What is the path to a faculty position with the 80/20 research/clinical work split?

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MDPhD2020

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What is the path after finishing medical school if you want to pursue a faculty position that aims for the 80% research / 20% clinical split? Do you need to go through a physician-scientist residency program, and if not should you expect to do a post-doc after residency (and for how long)?

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I'm sure there are many ways. One way - probably not ideal - My boss and many I know spent a few years building up a practice at their institution while securing grant funding. this is unfortunately seemingly the name of the game with how hospitals are run nowadays. then slowly pulling back on clinical effort in favor of research time. The key is getting your grant funding to cover your salary lined up ASAP I would think.
 
You don’t do a post-doc typically. You should go a physician-scientist track on an T32 (or F). As a junior faculty, you follow that up with a K.

Also you’d be very fortunate to get enough funds to cover 80% research effort when all is said and done. Very fortunate.
 
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You don’t do a post-doc typically. You should go a physician-scientist track on an T32 (or F). As a junior faculty, you follow that up with a K.

Also you’d be very fortunate to get enough funds to cover 80% research effort when all is said and done. Very fortunate.

I agree. The name of the game is get the right training, work hard, write grants and papers appropriate for your level at each stage, and hope for the best.

If you've finished an MD program but didn't come from an MD/PhD program, you will need to find PhD level training somewhere. A successful physician scientist who trained in my residency program took a few years out of residency and got a PhD. You have to find somewhere willing to support you in something like that. It doesn't have to be a formal PhD program, though it needs to be several years of protected time to do your own project, apply for grants, and get papers (i.e. major steps of PhD). There are several such programs out there tailored to MDs or some blaze their own path.

You can negotiate additional percentages of protected effort once you have funding of your own. K grants will typically mandate 50%-75% protected time. The first step is finding a faculty position that will absolutely support the K, and ideally will give you significant support even before you get the K (either as fellow, instructor, or asst prof). Then if you can spin that K into 20% effort as a PI on an R01 equivalent, that goes a long way. The institutions I've seen will often allow such a person to keep the 50% or less clinic time in such a situation, or the faculty member jumps elsewhere at that point to a new startup package that will allow it.

I'm sure there are many ways. One way - probably not ideal - My boss and many I know spent a few years building up a practice at their institution while securing grant funding. this is unfortunately seemingly the name of the game with how hospitals are run nowadays. then slowly pulling back on clinical effort in favor of research time. The key is getting your grant funding to cover your salary lined up ASAP I would think.

This is how I did it too.

It's much easier and preferred to come into a position on tenure track or something similar where you have significant resources and the expectation is that you will move to independent research funding. If you start as a clinician and try to be a researcher too, it is like working two jobs, and you get all the pressures of both paths at once. Transitioning out of the clinic can also be a real challenge, and even after a K grant and two R01 equivalents I'm still struggling with a lot of excess volume, a lot of direct referrals, and... I guess I still like clinic too and have a hard time saying no particularly to complex and interesting cases.
 
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I just did NIH study section. One observation ... every K08 that was discussed came from a MD/PhD graduate (one earned a PhD separate from MD), while every K23 came from either a MD/PhD graduate or a MD with MS in Clinical Investigation. Many of the better scoring K08/23 had T32 or R25 PSTP training during residency. Publication record was often a key driver of the score of the candidate.
 
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I'll give my take on Ks having been a K08 recipient and being an MD only and having sat on several study sections for K at this point including K-specific study sections (yep, those exist).

The publication record is important but only kinda, at least to me when I review applications. And its the type of publications that matter personally. To be honest, it's about "first-author" publications when I look. To me, that is the sign of productivity (and "last author" when looking at the transition from K to R). If you have a handful 3 or 4 first author publications by the time you submit the K and 50% are directly related to scientific, hypothesis driven research, that's fine. They should also be recent, ie one of them should be in the year or so of your submission. BUT you need at least one, and it has to be with the mentor who is the mentor on the K award. This is super important because 1) it shows you can produce something in that environment and that 2) it shows the mentor and you have some sort of productive, working relationship. In some regards that is the most important publication in the whole application. The rest matter less and they matter less for 2 reasons in my opinion. 1) Research activity can only be as fruitful as the environment you are in, especially as a trainee. If you are a hard worker and love science, but you are stuck in a sh-tty lab with a sh-tty PI, you will not be productive at no fault of your own. I mean, you can leave that environment and maybe be lucky that you don't burn bridges and get something out of it, but that's incredibly risky. 2) In larger labs, where publications have like more than 4 people from a lab, there tends to be lots of gift authorships. There's nothing wrong with that per se but it dilutes any meaning of middle authorships to the point where I generally consider middle authorship a sign of nothing. You didn't write the paper, you didn't facilitate the project, you didn't come up with the idea and actually there's a good chance you did little to nothing. Maybe you did or you felt you did, but it's impossible to tell when the authorship lists are growing and growing. I'm not suggesting people refuse middle authorships or anything of the sort but if you are applying for a K and you have 30 publications and the last first author was 3 years ago and most are middle authorships (I'm using this as an example but have also seen it personally), that is a red flag. If you have 5 publications on the other hand and 2 were in the past two years and you were first author on both, you're golden in my opinion.

