residency vs postdoc

[skittles]

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Do MD/PhDs usually do both a residency and a postdoc? If so in which order? Which way are you guys going? Why? Are there programs that combine residencies and postdocs?

 

[neurotiger]

It seems like most people from most institutions are doing residencies after completing both degrees...this is a question I keep asking at interviews though. I would be curious to find out if there are any institutions that encourage/produce more students doing post-docs...

 

[GlcNac]

At Stanford they seemed to emphasize that they really like to produce physician-scientists . I think they said that in a typical class, ~25% go on to do a post-doc and the other 75% do a residency.

 

[Habari]

a lot of residency programs that are geared to mdphds allow for 'short tracking' - finishing a residency a year earlier, and spending that time doing research [usually in concert with a subsequent fellowship]. it is the same amount of time but you have protected research time.

programs vary in structure and flexibility.

there are certainly pros and cons to this - and the guidance of your advisors at med school will point you to programs that are 'front-loaded' so you don't miss too much by shorttracking [though many clinicians will insist that you are not getting sufficient training].

traditional routs of pure clinical residency or trad post-doc certainly exist, and every year a couple people seem to go to the latter from our program. the residency programs here also seem to allow you to construct very unique arrangements with any of the 3 nearby institutions.

since this pathway is still far from canonical, there is a lot of flexibility in finding or designing exactly what you want. it takes knowing the programs/people to make it happen.

 

[looseygoosey]

San Diego and Columbia appeared to have a high % (20-40% like Stanford) go straight into a Post-Doc bypassing residency opportunities.

 

[Neuronix]

I'm not sure I believe the 20%+ statistics of students going straight into post-docs. The matchlists I've seen at Penn and at other programs where I interviewed showed much smaller numbers of people going straight to post-doc, averaging more like one per year. Does anyone know of displayed MSTP matchlists that show such high numbers of post-docing students?

In any case, I think all programs, especially the bigger name ones, are heavily recruiting students to become researchers. I certainly see it here, though their take on residency is that it's a necessary continuation of your clinical training in order to become a physician-scientist. There of course does seem to be an occasional student who goes straight to post-doc, and I think the administration is pretty happy with them.

 

[brotherbu]

Pardon me for being ignorant, but although I know how long trad residencies are, how long are trad post-docs and how long are the residencies that incorporate the two??

Brian

 

[skittles]

Originally posted by brotherbu
Pardon me for being ignorant, but although I know how long trad residencies are, how long are trad post-docs and how long are the residencies that incorporate the two??

Brian

From what the postdocs I worked under told me, it's 3 to 5 years. But I've also heard of people taking much longer than that.

So it sounds from these posts that if you want to do a residency, you have to do one right after md/phd. And then if you want to do research, you have to do a postdoc too? Geez, isn't that like another 8 years or so post-md/phd before you can get to a position where you can run your own lab?

😕 😱

 

[Nuel]

Originally posted by skittles
From what the postdocs I worked under told me, it's 3 to 5 years. But I've also heard of people taking much longer than that.

So it sounds from these posts that if you want to do a residency, you have to do one right after md/phd. And then if you want to do research, you have to do a postdoc too? Geez, isn't that like another 8 years or so post-md/phd before you can get to a position where you can run your own lab?

😕 😱

Though still far from the destiny, my plan is to do 4 yrs neurology residency, 3 year pos-doc. I am young, and God-willing, I will take it.

 

[Primate]

Fast track through medicine and do research during fellowship. Saves a couple years. In clinical med, you typically have 10 (rather than 6) years to come up for tenure, so you have a bit more time to get things going. It ends up being less than 8 years to your first "real job." (not to tenure, just the first professorship) More like 5-6. Not short, but that's only like half a neurosurge residency. 😉 Sorry Neuronix, just kidding. Oh wait......

Really, the best way to run a lab quickly is to rocket through a PhD, do a super-productive 3 year post doc in which you publish in top journals, and then get REALLY lucky the year you're looking for a job and have no other good candidates but lots of positions available. If you can swing that, congrats. If not, welcome to the world of a typical CD interested in lab work.

It takes a while, but it's fun. Path is a great way to go - 4 years total to do residency and fellowship (AP/NP for instance). 2 quick years in a productive lab after that and you're good to go, for a total of only ~12-14 years school after undergrad (and that's if you're FAST).

My point - there are ways to shorten the training, but the quickest route is to NOT do a combined degree. Before everyone gets all upset, I'm not saying that quickest = best. Different goals require different actions.

Best (and off to a stroke pt. admission - woohooooo! Brains are fun even when they don't work right - self included),
P

Four years of medical school - 4 years
Four years of PhD - 4 years
Four years of residency - 4 years
Two years of fellowship - 2 years
Three years of post-doc - 3 years

Having more degrees than a thermometer - timeless.

 

[Primate]

Corollary (Nuel's post-script reminds of this):

The race does not always go to the fastest.

But that IS the way to bet. 😉

P

 

[skittles]

So why do the PhD component if you can get through to the research part 3 or 4 years sooner? You can do a postdoc with an MD. And you can do special research programs that NIH or even a few med schools offer MD students, meaning you can be very emersed in research. And you can still be very competitive for grants (so long as your research proposals are very good). So yeah, it costs money to just do the MD, but then you're out a lot earlier. Why do you do it?

 

[dl2dp2]

as far as i know, (new information since my drawn out post of analysis about why getting out fastest entails NOT getting the combined degree):

(1) You can "fast-track" a number of residencies, including but not limited to: medicine, pathology, neurology, psychiatry
(2) You can do a pure research or 10% clinical 90% research fellowship (in fact, clinical time may even be smaller than 10%...like one afternoon every TWO TO THREE WEEKS). You get paid >=$80,000, while doing the work of a postdoc!
(3) MD/PhDs elegible for something called K12/K23 (don't remember the exact number) training grant that is NOT available for people with a PhD only. The salary cap is ~$125,000. Meaning: if the instituion can't pay for a purely research based fellowship, NIH can, and pretty sweetly too.
(4) Generally speaking, you write your first R01 during your fellowship years. Once you got your R01, any institution would want to hire you so long as they have a space. So it's not contingent upon the "vacant" spot per se. It's more about how much money can you bring into a particular institution. Of course, the more the merrier. High profile institutes generally don't give any additional funding to researchers.

