Thank you all for your helpful feedback! There were a lot of things that I had not known that you all brought to my attention. I'll do my best to answer your clarifying questions below, but judging by the feedback already mentioned, I already acknowledge that my theoretical plan is a terrible idea. I think I'll just enjoy my time during research in school, then focus on being a great psychiatrist after residency.
Big question would be, when do you plan on getting the extra research training in the first place, and how do you plan on keeping your research skills, stats knowledge sharp in the 20-30 year interval? Also, I'd say it is much harder to go from all or mostly clinical to research than the other way around. I can't imagine any place is really going to want to hire a late career clinician with no research portfolio. They're going to want the early career people with an established research line. What kind of research job do you envision having?
Great questions that I don't really have an answer for. Thank you for bringing this up. I did not think about that. Although, please entertain this scenario for a second. It is very reasonable to assume that a late career clinician without a research portfolio would not get very far. Would a late career clinician with a research portfolio dating back to prior medical school graduation make any difference? Or would they still be SOL? I suppose it would depend on the quality and significance of the research?
Generally, no. The direction of flow is from research to practice, not the reverse.
Clinical practice is noncompetitive: once you meet your licensing bar, it's straightforward to get a job or hang up a shingle. It's also nonprogressive: a clinician who has been practicing for 30 years isn't doing anything substantially different from one who has been practicing for 3.
Research is highly competitive (because you have to get people to give you money to do it), and also hierarchical and progressive, in that your ability to get the money and do the work is a function of what you have done previously, which gives you a basis to build on and also a track record of credibility with funders.
People bail out of research for other things, including clinical work, as a matter of course, at all stages of the pipeline, because it is competitive and few people reach the top of the pyramid. Conversely, it's extremely difficult to get back into research after having left it. Typically you would have to get back on the bottom rung by doing a PhD or, if you already have one, a postdoc. (An undesirable one usually, since the desirable postdocs will be taken by hungry young graduates.)
Thank you for being so detailed! Another person echoed your same sentiment that you'd need to start a Ph.D or postdoc to make this work, and even then, it seems to be an unnecessarily long road.
Do you want to do ‘big r’ research or ‘little r’ research? Transitioning to Research that far out of training won’t happen. If you are 20-30 years out, you would be ineligible for most, if not all training grants or early career awards(typically allowed for 3-5 years post last degree). NIH/VA funding would not be possible, or feasible. It’s possible to restart the clock if you get another degree, say a PhD, but otherwise you’re SOL. For bigger awards you’d be competing against people with much more success, so it would be a very uphill battle.
Being successful in research has very little to do with curiosity, intelligence, good ideas(IMO). It boils down to can you sell an idea to a group of people and also accept that you will likely suffer through several years of grant rejections before something sticks. Of course there are exceptions, but the best folks for researchers are those who are completely singleminded and tolerate a lot of rejection.
‘little r’ research you could do the whole time you’re a clinician. You could increase/decrease your time over the 20 years depending on what you like/don’t like. I know several folks who are mostly clinicians in community practice who are running clinical trials from their office—it takes luck, wealthy friends/philanthropy, good ideas and timing, and a lot of effort.
considering you might die before that 20 year mark, if you’re wanting to do research, I’d not plan on waiting.
Becoming ineligible for grants for this reason is definitely unexpected, but not surprising. It was certainly not something I considered when initially writing my post. Thank you for bringing it to my attention.
What you mention about "little r research" intrigues me. Could you go into more detail as to what that would look like? For instance, I'm passionate about human behavior, so my theoretical future research would most likely be about that.
I'd be interested in knowing the reasons for pursuing such a path.
A lot of research can be very technically demanding and by the time you're 50 or 60, it's harder to pick up skills. A lot of research also takes a lot of time to become productive and got to think how much time you'd have to spend on that career before hitting retirement.
As for feasibility, it would be almost impossible to become an NIH funded PI starting from scratch at that age. Unless you're willing to do a PhD (and get accepted). I do know one person who started very late at that age, but the question is if you're willing to do a PhD at 50. You might be eligible for a T32 which are not very competitive, but programs want applicants who can get K awards which are much more competitive and your path/age will become a liability. In both cases, you'd be paid peanuts and the level of stress is extremely high.
Also bare in mind that this is 20-30 years projecting forward. We have no idea how the research world might look at that time. I think the education/training fields is changing drastically so options/opportunities might be very different.
I'm now realizing that my thought process was very flawed, as any naive premed will be at times. My reason for theoretically pursing such a path was to treat a wide variety of patients over a significant period of time, then use those experiences to develop more insightful research. It feels quite silly to write that out given what I now know, but that was my reasoning nonetheless.
Your point on the research world being uncertain 20-30 years from now is completely valid. I imagine it will be incredibly different from today, for better or for worse. I still wanted to pose my question in the event that my thinking was incredibly flawed, which in this case, it is.
I think you should at least TRY some actual research as a pre-med to get a sense for whether it is a passion or just a fascination.
Having done a PhD and some post-doctoral research, I'll testify that it is definitely not for everyone.
Already in the process of doing this!
Re: your question about forensic psychiatry, starting fellowship after a period of practice is entirely possible and can even be viewed as a positive. Whether you can stand going back to the pay and status of "trainee" after so long is the bigger issue. Most people can't.
Thank you so much for addressing this! I'm happy to know that it's not entirely impossible like my other question. When you say it can be viewed as a positive, does that mean I would potentially have a competitive advantage over my peers when applying? Level playing field? Less so, but still at a disadvantage?
