Will dropping out of my MD/PhD program hurt my chances of getting into a PSTP or other research-intensive residency?

[MDPhD2020]

I'm considering not completing the PhD portion of my training because I can't find any mentors doing research I'm interested in or open to letting me start a project in their lab that would fit my research interests.

I’d still like to end up in a career primarily focused on research, and am thinking it would make more sense to do a PSTP or other research-intensive residency program followed by a longer fellowship/post-doc as an alternative to a PhD now.

Will dropping out and not completing a PhD have any significant impact on getting into residencies or fellowships later down the line?

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[tr]

Uh, yes for PSTP specifically. It should not affect your chances of getting into a good general clinical residency. It will almost certainly be a huge red flag for PSTPs.

Not completing PhD because you decided you don't want to do research is totally fine and won't affect your chances at a high-quality clinically focused residency. If you still want to do research of some kind and specifically if you are interested in PSTP, I'd find the best fit you can and do the PhD.

 

[AHDCard]

OP, I would recommend figuring out what your MSPE will look like if you drop out. If programs are able to see that you dropped the PhD, I agree that will raise questions. If they can't, then you'll be treated as any other MD-only applicant would be (ie, you can be competitive if you have substantial research, but you will be at a disadvantage to applicants with PhDs).

 

[ChordaEpiphany]

IMO research topic is almost entirely irrelevant to enjoyment. Process is what's important (think wet lab vs. dry lab, translational vs. fundamental). If you're struggling to find a professor who is researching the right topic, then I'd suggest finding a lab that follows an adjacent process. If you're struggling to find a professor who is researching with the right process, then consider dropping out. The latter situation is pretty rare. I'd bet someone could support your research goals.

Also, having started my own project, it's definitely a harder path. It might not be what you're imagining. It's better to start on an established project and then start something new 1-1.5 years into the PhD, borrowing from techniques learned in G1.

Lab mates who started on established projects quickly earned co-authorships and inherited vetted projects with a clear pathway towards graduation and high impact first author papers. Starting your own project usually results in less interest from your mentor (not their idea), less funding towards your project, fewer overall publications, poorer guidance, and significantly more work.

I was a "success" story of starting a new project. Eventually we received an R01, and I got a few grad students and a post-doc to help me. Still, I will likely graduate with fewer papers than if I had simply done a bread and butter thesis from my lab, and I have worked twice as hard. All I can hope for is that my PI writes a glowing letter about how I established an entire new branch of his lab. However, like most big-wigs in academia, he is not a grateful man. I think he's already convinced himself that all of my ideas are his own. Most big name PIs are like this to varying degrees.

This is all to say, you might not be thinking about this the right way. Grad school isn't the best time to fully flex your research independence. If anything, you'll be far more dependent on others' ideas and money if you try to pursue research with just an MD. The MDs in our lab are placed on the easiest and most well-established projects. Otherwise they are unproductive. Mostly clinical MD attendings who collaborate with us have zero say in overall research direction unless they come into it with grant money. If you are serious about a research career, my best advice is to add your own spin to someone else's pre-funded ideas while in grad school. When you start your lab, then you can go buck wild.

This is the game people play in academia. If you can't stand the thought of any of this, then welcome to being disillusioned with academia. You certainly wouldn't be alone in that.

 

[dl2dp2]

If you are fairly far out in your PhD, there's an argument to push through.

Residency programs don't care. You can start doing research later and see how you like it.

 

[SurfingDoctor]

IMO research topic is almost entirely irrelevant to enjoyment. Process is what's important (think wet lab vs. dry lab, translational vs. fundamental). If you're struggling to find a professor who is researching the right topic, then I'd suggest finding a lab that follows an adjacent process. If you're struggling to find a professor who is researching with the right process, then consider dropping out. The latter situation is pretty rare. I'd bet someone could support your research goals.

Also, having started my own project, it's definitely a harder path. It might not be what you're imagining. It's better to start on an established project and then start something new 1-1.5 years into the PhD, borrowing from techniques learned in G1.

Lab mates who started on established projects quickly earned co-authorships and inherited vetted projects with a clear pathway towards graduation and high impact first author papers. Starting your own project usually results in less interest from your mentor (not their idea), less funding towards your project, fewer overall publications, poorer guidance, and significantly more work.

I was a "success" story of starting a new project. Eventually we received an R01, and I got a few grad students and a post-doc to help me. Still, I will likely graduate with fewer papers than if I had simply done a bread and butter thesis from my lab, and I have worked twice as hard. All I can hope for is that my PI writes a glowing letter about how I established an entire new branch of his lab. However, like most big-wigs in academia, he is not a grateful man. I think he's already convinced himself that all of my ideas are his own. Most big name PIs are like this to varying degrees.