Hence: you have two options: (1) get a ridiculous amount of grants from NIH/other agencies, and draw your own payroll from the grant
(2) take partial clinical positions to supplant your payroll and fund your research in part

the second route is taken most frequently by people like orthopedic/neurosurgeons because the (academic) practice is generally SO lucrative that they can spend 1 day a week doing operations and fully fund their research projects without the trouble of applying for NIH money.


BTW, these days in medical school departments, "tenure" has lost its meaning. As most of the professors get their payroll out of the NIH budget, the institution doesn't pay a dime and will not garentee anything besides the working space/supply of post-docs or grad students (and sometimes not even that, and you DO have to pay your employees as well) Hence, even if you were "tenured", you may still fire yourself if you, say, lost a grant during an application cycle.

On the other hand, there is suffecient money in biomedical research that some hot-shot researchers can make 7 digits through both public and private funding. Are we in better shoes compare to humanities professors? You judge for yourself...

 

[nuclearrabbit77]

You are refering to the NIH K award series, which essentially is a career development grant program that isn't MD/Ph.D exclusive.

http://grants1.nih.gov/training/careerdevelopmentawards.htm

good luck MSTP'ers. sometimes i really think that i'm a MSTP'er at heart but we'll see if i'll be successful doing research with just the MD.

 

[Primate]

OK, for something like the THOUSANDTH time, MD v PhD v MSTP are different. Pros and cons to each. Figure out what you most want to get out of your training/career and go for it. For some, it's an MD and research, others private practice, the PhD, others the combined degree. For an idea of the difference, try the search function in this forum - it's been commented on at some length.

For me, the CD made the most sense. That's all that matters.

P

 

[Stroganoff]

What's a CD? Certified Doctor? Pardon my innocence.

 

[dl2dp2]

Actually...i disagree...if anything, at the later stages of your career, whether you have an MD or a PhD or an MD PhD probably doesn't matter. I think we ought to be delivering a different message: don't do a degree program because what you think it'll do for your career...instead, do a degree program because you like the program itself.

Originally posted by Primate
OK, for something like the THOUSANDTH time, MD v PhD v MSTP are different. Pros and cons to each. Figure out what you most want to get out of your training/career and go for it. For some, it's an MD and research, others private practice, the PhD, others the combined degree. For an idea of the difference, try the search function in this forum - it's been commented on at some length.

For me, the CD made the most sense. That's all that matters.

P

 

[nuclearrabbit77]

my post was meant to clarify the K award, not to ask you what the difference between md v phd v MSTP is.

Originally posted by Primate
OK, for something like the THOUSANDTH time, MD v PhD v MSTP are different. Pros and cons to each. Figure out what you most want to get out of your training/career and go for it. For some, it's an MD and research, others private practice, the PhD, others the combined degree. For an idea of the difference, try the search function in this forum - it's been commented on at some length.

For me, the CD made the most sense. That's all that matters.

P

 

[Andrew_Doan]

Originally posted by skittles
Do MD/PhDs usually do both a residency and a postdoc? If so in which order? Which way are you guys going? Why? Are there programs that combine residencies and postdocs?

Most MD-PhD grads complete residencies and then fellowships. During both the residency and fellowship, there are opportunities to do research.

A few grads do postdocs, but the ones that do only postdocs do not practice clinical medicine.

 

[Primate]

Originally posted by nuclearrabbit77
my post was meant to clarify the K award, not to ask you what the difference between md v phd v MSTP is.

Hi,

I know - my post wasn't in response to yours (it just happened to be right after yours). It was in response to the several before.

P

PS - "CD" = combined degree. Just a shorthand we use here that may not be common - you just get used to saying it.

 

[ImmunoANT]

just out of curiosity,
what kind of residency are you guys thinking of?
I know it's kind 10 years from now, and there's no way of knowing what'll happen either. But am just curious.
How is that related to your graduate work?

For me, I am intersted in immunology / genetics for my graduate work. As for residency, am intersted in pathology, and urology, as least for now.

Any feedback??? 😀 😀

 

[surge]

Originally posted by sluox

(2) take partial clinical positions to supplant your payroll and fund your research in part

the second route is taken most frequently by people like orthopedic/neurosurgeons because the (academic) practice is generally SO lucrative that they can spend 1 day a week doing operations and fully fund their research projects without the trouble of applying for NIH money.

This is very interesting - I was never aware of this.
Isn't it the usual argument against MSTPs doing surgery that there is no time for research because you CANNOT do very limited part-time clinical practice?
Do you know of people doing this?

 

[Neuronix]

Originally posted by sluox
the second route is taken most frequently by people like orthopedic/neurosurgeons because the (academic) practice is generally SO lucrative that they can spend 1 day a week doing operations and fully fund their research projects without the trouble of applying for NIH money.

Wait, I just noticed this. To cover overhead and malpractice insurance you would have to be operating at least 1 day a week (2?). I can't believe enough money would be made with this strategy.

There are several people mixing research and surgery here at Penn, though I don't know how possible it is to get much below about 30% clinical due to overhead and technical profeciency concerns. Here's one Neurosurgery example with a basic science lab who does about 50/50: http://www.uphs.upenn.edu/neursurg/faculty/orourke.html. There are others in neurosurgery here who are more clinical, but still devote a certain percentage of their time (20% - 30%) to translational research collaborations. I met a few months ago with a fetal surgeon who does about 70 (research) / 30 (clinical) and today I met with a neurologist who is about 50 / 50 and has several grad students. He's just not my type because he's doing almost exclusively computer modeling. There's plenty more examples. Anyone who says that surgery and research are not possible are just plain wrong. It may be challenging and the majority may just do clinical work--that's true--but there are plenty of examples of surgeons doing translational or even basic research.

I don't know exactly how it plays out with authorship and PI on grants, but everything here at Penn Bioengineering/Neurosurgery is so collaborative I can never make any sense out of whose money is whose anyways.

