What percent of MD/PhD grads end up with 80-20 research-clinical academic appointments?

[langwang3]

Most MD/PhD program directors at the top schools I’ve interviewed at say ~60% of their graduates end up in academic appointments, rest in industry or private practice. However, they never subcategorize the 60%, perhaps disingenuously, into 80:20 NIH-funded PI appointments vs mostly clinical academic appointments that an MD can get. I’m too much of a coward to directly ask them for the numbers lest they think I am a jackass, but since this is the internet, I am perfectly willing to appear like a jackass and put forth this question to you lovely people. I am especially interested in recent numbers (top 20 MD/PHD program graduates from 2000-2012 ) since things have changed greatly with funding and academia.

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[Neuronix]

Of the 57% working full-time in academics, 17% had an 80% or greater research role. See: JCI Insight - The national MD-PhD program outcomes study: Relationships between medical specialty, training duration, research effort, and career paths

PS: Don't worry about looking like a jackass on here. I've been doing that for almost 20 years.

 

[langwang3]

Of the 57% working full-time in academics, 17% had an 80% or greater research role. See: JCI Insight - The national MD-PhD program outcomes study: Relationships between medical specialty, training duration, research effort, and career paths

PS: Don't worry about looking like a jackass on here. I've been doing that for almost 20 years.

Wow, these stats are very disappointing. So in a class of 10 MD/PhD, on ~1 will go on to have 80% or more research time, and ~2 will go on to have 70% or more research time. Looking at the 2008 Stanford MSTP class (MSTP Alumni (before 2015)), it seems 3/13 have become lab PI's. I suppose this is significantly better than the rate for straight PhD's, but still...

 

[Fencer]

I have been continuously funded for 22 years... doing what I love. I was only 75% research for 4 of those years. The majority of my time I was only doing 20-40% in research. I now have over 50 pubs, over 10 patents, and I been training others (>100) at multiple levels. The sky has been falling along the way, but I still managed to do basic, clinical, and health care outcome research, and co-founded a company. My salary was below the median for specialty for the majority of this time until last 5 years, but I was able to protect my research time and scrap some funds to do it. You need to enjoy the journey and negotiate for what you love. It is not easy as a single income family, but it is doable. No fancy cars, do travel.

 

[Neuronix]

Wow, these stats are very disappointing. So in a class of 10 MD/PhD, on ~1 will go on to have 80% or more research time, and ~2 will go on to have 70% or more research time. Looking at the 2008 Stanford MSTP class (MSTP Alumni (before 2015)), it seems 3/13 have become lab PI's. I suppose this is significantly better than the rate for straight PhD's, but still...

There is a huge disconnect between training programs who expect you to say you're going to be a researcher and the reality of limited research opportunities once you graduate. You'll get interviewed and advising along the way from the successful only. This is called survivorship bias.

The reality is that all you can do is train to be a physician scientist and take a gamble on becoming one. Nobody ever said this was an easy pathway.

 

[dl2dp2]

Wow, these stats are very disappointing. So in a class of 10 MD/PhD, on ~1 will go on to have 80% or more research time, and ~2 will go on to have 70% or more research time. Looking at the 2008 Stanford MSTP class (MSTP Alumni (before 2015)), it seems 3/13 have become lab PI's. I suppose this is significantly better than the rate for straight PhD's, but still...

You would be correct. The numbers published in the article actually seem very realistic in terms what I see in the field.

Out of about 80% ish people who work full time in academia, about 50% people do at least 50% research. 15-20% do > 80% research, etc. etc.

OTOH, to be honest, you don't have other alternatives. The comparable number for straight MD or straight PhD programs are probably at minimum 3-5x worse. If you sample the entire PhD cohort in biomed nationally, I wouldn't be surprised if some low single-digit number eventually end up with >80% academic research. The top 10 PhD programs have a 10-20% "success" rate. The top 10 MDPhD programs probably have a 20-30% eventual "success" rate.

Keep in mind, even after you have an R01, there's a below 10-20 year half-life for dropping out of research. There are often long gaps in between grants even for successful researchers, where their salary support is mainly funded by clinical or other kinds of work.

 

[tr]

You'll get interviewed and advising along the way from the successful only. This is called survivorship bias.

Yes. Survivorship bias is so huge in scientific training, and I feel like it just doesn't get talked about. In addition to being smart, hardworking, and politically savvy, there is also an element of luck in achieving the requisite scientific discovery at the appropriate career junction to attain PI ship. Trainees are only ever exposed to faculty who hit this magic mix. This inevitably colors the advising they receive.

 

[SurfingDoctor]

Yes. Survivorship bias is so huge in scientific training, and I feel like it just doesn't get talked about. In addition to being smart, hardworking, and politically savvy, there is also an element of luck in achieving the requisite scientific discovery at the appropriate career junction to attain PI ship. Trainees are only ever exposed to faculty who hit this magic mix. This inevitably colors the advising they receive.

I agree and would emphasize, politics and luck are easily two of the most important attributes of longevity in academic research. I would also add persistence in that adds more time to achieve the former.

 

[CheGuevaraMD]

What is to be done?

The vast, vast majority of colleagues from my grad school and my fellowship did not end up in a tenure track, 80/20 job where they could reach some surety in research employment. Almost everyone had to take a position as an instructor, clinical assistant professor, do another postdoc, etc. or leave academia entirely and head to industry or practice. Sure, maybe those that ended up as instructors or clinical APs will bootstrap their way to Ks and Rs even with minimal protected time and start up funds, but it's statistically unlikely. Most of these people will never consistently be PIs and will do research on an ad hoc basis when funding is available.

Institutions seems to prefer these part time researchers because it's a less risky proposition -- if junior researchers fail it's no big deal, because they already have a clinical load that they can just increase. But, without significant protected time, junior researchers never really get off the ground, and sort of flounder as quasi-PIs on small dollar projects or as staff scientists/co-Is. To me, this is so sad! What's the point of 5-7 years of additional training (PhD + postdoc), to just go nowhere?

The market definitely cannot support the number of researchers we are churning out, and yet we continue to direct young students to MD/PhD programs (even on these forums). What is to be done? Should we close these programs down? It seems unethical to continue to direct students along a increasingly risky and fruitless path.

 

[dl2dp2]

What's the point of 5-7 years of additional training (PhD + postdoc), to just go nowhere?

The market definitely cannot support the number of researchers we are churning out, and yet we continue to direct young students to MD/PhD programs (even on these forums). What is to be done? Should we close these programs down? It seems unethical to continue to direct students along a increasingly risky and fruitless path.

