First-generation physician-scientists are under-represented and need better support

[Dormouse]

Nature Medicine article:

First-generation physician-scientists are under-represented and need better support - Nature Medicine

First-generation students, whose parents do not have baccalaureate degrees, are less likely to apply to MD-PhD programs than to MD programs, which has led to a worrying lack of diversity among physician-scientists.

www.nature.com

"First-generation students, whose parents do not have baccalaureate degrees, are less likely to apply to MD-PhD programs than to MD programs, which has led to a worrying lack of diversity among physician-scientists.
Physician-scientists occupy a unique and important space that bridges scientific research and medical practice, and many have expressed concern that physician-scientists are an endangered species, with a dwindling pool of interested future researchers1,2,3,4. Indeed, the number of MD-PhD applicants in the USA has remained stagnant from 2012, when there were 1,853 applicants, to 2020, when there were 1,825. Meanwhile, applications to medical school have steadily increased during the same time period, from 45,266 to 53,030 (refs. 5,6). Is this because the traditional pool of applicants—those who have adequate advising and probably do not come from minority identities—has reached saturation? If so, there is a pressing need to recruit students who do not fit the traditional mold into the physician-scientist career path...
... ...

According to data from the Association of American Medical Colleges, a total of 666 first-generation students matriculated into MD-PhD programs between 2012 and 2020, compared with a total of 5,461 matriculants during this period5. The total enrollment increased from 5,010 to 5,830, while the representation of first-generation applicants and matriculants remained unchanged across the same 9-year period14,15. The ‘first-generation indicator’, a more recent designation created by the Association of American Medical Colleges in 2018 to identify applications by first-generation students, was used by 11% of MD-PhD program applicants and 8% of matriculants in the 2020–2021 academic year16,17. The gap between applicants and matriculants was greatest for first-generation students, relative to that of students whose parents have degrees. We conclude that first-generation students are under-represented among applicants to MD-PhD programs, and that these students do less well during admissions, as evident by the applicant-to-matriculant ratio (Fig. 1).

In contrast, for medical-school matriculants, the percentage of first-generation enrollees is double that for MD-PhD enrollees, and a lower proportion of students have parents with graduate degrees18. Differences between MD-PhD and MD-only applicants and matriculants suggest there are real and perceived barriers to matriculation into MD-PhD program, relative to those for MD programs, that exacerbate the under-representation of first-generation students among MD-PhD trainees.

The observations noted above are best understood in the context of intersecting identities. First-generation status often converges with other identities under-represented in science and medicine, including minority race and ethnicity and lower socioeconomic status19,20. These identities are also under-represented in MD-PhD programs. 64% of MD-PhD applicants and 71% of matriculants in 2020 had parents with a master’s degree or higher5. Over 40% of matriculants in the past 9 years have had at least one parent with a doctoral degree5. Nationwide, the majority of medical students came from households with incomes in the top quintile (greater than $120,000 per year), and over 20% of the students’ households had incomes in the top 5% (ref. 21). Among MD-PhD students, 41% of applicants and 49% of matriculants came from families with a household income of $100,000 or greater, with no substantial changes between 2014 and 2020. Only 9% of applicants and 6% of matriculants had childhood household incomes in the lowest quintile (less than $25,000 per year)22."

---

Members don't see this ad.

 

[DoctorWhere]

Thank you for sharing. Looking forward to the comments from others to follow.

 

[theendisnigh]

Interesting. I would suppose it would have to do with the lack of education on MD-PhD programs at some undergraduate colleges. I know that my pre-med advisor did not promote or have sessions on MD-PhD programs (mid-tier LAC). Another reason may be getting to the career faster; as a first-gen, urm incoming student, 7-8 years in medical school will put me at a further position from being able to help support my family (as I did in undergrad and high school) than 4 years of medical school (although I now understand that many of these programs come with tuition assistance, but I again refer to lack of education here).

I would also consider the drive that first-gen students may have to become practitioners in underserved communities they may arise from. I myself want to pursue primary care in my underserved community and others may be looking towards a similar goal. I was taught to go far and then give back to your community; many other first gens may be taught the same. There could then be the drive of becoming an everyday practitioner than a physician-scientist.

 

[Fencer]

A friend of mine, Mytien, has a manuscript in late stages of peer-review (acceptable) with a lot of more data showing the extent of the impact and historical choices. I will share once it becomes in-press.

 

[ValentinNarcisse]

Nature Medicine article:

First-generation physician-scientists are under-represented and need better support - Nature Medicine

First-generation students, whose parents do not have baccalaureate degrees, are less likely to apply to MD-PhD programs than to MD programs, which has led to a worrying lack of diversity among physician-scientists.

www.nature.com

"First-generation students, whose parents do not have baccalaureate degrees, are less likely to apply to MD-PhD programs than to MD programs, which has led to a worrying lack of diversity among physician-scientists.
Physician-scientists occupy a unique and important space that bridges scientific research and medical practice, and many have expressed concern that physician-scientists are an endangered species, with a dwindling pool of interested future researchers1,2,3,4. Indeed, the number of MD-PhD applicants in the USA has remained stagnant from 2012, when there were 1,853 applicants, to 2020, when there were 1,825. Meanwhile, applications to medical school have steadily increased during the same time period, from 45,266 to 53,030 (refs. 5,6). Is this because the traditional pool of applicants—those who have adequate advising and probably do not come from minority identities—has reached saturation? If so, there is a pressing need to recruit students who do not fit the traditional mold into the physician-scientist career path...
... ...

According to data from the Association of American Medical Colleges, a total of 666 first-generation students matriculated into MD-PhD programs between 2012 and 2020, compared with a total of 5,461 matriculants during this period5. The total enrollment increased from 5,010 to 5,830, while the representation of first-generation applicants and matriculants remained unchanged across the same 9-year period14,15. The ‘first-generation indicator’, a more recent designation created by the Association of American Medical Colleges in 2018 to identify applications by first-generation students, was used by 11% of MD-PhD program applicants and 8% of matriculants in the 2020–2021 academic year16,17. The gap between applicants and matriculants was greatest for first-generation students, relative to that of students whose parents have degrees. We conclude that first-generation students are under-represented among applicants to MD-PhD programs, and that these students do less well during admissions, as evident by the applicant-to-matriculant ratio (Fig. 1).

In contrast, for medical-school matriculants, the percentage of first-generation enrollees is double that for MD-PhD enrollees, and a lower proportion of students have parents with graduate degrees18. Differences between MD-PhD and MD-only applicants and matriculants suggest there are real and perceived barriers to matriculation into MD-PhD program, relative to those for MD programs, that exacerbate the under-representation of first-generation students among MD-PhD trainees.

The observations noted above are best understood in the context of intersecting identities. First-generation status often converges with other identities under-represented in science and medicine, including minority race and ethnicity and lower socioeconomic status19,20. These identities are also under-represented in MD-PhD programs. 64% of MD-PhD applicants and 71% of matriculants in 2020 had parents with a master’s degree or higher5. Over 40% of matriculants in the past 9 years have had at least one parent with a doctoral degree5. Nationwide, the majority of medical students came from households with incomes in the top quintile (greater than $120,000 per year), and over 20% of the students’ households had incomes in the top 5% (ref. 21). Among MD-PhD students, 41% of applicants and 49% of matriculants came from families with a household income of $100,000 or greater, with no substantial changes between 2014 and 2020. Only 9% of applicants and 6% of matriculants had childhood household incomes in the lowest quintile (less than $25,000 per year)22."

Well done, this has been an issue we have discussed at length on this forum before. The focus here on parental education level and household income is key. Without early exposure to research careers and appropriate mentorship, it is very difficult to become competitive for the MD/PhD path without taking extra years after college (which should be strongly discouraged, training is lengthy enough). Moreover, we should not be surprised that a significant proportion students and graduates reject the notion that one should train longer to have a lower income than an MD-only career. Until this is addressed, physician scientists will overwhelmingly be a game for the independently wealthy or those with no financial responsibility to their parents/extended family.

 

[tortuga87]

Fix the grant system, leaky pipeline and money before complaining about diversity.

No one cares for jobs that involve working harder, longer only to make half the money of their clinic counterparts and generate a pile of rejected grants. Best you can do is fill those spots with foreign students who will do it for the J1 - there's diversity for you.