 

[surge]

Originally posted by Neuronix
Wait, I just noticed this. To cover overhead and malpractice insurance you would have to be operating at least 1 day a week (2?). I can't believe enough money would be made with this strategy.

That would definitely be my guess

There are several people mixing research and surgery here at Penn, though I don't know how possible it is to get much below about 30% clinical due to overhead and technical profeciency concerns. Here's one Neurosurgery example with a basic science lab who does about 50/50: http://www.uphs.upenn.edu/neursurg/faculty/orourke.html.

This guy sounds very interesting. I have to admit, as much as I hate it, that as of now I have been unable to find someone similar at Yale. The search continues.

Anyone who says that surgery and research are not possible are just plain wrong. It may be challenging and the majority may just do clinical work--that's true--but there are plenty of examples of surgeons doing translational or even basic research.

Word.
And that's why we'll be so cool when we grow up 😉

I got asked that at an interview (rather, the guy was telling me how there are no real surgeon scientists) - and I told him: "Great, then I'll be the first one". He thought it was a good answer (albeit by definition, a bit arrogant). I got in 😀

 

[dl2dp2]

There is a guy named Mehmet Oz who does thoracic surgery at Columbia. He makes over a million a year (his salary is public data on the Chronicles of Higher Education database) and he does both surgery and runs a lab, which does mostly basic science (biomechanics of the valves? i don't think molecular biology though...most translational i guess) stuffy about the heart.

AND, he has a show on Discovery Channel...AND he appeared on Oprah...Just to show you that, YES 🙂 you can be a surgeon and run a lab...though he never bothered with a PhD. On the other hand, i've known a couple of neurosurgeons who are MD/PhDs. actually I think it's a somewhat useful credential, particularly when neurosurgery these days are so high-tech (even compared to the other surgerical specialties). Although, they do have portions of that residency devoted to research. One recent paper on Nature was a neurosurgeon at Yale?? collaborating with neurologist in planting depth electrodes in the hippocampus and record memory related activity from HUMAN (for localizing epleptic seizure sources) (i can't remember the exact citation...but remember most of the memory experiemnts currently are from rats, so it was somewhat exciting) Actually I think neurosurgey, which occurs while the patient is awake and alert, is one of the ONLY pathways that we may be able to solve of the most foundamental problems in neuroscience, particularly in higher cognitive functions that are NOT present EVEN IN monkeys. Alas, do I digress 🙂 I just need a few more good neurosurgeons to collaborate with...

The residency director for orthopedic surgery at Columbia recently gave a talk to the medical students. And he said that basically he has 1 day a week of surgerical appoints and about two full days which was scheduled for research, but is often taken to advise 3rd year medical students on rotation. (YES you DO have to teach them 🙂 ) But he said that he is able to fund most of the research through his practice, where the rest is funded by a private grant. So he never was involved with the whole NIH/R01 biz.

And, by the way, the overhead/malpractice is taken care of by the hospital generally, so even though you'd be expected to get paid much less than if you were in a private hospital, the hassle level is much lower.

Unfortunately this doesn't apply to the medicine field at large...most of the researchers in the Dept of Medicine/Pathology/Neurology etc have full blown R01 grants or large grants from private foundations (i.e. Keck/Sloan etc) from which most of their salary comes out of. And they practice very little (some only moonlight on weekends, AT HOME 🙂 which is sweet)

 

[msdaisy]

What are the hours like for a typical post-doc?

 

[gutonc]

What are the hours like for a typical post-doc?

I worked more hours during the post-doc part of my fellowship than I did during the purely clinical part.

 

[Student's T]

Haha, Dr. Oz, what a joke...

 

[gutonc]

Haha, Dr. Oz, what a joke...

You do realize that you're commenting on an 11 year old thread, right? I mean, I know I did it to, but at least I knew about it going in.

 

[Petypet]

What are the hours like for a typical post-doc?

Necrobump!

I worked between 50-70 hours per week. However, there is a lot of downtime while waiting for experiments to run (cells to grow, mice to grow, etc etc etc).

 

[dl2dp2]

(1) You can "fast-track" a number of residencies, including but not limited to: medicine, pathology, neurology, psychiatry
(2) You can do a pure research or 10% clinical 90% research fellowship (in fact, clinical time may even be smaller than 10%...like one afternoon every TWO TO THREE WEEKS). You get paid >=$80,000, while doing the work of a postdoc!
(3) MD/PhDs elegible for something called K12/K23 (don't remember the exact number) training grant that is NOT available for people with a PhD only. The salary cap is ~$125,000. Meaning: if the instituion can't pay for a purely research based fellowship, NIH can, and pretty sweetly too.
(4) Generally speaking, you write your first R01 during your fellowship years. Once you got your R01, any institution would want to hire you so long as they have a space. So it's not contingent upon the "vacant" spot per se. It's more about how much money can you bring into a particular institution. Of course, the more the merrier. High profile institutes generally don't give any additional funding to researchers.

On the other hand, there is sufficient money in biomedical research that some hot-shot researchers can make 7 digits through both public and private funding. Are we in better shoes compare to humanities professors? You judge for yourself...

Wow. I'm reading the post I made 11 years ago... I feel like a completely different person. On the other hand, the information that I posted back then is essentially still correct, so I suppose I was not misinformed.

Everyone can disregard the Dr. Oz post. I feel ashamed just reading it.

A few corrections to my original post. (1) The K award program is K23/K08 for MDs and MD/PhDs, which still exists and in some ways a "loophole" for MSTPs to at least get a foot in the door for a junior faculty position.

(2) the salary numbers are still pretty much correct. Which is a testament of the sad state of affairs, given that this is the 2003 number, it's pretty fair to say that the NIH salary line has not been kept up with inflation and basically is more like subprime housing than an actual viable line of work.

(3) I think while I wasn't entirely wrong that many fellows, especially senior fellows, wrote R01s during fellowship, this is now extremely rare. Senior fellows generally now only gun for K awards, which are much smaller and less viable to start a basic science lab without significant institutional start-up.