There's actually a whole bunch of other stuff that goes into Ks (I find the publication thing to be important again kind of, but also a mixed bagged in judging an applicants fortitude that can be easily offset by other parts of the application) that I'm happy to write about both my experience as a writer and reviewer, but that's just my take on publications.
 
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I just did NIH study section. One observation ... every K08 that was discussed came from a MD/PhD graduate (one earned a PhD separate from MD), while every K23 came from either a MD/PhD graduate or a MD with MS in Clinical Investigation. Many of the better scoring K08/23 had T32 or R25 PSTP training during residency. Publication record was often a key driver of the score of the candidate.
It does seem as if things are getting increasingly competitive for K awards. It used to be that you if have one first author paper it's okay. Now you need 2 or 3.

What is the path after finishing medical school if you want to pursue a faculty position that aims for the 80% research / 20% clinical split? Do you need to go through a physician-scientist residency program, and if not should you expect to do a post-doc after residency (and for how long)?

Ultimately the issue is funding, and there's no set path to get there. Let's say someone offered you a faculty position, you have no "protected time" to do research, how do you get funding so you can do 80/20 research? You just have to write grants. Write 3 R01s in a year. Each R01 has 12 pages of science, plus one page spec aims, plus budget, f&e, biosketches, letters of support, subcontracts, data sharing, form E for human subjects, and various other items of paperwork. The finalized package is usually > 100 pages. When you say when you are faculty with 80/20, that's the actual content of your job.

If you can write 3 R01s a year year after year after year, generally you'll be able to have 80/20 career so you choose. If you can't write that many grants, it's possible that you can still get enough funding if you are really good at getting individual submissions funded, but the odds are against you. So one should aim for that pacing of productivity. If you are good at getting funding AND you write 3+ grants a year, then you could possibly get promoted faster, get a chair, write larger grants (P01/U54), etc.

If you are PI for grants, any paper coming out of the grant you'll be the senior author, so it counts toward your promotion, productivity, etc. so once you are PI you usually don't need to write your own papers, though many still do from time to time.


It's interesting because in grad school I've never seen an R01, so I was never exposed to the actual work of a PI. This aspect is generally shielded as PIs themselves consider it to be problematic to share with grad students because it detracts from the actual science. This aspect of PhD training has changed somewhat and now there is more grant writing etc in grad school.
 
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Then if you can spin that K into 20% effort as a PI on an R01 equivalent.
This is easily the hardest part of the K to R transition. At that juncture, publications matter but not really. But even if your K was productive, you usually have to pivot and not pursue the same idea. So all that work on the K only really helps if in the process you deviate from the K, which is hard with limited resources. Like my K gave me 75% time, but I didn’t have anyone provide me resources so I had to milk the directs of the K. I mean, protected time is critical, but you need money and resources to make use of that time.

I think I submitted about 3 or 4 different R ideas (not including resubmissions) in the last 1.5 years of the K till something stuck. But it was really challenging because even as an ESI and NI, you’re competing against Department Chairs 25 years your senior with endowments and 2 to 3 research assistants and post-docs.

Anyway, that was just as an aside, but I thought the transition from K to R was much harder than getting the K.
 