This is silly. MD/PhDs are anything BUT a risky and fruitless path. With an MD/PhD, you either 1. become a reasonably good researcher and get paid more than your PhD counterpart, or 2. become a well-to-do practicing physician with 0 student debt. What's the risk here? Furthermore, an MD/PhD candidate can typically match into a better specialty/better residency irrespective of their final interest /outcome in research.

If anything, PhD (only) programs should be shut down first.

And the market largely agrees with me. As MD programs become more expensive, MD/PhD programs are getting more and more competitive and they are notably more competitive now than a straight MD program and astronomically more competitive than a PhD program at a similar institution. My estimation is that MD/PhD programs are probably now the most competitive graduate programs in the country, and for good reasons.

 

[CheGuevaraMD]

This is silly. MD/PhDs are anything BUT a risky and fruitless path. With an MD/PhD, you either 1. become a reasonably good researcher and get paid more than your PhD counterpart, or 2. become a well-to-do practicing physician with 0 student debt. What's the risk here? Furthermore, an MD/PhD candidate can typically match into a better specialty/better residency irrespective of their final interest /outcome in research.

If anything, PhD (only) programs should be shut down first.

And the market largely agrees with me. As MD programs become more expensive, MD/PhD programs are getting more and more competitive and they are notably more competitive now than a straight MD program and astronomically more competitive than a PhD program at a similar institution. My estimation is that MD/PhD programs are probably now the most competitive graduate programs in the country, and for good reasons.

This is a very bizarre comment for many reasons.

(1) An MD-PhD is never a good financial decision for someone who doesn’t end up doing research. Trading 7 years of your life (PhD + postdoc) for $300k is a bad deal. This is the same poor argumentation that premeds fall into when they join the military to pay for med school. The private sector pays more than enough to pay off one’s loans.

(2) Many PhD programs should be shut down, along with MD-PhD programs. Training people for jobs that don’t exist is wasteful and cruel.

(3) This is a huge waste of public money. Training people to become professional researchers when they never will be is not a good use of resources. The Canadian MSTP program was recently shuttered, as were the RWJF postdocs. I’m sure the US MSTP program will be soon to follow.

 

[dl2dp2]

This is a very bizarre comment for many reasons.

(1) An MD-PhD is never a good financial decision for someone who doesn’t end up doing research. Trading 7 years of your life (PhD + postdoc) for $300k is a bad deal. This is the same poor argumentation that premeds fall into when they join the military to pay for med school. The private sector pays more than enough to pay off one’s loans.

(2) Many PhD programs should be shut down, along with MD-PhD programs. Training people for jobs that don’t exist is wasteful and cruel.

(3) This is a huge waste of public money. Training people to become professional researchers when they never will be is not a good use of resources. The Canadian MSTP program was recently shuttered, as were the RWJF postdocs. I’m sure the US MSTP program will be soon to follow.

1) No It’s 450k (post tax with interest) with interest for 3 years, plus 35k salary for 7 years. Plus the opportunity cost of investment during that 7-8 years of investing that 450k. Why would you do a postdoc if you don’t want to do research? We are talking about a net of half a million to a million minimum if you invest this money throughout your career. Very few career tracks get you this high a salary right after college. Whatever, don’t believe me. Do whatever your want. I have basically never encountered an MDPhD who has exited full time science (Which is now the majority) who said oh I would have been better off financially if i had gone to med school straight instead. Never. And this is taken into consideration of the whole pslf windfall.

Having 300k in your bank at the start of the career is very very very different from making 300k extra at the end o your career. If you don’t know why that is you should take a basic financial literacy class.

2) PhD programs exist for a reason: talented students from third world countries are willing to put up with a few years of slave labor to transition to an industry job in the US so they can escape whatever they were destined in their home country. I’m actually fine with that, as long as everyone knows the reality. There are lots of inefficiencies—for example the PhD to academia job should be a match system. All the tenure track spots should be publicly published etc. but that’s a different issue.

3) LOL compare to how the government wastes money elsewhere, training PhDs in biomedicine is 1. a pittance. 2. Probably a net positive if you count total economic product produced. If you really want to shut down things in education perhaps you should start with UNDERGRAD student loans that never yield positive returns. Or should we do a survey of how many funded R01s are “wasteful”?

You need to remove yourself from the academia bubble—you’ll gain some clarity. People In academia like to BS. You need to look through the BS if yo want to succeed.

 

[langwang3]

1) No It’s 450k (post tax with interest) with interest for 3 years, plus 35k salary for 7 years. Plus the opportunity cost of investment during that 7-8 years of investing that 450k. Why would you do a postdoc if you don’t want to do research? We are talking about a net of half a million to a million minimum if you invest this money throughout your career. Very few career tracks get you this high a salary right after college. Whatever, don’t believe me. Do whatever your want. I have basically never encountered an MDPhD who has exited full time science (Which is now the majority) who said oh I would have been better off financially if i had gone to med school straight instead. Never. And this is taken into consideration of the whole pslf windfall.

Having 300k in your bank at the start of the career is very very very different from making 300k extra at the end o your career. If you don’t know why that is you should take a basic financial literacy class.

2) PhD programs exist for a reason: talented students from third world countries are willing to put up with a few years of slave labor to transition to an industry job in the US so they can escape whatever they were destined in their home country. I’m actually fine with that, as long as everyone knows the reality. There are lots of inefficiencies—for example the PhD to academia job should be a match system. All the tenure track spots should be publicly published etc. but that’s a different issue.

3) LOL compare to how the government wastes money elsewhere, training PhDs in biomedicine is 1. a pittance. 2. Probably a net positive if you count total economic product produced. If you really want to shut down things in education perhaps you should start with UNDERGRAD student loans that never yield positive returns. Or should we do a survey of how many funded R01s are “wasteful”?

You need to remove yourself from the academia bubble—you’ll gain some clarity. People In academia like to BS. You need to look through the BS if yo want to succeed.

After taxes and living expenses wouldn’t most MD/PhD grads, esp in high COL areas where many of the top schools are, have ~$0 in the bank after graduating?

 

[EvoMed]

Very interesting thread.

For me, it’s not all-or-nothing, academics or bust. An undergrad, applicant, or student cannot fully know the realities of running a lab, and the administrative and political responsibilities that come with it. I suspect that many of the MD PhDs who are not “80-20” made that decision for themself.

Moreover, it should not be viewed as a “failure” to not run a lab. These degrees are ultimately pieces of paper. What’s important is the skills we acquire, opportunities made available, and ultimately what we can do with our lives. If a graduate feels that the research environment in private industry will facilitate discovery and translation more efficiently than academia, or is a better match for their skill set and preferences, I see no reason why this wouldn’t be preferred. Similarly, if an MD PhD ultimately feels that they can make the greatest impact and feel the most rewarded by primarily treating patients in a practice, then there is nothing wrong with that. Their training still equips them with the skills to publish case reports, contribute as a collaborator, and stay involved with the medical/research community.