(4) There are perhaps still a ? handful (maybe slightly more, a dozen?) of researchers (lets say someone who's a PI on at least one R01) in the country who draw 7 digit salaries, primarily through their links with intellectual property and administrative roles, as well as extremely profitable clinical work (i.e. mostly subspecialty surgery, but also occasionally interventional cardiology, and niche fields like dermatopathology and retinal surgery) but now that I'm more aware of the institutional ins-and-outs of salary standards, I can say that the vast vast majority (99.99%) of academic faculty members in cognitive specialties operate under a "salary cap." Which means that even if you can bring in 10 millions of grants a year, your salary is still capped by the institution and NIH's rule on "percent effort". It will still be higher than everyone else's salary, but you won't become a private equity maven. When academic physician researchers make a lot of money, it's almost always *outside* of their research work. Interestingly, this thread does track the career of Dr. Oz, who's at the time a relative unknown and still had involvements with NIH grants, yet was netting more than 1 mil mostly through his cardiac valve surgery revenue. At this point I do not think he does any research, but he probably makes a much higher salary.

All in all, on average the physician-scientist track in a cognitive specialty can expect about ~150k to start as a junior faculty member and perhaps 250k in mid/late career. 30-40% higher salary is to be expected for a procedural specialty, but as you can see, the difference is really not meaningful enough to go into a specialty you won't enjoy. There is some variability depending on the mix of grant/clinical revenue, but suffice it is to say, it's not the most optimal way to make a lot of money, but you still make much more than the vast majority of university professors.

 

[tr]

For the person who bumped this ancient thread to ask

What are the hours like for a typical post-doc?

I think your average postdoc in a wet lab probably works 50-70 hours per week, though there are always the stalwart few who refuse to work more than 40 hours for $45K/year, which is a valid stance IMO.

I just want to emphasize that this is strongly strongly dependent on your field though. I notice that people who do computational, theoretical, or epidemiological work where a lot of the work involves crunching numbers tend to work significantly fewer hours than people who do wet-lab work. It's just easier to put a boundary on your hours when you can take a break any time without destroying hours or days of previous time investment.



On Dr. Oz: He was a legitimate faculty physician at CUMC back when this thread originated. Who could know then what the future held?

 

[tr]

(3) I think while I wasn't entirely wrong that many fellows, especially senior fellows, wrote R01s during fellowship, this is now extremely rare. Senior fellows generally now only gun for K awards, which are much smaller and less viable to start a basic science lab without significant institutional start-up.

I don't think you can be eligible for an R-level award as a fellow. At my institution, fellows can only apply for K awards, with a 'PI waiver' that states they will be granted faculty status when the award begins. You have to be at least an Instructor to apply for an R-level award.

 

[Student's T]

You do realize that you're commenting on an 11 year old thread, right? I mean, I know I did it to, but at least I knew about it going in.

Yes. It just shows how somebody's career can change over the course of a decade or so.

Oz sighed. “Medicine is a very religious experience,” he said. “I have my religion and you have yours. It becomes difficult for us to agree on what we think works, since so much of it is in the eye of the beholder. Data is rarely clean.” All facts come with a point of view. But his spin on it—that one can simply choose those which make sense, rather than data that happen to be true—was chilling. “You find the arguments that support your data,” he said, “and it’s my fact versus your fact.”

http://www.newyorker.com/magazine/2013/02/04/the-operator

 

[dl2dp2]

I don't think you can be eligible for an R-level award as a fellow. At my institution, fellows can only apply for K awards, with a 'PI waiver' that states they will be granted faculty status when the award begins. You have to be at least an Instructor to apply for an R-level award.

I vaguely remember back then a number of examples of senior fellows in their last year filing for R01s, especially in clinical research, with their salary supporting the first year of faculty research. But you are absolutely right, this is extremely rare (if even technically feasible) now. I think this is a genuine change where R01s in clinical research were not as competitive. Ks were really used for residents to file for fellowship research funding. Today it's very clear that Ks are generally for your first faculty job.

 

[gbwillner]

I vaguely remember back then a number of examples of senior fellows in their last year filing for R01s, especially in clinical research, with their salary supporting the first year of faculty research. But you are absolutely right, this is extremely rare (if even technically feasible) now. I think this is a genuine change where R01s in clinical research were not as competitive. Ks were really used for residents to file for fellowship research funding. Today it's very clear that Ks are generally for your first faculty job.

For the record, you technically cannot apply for a K award until you have documentation that you have a faculty position as of the time when the K would begin funding. There are no exceptions. I don't think this is something new, either.

So you can apply for a K while as a fellow, but you have to have your faculty position lined up to being within 4-6 months or whenever the funding would begin on said grant. And this requires a letter from the chair that you have formally been given the position. You can use this letter as leverage even if you do not acquire the grant, as the grant stipulates that your position cannot be contingent upon you getting the money.

As for an R as a fellow... As primary PI... Forget it. Even if it was possible before it is impossible now. You need to have clear documented results and publications showing that you are a leader in a field, with a proven track record of success. Good luck when you are spending most of your time in the clinic as scut-monkey.

 

[Elixir6]

Interesting decade old zombie thread here...

I have to say, being in the last throes of my PhD, I find it hard to imagine I will ever touch a pipette again unless I find the an great project, awesome PI and a tonne of good support personnel and collaborators... which is probably never going to happen. The other time I might touch a pipette is if its part of a fellowship where you do 1 to 2 research years in the lab and get nothing done (at least it seems to me most of these fellows get nothing done other than realize wet-bench is not for them).

My stomach churns thinking of spending 70 hrs in the lab doing an experiment for the mteenth failed repeat. Does anyone who has an option not to do that find that lifestyle rewarding??? And then to take a major pay cut to do this as part of your career. It seems to me that more and more of MD/PhD classmates are having difficulties in the lab and are getting turned off research as well. If I do research in the future, it will be 20% as a little aside that may break up some of the eventual monotony of clinical work (so I have heard some MD PIs tell me).