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If you are PI for grants, any paper coming out of the grant you'll be the senior author, so it counts toward your promotion, productivity, etc. so once you are PI you usually don't need to write your own papers, though many still do from time to time.
I wish this was the case. My lab is super small. It’s me and a research assistant and for a large chunk it was just me. Most of my science publications have 1 to 5 authors. If I didn’t write at least 50 to 90% of the paper and organize and graph all the figures, nothing would ever be published. That being said, I also don’t mind writing and enjoying having created a work product of my own. But my division chief who is 20 years my senior also has to write his own papers mostly. Unfortunately, he doesn’t like writing so it’s a slog for him.
 
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There's actually a whole bunch of other stuff that goes into Ks (I find the publication thing to be important again kind of, but also a mixed bagged in judging an applicants fortitude that can be easily offset by other parts of the application) that I'm happy to write about both my experience as a writer and reviewer, but that's just my take on publications.

Would like to hear all your other thoughts about K08s as a reviewer, e.g., with the research plan, career development plan, biosketches, letters of rec, etc.

Where I am at, if you don't get a K of some sort during your last year of residency/fellowship, then you get put on the clinician educator track and have to do a full time clinical job + a full time research job until you get a K or an R
 
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Would like to hear all your other thoughts about K08s as a reviewer, e.g., with the research plan, career development plan, biosketches, letters of rec, etc.

Where I am at, if you don't get a K of some sort during your last year of residency/fellowship, then you get put on the clinician educator track and have to do a full time clinical job + a full time research job until you get a K or an R
I will preface this by saying that I think every reviewer has a different take. I had a K from an applicant who I thought was great, but the other reviewer saw flaws. Alternatively, there was an K that I and another reviewer had significant issues but the third reviewer "rescued" the application. So take all of it with a grain of salt.

My single best advice is to see what a funded K application looks like. Generally speaking, funding Ks (and well any grant) has typically gone through considerable polishing. This can be from colleagues, internal reviews, peer-reviewer mechanisms (ie unfunded attempts), whatever. But the more feedback one gets, generally the better the application gets. I did a number of mock study sections, external KL2s and other feedback prior to my K submission. But the baseline for that was seeing what a successful K looked like. If you've never written a grant, how can you know what a success looks like?

Generally speaking, the candidate >> research plan. That doesn't mean the research plan doesn't matter, it does, it just doesn't matter as much. The candidate like I mentioned above needs to be published, have a recent first author publication and one with the mentor. The mentor has to have 1) a track record of some K mentorship and hopefully a transition of someone from a K to an R, 2) must be an associate professor or higher and 3) must have active NIH at the time of the K award through a renewal mechanism (no R21). The mentoring team should be broad. This is one of the things were potentially the more, the better. It is a red flag if the mentoring team is 3 people or less. Ideally, one mentor should be external to the institution. There should be very clear roles of each mentor, what expertise they provide and how they will help the candidate in their career development. There should be VERY clear timelines of meetings, benchmarks of success. Career development plans should also include some didactics, but no more than 4 structured sessions in my opinion. If you have to few, it gives a sense you aren't learning anything new and if its too many, then when are you going to do the science? There should be conferences and presentations of course. There should be a plan of structured peer mentoring. These can be hard to find. Typically, they will be at your institution. Occasionally, there are national ones. The MOSAIC program comes to mind which has annual conferences and meeting of peer-mentoring, though that program is only open to certain individuals. But something structured. There should also be a plan to take a structured grant writing course or seminar. A lot of this is boilerplate stuff, so in that regard, every applicant writes a version of this. But the applicant who sets themselves apart is someone who writes WHY they are doing what they are doing, WHAT gaps it fills and HOW they see it helping them.

I talked about the candidate and publications before. The Candidate's Statement is very important. This is your chance to explain why you want this path, what obstacles you faced (and a place to explain training gaps or publication deficits) and how you overcame them, what training yu've had and what you think you need to become successful. Some of these items can and should also be embellish in the mentors' letters. You have 6 pages for the mentors' letter so use them all. It's especially helpful if the mentors' letter give very clear details about 1) what you have achieved thus far 2) who you sought as experts 3) how the mentor has been successful and 4) how you and the mentor have clearly discussed your plans for success. Along these lines, the Institutional Letter of Commitment must say that you will "be at the rank of assistant professor on the tenure track at the time of the award", that your "continued employment is not dependent on receipt of the award" and they will commit "at least 75% protected research time which takes into account clinical and administrative duties". If any of these are missing, its a red flag.

