Many of us aspire to acquire an 80-20 research-clinical career, or some other split. I am wondering though what is really meant by "80% research." As in, what do the faculty-level physician scientists actually do on a day-to-day basis when they say they are "doing research."
Mostly writing grants.
I'd say from what I can gather people who consistently have 2 R01s basically spend at least 30-50% of their "80%" writing grants. If not directly sitting in from the laptop writing then thinking about new grant ideas and discussing with other people about grant ideas. Then the rest of the time is more about supervising people who would implement the previous grant (i.e. postdoc/students/staff).
Once there is money, you can hire people to do everything else for you, and cheaply. The reason that faculty don't do postdoc things is that postdocs do postdoc things much much more cheaply. It's a pyramid scheme and simple economics.
It's not entirely true that you need to be PIs on 2 R01s to sustain 80% research. There are other mechanisms from NIH that would allow you to do that (e.g. K22/K24, "MERIT", co-Is, etc.) Still, the salary from NIH funding is pennies compared to what you can generate from clinical work. It used to be that the indirects going to the department still makes it somewhat worth it. As inflation bumps up physician reimbursement even in non-procedural specialties, NIH salary line has not kept pace, especially when funding rates are so low, and therefore more recently many departments are becoming much less willing to take a hit to "support" research at a salary level that's comparable to doing clinical work. This creates distorted and perverse incentives, and makes it especially difficult for women and people from a disadvantaged background to sustain a research career. I think the senior members on this forum (Fencer, SurfingDoctor etc.) entered into the system at a propitious time. As far as I know, nobody in my generation (i.e. 5-10 years out of MD/PhD) who has been active on this forum (sure selection bias plays a part perhaps) is even close to getting an R01 (let alone 2), which used to be the norm. It's becoming increasingly clear that institutions cannot be relied upon, and it's a eat-what-you-kill world. As time goes on, things get easier, but not because the game itself becomes easier, but because you get to used to the idea of not having a solid job every grant cycle and come up with creative and sustainable ways (and that's different for each person) to deal with it.
Some of the blogs can be helpful (i.e. DrugMonkey, FemaleScienceProfessor, etc.) If you ask a professor in real life it's often difficult to get the "real story" so to speak because there's a strong tendency to try to convince people to continue. The reality is that the game is very rough and very frequently devastating to a lot of people, so it's always helpful to think about alternatives and diversify.