Sorry, had to vent. Youngsters need to know what they are *really* getting into, particularly the disadvantaged ones.

 

[DoctorWhere]

Fix the grant system, leaky pipeline and money before complaining about diversity.

No one cares for jobs that involve working harder, longer only to make half the money of their clinic counterparts and generate a pile of rejected grants. Best you can do is fill those spots with foreign students who will do it for the J1 - there's diversity for you.

Sorry, had to vent. Youngsters need to know what they are *really* getting into, particularly the disadvantaged ones.

Why not work on the grant system, the leaky pipeline, and diversity concurrently? These are not issues that will be fixed overnight, so why put one area on hold?

 

[turtle114]

I feel like the recent push discouraging gap years may also disadvantage socioeconomically disadvantaged students. Working for $ was the only way I could afford my cycle, and I was asked multiple times by directors while interviewing "Why did you take gap years?" (I took 2.) Also, people who aren't connected to science/medicine before college tend to be slower to get in labs, and are more likely to benefit from additional research hours after college. Of course there are going to be people who take gap years so they can try to get into a more "elite" program, but I would say by and large the reason most people are taking them is just to become competitive in the first place.

If programs are going to start pushing people to apply sooner, they need to also be prepared to engage in a true "holistic" review and commit to reducing the economic barriers to applying (covering travel costs when that becomes a thing again, decreasing/abolishing secondary fees, etc.)

 

[ValentinNarcisse]

I feel like the recent push discouraging gap years may also disadvantage socioeconomically disadvantaged students. Working for $ was the only way I could afford my cycle, and I was asked multiple times by directors while interviewing "Why did you take gap years?" (I took 2.) Also, people who aren't connected to science/medicine before college tend to be slower to get in labs, and are more likely to benefit from additional research hours after college. Of course there are going to be people who take gap years so they can try to get into a more "elite" program, but I would say by and large the reason most people are taking them is just to become competitive in the first place.

If programs are going to start pushing people to apply sooner, they need to also be prepared to engage in a true "holistic" review and commit to reducing the economic barriers to applying (covering travel costs when that becomes a thing again, decreasing/abolishing secondary fees, etc.)

I think the scenario you describe is the appropriate use for the gap years. Unfortunately, I often see the opposite scenario: Ivy League grad takes two years off in Boston/Manhattan/San Francisco to work in elite lab to generate high impact pub, where their monthly rent exceeds their RA salary by double. This furthers the inequality as middle class and below students cannot afford to do this and will look worse in comparison, even if they had great undergraduate performance.

 

[dl2dp2]

I'm shocked how non-competitive MD PhD programs are. Overall acceptance rate is about 40%.

This tends to suggest that lower-ranked MD PhD may not be as value add vs. just MD.

I'm also confused by the astronomically high GPAs reported by the top medical schools. If the applicant pool hasn't changed much, does that just mean that grade inflation has worsened over time?

 

[theendisnigh]

I'm shocked how non-competitive MD PhD programs are. Overall acceptance rate is about 40%.

This tends to suggest that lower-ranked MD PhD may not be as value add vs. just MD.

I'm also confused by the astronomically high GPAs reported by the top medical schools. If the applicant pool hasn't changed much, does that just mean that grade inflation has worsened over time?

Overall acceptance rate is high because it's an extremely self-selective pool of candidates. And grade inflation hasn't worsened as much as the supply of pre-meds is high and everyone knows they need 90th percentile GPAs and MCATs to stand a chance, again self-selection.

 

[dl2dp2]

Overall acceptance rate is high because it's an extremely self-selective pool of candidates. And grade inflation hasn't worsened as much as the supply of pre-meds is high and everyone knows they need 90th percentile GPAs and MCATs to stand a chance, again self-selection.

I don't really understand how top 10 schools have GPAs ~ 3.9+. This means that basically, you have an A in everything. Never A-. Only A. How is this not grade inflation.

 

[ValentinNarcisse]

I don't really understand how top 10 schools have GPAs ~ 3.9+. This means that basically, you have an A in everything. Never A-. Only A. How is this not grade inflation.

What is even more bizarre is that at most top engineering schools such GPAs are extremely rare and not required to secure a top engineering job. All this achieves is motivating students to select the easiest majors with the easiest requirements in order to generate the highest GPA possible. My medical school had a decent number of students who attended its undergrad. The vast majority of these students majored in Spanish. I do not think that was a coincidence.

 

[Dormouse]

Moreover, we should not be surprised that a significant proportion students and graduates reject the notion that one should train longer to have a lower income than an MD-only career. Until this is addressed, physician scientists will overwhelmingly be a game for the independently wealthy or those with no financial responsibility to their parents/extended family.

Fix the grant system, leaky pipeline and money before complaining about diversity.

No one cares for jobs that involve working harder, longer only to make half the money of their clinic counterparts and generate a pile of rejected grants. Best you can do is fill those spots with foreign students who will do it for the J1 - there's diversity for you.

Sorry, had to vent. Youngsters need to know what they are *really* getting into, particularly the disadvantaged ones.

Absolutely, the problem with the leaky pipeline is not so much with qualities and characteristics of the trainees as it is with the low pay and low funding rates of the system itself. NIH can easily increase the amount of physician scientists by increasing the percentage of grants that are open to clinician scientists only for example, or by demanding that all studies with heavy human disease focus have a physician scientist as at least a co-PI. But why do so, when there are so many PhD-only researchers, especially international ones, who'd be super willing to work much longer hours at a tiny fraction of the salary for a chance for a job in the US?

Also, the way the US research enterprise is designed is to over-train a large number of trainees who have little to no chance of a permanent faculty position but to use them as cheap labor to produce data, and have a large number of investigators compete for the few funding opportunities so you can take the best idea or reward whatever fits the funding priorities of the time... A system that's the best for the careers of every scientists and physician-scientists isn't necessarily the best for research productivity or interest at a national level. I'm not sure that those in power have any incentive to fix the system that's been working well, from a certain perspective.

Why not work on the grant system, the leaky pipeline, and diversity concurrently? These are not issues that will be fixed overnight, so why put one area on hold?

It's such an interesting problem because scientific research often does not generate wealth or career stability as much as a clinical career does. I think that's also why first-gen students are wary of choosing the long training of MD/PhD path, unless they're truly committed.

 

[Dormouse]

I'm shocked how non-competitive MD PhD programs are. Overall acceptance rate is about 40%.

This tends to suggest that lower-ranked MD PhD may not be as value add vs. just MD.

To be honest, I don't think admission to the MD PhD program at my school is any more competitive than to the MD only track.

I don't really understand how top 10 schools have GPAs ~ 3.9+. This means that basically, you have an A in everything. Never A-. Only A. How is this not grade inflation.

This is part of where inside knowledge and mentorship become important, which first-gen students often lack. As far as I know, the trick was to take as few of the required pre-med courses that are graded harshly on a curve as you absolutely need, but then buffer your GPA with a lot of upper level seminar-type courses or grad courses where grading is "easy" or even irrelevant, and use all your free time to work in research lab to generate papers and presentations. You're not rewarded for taking harder courses if you end up with a lower GPA. To many first generation students, ditching classes so you can focus on working in lab is not very obvious.

Also, people who aren't connected to science/medicine before college tend to be slower to get in labs, and are more likely to benefit from additional research hours after college. Of course there are going to be people who take gap years so they can try to get into a more "elite" program, but I would say by and large the reason most people are taking them is just to become competitive in the first place.

Absolutely! But remember too that you will be older later on and feel the pressure of not having a real job as your friends are all attendings. The less financially secure someone is, the more s/he will likely feel this pressure.

 

[CheGuevaraMD]

I'm shocked how non-competitive MD PhD programs are. Overall acceptance rate is about 40%.

This tends to suggest that lower-ranked MD PhD may not be as value add vs. just MD.

I'm also confused by the astronomically high GPAs reported by the top medical schools. If the applicant pool hasn't changed much, does that just mean that grade inflation has worsened over time?

Where did you see this acceptance rate stat? It doesn't seem that surprising to me, though. Biology is consistently one of the highest doctorate-producing disciplines, according to the NSF's Survey of Earned Doctorates. A MD is valuable, but a bio PhD is junk, hence the lack of difference in acceptance rates between MDs and MD-PhDs.