The biosketches, honestly I glance through those though not everyone will just glance. The personal statement is usually similar to the candidate's statement but you can write more details about experiences if you run out of room in the main grant. The only things I will definitely look at are 1) the Position/Honors to see if there is anything interesting or unique (awards for research, prior LRP awardee, etc.) and 2) the bibliography link (so make sure it is accurate and up to date). Nothing is more annoying to get the biosketch of applicant "joe blow" and the hyperlink doesn't work and so I have to go to PubMed and type in "joe blow" and have 50 hits come up and try to decipher which one is which.

The Research Strategy is going to be ~6 pages (this doesn't include the Aim page which you get 1 page for). Really, the most important parts to me is does it read well and make sense and are the tools, equipment, personnel you need to complete the aims readily accessible. Is the person with expertise and equipment 3 hours away? Red flag. And the clinical samples you plan to obtain dependent on a person who isn't nearby or there isn't at least a demonstration that you can get them? Red flag. Have you even done a proper estimate of the number of patient or animals you need? Are the numbers that you suggest even reasonable and obtainable? Do the numbers to state in the research proposal match the numbers you've 1) budgeted for and 2) suggested in the animal or human subjects documents. If all those are in place, it general comes down to grantsmanship. You need to explain to people (who may not be experts in your field) WHY you question matters, WHAT are the knowledge gaps and HOW you will complete them. While preliminary data is not technically required, it is. This data will be a demonstration of the HOW. Typically, you only need a couple of figures of preliminary data. There should be 1 figure of a diagram of all the aims and how they are related. Remember that aims should be independent of one another (ie the success of aim 2 can't depend on aim 1) but they are suppose to be connected to complete the story. In this regard, a figure that nicely sums up the WHY, WHAT and HOW can go a long way. Generally speaking, this part of the grant almost always get the worst score from reviewers, so that is typical. The best way to reduce the negative scoring is to make it readable and clear. If it is those things and the reviewer has a sense that you really understand what you are talking about with a clear knowledge of the gaps in research and how your research strategy will fill them, that always helps to defuse the scoring issues.


As for your last comment, that's institution and field dependent. And it's hard. The best you can do in that situation is use the people and resources around you (remember, it doesn't have to be your preliminary data exactly) to put together the most comprehensive grant together you can.
 
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Where I am at, if you don't get a K of some sort during your last year of residency/fellowship, then you get put on the clinician educator track and have to do a full time clinical job + a full time research job until you get a K or an R

This is basically standard for tier 1 institution cognitive specialties. Write your K on weekends, if you care enough. Or take a much lower salary and marry a finance guy. I wish I’m joking but I’m not. I don’t know a *single* married female K awardee who’s a primary bread winner. The general rule is that they make substantial less than their husband.

Generally speaking, the candidate >> research plan. That doesn't mean the research plan doesn't matter, it does, it just doesn't matter as much. The candidate like I mentioned above needs to be published, have a recent first author publication and one with the mentor. The mentor has to have 1) a track record of some K mentorship and hopefully a transition of someone from a K to an R, 2) must be an associate professor or higher and 3) must have active NIH at the time of the K award through a renewal mechanism (no R21). The mentoring team should be broad. This is one of the things were potentially the more, the better. It is a red flag if the mentoring team is 3 people or less. Ideally, one mentor should be external to the institution. There should be very clear roles of each mentor, what expertise they provide and how they will help the candidate in their career development. There should be VERY clear timelines of meetings, benchmarks of success. Career development plans should also include some didactics, but no more than 4 structured sessions in my opinion. If you have to few, it gives a sense you aren't learning anything new and if its too many, then when are you going to do the science? There should be conferences and presentations of course. There should be a plan of structured peer mentoring. These can be hard to find. Typically, they will be at your institution. Occasionally, there are national ones. The MOSAIC program comes to mind which has annual conferences and meeting of peer-mentoring, though that program is only open to certain individuals. But something structured. There should also be a plan to take a structured grant writing course or seminar. A lot of this is boilerplate stuff, so in that regard, every applicant writes a version of this. But the applicant who sets themselves apart is someone who writes WHY they are doing what they are doing, WHAT gaps it fills and HOW they see it helping them.

