What is the job market like for early career physician scientists?

[ValentinNarcisse]

Hm. you are not "offering" anything. You are asking for things. Lower tier schools do invest more protected time and salary, but this seems to be not necessarily correlated to eventual funding success. It also is a pattern that people who complain the most "just can't move out of San Francisco".

The reality is, being a fancy private practice physician in Manhattan or an executive at a pharma company making 400k is just *plainly* a better job than doing low impact research in nowhere, R01 funded or not, for most people. As I said, it's easy to get by as a "physician-scientist" with protected research time: you write 3 grants a year and be happy living where ever your job is and make about 30-50% less than your clinician colleagues. Grant money is unpredictable but if you do these things there's no reason why most departments can't keep you. As I said, people LEAVE for better jobs not because they get fired. Nobody ever gets fired unless you say something bad on social media.

Just plan to live on 150k a year. That's plenty money for most parts of America. Make a decision and do it. Or not. What's the point of complaining?

The situation with women is changing and in the long run, won't be a problem. Because being a medical researcher is now becoming less prestigious a job overall, mid-tier research trained men are now exiting academia--or never planned to enter into academia from day 1--this is a clear trend for both PhD and MD/PhD. Mid-tier research jobs are now becoming more mommy track, especially those with hard money salaries and don't expect consistent grant productivity. In larger cities, these women end up with bankers/doctors/tech workers, so they are happy being paid even less as long as they have a flexible vanity job at a non-profit, which is *exactly* what this job is. You need to say it out loud with me: "being a physician-scientist is a vanity job at a non-profit." Men who do this job are less likely to marry up, but with a stay at home wife their comparably lower but still reasonably high salary is generally enough if they move out of the tier 1 neighborhood/suburbs, or they have family money (which is not rare as discussed). I don't see which part of "the system" is not working. Vanity jobs are not for everyone (and most lower-middle-class kids of various ethnicities will drop out), and I'm very much questioning if more tax dollars should be thrown at it, especially when the labor market is managed in such a bad way--if you increase the total tax input, all it does is that the current winners will be even more winning.

@sluox you just kept it too real. I wonder how many students would embark on MSTP if they knew up front this was the ultimate outcome after 15 years of post college training.

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[ChordaEpiphany]

How do you evaluate "best" at those earlier stages?

I imagine the same way every other profession chooses its winners. We've already had filtration at the high school, college, med school, PhD, and residency/fellowship level. If that is not enough, then nothing will be. We lose more of the "best" people asking them to jump through hoops than we gain with an extra decade of filtration.

Perhaps we should not weed out early, or any time, early stage researchers who lack these assets, but rather ask how the system should be adjusted to better support ALL the trainees that the physician scientist pathway had intended to recruit.

My point is that these assets stratify us more as we get older. A more equitable system would allow stability after fellowship to achieve parity with non-academic tracks. Most of us can afford low salary jobs or geographical instability at a young age. It's only the privileged, single, (or masochistic) who can continue moving around the country and taking a low salary into their 40s, and academic centers typically don't have the resources to better support trainees.

No one cares. You either do it or you don't. Complaining gets you nowhere. It's really best to 1) know the game 2) make a decision as to whether you want to play it or not. You can sit there and pontificate as to "what's the best system" to do A B C but really it's just purely an armchair exercise. Life is far too short to be unhappy about things you have no power to change.

Am I complaining, though? I'm just stating the obvious: this career pathway has become undesirable, and the profession is suffering for it. I'm not personally suffering. Having the option to "fail upwards" into a higher paying, more stable job is blessing, and I have no delusions about my chances of becoming a core faculty member at a top research institution. However, good physician-scientists, even those who succeed, are punished for going through it, and a physician-scientist forum is exactly the sort of place to discuss the deficiencies of the profession. As a trainee, yes, either buck up and play the game or get out of it. You won't find me going on tirades to my program directors or residency directors. However, we should still strive to create a dialogues around important issues, especially if you find yourself in a position of power (or with the ear of those who are). When the next generation is in power, I do hope we find it problematic that, as you accurately stated, being a physician-scientist has become a "vanity job at a non-profit."

The situation with women is changing and in the long run, won't be a problem. Because being a medical researcher is now becoming less prestigious a job overall, mid-tier research trained men are now exiting academia--or never planned to enter into academia from day 1--this is a clear trend for both PhD and MD/PhD. Mid-tier research jobs are now becoming more mommy track, especially those with hard money salaries and don't expect consistent grant productivity. In larger cities, these women end up with bankers/doctors/tech workers, so they are happy being paid even less as long as they have a flexible vanity job at a non-profit, which is *exactly* what this job is.

Surely you can see how problematic this statement is. Solving the crisis of women in academia by 1) assuming they will marry up, and 2) assuming the profession will continue to decline, is not an acceptable resolution.

The part of the system that isn't working is the fact that most of us are training for a vanity job. Even if you can't increase real job opportunities for physician-scientists in academia, we should acknowledge on a widespread level that most MD/PhD trainees will wind up in private practice or industry. Training and expectations should be adjusted accordingly, much like PhD training today.

 

[tortuga87]

@sluox you just kept it too real. I wonder how many students would embark on MSTP if they knew up front this was the ultimate outcome after 15 years of post college training.

Lol this is why I love the guy. I’ve learned a ton from him in the last decade. Straight up no BS. He will make you feel bad at times but it’s the truth.

 

[Alyssum]

Hm. you are not "offering" anything. You are asking for things. Lower tier schools do invest more protected time and salary, but this seems to be not necessarily correlated to eventual funding success. It also is a pattern that people who complain the most "just can't move out of San Francisco".

The reality is, being a fancy private practice physician in Manhattan or an executive at a pharma company making 400k is just *plainly* a better job than doing low impact research in nowhere, R01 funded or not, for most people. As I said, it's easy to get by as a "physician-scientist" with protected research time: you write 3 grants a year and be happy living where ever your job is and make about 30-50% less than your clinician colleagues. Grant money is unpredictable but if you do these things there's no reason why most departments can't keep you. As I said, people LEAVE for better jobs not because they get fired. Nobody ever gets fired unless you say something bad on social media.

Just plan to live on 150k a year. That's plenty money for most parts of America. Make a decision and do it. Or not. What's the point of complaining?

The situation with women is changing and in the long run, won't be a problem. Because being a medical researcher is now becoming less prestigious a job overall, mid-tier research trained men are now exiting academia--or never planned to enter into academia from day 1--this is a clear trend for both PhD and MD/PhD. Mid-tier research jobs are now becoming more mommy track, especially those with hard money salaries and don't expect consistent grant productivity. In larger cities, these women end up with bankers/doctors/tech workers, so they are happy being paid even less as long as they have a flexible vanity job at a non-profit, which is *exactly* what this job is. You need to say it out loud with me: "being a physician-scientist is a vanity job at a non-profit." Men who do this job are less likely to marry up, but with a stay at home wife their comparably lower but still reasonably high salary is generally enough if they move out of the tier 1 neighborhood/suburbs, or they have family money (which is not rare as discussed). I don't see which part of "the system" is not working. Vanity jobs are not for everyone (and most lower-middle-class kids of various ethnicities will drop out), and I'm very much questioning if more tax dollars should be thrown at it, especially when the labor market is managed in such a bad way--if you increase the total tax input, all it does is that the current winners will be even more winning.

Starting your research program is not a mommy job no matter how low you'd be willing to lower your salary. MD/PhDs enter their first job now at an older age than previous generation. By the time you can cruise by in your career, the kids are older and you no longer need the flexible hours that you need early on. I also haven't found people taking positions with comparable pay to their academic clinical colleagues to be as rare as SDN makes it out to be, so that could be part of where the stress is.

 

[dl2dp2]

However, we should still strive to create a dialogues around important issues, especially if you find yourself in a position of power (or with the ear of those who are). When the next generation is in power, I do hope we find it problematic that, as you accurately stated, being a physician-scientist has become a "vanity job at a non-profit." Surely you can see how problematic this statement is. Solving the crisis of women in academia by 1) assuming they will marry up, and 2) assuming the profession will continue to decline, is not an acceptable resolution.

Even if you can't increase real job opportunities for physician-scientists in academia, we should acknowledge on a widespread level that most MD/PhD trainees will wind up in private practice or industry. Training and expectations should be adjusted accordingly, much like PhD training today.

I don't feel like my expectation of the job 15 years ago differs significantly from the job that I have now, which is why I'm confused by all the negative energy. I feel like the MSTP students these days are pretty sophisticated as to not be particularly bothered by the negative aspect of the job (primarily having to do with, sometimes quite substantially, lower salary).