 

[Dormouse]

"71% of matriculants in 2020 had parents with a master’s degree or higher. Over 40% of matriculants in the past 9 years have had at least one parent with a doctoral degree."

That's crazy!!!

 

[StilgarMD]

I'm sort of on the side of @tortuga87. I'm URM, child of immigrants, neither parent w/ any college, and being in an MD/PhD program has been difficult for reasons related to (as far as I can tell) to missing out on training prior to the program (Elite undergrads, Post-bacc research) that my peers got, and I didn't. and I happen to be in a lab bad at mentorship/training, so I'm just cobbling things together as I go along.

There are a variety of reasons people from these backgrounds don't matriculate at the same rates, but part of the solution needs to be what happens after matriculation - otherwise you're just signing up people for mental health problems and the trauma that is widespread in grad school. The generally exploitative nature of graduate school for a lot of people just makes trying to convince more people from backgrounds like mine to sign up for it to feel... dishonest... I didn't need convincing. If you do, maybe your life would be better without it. There is plenty of fulfillment and satisfaction to be found outside of this institution/pursuit.

 

[mdphdapplicant1]

.

 

[SurfingDoctor]

I never quite understand studies that like to point out problems with no solution.

Given the lack of growth in the number of applicants to MD-PhD programs, growing the physician-scientist community will require supporting students from a wide range of backgrounds for the collective benefit of science and medicine.

So their solution is more support? Support how? What does that even mean? I need something more tangible than that to even understand what they are getting at. I mean, I haven't seen a university system not tout diversity measures openly and frequently. What specific other support is needed? It's a serious question.

 

[Dormouse]

So their solution is more support? Support how? What does that even mean? I need something more tangible than that to even understand what they are getting at. I mean, I haven't seen a university system not tout diversity measures openly and frequently. What specific other support is needed? It's a serious question.

The most valuable type of support for me is mentorship, where faculty and older students who were once in my shoes chose to give me guidance on how academia and medicine worked, which, I think, would not be all that intuitive especially for someone with no family connection to academia.

I'm grateful for the people who gave me honest feedback and tips on what I was doing right/wrong given the goals I had for myself, even if those were not the words I wanted to hear at the time. I was saved by advisors (and one person in particular) who steered me away from exploitative PIs and situations and pointed out to me the path of less resistance, which set me up for success. When everything was falling apart, there were people who took the time to tell me that everything would turn out okay, so I didn't give up when I easily could have. There are those people who believe in you before you believe in yourself.

Another type of support is financial support. Students who are financially well-off can focus all their attention on their research and studies whereas low income students either need to work, or take on a huge amount of loans that end up restricting their career choices. Programs (NIH PREP, etc) that provide financial support for students to work in research is a great start to leveling the playing field.

 

[DoctorWhere]

Makes me even more proud to say I’ll be matriculating into an MSTP, knowing my father never finished high school


What do you mean by leaky pipeline?

And what is a realistic fix to the grant system? More funding of course, but failure should be expected, no? Or have I just been conditioned into thinking that rejected grants is the norm?

Leaky pipeline is used to describe the attrition of scientists that leave research throughout different phases of their training/careers.

 

[Onco_Jeans]

Hi, I think I have a pretty unique take (but n=1) so I'm gonna contribute to this thread. I am a first-gen incoming MD/PhD student myself, and I wasn't 100% certain about this decision until early last year.
Some background on me: My parents both have degrees from our native country, my dad has a bachelors and my mom has a masters. When we moved to the US, they didn't find jobs in their fields. My mom was a math teacher, but she now works in insurance, and my dad went to community college to get an associates, and now works as a technician in a hospital. Finances were tough when we just moved, and I certainly don't think we are well off, but right now I don't have to worry about where my next meal is coming so I would say we are living comfortably in the suburbs outside of a major city.

My high school district was definitely on the weaker end in terms of opportunities, and I only realized how much of a difference this makes once I got into college. I was competing with kids who had already participated in research activities, usually from more affluent areas, and I didn't get started in research until my sophomore year in college because I had no idea what I was doing. I sort of knew I had no chance at attending an Ivy for college, so I only applied to state schools (I don't really regret this at all, but I can definitely see how attending an Ivy could have presented different opportunities). I was a part of one of the college honors groups, but everyone I met was pre-med, and not pre-MD/PhD. At any sort of student panel, there were plenty of successful pre-meds who gave you general advice and timeline examples, and medical student panels were the same way, without including MD/PhD students at all.

I count myself lucky to have ended up in a super supportive lab group in my Junior Year, and I was planning on applying straight MD so that I could start med school ASAP and have a simpler life. I ended up having to retake my MCAT and applied late, and only ended up on waitlists that year. While I was applying for MD programs, one of the grad students in my lab kept telling me to apply MD/PhD, because he thought I would be a pretty strong applicant for it. If i'm being completely honest, I couldn't really see the value in the degree at all at the time, as my priorities (like most other first gen americans) was to get into med school and end up in a respectable profession that I liked, and end up living in the Upper Middle Class. When I was ultimately rejected from everywhere, I took a long time to think about the future and what I wanted to do, and I WORKED for a doctor, and realized that I didn't find as much satisfaction from constantly seeing patients as I thought I would. I had clinical experience prior, but working in a medical practice opened my eyes a bit to the reality of the repetitive nature of the job, and the constant administrative work. I applied for research tech jobs, landed one, realized I really did like research, and then reconsidered my life goals, and now I'm here about to start school in august.

For most First gen americans, it really comes down to finances, time, and exposure. It's very unlikely for a first gen american to attend a high school thats very supportive and filled with opportunities (mine was just focused on getting kids to graduate), which translates to how hard they hit the ground running in college, which then translates to their exposure to different fields. Then the general mentality that we're pushed to have as children of immigrants (and I can completely understand why) is to land a stable job in as short a time as possible. When you consider that its probably not as easy for first gen students to do whatever they wan't in college without having to worry about finances (the only reason I could do summer research at my school was because I was able to get a summer grant from the school), the probability of them falling in love with research drastically drops, as it is a very time intensive field. Its hard to get a meaningful publication or poster presentation by just showing up for 5-8 hours a week in a lab (I realized quickly that I could learn better by watching the recorded lectures than attending class itself, so I just went to lab instead), and even if you put 10-20 hours its still not guaranteed. And don't forget about all the other ECs you have to do, as well as trying to make time for things you enjoy. I also think the issue starts in high school, and that theres also a lot of outreach along the way that is just isn't there, or doesn't reach first gen kids.

As the final nail in the coffin, I will offer an anecdote. Someone I know in research mentioned how their friends daughter was accepted into an MD program but not the MD/PhD, and that they were considering just taking a few years off between coursework and clinical years to get the research experience. My first response was "wow thats going to be quite expensive because living there is not cheap and there's no conferral of a degree so it doesn't seem financially savvy" and they responded saying "oh this person doesn't have to worry about those things." Something like that would be unthinkable for me.


TLDR; Life isn't simple and fair, and money makes things easier

EDIT: I guess one other thing is that i'm now constantly getting called by other people in my community who are sort of in my position and are curious about MD/PhD programs and the career overall. I'm always initially surprised that they're reaching out to me of all people, because I am in no ways an expert, but again these kids don't know who else to ask.

 

[Onco_Jeans]

I think the scenario you describe is the appropriate use for the gap years. Unfortunately, I often see the opposite scenario: Ivy League grad takes two years off in Boston/Manhattan/San Francisco to work in elite lab to generate high impact pub, where their monthly rent exceeds their RA salary by double. This furthers the inequality as middle class and below students cannot afford to do this and will look worse in comparison, even if they had great undergraduate performance.

I completely agree. I dont live in the city I work in so my commute can be two hours one way on a bad day, and its not something that most first gen students would even consider, because "why waste 3-4 more hours of my day ontop of working hours trying to reach a publication when I can simply scribe or do something medically related nearby and come out financially more stable."

 

[SurfingDoctor]

The most valuable type of support for me is mentorship, where faculty and older students who were once in my shoes chose to give me guidance on how academia and medicine worked, which, I think, would not be all that intuitive especially for someone with no family connection to academia.

