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

[Alyssum]

It seems that for most specialities, clinicians are in high demands, whereas in the basic biomedical sciences, it's nearly impossible now to find a tenure track academic job. What is currently the likelihood of finding an assistant professor position with ~50-80% protected research time for someone who recently completed residency+postdoc/fellowship? Do you have to bring with you some kind of early career grant? Do you foresee things changing in the upcoming years because of covid?

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[dl2dp2]

50% time is somewhat easier, though it's unclear as to what extent you can furnish your career on that. 80% research time is harder--issue is more or less how much pay cut you want to take. Institutions would happily take you on by paying your 50% less if you want 80% protected time for research. Having your own grant is always a good thing, and the K award system is currently the de facto gatekeeper for most cognitive specialties. It has about a ~40% (and decreasing) rate of funding.

People who don't secure K awards or something comparable by the 3rd to 4th try have a very diminished (though not impossible) chance of having any future in academia as a full time researcher driven by external grants (~10%--perhaps lower, I haven't seen a good example of this)--typically this is also the age where people start thinking about leaving around 40. However, other careers in academia remain open (i.e. clinician-educator, admin, etc.) Many researchers stay in a non-research primary role and write grants and get an R01 or two in their 50s or 60s, but they are not "continuously funded" and generally do not become "core" research staff in a department. Around age 40 is also where transition to industry happens most frequently, as this is the time where you can still have a spectacular career in industry. If you enter industry in your 50s as a lateral hire, usually you face issues relating to your peers being significantly younger. Senior management in academia do transition to senior management in industry with some regularity, but this doesn't change the content of the job prior in academia.

After K award there's further attrition between the K to R transition (~age 45), which is about optimistically 50%. After the first R01 the attrition rate slows down, perhaps to about 5-10% per decade. That said, with indirects, typically around two R01s, the total input would cover most of the institutional salary for 30 years, so 2 R01 is a breakeven point for most institutions, which is why the associate professor/tenure/hard salary line comes online between 1st and 2nd R01. This decreases attrition and at this point usually you can coast with minimal productivity or pursue riskier projects. This usually happens in your early 50s.

Compare this to a clinician's career trajectory, typically you start making 3x salary in your mid to late 40s, and if you do well saving and investing, by the time you are 55 you should be largely financially independent. At this point if you have an interest in research you can pursue some research in an offhanded way. Most people don't, though...as they prefer to say curate their real estate portfolio than getting rejected the third time by paper reviewers on material that's not important enough for most to care. Women and people coming from poorer origins also do worse statistically as they have other competing priorities that can interfere with devoting to these activities and have little direct monetary reward.

COVID is making working from home more acceptable, which likely means that institutions would be more willing to let full-time researchers to work remotely. However, for physician-scientists, not interacting with patients would not be easy even for cognitive specialties. I don't think this will change much the overall picture. The general problem is the system is being painfully selective and often the criteria are arbitrary and luck-driven. This has more or less to do with the funding climate and how poorly the labor market was designed.

 

[ValentinNarcisse]

50% time is somewhat easier, though it's unclear as to what extent you can furnish your career on that. 80% research time is harder--issue is more or less how much pay cut you want to take. Institutions would happily take you on by paying your 50% less if you want 80% protected time for research. Having your own grant is always a good thing, and the K award system is currently the de facto gatekeeper for most cognitive specialties. It has about a ~40% (and decreasing) rate of funding.

People who don't secure K awards or something comparable by the 3rd to 4th try have a very diminished (though not impossible) chance of having any future in academia as a full time researcher driven by external grants (~10%--perhaps lower, I haven't seen a good example of this)--typically this is also the age where people start thinking about leaving around 40. However, other careers in academia remain open (i.e. clinician-educator, admin, etc.) Many researchers stay in a non-research primary role and write grants and get an R01 or two in their 50s or 60s, but they are not "continuously funded" and generally do not become "core" research staff in a department. Around age 40 is also where transition to industry happens most frequently, as this is the time where you can still have a spectacular career in industry. If you enter industry in your 50s as a lateral hire, usually you face issues relating to your peers being significantly younger. Senior management in academia do transition to senior management in industry with some regularity, but this doesn't change the content of the job prior in academia.