People who are in a position of power have competing priorities. I don't see why you are so bothered by the idea that your job is a vanity job at a non-profit. Most university jobs are a vanity job at a non-profit. As are many private jobs in the arts, humanities, and social welfare. Many of these jobs are occupied predominantly by women and have attractive lifestyles, but also commensurately lower pay. Top jobs in these fields pay very well (but still much less than comparable positions in private industry) and are competitive and have a bad lifestyle, and are often occupied by men. These are not situations unique to being a physician-scientist.

Always love the serenity pledge from 12 step programs:
God, grant me the serenity to accept the things I cannot change,
courage to change the things I can,
and wisdom to know the difference.

The problems you quote belong to the things you absolutely cannot change. So you need to *accept* them and move on.

 

[dl2dp2]

Starting your research program is not a mommy job no matter how low you'd be willing to lower your salary. MD/PhDs enter their first job now at an older age than previous generation. By the time you can cruise by in your career, the kids are older and you no longer need the flexible hours that you need early on. I also haven't found people taking positions with comparable pay to their academic clinical colleagues to be as rare as SDN makes it out to be, so that could be part of where the stress is.

I don't know what your point is. This is all subjective. It's a mommy job compared to being a partner at a big law firm or a managing director at a bank or a full time practicing neurosurgeon. It's not a mommy job compared to being a part-time substitute teacher.

 

[Alyssum]

The part of the system that isn't working is the fact that most of us are training for a vanity job. Even if you can't increase real job opportunities for physician-scientists in academia, we should acknowledge on a widespread level that most MD/PhD trainees will wind up in private practice or industry. Training and expectations should be adjusted accordingly, much like PhD training today.

Nothing wrong with private practice or industry but I don't think most end up in either.

I don't know what your point is. This is all subjective. It's a mommy job compared to being a partner at a big law firm or a managing director at a bank or a full time practicing neurosurgeon. It's not a mommy job compared to being a part-time substitute teacher.

I do agree. Every path has its pros and cons and I admire people who work to make 400k in private practice or want to work as a executive at a pharma company. But people trying to build a research program work way more with higher stress/risk than their academic clinical colleagues (that to me could be a mommy job), it's only that the work is not billable and less revenue generating. A more supportive environment for physician scientists would try to compensate for this with salary support and improved mentoring at the department and institutional level, which has in fact been shown to correlate with higher funding success.

 

[CheGuevaraMD]

Hm. you are not "offering" anything. You are asking for things. Lower tier schools do invest more protected time and salary, but this seems to be not necessarily correlated to eventual funding success. It also is a pattern that people who complain the most "just can't move out of San Francisco".

The reality is, being a fancy private practice physician in Manhattan or an executive at a pharma company making 400k is just *plainly* a better job than doing low impact research in nowhere, R01 funded or not, for most people. As I said, it's easy to get by as a "physician-scientist" with protected research time: you write 3 grants a year and be happy living where ever your job is and make about 30-50% less than your clinician colleagues. Grant money is unpredictable but if you do these things there's no reason why most departments can't keep you. As I said, people LEAVE for better jobs not because they get fired. Nobody ever gets fired unless you say something bad on social media.

Just plan to live on 150k a year. That's plenty money for most parts of America. Make a decision and do it. Or not. What's the point of complaining?

The situation with women is changing and in the long run, won't be a problem. Because being a medical researcher is now becoming less prestigious a job overall, mid-tier research trained men are now exiting academia--or never planned to enter into academia from day 1--this is a clear trend for both PhD and MD/PhD. Mid-tier research jobs are now becoming more mommy track, especially those with hard money salaries and don't expect consistent grant productivity. In larger cities, these women end up with bankers/doctors/tech workers, so they are happy being paid even less as long as they have a flexible vanity job at a non-profit, which is *exactly* what this job is. You need to say it out loud with me: "being a physician-scientist is a vanity job at a non-profit." Men who do this job are less likely to marry up, but with a stay at home wife their comparably lower but still reasonably high salary is generally enough if they move out of the tier 1 neighborhood/suburbs, or they have family money (which is not rare as discussed). I don't see which part of "the system" is not working. Vanity jobs are not for everyone (and most lower-middle-class kids of various ethnicities will drop out), and I'm very much questioning if more tax dollars should be thrown at it, especially when the labor market is managed in such a bad way--if you increase the total tax input, all it does is that the current winners will be even more winning.

While I agree that one could make far more money in private practice or in pharma -- these are NOT easy jobs. Private practice is always precarious (unless you have a lucky specialty/geography), and people in pharma work a LOT and are always jockeying for favor from their bosses. Academia is essentially a waking retirement. That's why the pay is low. You get to do what you want, you work less, and the job security is very high (although this is becoming more precarious as funding declines). But running your own small business or maintaining your status a high-powered executive is very hard, and the skills to do either are not selected for by MD/PhD or PhD programs. I doubt that most great researchers would be great businesspeople.

 

[ChordaEpiphany]

I don't feel like my expectation of the job 15 years ago differs significantly from the job that I have now, which is why I'm confused by all the negative energy. I feel like the MSTP students these days are pretty sophisticated as to not be particularly bothered by the negative aspect of the job (primarily having to do with, sometimes quite substantially, lower salary).

People who are in a position of power have competing priorities. I don't see why you are so bothered by the idea that your job is a vanity job at a non-profit. Most university jobs are a vanity job at a non-profit. As are many private jobs in the arts, humanities, and social welfare. Many of these jobs are occupied predominantly by women and have attractive lifestyles, but also commensurately lower pay. Top jobs in these fields pay very well (but still much less than comparable positions in private industry) and are competitive and have a bad lifestyle, and are often occupied by men. These are not situations unique to being a physician-scientist.

Always love the serenity pledge from 12 step programs:
God, grant me the serenity to accept the things I cannot change,
courage to change the things I can,
and wisdom to know the difference.

The problems you quote belong to the things you absolutely cannot change. So you need to *accept* them and move on.

I think the concern is less about the label and more about the access, opportunity, and influence of the job. Why have a training pathway that drives away many of the best trainees to other areas? Why train people for 15+ years if the end result for so many is the low-impact, weekend-warrior researcher so many have described in this thread? That human capital could be deployed better elsewhere.

Training programs could also shift their focus from purely driving their students down the academic path to branching out. My PhD program has had me attend multiple week-long courses on business and translation in medicine (paid for by the NIH/T32 funding). People recognize that academia is not a viable career path for most, and the NIH is actually sponsoring pathways towards private industry now. Even in my program (top 10 in my field for the PhD portion), I think only 1 in 10 of my PhD colleagues have even considered a career in academia, even from day 1. Maybe we need a bit more of that in the physician-scientist pathway if the career opportunities in actual research are as slim as this thread makes them out to be.

The physician-scientist community is very small. If there's any place where you can make a difference to a greater cause, it's within your own small community. The nihilistic approach isn't necessarily the best one. It's a fake quote, but "be the change you wish to see in the world," is as valid here as a mantra from a 12 step program, maybe more valid since 12 step programs are inherently individualistic. Though I completely understand your take.

It's not worth getting upset over (I don't think anyone is particularly upset or bothered here), because you can't change it alone, but don't dismiss the very act of discussing problems within your own field. It's absolutely worth discussing.

 

[ValentinNarcisse]

While I agree that one could make far more money in private practice or in pharma -- these are NOT easy jobs. Private practice is always precarious (unless you have a lucky specialty/geography), and people in pharma work a LOT and are always jockeying for favor from their bosses. Academia is essentially a waking retirement. That's why the pay is low. You get to do what you want, you work less, and the job security is very high (although this is becoming more precarious as funding declines). But running your own small business or maintaining your status a high-powered executive is very hard, and the skills to do either are not selected for by MD/PhD or PhD programs. I doubt that most great researchers would be great businesspeople.

I think it comes down to whether it is an institutional priority to attract the best and brightest to our field as physician scientists. Asking people to be selfless in the pursuit of this pathway is only going exacerbate the losses to finance and tech after college that already occur. At one time, it was actually prestigious and coveted to pursue this or other research related careers. If we ask people to give up their entire 20-30s, with no clear career outcome or financial security at the end, how can we expect to retain anyone but the independently wealthy? Again this is for the elite cadre of students, I am not sure that the average top MSTP student would be interested in going to medical school and entering pure clinical practice if this was not a training path. They would likely go into another high power career.

 

[CheGuevaraMD]

I think it comes down to whether it is an institutional priority to attract the best and brightest to our field as physician scientists. Asking people to be selfless in the pursuit of this pathway is only going exacerbate the losses to finance and tech after college that already occur. At one time, it was actually prestigious and coveted to pursue this or other research related careers. If we ask people to give up their entire 20-30s, with no clear career outcome or financial security at the end, how can we expect to retain anyone but the independently wealthy? Again this is for the elite cadre of students, I am not sure that the average top MSTP student would be interested in going to medical school and entering pure clinical practice if this was not a training path. They would likely go into another high power career.

