Poll & General Discussion on Physician Scientist Career

[SynBio]

1.

Hey all,

To deviate from the typical "what are my chances threads" I thought it would be interesting to poll

--individuals that are preparing to go down the physician scientist path (MD applicants & MD-PhD applicants),
--individuals that are currently going down the initial physician scientist path (MD students & MD-PhD students),
--individuals that are currently going down the middle physician scientist path (residents, post-docs, & fellows)
--individuals that are currently going down the late physician scientist path (assistant professor, associate, full, or industry)
--individuals that have left the physician scientist pathway to focus on clinical duty alone or basic science research alone.

And see which area of medicine THEY believe best facilitates physician scientist goals. I think these goals are discussed a lot, but the simplest summary might be spends a significant amount of time each week doing research and routinely sees/treats/diagnoses/interacts/etc. with patients each week. The actual amount of time may vary by individual, but I think many can agree these are the two main components.

Obviously, there is no right answer, I just would like to get opinions.

As a disclaimer, I obviously was limited to space on this poll so don't be angry if left out your specialty, just add it below!

Also, feel free to be even more specific and list sub-specialties!

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2.
Additionally, I know many times, people decide to focus on either clinical work or basic science alone. Perhaps, those of you that have, can comment on non-monetary factors that lead to this. Of course, there are many variables that would influence this, but maybe comment on aspects related to your specialty that influenced this decision and how it influenced your career as a physician, a scientist, or a physician-scientist.

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3.
I was hoping some of the members who have gone through the training process in particular specialties could comment on non-monetary aspects of their specialty which are productive to a physician scientist career and those which are unproductive.

My goal here is not to point fingers and say this 'specialty is better than that specialty' for a physician scientist career, but to compile pros and cons through opinions and experiences of different areas of medicine.

Perhaps,

@Spacedman could comment on anesthesiology,
@gutonc & @Doctor&Geek could comment on medical oncology,
@gbwillner on pathology,
@Gfunk6 & @Neuronix could comment on radiation oncology,
@Fencer could comment on neurology,
@tr and @sluox could comment on psychiatry.

Also, any others that join in is well appreciated .
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I know funding is a BIG reason why many people leave the physician scientist pathway. However, for the sake of this discussion I was hoping we can focus on other aspects (good or bad) with the physician scientist pathway.

I would like to do this because

1) it seems like many of the discussion on this topic break down to a funding problem (which perhaps is rightfully so), but sometimes overshadow other pros or cons

and

2) Money is a problem with any career, any interest, any goal, anything in life, so this is a given anyway. Let's talk about other things that are or are not always a given.

As a ending note, there are a lot of good threads out there for others interested in some of these topics and more including:

1. Here.
2. Here.
3. Here.

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[Neuronix]

And see which area of medicine THEY believe best facilitates physician scientist goals. I think these goals are discussed a lot, but the simplest summary might be spends a significant amount of time each week doing research and routinely sees/treats/diagnoses/interacts/etc. with patients each week. The actual amount of time may vary by individual, but I think many can agree these are the two main components.

Obviously, there is no right answer, I just would like to get opinions.

As a disclaimer, I obviously was limited to space on this poll so don't be angry if left out your specialty, just add it below!

Also, feel free to be even more specific and list sub-specialties!

None of the above. It's hard to be a physician-scientist in any specialty. It's more important to pick a specialty that you enjoy clinically. I don't see the problems for physician-scientists as specialty specific problems.

2.
Additionally, I know many times, people decide to focus on either clinical work or basic science alone. Perhaps, those of you that have, can comment on non-monetary factors that lead to this. Of course, there are many variables that would influence this, but maybe comment on aspects related to your specialty that influenced this decision and how it influenced your career as a physician, a scientist, or a physician-scientist.

You linked multiple threads where this has been discussed by everyone you're asking. I don't know what else you expect us to say.

3. I was hoping some of the members who have gone through the training process in particular specialties could comment on non-monetary aspects of their specialty which are productive to a physician scientist career and those which are unproductive.

1) it seems like many of the discussion on this topic break down to a funding problem (which perhaps is rightfully so), but sometimes overshadow other pros or cons

and

2) Money is a problem with any career, any interest, any goal, anything in life, so this is a given anyway. Let's talk about other things that are or are not always a given.

Money is the root of the entire problem. You expect a salary that has to come from somewhere. If there are very few grants large enough to support your salary, and your odds are getting one are slim, how do you expect to be a researcher? All the problems stem from this. I don't understand what you're asking otherwise.

 

[SynBio]

It's hard to be a physician-scientist in any specialty.

I imagine so, I am not saying otherwise.