I'm grateful for the people who gave me honest feedback and tips on what I was doing right/wrong given the goals I had for myself, even if those were not the words I wanted to hear at the time. I was saved by advisors (and one person in particular) who steered me away from exploitative PIs and situations and pointed out to me the path of less resistance, which set me up for success. When everything was falling apart, there were people who took the time to tell me that everything would turn out okay, so I didn't give up when I easily could have. There are those people who believe in you before you believe in yourself.

Another type of support is financial support. Students who are financially well-off can focus all their attention on their research and studies whereas low income students either need to work, or take on a huge amount of loans that end up restricting their career choices. Programs (NIH PREP, etc) that provide financial support for students to work in research is a great start to leveling the playing field.

Well, mentorship can be a challenge no matter the background. While some people are great mentors, there are just as many (if not more) that are terrible mentors. Unfortunately, there is a bit of self-selection as the people who get the most funding (and thus, are viewed by the NIH as the best mentors) can often be terrible mentors. I've had a handful of people I go to, but I can tell you that the "mentor" on my K award, never read any paper I put them on and never read a grant I submitted. I eventually gave up and just forged their letters for progress reports because I knew they didn't want to be bothered and didn't care and stopped inviting them to my mentoring committee meetings. A co-mentor however read everything and gave feedback, but from the NIH's standpoint, the primary mentor who had more funding was the better mentor as when I tried to make the co-mentor the primary mentor, the grant got triaged. It is what it is. Mentorship can be and likely always will be a crapshoot and there becomes a bit of onus on the trainee to find the right support system for them.

The financial thing I do get and certainly the US education system rewards those well to do better than those who don't. I think that's probably more a reflection of the terrible cost of "education" in this country. I'd be all for more tuition support for people with less financially well to do backgrounds... of course, that costs money that not everyone is willing to pay into. The better solution is to just make education more streamlined (you don't need a state of the art foozeball table in every dorm and you don't need German Fairytales as a major and you don't need 15 idle administrators with made up titles)... but then again, education in this country is also a business (and a lucrative one) and so that's also a hard fix. Probably one that is desperately needed, but there's too much inertia.

 

[tr]

And what is a realistic fix to the grant system? More funding of course, but failure should be expected, no? Or have I just been conditioned into thinking that rejected grants is the norm?

1) Team science: replace inefficient, effort-duplicative, winner-take-all competition among tiny academic fiefdoms with large divide-and-conquer consortia. Model on astrophysics

2) Eliminate financial reliance of academic institutions on NIH dollars to salary their faculty. Academic institutions should salary their own employees and stipend their own students.

3) Replace exploitative slave-labor positions disguised as education (grad students/endless postdocs) with career positions as lab tech/research scientist, with reasonable salary, stability, and health insurance. These could be NIH funded.

Biomedicine PhD programs/postdocs would become much smaller and more competitive but also more in balance with the actual need/likelihood of advancing to PI. People who are not realistically competitive to become PIs but are interested in laboratory science would be rerouted into an actual job, not spit out on the street when they can no longer reasonably be called a trainee after having completed their fourth postdoc in their mid-40s. Instead of wasting energy competing with each other and writing unfunded grants, PIs could spend their time managing the research enterprise and coordinating consortia.

 

[deleted1082744]

I'm sort of on the side of @tortuga87. I'm URM, child of immigrants, neither parent w/ any college, and being in an MD/PhD program has been difficult for reasons related to (as far as I can tell) to missing out on training prior to the program (Elite undergrads, Post-bacc research) that my peers got, and I didn't. and I happen to be in a lab bad at mentorship/training, so I'm just cobbling things together as I go along.

There are a variety of reasons people from these backgrounds don't matriculate at the same rates, but part of the solution needs to be what happens after matriculation - otherwise you're just signing up people for mental health problems and the trauma that is widespread in grad school. The generally exploitative nature of graduate school for a lot of people just makes trying to convince more people from backgrounds like mine to sign up for it to feel... dishonest... I didn't need convincing. If you do, maybe your life would be better without it. There is plenty of fulfillment and satisfaction to be found outside of this institution/pursuit.

I'm just curious, did md/phd programs care that you were first gen and/or low income when applying or after matriculating? Do you regret going into an md/phd program? Considering this route, but it's getting harder to see myself doing this when my friends already make more than my parents at their summer internships in other fields.

 

[dl2dp2]

The generally exploitative nature of graduate school for a lot of people just makes trying to convince more people from backgrounds like mine to sign up for it to feel... dishonest...

Not really sure what this means-- would appreciate it if you can give out more examples.

The most valuable type of support for me is mentorship...

Another type of support is financial support. Students who are financially well-off can focus all their attention on their research and studies whereas low income students either need to work, or take on a huge amount of loans that end up restricting their career choices. Programs (NIH PREP, etc) that provide financial support for students to work in research is a great start to leveling the playing field.

Both are really financial. One might imagine a scenario where people are paid to provide unbiased mentorship. Right now people are way too busy to mentor junior scientists. MSTP is basically designed to "level the playing field" to some extent as everyone's paid the same amount.

1) Team science: replace inefficient, effort-duplicative, winner-take-all competition among tiny academic fiefdoms with large divide-and-conquer consortia. Model on astrophysics

2) Eliminate financial reliance of academic institutions on NIH dollars to salary their faculty. Academic institutions should salary their own employees and stipend their own students.

3) Replace exploitative slave-labor positions disguised as education (grad students/endless postdocs) with career positions as lab tech/research scientist, with reasonable salary, stability, and health insurance. These could be NIH funded.

1. This is already happening.
2. Is it really better? I can cut your salary and make it less dependent on external funding... or I can just increase your salary and make it based on performance. Plus if you want the former model there are plenty of jobs that are like this (i.e. university faculty jobs, particularly at tier 2 schools).
3. I think "reasonable salary" is the problem. Postdoc salary is higher than median household income, but much lower than income of their peers.
4. I'm all for shutting down programs--but this likely will lead to even worse opportunities for "first-generation" students. These interventions have a similar effect as unionization--you limit supply, but whenever you limit supply you also reduce access. As they say in healthcare management, cost, access, quality, you pick two.

I'm just curious, did md/phd programs care that you were first gen and/or low income when applying or after matriculating? Do you regret going into an md/phd program? Considering this route, but it's getting harder to see myself doing this when my friends already make more than my parents at their summer internships in other fields.

I think this is a psychological problem rather than a systemic problem. You *always* had the option to go into i-banking. It's not like you aren't aware that some jobs pay more than others. I think systemic justifications are posthoc -- i.e. people like to rationalize their choices to make it seem as if they had no agency so as to avoid negative emotions of the consequences of these choices.

Yes, you are always better off if you were #BornRich, but this is kind of an irrelevant ipso facto. There's no treatment by covariate interaction, so to speak--it's not like if you made a decision X if you were poor, but if you made a decision Y if you were rich, somehow this preferentially alters the outcome. No. The decisional process is the same. You are ALWAYS better off if you had rich parents. If the world is such that you are worse off if you had rich parents (i.e. Soviet Union right after collectivization), we would actually be in VERY bad shape.

 

[ValentinNarcisse]

I'm just curious, did md/phd programs care that you were first gen and/or low income when applying or after matriculating? Do you regret going into an md/phd program? Considering this route, but it's getting harder to see myself doing this when my friends already make more than my parents at their summer internships in other fields.

Not especially, but I would say some of the guidance by administration can be tone deaf (through no fault of their own). I think most first gen students wrongly assume that becoming a physician will guarantee you a safe route to an upper middle class lifestyle. In addition, students wrongly assume that junior faculty at elite institutions would be adequately compensated. Once I was a student, I was shocked to find the opposite was true. For example, a physician scientist track assistant professor in pediatrics could be making less than 100K/year at a very elite university hospital. In addition, you may receive advice to ”take a few years as instructor to generate data and delay start of you tenure clock”. This would be to someone in their mid to late 30s. It is completely unreasonable to give this advice to people at this age who expect to support their family after 15+ years of higher education. There is no transparency regarding these issues. Also do not assume when you visit a faculty member’s home that they are supporting their comfortable lifestyle from their university salary. Almost always it is independent wealth unless you are in a low cost area of the country.

FWIW - all the first gen students in my class figured this out by the time we reached grad school and gravitated to specialties with more secure compensation. We all remain active in science to some degree, but this was definitely not the default pathway.