This a cultural and political problem. The federal government needs to raise NIH funding. Tech and finance get free money from the Fed. Our priorities are out of wack in this country.

 

[dl2dp2]

Nothing wrong with private practice or industry but I don't think most end up in either.

I do agree. Every path has its pros and cons and I admire people who work to make 400k in private practice or want to work as a executive at a pharma company. But people trying to build a research program work way more with higher stress/risk than their academic clinical colleagues (that to me could be a mommy job), it's only that the work is not billable and less revenue generating. A more supportive environment for physician scientists would try to compensate for this with salary support and improved mentoring at the department and institutional level, which has in fact been shown to correlate with higher funding success.

The physician-scientist community is very small. If there's any place where you can make a difference to a greater cause, it's within your own small community. The nihilistic approach isn't necessarily the best one. It's a fake quote, but "be the change you wish to see in the world," is as valid here as a mantra from a 12 step program, maybe more valid since 12 step programs are inherently individualistic. Though I completely understand your take.

It's not worth getting upset over (I don't think anyone is particularly upset or bothered here), because you can't change it alone, but don't dismiss the very act of discussing problems within your own field. It's absolutely worth discussing.

I don't think my approach is nihilistic--it's minimalistic, but actually quite the opposite of nihilistic. My approach simplifies things greatly and is much more active and engaging. If your career decision hinges on whether the institution you participate in is "supportive" or is "deploying human capital optimally", to me, this is actually nihilistic. Institutions can never be "supportive" ENOUGH. You'll never be happy with where you are assigned--people in general don't like it when they have no agency and control over their lives.

Training programs that focus on skills necessary for industry is also BS IMO. You don't need skills to work in industry. You need experience and relationships. If you want to work in industry you should just apply for a job in industry. It's really that simple. You don't need endless government-sponsored seminars on how industry jobs work. "Mentorship" is also bogus. Mentors **** you over--so many stories. You really just one mentorship advice to live in academia: apply for 3 grants a year. The rest of the "mentorship" you can get from a therapist or a life coach.

Peter Thiel wrote a book called Zero to One -- you are obsessing over either getting zero or getting 10 ("greater cause", "institutional change", blah blah blah). I'm telling you to go for One--make a decision and do it. You don't need 10 or 20. Simplicity is not the same as nihilism.

 

[dl2dp2]

If we ask people to give up their entire 20-30s, with no clear career outcome or financial security at the end, how can we expect to retain anyone but the independently wealthy?

To be fair, it's not just people who have family money--and that itself is kinda big range. There are also people who are quote-unquote autistic, people who have wealthy spouses, people who live in very low cost areas, etc.

Financial security to me frankly is a nonsense excuse BS. You don't have to live in a mansion in a top zip code. Plenty of immigrant parents send their kids to high-quality schools for half as much in income. Plenty of families give their MD/PhD kids a big down payment to buy a house and they aren't "wealthy".

This way to think about all of this is extremely unproductive, IMO. It's all very black and white and just self-pitying victimizing nonsense. It's like, oh, if I can't make 300k then WHY bother making 150k. If I'm making 90k as a postdoc I'm being "asked to give up my 30s". Maybe I should be a banker instead. Woe is me. The system is a failure. LOL This is just so absurd.

 

[ValentinNarcisse]

To be fair, it's not just people who have family money--and that itself is kinda big range. There are also people who are quote-unquote autistic, people who have wealthy spouses, people who live in very low cost areas, etc.

Financial security to me frankly is a nonsense excuse BS. You don't have to live in a mansion in a top zip code. Plenty of immigrant parents send their kids to high-quality schools for half as much in income. Plenty of families give their MD/PhD kids a big down payment to buy a house and they aren't "wealthy".

This way to think about all of this is extremely unproductive, IMO. It's all very black and white and just self-pitying victimizing nonsense. It's like, oh, if I can't make 300k then WHY bother making 150k. If I'm making 90k as a postdoc I'm being "asked to give up my 30s". Maybe I should be a banker instead. Woe is me. The system is a failure. LOL This is just so absurd.

@sluox - I’m not saying I disagree with your points.

However, definition of “wealthy” is relative. Immigrant families hustle and sacrifice to make sure their children do not have the same struggles they did. From my perspective, I think someone with our level of education and training should ideally be able to expect: 1. Near median academic salary for your speciality., 2. Ability to support parents and children care costs., 3. Retirement savings., 4. Clearing of any undergraduate debt.

No residency trained MD, PhD is going to pivot to finance and rarely will move to consulting or industry.

However, if you told a top 21y/o undergraduate today with great grades, research/work experience, etc to enter a 15 year training path where you will make significantly less than your MD counterparts in order to just have a shot of obtaining a tenure track position and R01 funding by age 40, how can you expect them to sign up? If they took a job in tech or finance, they would start earning immediately after graduation and with compounding interest and career advancement they would be very very secure by age 40.

I agree that is it a conscious choice when we all signed up for this as students and so we should be comfortable with the outcome. However, I think MSTP directors on the whole downplay the realities of this career dramatically, and when students or residents realize this, they pivot to their exit option which is generally pure clinical practice.

I think the comparisons to PhD and postdoc salaries are not relevant, because almost none of us would have gone down a pure-PhD pathway. There is a reason why such a large percentage of grad students and postdocs are from abroad. The science situation (including salary) here is relatively better (for now) than their home country, but this does not reflect a financially reasonable option for most who came through the US education system with many other remunerative opportunities open to them.

We, as a society, can decide that we do not need or want to invest in the production of American physician scientists and instead, at lower cost, can import specialized labor to work in our world class universities. However, I think that is not sustainable as career opportunities, research output, quality from China and elsewhere continues to grow exponentially.

tl;dr Agree - all of us knew what we got into when we started, but it’s worth reflecting the purpose and goal of this program for the next generation.

 

[psychacad]

Science has never been a well paying job, for good reason. It will always come with some sacrifice, and it is what it is. The difference is that as a physician-scientist you have ways to supplement your salary in ways PhD scientists never can. Depending on specialty, you can realistically add 100k from moonlighting. You also can better market yourself for research and have more flexibility even in academic institutions. The comparison to clinical-only is very misguided. We should be comparing ourselves to other scientists and we are lucky to have it so much better.

The other line of 'complaints' is the lack of guaranteed career path. But I feel people should be aware of this. Just because you have a PhD does not mean, that's it, you made it. You have to prove your worth at every stage, and the real bottleneck is your productivity after several years in the field and your grant writing ability.

Where I do agree we can and should make a difference is when it comes to increasing government funding for research. But the idea that somehow government-funded physician-scientists need to be treated as their clinical-only counterparts smells of entitlement.

 

[Alyssum]

I don't think my approach is nihilistic--it's minimalistic, but actually quite the opposite of nihilistic. My approach simplifies things greatly and is much more active and engaging. If your career decision hinges on whether the institution you participate in is "supportive" or is "deploying human capital optimally", to me, this is actually nihilistic. Institutions can never be "supportive" ENOUGH. You'll never be happy with where you are assigned--people in general don't like it when they have no agency and control over their lives.

No one is being assigned. When physician scientists walk away from research, it's a loss for the scientific enterprise of this country and a waste of the capital invested, not all that much of a loss for the individual person. I don't disagree with you at all but I think physician scientists have more power than you seem to settle for. At least for now. You're paying yourself out of your own grants and providing a service.

Science has never been a well paying job, for good reason. It will always come with some sacrifice, and it is what it is. The difference is that as a physician-scientist you have ways to supplement your salary in ways PhD scientists never can. Depending on specialty, you can realistically add 100k from moonlighting. You also can better market yourself for research and have more flexibility even in academic institutions. The comparison to clinical-only is very misguided. We should be comparing ourselves to other scientists and we have it so much better.

The other line of 'complaints' is the lack of guaranteed career path. But I feel people should be aware of this. Just because you have a PhD does not mean, that's it, you made it. You have to prove your worth at every stage, and the real bottleneck is your productivity after several years in the field and your grant writing ability.

Where I do agree we can and should make a difference is when it comes to increasing government funding for research. But the idea that somehow government-funded physician-scientists need to be treated as their clinical-only counterparts smells of entitlement.

Science has never been a well paying job but it used to be a more viable career. There's the decrease of NIH funding, the flooding of the job market with endless amounts of PhD graduates because they were needed for cheap labor, the willingness of hire immigrant scientists and pay them much less for the same/more work, and turning a blind eye when institutions replaced permanent faculty with temporary adjuncts, just to name a few. Senior investigators profited from the system as it came into shape, and everybody else threw up their hands and said, well we should be grateful for what we have. Scientists in general should absolutely complain more. It's not entitlement.