I talked about the candidate and publications before. The Candidate's Statement is very important. This is your chance to explain why you want this path, what obstacles you faced (and a place to explain training gaps or publication deficits) and how you overcame them, what training yu've had and what you think you need to become successful. Some of these items can and should also be embellish in the mentors' letters. You have 6 pages for the mentors' letter so use them all. It's especially helpful if the mentors' letter give very clear details about 1) what you have achieved thus far 2) who you sought as experts 3) how the mentor has been successful and 4) how you and the mentor have clearly discussed your plans for success. Along these lines, the Institutional Letter of Commitment must say that you will "be at the rank of assistant professor on the tenure track at the time of the award", that your "continued employment is not dependent on receipt of the award" and they will commit "at least 75% protected research time which takes into account clinical and administrative duties". If any of these are missing, its a red flag.

The biosketches, honestly I glance through those though not everyone will just glance. The personal statement is usually similar to the candidate's statement but you can write more details about experiences if you run out of room in the main grant. The only things I will definitely look at are 1) the Position/Honors to see if there is anything interesting or unique (awards for research, prior LRP awardee, etc.) and 2) the bibliography link (so make sure it is accurate and up to date). Nothing is more annoying to get the biosketch of applicant "joe blow" and the hyperlink doesn't work and so I have to go to PubMed and type in "joe blow" and have 50 hits come up and try to decipher which one is which.

The Research Strategy is going to be ~6 pages (this doesn't include the Aim page which you get 1 page for). Really, the most important parts to me is does it read well and make sense and are the tools, equipment, personnel you need to complete the aims readily accessible. Is the person with expertise and equipment 3 hours away? Red flag. And the clinical samples you plan to obtain dependent on a person who isn't nearby or there isn't at least a demonstration that you can get them? Red flag. Have you even done a proper estimate of the number of patient or animals you need? Are the numbers that you suggest even reasonable and obtainable? Do the numbers to state in the research proposal match the numbers you've 1) budgeted for and 2) suggested in the animal or human subjects documents. If all those are in place, it general comes down to grantsmanship. You need to explain to people (who may not be experts in your field) WHY you question matters, WHAT are the knowledge gaps and HOW you will complete them. While preliminary data is not technically required, it is. This data will be a demonstration of the HOW. Typically, you only need a couple of figures of preliminary data. There should be 1 figure of a diagram of all the aims and how they are related. Remember that aims should be independent of one another (ie the success of aim 2 can't depend on aim 1) but they are suppose to be connected to complete the story. In this regard, a figure that nicely sums up the WHY, WHAT and HOW can go a long way. Generally speaking, this part of the grant almost always get the worst score from reviewers, so that is typical. The best way to reduce the negative scoring is to make it readable and clear. If it is those things and the reviewer has a sense that you really understand what you are talking about with a clear knowledge of the gaps in research and how your research strategy will fill them, that always helps to defuse the scoring issues.


As for your last comment, that's institution and field dependent. And it's hard. The best you can do in that situation is use the people and resources around you (remember, it doesn't have to be your preliminary data exactly) to put together the most comprehensive grant together you can.
Doesn’t all of this strike you as idiotic. One could get the same amount of information with perhaps 4 pages altogether.

The barrier alone is put up such that it eliminates certain types of candidates, namely the type who don’t have or care to use all this leisurely time to play this game…
 
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Doesn’t all of this strike you as idiotic. One could get the same amount of information with perhaps 4 pages altogether.

The barrier alone is put up such that it eliminates certain types of candidates, namely the type who don’t have or care to use all this leisurely time to play this game…
I guess, in some degree though one could make that argument about nearly anything.

And I wouldn’t say it leisure time. I often worked on nights and weekends to write or collect data. It’s a question to me rather of actually wanting it and what I find professional satisfying. I have clinical colleagues that constantly lament that they have to work 40 more shifts annually than me (ie 2+ shifts more per month) and how they wish they had the “leisure” (ie less clinical time) that I do, but they don’t work on the weekends and nights then arent assigned. I easily do more hours/week than they do. One of them saw me the other day and they were appalled I was consenting and enrolling patients into my own study instead of a high school graduate.

BUT despite their complaints, they also do nothing to change it. I told one of them who constantly complains “Write an R03. It’s work but it’s also practically free money. You basically just need to write an idea on paper and submit it”. Sure they don’t really buy down time but it’s a start. I also mentioned an R21. Their answer was “Hmpf”.

Well…
1675645207600.jpeg


As for playing the game, there are certainly changes the NIH could made to distribute the funds. Honestly, I think the NIH does a reasonable decent job at it (and constantly seeks feedback) realizing it’s never going to be perfect or 100% satisfactory for all parties. Personally I’m content that I get to do what I do as long as my peers let me and think the pursuit is worthy of taxpayer money.
 