 

[deleted1082744]

I think this is a psychological problem rather than a systemic problem. You *always* had the option to go into i-banking. It's not like you aren't aware that some jobs pay more than others. I think systemic justifications are posthoc -- i.e. people like to rationalize their choices to make it seem as if they had no agency so as to avoid negative emotions of the consequences of these choices.

Yes, you are always better off if you were #BornRich, but this is kind of an irrelevant ipso facto. There's no treatment by covariate interaction, so to speak--it's not like if you made a decision X if you were poor, but if you made a decision Y if you were rich, somehow this preferentially alters the outcome. No. The decisional process is the same. You are ALWAYS better off if you had rich parents. If the world is such that you are worse off if you had rich parents (i.e. Soviet Union right after collectivization), we would actually be in VERY bad shape.

I'm not applying yet and still have the option to go into the other field (which is indeed i-banking). Just looking to hear more about other people's experiences.

 

[dl2dp2]

Not especially, but I would say some of the guidance by administration can be tone deaf (through no fault of their own). I think most first gen students wrongly assume that becoming a physician will guarantee you a safe route to an upper middle class lifestyle. In addition, students wrongly assume that junior faculty at elite institutions would be adequately compensated. Once I was a student, I was shocked to find the opposite was true. For example, a physician scientist track assistant professor in pediatrics could be making less than 100K/year at a very elite university hospital. In addition, you may receive advice to ”take a few years as instructor to generate data and delay start of you tenure clock”. This would be to someone in their mid to late 30s. It is completely unreasonable to give this advice to people at this age who expect to support their family after 15+ years of higher education. There is no transparency regarding these issues. Also do not assume when you visit a faculty member’s home that they are supporting their comfortable lifestyle from their university salary. Almost always it is independent wealth unless you are in a low cost area of the country.

FWIW - all the first gen students in my class figured this out by the time we reached grad school and gravitated to specialties with more secure compensation. We all remain active in science to some degree, but this was definitely not the default pathway.

Hmm... I don't get this. Do you expect the faculty to release their net worth to you? So you can do what with it exactly? What exactly is the transparency you are looking for?

Also, becoming a physician will guarantee you a safe route to an upper-middle-class lifestyle. I don't see how that part is not true. Yes some small minority of physician-scientists, upon their own prerogative, decide to take a low-paying academic position to focus on research. Are you saying that this practice should be banned? We need a "federal minimum wage" for physician-scientists? Is 100k not high enough or are you being greedy? What kind of optics are you hoping to create out of this? LMAO

Plus, it's not like any of this information is not easily searchable on SDN. I feel like every other thread on this talks about how MD/PhDs get paid, and whether it's financially worth it, etc. that sort of thing.

I'm not applying yet and still have the option to go into the other field (which is indeed i-banking). Just looking to hear more about other people's experiences.

Out of all the options with which you can develop a career in biomedical research, MD PhD, especially at a top school, is your best bet.

Out of all the options accessible to top college students, MD PhD (or medical school per se) is not even in the top 5 if you want to make the most $$ most quickly. Although I don't see how this is the entire motivation behind "first-generation" students. There also must be at least a part of this that has to do with subject matter engagement (i.e. you have to enjoy the training/early career phase). I know of people who entered into banking and then dropped out because they didn't really like it or had to take a much lower-paying corporate job after a number of years because they couldn't get promoted. Outside of the bulge bracket jobs and their downstream cohort (i.e. into PE, funds, tech etc), mid-career salary in financial services or a corporate role in a similar capacity is actually not all that great. Similar with things like corporate law--how many people actually make partners? How many sort of fizzle out in an in-house job? How many corporate lawyers hate what they do? Have you scrutinized the path of what it takes to get where you want to go?

 

[ValentinNarcisse]

Also, becoming a physician will guarantee you a safe route to an upper-middle-class lifestyle. I don't see how that part is not true. Yes some small minority of physician-scientists, upon their own prerogative, decide to take a low-paying academic position to focus on research. Are you saying that this practice should be banned? We need a "federal minimum wage" for physician-scientists? Is 100k not high enough or are you being greedy? What kind of optics are you hoping to create out of this? LMAO

I am not hoping to create any optics out of this, but simply trying to address the core question of this article which is “what are the barriers that prevent or discourage first generation students from pursuing the physician scientist path?”. While we all have inherent interest in the subject matter, we are not saints. Students have real life concerns and responsibilities to our families and community. You can trivialize them if you wish, but we do not exist in a vacuum: students and their families work overtime/second/third jobs in order to scrape together money to pay for SAT/MCAT courses, application fees, and monthly train tickets to commute to labs in major metros to gather the “pre-requisites” to even enter this career path. To call someone “greedy” for expecting compensation commiserate with 15+ years of higher education, involving multiple rounds of selective examinations, and specialty medical training I think is inappropriate. Simply put, our parents/extended family struggled so we do not have the same struggles they did. After clearing all of these educational hurdles, to be unable to afford a home, child/eldercare, or children’s college education is not going to appeal to most first generation students.

Now our discipline can decide that attracting such students to the field is not worthwhile, as a significant proportion of scientific advancement in western history was performed by independently wealthy “gentleman scientists”, but this will be at the expense of leaving out many in our country who have the capability and aptitude for this work. They will enter other fields. However, public sector workers in my hometown (police, transit workers, etc.) start working in early 20s with no college requirement, are comfortably in the six figure range by age 30 (not including overtime which is significant), and retire after 20 years with a pension. This is well deserved and it is a public good to attract people to these careers. I think physician scientists should be similarly prioritized by society in terms of compensation, and I do not think this is an unreasonable request. In regard to your minimum wage comment, I think having a cohort of wealthy trainees willing to take these faculty jobs for salaries not commiserate with their level of education, undermines those from working class backgrounds. I would be curious to hear others thoughts.

 

[dl2dp2]

However, public sector workers in my hometown (police, transit workers, etc.) start working in early 20s with no college requirement, are comfortably in the six figure range by age 30 (not including overtime which is significant), and retire after 20 years with a pension. This is well deserved and it is a public good to attract people to these careers. I think physician scientists should be similarly prioritized by society in terms of compensation, and I do not think this is an unreasonable request. In regard to your minimum wage comment, I think having a cohort of wealthy trainees willing to take these faculty jobs for salaries not commiserate with their level of education, undermines those from working class backgrounds. I would be curious to hear others thoughts.

Really? You want to convert the physician-scientist track to one where you become a police officer at 20 and get a pension at 40? This is called "prioritization"? That track is not a good deal. Otherwise being a police officer would be competitive for those who are highly capable intellectually. MAYBE a firefighter, and even then it's a question mark. These kinds of hyperstable public servant tracks are not good deals in American society where a robust private sector tends to be highly profitable.

What exactly is a salary that's commensurate with someone's education? PhDs in academia get paid $100k routinely after 8 years of postdoc. If an MD PhD does the same job as a PhD, why should this person get paid more? Why should a PhD in humanities get paid a lot less? Who makes these decisions? Do you *really* want a central agency making these decisions? BTW, this already happens with PhDs, where their salary and oversupply are dictated by NIH edicts. And the PhD life is a clusterf as a result. Give me an example of a field where the wealthy entering into it by demanding a lower salary *doesn't* undermine people who enter it from disadvantaged backgrounds. ? LOL? Is there one?

I think your complaint of MD PhD researcher salary being too low will be ignored by powers that be. Salaries are dictated by supply and demand and value creation. With equivalent value creation, the only way to get up the salary is to restrict supply, which will just hurt access by poor students earlier. This is seriously just not a priority at all for anyone right now and I don't think it will be in the next 50 years. So if this is a hiccup for you to pursue this career, you should drop out ASAP---and by that I don't mean drop out of medical school--there are plenty of career paths that are much more profitable within medicine, or even within research careers--you have to give up the idea that you can just follow institutional rules and become wealthy, or that complaining about your predicament can change your fate. You have to drop out of the matrix created by these *assumptions*.

I know a number of "first-generation students" who end up becoming successful PIs (and others who didn't, but ended up successful in a different way). They are all wealthy now. So I would say that MD PhD certainly didn't prevent them from becoming wealthy. LMAO. For starters, don't take that job that pays 100k, or if you really want to take that job that pays 100k, moonlight somewhere else to make up the difference.