 

[psychacad]

Science has never been a well paying job but it used to be a more viable career. There's the decrease of NIH funding, the flooding of the job market with endless amounts of PhD graduates because they were needed for cheap labor, the willingness of hire immigrant scientists and pay them much less for the same/more work, and turning a blind eye when institutions replaced permanent faculty with temporary adjuncts, just to name a few. Senior investigators profited from the system as it came into shape, and everybody else threw up their hands and said, well we should be grateful for what we have. Scientists in general should absolutely complain more. It's not entitlement.

As mentioned in my post, the entitlement comes in when people compare their status/salaries to clinical-only MDs. Ironically we're less affected by what you're describing precisely because of the MD degree.

 

[Alyssum]

The problem with physician scientists, just as it is with non-physician scientists, is not so much that the academic clinician salary is too high (it really is not, especially in primary care type specialties) but rather that compensation and prospects for conducting government funded science is too poor for individuals with so much training. Do you really want the only people left to work on the basic and translational research necessary for your covid vaccine to be those who are essentially cruising in waking retirement? My goodness. Please be more entitled and advocate for a better future for junior scientists.

 

[psychacad]

The problem with physician scientists, just as it is with non-physician scientists, is not so much that the academic clinician salary is too high (it really is not, especially in primary care type specialties) but rather that compensation and prospects for conducting government funded science is too poor for individuals with so much training. Do you really want the only people left to work on the basic and translational research necessary for your covid vaccine to be those who are essentially cruising in waking retirement? My goodness. Please be more entitled and advocate for a better future for junior scientists.

I am not disputing that there are issues within academic science that we can improve on, but I disagree that the problem is 'not so much with clinical salary'. A cursory read of this thread makes that fairly obvious. I think the issue is exactly that people have a choice between a much higher paying clinical job and the difficult trajectory of a career in science, which ultimately creates a lot of indecision and resentment. I think this needs to be placed in perspective. As a physician-scientist, you have a shot at a career in science with LESS research training than a Phd-only researcher. And say you fail at the R01 bottleneck, would that still be considered a 'failed' investment/career? You still presumably did what you love and contributed to the scientific field, and you bail out with a higher paying career. Thing is, as mentioned before, I don't think anyone should be doing this unless they don't see themselves doing anything else. That's always been how science worked; the material benefits are negligible.

 

[Alyssum]

A cursory read of this thread makes that fairly obvious.

When I was a kid and my family couldn't afford to eat at a particular restaurant, we would go somewhere else but say, well, we never really liked that place anyways. Some comments in this thread have that same tone. It's not just the salary, but also the job availability given reasonable geographical limitations and research interest and other factors that makes it a "difficult trajectory". Back when the current senior scientists were first starting their labs decades ago, you did not need the protracted "training" period you need today to start a NIH funded research program. That changed within the past couple of decades and it's only getting worse.

I actually agree completely with the sentiments expressed on SDN and everything you said, but to suggest that early stage physician scientists leave research solely because we want a higher paying career is inaccurate. I may be wrong but I think a much higher percentage of MD/PhDs stay in research in some capacity than their PhD-only counterparts, despite (and probably because of) the highly secure alternative career options should their research endeavor not work out as planned at any stage. The attrition for PhD-only scientists seem to be more, anecdotally speaking.

 

[ChordaEpiphany]

This is just my ignorance as a student, but what are the alternatives within academic medicine if you "fail" along the K-grant, R-grant, NIH-independence pathway? Obviously you can't run an NIH-funded lab on your own, and this thread makes it sound like you are doomed to practice clinical medicine along the "mommy-track" with no appreciable contribution to research. However, in practice I see a wide variety of positions MD/PhDs are filling at academic institutions, from staff physicians who just take a salary and go home to tenure track clinical professors who run clinical trials and translational studies (typically as co-PIs with an R01-holding investigator) to "Director-level" physicians who run a center (e.g. "Director of Diabetes at the Center of Endocrinology Stuff"). I'd even say MD/PhDs and physician-scientists in general are overrepresented as department Chiefs and Chairs.

What is the practical difference between these positions? Are the staff physicians who are not on the tenure track making more money? Does the PhD/academic clout help to advance you in the non basic science aspects of academic medicine? It seems like the Assistant or Associate Professors of Medicine typically don't have their own grants (outside of a small foundational grant or a sliver of an R01). What are these positions, and are they really "mommy-track" if they could potentially one day lead to a position as chief of a department?

I simply don't really understand what happens to MD/PhDs who fail. No one ever talks about it.

 

[tr]

Science has never been a well paying job but it used to be a more viable career.

Science is something that almost never produces a marketable product, and is done out of interest/excitement/curiosity.
As such, it doesn't participate in market principles and historically has almost never been a viable career. For most of history, it was done either by wealthy 'gentleman scientists' who had the independent means to afford them the leisure time to pursue knowledge for its own sake, or by monks or university scholars whose meager livelihoods were institutionally supported.

There were a few brief decades in the US (1950s-1990s) when the economy was going very well, there was public funding for science, and the level of education of the average citizen was such that most people didn't have 'scientist' as a career option.

Now the economy is in the ****ter and skyrocketing credentialism means that higher degrees are much more accessible to the general population, bringing more people into competition for the shrinking largesse of the federal government. Nobody 'designed' the system this way, it's the natural outgrowth of the tournament-style incentive structure. See also: Hollywood actors, cocaine kingpins. Tournament theory - Wikipedia

 

[tr]

This is just my ignorance as a student, but what are the alternatives within academic medicine if you "fail" along the K-grant, R-grant, NIH-independence pathway? Obviously you can't run an NIH-funded lab on your own, and this thread makes it sound like you are doomed to practice clinical medicine along the "mommy-track" with no appreciable contribution to research. However, in practice I see a wide variety of positions MD/PhDs are filling at academic institutions, from staff physicians who just take a salary and go home to tenure track clinical professors who run clinical trials and translational studies (typically as co-PIs with an R01-holding investigator) to "Director-level" physicians who run a center (e.g. "Director of Diabetes at the Center of Endocrinology Stuff"). I'd even say MD/PhDs and physician-scientists in general are overrepresented as department Chiefs and Chairs.

What is the practical difference between these positions? Are the staff physicians who are not on the tenure track making more money? Does the PhD/academic clout help to advance you in the non basic science aspects of academic medicine? It seems like the Assistant or Associate Professors of Medicine typically don't have their own grants (outside of a small foundational grant or a sliver of an R01). What are these positions, and are they really "mommy-track" if they could potentially one day lead to a position as chief of a department?

I simply don't really understand what happens to MD/PhDs who fail. No one ever talks about it.

No, you're right. People drop in and out of NIH funding at all points, and those who leave basic research end up doing all kind of different things, including clinical-track academic positions that may include anything from 0% to 80+% research or chief/chair positions as well as private practice or industry.

Generally yes, depending on specialty, people doing mostly clinical work will make more money than people doing mostly research. Sometimes a lot more, in high-paying specialties. Clinician-line jobs can be all over the map. You can choose to make them a mommy-track job by punching the clock on your patients, supervising some residents, maybe doing a lecture or two every year, and calling it a day. You can also choose to increase the ambition factor by doing clinical or translational research or by climbing the administrative ladder. It's a very soft landing, unlike PhDs who can't fund their salaries and labs and end up with few appealing alternatives.

 

[kepler16b]

No, you're right. People drop in and out of NIH funding at all points, and those who leave basic research end up doing all kind of different things, including clinical-track academic positions that may include anything from 0% to 80+% research or chief/chair positions as well as private practice or industry.

Generally yes, depending on specialty, people doing mostly clinical work will make more money than people doing mostly research. Sometimes a lot more, in high-paying specialties. Clinician-line jobs can be all over the map. You can choose to make them a mommy-track job by punching the clock on your patients, supervising some residents, maybe doing a lecture or two every year, and calling it a day. You can also choose to increase the ambition factor by doing clinical or translational research or by climbing the administrative ladder. It's a very soft landing, unlike PhDs who can't fund their salaries and labs and end up with few appealing alternatives.

Well said. Like I posted before, MD/PhD training is bet-hedging to have a fulfilling career in academia.

 

[agp4]

Now the economy is in the ****ter and skyrocketing credentialism means that higher degrees are much more accessible to the general population, bringing more people into competition for the shrinking largesse of the federal government. Nobody 'designed' the system this way, it's the natural outgrowth of the tournament-style incentive structure. See also: Hollywood actors, cocaine kingpins. Tournament theory - Wikipedia

Agreed. The take-home that every MD-PhD and PhD student should get out of this thread is that there are way more junior faculty members than there are shiny tenure-track faculty spots. Assuming that you're going to luck into a tenure-track position is a recipe for disaster. I have seen plenty of colleagues get screwed over by counting on the generosity of a chair or provost (see Simone's maxims, "the institution never loves you back").