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K grants are becoming more competitive. I agree with the comments above with slight alternative viewpoint. I think that each of the K sections is important in their own way, and a fatal flaw in ANY of them will drive the scoring in a negative manner.

Each of us has their own methods. I start by reading the abstract, then the candidate biosketch, and then the specific aims (SA) page. I carry all the SA pages in my pocket for a week reading them at odd times and making mental notes. Then, I take the best and the worst (in my head) applications and read them from beginning to end while I fill the critique. If you scroll down to Section V of the K-08 FOA you will see about 30 questions that we are asked to report. The review process is also being updated, so in the future we might have only 3 major categories: 1) candidate + career plan, 2) research plan, and 3) mentor + environment. Only the first two would likely be scorable, but major flaws in the third would drive the scores negatively.
 
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As a MD that went back to get a MS and PhD in STEM, I honestly have no idea how straight MDs are competitive anymore with the quality of submission from MD/PhDs and PhDs and increasing competition. It seems like 3 years of "PhD equivalent" research is a minimum. Medical school and residency certainly do not allow this, thus a post-residency or post-fellowship research "post-doc", where the MD functions more as an advanced undergrad than even as a PhD student. My lab is small but it feels like we are fighting to the death for every R and U we are awarded.
 
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Would like to hear all your other thoughts about K08s as a reviewer, e.g., with the research plan, career development plan, biosketches, letters of rec, etc.

Where I am at, if you don't get a K of some sort during your last year of residency/fellowship, then you get put on the clinician educator track and have to do a full time clinical job + a full time research job until you get a K or an R
I think we can all agree that this is pretty much everywhere now. It is why I tell trainees that there is nothing "academic" about "academic medicine" anymore if you consider a classic academic medicine career as anything close to an 80/20 split. Clinical Educator track = probability of 0.98 that your "academic" career consists of seeing nearly as many patient as you would in the community / private practice, tons of clinical teaching to med students, residents, fellows and drowning in "citizenship tasks", whether as an assistant program director, medical director, quality committee, etc. For those of us interested in research, none of that stuff is academic.

As dl2dp2 said, anything in research after that means you are carving out a second, unpaid job during nights, weekends, and off-service time (if you have any).

What really surprises me is how many residency/fellowship graduates have no research experience at all and are hunting for their first attending job and are expecting to land close to 50% protected research time, thinking they can be competitive for a T32 or K from scratch when there are PhDs, MD/PhDs, and some MDs that have been working for years towards the goal. It seems to largely be a result of clinical burnout before even being an attending.
 
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As a MD that went back to get a MS and PhD in STEM, I honestly have no idea how straight MDs are competitive anymore with the quality of submission from MD/PhDs and PhDs and increasing competition. It seems like 3 years of "PhD equivalent" research is a minimum. Medical school and residency certainly do not allow this, thus a post-residency or post-fellowship research "post-doc", where the MD functions more as an advanced undergrad than even as a PhD student. My lab is small but it feels like we are fighting to the death for every R and U we are awarded.
Well, one will always need additional training to do research that MD-only clinical training doesn’t provide. And while it certainly depends on the field, I also think “science” is changing.

When I was on study section last, out of 76 applications, there was 1 K08. Just 1. And it got triaged. I actually rescued the application but the fact that there was only K08 proposal in the whole field was telling to me. On the other hand there were like 5 or 6 K23s and all but 1 got discussed.

MD, MD/PhD or PhD… in the end it’s about extra training but also finding your own niche that you can carve out for yourself and likewise convince your peers to give to money to pursue it. Writing well and writing convincingly is just as much the key to research as any preliminary data.
 
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I was recently in a study section with almost 40 K award applications with about 40% K08 and 60% K23. We discussed about half on each mechanism.
Yeah, that’s probably study section/field specific cause that has never been my experience. But I’ve only sat on 2 standing sections and a couple of special emphasis sections so maybe that’s why.
 
I was recently in a study section with almost 40 K award applications with about 40% K08 and 60% K23. We discussed about half on each mechanism.
What proportion of those K08 applications were from straight MDs?
 