This is all to say, you might not be thinking about this the right way. Grad school isn't the best time to fully flex your research independence. If anything, you'll be far more dependent on others' ideas and money if you try to pursue research with just an MD. The MDs in our lab are placed on the easiest and most well-established projects. Otherwise they are unproductive. Mostly clinical MD attendings who collaborate with us have zero say in overall research direction unless they come into it with grant money. If you are serious about a research career, my best advice is to add your own spin to someone else's pre-funded ideas while in grad school. When you start your lab, then you can go buck wild.

This is the game people play in academia. If you can't stand the thought of any of this, then welcome to being disillusioned with academia. You certainly wouldn't be alone in that.

Oof, that hits home. Not for me, my lab is literally me and a RA (and for periods, just me), but when you get post-docs and junior PIs clamoring over an idea that the graduate student generated for the well funded, senior PI who used that idea as the catalyst for their next grant…

Also, I’ve been instructed to throw data I generated at students and trainees to help me look more like I’m mentoring from the tenure people for promotion despite those people not really even wanting to be involved in research. I could say a lot more about that… but double oof.

 

[ChordaEpiphany]

when you get post-docs and junior PIs clamoring over an idea that the graduate student generated for the well funded, senior PI who used that idea as the catalyst for their next grant…

I think using others' ideas in your grants is fair game if it's a grad student in your lab. It's not like the student is going to write an R01 and get it funded in their name. Ideas are more often generated at the bottom and cultivated at the top. That's understood in academia, and it's part of the game. In exchange for funding support and career mentorship, you slave away in the lab and give your PI credit for much of the work you do. That is all represented well enough with the 1st author vs. last author hierarchy.

I draw the line at commercialization. At my previous institution, spin-off companies were largely run by grad students or post-docs exiting the lab. The PI would sign on as either a scientific co-founder with a small piece of equity or would simply act as a scientific advisor. The student/post-doc would join the local incubator and fight for funding as founder and majority stakeholder. This was fair. I don't know if the times have changed or my new institution is different, but here the PIs are ruthless in their pursuit of commercialization of students' ideas. I have a friend whose PhD thesis was turned into a company and sold for an 8 figure sum (undiluted by investor money, supported entirely by state/federal grants). They were a "co-founder," but received almost nothing in compensation while the PI made literal millions. My PI "offered me" a 5% stake in a company based on my own technology (which he doesn't even close to understand) if I joined on as CEO after graduation. They even start shell companies and license the IP before students graduate to ensure they have the upper hand when it comes time to negotiate equity. A new student just generated a very nice set of data that looks extremely translatable. My PI called a meeting via email misspelling the name of the technology and demonstrating beyond a shadow of a doubt that they do NOT understand it in the slightest. By the end of the meeting, they had bullied everyone involved into agreeing that he was the sole owner of the IP generated.

The behavior around commercialization and using status to steal ideas and bully vulnerable grad students into working for peanuts just to see their own ideas come to fruition is abhorrent. I don't know where it came from. I did an I-Corps program ~6 years ago and most companies were run and controlled by those who had developed the idea. These days senior PIs have an iron grip on the IP.

 

[SurfingDoctor]

I think using others' ideas in your grants is fair game if it's a grad student in your lab. It's not like the student is going to write an R01 and get it funded in their name. Ideas are more often generated at the bottom and cultivated at the top. That's understood in academia, and it's part of the game. In exchange for funding support and career mentorship, you slave away in the lab and give your PI credit for much of the work you do. That is all represented well enough with the 1st author vs. last author hierarchy.

I draw the line at commercialization. At my previous institution, spin-off companies were largely run by grad students or post-docs exiting the lab. The PI would sign on as either a scientific co-founder with a small piece of equity or would simply act as a scientific advisor. The student/post-doc would join the local incubator and fight for funding as founder and majority stakeholder. This was fair. I don't know if the times have changed or my new institution is different, but here the PIs are ruthless in their pursuit of commercialization of students' ideas. I have a friend whose PhD thesis was turned into a company and sold for an 8 figure sum (undiluted by investor money, supported entirely by state/federal grants). They were a "co-founder," but received almost nothing in compensation while the PI made literal millions. My PI "offered me" a 5% stake in a company based on my own technology (which he doesn't even close to understand) if I joined on as CEO after graduation. They even start shell companies and license the IP before students graduate to ensure they have the upper hand when it comes time to negotiate equity. A new student just generated a very nice set of data that looks extremely translatable. My PI called a meeting via email misspelling the name of the technology and demonstrating beyond a shadow of a doubt that they do NOT understand it in the slightest. By the end of the meeting, they had bullied everyone involved into agreeing that he was the sole owner of the IP generated.

The behavior around commercialization and using status to steal ideas and bully vulnerable grad students into working for peanuts just to see their own ideas come to fruition is abhorrent. I don't know where it came from. I did an I-Corps program ~6 years ago and most companies were run and controlled by those who had developed the idea. These days senior PIs have an iron grip on the IP.