So, if you want to succeed in academia, you have to be strategic in how you proceed in the transition from clinical fellowship to independence. That means picking a well-positioned mentor, developing an academic niche, and advocating for yourself. Also, it helps to be realistic - an academic researcher will never get paid as much as a pure clinician. Period. Like seriously, it won't happen. I've tried and gotten laughed at. Accept it and move on. You'll make more headway fighting for more practical things (e.g. more protected time or more flexibility in your startup).

 

[ChordaEpiphany]

No, you're right. People drop in and out of NIH funding at all points, and those who leave basic research end up doing all kind of different things, including clinical-track academic positions that may include anything from 0% to 80+% research or chief/chair positions as well as private practice or industry.

Generally yes, depending on specialty, people doing mostly clinical work will make more money than people doing mostly research. Sometimes a lot more, in high-paying specialties. Clinician-line jobs can be all over the map. You can choose to make them a mommy-track job by punching the clock on your patients, supervising some residents, maybe doing a lecture or two every year, and calling it a day. You can also choose to increase the ambition factor by doing clinical or translational research or by climbing the administrative ladder. It's a very soft landing, unlike PhDs who can't fund their salaries and labs and end up with few appealing alternatives.

This makes sense. When put in this light, the career track feels much less perilous. It seems like the key is to know when to walk away and how to pursue one career (e.g. independent NIH-funded investigator) without giving up opportunities for another (e.g. clinical administrative track, translational/clinical research, etc...).

However, now I'm wondering how you make the decision for yourself at the K-to-R level. If you get the K08, start a basic science lab, and fail to secure R01 funding in the 6-7 years you have before tenure (which is >75% of K awardees, according to the NIH), it's hard to say you haven't wasted your time. Your exit options will pretty much all look at you less favorably. You'll have less clinical experience, which will look bad for private practice, medical director positions in pharma, promotion to Director or Chair-level positions in academics, etc... You'll have a smaller clinical/translational research portfolio as well, which puts you behind on that research path.

Definitely not an easy decision to make. It's basically a 25% chance at being a PI and a 75% chance you'll wind up 7 years behind your peers (and close to a decade behind if you compare yourself to MD-only colleagues) with very little to show for it for the career paths that are now open to you, all while taking fairly sizable pay cut for the duration.

Also, if you want to make serious $$$ as a researcher, the only way to do so is to start a company or to build up such a name for yourself that you can charge absurd amounts of money to sit on advisory boards at pharma companies. Both are exceedingly difficult. I worked in "small pharma" before, and the space is packed with professors and their spin off companies. Most of them cycle through SBIRs ad infinitum, but the company across the way from us in the university incubator IPO'd not too long ago and is now valued at over $500M. If the professor who co-founded it retained even 2% ownership, he's made more from that than most physicians can hope to make in a career. This type of success is extremely rare, but you could become the next Bob Langer.

 

[blissworm]

*reconsiders entire life path*

sorry to take it there but I have to ask. what do you think about the possibility of UHS/MFA/ACA type developments that will slowly cut physician salaries down? specialists in sweden make like150k, will physician scientists get equalized over the years to their clinical counterparts or take an equal percentage hit and settle in as 80-90k? I have more questions but this one has been inoculating inside my head for a while

 

[dl2dp2]

I simply don't really understand what happens to MD/PhDs who fail. No one ever talks about it.

Definitely not an easy decision to make. It's basically a 25% chance at being a PI and a 75% chance you'll wind up 7 years behind your peers (and close to a decade behind if you compare yourself to MD-only colleagues) with very little to show for it for the career paths that are now open to you, all while taking fairly sizable pay cut for the duration.

I thought 25% chance is decent, no? At a name-brand institution, it's more like 50%. People who don't get Rs do various things. If you want to be in research, you go on other people's grants and gradually apply for an R (if you want). If you don't want to do research, you do various other things (admin, practice, etc). No harm no foul.

W.r.t. the other factors, K->R "failures" routinely get recruited by pharma as medical directors or go into PP. This does not seem to be an issue in terms of "being behind" on any of these fronts. As a pattern, K award seems to be a net-net positive on career development regardless of the K to R transition success even if (sometimes especially) you end up in academic admin, etc. K just declares you as an expert in some specific niche field, which you can very naturally leverage to be the [administrative] director of X clinic, etc.

I *strongly* disagree with the idea that these other career pathways are "failures" and a "waste of investment". In particular, in other threads, I've cited the NIH mission statement for MSTP where they aim to train people for a fairly diverse portfolio of jobs. A lot of these jobs are frankly just better jobs vs. the canonical R01 driven careers, especially at an undesirable location where the quote-unquote quality of science is below par (let's not mince words here). Is it really better [and for whom?] to be handed 2 R01s on obscure topics and work as the only token researcher in a primarily clinical department in the middle of nowhere? These are well-known features ("?bugs") of the system, but of course, you can't say these things on Twitter. On Twitter every project is awesome and every institution is fabulous.

*reconsiders entire life path*

sorry to take it there but I have to ask. what do you think about the possibility of UHS/MFA/ACA type developments that will slowly cut physician salaries down? specialists in sweden make like150k, will physician scientists get equalized over the years to their clinical counterparts or take an equal percentage hit and settle in as 80-90k? I have more questions but this one has been inoculating inside my head for a while

All this risk aversion is absurd. When you are so risk-averse I'm asking you what are your alternatives. What IS the opportunity cost here? You don't want to be a doctor. What are you going to do? Go into finance? Be the President? Come on. What field has no risks in advancement?

Also, it helps to be realistic - an academic researcher will never get paid as much as a pure clinician. Period. Like seriously, it won't happen. I've tried and gotten laughed at. Accept it and move on. You'll make more headway fighting for more practical things (e.g. more protected time or more flexibility in your startup).

Institutionally, yes. Individually, no. I bet if you surveyed 100 working research-focused MD/PhDs, a sizable minority's total household income (i.e. line 9 of Form 1040) is greater than those of their pure clinical colleagues. If you want to make money you need to creatively hustle. Your statement simply says if you work in a research capacity for a university, your salary will be lower. Salary != total income.

 

[kepler16b]

I *strongly* disagree with the idea that these other career pathways are "failures" and a "waste of investment". In particular, in other threads, I've cited the NIH mission statement for MSTP where they aim to train people for a fairly diverse portfolio of jobs. A lot of these jobs are frankly just better jobs vs. the canonical R01 driven careers, especially at an undesirable location where the quote-unquote quality of science is below par (let's not mince words here). Is it really better [and for whom?] to be handed 2 R01s on obscure topics and work as the only token researcher in a primarily clinical department in the middle of nowhere? These are well-known features ("?bugs") of the system, but of course, you can't say these things on Twitter. On Twitter every project is awesome and every institution is fabulous.

Retweet. One of the amazing things about graduating from a fully funded MD/PhD program is that you are not burdened by debt. You can truly do whatever you want, including industry and entrepreneurship.

 

[turtle114]

I'm shocked by the number of people I've met who view MD/PhD as a mechanism by which to move into the top 0.5% of earners. Science should not be a path towards riches. Pharma pays well because they profit off of shady practices that make essential medications unaffordable for many people. If you want the multi-million dollar house, the vacation home in Cape Cod, the full time nanny, etc etc, it only takes a few minutes of research to figure out that academic MD/PhD is not the path for you. Many people are unemployed right now due to the pandemic, and we have basically guaranteed employment for the rest of our lives as long as we don't quit. That's an enormous privilege and I suspect that the people who are still dissatisfied are more likely to have "family money" and feel pressured to keep up with their peers.

I hope that I can get a K award, RO1 etc but changing plans and working 100% clinical would not be a failure or a disappointment. If they gave out RO1s like participation trophies then the competition would just shift to something else (or the costs of postdocs, reagents, etc would just inflate in turn, LOL).

 

[Lucca]

I'm shocked by the number of people I've met who view MD/PhD as a mechanism by which to move into the top 0.5% of earners. Science should not be a path towards riches. Pharma pays well because they profit off of shady practices that make essential medications unaffordable for many people. If you want the multi-million dollar house, the vacation home in Cape Cod, the full time nanny, etc etc, it only takes a few minutes of research to figure out that academic MD/PhD is not the path for you. Many people are unemployed right now due to the pandemic, and we have basically guaranteed employment for the rest of our lives as long as we don't quit. That's an enormous privilege and I suspect that the people who are still dissatisfied are more likely to have "family money" and feel pressured to keep up with their peers.

