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

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ChordaEpiphany

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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 post-doc time look slim. My advisors are pushing me towards professorship at a lower- or mid-tier institution, but these environments are often poorly funded and my capacity to do impactful work there feels low. I don't see the point of making half the pay of my peers in clinical medicine so I can run a rag-tag group of graduate students publishing 3-5 low impact papers per year and constantly stressing about funding. Private practice doesn't really appeal to me, nor does climbing the academic medicine ladder as an admin.

Pharma, however, feels like a fantastic compromise and a way to be a part of a team doing truly impactful scientific work while utilizing scientific and clinical skills. I worked at a pharma startup after college and loved it. I have consulted for my PI's startup companies as a graduate student. However, the subject is so taboo among academics that I don't know where to begin asking.

What could someone reasonably expect from this route? Say someone completes an MD/PhD and trains at name brand institutions for residency and fellowship. It seems like there are few routes to pharma from here.

1) Immediately join pharma at the assistant/associate director level. Work your way up in the company/industry.

2) Take a non-tenure track academic job and involve yourself with clinical trials for several years, join pharma at full director level.

3) Take a tenure-track academic job, start a basic or translational science lab, involve yourself with clinical trials, and join pharma at the full director level or possibly at the vice president level if you are extremely successful after 5-7 years.

4) Establish yourself as an academic and world expert and join at the Vice President, Senior Vice President, or Chief/CMO level (depending on the size of the company).

Can anyone enlighten me as to what to expect? How would compensation compare to something like academic heme/onc? How does upward mobility vary between these approaches? Maybe most importantly, where can I find more information on the respective career paths and how MD/PhDs navigate them?

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I dont have much to answer for your questions, but I just want to mention that your PhD was very successful with 3-4 first author publications in quality but not necessarily top tier journals. I know we are hard on ourselves in medicine and sometimes we do not recognize our own potential.

You are still very much in the running for a faculty position at a top institution. Remember that faculty positions hinge much more on your ability to get a K award, not on your publication record. There are many people who publish well, do not get a K and are therefore forced into clinical time. Others only have mediocre publication records - in fact, basically what you have now but at the end of fellowship - but get a K and are therefore hired.

Look at the predictors of a successful K award - decent publication record plus solid mentors, resources and training plan. Too many publications may in fact hurt you because they may assume you are already independent and should just shoot for an R. The science is only one component.

Also, you will notice that breakthroughs happen anywhere and are published in all kinds of journals as you become more advanced. Science and evaluation of its quality is all in the details that only a few in your subfield can understand. You will know what I am talking about as you find many amazing discoveries in papers that are barely recognized over your career. The idea that science progresses with Science, Nature, PNAS, etc pubs is clearly not true. Leave those shallow judgments of prestige to the media, not to real scientists.
 
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Agree with above. You're actually a strong candidate to match IM-PSTP at institutions with a track record of trainees getting K08s (think UCSF, Penn, WashU...). If you do IM-Heme/Onc PSTP, you'll have about 3.5y of postdoc time built in anyways, which is when you hopefully will be able to work towards the K. A lot of people stay on faculty at these institution after getting their Ks, so I say you have a good shot of starting a lab at a "top" school.

Caveat emptor, I'm only a med student. However, I've been around many who've been on this path, so I'm sharing insights that I've gotten from chatting with them.
 
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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 post-doc time look slim. My advisors are pushing me towards professorship at a lower- or mid-tier institution, but these environments are often poorly funded and my capacity to do impactful work there feels low. I don't see the point of making half the pay of my peers in clinical medicine so I can run a rag-tag group of graduate students publishing 3-5 low impact papers per year and constantly stressing about funding. Private practice doesn't really appeal to me, nor does climbing the academic medicine ladder as an admin.

You can match at a top residency and still pursue a top-tier fellowship if you so desire. The success rate for securing a K is about 30-50%, then an R01 is about 30-50%, for a total odds of "independence" about 10-25% at 10 years post-residency. This is all based on documented empirical data. If you follow the right PI you still have a non-trivial chance of success IN THAT way.

But yes, overall your big picture vision is the correct one. Even if you are at a top program as faculty it's challenging to even publish 3-5 low impact papers and not stress about funding REGARDLESS of how good you are. That's just a reality which you have to sort of be okay with to survive in academia in the long run.


Pharma, however, feels like a fantastic compromise and a way to be a part of a team doing truly impactful scientific work while utilizing scientific and clinical skills. I worked at a pharma startup after college and loved it. I have consulted for my PI's startup companies as a graduate student. However, the subject is so taboo among academics that I don't know where to begin asking.

What could someone reasonably expect from this route? Say someone completes an MD/PhD and trains at name brand institutions for residency and fellowship. It seems like there are few routes to pharma from here.

1) Immediately join pharma at the assistant/associate director level. Work your way up in the company/industry.

It's not possible to join w/o a residency at a minimum, and the jobs you are looking at that are desirable you need [clinical] fellowship. Research fellowship with academic trial experience is desired. You could move in at the associate director level, but the salary is not that much higher.

2) Take a non-tenure track academic job and involve yourself with clinical trials for several years, join pharma at full director level.

If you know you want to do pharma, the earlier the better (i.e. I would skip the non-tenure job unless it's funded by K award in an area of relevance, either translational medicine or clinical development)

3) Take a tenure-track academic job, start a basic or translational science lab, involve yourself with clinical trials, and join pharma at the full director level or possibly at the vice president level if you are extremely successful after 5-7 years.

Easier to do this internally with industry experience. This does happen if the research you do is a really good match, but in general, no. Lots of tenured professors enter pharma at a director level, as tenured professors' salaries are often low and they exit with bad timing. It does happen but is rare. Generally, once you get to funding stability in academia you don't quit unless you get scooped for really good reasons, but if you don't get scooped it's unlikely you'll be able to go in at a high level (i.e. probably your academic research is very niche at this point, and that you are too old to train at the associate level). This is where the careers become parallel. The typical academic would plan to work till retirement in academia at this point. This roughly happens around age 50-55. Somewhat earlier for basic scientist in their late 40s.

Some clinicians/clinical scientists do a stint of industry when they are 55+, but this is more for diversification of experience rather than with any hope of "advancement".

4) Establish yourself as an academic and world expert and join at the Vice President, Senior Vice President, or Chief/CMO level (depending on the size of the company).

Again, is this possible? Yes. Does this happen routinely? No. The VP level holes get filled by people who are director level at competing companies. But yes, if you are Tassier-Lavigne you could get hired by Genetech. But rare and I would argue not something to worry about in terms of long-term career planning. Like, work your butt off in academia with the plan to move to industry as a CMO is an insane plan.

There are also examples where academics who are successful exit to industry in their late 40s or early 50s as entrepreneurs and grow company quickly in 5-10 years with VC support. This is also rare and I would say is very much a lucky chancy thing. You can look at some well-known examples and see when/where they exited.

Can anyone enlighten me as to what to expect? How would compensation compare to something like academic heme/onc? How does upward mobility vary between these approaches? Maybe most importantly, where can I find more information on the respective career paths and how MD/PhDs navigate them?

Comp - base, bonus, stock -- about 1.5-2x academic job at the entry inclusive of bonus.
Director level 300-500
VP level 500-1M
Above would be C-suite, comp depends on company performance 1M+ not unusual for midsize company. You can check the recent exec comp filing for public biotech/pharma with Sec. 1B valuation is roughly 200-500 people group and typical comp all in for CMO is around 800-1.5M at that size. This is all in. Problem is of course a lot of this depends on stock performance, post-money valuation, that sort of thing. Wide range.

You can find more information by talking to recruiters. However, you are WAY too early to think about this as the exit point is post-residency/during fellowship.

Also consider a broad portfolio of "pharma" companies, including big/small/startup/CROs/device/diagnostics/lab sciences/specialty consulting (i.e. regulatory), etc. and there are nuances, but the general pathway is outlined above.



There are some interesting jobs for MD PhDs that have entry points post MD pre-residency and/or pre-fellowship. I have interviewed for a few but ultimately decided against them back then.

1. investment bank associate - this is hard as they want MBA rather than MD, but doable. Typically 150 bae + 100% bonus first year, then 2-3 year to VP, 3-5 years to MD (managing director). When you are MD it's 450k base + bonus. Bonus is typically 10% year end fee pool. So if you close 2 deals that are 1B, the commission is about 5%, you make 50M fee, then out of that you might get a 5M bonus pool in your group, then you get most of that.

===> this route opens up to other roles in finance later on on the buy-side (PE/VC), where the sky's the limit w.r.t. comp. Typical exit is around age 40. If you can't make managing director at an ibank by 40 your future growth potential is very low.

===> you can also enter through other related roles such as back-office equity research, then jumping to PE/VC, etc. Similar starting comp. Later mid-management comp is lower as there's no commission.

What exactly are you doing with those jobs and why would they hire you? You evaluate the company that makes medical/pharma products that are related somewhat to your PhD research and create content for investors and cement transactions for investors. The level of knowledge and experience on the pure finance side can still be caught up really quickly (i.e. 6 months).

