said everything I know in that thread. Also, it may come as a shock but "cutting edge AI/ML" is almost worthless vs. MD in the most lucrative subspecialties. That field (which I know well) is so oversaturated and has no contact with the people who actually have money. People in that field who make money are all managers and investors. Make money as an MD, save and invest, for the vast majority of people, especially "mid-lower-tier" is the way to go.

There are exceptional cases, I know some of them, some personally, but the pathways are not teachable, and it's almost 100% relationship-driven and not technical skills driven, and in the vast majority of cases doing a residency in a lucrative subspecialty is value-enhancing. Sometimes I look at some impressive people at big tech/big pharma on LinkedIn and I'm like your resume looks like complete garbage. It doesn't matter.

 

[solitude]

Just read that thread. I've said everything I know in that thread. Also, it may come as a shock but "cutting edge AI/ML" is almost worthless vs. MD in the most lucrative subspecialties. That field (which I know well) is so oversaturated and has no contact with the people who actually have money. People in that field who make money are all managers and investors. Make money as an MD, save and invest, for the vast majority of people, especially "mid-lower-tier" is the way to go.

There are exceptional cases, I know some of them, some personally, but the pathways are not teachable, and it's almost 100% relationship-driven and not technical skills driven, and in the vast majority of cases doing a residency in a lucrative subspecialty is value-enhancing. Sometimes I look at some impressive people at big tech/big pharma on LinkedIn and I'm like your resume looks like complete garbage. It doesn't matter.

agree. Read the recent WaPo articles on doctor salary. If you go into a lucrative specialty and do PP, it's pretty easy to make 7 figures annually. Although not unheard of, it's atypical even in tech, and you usually have to live somewhere expensive.

 

[dl2dp2]

agree. Read the recent WaPo articles on doctor salary. If you go into a lucrative specialty and do PP, it's pretty easy to make 7 figures annually. Although not unheard of, it's atypical even in tech, and you usually have to live somewhere expensive.

lol i don't know about that, but yes, it's a tractable set pathway to make 7 figures as a plastic surgeon in a Midwest metro... it's not easy but it's not intractable like in most of corporate America. in small parts of big tech there is a pathway, but there is a high barrier to entry, and the pathways idea for other jobs that have that system set up you already missed it (i.e. big law, high finance, management consulting). still, none of these pathways are easy. Is it easier to be an interventional radiologist or a big law partner? LOL It's an absurd question.

Also I think while I'd be lying if I said I don't care about money, as it's one of the few things I do care about, but there must be other things you care about than a total comp figure? Setting yourself to make a mil a year at all cost by a "pathways" model seems a bit tail-wagging the dog. I'll tell you I personally am making way more money than I had anticipated at the end of md phd, but it had nothing to do with this "pathways" model. Same with a lot of people I know and posters here. You often luck INTO money by making a few pivots along the path of least resistance. Greedy algorithms often work better than prespecified fine-tuning.

I was at the home of a private equity executive this weekend that he purchased for 5.9M in 2021 and is now worth 7.2M by Zillow but he also put in a pool and hot tub so it's probably worth 8M at the moment. My spouse was like "well, if you can afford all that it's not a bad life". So yes, if that's what you *want* that is definitely POSSIBLE--but the reality was that when I was 30 I didn't even know what private equity is. I may have not even heard of those two words used together in a sentence. I think there's a top and a bottom, and we want to avoid the bottom which was the situation I described where you can barely make ends meet and is the unfortunate fate of a lot of basic science-academia-focused people. The goal is to try to SEE more stuff out in the world so you get a better sense of what is the top that is important to you and what you have the most fun with and align your life along these complex dimensions.

 

[solitude]

lol i don't know about that, but yes, it's a tractable set pathway to make 7 figures as a plastic surgeon in a Midwest metro... it's not easy but it's not intractable like in most of corporate America. in small parts of big tech there is a pathway, but there is a high barrier to entry, and the pathways idea for other jobs that have that system set up you already missed it (i.e. big law, high finance, management consulting). still, none of these pathways are easy. Is it easier to be an interventional radiologist or a big law partner? LOL It's an absurd question.

