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.