2. associate at management consulting -- typically 150 base + some fixed bonus. hourly rate at this stage is about 300-500. This goes up incrementally to $1500 at a partner. Yearly billing for partner should be around 1200-2500 hours? Something like that. Total comp brackets around ~1-2M for partner managing a small pharma-focused specialist group that's fairly busy.

===> this role can open a path where you go into non-medical operational roles at pharma companies (i.e. become hired professional CSO/CEO). Your credential of MDPhD is generally enough for later stages and don't need a residency.

3. Pharma - at this level you can get a job as an MSL or project scientist at a pharma company and gradually go up. The typical salary is 150k + some bonus. However, this is seen as not a great option unless u really don't want to practice a lick of medicine and don't want above positions, as you are seen as someone who's competing with MS+ experience, straight PhDs, etc.

4. Enterpeneurialship - this is the same as any other type of activity of this type. You can start your company or join another company that has direct subject matter relevance to your PhD.

Post-residency/fellowship entry into finance/operations is not easy. Typically this is when you make too much money as a clinician and your age is not friendly for conceptual re-training. The typical trajectory there is you enter the industry at the pharma director level, then join an investor once you have industry leadership experience or have successfully led a company to an exit.


This pretty much encompasses the entire portfolio of career trajectories of all MD PhD credential-specific jobs outside of academia in industry. Lots of MD PhDs end up doing MD-oriented but nonclinical jobs (i.e. non-clinical managerial jobs inside or outside of academia), but that's a separate topic, right? Also, going back up, a lot of these industry jobs are NOT more compelling than being a practicing sub-specialist clinician either in academia or private, which is why that third option is still tried and true for many MD PHDs.
 
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There’s one thing I didn’t see (or maybe it’s in there but I missed it). There is one key ingredient in research success that is the driving factor of it all… luck. Just dumb luck. Right place and the right time with the right connections, with each of those components being fundamental.

That component is really the only difference between PIs. I will say that certainly perseverance improves your chances of luck (like buying a handful of lottery tickets every Powerball as opposed to a Powerball ticket every 5 years), but in the end it boils down to luck.

An anecdote: I guy I know was a division chief. Now he became chief because the prior chief was booted for alcoholism and drug abuse on the job and he, at the time, was the only person with an R01, so he became chief like 6 years out of training. He renewed his only R01 once (which there is something to be said for that) and was hired at a new institute as chief. There, through his chief endowment, he hired 3 PhDs as RAs and rode his endowment as chief. He would submit grants, but never was the contact PI, he was to Co-PI once. Continued to submit maybe 1 grant a year. So in 10 years he had one Co-PI grant that produced no results and this, was no renewable. Then he takes the data that his 3 PhDs had produced, gave it to his previous PhD mentor who was a decade his senior and they repurposed the grant into a combo grant of the work of the 3 PhDs and the same idea the PhD mentor used as a funded R01 a decade prior. Scored 1st percentile. The take home, if you have enough labor and can repurpose stuff with the right people and the right time… you get rewarded. I asked him one time what the best way to stay alive in research. His answer was “become a chief and get an endowment”. Inspiring.

Though I haven’t worked in industry, I do know a Hem/Onc chief who had an R01 and was recruited away to Europe to be a CSO of a major pharmaceutical company. His protege, who had never completed for a grant, was essentially given his R01s and all his resources in his departure. Now she, has done well with it (and some how was given a P01 in its second decade of funding), but it was all given to her. His departure and her subsequent procurement of resources… largely luck. Right place, right time.
 
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But yes, overall your big picture vision is the correct one. Even if you are at a top program as faculty it's challenging to even publish 3-5 low impact papers and not stress about funding REGARDLESS of how good you are. That's just a reality which you have to sort of be okay with to survive in academia in the long run.
Well, that's disappointing, but I'm glad to hear my instincts were correct. This just doesn't appeal to me. If I were to do academia, I'd likely wind up taking a similar approach to my current PI, which is to basically just run an NIH-funded R&D lab with the sole intent of spinning off SBIR-seeded biotech companies.
It's not possible to join w/o a residency at a minimum, and the jobs you are looking at that are desirable you need [clinical] fellowship. Research fellowship with academic trial experience is desired. You could move in at the associate director level, but the salary is not that much higher.
Ah, I meant immediately after a residency/fellowship. I would expect residency/fellowship, ideally at a high-caliber cancer center as part of a PTSP, and then assistant/associate director position in pharma/biotech, probably biotech.
If you know you want to do pharma, the earlier the better (i.e. I would skip the non-tenure job unless it's funded by K award in an area of relevance, either translational medicine or clinical development)
This is great advice. Thank you. The plan is to apply for a K award during a PTSP or during fellowship. At the very least, I do know that profs who get a K but don't make tenure typically do well transitioning to pharma.
Easier to do this internally with industry experience. This does happen if the research you do is a really good match, but in general, no. Lots of tenured professors enter pharma at a director level, as tenured professors' salaries are often low and they exit with bad timing. It does happen but is rare. Generally, once you get to funding stability in academia you don't quit unless you get scooped for really good reasons, but if you don't get scooped it's unlikely you'll be able to go in at a high level
This is good to know, but I've seen plenty of professors do well transitioning to industry after failing to make tenure. Maybe I wasn't watching closely enough and they entered at a level below where they would have been without the failed tenure experience.
Again, is this possible? Yes. Does this happen routinely? No. The VP level holes get filled by people who are director level at competing companies. But yes, if you are Tassier-Lavigne you could get hired by Genetech.
This I'll contest somewhat. I have personally seen plenty of mid-sized companies scoop minor KOLs at the VP level, but "VP level" can mean many different things. Tassier-Lavigne was hired at a Senior VP level at a large cap and very hot biotech company. That's a 7-figure position. There's a huge gap between making Senior VP at Genentech in your mid-40s and a VP position at a small or mid-sized biotech company. But I hear what you're saying, better to either pursue academics or pursue industry. Once you're down one path it doesn't sound like it's great to jump to another.
There are also examples where academics who are successful exit to industry in their late 40s or early 50s as entrepreneurs and grow company quickly in 5-10 years with VC support. This is also rare and I would say is very much a lucky chancy thing. You can look at some well-known examples and see when/where they exited.
This world I know extremely well, having worked in the space for a few years. I've (shadow) written funded SBIRs and even consulted for spinoff companies during my PhD. Personally I would just be wary of trying this approach anywhere other than the classic Stanford/UCSF/MIT/Harvard/etc... Most universities do not have good connections or infrastructure for this, even some big names like Johns Hopkins, which really only got off the ground translationally 5-6 years ago. It's a viable path, obviously, but I'm not sure I'd stake my whole career on the idea that maybe someday my SBIR/STTR pet project will make me a decamillionaire in my 50s or 60s, especially if I weren't at one of the above universities with consistent industry and VC interest.

Thank you for your reply. It was extremely informative and exactly the sort of information I was looking for.
 
There’s one thing I didn’t see (or maybe it’s in there but I missed it). There is one key ingredient in research success that is the driving factor of it all… luck. Just dumb luck.
Even your Chief/R01 anecdote aside, how about the luck that goes into simply starting a successful research career? Even at the MSTP admissions level, seeing which undergrads are published from the PhD student perspective reveals how random it all is. You just know some kids are DOA because the PI avoids publishing undergrads or the lead grad student isn't invested. Others just luck into 3-4 mid-author papers riding the coattails of a grad student or postdoc with a hot hand just by running some ELISAs or westerns.

Regardless, most of life is luck. I had a streak of horrendous luck the last 5-6 years, but more recently, just as I was reaching unthinkable levels of cynicism, I got some very lucky breaks. In medicine we at least have some control over the outcomes and a solid number of backup plans, as this thread clearly demonstrates. The rest is hard work and preparation, and that's the only part we can control.
 
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Even your Chief/R01 anecdote aside, how about the luck that goes into simply starting a successful research career? Even at the MSTP admissions level, seeing which undergrads are published from the PhD student perspective reveals how random it all is. You just know some kids are DOA because the PI avoids publishing undergrads or the lead grad student isn't invested. Others just luck into 3-4 mid-author papers riding the coattails of a grad student or postdoc with a hot hand just by running some ELISAs or westerns.

Regardless, most of life is luck. I had a streak of horrendous luck the last 5-6 years, but more recently, just as I was reaching unthinkable levels of cynicism, I got some very lucky breaks. In medicine we at least have some control over the outcomes and a solid number of backup plans, as this thread clearly demonstrates. The rest is hard work and preparation, and that's the only part we can control.
Oh, sure there’s a lot of luck at all levels. A lot. And yes, as a student or junior faculty, attaching yourself to a PI who is productive and tacks you on everything and does everything to promote your career is very, very rare. But it does exist. I have definitely seen a PI essentially support trainees and junior faculty to the point where the productivity of that person is boosted tremendously, mostly through gift authorships and giving away other promotional activities (eg talks). But I think that is uncommon. Another anecdote. There was a fellow in the division, MD/PhD, who wanted to go the physician scientist route. He was given some terrible project by a PI that the PI had no experience in but read one paper and thought it would be “cool” to try. The PI left it pretty much all to the fellow and diverted none of his support staff to help in the project. That fellow produced 0 papers in 3 years. 0. I felt bad for him and actually just gave him data I had collected, made him write it up with my help and he got a first author publication in a medium impact journal. But his PI was not looking out for his best interests and that is just unlucky. There’s more to this story and the PI but I don’t think I need to divulge more because again, these stories are all just a matter of unlucky versus lucky.