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As I indicated previously, the only K08s that were discussed were from MD/PhD graduates, whereas some K23s had MD/PhD or MD/MS with strong publication track records. The straight MD needs to do a longer postdoc in a R25/T32 (or other) to get to a similar publication track record. Remember that the age to 1st R01 is the same for MD and MD/PhD; there are no shortcuts...
 
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I also think it general, the number of MDs going into physician-scientist tracks are globally down trending. I bet someone has that data, but where I did training over a decade ago, there was a good number of MD-only Ks (actually 5 in a group of 11 total faculty). But there were also a good number of MD-only faculty who pursued basic science and as part of their training, went into labs. At the institution I’m on now and have been for a decade, than number in my tenure has been zero. In fact, getting any MD-only trainee to do much beyond data mining and sending it off to a Biostats person is essentially an impossibility.

As a correlative, in my field, as the number of global physician-scientists have decreased, I’ve noticed rates of burnout and job dissatisfaction go up despite working less clinical hours. I’m not saying it’s a global trend nor cause and effect… merely my own observation.
 
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As I indicated previously, the only K08s that were discussed were from MD/PhD graduates, whereas some K23s had MD/PhD or MD/MS with strong publication track records. The straight MD needs to do a longer postdoc in a R25/T32 (or other) to get to a similar publication track record. Remember that the age to 1st R01 is the same for MD and MD/PhD; there are no shortcuts...
Thanks Fencer as always. I have not sat on a study section so I am not informed on all the logistics. I understand you said that the only K08s "discussed" were from MD/PhDs, but were there MD-only applications that were scored prior to or during the study section that simply did not meet a score criteria for discussion? My real question is were there simply no K08s from MD-only applicants or were the applications from MD-only applicants for the K08 scored so low that they never made it to discussion? Clearly, those are two different "issues" with MD-only appplications, one being a lack of interest from MDs in basic research vs the other being a lack of quality in their applications.
 
I did not reviewed all the applications, so I can't tell you. However, it has been my practice to look at the biosketch, abstract and specific aim page of every grant that is discussed. For the record, I am also one of the few people in my study section that votes out of range.
 
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As a correlative, in my field, as the number of global physician-scientists have decreased, I’ve noticed rates of burnout and job dissatisfaction go up despite working less clinical hours. I’m not saying it’s a global trend nor cause and effect… merely my own observation.

I wonder why buddy I wonder why lmao
 
I wonder why buddy I wonder why lmao
My field wasn’t even really hit by COVID though. That was an adult ICU disease, not a pediatric ICU disease.

Nevertheless, all my colleagues are desperate to find people to help them buy down time so they can, as the chair likes to put it, “go sit in the grass with medical students while they drink Diet Coke and talk about their feelings”.
 
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My field wasn’t even really hit by COVID though. That was an adult ICU disease, not a pediatric ICU disease.

Nevertheless, all my colleagues are desperate to find people to help them buy down time so they can, as the chair likes to put it, “go sit in the grass with medical students while they drink Diet Coke and talk about their feelings”.
Nah. COVID is a sideshow. The bigger picture is funding. COVID made inflation worse, which amplified the brewing slow burn.

There's an NIH announcement to solicit postdoc opinion on why they are mass quitting. I trust you saw.
 
Nah. COVID is a sideshow. The bigger picture is funding. COVID made inflation worse, which amplified the brewing slow burn.

There's an NIH announcement to solicit postdoc opinion on why they are mass quitting. I trust you saw.
Ah, is that what you meant? There’s definitely a component of that too, though I personally don’t think that this the only reason and it’s much more multifactorial. People also don’t usually go into critical care (or emergency medicine) to do research. That’s not the draw.

Yes, I saw the Open Mike Blog though I have read it yet. The post-doc issue on the other hand is a symptom of the disease. This goes beyond post-docs of course, where it is increasingly hard to find trained and qualified research support staff. My RA position sat unfilled for over 6 months and I’ve heard people waiting even longer. And it wasn’t like I was turning down applicants. There was literally only 1 in that entire time and the options were hire them or have clinical responsibilities with a vacant RA position till whenever. That being said, I understand why there is no retention. Why would someone want to be a RA or a post-doc or a staff scientist if the lab could shutter tomorrow? Nobody wants to deal with that level of job insecurity.
 
Today, I talked to the "person doing the functions of the NIH director" ... That is too funny. Congress and Executive can't get their act together to nominate and confirm a NIH director. After >200+ days of "acting director", he received that title in July (Francis Collins retired in Dec. 2021).