It's more important to pick a specialty that you enjoy clinically. I don't see the problems for physician-scientists as specialty specific problems.

I think there is some validity to this statement, but I would suspect one would at least attempt to seek research experiences related to the medical specialty they are interested in anyway.

Say I am really interested in cancer biology. I could go into medical oncology, radiation oncology, surgical oncology, or pathology to name several. Would you agree/disagree that despite the variation in physician-scientist support structures in each of these specialties, your chances of obtaining funding are independent of which route you choose?

You linked multiple threads where this has been discussed by everyone you're asking. I don't know what else you expect us to say.

I am curious about the more subtle attributes within these specialties that may affect the success of physician scientist. These are all related to money? What about social support systems for residents/post-docs/fellows/assistant professors such as the ones that exist in MD-PhD programs (journal clubs, yearly retreats, yearly poster/presentation meetings) or are these aspects weak to non-existent after medical school/dual degree program? If these do exist, don't these affect, at least partially, the accomplishment of physician scientist goals?

Money is the root of the entire problem. You expect a salary that has to come from somewhere. If there are very few grants large enough to support your salary, and your odds are getting one are slim, how do you expect to be a researcher? All the problems stem from this.

I realize this is the rate-limiting step. I am simply interested in what these subtle supportive/inhibitory aspects in each specialty. Perhaps you are right and these problems are all derived from financial pressures.

 

[Neuronix]

Say I am really interested in cancer biology. I could go into medical oncology, radiation oncology, surgical oncology, or pathology to name several. Would you agree/disagree that despite the variation in physician-scientist support structures in each of these specialties, your chances of obtaining funding are independent of which route you choose?

I would agree with that statement. There is no clear data to indicate one way or the other.

I am curious about the more subtle attributes within these specialties that may affect the success of physician scientist. These are all related to money? What about social support systems for residents/post-docs/fellows/assistant professors such as the ones that exist in MD-PhD programs (journal clubs, yearly retreats, yearly poster/presentation meetings) or are these aspects weak to non-existent after medical school/dual degree program? If these do exist, don't these affect, at least partially, the accomplishment of physician scientist goals?

Those are program specific, not specialty specific. There are physician-scientist supporting programs in all specialties, and there are programs that do not support physician-scientists in all specialties.

I realize this is the rate-limiting step. I am simply interested in what these subtle supportive/inhibitory aspects in each specialty. Perhaps you are right and these problems are all derived from financial pressures.

Choose the specialty you enjoy doing clinically, then worry about how to build a career as a physician-scientist in that specialty later. In radiation oncology, that pathway includes a Holman Pathway residency, hopefully with some grant support by the time you finish residency, followed by either research fellowship or instructor/asst prof appointment.

 

[tr]

I know funding is a BIG reason why many people leave the physician scientist pathway. However, for the sake of this discussion I was hoping we can focus on other aspects (good or bad) with the physician scientist pathway.

I didn't vote on the poll because I only have experience in my own specialty so I can't reasonably compare it to any other specialty.

I do think psychiatry is a fantastic place for physician-scientists though, mainly because the territory is so unexplored. We have no (or extremely minimal) pathophysiology for the vast majority of the disorders we see. This means that there are a large number of totally unsolved and mostly unexplored questions, and it's relatively easy to find an area of research where you can make an impactful contribution.

Also the actual clinical practice is not very intellectually demanding (at least the psychopharm is not - good therapy is very hard to do) so you can easily do it 20% time or less without worrying about skill loss. Also from a monetary standpoint, there's the option of doing private practice, without accepting insurance - private pay only - for almost no overhead. If you are boarded in psychiatry you can get some malpractice insurance (cheap for us), rent a room, hang out a shingle, and get going. This is unique to psychiatry as far as I know, and it can potentially be combined with academics (depending on the tolerance of your department chair) for a salary bump, which can make the whole business of being a penniless researcher much more tolerable.

I do agree with Neuronix that this stuff

What about social support systems for residents/post-docs/fellows/assistant professors such as the ones that exist in MD-PhD programs (journal clubs, yearly retreats, yearly poster/presentation meetings)

seems to be much more program-dependent than specialty-dependent. You could probably find programs in almost any specialty that are very supportive of research, and others that are not at all supportive of research.

However I don't think the things you mentioned are actually important factors. More important are whether the department is willing to offer salary support for research during your residency, fellowship, postdoc, or early faculty stages; how much protected time might be available; what mentors are there; how open the research community is to collaboration; and other stuff like that. I really can't imagine these things would differ across specialties in a meaningful way. I think it's much more fine-grained and dependent on your chair, program director, and the culture of your institution and department.