After K award there's further attrition between the K to R transition (~age 45), which is about optimistically 50%. After the first R01 the attrition rate slows down, perhaps to about 5-10% per decade. That said, with indirects, typically around two R01s, the total input would cover most of the institutional salary for 30 years, so 2 R01 is a breakeven point for most institutions, which is why the associate professor/tenure/hard salary line comes online between 1st and 2nd R01. This decreases attrition and at this point usually you can coast with minimal productivity or pursue riskier projects. This usually happens in your early 50s.

Compare this to a clinician's career trajectory, typically you start making 3x salary in your mid to late 40s, and if you do well saving and investing, by the time you are 55 you should be largely financially independent. At this point if you have an interest in research you can pursue some research in an offhanded way. Most people don't, though...as they prefer to say curate their real estate portfolio than getting rejected the third time by paper reviewers on material that's not important enough for most to care. Women and people coming from poorer origins also do worse statistically as they have other competing priorities that can interfere with devoting to these activities and have little direct monetary reward.

COVID is making working from home more acceptable, which likely means that institutions would be more willing to let full-time researchers to work remotely. However, for physician-scientists, not interacting with patients would not be easy even for cognitive specialties. I don't think this will change much the overall picture. The general problem is the system is being painfully selective and often the criteria are arbitrary and luck-driven. This has more or less to do with the funding climate and how poorly the labor market was designed.

As an aside, anyone at the NIH or in physician scientist leadership who looks at the success/average age at these various grant milestones and think this is reasonable pathway baffles me. The system is broken when you obtain your first real R01-level success in your 40s. Up until that point, you have made a significant financial opportunity cost (PhD, fellowship/post-doc, instructor/assistant prof) for just the chance to convert to associate professor. Moreover, the tenure title confers little tangible benefit for medical center faculty compared to main university faculty. Particularly as we push to encourage more individuals from underrepresented groups and economically disadvantaged backgrounds to embark on this pathway, I do not see how one can expect trainees, particularly those who may be the first person in their family to become a professional, to give up millions of dollars in lifetime earnings just for a shot to become a NIH-funded investigator. Keep in mind this is just to have the opportunity to attempt make a major discovery that will benefit patients. Compare this to a full-time position treating patients accompanied by a clinical salary that will help support your family and community directly. While I still remain committed to this pathway myself, the further I move along this trajectory, my peers who are seriously pursuing basic science physician scientist careers are increasingly from the elite economic rungs of society compared to our starting MSTP cohort. When you factor the cost of housing, child care, elder care, and tuition, this system relies on people sacrificing their family's well being for the greater good, and thus favors those who are independently wealthy. I think we are losing a lot of talent from the pipeline.

 

[dl2dp2]

While I still remain committed to this pathway myself, the further I move along this trajectory, my peers who are seriously pursuing basic science physician scientist careers are increasingly from the elite economic rungs of society compared to our starting MSTP cohort.

This is a pretty under-discussed but widely observed and acknowledged phenomenon, amplified at "tier 1" locations/institutions (we all know what they are!). Everyone knows, nobody cares.

 

[tortuga87]

Yes basically us poor folk still need to achieve financial independence (the "FI" in FIRE). You cannot skip FI (even with the MSTP stipend) and go straight into academia without dying on the inside. FYI the guy working in academia making 150K also has an investment portfolio making an additional >500K.

This problem has been going on for thousands of years. It's just covered up better now.

 

[Lucca]

This is a pretty under-discussed but widely observed and acknowledged phenomenon, amplified at "tier 1" locations/institutions (we all know what they are!). Everyone knows, nobody cares.

absolutely. Though i do think many care, I dont think anyone has come up with any real solutions. There's not much anyone can do without a top-down restructuring of the job market, grant funding, etc. How else to fix a fundamental problem of resource distribution?

 

[SurfingDoctor]

50% time is somewhat easier, though it's unclear as to what extent you can furnish your career on that. 80% research time is harder--issue is more or less how much pay cut you want to take. Institutions would happily take you on by paying your 50% less if you want 80% protected time for research. Having your own grant is always a good thing, and the K award system is currently the de facto gatekeeper for most cognitive specialties. It has about a ~40% (and decreasing) rate of funding.