I hope that I can get a K award, RO1 etc but changing plans and working 100% clinical would not be a failure or a disappointment. If they gave out RO1s like participation trophies then the competition would just shift to something else (or the costs of postdocs, reagents, etc would just inflate in turn, LOL).

I agree with the overall sentiment, but its not entitled or asking for "participation trophies" to ask for NIH funding lines to justify having a pyramid scheme as a training pipeline lol

 

[Alyssum]

I'm shocked by the number of people I've met who view MD/PhD as a mechanism by which to move into the top 0.5% of earners. Science should not be a path towards riches. Pharma pays well because they profit off of shady practices that make essential medications unaffordable for many people. If you want the multi-million dollar house, the vacation home in Cape Cod, the full time nanny, etc etc, it only takes a few minutes of research to figure out that academic MD/PhD is not the path for you. Many people are unemployed right now due to the pandemic, and we have basically guaranteed employment for the rest of our lives as long as we don't quit. That's an enormous privilege and I suspect that the people who are still dissatisfied are more likely to have "family money" and feel pressured to keep up with their peers.

The question is more about how willing you'd be to work at potentially below median income for a very long time for the love of science. We're talking here about working resident hours on a resident salary into your 40s. At some point, it's not about you and your own career aspirations anymore, but what's the best and most responsible decision for those who depend on you.

Most MD/PhDs start in med school these days around 25. For the next 8-9 years, you'll live on your $30,000 stipend, which admittedly should allow you to live quite comfortably as a single person without dependents. By the time you're around 34, you start residency and fellowship, which will take 6-7 years. While residents and fellows certainly have middle class income, if you adjust for the hours work, you're actually paid around minimal wage. You may be delayed even longer if you're a woman and decide to pause the clock to have kids. Your family will start to wonder, when will you get a real job so you can start contributing more to paying the bills?

When you finally start looking for your first job, you could uproot your whole family and make your spouse leave his or her job so you can get a research position in the middle of nowhere where your significant other will not be able to find any work (because that's often where available research track positions are)- that is, if you even get offers - or you could "settle" for a clinical job with higher salary, better hours, at exactly where your family wants to live.

Throughout the process, you sacrifice many things. When your child is sick because he caught something from daycare and you didn't take that part time clinical job that could've let you stay home (while paying a higher salary), you might wonder if it's worth it to keep pursuing those cancer cures that you're working on that will probably never come to fruition (like most research), and at what point is it selfish to keep putting your idealistic career goals for yourself ahead of the welfare of those who depend on you. You absolutely need at least a part time nanny if you want to stay as a physician scientist, unless you have a stay home spouse or help from extended family. Daycare only opens for normal working hours, not on holidays, not on weekends, not after 5pm. Research is all consuming if you let it be. I also don't think this struggle is unique to physician scientists. No one starts off looking for multi-million dollar house or vacation home in Cape Cod, but everything is easier if you 1) have help or 2) have money.

 

[ValentinNarcisse]

The question is more about how willing you'd be to work at potentially below median income for a very long time for the love of science. We're talking here about working resident hours on a resident salary into your 40s. At some point, it's not about you and your own career aspirations anymore, but what's the best and most responsible decision for those who depend on you.

Most MD/PhDs start in med school these days around 25. For the next 8-9 years, you'll live on your $30,000 stipend, which admittedly should allow you to live quite comfortably as a single person without dependents. By the time you're around 34, you start residency and fellowship, which will take 6-7 years. While residents and fellows certainly have middle class income, if you adjust for the hours work, you're actually paid around minimal wage. You may be delayed even longer if you're a woman and decide to pause the clock to have kids. Your family will start to wonder, when will you get a real job so you can start contributing more to paying the bills?

When you finally start looking for your first job, you could uproot your whole family and make your spouse leave his or her job so you can get a research position in the middle of nowhere where your significant other will not be able to find any work (because that's often where available research track positions are)- that is, if you even get offers - or you could "settle" for a clinical job with higher salary, better hours, at exactly where your family wants to live.

Throughout the process, you sacrifice many things. When your child is sick because he caught something from daycare and you didn't take that part time clinical job that could've let you stay home (while paying a higher salary), you might wonder if it's worth it to keep pursuing those cancer cures that you're working on that will probably never come to fruition (like most research), and at what point is it selfish to keep putting your idealistic career goals for yourself ahead of the welfare of those who depend on you. You absolutely need at least a part time nanny if you want to stay as a physician scientist, unless you have a stay home spouse or help from extended family. Daycare only opens for normal working hours, not on holidays, not on weekends, not after 5pm. Research is all consuming if you let it be. I also don't think this struggle is unique to physician scientists. No one starts off looking for multi-million dollar house or vacation home in Cape Cod, but everything is easier if you 1) have help or 2) have money.

This. Absolutely this.

 

[turtle114]

Yes but wouldn't it be the same/worse if you were in a higher paying field? I'm thinking finance, certain types of law, consulting, etc. And there are many lower or similar paying fields which also require long time commitments and inflexible hours.

It seems that residency is the biggest hurdle for young physician scientists, particularly female trainees. Having kids before residency requires $$, having them during sounds like a nightmare, and after might be too late biologically. Compromises will likely have to be made with either career goals or family.

I think that greater support for young families would be the most helpful change for physician scientists. Even if more $ was available, if women have dropped out of science entirely for a "mommy track" (I hate this term) position, it won't necessarily help. Institutions should provide universal childcare to grad students, residents, and postdocs with young kids. Once they enter school (as a former latchkey kid) I would argue that a nanny isn't necessary, but times may have changed too much for that to be possible. Also, what happened to free aftercare in public schools? In elementary school I used to stay in aftercare every day until my parents got off work around ~6-7pm.

Aside from that issue, being below median income up until ~35-8 is not the end of the world! I disagree that there has been a bait and switch put in front of us. Academia in most disciplines is a middle class income with a significant time commitment.

 

[psychacad]

Aside from that issue, being below median income up until ~35-8 is not the end of the world! I disagree that there has been a bait and switch put in front of us. Academia in most disciplines is a middle class income with a significant time commitment.

I mean, is it even true that post-residency fellows are below the median income? Can easily make significant extra-money with moonlighting. Heck, I know several research fellows who opened up a side private practice. In some places it's almost the norm. Potentially can also go through right to K if you were in research track-residency.

 

[ValentinNarcisse]

Yes but wouldn't it be the same/worse if you were in a higher paying field? I'm thinking finance, certain types of law, consulting, etc. And there are many lower or similar paying fields which also require long time commitments and inflexible hours.

It seems that residency is the biggest hurdle for young physician scientists, particularly female trainees. Having kids before residency requires $$, having them during sounds like a nightmare, and after might be too late biologically. Compromises will likely have to be made with either career goals or family.

I think that greater support for young families would be the most helpful change for physician scientists. Even if more $ was available, if women have dropped out of science entirely for a "mommy track" (I hate this term) position, it won't necessarily help. Institutions should provide universal childcare to grad students, residents, and postdocs with young kids. Once they enter school (as a former latchkey kid) I would argue that a nanny isn't necessary, but times may have changed too much for that to be possible. Also, what happened to free aftercare in public schools? In elementary school I used to stay in aftercare every day until my parents got off work around ~6-7pm.

Aside from that issue, being below median income up until ~35-8 is not the end of the world! I disagree that there has been a bait and switch put in front of us. Academia in most disciplines is a middle class income with a significant time commitment.

The difference is that a 21y/o analyst is making 6 figures in finance not including bonuses. A 25y/o new associate at a big law firm heading to partner track is starting at ~150K. We only approach this range in our mid 30s after residency and fellowship. That is 10+ years of lost opportunity to invest or support your family. Nobody is complaining about the hours, becoming a VP in finance or partner in a law firm is grueling with similar hours to surgical residency, but they are earning comfortably along the way. We are making ends meet until we become attendings, and then have a lot of ground to cover to secure our future.

 

[ChordaEpiphany]

W.r.t. the other factors, K->R "failures" routinely get recruited by pharma as medical directors or go into PP. This does not seem to be an issue in terms of "being behind" on any of these fronts.

I disagree, and this I actually know quite a bit about. You're very optimistic about the value pharma puts on basic science research for that role. The CEO of the pharma startup I worked for prior to med school said to me before I left, "When we hire medical directors, all we care about is your clinical experience. An MD without the residency is a language degree, and the PhD and lab research you'll do will only be valuable for quantitative skills." In terms of "efficiency" in advancing down that pathway, the PhD and K-grant years are usually seen as tangential distractions with some nice perks, like expertise in a particular field (which might get you hired in a specific job if the stars align). Assuming you are mid-40s when the K-to-R failure occurs, and you immediately make the move, you'll definitely be behind your age-matched MD-only peers.