Now clearly I've become jaded, since I originally wanted to do all research and collaborate with industry. Now I really feel its not worth it. I think when I have kids I would like to see them or go out to dinner with my wife and not have a grant deadline on my mind. Seems to me clinical work you can find a practice where you do only 40 hrs a week or a practice where you do 100 hrs a week, but at least you can turn it off when you go home. Maybe my assessment here is wrong. And obviously there is personal preference here and how excited you are about research. I've found it quite interesting when I hear a good research talk, but I just have never gotten that excited to hear that deleting protein X from a mouse causes such and such phenotype mediated through signaling of protein Y. That's mildly interesting to hear about over an hour, but to spend 5 years working on that... I dunno.

Any comments? For you senior posters: Was it worth it to do a post-doc? Anyone here running/going to run their own lab? Anyone say F it, and go all clinical and not look back (maybe those people don't post here)?

 

[tr]

If I do research in the future, it will be 20% as a little aside that may break up some of the eventual monotony of clinical work (so I have heard some MD PIs tell me).

That's actually sort of hard to do. This is because in order to do research, you need to be associated with a medical school, and the medical school will want you to obtain your own salary, either through clinical work or through grants. In order to get grants you generally have to have a track record of research productivity. It's almost impossible to maintain a track record of productivity with <80% of your time dedicated to research. To maintain a 20% time involvement in research, you would have to be attached to other people's grants as a consultant or co-investigator, and this is difficult to control or make happen at the time and level of involvement that you want it.

I think when I have kids I would like to see them or go out to dinner with my wife and not have a grant deadline on my mind. Seems to me clinical work you can find a practice where you do only 40 hrs a week or a practice where you do 100 hrs a week, but at least you can turn it off when you go home.

Actually I have found research to be *more* compatible with raising children than clinical work, and this is because it is more flexible. Not only can you 'turn off' your clinical work when you go home, there actually is not an option to accomplish any of it (other than a bit of charting) from home. The problem with combining career and children is that the time demands of children are unpredictable. Kids get sick and have to stay home from school or day care with no notice. As a clinician it's a huge deal to have to cancel a day's worth of patients at the last minute. As a researcher the hit is generally lower, and you may still be able to accomplish a fair amount of your work from home that day. The higher up you get, the more of your work is research/writing, and the more this is true. I find the ability to get work done from home a huge plus. I stuff work into the odd hours (midnight, early am, weekends) which is so much less disruptive to my family than if I were chained to a rigid clinic schedule and getting home after 6pm every day.

That said, from your post it sounds like you're expecting to have a wife who will do most of the heavy lifting and you'll just be around to 'see the kids' or 'go out to dinner'. It's pretty nice to have that option (as a woman, I don't) and it might make the flexibility aspect of research less of a draw for you.

Any comments? For you senior posters: Was it worth it to do a post-doc? Anyone here running/going to run their own lab?

I'm working through this one year at a time. There was a period of time in residency when I was rather sure I was not going to end up doing much research. (I really like clinical work and had a bad PhD experience.) Then I developed an interest in an area of research that was more clinical/translational, and decided to do the combined fellowship/postdoc to pursue this interest. The project worked out well and I am applying for funding based on those data.

(I should note that I'm at an 'elite' institution and here they don't fund your salary to be a researcher (at least not in the medical school). You pretty much have to have a K to get started, and if you don't get one you go clinical or you leave. On the other hand I know several people who are at less research-intense places, who have sweet deals where the institution protects 50% or more of their time for research. Unfortunately I'm geographically limited so I can't pursue this strategy. Overall I think it actually might be easier to make the research thing work at a place that is less research-intense. They'll be happier to have you and back it up with $. Nobody needs me here, if I can't fund myself there are another ten people in line behind me.)

I'm happy I did the fellowship/postdoc because it was fun, interesting, and far far more flexible than a clinical job would have been, and I had two small kids during that time. I don't think I will be running my own wet lab but I could see myself running my own research group and continuing to collaborate closely with people who have wet labs to accomplish the bench-based part of my work. (My primary mentor works this way.) On the other hand if I'm unable to get funding and I end up going totally clinical, I think I would be quite happy with that outcome as well.

My point here is, there are other options besides the canonical wet lab. I did my PhD in one of those and swore I would never go back. However I kept my eyes open to the possibilities during residency and made a move into an area that was more interesting to me, more in line with my aptitudes, and more compatible with having a life. My basic mode of data acquisition involves meeting with a patient, doing an interview, and collecting a sample, with a minimal amount of lab work later on and a whole lot of data analysis. This is super controllable and a lot of the facetime can actually be farmed out to residents, grad students, and research assistants.

Anyone say F it, and go all clinical and not look back (maybe those people don't post here)?

Yes, a lot of people do. I think like 30-40% of all MD-PhDs end up doing all or almost all clinical work. Very few people post here generally and you're right that those who have gone straight clinical are even less likely to hang around here. I saw that gutonc gave a good explanation of why he decided to go over (mostly) to the clinical track, which matches what I have heard from many others at my institution:

http://forums.studentdoctor.net/thr...ect-your-career-choices.988879/#post-13762609

 

[Elixir6]

That's actually sort of hard to do. This is because in order to do research, you need to be associated with a medical school, and the medical school will want you to obtain your own salary, either through clinical work or through grants. In order to get grants you generally have to have a track record of research productivity. It's almost impossible to maintain a track record of productivity with <80% of your time dedicated to research. To maintain a 20% time involvement in research, you would have to be attached to other people's grants as a consultant or co-investigator, and this is difficult to control or make happen at the time and level of involvement that you want it.



Actually I have found research to be *more* compatible with raising children than clinical work, and this is because it is more flexible. Not only can you 'turn off' your clinical work when you go home, there actually is not an option to accomplish any of it (other than a bit of charting) from home. The problem with combining career and children is that the time demands of children are unpredictable. Kids get sick and have to stay home from school or day care with no notice. As a clinician it's a huge deal to have to cancel a day's worth of patients at the last minute. As a researcher the hit is generally lower, and you may still be able to accomplish a fair amount of your work from home that day. The higher up you get, the more of your work is research/writing, and the more this is true. I find the ability to get work done from home a huge plus. I stuff work into the odd hours (midnight, early am, weekends) which is so much less disruptive to my family than if I were chained to a rigid clinic schedule and getting home after 6pm every day.