Yes, a faculty appointment is a prestigious honor. Many of us starting out an MD PhD would be happy if that is what our future holds in store. But from where we stand, there is no way for us to know what’s really best for us in 10-20 years from now. This journey is far too long to be in it for the finish line.

 

[dl2dp2]

After taxes and living expenses wouldn’t most MD/PhD grads, esp in high COL areas where many of the top schools are, have ~$0 in the bank after graduating?

Here's how the math works:
At the end of med school, the MD-PhD has $0 in debt but also $0 net worth.
The MD-only has ~300g in debt.

At the end of 5- year residency (let's say they both go into something nice and lucrative, like diagnostic radiology or rad onc or ortho), the MD-PhD has $0 in debt--perhaps if he pinches himself he saves 5g per year in a Roth IRA for 5 years, plus compounding, but let's just discount it.
The MD-only has ~450g in debt because the 300g debt now compounded at a 6-8% interest rate.

At the end of 5 years post-residency, the MD-PhD and the MD-only each saved about 100g a year, which is not unreasonable.
Simplistically, neglect tax, interests, investment yield etc., at this point the MD-PhD now has a net worth of 500g. The MD-only has 50g net worth.

Assuming a 7% rate of return investing in broad market index fund, at the end of 25 years (assuming a 30-year career), that 500g is now 2.7M. The 50g? 270g.

Now let's say the MD only works 4 years extra, since she started early and graduated early (I don't know why she would tho, since the total duration of employment AFTER training is exactly the same). She saves another 100g per year at the end of her career. The total dollar differential is 2.7M - 670g + ~ $80g (4 years of compounding of 270g) = ~ 1.8 M.

Now, if you save 100g per year consistently for 30 years as an ortho, your net worth would be > 10M, so that 1-2M net worth difference wouldn't really matter--especially if you would've hated doing a PhD in your 20s vs. either doing something else or just retire 4 years early, but just on a financial level, the differential is very real. PSLF changes things somewhat, but the gestalt remains the same. The only way MD-only would beat MD-PhD is if MD-only makes a series of choices later that prove a much higher overall income and savings, which on the whole is true, since most MD-PhDs go into research-oriented jobs or academia, which means they take a substantial job cut over the length of the career. But if you don't do that you are much much better off doing the MD-PhD than MD-only.

I'm being extreme to illustrate the point: this difference can easily be a million or more over 30 years.

This math also shows that the total financial return of value for the PhD years is very high. Even not counting the salary increase, just purely based on tuition, the PhD gives 100g *post-tax* savings with a 35k living standard. This means a pre-tax total income in the 150k+ level for 3-4 years. The only jobs that pay 150k+ a year for a fresh undergrad are 1) investment banking 2) management consulting or 3) big tech.

 

[Fencer]

The research experience that matters the most for your career as a physician-scientist is the 1-2 yrs research training during fellowship/post-doc. Being at one of the top 10 groups in your particular area of research (regardless of institution NIH ranking) at that point in your career is truly what matters the most to optimize the launching of your career as junior investigator/Assistant Professor. The real role of MD/PhD programs is to get you prepared to successfully land a spot at one of the top 10 locations for your area of investigation (i.e.: develop student's critical thinking, presentation skills, etc. to convince them that you are awesome with high potential). As you evaluate MSTPs and MD/PhD programs, the key stats are time to PhD, publications at graduation, fellowship grants by students, and residency matching record for MD/PhD students. Important considerations also include total research enterprise near you (not just NIH for potential collaborations), geography, and personal fit into the program. Honestly, there are about 20 MSTPs outside of the 2019 FY top 40 NIH ranked institutions based upon funding (Partly this is due to Harvard's hospitals, and other units of HU/other institutions listed as individual institutions), and you can get outstanding training in any MSTP or large MD/PhD program. The key is whether they can serve you to train you and get you to be a desirable level to get into a top 10 in your area. Top 10 in your area (i.e.: retina, neurodegeneration, diabetes, tumor immunology, aging, HIV, etc.) does not mean top 40 NIH; in some cases, it does.

See: https://report.nih.gov/award/index.cfm

 

[tortuga87]

Yes, a faculty appointment is a prestigious honor. Many of us starting out an MD PhD would be happy if that is what our future holds in store. But from where we stand, there is no way for us to know what’s really best for us in 10-20 years from now. This journey is far too long to be in it for the finish line.

I also think we should ask ourselves if we really want to become faculty. Yes, it is prestigious. You will get complimented about how smart you must be for being a professor. I view it like going to Harvard. You get compliments, people look up to you, but at the end of the day Harvard/being faculty does not discover general relativity, the principle of evolution, new cancer treatments, etc for you. What does do that is long hours in the lab, thinking hard/working hard on the actual scientific problem, being ignored by the scientific community for many years because you go left when others go right, and then finally arriving at an actually good solution.

At the end of the day, faculty are workers for the university. They make money for the university. The university obviously wants you to view faculty as prestigious so you will devote lots of time and energy making money for the university. Being faculty means spending many hours of the day writing grants, attending meetings and teaching students; these things all make money for the university. However, all these things can be very boring unless you are into that stuff. I personally prefer to do research and clinical work only, and would like to cut out all of that extra stuff - teaching, admin, opinion writing (i.e. grant writing), perfecting that manuscript so you can publish in Science/Nature/Cell just so that one reviewer in Delaware likes it, trying to impress ppl with a CV so you will get a 10/10 on review rather than a 8/10. These things are basically just politics; they distract *a lot* of time from patient care and making real discoveries that honestly better patient care.

If you want to be a physician scientist, you should make it so that you be a physician and a scientist. The gold standard should not be a faculty member which equals physician-scientist-teacher-administrator-grant writer-reviewer-powerpoint presenter etc. Now if you want to be a physician scientist and have borderline ADHD, then a faculty position might be a good fit for you (kidding on this last sentence).

 

[deleted819639]

I also think we should ask ourselves if we really want to become faculty. Yes, it is prestigious. You will get complimented about how smart you must be for being a professor. I view it like going to Harvard. You get compliments, people look up to you, but at the end of the day Harvard/being faculty does not discover general relativity, the principle of evolution, new cancer treatments, etc for you. What does do that is long hours in the lab, thinking hard/working hard on the actual scientific problem, being ignored by the scientific community for many years because you go left when others go right, and then finally arriving at an actually good solution.