That is probably the most frustrating paper of grants. Usually the science isn’t that much different or better and the person isn’t harder working in the grants that get funded compared to the ones that don’t. It mostly ends up being the person who got funded was lucky enough to have the right study section with the right pedigree. That’s about it. They only thing I’ve found that an applicant can do to even slightly improve their odds is submit grants constantly and keep twisting grants and take old ideas and repackage them as new.

I would hope industry would be different for you if that’s your plan, but it comes with a lot of uncertainty as well. That is unless you go work for a major and already established pharmaceutical/device company, where if you play your cards right and are good at pleasing your boss and the suits, you can make a good salary and have some job consistency. You may not get the CSO golden parachute, but you can still do well. I had a recent colleague burn out from clinical care and went to get an MBA and work for Eli-Lilly.
 
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There's a huge gap between making Senior VP at Genentech in your mid-40s and a VP position at a small or mid-sized biotech company. But I hear what you're saying, better to either pursue academics or pursue industry. Once you're down one path it doesn't sound like it's great to jump to another.

It's not that it's not "great". Whenever the jump happens it's typically pretty awesome. It's that it's not feasible to jump. Think about it for a second, how hard is it to jump BACK into academia after you worked in the industry for X number of years? You just wouldn't. First of all you'd take a pay cut, second your resume is totally different, and third you don't really want to do the kind of work (raising a much smaller quantity of money to do very niche work). Similarly, you won't jump into industry because while you are paid more you lose visibility and prestige in the community, and you are no longer able to focus on the niche which you developed throughout your career.
 
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He was given some terrible project by a PI that the PI had no experience in but read one paper and thought it would be “cool” to try. The PI left it pretty much all to the fellow and diverted none of his support staff to help in the project. That fellow produced 0 papers in 3 years. 0. I felt bad for him
Tbh this sounds like a lot of projects in my current lab. The PI is spread so thin he often doesn't even know what a given project is, and he's remarkably slow to submit manuscripts. Though I also find that it changes field by field. In genetics/bioinformatics it would be unthinkable, in basic biology it would be really bad, and in engineering most students go the first 3 years without FA papers. Still, if you work for 3 years and produce nothing, at least part of that is on you. I changed projects a few times early on because my PI's pet project simply wasn't working out.
Similarly, you won't jump into industry because while you are paid more you lose visibility and prestige in the community, and you are no longer able to focus on the niche which you developed throughout your career.
Lord, I could not care less about visibility and prestige in a niche academic community. If that's really the main appeal that academic medicine offers, I'll probably wind up elsewhere.
 
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Lord, I could not care less about visibility and prestige in a niche academic community. If that's really the main appeal that academic medicine offers, I'll probably wind up elsewhere.

Well, it kind of is, right? You become a KOL in a niche field. Otherwise what else is there? There's no money. Your team is typically fairly small, if you care about "power". You have little in terms of lay prestige, unless somehow you get famous otherwise, which is rare. Etc. You generate IP that's public. It's purely intrinsic and intellectual.
 
Do any of you guys commenting here actually work for a pharma company? I find the salary ranges being thrown out pretty far north of what I've seen or been offered at the Director or even CMO positions. The only way it comes even close is if you include total comp, not salary, and that includes stock which may or may not be worth what is advertised. Also, this would only be for the larger blue chips. Smaller companies or start ups don't really pay more than academia.
 
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Do any of you guys commenting here actually work for a pharma company? I find the salary ranges being thrown out pretty far north of what I've seen or been offered at the Director or even CMO positions. The only way it comes even close is if you include total comp, not salary, and that includes stock which may or may not be worth what is advertised. Also, this would only be for the larger blue chips. Smaller companies or start ups don't really pay more than academia.
I'm also a bit confused. What I see here vs. other threads vs. publicly available information vs. my own personal experience vs. general sentiment vary widely.

People talk about "selling out" to pharma. Family friends in medicine all imply that their colleagues who transitioned to pharma did extremely well for themselves. The general sentiment says that there's a lot of money in pharma if you're qualified and able to move up the corporate ladder. Supporting this are threads like this one, claiming that VPs can make $500K+ and easily reach into the mid-upper six figure range.

However, I have experience in small pharma and I know the comp is not nearly as high as what's been discussed here, even in the C-suite, but that's different. In small pharma you are playing the IPO lottery. Glassdoor also shows much lower compensation packages as well, and pretty consistently. For instance, at Eli Lilly, Novartis, J&J, etc... VP is listed at about $400K total comp. Director is $200K. If we believe this data, rather than posts on SDN, then pharma should have the reputation of primary care, and doing the MD/PhD to pharma route should basically qualify you for sainthood. Meanwhile, Abbvie shows a completely different picture (VP Clinical Development $800K, VP Medical Affairs $650K, etc...).

For me, the answer to this changes the game. If the pay is not much better in pharma, I'll stick with academic medicine. At least there I'll have some flexibility, I can play the SBIR/STTR game and spin out companies, I can pick up more clinical work if I need more money, and I can vie for some actual influence, even if I know I'll most likely be another nameless niche academic. Further, I can bail to fulltime clinical work and apparently beat out the salaries pharma is willing to pay while retaining better job security. If the compensation picture painted above is correct, then pharma represents a bit of a mecca for MD/PhDs and translationally-oriented MDs who prefer translation to clinical practice.

I love the atmosphere of pharma, and I like building something with a big team for translation much better than I like tinkering around in the lab. However, I'm not willing to give up clinical practice and financial security to do it, especially when I could try my hand at licensing my IP from the university and building my own company as an academic. If I could join a team in pharma and feel at least somewhat confident that I could consistently make something comparable to a fulltime clinical physician in heme/onc, so around $375-400K, I'd make the jump. If instead it's more "sacrifice so you can do science," then I'll at least do that science on my own terms or bow out entirely and focus on financial independence.
 
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I'm also a bit confused. What I see here vs. other threads vs. publicly available information vs. my own personal experience vs. general sentiment vary widely.

People talk about "selling out" to pharma. Family friends in medicine all imply that their colleagues who transitioned to pharma did extremely well for themselves. The general sentiment says that there's a lot of money in pharma if you're qualified and able to move up the corporate ladder. Supporting this are threads like this one, claiming that VPs can make $500K+ and easily reach into the mid-upper six figure range.

However, I have experience in small pharma and I know the comp is not nearly as high as what's been discussed here, even in the C-suite, but that's different. In small pharma you are playing the IPO lottery. Glassdoor also shows much lower compensation packages as well, and pretty consistently. For instance, at Eli Lilly, Novartis, J&J, etc... VP is listed at about $400K total comp. Director is $200K. If we believe this data, rather than posts on SDN, then pharma should have the reputation of primary care, and doing the MD/PhD to pharma route should basically qualify you for sainthood. Meanwhile, Abbvie shows a completely different picture (VP Clinical Development $800K, VP Medical Affairs $650K, etc...).

For me, the answer to this changes the game. If the pay is not much better in pharma, I'll stick with academic medicine. At least there I'll have some flexibility, I can play the SBIR/STTR game and spin out companies, I can pick up more clinical work if I need more money, and I can vie for some actual influence, even if I know I'll most likely be another nameless niche academic. Further, I can bail to fulltime clinical work and apparently beat out the salaries pharma is willing to pay while retaining better job security. If the compensation picture painted above is correct, then pharma represents a bit of a mecca for MD/PhDs and translationally-oriented MDs who prefer translation to clinical practice.

I love the atmosphere of pharma, and I like building something with a big team for translation much better than I like tinkering around in the lab. However, I'm not willing to give up clinical practice and financial security to do it, especially when I could try my hand at licensing my IP from the university and building my own company as an academic. If I could join a team in pharma and feel at least somewhat confident that I could consistently make something comparable to a fulltime clinical physician in heme/onc, so around $375-400K, I'd make the jump. If instead it's more "sacrifice so you can do science," then I'll at least do that science on my own terms or bow out entirely and focus on financial independence.
Thank you for confirming my sanity.

From my experience, unless you are an executive at a highly profitable and revenue-rich company like Roche or something, you will make substantially less in pharma than you would in PP as a full time physician. Since the general staff salaries are not substantially (or at all) better than academia, many of the physicians employed by these companies are often of dubious quality and or intellect.

Also, while you do get to work on building something in a team setting, unless you are an executive, you have little control over your own projects, which can be frustrating.
 
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Since the general staff salaries are not substantially (or at all) better than academia, many of the physicians employed by these companies are often of dubious quality and or intellect.
I don't know if I would go that far. I have worked with plenty of physicians in pharma and industry, and they seem to come from all walks of medicine. I even hosted a seminar series at my medical school that brought in a new guest each month from careers outside medicine. Most were highly decorated. In general, I would actually argue that you are more likely to find physicians with impeccable resumes in industry than in a typical practice setting. The demand for physicians is so high that securing a position in the community upon finishing residency is essentially guaranteed, and when physicians have to deal with conditions endured by most of the working public (e.g., recently in rad onc or EM), it's considered a travesty within that field. That is the whole appeal of med school for many, isn't it? The whole, "What do you call the person who graduates last in their class in med school?" trope. Any of these people, dubious quality or not, could obtain a position as a physician in the community, supposedly making substantially more than someone in academia.