As for PP, I know less about it from personal experience, but it's hard to imagine any practice places an enormous value on research experience. Why would they? Again, you can get the job, but the 7 years you spent on the K-grant did not help you. You are basically no better off than you were the day you got the grant. So in terms of partner track, pay ramp up, and ownership of the practice, you will definitely be "behind" compared to MDs who join the practice out of fellowship at 32-35 years old or even MD/PhDs who join at 36-39 years old.

I *strongly* disagree with the idea that these other career pathways are "failures" and a "waste of investment". In particular, in other threads, I've cited the NIH mission statement for MSTP where they aim to train people for a fairly diverse portfolio of jobs.

I think you misunderstand my point. Those career pathways aren't a waste of investment at all. It's that the K-to-R time (and the PhD time) is a "waste" of time in terms of development along those pathways.

That is, if you have to spend 7 years doing something to help you become a better private practice physician, medical director, etc... doing basic science research gives a poor bang for your buck. 7 years later you'll be much further along those pathways doing something else related to those pathways. For almost all pathways available after a "failed" K-to-R transition, your basic science research experience just isn't that helpful. So you pursue that research knowing that there's a ~75% chance you exit with not nearly as much to show for that time as if you hadn't gotten the grant. I imagine this is not true in academia, but it is definitely true in pharma and must be true in private practice as well.

I agree it's not a total waste, just not efficient. In some cases, for instance MD/PhDs who become experts in really hot fields like big data analysis, it can be a huge plus.

 

[ChordaEpiphany]

That's an enormous privilege and I suspect that the people who are still dissatisfied are more likely to have "family money" and feel pressured to keep up with their peers.

I think you may be right with a few caveats. I also think there's a bit of jealousy (which I'll freely admit to feeling from time-to-time), when you see some classmates who you viewed as... less deserving, match into name-brand ortho residencies on their way to near 7-figure incomes. I also think there is a large amount of privilege in the idea that it's "okay" to make $30K until you're 32 and $50k until you're 40. A lot can go wrong with your family, health, well-being, etc... You're playing with fire by delaying financial security. God forbid something happens to you or a loved one in the meanwhile.

Nobody is complaining about the hours, becoming a VP in finance or partner in a law firm is grueling with similar hours to surgical residency, but they are earning comfortably along the way. We are making ends meet until we become attendings, and then have a lot of ground to cover to secure our future.

Also, work hours are not the only consideration. Sure, a partner-track law firm position is grueling like residency, but you have the money to make your life convenient. A young professional in any other high-achieving profession has the money for things like grocery delivery, take out, laundry service, ubers instead of public transit, and (most importantly) childcare. So even an 80 hour work week with 8 hours sleep per night leaves you with 4.5 hours/day for yourself/your family. These little chores/errands can take up a good chunk of our lives otherwise. Functionally, working 80 hours/week while rich can look more like working 60 hours/week while poor or middle class.

 

[blissworm]

Yet again somehow the hidden devil comes to light. Residency, and often fellowships I would assume, are a major problem here. Like I said, I'm 19 so it's major planning time. Taking into account around 5 years at <50k with 80+ hour weeks is insane to consider. I would be happy to go through that rite of passage as a 22 year old or something. But at around 30-35 years of age? I don't know if I have that in me; my hypothetical family (something I do really want) would most certainly suffer.

Residency needs to be the first thing that gets a makeover, in my opinion. It feels like it would solve a lot of, or at least some of, the 'starting way after our peers in careers' part and familial concerns.

 

[psychacad]

Yet again somehow the hidden devil comes to light. Residency, and often fellowships I would assume, are a major problem here. Like I said, I'm 19 so it's major planning time. Taking into account around 5 years at <50k with 80+ hour weeks is insane to consider. I would be happy to go through that rite of passage as a 22 year old or something. But at around 30-35 years of age? I don't know if I have that in me; my hypothetical family (something I do really want) would most certainly suffer.

Residency needs to be the first thing that gets a makeover, in my opinion. It feels like it would solve a lot of, or at least some of, the 'starting way after our peers in careers' part and familial concerns.

A ton of misconceptions here.

I can tell you about psychiatry as this is extremely variable depending on specialty.

1) You aren't working 80 hours+ in residency or fellowship. It's closer to 60 when it's 'hard' in PGY1-2, and by the time you're hitting PGY3-4, you're closer to 40.
2) You get even more flexibility in research-track residencies, with up to 80% protected time in PGY-4 and some will also give you ~50% in PGY3.
3) You aren't making <50k, certainly not in HCOL areas. It's closer to 70k.
4) You can easily supplement your salary with moonlighting and hit 6 figures without breaking your back.

This applies to research fellowships as well, assuming you don't jump straight into K. You can very realistically make a decent 6 figure salary.

The issue isn't residency/fellowship imo. I think the hardest part in this track is getting the two degrees done, and I suspect what you're hearing from are a lot of burned out students. Heck, by the time you're in residency you can probably bail all of this out and do whatever you want.

 

[Alyssum]

Can easily make significant extra-money with moonlighting. Heck, I know several research fellows who opened up a side private practice. In some places it's almost the norm. Potentially can also go through right to K if you were in research track-residency.

It's not entirely an issue of money but also an issue of time. Like @ChordaEpiphany said, money is there to buy you time. You need time free from clinical obligations to put together a research portfolio. If the goal is transition to independent research, at some point moonlighting doesn't make sense to me anymore... you're better off using that time putting together more publications and grant applications instead so you can get a job.

 

[dl2dp2]

everything is easier if you 1) have help or 2) have money.

Well, either get help or make more money. Make it work. Again, I don't know what the point of this is. If you just need an empathic ear to hear your grievances and how hard it is that your chosen career is not friendly to you in numerous ways, then by all means, assume that I will be saying that on Twitter if you complained there. Or get a therapist. I'm pretty sure lots of senior PIs are thinking exactly in the same (and harsher) ways--especially if they are in their 50s and "only" have a PhD and living in a townhouse in tier 3 suburbs and driving a 10-year-old Toyota. How do you think they'll react to you trying to get a part-time nanny when you already pay 50g for daycare in the middle of tier 1 neighborhood. Maybe you should just...move to a fixer-upper and work harder after the kids went to sleep..like they did.

BTW, this is what my div chief told me. Buy a cheap house and send your kids to cheap daycare. So much for #mentorship. No thanks. I prefer being a #winner and hustle.

What do you want me to say? Life is so hard. I'm so sorry for you. Your life is really tough. I hear you and we at the NIH (and Prestige U) are trying to make things easier, but it takes time! So much time! Please be patient! Let's start a junior faculty wellness group to air all your grievances. Oh, you are leaving? We are SO sorry to see you go. It's really unfortunate that so many women and minorities are leaving. I admit that the environment is SO unfriendly to everyone. We really MUST do something to change things. Best wishes to your future career.

LOL that's the pitfall of relying on others.

This blog is a helpful read:

Drugmonkey

Grants, research and drugs

drugmonkey.scientopia.org

As I said. Make a decision. Do it. Or not. Nobody cares. Buy a Tesla and be a #winner. Stop with the self-victimizing nonsense.

like expertise in a particular field (which might get you hired in a specific job if the stars align). Assuming you are mid-40s when the K-to-R failure occurs, and you immediately make the move, you'll definitely be behind your age-matched MD-only peers.

That is, if you have to spend 7 years doing something to help you become a better private practice physician, medical director, etc...

W.r.t. academia --> pharma, pre-K attendings get associate medical director, K gets medical director, R gets senior medical director, multiple R/center/div chief goes to global head of clinical dev/translational medicine/CMO. So I think K is typically a lateral move.

W.r.t. PP -> partnership track requires you to build up a book of business. The K award doesn't contribute to that, only to the extent that you have perhaps learned some skills that are valuable in running a business (i.e. budgeting, managing personnel, marketing, etc.), but if was a managing partner and have one candidate who had a K vs. one candidate who's younger but didn't, I'd probably pick the one who had a K. K is just a prestige signal--it says the junior level manager pulled it together to get a million dollars to do a project.

 

[dl2dp2]

The difference is that a 21y/o analyst is making 6 figures in finance not including bonuses. A 25y/o new associate at a big law firm heading to partner track is starting at ~150K. We only approach this range in our mid 30s after residency and fellowship. That is 10+ years of lost opportunity to invest or support your family. Nobody is complaining about the hours, becoming a VP in finance or partner in a law firm is grueling with similar hours to surgical residency, but they are earning comfortably along the way. We are making ends meet until we become attendings, and then have a lot of ground to cover to secure our future.