Forgive my naivete, but if we are not faculty, then how can we become physician-scientists? One does not need to be a faculty member to become a physician or a researcher, but a faculty position seems like a prerequisite if you want to do both research and clinical work (especially if you're interested in basic/translational research). It's interesting to see that some integrated care organizations like Kaiser and Geisinger are now starting to dabble in research, but these are the exception, not the norm.

 

[FalconSlice]

Forgive my naivete, but if we are not faculty, then how can we become physician-scientists? One does not need to be a faculty member to become a physician or a researcher, but a faculty position seems like a prerequisite if you want to do both research and clinical work (especially if you're interested in basic/translational research). It's interesting to see that some integrated care organizations like Kaiser and Geisinger are now starting to dabble in research, but these are the exception, not the norm.

To just comment on being "faculty" and what it might mean in different places:

I think it depends on your institution's infrastructure (both the hospital and the university). Sometimes, the hospital is owned by the university (e.g. University of Michigan own's its hospital) and sometimes, the hospital and university are separate entities that are just affiliated. Therefore, being "faculty" might mean holding clinical position at the hospital and/or (again, depending on your institution's infrastructure) "faculty" could mean holding a research position at the university. I'm skipping over lots of mumbo-jumbo, but suffice to say being "faculty" is a nebulous term without specific appointments and affiliation that follows the title.

 

[dl2dp2]

Forgive my naivete, but if we are not faculty, then how can we become physician-scientists? One does not need to be a faculty member to become a physician or a researcher, but a faculty position seems like a prerequisite if you want to do both research and clinical work (especially if you're interested in basic/translational research). It's interesting to see that some integrated care organizations like Kaiser and Geisinger are now starting to dabble in research, but these are the exception, not the norm.

You are not thinking about this the right way. A "faculty position" with whatever pros and cons it contains, is a shell. The substance in the shell is the total $ you are bringing in, either as a clinician or as a researcher. If you bring in enough dollars, you have more leverage to discuss with large organizations to design a shell that fits what you want. It may be a "tenure track" "faculty position", or it may be something else.

Administratively, you might consider your job, in effect, as starting your own non-profit research organization and become the recipient of federal grants, and also start your own practice and practice medicine at the same time. Increasingly universities and medical centers are essentially a shopping mall of these smaller independently entities organized together without too much central cohesion. The possibility is endless here as long as you have worked out some arrangements with the right people. Think about it for one second: if you are the department chair in name but a member of the faculty is the PI of a center grant that drives most of the employment of the department, how much power do you really have in directing the workflow of most of the employees? You don't have the hiring/firing final authority, except perhaps administratively. The power that's derived from the executor of the NIH contract is much more significant.

In particular, the title of faculty is also not useful even in lateral moves. If you raised X number of R01s and have X papers, but you worked as a staff scientist at an independent research organization, if you move to a university you would start at a certain level, even if you never had a faculty position. Again, the content of the work is $X raised, X paper written, X staff managed, practiced in X specialty in X years, managed a service, etc (i.e. being a "physician-scientist"). "Faculty" position is like a job perk, not the content of a job, if that makes sense.

 

[Lucca]

You are not thinking about this the right way. A "faculty position" with whatever pros and cons it contains, is a shell. The substance in the shell is the total $ you are bringing in, either as a clinician or as a researcher. If you bring in enough dollars, you have more leverage to discuss with large organizations to design a shell that fits what you want. It may be a "tenure track" "faculty position", or it may be something else.

Administratively, you might consider your job, in effect, as starting your own non-profit research organization and become the recipient of federal grants, and also start your own practice and practice medicine at the same time. Increasingly universities and medical centers are essentially a shopping mall of these smaller independently entities organized together without too much central cohesion. The possibility is endless here as long as you have worked out some arrangements with the right people. Think about it for one second: if you are the department chair in name but a member of the faculty is the PI of a center grant that drives most of the employment of the department, how much power do you really have in directing the workflow of most of the employees? You don't have the hiring/firing final authority, except perhaps administratively. The power that's derived from the executor of the NIH contract is much more significant.

In particular, the title of faculty is also not useful even in lateral moves. If you raised X number of R01s and have X papers, but you worked as a staff scientist at an independent research organization, if you move to a university you would start at a certain level, even if you never had a faculty position. Again, the content of the work is $X raised, X paper written, X staff managed, practiced in X specialty in X years, managed a service, etc (i.e. being a "physician-scientist"). "Faculty" position is like a job perk, not the content of a job, if that makes sense.

How can anyone find the startup funds to develop this kind of set up without a faculty position though? Or have access to core facilities they need for their research before they are able to purchase their own kit outright? Do I just walk up to Merck and say give me some lab space 4 days a week? Who are examples of the “right people”? It’s just tough for me to imagine what the non-faculty version of what you’re talking about looks like, but I’ve spent my entire career thus far in academia and I had no idea industry would ever let u continue to practice medicine or work freely on your own science when u could be making them money full time.

 

[FalconSlice]

How can anyone find the startup funds to develop this kind of set up without a faculty position though? Or have access to core facilities they need for their research before they are able to purchase their own kit outright? Do I just walk up to Merck and say give me some lab space 4 days a week? Who are examples of the “right people”? It’s just tough for me to imagine what the non-faculty version of what you’re talking about looks like, but I’ve spent my entire career thus far in academia and I had no idea industry would ever let u continue to practice medicine or work freely on your own science when u could be making them money full time.

To respond to your latter concern first: I haven't heard of a company being as forgiving to being a true physician-scientist as an academic university...but I'm still a little green so take it with a grain of salt.

To talk about how to find the startup funds w/o a faculty position: I think what @sluox was mentioning was that, in essence, being a "faculty member" doesn't mean anything...it's just a label and what truly matters are the $, papers, etc. you bring in (and RVUs for the hospital if we're talking clinical faculty as well). So how to get the funds (at least at an academic center)? Well, I think it's most commonly bringing your K99/R00 or K08 (and maybe more grants that you have amassed?) as a post-doc fellow to another institution as a "faculty"... and if the chair is invested enough (or maybe a company's division chief?), the department might also give startup funds for a predetermined "investment period" to really get you set up to see how you can produce before they reassess how good of an investment you are. Maybe in those several years as a new faculty, you have finally got an R01 and working on a second and have published several high impact papers! Or maybe you haven't produced anything...