A quick LinkedIn search will show you that most of these people skew towards top 10 MD schools/residencies, not the other way around.

So my question is, why do people take these roles? Are they taking pay cuts to pursue a passion? Do they simply hate clinical medicine? Is the pay or upwards mobility substantially greater in these fields? MSTP programs are hyper focused on getting you into the physician-scientist pipeline so it can be reported on their T32, but that just leaves me in the dark as to how it all works. What's a desirable position look like in this field?
 
I don't know if I would go that far. I have worked with plenty of physicians in pharma and industry, and they seem to come from all walks of medicine. I even hosted a seminar series at my medical school that brought in a new guest each month from careers outside medicine. Most were highly decorated. In general, I would actually argue that you are more likely to find physicians with impeccable resumes in industry than in a typical practice setting. The demand for physicians is so high that securing a position in the community upon finishing residency is essentially guaranteed, and when physicians have to deal with conditions endured by most of the working public (e.g., recently in rad onc or EM), it's considered a travesty within that field. That is the whole appeal of med school for many, isn't it? The whole, "What do you call the person who graduates last in their class in med school?" trope. Any of these people, dubious quality or not, could obtain a position as a physician in the community, supposedly making substantially more than someone in academia.

A quick LinkedIn search will show you that most of these people skew towards top 10 MD schools/residencies, not the other way around.

So my question is, why do people take these roles? Are they taking pay cuts to pursue a passion? Do they simply hate clinical medicine? Is the pay or upwards mobility substantially greater in these fields? MSTP programs are hyper focused on getting you into the physician-scientist pipeline so it can be reported on their T32, but that just leaves me in the dark as to how it all works. What's a desirable position look like in this field?
I'm not in the pharma industry, but I have had several colleague leave academia. I would say each individual's reasons vary, but there is an underlying feeling they all share, they are just tired of academia. They have academic burnout for lack of a better term. I think the salary question is probably that they aren't making much different than they were in academia. One I know makes about the same, the other makes quite a bit more but they also had to move their entire family to one of the most expensive countries in the world. They also were both mid to late career and went to work for big pharmaceutical companies that could support comparable salaries that they were making. I think at least of them would have just taken a pay cut because they were that burned out. So it wasn't passion so much as desperation. In general, I would also say that if someone goes to work for a big company, they salary is comparable. But note that these people were also more senior and working for major companies and I think that is one group of people.

Those are different from smaller companies and start ups. The thing with industry in general (pharma, but devices and informatic tools too) is that it is general, a high risk but high reward. The reality is the pharma and biotech market is highly volatile and the chance of success is just as likely (if not more unlikely) that the chance of failure and folding. In that scenario, I think it boils down to 2 things: 1) is a passion (like I knew a guy who developed his company and product because he suffered from the disease) because there is some sacrifice and of course 2) wanting to hit pay dirt. That's why you'll see people perpetually moving around, chasing lots of products, folding and restarting. None of those people are raking in the dough. Far from it. But in the lucky chance (yep, that again) that they do find some product that it is successful, then they have 2 options again: 1) try to increase market share/cap to increase the wealth of the company (think Tesla... but also clearly not Tesla) or 2) they sell the company to a major company and get folded into it (think Sigma-Millipore, which used to be two different companies BTW, who essentially buy up smaller, start-up biotechs with marketable products). Most companies are gonna take the latter route, because up until that point, they had no money and were more or less, just borrowing and loans. And they didn't really have typically disposable income in the salary either. But now they have something else, stock options. And if you get bought out (or if you take the risk further and try to increase market cap) and all those shares you issued yourself and the employees increase by 100% to 200%, then you finally can cash out those options and have disposable income.
 
I think at least of them would have just taken a pay cut because they were that burned out. So it wasn't passion so much as desperation.
I guess I would then ask the question, why industry instead of clinical medicine? Clinical medicine is interesting, relatively autonomous, pays well (better than industry, apparently), comes with incredible job security, requires no new skill acquisition for a physician scientist, and skips most of the political nonsense associated with climbing the corporate ladder (or even staying put on a given rung).

Those are different from smaller companies and start ups. The thing with industry in general (pharma, but devices and informatic tools too) is that it is general, a high risk but high reward. The reality is the pharma and biotech market is highly volatile and the chance of success is just as likely (if not more unlikely) that the chance of failure and folding. In that scenario, I think it boils down to 2 things: 1) is a passion (like I knew a guy who developed his company and product because he suffered from the disease) because there is some sacrifice and of course 2) wanting to hit pay dirt. That's why you'll see people perpetually moving around, chasing lots of products, folding and restarting. None of those people are raking in the dough. Far from it. But in the lucky chance (yep, that again) that they do find some product that it is successful, then they have 2 options again: 1) try to increase market share/cap to increase the wealth of the company (think Tesla... but also clearly not Tesla) or 2) they sell the company to a major company and get folded into it (think Sigma-Millipore, which used to be two different companies BTW, who essentially buy up smaller, start-up biotechs with marketable products). Most companies are gonna take the latter route, because up until that point, they had no money and were more or less, just borrowing and loans. And they didn't really have typically disposable income in the salary either. But now they have something else, stock options. And if you get bought out (or if you take the risk further and try to increase market cap) and all those shares you issued yourself and the employees increase by 100% to 200%, then you finally can cash out those options and have disposable income.
I'm not going to claim to be an expert in small pharma, but I have actually spent several years in the industry, did an NIH I-Corps program, and I've also consulted for early stage biotechs in grad school. I agree with a lot of this, but I also disagree with some pieces of this.

High risk, high reward is definitely correct. However, in the therapeutics/diagnostics space, valuation is basically 100% regulatory, so almost all companies take the latter route you described. Each hurdle increases valuation, and founders trade risk for money with each step, hoping to attract a bigger fish to acquire them. Large cap companies are the customers, the whole company is the product, and the price for that product is almost entirely determined by how far along the clinical trial process you are. Also, Sigma-Millipore isn't really the target unless you're making lab supplies/assays/kits, which is more of a PhD thing. You're looking at large-scale therapeutics companies, firms like Novartis, Sanofi, Gilead, Biogen, etc... This site is a good spot to track some of these acquisitions.

The other side of this, which is more relevant to the discussion of this thread, is that MD/PhDs almost never leave medicine to go work for a small pharma company. The small pharma space is nearly entirely academic physicians or PhDs who spin out companies as founders. The employees are PhDs, and MDs are KOLs who consult for a small fee (<$10K, typically). Usually the founders stick around for 1-2 years as active contributors, but never make it a full time job. It's an investment if anything, not a career. If you're thinking of leaving medicine for pharma as a job, the vast majority of physicians would join big pharma. That's the world I don't understand (and am trying to understand), physicians working in big pharma.
 
I guess I would then ask the question, why industry instead of clinical medicine? Clinical medicine is interesting, relatively autonomous, pays well (better than industry, apparently), comes with incredible job security, requires no new skill acquisition for a physician scientist, and skips most of the political nonsense associated with climbing the corporate ladder (or even staying put on a given rung).


I'm not going to claim to be an expert in small pharma, but I have actually spent several years in the industry, did an NIH I-Corps program, and I've also consulted for early stage biotechs in grad school. I agree with a lot of this, but I also disagree with some pieces of this.

High risk, high reward is definitely correct. However, in the therapeutics/diagnostics space, valuation is basically 100% regulatory, so almost all companies take the latter route you described. Each hurdle increases valuation, and founders trade risk for money with each step, hoping to attract a bigger fish to acquire them. Large cap companies are the customers, the whole company is the product, and the price for that product is almost entirely determined by how far along the clinical trial process you are. Also, Sigma-Millipore isn't really the target unless you're making lab supplies/assays/kits, which is more of a PhD thing. You're looking at large-scale therapeutics companies, firms like Novartis, Sanofi, Gilead, Biogen, etc... This site is a good spot to track some of these acquisitions.

The other side of this, which is more relevant to the discussion of this thread, is that MD/PhDs almost never leave medicine to go work for a small pharma company. The small pharma space is nearly entirely academic physicians or PhDs who spin out companies as founders. The employees are PhDs, and MDs are KOLs who consult for a small fee (<$10K, typically). Usually the founders stick around for 1-2 years as active contributors, but never make it a full time job. It's an investment if anything, not a career. If you're thinking of leaving medicine for pharma as a job, the vast majority of physicians would join big pharma. That's the world I don't understand (and am trying to understand), physicians working in big pharma.
That's fair.

As to your first question, monotony and some straight up depression are the reasons I've seen. Mid-career can be very challenging on the psyche.
 
Mid-career can be very challenging on the psyche.
How about mid-PhD? After this last year and a half, I don't know a single PhD student who isn't in the absolute gutter mentally. That might even explain my soul searching here.
 
How about mid-PhD? After this last year and a half, I don't know a single PhD student who isn't in the absolute gutter mentally. That might even explain my soul searching here.
Sorry, I can’t really speak to that. I do know in many institutions, if you aren’t grant funded or lose funding, your options are to teach or leave. I can imagine that can be as depressing. Not in my division, but in another clinical division, there was a previously R01 funded mid-career who couldn’t renew his grant and was told he could teach to keep his job but that no soft money would be sent his way to keep the research afloat. He peaced out.