 

[SurfingDoctor]

1) Team science: replace inefficient, effort-duplicative, winner-take-all competition among tiny academic fiefdoms with large divide-and-conquer consortia. Model on astrophysics

2) Eliminate financial reliance of academic institutions on NIH dollars to salary their faculty. Academic institutions should salary their own employees and stipend their own students.

3) Replace exploitative slave-labor positions disguised as education (grad students/endless postdocs) with career positions as lab tech/research scientist, with reasonable salary, stability, and health insurance. These could be NIH funded.

Biomedicine PhD programs/postdocs would become much smaller and more competitive but also more in balance with the actual need/likelihood of advancing to PI. People who are not realistically competitive to become PIs but are interested in laboratory science would be rerouted into an actual job, not spit out on the street when they can no longer reasonably be called a trainee after having completed their fourth postdoc in their mid-40s. Instead of wasting energy competing with each other and writing unfunded grants, PIs could spend their time managing the research enterprise and coordinating consortia.

There is some effort at the NIH through R35 mechanisms to do number 1 specifically with the consolidation of multiple R01s into one R35 whose total expenditure is based on productivity. I had a collaborator (mostly in name) on a grant and when they got an R35, they had to come off because the R35 in theory funds them for team-based science. I mean, I think it’s a good idea in theory. For some institutions, the award also only needs to be renewed every 7 years as opposed to 4, which offers more consistency for hires. I’ve heard a lot of senior people complain that know their $500K in directs isnt enough to fund their programs which previously ran on $750K, but to make an omelette...

I would agree that the institutional indirect costs are kinda BS. They are hardly justifiable by most institutions at the rates they charge and could easily be used in many cases to fund an additional 1 or 2 RPGs.

 

[StilgarMD]

Not really sure what this means-- would appreciate it if you can give out more examples.

In reference to "The generally exploitative nature of graduate school for a lot of people just makes trying to convince more people from backgrounds like mine to sign up for it to feel... dishonest..."

I say graduate school is generally exploitative for a lot of people because I know personally many many graduate students who feel like they are in lab to 'perform', rather than learn. Many PIs have students and do very little to make sure they have coherent training and the skills needed to tackle the problems they'll face, both scientific but also 'graduate school generic'.

What I'll often hear folks reply is graduate school is unique - its a lot of figuring things out on the fly, guiding your own experience and learning. I believe it has to be that way, but this line of thinking is used to defend PIs who are completely apathetic to the cultivation of their students and post docs as colleagues. PIs who check in on your once every few weeks, and need constant reminding of what you last spoke about. I can rant about this for hours but I think if a PI is minimally invested in their trainees, but still on boards them and expects them to advance their scientific interests through publications, this is exploitation.

 

[Lucca]

to add to the already great discourse, re: the problem of the lengthy pipeline. I feel like it's very hard to tackle this issue because the length of time pre-medschool which has been extending the pipeline at the front-end is really a product of increased competition. It just isn't possible to get into undergrad and go straight through to an MD/PhD program unless you A) come from a well-connected science background and know what u want very early on or B) go to Harvard or similar where you have every resource in the known universe to help you succeed. Ideally, both.

I actually am a big believer in pipeline programs that get people introduced to science careers early on, as a product of one myself, and I *still* needed to take gap years and would not have even interviewed at the majority of programs I did without them due to competition. So I don't think NIH PREP or similar are *bad* per se because they do serve as a form of very robust pipeline program. But the time thing is an issue. I'm also not a huge fan of cutting corners on the front-end because its precisely in this exploratory and fledgling stage of ones professional life that time and freedom are a very valuable commodity not just for preparing for science, but for exploring many other options and living life, growing up. I think its highly reasonable to believe that medicine, science, and especially being a physician scientist are not careers one should just jump into without considerable thought.

If I was going to trim fat from the pipeline, I'd reorganize all preclin curricula to 1 year, and push for programs to get creative about ways to integrate third and fourth year requirements into the PhD years as much as possible. It wouldn't work for everyone or all projects, but imagine doing a medicine clerkship over 8 months, 1 week on service every month at a time. It would ask more of a grad students organizational skills when they are doing it, but it might potentially shorten the required FT clinical time to 1 year instead of 2, and the largely pointless post-match M4 time could be used for PhD defense or finishing up projects, applying for fellowships / grants for residency or postdoc and beyond. I havent been to residency so it's hard to know what fat can be cut there, or how the two sides can be better integrated, but as it stands I think the MD part of the MD/PhD is much more ripe for trimming than the PhD, apart from advising students against doing insane projects because they want a CNS pub.

---

as for the first-gen issue, as a first-gen student, frankly, that issue cannot be solved by MSTPs. That problem is about economics and opportunities. Show first-gen budding scientists the money and opportunities and they will come. Another reason I think pipeline programs and leaving room/time for people to develop/come to science in UG is important. I think a more pressed UG timeline would push first-gen students out rather than in.

 

[Dormouse]

Both are really financial. One might imagine a scenario where people are paid to provide unbiased mentorship. Right now people are way too busy to mentor junior scientists.

Or mentorship should simply be factored more heavily into assessments and promotion decisions, and people who do more of it should be awarded for their time. In the department where I'm doing research, grad students are recognized if they get some kind of grant or fellowship, or if they have high impact papers accepted for publication. Rarely are people ever recognized for mentoring younger students, even though there are a few who take a disproportionate amount of that work. In fact, being a great mentor can get a junior scientist into trouble, if you step on the toes of more senior PIs and collaborators when trying to protect a student.

 

[Dormouse]

I am not hoping to create any optics out of this, but simply trying to address the core question of this article which is “what are the barriers that prevent or discourage first generation students from pursuing the physician scientist path?”. While we all have inherent interest in the subject matter, we are not saints. Students have real life concerns and responsibilities to our families and community. You can trivialize them if you wish, but we do not exist in a vacuum: students and their families work overtime/second/third jobs in order to scrape together money to pay for SAT/MCAT courses, application fees, and monthly train tickets to commute to labs in major metros to gather the “pre-requisites” to even enter this career path. To call someone “greedy” for expecting compensation commiserate with 15+ years of higher education, involving multiple rounds of selective examinations, and specialty medical training I think is inappropriate. Simply put, our parents/extended family struggled so we do not have the same struggles they did. After clearing all of these educational hurdles, to be unable to afford a home, child/eldercare, or children’s college education is not going to appeal to most first generation students.

Agree that lower salary is a likely reason why low income and first generation students (or anyone) drop out of the physician scientist path after MD PhD programs, but to be honest I'm not sure that that's the reason why first-gen students do not pursue a dual degree in the first place. I would think it has more to do with not having the research background at the time of application because of the lack of early mentorship and access to research opportunities, and the unwarranted worry that it is harder to be admitted to a dual degree program than MD-only tracks.

I also think that the thought of being "in-school" for 8 years is scary if you do not know of anyone even going to college. I highly, highly doubt that all that many first-gen students are aware or even think about, at the time of med school application, how physician scientists are paid or how the grant system or clinical reimbursement works.

 

[Dormouse]

I think having a cohort of wealthy trainees willing to take these faculty jobs for salaries not commiserate with their level of education, undermines those from working class backgrounds. I would be curious to hear others thoughts.

Here are my thoughts- over 40% of matriculants in the past 9 years have had at least one parent with a doctoral degree, but those with doctorates are not necessarily always wealthy, as you yourself have emphasized many times. In fact, if they are PhDs and got their PhDs from another country and then immigrated to the US, it is very possible that their families are still middle class or lower middle class, or they never use their doctoral degree in the first place. If they use their PhD to teach as an adjunct for example, I would not call them "wealthy". You cannot always assume that your fellow MD PhDs come from "wealthy" families because they have parents with higher education, or that they receive any more financial support from their families, or that they are well off currently and they continue to pursue research because money is not an issue for them and their extended families. Even if there are those who truly come from well off family, which I do not deny could be a significant number, I think everyone, by human nature, prefers to earn more money themselves and live comfortably.

Perhaps another way of looking at the data in this article is that a significant number of students, despite having family members with higher education and therefore could be quite familiar with the trials and tribulations of research and medicine, choose to pursue that path themselves. Alternatively, one could look at the data as, parents with doctoral degrees are more likely to encourage (or less likely to successfully discourage) their kids from becoming physician scientists, relative to parents without higher education.