 

[dl2dp2]

How can anyone find the startup funds to develop this kind of set up without a faculty position though? Or have access to core facilities they need for their research before they are able to purchase their own kit outright? Do I just walk up to Merck and say give me some lab space 4 days a week? Who are examples of the “right people”? It’s just tough for me to imagine what the non-faculty version of what you’re talking about looks like, but I’ve spent my entire career thus far in academia and I had no idea industry would ever let u continue to practice medicine or work freely on your own science when u could be making them money full time.

Again, you are not thinking about this in the right way. It's not about having someone else "let" you do something. it's about raising money to do the science you want to do. The way to raise money is to convince someone who's in charge of giving out money or has money to give you the money to do the research you want to do. Traditionally, this entity is NIH, which has laid out some pathways. It need not be from NIH--for example, it could be Burroughs Wellcome, or it could be some other private foundation. It could be a wealthy person/foundation--for certain kinds of research, there are well-known examples (RWJ, etc).

Yes, you CAN "walk up to Merck" and give me some lab space, but you need to craft a story to convince Merck that this is worth their investment. You can cold call people, but the right way to do it is to talk to people who know people at Merck. In fact, there are extramural grant funding FROM Merck that you can apply to. Once you have money it really doesn't matter if the lab space is at Merck, or at the Alexandria Center, or at Verily Life Sciences or at MGH--again, these are SHELLS, you are obsessing over shells. You need the right content. The shell is purely administrative.

The only reason that you are thinking in a very narrow way is because nobody [outside of the NIH] is interested in the kind of science you are doing. That's the fundamental problem. Your science is not compelling or economically interesting to people who have money to give out, except the NIH--and even then not really, since your grant will likely be rejected.

 

[Lucca]

Again, you are not thinking about this in the right way. It's not about having someone else "let" you do something. it's about raising money to do the science you want to do. The way to raise money is to convince someone who's in charge of giving out money or has money to give you the money to do the research you want to do. Traditionally, this entity is NIH, which has laid out some pathways. It need not be from NIH--for example, it could be Burroughs Wellcome, or it could be some other private foundation. It could be a wealthy person/foundation--for certain kinds of research, there are well-known examples (RWJ, etc).

Yes, you CAN "walk up to Merck" and give me some lab space, but you need to craft a story to convince Merck that this is worth their investment. You can cold call people, but the right way to do it is to talk to people who know people at Merck. In fact, there are extramural grant funding FROM Merck that you can apply to. Once you have money it really doesn't matter if the lab space is at Merck, or at the Alexandria Center, or at Verily Life Sciences or at MGH--again, these are SHELLS, you are obsessing over shells. You need the right content. The shell is purely administrative.

The only reason that you are thinking in a very narrow way is because nobody [outside of the NIH] is interested in the kind of science you are doing. That's the fundamental problem. Your science is not compelling or economically interesting to people who have money to give out, except the NIH--and even then not really, since your grant will likely be rejected.

Ah I see what you mean now by “shell”, that’s an interesting perspective I hadn’t heard before, but in academia most mentorship you are exposed to is mostly folks who have followed a traditional academic career ladder or are fully employed by industry so it’s interesting to hear about other potential careers. At least in the fields I’ve been active in the workhorse technology tends to be extremely expensive so one would need to negotiate access to core facilities at the very least to really get started so I imagine it could be tougher to at least start the kind of career you describe without establishing yourself in either academia or industry beforehand.

 

[deleted819639]

Again, you are not thinking about this in the right way. It's not about having someone else "let" you do something. it's about raising money to do the science you want to do. The way to raise money is to convince someone who's in charge of giving out money or has money to give you the money to do the research you want to do. Traditionally, this entity is NIH, which has laid out some pathways. It need not be from NIH--for example, it could be Burroughs Wellcome, or it could be some other private foundation. It could be a wealthy person/foundation--for certain kinds of research, there are well-known examples (RWJ, etc).

Yes, you CAN "walk up to Merck" and give me some lab space, but you need to craft a story to convince Merck that this is worth their investment. You can cold call people, but the right way to do it is to talk to people who know people at Merck. In fact, there are extramural grant funding FROM Merck that you can apply to. Once you have money it really doesn't matter if the lab space is at Merck, or at the Alexandria Center, or at Verily Life Sciences or at MGH--again, these are SHELLS, you are obsessing over shells. You need the right content. The shell is purely administrative.

The only reason that you are thinking in a very narrow way is because nobody [outside of the NIH] is interested in the kind of science you are doing. That's the fundamental problem. Your science is not compelling or economically interesting to people who have money to give out, except the NIH--and even then not really, since your grant will likely be rejected.

This is a fascinating viewpoint; thank you for sharing. You are absolutely correct that the "shell" isn't everything, and I suppose one can find more paths to do GOOD science as a physician-scientist if you keep an open mind and raise the necessary funds. Treating the faculty position as a means and not the end makes sense to me.

However, 1) is there an alternate pathway to MD/PhD->K series grant->R series grant that will ensure a productive career as a physician scientist? and 2) if not, then is obtaining a faculty position a necessary prerequisite to eventually obtaining a R01 or other stable funding sources as a physician-scientist? While I must confess that I have not looked how plentiful and accessible external funding is to a physician scientist, I cannot think of a single example where a non-faculty (or non-university/non-hospital affiliated) physician-scientist obtained a R01. NIH Reporter tells me that the last time someone at Merck obtained a R01 was in 2003...

 

[PumpernickelCloudberry]

1) is there an alternate pathway to MD/PhD->K series grant->R series grant that will ensure a productive career as a physician scientist? and 2) if not, then is obtaining a faculty position a necessary prerequisite to eventually obtaining a R01 or other stable funding sources as a physician-scientist?

I feel like it's the other way around, that the ability to obtain funding is the prerequisite to the faculty position. Being a faculty member is an administrative title from the university, given to people who have grant money or the desirable skills (teaching, clinical, administrative, etc) to bring in money. It's the clinicians and the productive scientists that fund the university, not the other way around. In fact, if you have the faculty position but not the money, chances are you will not be staying in that position for very long. Institutional support and startup awarded to early career researchers are like loans, you have to pay it back. They're necessary for helping you build up your intrinsic value, but they're not sufficient for your career. In research, your value as a physician scientist is tied to your scientific reputation, established by publication history. In clinical world, it could be your experience, clinical skills, and credentialing in different specialties.

When you have enough intrinsic value, the faculty position itself is disposable and exchangeable. Perhaps a good way to think about this is, what happens if a PI no longer wants to work in a particular department? Do they cease to be physician-scientists if they suddenly find that their position no longer serves them? If this person is a senior investigator with many grants and a well established research program, then s/he can simply move his lab to whichever institution that is willing to take the money or prestige that he can offer, in exchange for a faculty position/title. Even for an early stage investigator without an independent grant, if you are highly skilled in a technique that someone finds valuable, or have a growing number of high impact publications in a field, you can convince someone to give you the money to investigate the research questions they're interested in. With that money, even if you're denied tenure by your university and lose your faculty title, you can go to another university or institute and "buy" yourself a new position, lab space, or a core service.