That being said, I know another mid-career PhD who submits no grants and no papers and has no teaching responsibilities and rides on other’s soft money for “technical expertise”. That guy’s never leaving… till the soft money distributor retires or dies. I knew another guy, similar position but slightly younger and had a family. He didn’t want to wait for the soft money PI to die and changed careers entirely.

But those are all just anecdotes.
 
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I was a lifer in academia- till I wasn't and left for industry back in 2014. It's been quite a trip.

Can we get a synopsis of what happened, lessons learned, general recommendations from your experiences?
 
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I'm also a bit confused. What I see here vs. other threads vs. publicly available information vs. my own personal experience vs. general sentiment vary widely.

People talk about "selling out" to pharma. Family friends in medicine all imply that their colleagues who transitioned to pharma did extremely well for themselves. The general sentiment says that there's a lot of money in pharma if you're qualified and able to move up the corporate ladder. Supporting this are threads like this one, claiming that VPs can make $500K+ and easily reach into the mid-upper six figure range.

Okay numbers quoted in this thread were from 2005!!!!! Please use your inflation-adjusted figures and you'll see that the numbers I gave are pretty much right on the same range.


From my experience, unless you are an executive at a highly profitable and revenue-rich company like Roche or something, you will make substantially less in pharma than you would in PP as a full time physician. Since the general staff salaries are not substantially (or at all) better than academia, many of the physicians employed by these companies are often of dubious quality and or intellect.

I don't think either of us is "wrong", we are just drawing trends about different things. There are VPs who make 500k+, and I'm pretty sure CMO of a midsize public pharma can very easily make 1M+. Check exec comp info on SEC. However, you would be right in saying that the MEDIAN salary of a run of the mill VP in a therapeutic area (i.e. say VP of clinical development in CNS) at a large pharma might make 300k vs. an executive VP who's a major rainmaker (i.e. oncology) might make 500k+. Also just to be explicit the numbers I quoted are for total comp. Depending on the capital gain of the RSUs or options if it's pre-public there is a lot of variation there.

The range is very large, and it's very difficult to predict a priori what you might be paid. So it's hard to say oh ok I'm going to plan to go academia rather than industry because I know median industry salary is X (i.e. 1.5-2x academia), but that's not worth the trouble. Yes, the median is X, but the top is Y.

I think you should think of it as I am always keeping my options open by actively engaging with the market. Things also change very quickly depending on supply vs. demand in your specialty. Once you are done with clinical fellowship, you should just send some feelers out and apply and see where it gets you.

Similar things can be said about PP. Median total comp in PP might be 300k, but top 10% of PP might be making 500k+ to 1M in any number of cognitive specialties. A lot of academics can leverage their reputation to monetize their clinical practice either part-time or even full-time. Again, I would HIGHLY recommend dipping your toes in PP as well when you are done with fellowship. Ask around and see what kind of offers you can get, etc.

I would say pharma median total comp is comparable to PP, which makes a lot of sense, because pharma is mainly scooping people from PP. They would prefer people who have a relevant PhD and relevant experience in academia, than retrain a PP physician, yes, but the supply-demand indicates that the pool of PP physicians who want to enter pharma is much, much larger. Top pharma in general > PP because the business scales better than PP, but even there things can vary a bit depending on specialty, therapuetic area, etc...Median PP ~ 1.5-2x academia, right?
 
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Sorry, I can’t really speak to that. I do know in many institutions, if you aren’t grant funded or lose funding, your options are to teach or leave. I can imagine that can be as depressing. Not in my division, but in another clinical division, there was a previously R01 funded mid-career who couldn’t renew his grant and was told he could teach to keep his job but that no soft money would be sent his way to keep the research afloat. He peaced out.

That being said, I know another mid-career PhD who submits no grants and no papers and has no teaching responsibilities and rides on other’s soft money for “technical expertise”. That guy’s never leaving… till the soft money distributor retires or dies. I knew another guy, similar position but slightly younger and had a family. He didn’t want to wait for the soft money PI to die and changed careers entirely.

But those are all just anecdotes.

The anecdotes are really just all manifestations of the underlying issue which is there's not enough money to float people who are living in the system. People do various different things in response to that reality.

In an alternative universe, you might imagine that while there's still a back and forth process where your grant applications are reviewed and revised, once you get to a certain level your salary support per se is always protected because the total funding level is flush enough vs. total candidates who can enter into the system. This was what was happening in the 80s.
 
The anecdotes are really just all manifestations of the underlying issue which is there's not enough money to float people who are living in the system. People do various different things in response to that reality.

In an alternative universe, you might imagine that while there's still a back and forth process where your grant applications are reviewed and revised, once you get to a certain level your salary support per se is always protected because the total funding level is flush enough vs. total candidates who can enter into the system. This was what was happening in the 80s.
Oh, there’s so many flaws in the funding system. The idea that grants pay salary and not the institution is pretty ridiculous. I mean, grant funding paying for salary for a PI to pontificate and order around the RA and post-doc is the most inefficient use of taxpayer money ever.
 
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Okay numbers quoted in this thread were from 2005!!!!! Please use your inflation-adjusted figures and you'll see that the numbers I gave are pretty much right on the same range.




I don't think either of us is "wrong", we are just drawing trends about different things. There are VPs who make 500k+, and I'm pretty sure CMO of a midsize public pharma can very easily make 1M+. Check exec comp info on SEC. However, you would be right in saying that the MEDIAN salary of a run of the mill VP in a therapeutic area (i.e. say VP of clinical development in CNS) at a large pharma might make 300k vs. an executive VP who's a major rainmaker (i.e. oncology) might make 500k+. Also just to be explicit the numbers I quoted are for total comp. Depending on the capital gain of the RSUs or options if it's pre-public there is a lot of variation there.

The range is very large, and it's very difficult to predict a priori what you might be paid. So it's hard to say oh ok I'm going to plan to go academia rather than industry because I know median industry salary is X (i.e. 1.5-2x academia), but that's not worth the trouble. Yes, the median is X, but the top is Y.

I think you should think of it as I am always keeping my options open by actively engaging with the market. Things also change very quickly depending on supply vs. demand in your specialty. Once you are done with clinical fellowship, you should just send some feelers out and apply and see where it gets you.

Similar things can be said about PP. Median total comp in PP might be 300k, but top 10% of PP might be making 500k+ to 1M in any number of cognitive specialties. A lot of academics can leverage their reputation to monetize their clinical practice either part-time or even full-time. Again, I would HIGHLY recommend dipping your toes in PP as well when you are done with fellowship. Ask around and see what kind of offers you can get, etc.

I would say pharma median total comp is comparable to PP, which makes a lot of sense, because pharma is mainly scooping people from PP. They would prefer people who have a relevant PhD and relevant experience in academia, than retrain a PP physician, yes, but the supply-demand indicates that the pool of PP physicians who want to enter pharma is much, much larger. Top pharma in general > PP because the business scales better than PP, but even there things can vary a bit depending on specialty, therapuetic area, etc...Median PP ~ 1.5-2x academia, right?
Other things to keep in mind is that the companies that pay out high salaries are few and far between, and there is only one spot at each company for a CMO and very few high paying VPs or directors. From my experience, industry and pharma (maybe these should be considered separately) do not pay as well as PP MOST OF THE TIME. Most companies are not Roche, most equity provided as part of total comp becomes worthless. As an example, I have received either equity (shares, options, or contractual obligations for equity) at 4 different companies over the past 7 years; only 1 is worth actual money (can be traded/sold on an exchange). Others are either paper promises or already worthless. On the other hand, PP pays you in cash and more cash. Even if "total comp" may appear similar, the mode may make it very different.
 
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Can we get a synopsis of what happened, lessons learned, general recommendations from your experiences?
My department was losing money, and despite having a few active private grants, I was told to pack up (as instructor at a top place). I got great offers at top places for tenure track positions. However, I was a bit dismayed at the prospect of needing an R01 within 6 years or be left out in the cold, and at the time, NCI R01 success rates were 5%. I was also seeing tenured faculty losing their jobs. Eventually I accepted a great academic offer that gave me everything I wanted (start up $$ and space, protected research time, a commitment that R01s are not required dut to ample philanthropy at the institution). It was my dream job.

While waiting for the offer to be approved by the provost (this can take up to 6 months sometimes!) I started getting calls from industry. I thought I would at least check it out. I got 2 offers for director positions. Neither paid more salary than the academic position I had accepted. One was a publicly traded company but their stock has really been pummeled over the past few years. The other was still in start up and there were no guarantees of funding parst 3 years. Neither was more enticing than the academic job I had accepted. Then a third company called me up, and had what it thought at the time great momentum in my specialty. Then they offered me double what the academic job was paying me AND promised equity. I accepted.

Turned out that company was a very good learning experience of how not to run or manage a company. I was miserable there, and the equity never materialized, and even if it did, it would be worthless.

Although it was miserable, I was able to network successfully, and then got opportunities elsewhere for other, better companies. Some went public and are now worth billions, some are still private and are still looking for an acquisition or an IPO.