If truly this longer training path is a ridiculous endeavor, then you would not see this pattern. I do not think that 71% of firefighters or social workers for example have parents with master degree or higher. This suggests that there is something attractive or rewarding about this career to people who are more familiar with it, that is perhaps not yet obvious to those like me who are younger and still "in training".

 

[Dormouse]

Hi, I think I have a pretty unique take (but n=1) so I'm gonna contribute to this thread. I am a first-gen incoming MD/PhD student myself, and I wasn't 100% certain about this decision until early last year.
Some background on me: My parents both have degrees from our native country, my dad has a bachelors and my mom has a masters. When we moved to the US, they didn't find jobs in their fields. My mom was a math teacher, but she now works in insurance, and my dad went to community college to get an associates, and now works as a technician in a hospital. Finances were tough when we just moved, and I certainly don't think we are well off, but right now I don't have to worry about where my next meal is coming so I would say we are living comfortably in the suburbs outside of a major city.

You're an inspiration to me with your story, but to clarify, you're not considered "first-generation" in the context of this article, where first-gen referred to first in your family with higher education. You would fall in the 71% majority. Privilege or lack thereof is complex, and the type of hardship you overcame, to the best of my knowledge, is not currently captured or acknowledged in the current admission system.

 

[Onco_Jeans]

You're an inspiration to me with your story, but to clarify, you're not considered "first-generation" in the context of this article, where first-gen referred to first in your family with higher education. You would fall in the 71% majority. Privilege or lack thereof is complex, and the type of hardship you overcame, to the best of my knowledge, is not currently captured or acknowledged in the current admission system.

Thanks for pointing it out! I can see that in the context of this article that my status as "first gen" doesn't apply, but I see that more as a flaw in the study. Simply comparing the level of education of the parents will probably apply to several people, but it definitely leaves out a chunk of students who have similar stories to mine (no functional use of higher education degrees/unable to utilize but thats a much different and much harder metric to analyze). I disagree, as I think most of the hardships I faced are similar, if not identical to that of someone who's parent's didn't have higher education and are actually first gen(lack of resources, general confusion about the process, fear of the timeline) but I do agree that my story is definitely not captured in the current admissions system (I'm a US citizen now). I do appreciate the sentiment though, as I know this is just the start of my journey, but choosing this path and trying to walk it has been by far the hardest thing i've done.

I wonder if there is any study on immigration status and the MD/PhD pipeline, cause thats more so where I would fall in to all of this

 

[Bonefish]

I am the only college grad in my entire family. My grandparents emigrated from Scotland and I grew up in a single-parent household. The biggest obstacle I've faced with the MD admissions is that they don't see my education as "prestigious" or "rigorous" enough. Admittedly, I have only attended community colleges and small institutions. It has taken me three application cycles to get accepted, despite my grades, MCAT, research experience, and current work CV. Applications waived, disadvantaged status, applied to 50+ schools, etc... I would have loved to get my doctorate as well, but I think the only path I really have to go is to work hard and get into an academic focused specialty to do research... Not a bad route, but frustrating, since I know very few osteopaths in research.

Tl;dr thanks for posting this. It feels good to know I'm not alone.

 

[Loliswirl]

I feel like the recent push discouraging gap years may also disadvantage socioeconomically disadvantaged students. Working for $ was the only way I could afford my cycle, and I was asked multiple times by directors while interviewing "Why did you take gap years?" (I took 2.) Also, people who aren't connected to science/medicine before college tend to be slower to get in labs, and are more likely to benefit from additional research hours after college. Of course there are going to be people who take gap years so they can try to get into a more "elite" program, but I would say by and large the reason most people are taking them is just to become competitive in the first place.

If programs are going to start pushing people to apply sooner, they need to also be prepared to engage in a true "holistic" review and commit to reducing the economic barriers to applying (covering travel costs when that becomes a thing again, decreasing/abolishing secondary fees, etc.)

Wait I thought gap years were encouraged? First gen ORM here and had to take gap years for familial reasons....although adcoms probably won’t look at my reason in a good light lol

 

[Loliswirl]

I am the only college grad in my entire family. My grandparents emigrated from Scotland and I grew up in a single-parent household. The biggest obstacle I've faced with the MD admissions is that they don't see my education as "prestigious" or "rigorous" enough. Admittedly, I have only attended community colleges and small institutions. It has taken me three application cycles to get accepted, despite my grades, MCAT, research experience, and current work CV. Applications waived, disadvantaged status, applied to 50+ schools, etc... I would have loved to get my doctorate as well, but I think the only path I really have to go is to work hard and get into an academic focused specialty to do research... Not a bad route, but frustrating, since I know very few osteopaths in research.

Tl;dr thanks for posting this. It feels good to know I'm not alone.

hearing stories like this just convinces me that ORM first generation students are automatically considered to be privileged, regardless of educational status. Sad, but may be true.

 

[dl2dp2]

hearing stories like this just convinces me that ORM first generation students are automatically considered to be privileged, regardless of educational status. Sad, but may be true.

This is not the right read. There is a category of students who lack a coherent marketing strategy. This isn't necessarily something that's easily fixed even if you had money, though the virtue of having money is associated with being more cognizant of these issues (i.e. your parents might have run a business, etc).

The idea is that if you have the hard requirements (numbers, grades, pubs, research experience, etc), to succeed you also need to analyze the strong and weak components of an application, and then find out a way to describe the application in a way that's likely to "tell a story" that would draw attention. This requires a lot of very expensive work, but can be made free to you if you seek mentorship from people who are in the community if you can articulate their value add in helping you. In other words, if you begged hard enough you can get it. However, people don't value relationships nearly as much as they should, usually, so they don't do the [psychologically] hard work of begging. It's really not hard logistically--it takes persistence and people skills.

These are complicated skills. It's similar to the type of skills in presenting your narrative when you are applying for a job, or a contract/grant, etc. It's also very flexible--how do you infer what a review committee wants, and how do you manufacture a vision that what you have (yourself, or your team) just so happens to be the perfect fit. In reality, of course, nobody is a perfect fit. In fact, you might be a very BAD fit. But the trick is to convince people otherwise because once you get there you can then have greater latitude in turning around things. A simplistic example would be MD PhD can be used for things other than the proverbial $100k academic pediatrician job, even though perhaps admitting to it would make you a "bad fit" at the time of admission. Still, you feed the committee what they want to hear, get in, succeed in a way that's true to yourself, and then later on the committee would look in hindsight and say, ah we were wrong to pigeonhole you into only this or that.

A more complicated example would be that an institute (say an NIH IC) might want to fund a certain research effort that costs 30M, which is actually very bad science (or more likely very vague science, but vague science is generally bad science). But if you can convince the institute that your team and project is the perfect fit for their science, get the 30M, then you can do the good science once you gained control. These things require a very high level of empathy and identity boundary: knowing and figuring out what people want on an emotional level, give them that, then be secure enough to know what you (or your team) want, do that in reality, and then posthoc come with a consistent story that these at first glance seemingly divergent interests are one and the same, or that they naturally evolved from one to the other, so you have ample room for future growth.

Whenever there's a conflict, there's an opportunity. People are very bogged down by the idea that someone more powerful wants X, and I'm not X. #sadface. "The system doesn't support me enough." Maybe 1. you can become X; 2. maybe someone powerful doesn't even know they actually want Y. People are very stuck on rules where the reality is that rules are there so that you can become the exception to the rules. And I don't mean breaking rules impulsively just so you can get punished. I mean to understand WHY rules exist and carve out advantageous scenarios where rules shouldn't apply to your case specifically, and when the macro-environment is ready campaign for rules to change.

There's a lot of free content on SDN. Read them to develop a better set of soft skills.

 

[Neuronix]

This summarizes things nicely.

I am proud of SDN. SDN has done more work to counsel undergraduates about MD/PhD programs and careers than any other service.

I have spent nearly 20 years on this site exploring, discussing, and later advising based on my experiences as a random guy who fell in love with the physician-scientist pathway as an undergrad. I was a high school dropout with a GED who backdoored his way into a part-time then full-time "no name state school" with no partner medical school.

It is because of SDN that I am here, and I am sure that there are plenty others out there like me. If you ever want advice, just post or PM me. We are here to help you break down the cultural and social barriers.