Ah, I see. I’m not really in a field of product development that leads to commercialization… at least not successfully. Certainty, people patent stuff all the time, I had provisional patent myself, and nearly all of it dies on the vine because drug development is mostly a money losing boondoggle.

 

[ChordaEpiphany]

Ah, I see. I’m not really in a field of product development that leads to commercialization… at least not successfully. Certainty, people patent stuff all the time, I had provisional patent myself, and nearly all of it dies on the vine because drug development is mostly a money losing boondoggle.

This really depends on your field, reach, and how much capital you have to throw around. I'm in oncology ($$), most professors in my department have 10+ grad students, several post-docs, and a few million to throw around on projects, and I am in an area that is flooded with biotech investors. I'm 4 years into a PhD and I've already filed 4 provisional patents just from my PhD work, with more coming inevitably. Most profs here have several companies and close relationships with VCs, patent attorneys, etc... At my old lab, PhD students would publish close to 15-20 patents from their time in the lab.

If you have a single RA and maybe a few hundred thousand in grants each year, then you can't compete. If you are one of these professors, then you can make a killing being the direct contact of some VC firm. You have your hand in 10-15 projects at all times. Any given year 1-2 of them will show enough promise to spin off as a company, and you gain more traction because you already have a relationship with the VCs and you have perfected the SBIR grant writing process (read: zero personal investment). Do this for 10 years as a big shot in academia and you'll probably have at least one major acquisition that will net you 7-8 figures. My PI is worth at least $25M, from what we can gather, though he keeps it very close to the chest. On the extreme end of things, you have people like Bob Langer, who essentially runs the Boston academic biotech startup scene, and then you have thousands of others doing what he does on a smaller scale. A lot of bigger professors in the Bay Area, San Diego, Boston, Seattle, and the Maryland Biotech Corridor publish far more patents than they do papers these days.

Betting on a single drug is a money losing boondoggle. Growing big enough that you can bet on 10-20 without significant personal investment is extremely profitable.

 

[SurfingDoctor]

This really depends on your field, reach, and how much capital you have to throw around. I'm in oncology ($$), most professors in my department have 10+ grad students, several post-docs, and a few million to throw around on projects, and I am in an area that is flooded with biotech investors. I'm 4 years into a PhD and I've already filed 4 provisional patents just from my PhD work, with more coming inevitably. Most profs here have several companies and close relationships with VCs, patent attorneys, etc... At my old lab, PhD students would publish close to 15-20 patents from their time in the lab.

If you have a single RA and maybe a few hundred thousand in grants each year, then you can't compete. If you are one of these professors, then you can make a killing being the direct contact of some VC firm. You have your hand in 10-15 projects at all times. Any given year 1-2 of them will show enough promise to spin off as a company, and you gain more traction because you already have a relationship with the VCs and you have perfected the SBIR grant writing process (read: zero personal investment). Do this for 10 years as a big shot in academia and you'll probably have at least one major acquisition that will net you 7-8 figures. My PI is worth at least $25M, from what we can gather, though he keeps it very close to the chest. On the extreme end of things, you have people like Bob Langer, who essentially runs the Boston academic biotech startup scene, and then you have thousands of others doing what he does on a smaller scale. A lot of bigger professors in the Bay Area, San Diego, Boston, Seattle, and the Maryland Biotech Corridor publish far more patents than they do papers these days.

Betting on a single drug is a money losing boondoggle. Growing big enough that you can bet on 10-20 without significant personal investment is extremely profitable.

Yeah, I’m the 1-2 RA lab with no trainees because “science isn’t cool” in critical care, only surveys about CPR and feelings. And there’s is no such thing as a sepsis drug, so that’ll never be me.

Just have to bet on Index ETFs and maybe a rich dead relative for the extracurricular money generation.

 

[ChordaEpiphany]

Yeah, I’m the 1-2 RA lab with no trainees because “science isn’t cool” in critical care, only surveys about CPR and feelings. And there’s is no such thing as a sepsis drug, so that’ll never be me.

Just have to bet on Index ETFs and maybe a rich dead relative for the extracurricular money generation.

Critical care is a tough field for therapeutics, but this is defeatist. As a physician-scientist you have the ability to extend beyond your immediate clinical area. I guarantee you've got enough clinical expertise to rope some engineering professor into working with you on some disease they have a great technology for but no clue how to approach clinically. My PI is a world class chemist who barely knows what a nucleotide is, and he's made 8 figures selling genetic engineering companies and holds 4 R01s in fields he can barely pronounce.

You're pigeonholing yourself. ETFs are great. Nothing wrong with low and slow investing, and it should be everyone's staple strategy for long-term financial security, but you don't think anything you study can be translated or adapted to something commercially viable? I literally just talked to a guy who sold a company whose sole mission was sustainable manufacturing to an aeronautics company for a completely different purpose.