To answer your question on whether there are alternative pathways as a physician scientist, yes, there definitely are. For example, if you have sufficient research experience and publications, then you no longer need the PhD. The PhD is just a title. In recent years, it looks like a very small handful of MD/PhD graduates have been getting tenure track faculty positions at R1 institutions straight out of their MD/PhD training, without residency or postdoc. They established enough "intrinsic value" during their PhD alone that they could convince some universities to give them startup money and to take a gamble on them.

 

[PumpernickelCloudberry]

This is a huge waste of public money. Training people to become professional researchers when they never will be is not a good use of resources.

PhD programs are not a waste of money even if zero PhD student continues in academia. PhD students and postdocs are necessary for supplying a very essential labor force that holds up the research enterprise of most countries. How else are you going to get a large number of willing workers who are reasonably skilled, and highly motivated to work for very little in compensation, in order to do the grunt work in academia? Even if no domestic U.S. student wants to pursue PhD training, you'd still be looking for people from other countries to fill those spots.

PhD and MD/PhD students do not even pay tuition. Their positions are not entirely there to serve *them*. As a society, you would want a reasonable number of physician-scientists trained each year even if you do not currently have the perfect position for exactly what they were trained for. For example, in the event that you do immediately need more physician scientists, such as in a public health crisis, then all you have to do is to make the research money available, and the physician scientist work force staying dormant in clinician-only roles might come out and make themselves useful immediately. It's much more efficient than waiting for a new generation to be created. Also, from a public health perspective, physician scientists can be very versatile in the roles they can fulfill, useful even when they're not a perfect 80-20 research positions.

 

[dl2dp2]

However, 1) is there an alternate pathway to MD/PhD->K series grant->R series grant that will ensure a productive career as a physician scientist? and 2) if not, then is obtaining a faculty position a necessary prerequisite to eventually obtaining a R01 or other stable funding sources as a physician-scientist? While I must confess that I have not looked how plentiful and accessible external funding is to a physician scientist, I cannot think of a single example where a non-faculty (or non-university/non-hospital affiliated) physician-scientist obtained a R01. NIH Reporter tells me that the last time someone at Merck obtained a R01 was in 2003...

First of all, you wouldn't apply to NIH to get a grant to do research at Merck--the total R&D in pharma > total govt sponsored R&D, by quite a bit, actually. Secondly, even if you were to apply for R&D from industry, it would be a SBIR/STTR mechanism, not an R01. Thirdly, small companies don't apply for R01s to do research, they typically would aim to get venture funding.

Out of ~ 10-12ish people who entered MSTP with me, 3 people are now CEOs of biotech companies. Two have raised > 10M, one have raised > 5M. In our alumni list there's someone who's potentially a billionaire. Out of the top 30-50 top MSTPs who went into the industry early on in their career, I suspect a decent number of them are decamillionaires. Then the rest of the people who went into ortho or interventional radiology or dermatologists who are also decamillionaires and at times self fund their own research. Successful clinicians BUY hospitals and universities GIVE them wings to make money to subsidize researchers they hire. They *own* you. Who *is* the "failure" here? Lol I find it hilarious that you people think not being a rinky dinky professor is somehow the worst thing ever. Most MSTPs drop out because they found a better job. It's not like being a professor is really that hard. I can almost guarantee you if you write 3 R01s a year for 5-7 years any idiot will get an R01. Do you know how much PhD professors get paid at universities? Do you *really* want to live on public assistance in a major city or in a college town in the middle of nowhere?

 

[FalconSlice]

Successful clinicians BUY hospitals and universities GIVE them wings to make money to subsidize researchers they hire. They *own* you. Who *is* the "failure" here? Lol I find it hilarious that you people think not being a rinky dinky professor is somehow the worst thing ever. Most MSTPs drop out because they found a better job. It's not like being a professor is really that hard. I can almost guarantee you if you write 3 R01s a year for 5-7 years any idiot will get an R01. Do you know how much PhD professors get paid at universities? Do you *really* want to live on public assistance in a major city or in a college town in the middle of nowhere?

Being a physician-scientist in training, I am quite happy with my journey so far and looking forward to the rest of my career(s)! However, you have lost me with what point you are trying to make here (bolded part specifically)?

I have to say that while your statements about R01s isn't wrong, it certainly doesn't seem "easy" and filled with a lot of hard work and luck. Additionally, what do you mean about "how much PhD professors get paid" and "living on public assistance"? Sorry, but I don't follow

 

[CheGuevaraMD]

Here's how the math works:
At the end of med school, the MD-PhD has $0 in debt but also $0 net worth.
The MD-only has ~300g in debt.

At the end of 5- year residency (let's say they both go into something nice and lucrative, like diagnostic radiology or rad onc or ortho), the MD-PhD has $0 in debt--perhaps if he pinches himself he saves 5g per year in a Roth IRA for 5 years, plus compounding, but let's just discount it.
The MD-only has ~450g in debt because the 300g debt now compounded at a 6-8% interest rate.

At the end of 5 years post-residency, the MD-PhD and the MD-only each saved about 100g a year, which is not unreasonable.
Simplistically, neglect tax, interests, investment yield etc., at this point the MD-PhD now has a net worth of 500g. The MD-only has 50g net worth.

Assuming a 7% rate of return investing in broad market index fund, at the end of 25 years (assuming a 30-year career), that 500g is now 2.7M. The 50g? 270g.

Now let's say the MD only works 4 years extra, since she started early and graduated early (I don't know why she would tho, since the total duration of employment AFTER training is exactly the same). She saves another 100g per year at the end of her career. The total dollar differential is 2.7M - 670g + ~ $80g (4 years of compounding of 270g) = ~ 1.8 M.

Now, if you save 100g per year consistently for 30 years as an ortho, your net worth would be > 10M, so that 1-2M net worth difference wouldn't really matter--especially if you would've hated doing a PhD in your 20s vs. either doing something else or just retire 4 years early, but just on a financial level, the differential is very real. PSLF changes things somewhat, but the gestalt remains the same. The only way MD-only would beat MD-PhD is if MD-only makes a series of choices later that prove a much higher overall income and savings, which on the whole is true, since most MD-PhDs go into research-oriented jobs or academia, which means they take a substantial job cut over the length of the career. But if you don't do that you are much much better off doing the MD-PhD than MD-only.