 

[LadyDustyBlue]

I feel like the recent push discouraging gap years may also disadvantage socioeconomically disadvantaged students. Working for $ was the only way I could afford my cycle, and I was asked multiple times by directors while interviewing "Why did you take gap years?" (I took 2.) Also, people who aren't connected to science/medicine before college tend to be slower to get in labs, and are more likely to benefit from additional research hours after college. Of course there are going to be people who take gap years so they can try to get into a more "elite" program, but I would say by and large the reason most people are taking them is just to become competitive in the first place.

If programs are going to start pushing people to apply sooner, they need to also be prepared to engage in a true "holistic" review and commit to reducing the economic barriers to applying (covering travel costs when that becomes a thing again, decreasing/abolishing secondary fees, etc.)

Thanks for pointing it out! I can see that in the context of this article that my status as "first gen" doesn't apply, but I see that more as a flaw in the study. Simply comparing the level of education of the parents will probably apply to several people, but it definitely leaves out a chunk of students who have similar stories to mine (no functional use of higher education degrees/unable to utilize but thats a much different and much harder metric to analyze). I disagree, as I think most of the hardships I faced are similar, if not identical to that of someone who's parent's didn't have higher education and are actually first gen(lack of resources, general confusion about the process, fear of the timeline) but I do agree that my story is definitely not captured in the current admissions system (I'm a US citizen now). I do appreciate the sentiment though, as I know this is just the start of my journey, but choosing this path and trying to walk it has been by far the hardest thing i've done.

I wonder if there is any study on immigration status and the MD/PhD pipeline, cause thats more so where I would fall in to all of this

Yeah, I’ve actually been curious about the qualifications of being “first-gen” & I recently found out I *might* be qualified b/c some schools/colleges are starting to advise students that you’re 1st-gen even if you have 1 parent who went to a foreign university, which isn’t the same thing as attending an American college/university.

If that turns out to be true, perhaps I would consider a PhD/MD. However, I’m only familiar with the path I’m on in the pre-med to MD/DO stuff. My mother went to get her bachelors in nursing at a university in the country she grew up in back in the 80s. She never made it to her nursing exams b/c my father cheated on her & it screwed with her self-esteem & focus. Even if my father is a veteran, I personally won’t utilize any dependents benefits from him either b/c parents divorced when I was a baby & we don’t have the best relationship.

FYI, I’m a non-trad too & I’m discovering/re-discovering all of these scholarships or financial aid that may/may not be relevant to me now. I know 1 of the things that stopped me in taking the MD path the first time I started college was b/c neither of my parents, nor anyone on either sides of my family were ever doctors. The idea of going for it was very ambiguous and seemed too huge of a leap, financially.

Now that I’m older & gained more relevant life experiences that helped me choose this path, I can see more options than I initially thought. But that took a lot of asking people about different professions & trial/error.

SDN is a good resource if you can find the right people to ask, but I feel for anyone with parents of a similar educational background, or has other barriers than I’ve stated here, as achieving in academia is already tough as it is. So I can also see why it wouldn’t be for everyone.

Maybe if I knew more about it (issue: accessibility of information for 1st-gen minority women pursuing advanced degrees &/or medical school education), I’d consider it as an option. We need more early-action programs for high school students or something, on various fields (not just medicine). The solution may just be that we need to target more communities that universities say they want more of.

Of course there’s money & opportunity out there, but how about more outreach? It’s not just 1 thing we could do for future gens, but it’s definitely multiple things.

 

[Cognimancer]

Another n=1 here. I am a first gen college student, MD applicant, URM, with a masters degree (science) from a state school. After having a less than encouraging experience in graduate school, I do not recommend graduate degrees for anyone that isn't excessively curious and hyper intellectual. In fact, unless you have wealthy parents, I am reluctant to suggest research to anyone. I love science and research, but can not ignore the struggles of my advisors and peers. It seems like at least half of the post docs I talk to are looking for escape hatches. I had to overcome constant problems just to achieve a masters and ultimately left science for a modicum of career stability. Note: please know that I am not saying I was a perfect grad student and I do not believe the system was unfair to me.

On a different level, there are people counting on me and supporting me. Getting a PhD on top of an MD represents another layer of risk, risk that I am reluctant to externalize onto my loved ones. In addition, my loved ones are constantly looking for access to the existing standard of care. While I am personally a very future focused person, It is hard for me to ignore the need to bring existing levels of care to the people I grew up with.

I must also bring up an uncomfortable issue: culture. My graduate advisors were all wonderful people and I will personally vouch for the humanity in any of them. However, I was an alien among my peers and the isolation was greater than I expected. Unless the research environment becomes less harsh FOR ALL PARTIES INVOLVED, I am hesitant to encourage the participation of additional cultural outliers. It is fantastic to see institutions taking inclusion seriously, but I am concerned for the system they may be trying to include people into.

This is a hard post for me because I am not anti science or anti research. I applied to graduate school before I applied to medical school because I believe the expansion of knowledge is worthy of dedicating a life to. My hesitation to pursue or recommend scientific research stems from the environment in which it occurs, which is largely a result of how it is funded. It breaks my heart to say this, but it would be very difficult for me to meet a brilliant and enthusiastic young student and tell them that research is a safe career pathway, URM or not.

 

[Dormouse]

I love science and research, but can not ignore the struggles of my advisors and peers. It seems like at least half of the post docs I talk to are looking for escape hatches. I had to overcome constant problems just to achieve a masters and ultimately left science for a modicum of career stability.

The culture part is truly difficult, but the career outlook of MD PhDs is quite a bit different than pure PhDs. There are people in this thread and on SDN who are in a much better position than me to discuss this but no research track fellow I know worry about getting a job. There aren't many careers with more stability than a MD. If after a MD PhD all you want a job with 200k salary, it's almost guaranteed. And unlike your MD-only peers you have no loans from your postgraduate training.

If by difficulty finding a job you mean specifically applying for research funding or getting a position with protected time and startup money, in my inexperienced opinion it seems not anywhere remotely as difficult for a physician scientist in an academic clinical department as it is for PhDs looking for positions in basic science departments, where competition does look fierce and each position seems to get hundred of applications. The funding rates of clinician scientist K08 at some of these NIH institutes are like, 70%...

Most MD PhDs doing their postdoc are also paid at fellow or senior resident salary. While people complain about it because it's nowhere near attending salary, they are paid more than typical PhD postdocs. You can moonlight or take on locums jobs if money is important to you and you have the energy, an option not available to PhD-only researchers.

If your PhD-only advisors lose their grants and they're in a soft money type of position where their salaries had come mostly come out of that, their compensation will drop significantly, and if they're not yet tenured they may lose their job, so their livelihood can depend on renewing those grants. If the same happen to a physician scientist, you may have to shrink your lab but you can always compensate salary-wise by seeing more patients and taking on a higher clinical load in the department. It's difficult but not nearly the same level of stress.

If you're looking for an escape hatch from both academia and clinical practice, the career outlook of a residency trained MD PhD in industry is also very bright. If you like research, even basic science, you also do not necessarily need a PhD. It's not closed off just because you're not doing a PhD.

 

[Lucca]

Unrelated to the broader discussion, but if I was NIH Director and interested in bolstering the physician scientist pathway, I would create grant mechanisms awardable to graduating MD/PhDs to establish small but longitudinal research projects throughout residency. Like enough money to hire a tech, buy materials, produce 1 high impact paper or preliminary data and be taken on as a fellow in an established, larger lab at an academic center for the duration of clinical training. Awardees would be allowed to integrate leading this project in a role more akin to that of a PI than a postdoc, but likely a bit of both, during their clinical training. Up to clinical departments and the awardee how they want to split the time / organize things.

The goal? Financial and time support to begin to produce preliminary data +/- papers for applying for a K immediately at the end of clinical training. Less time away from science, a clear recognition of the benefit physician scientists bring to science, training in the PI role while still not being complete independence, faces the reality of doing modern science in that things take much longer than they used (and at least in the wet lab it might make more sense to run a project at 50% effort for 2 years than 100% effort for 1) to in most disciplines and might bring down that "average age to R01" number,

The youngest physician scientists I've met successfully doing the mythical 80/20 or similar basically finessed themselves into this kind of arrangement.

Basically I think we should work very hard to abolish the concept of postdoc as a position. Do this and science will be a much, much more attractive career path for people who are not independently wealthy.