That said, from your post it sounds like you're expecting to have a wife who will do most of the heavy lifting and you'll just be around to 'see the kids' or 'go out to dinner'. It's pretty nice to have that option (as a woman, I don't) and it might make the flexibility aspect of research less of a draw for you.



I'm working through this one year at a time. There was a period of time in residency when I was rather sure I was not going to end up doing much research. (I really like clinical work and had a bad PhD experience.) Then I developed an interest in an area of research that was more clinical/translational, and decided to do the combined fellowship/postdoc to pursue this interest. The project worked out well and I am applying for funding based on those data.

(I should note that I'm at an 'elite' institution and here they don't fund your salary to be a researcher (at least not in the medical school). You pretty much have to have a K to get started, and if you don't get one you go clinical or you leave. On the other hand I know several people who are at less research-intense places, who have sweet deals where the institution protects 50% or more of their time for research. Unfortunately I'm geographically limited so I can't pursue this strategy. Overall I think it actually might be easier to make the research thing work at a place that is less research-intense. They'll be happier to have you and back it up with $. Nobody needs me here, if I can't fund myself there are another ten people in line behind me.)

I'm happy I did the fellowship/postdoc because it was fun, interesting, and far far more flexible than a clinical job would have been, and I had two small kids during that time. I don't think I will be running my own wet lab but I could see myself running my own research group and continuing to collaborate closely with people who have wet labs to accomplish the bench-based part of my work. (My primary mentor works this way.) On the other hand if I'm unable to get funding and I end up going totally clinical, I think I would be quite happy with that outcome as well.

My point here is, there are other options besides the canonical wet lab. I did my PhD in one of those and swore I would never go back. However I kept my eyes open to the possibilities during residency and made a move into an area that was more interesting to me, more in line with my aptitudes, and more compatible with having a life. My basic mode of data acquisition involves meeting with a patient, doing an interview, and collecting a sample, with a minimal amount of lab work later on and a whole lot of data analysis. This is super controllable and a lot of the facetime can actually be farmed out to residents, grad students, and research assistants.


Yes, a lot of people do. I think like 30-40% of all MD-PhDs end up doing all or almost all clinical work. Very few people post here generally and you're right that those who have gone straight clinical are even less likely to hang around here. I saw that gutonc gave a good explanation of why he decided to go over (mostly) to the clinical track, which matches what I have heard from many others at my institution:

http://forums.studentdoctor.net/thr...ect-your-career-choices.988879/#post-13762609

Hi tr,

First off thanks for your very in depth answers/viewpoints to my rant. I have to say off the bat that I'm not ending up with a wife that is going to do all the housework and child rearing... she's turning out to be a successful career woman herself, so the balancing of our careers and kids later on is no doubt going to be challenging!

I think some of the things you mentioned are similar to how I feel in that I don't see myself running a wet lab myself, but hopefully also acting on the translational and commercialization end of things in collaboration with scientists with their own labs. However, I didn't think that 20% effort devoted to this would be too little time if you don't have your own lab. It seems you feel that its not enough? Or did you mean that 20% is generally not enough to run a lab oneself?

Anywho, maybe time will wash away my current discontent as it seems to have with you and your bad PhD experience. Maybe then my research curiosity/desires/enthusiasm will surface again.

 

[tr]

I think some of the things you mentioned are similar to how I feel in that I don't see myself running a wet lab myself, but hopefully also acting on the translational and commercialization end of things in collaboration with scientists with their own labs. However, I didn't think that 20% effort devoted to this would be too little time if you don't have your own lab. It seems you feel that its not enough? Or did you mean that 20% is generally not enough to run a lab oneself?

What you suggest is not impossible, but the problem is that it would be difficult to make it happen the way you like. Because 20% time isn't enough for you to produce enough data to get your own grant, you would be dependent on other people's grants. Whether they would want what you do, and want it at exactly 20% time, would be to a large degree out of your hands. You might have to have a fairly unique area of expertise that was of particular interest/use to research faculty at your institution.

Many clinical faculty in my department manage to do unfunded clinical research with no protected time (gathering data on patients they and others were seeing in hospital/clinic anyway) but this is pretty limited in scope. Also it's basically an unpaid hobby, which is nonetheless now becoming expected even of faculty who are 100% clinical.

It's possible 20% could be enough for you to collaborate with industry. I have noticed a fair amount of that with procedure-based specialties actually (e.g. collaboration with a company that makes a product they use in their procedures) but I haven't been close up enough to understand the ins and outs of what the MDs are actually doing and how much time it takes. Come to think of it I have been approached by a company for consulting work myself actually, personally I had too much else on my plate and wasn't interested but that could be one way that it possibly works.

 

[Neuronix]

This thread was started the year I started my MD/PhD program--2003. That was the peak of NIH funding adjusted for inflation.

(http://www.americanprogress.org/iss...eatens-u-s-leadership-in-biomedical-research/)

Due to lack of funding, nobody supports young physician-scientists anymore, especially not for that 80% research/20% clinical split ingrained in my head from day 1 of my program. When anyone asks me why as a resident I focus on a clinical career, I just tell them that I trained for a job that no longer exists.

 

[gbwillner]

The 80/20 track exists, but it is on life support. Even for the few deluded souls who still want to pursue it after their formal training ( including postdoc after residency) few will find a desirable position in the current funding climate. I recently went through this process with very good credentials, and was worried for a while I wouldn't get such an offer. Eventually I did, at a top institution, but most chairmen I spoke with said they just couldn't afford to hire anyone to do science anymore. Purse strings are much tighter than you can imagine, and it has as much to do with clinical reimburesment as anything.

 

[tr]

(http://www.americanprogress.org/iss...eatens-u-s-leadership-in-biomedical-research/)

Due to lack of funding, nobody supports young physician-scientists anymore, especially not for that 80% research/20% clinical split ingrained in my head from day 1 of my program. When anyone asks me why as a resident I focus on a clinical career, I just tell them that I trained for a job that no longer exists.