Also I think while I'd be lying if I said I don't care about money, as it's one of the few things I do care about, but there must be other things you care about than a total comp figure? Setting yourself to make a mil a year at all cost by a "pathways" model seems a bit tail-wagging the dog. I'll tell you I personally am making way more money than I had anticipated at the end of md phd, but it had nothing to do with this "pathways" model. Same with a lot of people I know and posters here. You often luck INTO money by making a few pivots along the path of least resistance. Greedy algorithms often work better than prespecified fine-tuning.

I was at the home of a private equity executive this weekend that he purchased for 5.9M in 2021 and is now worth 7.2M by Zillow but he also put in a pool and hot tub so it's probably worth 8M at the moment. My spouse was like "well, if you can afford all that it's not a bad life". So yes, if that's what you *want* that is definitely POSSIBLE--but the reality was that when I was 30 I didn't even know what private equity is. I may have not even heard of those two words used together in a sentence. I think there's a top and a bottom, and we want to avoid the bottom which was the situation I described where you can barely make ends meet and is the unfortunate fate of a lot of basic science-academia-focused people. The goal is to try to SEE more stuff out in the world so you get a better sense of what is the top that is important to you and what you have the most fun with and align your life along these complex dimensions.

well said. I am not, by ANY stretch, trying to maximize my income. I have plenty of research time. But I am able to provide a nice life for my family and that's important to me. The job security compared to being dependent on R01s, is nice for my family too.

I value a high correlation between input and output. If I work hard, I am generally successful: pts are happy, I spend my day productively helping people, and I get paid more. The correlation is much weaker in basic science research. Your gel might be contaminated through no fault of your own, your grant might be rejected because of the whims of grant reviewers, you may languish in your PhD for 6 years because as a 22-year-old you selected a bad mentor, etc etc. My experience with friends in industry is that there is a lot more serendipidity involved (which way does the project go, how does the stock price do, office politics), which weakens this correlation, rendering work less gratifying. Also, to make bank, you have to travel a lot, which sucks if you have small kids.

btw, I think you are underestimating how much money can be made in clinical medicine in the lucrative subspecialties, even in academics. The surveys are often wild underestimates and are skewed by people working part-time ("mommy track" or mostly research) or semi-retired.

 

[convolutional]

Thank you to everyone for your feedback! I really appreciate everyone’s insight.

I do have some personal connections in the start up/vc world due to where I went to undergrad so I don’t think I would be going into it blind. Either way, I can’t really start anything now so I am anticipating working and building expertise and trying to network. I can then make a final decision down the road if it still makes sense. I know the field is tight but I do think there are some interesting areas for innovation that really haven’t been explored but may prove very interesting. And while the market for biotech right now isn’t good, the industry is cyclic and I’ve seen all kinds of things being funded so. Either way, a lot can change in 5 years, let alone 10, in the world and in one’s personal life. If I decide that I can’t do my own company, I agree that the trade off isn’t that good and see little use in joining industry unless it’s at a very high level.

I feel in that situation, I’d prefer some kind of academic appointment in a lucrative specialty that will allow me flexibility for research but still compensate me sufficiently. I think I will miss the intellectual stimulation without research if I go 100% clinical. Due to low costs and the ease of collaborating, I don’t think I’ll have to compete day in and day out for grants to do science.

That said, I guess I’m not sure what specialties are worth targeting. Surgery is out for me due to a physical condition. That basically leaves: derm, IM sub-specialties, and maybe radiology/IR though I am a bit unsure of how technology will affect it. I will probably have an exceptional application for psychiatry just on the back of my research but I am unsure whether it will bring in enough money to justify the emotional costs. If anyone has any insight on this, I would greatly appreciate your thoughts @solitude @dl2dp2

My friends are in finance or in start ups or tech right now and are grossly out earning most physicians. I think medicine is a very stable path to financial security and wealth for most people but as my family’s financial picture has become more clear, I often find myself questioning this choice.

 

[solitude]

Thank you to everyone for your feedback! I really appreciate everyone’s insight.