The problem that I have is that they formed this post-doc ACD task force to produce a report, which might end up in a bookshelf...

I participated in the implementation taskforce for the ACD on the Physician-Scientist Workforce in 2014, and here we are almost 9 years later with many of the consensus recommendations still with no action. For example, a NIH Director told me essentially Francis [Collins] can order me to offer F30s, but I control the budget for how many (i.e.: 1 or 2/year). Each institute has a Congressionally mandated budget based upon their perceived needs and requests. Some are shortsighted and only see the ROI for their institute. They see training and F30s as a NIGMS problem, in reality, if those F30 trainees end up doing research for another institute as investigators, that is a outstanding ROI for us, the tax-payers.
 
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I participated in the implementation taskforce for the ACD on the Physician-Scientist Workforce in 2014, and here we are almost 9 years later with many of the consensus recommendations still with no action. For example, a NIH Director told me essentially Francis [Collins] can order me to offer F30s, but I control the budget for how many (i.e.: 1 or 2/year). Each institute has a Congressionally mandated budget based upon their perceived needs and requests. Some are shortsighted and only see the ROI for their institute. They see training and F30s as a NIGMS problem, in reality, if those F30 trainees end up doing research for another institute as investigators, that is a outstanding ROI for us, the tax-payers.

It took me a second to understand this paragraph but now I do. LOL The amount of institutional knowledge required to just digest the meaning of this paragraph is non-trivial.
 
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My field wasn’t even really hit by COVID though. That was an adult ICU disease, not a pediatric ICU disease.

Nevertheless, all my colleagues are desperate to find people to help them buy down time so they can, as the chair likes to put it, “go sit in the grass with medical students while they drink Diet Coke and talk about their feelings”.
Or as a Peds Onc friend once said: "These academic Pediatric Oncologists are all chasing endowed clinical professorships so they can get buy-down time and get paid to sit around and see less kids with cancer. Odd, given that these families are donating money to treat kids with cancer."
 
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It took me a second to understand this paragraph but now I do. LOL The amount of institutional knowledge required to just digest the meaning of this paragraph is non-trivial.
Sorry, writing for non-native English speakers is sometimes an [painfully] iterative process of editing many ****ty drafts until something that is readable and hopefully (grants/papers) compelling. The research infrastructure system has many incredible strengths inherited from their creator (i.e.: Congress), and checks-and-balances are sometimes very helpful (like preserving democracy ;)), they also make the system inefficient.

Each NIH Institute Director could set a different set of priorities or strategies than the overall Director, for example, an institute could push training/fellowship grants to a greater percentage of their expenditures, while another emphasizes large collaborative center grants to tackle specific scientific challenges, or more individual R01 investigators, etc. The intended flexibility is that each field has a different set of circumstances and opportunities. On the other hand, as discussed above, the institute might see training and fellowship grants very narrowly. I was co-PI of a T32 training grant to a different NIH institute than prior funding. The score was barely inside the published fundable range but the reviewers pointed out as criticism was that we were Neurologists doing Radiology. Not funded, we were not part of the guild... :rolleyes: Fundamental science discoveries often come from different fields. PCR came from a field trip to Yellowstone national park... The fact that some organisms survived and actually thrived in geysers led to an inquisitive question on how their dna/rna was able to function.
 
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Ah, is that what you meant? There’s definitely a component of that too, though I personally don’t think that this the only reason and it’s much more multifactorial. People also don’t usually go into critical care (or emergency medicine) to do research. That’s not the draw.

Yes, I saw the Open Mike Blog though I have read it yet. The post-doc issue on the other hand is a symptom of the disease. This goes beyond post-docs of course, where it is increasingly hard to find trained and qualified research support staff. My RA position sat unfilled for over 6 months and I’ve heard people waiting even longer. And it wasn’t like I was turning down applicants. There was literally only 1 in that entire time and the options were hire them or have clinical responsibilities with a vacant RA position till whenever. That being said, I understand why there is no retention. Why would someone want to be a RA or a post-doc or a staff scientist if the lab could shutter tomorrow? Nobody wants to deal with that level of job insecurity.

2% drop in research support staff since 2017, but 9% drop since 2020. Who knew job insecurity would lead to difficulties in retention?!
patrick-stewart-mild-shock.gif
 
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