I'm being extreme to illustrate the point: this difference can easily be a million or more over 30 years.

This math also shows that the total financial return of value for the PhD years is very high. Even not counting the salary increase, just purely based on tuition, the PhD gives 100g *post-tax* savings with a 35k living standard. This means a pre-tax total income in the 150k+ level for 3-4 years. The only jobs that pay 150k+ a year for a fresh undergrad are 1) investment banking 2) management consulting or 3) big tech.

This analysis is confusing and wrong. You crucially miss the fact that the MD-only grad will start their career 6-7 years early than the MD-PhD grad (no grad school or research fellowship), and so they can forgo retirement savings to aggressively pay down debt.

Maybe a MD-PhD comes out of the training pipeline debt-free, but they are much older and have likely chosen a path of permanently lower wages (academic jobs).

The only way your math works out is if the grad works in a clinical specialty that already has low pay (like pediatrics). Med school tuition is flat rate, so those in lower paying specialities are worse off. But in high paying specialities, 7 years is definitely enough time to aggressively pay down debt, especially if you are starting this process at 30 instead of 37.

 

[dl2dp2]

MD-only grad will start their career 6-7 years early than the MD-PhD grad (no grad school or research fellowship), and so they can forgo retirement savings to aggressively pay down debt.

Regrettably you are confused, but it doesn’t make me wrong. If the MD-PhD grad is not interested in a research career, she would likely never do a research fellowship. So it’s not 6-7 years but more like 3-4 years. You need an apple to apple comparison. After you do either MD or MD-PhD and decide to do a full time clinical career in the exact same specialty, what’s your expected net worth 30 years later. Simplistically, doing the MD-PhD puts you approximately 1.5-2M ahead, everything else held equal. This is regardless of the duration of your career. It’s all due to compound interest. it has nothing to do with any particular specialty choice. The math works as long as the MD and MD-PhD go into the same specialty.

As I said, in the original post had you read it carefully, if the MD-PhD decides to stay academia or go into a low paying specialty obviously she will make less money throughout her career. That is just a totally different trajectory. Doing an MD-PhD will not help you if you chose a carer that pays significantly less for 30 years. I.e. an orthopedic surgeon will save up way more than 2M than a pediatrician, even if the pediatrician was ahead of him at the start of the 30 year period.

if the math still confusing you, suppose you have two equivalent doctors who go into pediatrics, having no debt as they both got a full ride scholarships. However, one person received an inheritance at the start of residency of 400k. These two doctors work exactly the same amount make the same amount of money for 25 years, and neither of them was able to save a single cent—-hey pediatricians just don’t get paid enough. The doctor who didn’t get the inheritance works an extra 5 years—but he is still unable to save, since his kids are now in college. How much net worth do you have at the end of the 30 year period? Is it 400k vs 0? Or is it 2M vs 0?

BTW, being 10 years out, I'm already seeing this in real life. MD-PhDs who were consistent and had the good judgment to invest throughout their training program vs. their equivalent MDs who had/have med school debt who are on the same exact track (i.e. academic vs. academic / private vs. private), the MD-PhD typically has 500k+ worth of net worth, which means 1) they usually already own their primary residence; 2) they struggle much less with other big piece expenses like child care.

 

[dl2dp2]

Being a physician-scientist in training, I am quite happy with my journey so far and looking forward to the rest of my career(s)! However, you have lost me with what point you are trying to make here (bolded part specifically)?

I have to say that while your statements about R01s isn't wrong, it certainly doesn't seem "easy" and filled with a lot of hard work and luck. Additionally, what do you mean about "how much PhD professors get paid" and "living on public assistance"? Sorry, but I don't follow

Is it really harder to get an R01 than becoming an orthopedic surgeon or having > 10M net worth? What good things in life, pray tell, is not filled with a lot of hard work and luck? What makes this particular career track any more miserable than any other career track available--this is the part that doesn't compute for me.

There are late 30s early 40s postdocs living in major cities who have two kids and no working spouse who are on public assistance, on their way to hopefuly get into a "tenure track faculty position" to write 3 R01s per year for 5-7 years. LOL. Is that job really so desirable?

 

[CheGuevaraMD]

Regrettably you are confused, but it doesn’t make me wrong. If the MD-PhD grad is not interested in a research career, she would likely never do a research fellowship. So it’s not 6-7 years but more like 3-4 years. You need an apple to apple comparison. After you do either MD or MD-PhD and decide to do a full time clinical career in the exact same specialty, what’s your expected net worth 30 years later. Simplistically, doing the MD-PhD puts you approximately 1.5-2M ahead, everything else held equal. This is regardless of the duration of your career. It’s all due to compound interest. it has nothing to do with any particular specialty choice. The math works as long as the MD and MD-PhD go into the same specialty.

As I said, in the original post had you read it carefully, if the MD-PhD decides to stay academia or go into a low paying specialty obviously she will make less money throughout her career. That is just a totally different trajectory. Doing an MD-PhD will not help you if you chose a carer that pays significantly less for 30 years. I.e. an orthopedic surgeon will save up way more than 2M than a pediatrician, even if the pediatrician was ahead of him at the start of the 30 year period.

if the math still confusing you, suppose you have two equivalent doctors who go into pediatrics, having no debt as they both got a full ride scholarships. However, one person received an inheritance at the start of residency of 400k. These two doctors work exactly the same amount make the same amount of money for 25 years, and neither of them was able to save a single cent—-hey pediatricians just don’t get paid enough. The doctor who didn’t get the inheritance works an extra 5 years—but he is still unable to save, since his kids are now in college. How much net worth do you have at the end of the 30 year period? Is it 400k vs 0? Or is it 2M vs 0?

The math is simple but your reasoning makes no sense. Am I to believe that you think the average MD-PhD admit cynically has no interest in research prior to matriculation? Only then would someone try to obtain a 3 year PhD, no pursue a research fellowship, etc. Even if we assume the MD-PhD pursues a PhD in good faith for 5 years and gives up research, they are still no better off than the MD. If a MD attending earning $300k was committed to living on a MD-PhD-like salary for 5 years, they could easily pay off their $450k med school debt. To that end, both paths are equal, but the MD-PhD had to perform research instead of clinical medicine. It’s just a different type of identured servitude.

 

[FalconSlice]

Is it really harder to get an R01 than becoming an orthopedic surgeon or having > 10M net worth? What good things in life, pray tell, is not filled with a lot of hard work and luck? What makes this particular career track any more miserable than any other career track available--this is the part that doesn't compute for me.

There are late 30s early 40s postdocs living in major cities who have two kids and no working spouse who are on public assistance, on their way to hopefuly get into a "tenure track faculty position" to write 3 R01s per year for 5-7 years. LOL. Is that job really so desirable?