Lessons learned? One important one is that you only live once, you are blessed if you can wake up every day doing something you love. One problem I have with industry is the focus on money and returns. Not from the company's perspective, which is obvious, but from you- your perspective changes to focus on it in a way that is not healthy IMO. And once it does, I don't think you can ever go back. This is true for PP as well, although in a different way. I don't want to write for of a wall of text, but happy to go into it in more detail if you guys want.
 
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Okay numbers quoted in this thread were from 2005!!!!! Please use your inflation-adjusted figures and you'll see that the numbers I gave are pretty much right on the same range.
Yes, I was keeping that in mind. Your numbers and @pazzer2's numbers align well. I was looking more at these threads vs. what I've seen in the wild and Glassdoor, which were much lower than the numbers in that thread and your comment.
Oh, there’s so many flaws in the funding system. The idea that grants pay salary and not the institution is pretty ridiculous. I mean, grant funding paying for salary for a PI to pontificate and order around the RA and post-doc is the most inefficient use of taxpayer money ever.
Does it matter how the grant money is spent as long as it's given out and allows quality research to occur? Grants paying the salary leads to some stressful situations for PIs, but realistically you can't ask institutions to put up money for non-revenue generating activities. We rely on the government to make investments in things that private industry can/will not, but still provides long term gains for society.

If anything, I'd call for a different method of determining who gets money and for what projects.
 
Yes, I was keeping that in mind. Your numbers and @pazzer2's numbers align well. I was looking more at these threads vs. what I've seen in the wild and Glassdoor, which were much lower than the numbers in that thread and your comment.

Does it matter how the grant money is spent as long as it's given out and allows quality research to occur? Grants paying the salary leads to some stressful situations for PIs, but realistically you can't ask institutions to put up money for non-revenue generating activities. We rely on the government to make investments in things that private industry can/will not, but still provides long term gains for society.

If anything, I'd call for a different method of determining who gets money and for what projects.
Actually, you could, it just they are unwilling to do so. That being said, they have countless administrators they float with all the indirects. There is way too much spent on science that doesn’t actually produce science.
 
Actually, you could, it just they are unwilling to do so. That being said, they have countless administrators they float with all the indirects. There is way too much spent on science that doesn’t actually produce science.

I heard that in econ dept grants received get pooled into a portfolio that follow the endowment in investment. The PI then gets a portion of the investment return. LMAO. Econ people just do everything better.
 
I got 2 offers for director positions. Neither paid more salary than the academic position I had accepted. Then a third company called me up, and had what it thought at the time great momentum in my specialty. Then they offered me double what the academic job was paying me AND promised equity. I accepted.

This is also my experience. If you get offers from a variety of different companies, salary difference in offers can be 1.5-2x. This means of course that you'd never take the job that doesn't pay 2x, which is exactly what my point was initially.

One problem I have with industry is the focus on money and returns. Not from the company's perspective, which is obvious, but from you- your perspective changes to focus on it in a way that is not healthy IMO. And once it does, I don't think you can ever go back.

This is 100% spot on. Not sure if it's "unhealthy", but I think older post-2000s era MD PhDs generally get a taste of reality very quickly s/p fellowship, because of larger trends in the biomedical research community, and once you are 35+ you start to think more about #valueadd in your life, and the view in the back mirror of the advice you were given during training becomes totally different. As I said above, the entire point of academia is not having much #valueadd, and if you want to sit in academia you have to be foundationally okay with that, and all sorts of implications of that foundational reality.
 
This is also my experience. If you get offers from a variety of different companies, salary difference in offers can be 1.5-2x. This means of course that you'd never take the job that doesn't pay 2x, which is exactly what my point was initially.



This is 100% spot on. Not sure if it's "unhealthy", but I think older post-2000s era MD PhDs generally get a taste of reality very quickly s/p fellowship, because of larger trends in the biomedical research community, and once you are 35+ you start to think more about #valueadd in your life, and the view in the back mirror of the advice you were given during training becomes totally different. As I said above, the entire point of academia is not having much #valueadd, and if you want to sit in academia you have to be foundationally okay with that, and all sorts of implications of that foundational reality.
Of note, since 2014 I've now been offered or had headhunters call me for at least 30-40 positions, from Sr Medical Director, to SVP, to CMO. Current offers are really just for CMO at this point given my current role.

In general, my experience is that in industry an SVP is an SVP, and pays the same for the finance dept to the billing dept to the medical affairs division. 200k may be a lot for the head of finance but it is crap for a physician, particularly with the risk you the for joint such ventures. Its for this reason that I say most of the directors and SVPs and even CMOs are not the brightest or most accomplished in the field. To be fair, this is not across the board, and top places get top talent. But as I also stated, top places and opportunities are rare. There are lots of director roles at Roche, few SVP, and 1 CMO. Advancement is not guaranteed and even director jobs are mostly terminal.
 
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To be fair, this is not across the board, and top places get top talent. But as I also stated, top places and opportunities are rare. There are lots of director roles at Roche, few SVP, and 1 CMO. Advancement is not guaranteed and even director jobs are mostly terminal.
Agree. Several of my interviews were with the retirement age Senior Director of Executive Senior Directors.
 
My department was losing money, and despite having a few active private grants, I was told to pack up (as instructor at a top place). I got great offers at top places for tenure track positions. However, I was a bit dismayed at the prospect of needing an R01 within 6 years or be left out in the cold, and at the time, NCI R01 success rates were 5%. I was also seeing tenured faculty losing their jobs. Eventually I accepted a great academic offer that gave me everything I wanted (start up $$ and space, protected research time, a commitment that R01s are not required dut to ample philanthropy at the institution). It was my dream job.

While waiting for the offer to be approved by the provost (this can take up to 6 months sometimes!) I started getting calls from industry. I thought I would at least check it out. I got 2 offers for director positions. Neither paid more salary than the academic position I had accepted. One was a publicly traded company but their stock has really been pummeled over the past few years. The other was still in start up and there were no guarantees of funding parst 3 years. Neither was more enticing than the academic job I had accepted. Then a third company called me up, and had what it thought at the time great momentum in my specialty. Then they offered me double what the academic job was paying me AND promised equity. I accepted.

Turned out that company was a very good learning experience of how not to run or manage a company. I was miserable there, and the equity never materialized, and even if it did, it would be worthless.

Although it was miserable, I was able to network successfully, and then got opportunities elsewhere for other, better companies. Some went public and are now worth billions, some are still private and are still looking for an acquisition or an IPO.
As a student, what I'd really love is a rundown of your timeline and how you positioned yourself for these opportunities. There are all these black boxes in between each of these steps and I'm always curious how this actually goes down. If I'm reading this correctly, it seems like this was your general journey after residency/fellowship

"Instructor" non-tenure track faculty at a top institution. Was this a 20/80, 50/50, or 80/20 kind of job, and did you have your own lab/any students/techs? How does one even go about getting an R01 under these circumstances? I also assume you're taking a major pay cut even from 100% clinical academic medicine.

Offer from a top institution for a tenure-track job. Why was it that you were stuck at instructor at your institution, but upon your own department imploding you were offered several tenure-track jobs at top places with start up money and protected time?

Better opportunities elsewhere. Given you managed to successfully pivot out of a bad company, do you feel you made the right decision turning down the tenure track job/was your career as satisfying? Financially, do you think most who go down the industry path make better returns overall than those in academic medicine/employed/private practice?
Lessons learned? One important one is that you only live once, you are blessed if you can wake up every day doing something you love. One problem I have with industry is the focus on money and returns. Not from the company's perspective, which is obvious, but from you- your perspective changes to focus on it in a way that is not healthy IMO. And once it does, I don't think you can ever go back. This is true for PP as well, although in a different way. I don't want to write for of a wall of text, but happy to go into it in more detail if you guys want.
As far as the "you only live once" and focus on money/returns, is it not a completely healthy mindset at this stage in life to focus on maximizing finances? Basically any salary you make is 1/2 of the actual number because you are starting ~12-15 years after a typical worker and missing prime saving/investing years. If we paid residents/fellows the way law pays junior associates or the way SWE pays L1-L3s or the way consulting pays their more junior staff, then I'd understand this mentality. However, you are so far behind even a run-of-the-mill engineer that it feels almost selfish to keep pursuing your dreams and taking lower and lower pay when you've got a family to support. Maybe I'm the minority view here, but this mentality feels like more masochism from an already masochistic field. At a certain point it's gotta be "f- you, pay me."

Also, I haven't met too many MD/PhDs outside of the absurdly successful running well-funded labs in good locations making good money who are waking up everyday feeling blessed about their work. What I've seen in the wild is mostly jaded, aggravated former whiz kids who are struggling to figure out why they chased this dream for so long only to be shown the door or told to work from the sidelines.
 
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As a student, what I'd really love is a rundown of your timeline and how you positioned yourself for these opportunities. There are all these black boxes in between each of these steps and I'm always curious how this actually goes down. If I'm reading this correctly, it seems like this was your general journey after residency/fellowship

"Instructor" non-tenure track faculty at a top institution. Was this a 20/80, 50/50, or 80/20 kind of job, and did you have your own lab/any students/techs? How does one even go about getting an R01 under these circumstances? I also assume you're taking a major pay cut even from 100% clinical academic medicine.

