Hi all, I'm an MS4 very interested in hem/onc esp immunotherapy, applying IM now. I have a lot of background in lab research and have just started exploring clinical research the last few years, I like both. The situation I'm facing is I have interviews at some great academic centers in cities I like but which are far from family, as well as interviews at big community hospitals (Kaiser) with large hem/onc divisions that are right next to my family. My family means a lot to me and I'm torn about what to prioritize. I'm not looking for a career in charge of a lab but I would love to be faculty at an academic center one day where I could teach/research/partner with labs to start IITs and stuff. My question is basically - how many doors are closed to me if I end up at Kaiser? Should I push them down my list in favor of as many decent academic programs as possible? Or can I still go from there to a decent academic (or academic-adjacent) career? Similarly, how does this apply to fellowship down the line? Kaiser has in-house fellowships, does doing that instead of an acadmic fellowship basically lock me in to community hem/onc down the line? Appreciate any insight.
What am I giving up by choosing large community residency over academic program?
- Thread starter itzbitz
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Hello- please PM me. I am happy to talk you through this. I've trained and currently am on faculty at a large academic medical center. If you choose a community-based IM program, you're closing a lot of doors for fellowship- and ultimately an academic faculty position. Again, PM me and I'm happy to guide you.
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If you want to be true academic faculty, with dedicated research time (clinical, translational or basic science) and grant support (government, industry or foundation), you need to set yourself up for this from the very beginning of your career (residency) and continue it through fellowship.
Most med students overestimate the importance of going to a "academic powerhouse" residency for their career goals. You are vastly underestimating it.
This is not to say that you couldn't make it happen starting at Kaiser or another community based residency, just that it would be highly unlikely and a real uphill battle to do so.
You also need to recognize that the job you say you're looking for after training probably won't be available near your family if the training you need to get there now isn't near your family.
Most med students overestimate the importance of going to a "academic powerhouse" residency for their career goals. You are vastly underestimating it.
This is not to say that you couldn't make it happen starting at Kaiser or another community based residency, just that it would be highly unlikely and a real uphill battle to do so.
You also need to recognize that the job you say you're looking for after training probably won't be available near your family if the training you need to get there now isn't near your family.
Will do, thank you! New on this site so I hope I do it right lol
Thank you, I think this is the exact reality check I needed. Wasn't sure if I was missing something or if it really was a simple as "if you want the academic path, it's pretty much now or never". At the end of the day, I know I will need to decide what matters to me most and go from there.
I don't have an answer to the question of whether going to Kaiser would close academic doors at academic heme-onc fellowships, and I wish you the best of luck with your plans for an academic career.
But I do want to give you the perspective of an MD-PhD who thought their entire life was headed towards running a lab at Most Prestigious Cancer Center in The World and is now headed to community practice. There's a reason why so many people leave academics, and it's because academics is exploitative. They don't tell you this as a medical student, and certainly not as an MD-PhD student where the propaganda is nonstop about how important academia is.
1) Academics sounds wonderful - until you realize how little you will be paid. I'm headed towards at minimum $700K/year job working 4 days a week or a private practice job where I will work much much harder but be paid in the ~1M range. The academic jobs in my very high cost of living city are notorious for poor pay - think in the ~$250K-300K range. I hear faculty complaints about pay all the time. Do you want to go through medical school, residency, and fellowship so you can earn 1/3rd of what you're worth? There's nothing wrong with doing it, but I wish someone pointed this out to me earlier in my career.
2) You say you want to partner with labs to write IITs and presumably have molecular correlates in the studies that can be done in the labs. This sounds genuinely amazing and it is- until you start doing it and it makes you want to beat your head against a wall. I've worked on projects like this from both the lab side and the clinical fellow side, and I found it be miserable, exploitative, and genuinely depressing. Admittedly I had a horrible mentor, but horrible mentors are everywhere!
I do not want to discourage you from pursuing your goals, but as someone who is counting down the days to end of fellowship and moving out to community practice, I just want to make sure at least someone has given you this perspective.
Best of luck!
But I do want to give you the perspective of an MD-PhD who thought their entire life was headed towards running a lab at Most Prestigious Cancer Center in The World and is now headed to community practice. There's a reason why so many people leave academics, and it's because academics is exploitative. They don't tell you this as a medical student, and certainly not as an MD-PhD student where the propaganda is nonstop about how important academia is.
1) Academics sounds wonderful - until you realize how little you will be paid. I'm headed towards at minimum $700K/year job working 4 days a week or a private practice job where I will work much much harder but be paid in the ~1M range. The academic jobs in my very high cost of living city are notorious for poor pay - think in the ~$250K-300K range. I hear faculty complaints about pay all the time. Do you want to go through medical school, residency, and fellowship so you can earn 1/3rd of what you're worth? There's nothing wrong with doing it, but I wish someone pointed this out to me earlier in my career.
2) You say you want to partner with labs to write IITs and presumably have molecular correlates in the studies that can be done in the labs. This sounds genuinely amazing and it is- until you start doing it and it makes you want to beat your head against a wall. I've worked on projects like this from both the lab side and the clinical fellow side, and I found it be miserable, exploitative, and genuinely depressing. Admittedly I had a horrible mentor, but horrible mentors are everywhere!
I do not want to discourage you from pursuing your goals, but as someone who is counting down the days to end of fellowship and moving out to community practice, I just want to make sure at least someone has given you this perspective.
Best of luck!
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Feel free to do academics if you're dying to make hospitalist salaries and never catch up financially for the 3 lost years.
To make this fellowship worth it dollar-wise, you HAVE to do private practice or be hospital-employed, which translates to being comfortable with >1 cancer. It's better to know this earlier than later.
To make this fellowship worth it dollar-wise, you HAVE to do private practice or be hospital-employed, which translates to being comfortable with >1 cancer. It's better to know this earlier than later.
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you can do academics AND be happy and not be in a lab or be exploited. The key is finding a niche and making yourself irreplaceable and you will get fairly compensated and get to be on the cutting edge of whatever area you’re interested in. On the other hand it is very easy to get lost in the mix and base case is exploitation and unfairly low pay. Keep that in mind when deciding. Also why close doors if you’re not sure? That’s why a good academic training program where you get a wide range of exposure and training (ie not NIH) can be beneficial no matter what you do.
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This was what I was getting at. Now is not the time to close doors. An academic residency and fellowship will keep them open without closing any, while still allowing you to explore all of your options.
And like @ONC2023, I was MD-PhD, research pathway, run my own lab, blah blah blah. I'm 12+ years into a general community practice, and recently moved to a rural CAH where my practice is even more general than it was before (when I was in an office with 5 other docs, it was possible to kind of subspecialize, now that it's just me, I see literally everything. And I can't imagine any other kind of practice.
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