That graph really doesn't look so terrible to me as all that. First of all it's funding in constant 2013 dollars, so overall there's a solid upward trend, with more and more money funneled into biosci every decade. Second of all, the upward trend is pretty steady until the late 1990s, then there's a crazy bubble that lags the tech bubble by a few years but then crashes just like the rest of the economy in the mid-2000s. If you extrapolate the overall 1960-2000 trend to 2014 we are actually right where that trend would have put us without the intervening bubble. Of course there's the issue of overproduction of PhDs during those years, which makes the competition for funding now steeper than it would have been, just because there are more people competing for the same pot of money.

The 80/20 track exists, but it is on life support.

What's the '80/20 track'? Do you mean 80/20 like, 80% time for research paid by department forever? I don't think that ever really existed much, except that institutions used to be more willing to provide it for a few years until new investigators got their funding legs, vs now where many of them, like mine (but not all, as I mentioned above), pretty much want you to walk in funded. One of the profs around here who has to be 75 if he's a day told me he's been on soft money his entire career. I think most people are and pretty much have been, at least in living memory.

Even for the few deluded souls who still want to pursue it after their formal training ( including postdoc after residency) few will find a desirable position in the current funding climate. I recently went through this process with very good credentials, and was worried for a while I wouldn't get such an offer. Eventually I did, at a top institution, but most chairmen I spoke with said they just couldn't afford to hire anyone to do science anymore.

Congrats on the job gbwillner! So did you do a national job search? I haven't seen that really at all among the MDs and MD/PhDs I know. I know a few PhDs who have done it but all of the research-oriented MDs and MD/PhDs I know (except one who switched to a different but still local institution) have stayed at the institutions where they did residency and worked their way up the ranks. What made you decide to do the job search?

 

[gbwillner]

What's the '80/20 track'? Do you mean 80/20 like, 80% time for research paid by department forever? I don't think that ever really existed much, except that institutions used to be more willing to provide it for a few years until new investigators got their funding legs, vs now where many of them, like mine (but not all, as I mentioned above), pretty much want you to walk in funded. One of the profs around here who has to be 75 if he's a day told me he's been on soft money his entire career. I think most people are and pretty much have been, at least in living memory.

As most understand it, the 80/20 track is where you finish your medical training, do a post-doc and or clinical fellowship, and then get a start-up package and space to give you a reasonable chance at success in the field. 5 years ago, for an accomplished MD/PhD, this meant a $1M+ start-up, with 20% clinical service. You were expected to have 5 years to have sufficient data to obtain an R01 by that time. With funding rates at all time lows, programs started to lose their investments. With clinical revenue down and costs up, programs started to abstain from supporting physician scientists in clinical departments. Now, as you stated, you are expected to walk in with your own funding. Forget about a $1M start-up, unless you are already incredibly funded and published. Most institutions now balk at the whole notion or seriously jeopardize your ability to succeed by giving you a pittance (~$300K), no space, or have you do excessive clinical duties. There really are only a handful of places isolated enough from today's economic realities that they can still attempt these offers.

Congrats on the job gbwillner! So did you do a national job search? I haven't seen that really at all among the MDs and MD/PhDs I know. I know a few PhDs who have done it but all of the research-oriented MDs and MD/PhDs I know (except one who switched to a different but still local institution) have stayed at the institutions where they did residency and worked their way up the ranks. What made you decide to do the job search?

I did a national search at top academic and cancer centers. I could say that I wanted to leave my home institution because they couldn't provide me with the type of clinical position I wanted, or that it wasn't necessarily the right environment for me (these things were essentially true), but the reality is that I was forced to do this search, as were all MSTPs in my department, because we could no longer afford to pay people to do science in our clinical department. Some of us were incredibly accomplished. Some were already funded, including with K08s. It just didn't matter.

 

[tr]

As most understand it, the 80/20 track is where you finish your medical training, do a post-doc and or clinical fellowship, and then get a start-up package and space to give you a reasonable chance at success in the field. 5 years ago, for an accomplished MD/PhD, this meant a $1M+ start-up, with 20% clinical service. You were expected to have 5 years to have sufficient data to obtain an R01 by that time.

Wow, that sounds like some kind of fantasy to me. $1M startup and 5 years of 80% salary support? My jaw is on the floor.
I guess I wasn't really paying attention to what the monetary arrangements were prior to five years ago so I can't say whether things have changed recently. I can say that where I am, getting your own funding has long been emphasized as a priority. Our fellowship seminar was basically a class in how to apply for a K award and I am pretty sure it was that way for a number of years before I got there.

I could say that I wanted to leave my home institution because they couldn't provide me with the type of clinical position I wanted, or that it wasn't necessarily the right environment for me (these things were essentially true), but the reality is that I was forced to do this search, as were all MSTPs in my department, because we could no longer afford to pay people to do science in our clinical department. Some of us were incredibly accomplished. Some were already funded, including with K08s. It just didn't matter.

That sounds really rough. I'm glad to hear you ultimately found a position you liked. However, I'm surprised to hear your department couldn't keep people with K08s? That seems like it wouldn't take much outlay from the department, and additionally doesn't the department have to commit to the candidate in writing in order for them to even apply for a K08? How is it possible for an institution to support a candidate for a K and then withdraw the support after the funding is granted? That seems like it wouldn't be in anyone's interest.

 

[Neuronix]

Wow, that sounds like some kind of fantasy to me. $1M startup and 5 years of 80% salary support? My jaw is on the floor.

Three years of 50% research time with minimal to no startup package seems to be the norm to me, even with a K08. That said, there are a grand total of 3 K08s active in my entire *specialty* at a given time (http://www.ohsu.edu/xd/education/sc...d/NIH-funding-radonc_Steinberg_et_al_2013.pdf). Your chances of getting an R01 even if you're lucky enough to get the K08 are next to nothing. I've seen multiple investigators fail at getting significant funding after their K08 and be moved to 80-100% clinical within academics.

I don't even see how it's feasible to even try anymore with those odds.

 

[tr]

Three years of 50% research time with minimal to no startup package seems to be the norm to me, even with a K08.

This I don't get either. In the K application you have to stipulate, and your department has to provide a letter in support, that you are going to have at least 75% protected time for research. The K pays this salary. How can you have a K08 and then only get 50% protected time? Wouldn't the NIH raise a stink about that?