Offer from a top institution for a tenure-track job. Why was it that you were stuck at instructor at your institution, but upon your own department imploding you were offered several tenure-track jobs at top places with start up money and protected time?

Better opportunities elsewhere. Given you managed to successfully pivot out of a bad company, do you feel you made the right decision turning down the tenure track job/was your career as satisfying? Financially, do you think most who go down the industry path make better returns overall than those in academic medicine/employed/private practice?

As far as the "you only live once" and focus on money/returns, is it not a completely healthy mindset at this stage in life to focus on maximizing finances? Basically any salary you make is 1/2 of the actual number because you are starting ~12-15 years after a typical worker and missing prime saving/investing years. If we paid residents/fellows the way law pays junior associates or the way SWE pays L1-L3s or the way consulting pays their more junior staff, then I'd understand this mentality. However, you are so far behind even a run-of-the-mill engineer that it feels almost selfish to keep pursuing your dreams and taking lower and lower pay when you've got a family to support. Maybe I'm the minority view here, but this mentality feels like more masochism from an already masochistic field. At a certain point it's gotta be "f- you, pay me."

Also, I haven't met too many MD/PhDs outside of the absurdly successful running well-funded labs in good locations making good money who are waking up everyday feeling blessed about their work. What I've seen in the wild is mostly jaded, aggravated former whiz kids who are struggling to figure out why they chased this dream for so long only to be shown the door or told to work from the sidelines.
I'm traveling today and responding from my cell, so pardon typos of faulty autocorrects.

I was an MSTP at a great program and finished with several national honors and 7 papers. When seeking residency programs, I was really only interested in PSTPs. I went to a renowned program, in part because the chairman of my department told me they were hiring me as a faculty member. I was told that if I finished residency and did a post-doc, and published a few papers and applied for a grant, I would have $1M start-up funds waiting for me (this was 2007). So I did all those things. After post-doc I became an Instructor (pretty much required at the top institutions) at a significant discount to an Asst Prof salary. That said, it has its perks. I was basically 95% protected research time and shared space with my mentor where I did my post doc. The goal is to get data and apply for grants before the tenure clock starts. After 2 years, I had 2 grants and published 3 papers. I went to my chair and said that I was ready for that promised position....

I was warned by other faculty and mentors that it was in my best interest to go look around and see what I was worth. But I wasn't really interested in switching institutions as I was very happy there.

The talk with my chair did not go as expected. It was basically "Did I really promise that? Well, we are losing money and can't hire any new faculty. I'll help you find a job somewhere else."

I wrote letters to 7 chairmen at departments where I was interested in working, and my chair said he would follow up with them and support me (actually, he didn't really do anything other that review my letters, but luckily I didn't need any more support). I got return letters inviting me for an interview at 3 of them (others did not reply or stated they were not hiring). Another one was actually actively recruiting for a relevant job). So I interviewed at all 4 and got 3 offers.

(Will continue this later)...
 
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I'm traveling today and responding from my cell, so pardon typos of faulty autocorrects.

I was an MSTP at a great program and finished with several national honors and 7 papers. When seeking residency programs, I was really only interested in PSTPs. I went to a renowned program, in part because the chairman of my department told me they were hiring me as a faculty member. I was told that if I finished residency and did a post-doc, and published a few papers and applied for a grant, I would have $1M start-up funds waiting for me (this was 2007). So I did all those things. After post-doc I became an Instructor (pretty much required at the top institutions) at a significant discount to an Asst Prof salary. That said, it has its perks. I was basically 95% protected research time and shared space with my mentor where I did my post doc. The goal is to get data and apply for grants before the tenure clock starts. After 2 years, I had 2 grants and published 3 papers. I went to my chair and said that I was ready for that promised position....

I was warned by other faculty and mentors that it was in my best interest to go look around and see what I was worth. But I wasn't really interested in switching institutions as I was very happy there.

The talk with my chair did not go as expected. It was basically "Did I really promise that? Well, we are losing money and can't hire any new faculty. I'll help you find a job somewhere else."

I wrote letters to 7 chairmen at departments where I was interested in working, and my chair said he would follow up with them and support me (actually, he didn't really do anything other that review my letters, but luckily I didn't need any more support). I got return letters inviting me for an interview at 3 of them (others did not reply or stated they were not hiring). Another one was actually actively recruiting for a relevant job). So I interviewed at all 4 and got 3 offers.

(Will continue this later)...

*fills up a bowl of popcorn*

This is gonna be good
 
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The talk with my chair did not go as expected. It was basically "Did I really promise that? Well, we are losing money and can't hire any new faculty. I'll help you find a job somewhere else."

Last 3-5 years, especially 2020, this is the prevailing sentiment of many departments based on people I've talked to. The bottom line is that NIH total funding is decreasing in real dollars, so if you try to raise startup from the indirects, and you start to "lose money". It's increasingly unrealistic for departments to believe in you so much so that they'd cough up a startup based solely on connections and strengths of your publications during PhD/postdoc. You need either a K99 or frankly just a straight R01 starting year 1.

It does still happen at some 2nd tier universities that recently received a large philanthropic endowment, that sort of thing. I have friends who have multiple major grants who applied elsewhere and received an offer with startup funds lower than the indirect brought in, and when he negotiated the offer was rescinded. I think institutions also increasingly believe that even if you had an R01, the renewal and continuation is very much questionable, so they have to hedge their bets on their limited revenue for startups and scooping.

Larger centers would rather just scoop senior faculty who move for reasons other than career advancement directly instead.
 
Last 3-5 years, especially 2020, this is the prevailing sentiment of many departments based on people I've talked to. The bottom line is that NIH total funding is decreasing in real dollars, so if you try to raise startup from the indirects, and you start to "lose money". It's increasingly unrealistic for departments to believe in you so much so that they'd cough up a startup based solely on connections and strengths of your publications during PhD/postdoc. You need either a K99 or frankly just a straight R01 starting year 1.
Anecdotal, but I know for a fact they are cutting some programs significantly this year, and I feel very bad for the class coming up behind me. NCI pay lines for F30 were cut in half for 2022.

Also anecdotal, I wrote an R01 for (not with...) my PI this year that got funded. He just received notice that they cut the budget ~30%.

We seem to have money to spend on everything these days, but apparently biomedical science, in the wake of the worst biomedical disaster for a century, is not a priority.
I'm traveling today and responding from my cell, so pardon typos of faulty autocorrects.

I was an MSTP at a great program and finished with several national honors and 7 papers. When seeking residency programs, I was really only interested in PSTPs. I went to a renowned program, in part because the chairman of my department told me they were hiring me as a faculty member. I was told that if I finished residency and did a post-doc, and published a few papers and applied for a grant, I would have $1M start-up funds waiting for me (this was 2007). So I did all those things. After post-doc I became an Instructor (pretty much required at the top institutions) at a significant discount to an Asst Prof salary. That said, it has its perks. I was basically 95% protected research time and shared space with my mentor where I did my post doc. The goal is to get data and apply for grants before the tenure clock starts. After 2 years, I had 2 grants and published 3 papers. I went to my chair and said that I was ready for that promised position....

I was warned by other faculty and mentors that it was in my best interest to go look around and see what I was worth. But I wasn't really interested in switching institutions as I was very happy there.

The talk with my chair did not go as expected. It was basically "Did I really promise that? Well, we are losing money and can't hire any new faculty. I'll help you find a job somewhere else."

I wrote letters to 7 chairmen at departments where I was interested in working, and my chair said he would follow up with them and support me (actually, he didn't really do anything other that review my letters, but luckily I didn't need any more support). I got return letters inviting me for an interview at 3 of them (others did not reply or stated they were not hiring). Another one was actually actively recruiting for a relevant job). So I interviewed at all 4 and got 3 offers.

(Will continue this later)...
Thank you for doing this. This is exactly the sort of information MSTP students need to understand what they're walking into. At least for us, it's all kept so vague.

When you say 7 papers, do you mean 7 first author or 7 first/co-author manuscripts?
 
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Thank you for doing this. This is exactly the sort of information MSTP students need to understand what they're walking into. At least for us, it's all kept so vague.

When you say 7 papers, do you mean 7 first author or 7 first/co-author manuscripts?

I only have about 5 min between some scheduled calls, but can add a few more tidbits here:

1. I finished my PhD with 4 first-author papers, some high-caliber. These also reflected my projects and not softballs.

2. During residency/postdoc I was pretty successful too. I not only had the 3 publications I spoke of, I also won a national "young investigator" award in my field (precision medicine/ molecular diagnostics).

3. I applied for a K08 during my instructor year but was not funded. While not getting any one grant is deflating and you can chalk it up to bad luck, I was perturbed how little precision there is with reviews. One reviewer's comments were "this is the best application I have reviewed this year and will surely be funded" another was "institution does not have the resources or experience to support the proposal", also basically saying my institution sucked, despite it being one of the very best departments and institutions in the country. Also, the 2 grants I did get were supposedly much more difficult to attain than a K08. My project was in using NGS and bioinformatics approaches to understand cancer. I think I was ahead of the curve because at the time, most didn't know what NGS was.
 