This is somewhat better a question to pose at the end of undergrad rather than residency. Still, this is pretty silly on a second glance. The decision is rarely between MDPhD and JD/IBanking/MBA. The *content* of your job must matter to some extent. Typically the decision is between MD vs. MDPhD, and PhD here clearly wins as a form of investment. Please see my other threads for the exact mathematical calculation. W.r.t. to making "a lot" of money, in another thread I noted that per capita MDPhDs probably have more people with net worth > 100M as a degree recipient vs. any other degree. This is largely a selection effect, but nevertheless, being MDPhD does not prevent you from being a successful rainmaker. Au contraire: some MDPhDs are some of the best I've seen, handily beating out your average banker in their... pazzazz.

 

[Alyssum]

Well, either get help or make more money. Make it work. Again, I don't know what the point of this is. If you just need an empathic ear to hear your grievances and how hard it is that your chosen career is not friendly to you in numerous ways, then by all means, assume that I will be saying that on Twitter if you complained there. Or get a therapist. I'm pretty sure lots of senior PIs are thinking exactly in the same (and harsher) ways--especially if they are in their 50s and "only" have a PhD and living in a townhouse in tier 3 suburbs and driving a 10-year-old Toyota. How do you think they'll react to you trying to get a part-time nanny when you already pay 50g for daycare in the middle of tier 1 neighborhood. Maybe you should just...move to a fixer-upper and work harder after the kids went to sleep..like they did.

BTW, this is what my div chief told me. Buy a cheap house and send your kids to cheap daycare.

How would those senior PIs feel if you tell them that they're working towards riches or something like that?

 

[psychacad]

It's not entirely an issue of money but also an issue of time. Like @ChordaEpiphany said, money is there to buy you time. You need time free from clinical obligations to put together a research portfolio. If the goal is transition to independent research, at some point moonlighting doesn't make sense to me anymore... you're better off using that time putting together more publications and grant applications instead so you can get a job.

Eh I'm talking about no more than 10-20% of your overall time for clinical duties which is very much expected in your career track and doubt would make such a difference on your research career. This is sort of getting ridiculous frankly. I mean, if you feel this isn't feasible and a relatively few hours of clinical work wouldn't cut it for you, you're perfectly entitled to leave for greener pastures.

 

[Alyssum]

Eh I'm talking about no more than 10-20% of your overall time for clinical duties which is very much expected in your career track and doubt would make such a difference on your research career. This is sort of getting ridiculous frankly. I mean, if you feel this isn't feasible and a relatively few hours of clinical work wouldn't cut it for you, you're perfectly entitled to leave for greener pastures.

No I agree with you completely that objectively speaking, research fellows are not in a bad position. Otherwise like you said, no one will be there. I was replying to this impression that people working to survive in their career goals are aiming to move into the top 0.5% of earners or looking for a path to riches. Maybe some are but that's probably not most people's intention. That's never mine.
There're multiply people responding to each other so I'm mixing up who's saying what and who's responding to who. New to SDN here!
Edit: Want to add that I really enjoy reading everybody's comments and replies.

 

[ChordaEpiphany]

W.r.t. academia --> pharma, pre-K attendings get associate medical director, K gets medical director, R gets senior medical director, multiple R/center/div chief goes to global head of clinical dev/translational medicine/CMO. So I think K is typically a lateral move.

I've never once heard of this distinction. The majority of hires for medical director positions are never on the K-to-R NIH pathway to begin with. Perhaps you perceive it that way because people get hired based on experience and seniority. Having a prestigious record (e.g. brand name training, prestigious publications) will help with anything, and that might correlate with NIH grant success, but I wouldn't conflate that with pharma execs caring about which NIH awards you've won. There's also a bit of mutual rejection. For instance, a 55 year old attending who is 90% research and has 4 R01s cooking at all times in pure basic academic exploratory research is neither wanted nor wanting for a role as medical director.

Also, associate md vs. md vs. senior md are very much a function of company size and can't be flatly compared like that. Senior medical director means very different things at a big 10 vs. mid-size public vs. private startup pharma company.

W.r.t. PP -> partnership track requires you to build up a book of business. The K award doesn't contribute to that, only to the extent that you have perhaps learned some skills that are valuable in running a business (i.e. budgeting, managing personnel, marketing, etc.), but if was a managing partner and have one candidate who had a K vs. one candidate who's younger but didn't, I'd probably pick the one who had a K. K is just a prestige signal--it says the junior level manager pulled it together to get a million dollars to do a project.

Again, I don't know have personal experience with private practice, but all I've heard on SDN and in real life has been that non-academic environments don't often prefer MD/PhDs because we are 1) older and set in our ways, and 2) "too academic". I think I've seen @Neuronix say this at least a thousand times. Going from managing your own lab and answering to no one to transitioning into a private practice, hierarchically lower than the partners, is not usually a winning combination. It's even worse if you're expecting partnership off the bat. It's just so much easier to hire a younger doc who will bend the knee and gladly accept poor terms for several years for a shot at partner, all while providing the same (or greater) volume of care for the practice than someone "burdened" with a family and other responsibility.

I'd love to hear where your career has taken you. Not being cheeky. I'm genuinely curious if you know something I don't. You seem extremely confident in your answers, but it doesn't match my experience working in pharma at all. Nor does it match my experience talking to attendings who made the jump to medical director positions. The emphasis is on connections, clinical experience, and pedigree, in that order. There's even sometimes a bit of a flippant dismissal of academic standards (e.g. "I don't care that you're from Harvard, you work for the bottom line"). You often make better connections and get better experience at top institutions, but I don't think for a second that it's the NIH awards or the basic research publications that are tipping the scales for pharma companies making these hires.

 

[tortuga87]

To the MD/PhD students on this thread, I think you guys are getting the picture how important money is. Research unfortunately depends on money but ironically also runs counter to it. Many of us were born to do research and would go insane without it. At the same time, some of us also want to become rich in order to achieve financial independence *so we can do more research* (as opposed to wanting fancy stuff which are nice too but not the primary target). The above problems are nullified if you are worth tens of millions (or you are okay living meagerly as already talked about).

Sluox is very direct, but there is truth in hustling as early in life as possible. Like psychacad pointed out, one way of doing this is moonlighting while in residency even in the research track. Also take a look into *passive* investments as I mentioned previously. You can start this as an M1 by taking courses to learn the basics and then diving in by allocating a small chunk of your money every month. You will probably lose money in the beginning, but you can get pretty good at it with practice by the time the MD/PhD is over with perseverance. The more money you earn the earlier in life, the better. If you are an engineer, look into licensing of inventions as well. Your portfolio will grow big over time. There is a lot you can achieve outside of the medical or graduate school.

I know it's a hard reality to accept, but let it sink in for a couple of months, and you will grow to accept it. It runs counter to the "propaganda" given to you by training directors who push the K-R track, treat MD/PhDs in private practice as failures, talk about pharma scientists as sleeze-bags (the reps are sleeze-bags though lol) and/or speak of mentorship & collaboration so amazingly (it's not that important tbh as already talked about).

Yes, this forum may not be representative of the entire MD/PhD cohort, but it provides a way for more senior people to speak frankly. Notice that the attendings have questioned all of the propaganda points and have already processed them extensively, so these forums can also be viewed as a treasure trove to help you start questioning your own views.

You can still do research with these endeavours. If you fight the system this early in your career, you will just grow frustrated because you will not be taken seriously; even senior attendings struggle to make change at just one institution. It's okay to want to make changes, but realize that it will take a long time and likely will not be solved within a reasonable timeframe for *your* career.

 

[AlteredScale]

Any advice for middle of the road career? I’m a resident in the research track to get into IM subspecialty. I have a strong research mentor with R funding and VA funding however there is no institutional t32 currently and I’m a little nervous about what will happen in the way of funding during the research years of this track (80/20 for 3 years based on ABIM). I’ve been told “not to worry” because the chair of medicine is willing to put money into it. But what kind of salary should I be expected to have? Much less than a full clinical resident/fellow? I’ve been told I need to prepare to submit for F grant funding along with other extramural sources like CCFA or AASLD but obviously they all seem pretty lucrative sources of funding to secure..

 

[dl2dp2]

How would those senior PIs feel if you tell them that they're working towards riches or something like that?

Why would I tell them that? LOL Nobody except my accountant knows how much money I make. Nobody except my wife knows how much money I have. You tell people what they want to hear depending on who they are to make them like you.

Do you tell everyone every thought you ever have? What are you a 5 year old? Do I need to teach you to be prudent about expressing your intentions?

Plus, a smart manager knows that I know that they know. My boss knows that I am always on the job market. They expect it. In fact, they want it because if you bring in an offer they can go to their boss's boss and ask for more resources to retain me so that they would get more resources. It's a win-win-win. Basic organizational psychology 101.