I do have some personal connections in the start up/vc world due to where I went to undergrad so I don’t think I would be going into it blind. Either way, I can’t really start anything now so I am anticipating working and building expertise and trying to network. I can then make a final decision down the road if it still makes sense. I know the field is tight but I do think there are some interesting areas for innovation that really haven’t been explored but may prove very interesting. And while the market for biotech right now isn’t good, the industry is cyclic and I’ve seen all kinds of things being funded so. Either way, a lot can change in 5 years, let alone 10, in the world and in one’s personal life. If I decide that I can’t do my own company, I agree that the trade off isn’t that good and see little use in joining industry unless it’s at a very high level.

I feel in that situation, I’d prefer some kind of academic appointment in a lucrative specialty that will allow me flexibility for research but still compensate me sufficiently. I think I will miss the intellectual stimulation without research if I go 100% clinical. Due to low costs and the ease of collaborating, I don’t think I’ll have to compete day in and day out for grants to do science.

That said, I guess I’m not sure what specialties are worth targeting. Surgery is out for me due to a physical condition. That basically leaves: derm, IM sub-specialties, and maybe radiology/IR though I am a bit unsure of how technology will affect it. I will probably have an exceptional application for psychiatry just on the back of my research but I am unsure whether it will bring in enough money to justify the emotional costs. If anyone has any insight on this, I would greatly appreciate your thoughts @solitude @dl2dp2

My friends are in finance or in start ups or tech right now and are grossly out earning most physicians. I think medicine is a very stable path to financial security and wealth for most people but as my family’s financial picture has become more clear, I often find myself questioning this choice.

https://www.washingtonpost.com/business/2023/08/04/doctor-pay-shortage/

I am out-earning almost all of my friends in finance and start-ups/tech. Granted, they got to start much earlier than me, but they have much less job security. Some have been fired from FAANG. Finance is not an easy road to make 7 figures...lots of "call" and stress. Also, a lot of their compensation is in RSUs, but I get paid in cash which dollar-for-dollar is much more valuable. Most of them must live in very high COL hubs, whereas I am free to practice in much more reasonably priced areas. Often they age out of their profession in their 40s or 50s, but doctors in their 60s are in very high demand (if they still want to work).

Incidentally, they also don't enjoy their jobs nearly as much as I do, as in general FAANG is a bunch of nonsense and finance is the same. They recognize they have sold their souls for money; I go home energized by the lives I saved.

rest assured you can have a very nice quality of life, e.g. provide for your family and build substantial wealth, as an academic physician-scientist in many different specialties.

 

[dl2dp2]

I will probably have an exceptional application for psychiatry just on the back of my research but I am unsure whether it will bring in enough money to justify the emotional costs.

My friends are in finance or in start ups or tech right now and are grossly out earning most physicians. I think medicine is a very stable path to financial security and wealth for most people but as my family’s financial picture has become more clear, I often find myself questioning this choice.

Psych is an interesting field. A large number of MD PhDs who were attracted to psych end up doing pure clinical psychiatry (often psychoanalytically oriented psychiatry), as this field is clinically, and intellectually very satisfying and in the right context can compare favorably to the best lifestyle medicine specialties in all of medicine. On a per-hour basis, it reimburses very well. Currently, inpatient units are paying $250 per hour *net* in locum and private practice of course you can make substantially more. If you work 60 billable hours a week, like a cardiologist, you can probably easily make cardiology money in most metros. It's also a lot more flexible than many fields where clinicians can elect to work as much or as little as they want.

However, if you go the physician-scientist track in psychiatry, which is also well-trodden, financially it's a stretch. Most of the department chairs in mid-tier programs don't clear 350k. The typical outcome is one trains at a top residency/fellowship and then goes to a mid-tier program to get tenure with a mid-200k in 2023 dollars personal salary, and a senior faculty might get between 300 and 350k. This is definitely doable, if not luxurious, in Cincinnati or Winston-Salem, but not sure if that's the sort of life you have in mind... Now I suppose if there's no restrictive covenant you can work 20 hours in the physician-scientist job that says you are 80% research, then work another 20 hours locum getting $250k. That'll get you to 500k. That happens and is a path forward but I don't think it's a lifestyle-friendly. But you probably still work less than a surgeon. Still, many departments DO have restrictive covenants and then you are SOL.