Chances are if you can modulate nature in any meaningful way, there's a lucrative application for that modulation. From there, success is about being a ruthless opportunist with a fair amount of luck.

 

[SurfingDoctor]

Critical care is a tough field for therapeutics, but this is defeatist. As a physician-scientist you have the ability to extend beyond your immediate clinical area. I guarantee you've got enough clinical expertise to rope some engineering professor into working with you on some disease they have a great technology for but no clue how to approach clinically. My PI is a world class chemist who barely knows what a nucleotide is, and he's made 8 figures selling genetic engineering companies and holds 4 R01s in fields he can barely pronounce.

You're pigeonholing yourself. ETFs are great. Nothing wrong with low and slow investing, and it should be everyone's staple strategy for long-term financial security, but you don't think anything you study can be translated or adapted to something commercially viable? I literally just talked to a guy who sold a company whose sole mission was sustainable manufacturing to an aeronautics company for a completely different purpose.

Chances are if you can modulate nature in any meaningful way, there's a lucrative application for that modulation. From there, success is about being a ruthless opportunist with a fair amount of luck.

It’s very unusual and personally, I can’t think of a single example. There are probably only 30 to 40 R funded pediatric critical care physicians in the US. I know most of all of them in some capacity. Maybe some have nice side gigs, but it’s not common knowledge. A vast majority instead move up the academic ranks and become administrators.

Devices in critical care are also mostly useless. There used to be all sorts of devices to manage physiology, but they were off the market as soon as they were on it. Biotech is an interesting field. I actually have collaborators from BME on my current grant, but it’s more devices to mimics human physiology, no bedside application. I knew a different guy who was trying to make a bedside redox sensor for critically ill patients. Cool idea, but it has absolutely no practical use because even if you can detect “redox stress” at the bedside, you don’t know what it really means or how to fix it so it’s mostly a shiny machine that goes ping.

Anyway, translatable bench to bedside technology in critical illness is challenging because the population, disease and outcome is incredibly heterogenous. Maybe a ruthless opportunistic who has amazing luck could find a golden parachute… I’m not sure that’s for me though. Besides, I actually enjoy what I do.

 

[MonkeyArrow]

Yeah, I’m the 1-2 RA lab with no trainees because “science isn’t cool” in critical care, only surveys about CPR and feelings. And there’s is no such thing as a sepsis drug, so that’ll never be me.

I see from that from the trainee side also, as someone who is applying to try to do their PhD in resuscitation/critical care, the options are quite limited. I have found very few options for original, bench research in critical care, especially if you exclude LPS-induced sepsis models. It makes coming up with a cohesive application...interesting when there is only one PI at a given institution that does something.

 

[SurfingDoctor]

I see from that from the trainee side also, as someone who is applying to try to do their PhD in resuscitation/critical care, the options are quite limited. I have found very few options for original, bench research in critical care, especially if you exclude LPS-induced sepsis models. It makes coming up with a cohesive application...interesting when there is only one PI at a given institution that does something.

For a good several years, I was the only NIH-funded pediatric critical care physician scientist in a division of 20+. The adult side however is typically more robust, but I'm also at a Top 10 (or 20... I don't know) NIH-funded university so they intentionally attract physician-scientists or just scientists. They have about 80+ faculty. I don't know the numbers as well, but maybe 10+ do basic/translational science (only 2 do sepsis research, none do resuscitation). They have more than that who are NIH-funded, but they do clinical research.

Animal models of sepsis have kinda fallen out of vogue with the NIH. It's possible to still do them an get funding, but you need to be crafty and have a solid justification. This is more with NIGMS and less so with NIAID and NHLBI though.

Most people who go into critical care medicine don't go into it for understanding pathophysiology or mechanisms of disease. It's really not that interesting to them. Mechanisms in critical illness also tend to be very complex and convoluted. Physician trainees more like poking holes and putting in tubes and then when that doesn't work... giving everyone hydrocortisone or methylprednisolone. I literally had a fellow try to give a septic patient a nitric oxide scavenger (I don't think he knew nor cared my research is in nitric oxide) and when he I asked him why, his answer was "well why not?". Then I give him the literature from the mid-2000s that showed an RTC that NO-scavengers in sepsis improve blood pressure but also significantly increase mortality. I didn't go into the nitty gritty of sources and roles of NO because I knew it wouldn't interest them really. I also don't doubt he'll try it again because "why not" is like a mantra in critical care and many of my colleagues follow that mantra to the "T" (that's where they got the idea to give an NO-scavenger from to begin with).

This is of course just an anecdote, but the reality is in the 9 years I've been faculty, out of the 30+ fellows we've had, 4 have done a basic/translational science project during training and only 1 chose to stay in science. It's just not that interesting to people in this field.