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The talk with my chair did not go as expected. It was basically "Did I really promise that? Well, we are losing money and can't hire any new faculty. I'll help you find a job somewhere else."
That is some Grade A horsesh-t... but also another important life lesson.

If its not in writing... it doesn't count.
 
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Last 3-5 years, especially 2020, this is the prevailing sentiment of many departments based on people I've talked to. The bottom line is that NIH total funding is decreasing in real dollars, so if you try to raise startup from the indirects, and you start to "lose money". It's increasingly unrealistic for departments to believe in you so much so that they'd cough up a startup based solely on connections and strengths of your publications during PhD/postdoc. You need either a K99 or frankly just a straight R01 starting year 1.

It does still happen at some 2nd tier universities that recently received a large philanthropic endowment, that sort of thing. I have friends who have multiple major grants who applied elsewhere and received an offer with startup funds lower than the indirect brought in, and when he negotiated the offer was rescinded. I think institutions also increasingly believe that even if you had an R01, the renewal and continuation is very much questionable, so they have to hedge their bets on their limited revenue for startups and scooping.

Larger centers would rather just scoop senior faculty who move for reasons other than career advancement directly instead.
Alternatively, I have seen institutions apply for KL2/K12 awards and place potential faculty on these to offset the start up cost. Of course, they cherry pick the faculty they put on these awards (and even game the system, I was put on my institutions KL2 AFTER they found out my K08 was going to be awarded to fudge the success rate) but I have seen that mechanism used exactly for that purpose. It also moves up the K clock on an assistant professor (which is a bad thing generally) and thus they put people on the instructor track... which nets them more cost savings. Cha-ching!
 
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That is some Grade A horsesh-t... but also another important life lesson.

If its not in writing... it doesn't count.
My thoughts exactly as I walked in and out of his office. I sorta lied when I said it was unexpected... It should have been. But I knew the department's financial issues and had seen tenured faculty get shown the door. That said, when I accepted the residency PSTP position, I asked and got a lot of what I asked for. You don't think that you should require a written contract with your chairman. This was academia, not buying a house. But you are right. Did he not realize I had planned my whole career around his flippant words? You are right- it WAS a learning experience- and I did learn.
 
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I'm traveling today and responding from my cell, so pardon typos of faulty autocorrects.

I was an MSTP at a great program and finished with several national honors and 7 papers. When seeking residency programs, I was really only interested in PSTPs. I went to a renowned program, in part because the chairman of my department told me they were hiring me as a faculty member. I was told that if I finished residency and did a post-doc, and published a few papers and applied for a grant, I would have $1M start-up funds waiting for me (this was 2007). So I did all those things. After post-doc I became an Instructor (pretty much required at the top institutions) at a significant discount to an Asst Prof salary. That said, it has its perks. I was basically 95% protected research time and shared space with my mentor where I did my post doc. The goal is to get data and apply for grants before the tenure clock starts. After 2 years, I had 2 grants and published 3 papers. I went to my chair and said that I was ready for that promised position....

I was warned by other faculty and mentors that it was in my best interest to go look around and see what I was worth. But I wasn't really interested in switching institutions as I was very happy there.

The talk with my chair did not go as expected. It was basically "Did I really promise that? Well, we are losing money and can't hire any new faculty. I'll help you find a job somewhere else."

I wrote letters to 7 chairmen at departments where I was interested in working, and my chair said he would follow up with them and support me (actually, he didn't really do anything other that review my letters, but luckily I didn't need any more support). I got return letters inviting me for an interview at 3 of them (others did not reply or stated they were not hiring). Another one was actually actively recruiting for a relevant job). So I interviewed at all 4 and got 3 offers.

(Will continue this later)...
OK, more to the story...

These institutions offered a range of protected time for these tenure track positions. I will say at this point I became pretty wary of the tenure system, having seen tenured faculty get shown the door. However, I never saw myself doing anything more than academia, unlike many of my colleagues who were just looking to get out as soon as they finished residency. Of note, one of my colleagues was in the same exact boat as me. He also was highly successful and did his MSTP at the same institution. He did his post doc with a very famous physician scientist, and had great publications. He was on the same path as me, and actually got his K08. It didn't matter for him either, he was shown the door just like me. Unlike me, he was very bitter about it (and still is to this day).

A breakdown of the offers:

1. 80/20 position at a great ivy league program that was very traditional (6/7 years to R01 or you get the boot). Great support, great staff, great location. Compensation was... terrible (below mean for academia in my specialty). Start up, space, everything included (final start-up figure was never supplied).

2. 50/50 position at another prominent ivy league-affiliated program. However, there was a lot of politics and in-fighting between the affiliated hospitals. It looked like walking into a minefield. I walked away.

3. 50/50 position at another prominent program in my field. However, they really made it pretty clear they were going to rely on me to focus on medical services. When I pressed for the need for protected time, they told me they thought the position was probably not in my best interest and steered me away.

4. 75/25 position at a top cancer center. More specifically, 50% protected research time, 25% technology development, and 25% clinical. Great staff and atmosphere. All said and done, did 50 interviews (I am not exaggerating) with all relevant clinical staff and research staff. Great location, although expensive. Good salary (very good for academia, but offset by cost of living). $500K start-up funds, space (which was hard to come by). However, this would go far because I would have access to very expensive equipment. The best part was that I was told that my job would not depend on grants, that if I I got grants they would only ask for 10% overhead, otherwise, they would fund me from their large philanthropy contributions, which exceeded $300M most years. Now, to be sure, this last bit was not on a contract anywhere and you just had to trust them at their word.

I also applied to a few other advertised positions, but dropped them all since I would not really have taken them over the places above. I didn't really have to think about my options very hard for the first time when facing such decisions, when I saw #4 as a clear cut winner.

I verbally accepted their offer ~ Nov/Dec 2013. Now, just so you get a sense for timelines, #1 was also a compelling offer. But it took them so long to get details together and make the offer official that I ended up accepting offer #4 despite interviewing there months later.

.... More later (if you guys want to hear the rest of the story).
 
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My thoughts exactly as I walked in and out of his office. I sorta lied when I said it was unexpected... It should have been. But I knew the department's financial issues and had seen tenured faculty get shown the door. That said, when I accepted the residency PSTP position, I asked and got a lot of what I asked for. You don't think that you should require a written contract with your chairman. This was academia, not buying a house. But you are right. Did he not realize I had planned my whole career around his flippant words? You are right- it WAS a learning experience- and I did learn.
For tenured faculty (and not just tenure track), the bolded is incredibly unusual. Those finances must have been an absolute dumpster fire. It also shows, when push comes to shove… tenure is practically meaningless.

Edit: Holy crap, the follow up to your story when someone got a K08 and was asked to leave during the award period is also incredibly unusual. That institution sounds like it’s run by idiots.
 
For tenured faculty (and not just tenure track), the bolded is incredibly unusual. Those finances must have been an absolute dumpster fire. It also shows, when push comes to shove… tenure is practically meaningless.

Edit: Holy crap, the follow up to your story when someone got a K08 and was asked to leave during the award period is also incredibly unusual. That institution sounds like it’s run by idiots.

They ended up coming out of it just fine, but for a while the sky was apparently falling. The other issue was that there was a disconnect between the Chair and the clinical department. While a tremendous scientist, he was not a good manager of people and made terrible decisions. He would hire scientists that worked on topics related to his interests, but let promising up-and-coming faculty walk without realizing what he was losing (or caring?).

BTW, my buddy that had the K08 had little trouble getting another position, as you can imagine. He similarly went to another prominent institution with a lot of philanthropy, and they gave him the equivalent of a $2M startup, which I thought was unreal.
 
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They ended up coming out of it just fine, but for a while the sky was apparently falling. The other issue was that there was a disconnect between the Chair and the clinical department. While a tremendous scientist, he was not a good manager of people and made terrible decisions. He would hire scientists that worked on topics related to his interests, but let promising up-and-coming faculty walk without realizing what he was losing (or caring?).

BTW, my buddy that had the K08 had little trouble getting another position, as you can imagine. He similarly went to another prominent institution with a lot of philanthropy, and they gave him the equivalent of a $2M startup, which I thought was unreal.
Oh, I’m sure he took his K08 elsewhere (it’s a good bargaining tool) but it’s still unusual and total bull.
 
Oh, I’m sure he took his K08 elsewhere (it’s a good bargaining tool) but it’s still unusual and total bull.
Sure. Look, I can't really explain the logic other than even with the K08, the department has to take a risk and foot part of the bill. Our chairman was not willing to do that for us for whatever reason, although he did hire some researchers that year.

He didn't last very long after that and was gone within a few years.
 
Sure. Look, I can't really explain the logic other than even with the K08, the department has to take a risk and foot part of the bill. Our chairman was not willing to do that for us for whatever reason, although he did hire some researchers that year.

He didn't last very long after that and was gone within a few years.
Yes, Ks in general are money losing for an institution from a clinician standpoint. It’s more of the principle of it. By saying an institution will support an applicant (which is part of the proposal and an important review item) and them knowing full well that they won’t, it’s just so freaking dishonest. I mean, it wouldn’t be the first time some lied on a grant application (at no fault of the applicants in this regard), but it totally grinds my gears.
 
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