I don't know the statistics even though there's a lot out there... but in this regard, I'd have to say, it looks like you are pointing out the people that are not doing well as if they are the majority?

Surely, the majority of want-to-be-tenure-track MD/PhD researchers aren't on public assistance or even having a bad life? What about the people that actually do get tenure? Or even the non-tenure track clinician-scientists that have a successful lab and a clinical appointment? I know a large population of both, and they seem to be rather well off...

Forgive me if I'm dense, but...Overall, I'm still confused what your stance is on MD/PhDs given all of your past comments? Are you for or against the physician-scientist pathway? Do the MD/PhD for free, go into a lucrative field, shun basic science, and have a happy life collecting 4% annual returns on the millions you accrue over the years as an orthopedic surgeon?

 

[dl2dp2]

The math is simple but your reasoning makes no sense. Am I to believe that you think the average MD-PhD admit cynically has no interest in research prior to matriculation? Only then would someone try to obtain a 3 year PhD, no pursue a research fellowship, etc. Even if we assume the MD-PhD pursues a PhD in good faith for 5 years and gives up research, they are still no better off than the MD. If a MD attending earning $300k was committed to living on a MD-PhD-like salary for 5 years, they could easily pay off their $450k med school debt. To that end, both paths are equal, but the MD-PhD had to perform research instead of clinical medicine. It’s just a different type of identured servitude.

It's your reasoning that makes no sense. People don't start having no interest in research, but plenty of people finish MD PhD having lost their interest in research. It's like people don't start having no interest in ibanking when starting as a first year associate, but by the end of their 7th year many lose interest in staying an ibanker. This doesn't mean that they didn't make lots of $$ as a first year associate. All I'm saying is the indentured servitude for the duration of the PhD in an MSTP is extremely valuable from a financial perspective. It's comparbale to that of a 1st year ibank associate.

 

[dl2dp2]

Forgive me if I'm dense, but...Overall, I'm still confused what your stance is on MD/PhDs given all of your past comments? Are you for or against the physician-scientist pathway? Do the MD/PhD for free, go into a lucrative field, shun basic science, and have a happy life collecting 4% annual returns on the millions you accrue over the years as an orthopedic surgeon?

MD PhD is extremely valuable. I'm 1000% for it. Either way you do well. I'm trying to dispell the idea that MD/PhD is "pointless" and should be "shut down" (as one poster said), because it's "hard" to be a 80/20.

In fact, as it's shown, just purely on a financial level, doing MD/PhD equivalent to having an inheritance of 400k at 30 or having 2M at 60. This is not counting the intangible benefits.

When I started this program, med schools were 50% cheaper and competitive specialties (esp. in good locations) weren't nearly as hard to get into, it was still sort of equivocal whether MSTP would be worth it from a purely $ level for people having no interest in research at the end of med school. Now it's not even close.

 

[CheGuevaraMD]

It's your reasoning that makes no sense. People don't start having no interest in research, but plenty of people finish MD PhD having lost their interest in research. It's like people don't start having no interest in ibanking when starting as a first year associate, but by the end of their 7th year many lose interest in staying an ibanker. This doesn't mean that they didn't make lots of $$ as a first year associate. All I'm saying is the indentured servitude for the duration of the PhD in an MSTP is extremely valuable from a financial perspective. It's comparbale to that of a 1st year ibank associate.

You are making a lot of unstated assumptions here - how do MD-PhDs have significant income to save on a training salary? They’re married? Lucky enough to attend a program in a very cheap city? Most people do not have these luxuries, especially in highly ranked programs. I’m only a few years out, and most of my MD-PhD peers are single and have modest savings. The straight clinical MDs have money and families.

I don’t want to cause a flame war, but you seem out of touch with the direction that academia is headed.

 

[dl2dp2]

You are making a lot of unstated assumptions here - how do MD-PhDs have significant income to save on a training salary? They’re married? Lucky enough to attend a program in a very cheap city? Most people do not have these luxuries, especially in highly ranked programs. I’m only a few years out, and most of my MD-PhD peers are single and have modest savings. The straight clinical MDs have money and families.

I don’t want to cause a flame war, but you seem out of touch with the direction that academia is headed.

No, my math makes NONE of these assumptions. It's a purely apple to apple comparison. Yes, one would always be better off financially if they 1) married someone who is wealthy and/or makes a lot of money 2) lives in a low cost of living area. However, this is, very clearly and explicitly, unrelated to my math. The only assumption here is 1) you get paid 30-35k stipend as an MDPhD, 2) your med school costs 50k a year (a low ball number) and you receive no help from family 3) you do your PhD in 3-4 years.

Incidentally, the assumptions you are making are also false. 1) lots of poeple save/invest during MD PhD through a variety of means, including real estate, Roth IRAs, and other mechanisms. 2) people who live in very expensive areas are not necessarily living poor or the school subsidizes cost of living. 3) married people aren't necessarily financially better off since often a lot of their spouses don't work--but in general they are better off one way or another but this is because people who marry by the time they graduate tend to be more frugal. that's a separate issue.

 

[tortuga87]

Forgive my naivete, but if we are not faculty, then how can we become physician-scientists? One does not need to be a faculty member to become a physician or a researcher, but a faculty position seems like a prerequisite if you want to do both research and clinical work (especially if you're interested in basic/translational research). It's interesting to see that some integrated care organizations like Kaiser and Geisinger are now starting to dabble in research, but these are the exception, not the norm.

The answer to this is going to vary depending on a lot of things, including at least the specialty you choose and the type of research that you do. If your specialty requires enormous hours (e.g. surgery), or your research is not that useful (e.g., theoretical neuroscience of olfaction), then I am not aware of anything that you can do besides faculty.

However, if you are smart in choosing your specialty, your PhD, and you critically view your research projects as investments, then you may be able to work something out. What I have seen before:

1) Start your own practice + license your inventions to industry. Over time, the money coming in from many of your inventions builds up.

2) Improving a derivative of devices in industry which you perfect in clinic. You can let a clinical scientist run the final clinical trials after the device is fine tuned, so you can move onto creating the next device.

3) Doing research primarily with industry during residency (establish connection e.g. at conferences or cold email) rather than a university PI, proving yourself as valuable to them in the process, and then leading projects that translate between bench to bedside after graduation.

4) If you go into a lifestyle specialty and do not care about the usefulness in your research, then you can make more money in a practice working less hours and doing research on your own than being a faculty member while having more time to do research. Private practice does not always equal 80 hours per week of clinical practice, so do not assume private practice = no research.