That said, there are a grand total of 3 K08s active in my entire *specialty* at a given time (http://www.ohsu.edu/xd/education/sc...d/NIH-funding-radonc_Steinberg_et_al_2013.pdf). Your chances of getting an R01 even if you're lucky enough to get the K08 are next to nothing. I've seen multiple investigators fail at getting significant funding after their K08 and be moved to 80-100% clinical within academics.

I agree in general that the funding climate is horrible. That said, there was a 36% success rate for K08 applications in 2013.
http://report.nih.gov/success_rates/
(it's the Career Development Awards spreadsheet, at the bottom)

I would suspect that the reason there are very few Ks in rad onc is that there are very few radiation oncologists generally, and even fewer who are actually interested in applying for research funding given the fact that they could be making 5-8x the salary they would get as an early-career academic if they went into practice.

Agreed that the problem of transition to R01 sounds even bleaker than the K prospects with funding lines in the 10-18% range, but again it's not like you just apply for one R01 once and then bail out. The faculty here all seem to have multiple funding applications in at all times, some of them as PI and others as co-PI or consultant. I get the sense that in order to have half a chance at success you need to keep chucking darts at the dartboard until one sticks.

I just looked back at my old files and I applied for eight separate foundation grants (some of them twice) before I got one (not a big one either). It sucks but it's reality. This is a game of roulette. Maybe you don't want to play. That's fair, maybe I wouldn't either if I were looking at the amount of forgone salary potential you are. The gradient in psychiatry isn't as steep (though it's there) and I'm willing to play this game for a couple more years before I throw in the towel.

 

[Neuronix]

This I don't get either. In the K application you have to stipulate, and your department has to provide a letter in support, that you are going to have at least 75% protected time for research. The K pays this salary. How can you have a K08 and then only get 50% protected time? Wouldn't the NIH raise a stink about that?

Good point. If you have the K08 you get the 75% protected time. Though you often end up really with 75% research and 50% clinical time, if you get my drift 😉 Sure your clinic is only 1 day a week, but they can jam pack that clinic in... One MD/PhD faculty at my institution who had a small grant supposedly had 50% protected time, but his 2.5 days of clinic were so busy that he had the second highest volume in the department. That 50% clinical effort spilled over into 3.5-4 days of work. He since quit and went to private practice.

This is a game of roulette. Maybe you don't want to play.

I don't mind making less money to do research. That has always been a part of the equation since day one. But there are so many additional problems that make it not worth it.

 

[Shifty B]

Good point. If you have the K08 you get the 75% protected time. Though you often end up really with 75% research and 50% clinical time, if you get my drift 😉.

This is the old joke that you should take whatever clinical expectations you have, and double it. It's common for a half-day clinic to take an entire day. If you have 50% clinical expectations (or 5 half day clinics a week), then... you get the point.

 

[gbwillner]

Wow, that sounds like some kind of fantasy to me. $1M startup and 5 years of 80% salary support? My jaw is on the floor.
I guess I wasn't really paying attention to what the monetary arrangements were prior to five years ago so I can't say whether things have changed recently. I can say that where I am, getting your own funding has long been emphasized as a priority. Our fellowship seminar was basically a class in how to apply for a K award and I am pretty sure it was that way for a number of years before I got there.

It's not as much money as you think. Because the term was 5 years, that's $200K per year. A technician will cost you 50-75K of that once all benefits come out. Add a couple of grad students and 1/2 to 3/5 of all that money is gone before you can even buy any reagents. It's enough for you to get by for 5 years. Now, on the flip side, getting $300K for 3 years (on par with many of the offers I saw) is not likely to get you too far. $100K/year may sound like a lot to you, but when you start supporting people and paying for equipment and reagents it will go by in a flash. So on these types of arrangements, I think most chairmen are expecting you to do most of the heavy lifting yourself, which is compounded by the fact that you have clinical service, and you don't have the time to write those grants that will actually advance you career. Once you sit down and write NIH grants you will see how little else can be accomplished at the same time. Getting less than $1M seriously jeopardizes your chances at running an independent laboratory. If that is not your objective than obviously you can get by with far less.

That sounds really rough. I'm glad to hear you ultimately found a position you liked. However, I'm surprised to hear your department couldn't keep people with K08s? That seems like it wouldn't take much outlay from the department, and additionally doesn't the department have to commit to the candidate in writing in order for them to even apply for a K08? How is it possible for an institution to support a candidate for a K and then withdraw the support after the funding is granted? That seems like it wouldn't be in anyone's interest.

I will tackle the second part of your comment first, regarding the department's commitment to the candidate. I don't have to state that not all chairmen or directors are reputable people and will tell you whatever you need to say for you to qualify for the application. You want the grant, and they want you to get the grant. But sometimes there is an understanding that despite what is written in the promissory note, they have no intention of hiring you without the money. What are you going to do about it? Sue them? Of course you could, and burn every bridge you've ever established in the department. But most chairmen I have come across are far more trust worthy. They DO give you the job anyway. The trick, however, is the job you get. Most will hire you as Instructor. That job comes with virtually no guarantees and is renewed on a yearly basis. You get paid on something close to the PGY scale. That buys you 1-2 years to secure major funding, and if you don't, you are out the door anyway.

Regarding the K08's.... although they ought to be a golden ticket to any department in the country, in reality, the money you get from such a grant is a small piece of the expenditures a department will spend on grooming a young clinician-scientist. The K will only cover your salary. While this should be incentive for your department to spend money on your lab and equipment (like I said, about $1M) since you: A) come free, and B: have shown you can successfully compete for grants, so they aren't taking THAT big a chance on you. However, once again, the department is spending a lot of money. And because of the current climate in both reimbursement and NIH pay lines, many departments have decided to spend that money elsewhere. It's not that they are evil and don't care, its that they either give that money to a young clinician-scientist to start his/her career, or they use that money to retain their clinical staff who are all about to walk because their salaries are all about to be cut because payors have renegotiated all their contracts. And for a while, departments were still taking a chance on young outstanding scientists, hoping the grant funding situation would reverse itself. Well, it didn't, and they started to lose on their investments, making it even tougher on the next pool of young scientists.

Having said all that, you can get a good position out there. They are just getting rarer and rarer by the day.