People who don't secure K awards or something comparable by the 3rd to 4th try have a very diminished (though not impossible) chance of having any future in academia as a full time researcher driven by external grants (~10%--perhaps lower, I haven't seen a good example of this)--typically this is also the age where people start thinking about leaving around 40. However, other careers in academia remain open (i.e. clinician-educator, admin, etc.) Many researchers stay in a non-research primary role and write grants and get an R01 or two in their 50s or 60s, but they are not "continuously funded" and generally do not become "core" research staff in a department. Around age 40 is also where transition to industry happens most frequently, as this is the time where you can still have a spectacular career in industry. If you enter industry in your 50s as a lateral hire, usually you face issues relating to your peers being significantly younger. Senior management in academia do transition to senior management in industry with some regularity, but this doesn't change the content of the job prior in academia.

After K award there's further attrition between the K to R transition (~age 45), which is about optimistically 50%. After the first R01 the attrition rate slows down, perhaps to about 5-10% per decade. That said, with indirects, typically around two R01s, the total input would cover most of the institutional salary for 30 years, so 2 R01 is a breakeven point for most institutions, which is why the associate professor/tenure/hard salary line comes online between 1st and 2nd R01. This decreases attrition and at this point usually you can coast with minimal productivity or pursue riskier projects. This usually happens in your early 50s.

Compare this to a clinician's career trajectory, typically you start making 3x salary in your mid to late 40s, and if you do well saving and investing, by the time you are 55 you should be largely financially independent. At this point if you have an interest in research you can pursue some research in an offhanded way. Most people don't, though...as they prefer to say curate their real estate portfolio than getting rejected the third time by paper reviewers on material that's not important enough for most to care. Women and people coming from poorer origins also do worse statistically as they have other competing priorities that can interfere with devoting to these activities and have little direct monetary reward.

COVID is making working from home more acceptable, which likely means that institutions would be more willing to let full-time researchers to work remotely. However, for physician-scientists, not interacting with patients would not be easy even for cognitive specialties. I don't think this will change much the overall picture. The general problem is the system is being painfully selective and often the criteria are arbitrary and luck-driven. This has more or less to do with the funding climate and how poorly the labor market was designed.

That can not be emphasized enough. I also think this doesn't lead to the best science or results in my opinion. If you go on NIH Reporter and find grants that are relative to your interests, you can see many grants that don't produce work relevant to the grant aims (lots of editorial padding and middle author consortium papers) and in some cases don't produce anything at all. Granted, hypotheses don't work out sometimes, but the NIH Reporter appears to show that for hypothesis-driven grant funding, not producing anything relevant to the grant seems more of the norm and less so the exception. So then despite the idea that great hypothesis will get you a grant, what you are really left with is knowing the right people and having a good dose of luck and a lot of persistence to hopefully improve the chances in both realms.

As a case in point, in the last study section I sat on, the most well funded and senior investigators got the 1s and 2s. The reasoning seemed to be they had access to state of the art techniques (because they knew everyone) and they were leaders in the field (because they knew everyone). I'm not suggesting they didn't have good science too (I wasn't a reviewer for those grants), but the discussion was mostly about how great they are and have been. All the other grants though seemed to have more nitpicking. Again, maybe they deserved it in comparison, but the contrast in the discussion of the investigators was painfully obvious.

Even then though, the idea of "continuously funded" at least anecdotally seems increasingly less common.

 

[SurfingDoctor]

absolutely. Though i do think many care, I dont think anyone has come up with any real solutions. There's not much anyone can do without a top-down restructuring of the job market, grant funding, etc. How else to fix a fundamental problem of resource distribution?

This is a real problem and I would agree that since the current system created the problem, it seems impossible for the system to therefore fix the problem it created. I will say there is some recognition at the institutional level that this is a problem and at least for NIGMS, I think they are trying to address it:

National Institute of General Medical Sciences

NIGMS supports basic research to understand biological processes and lay the foundation for advances in disease diagnosis, treatment, and prevention.

www.nigms.nih.gov

I think the problem is it doesn't address the real issues with science in the modern era. Science needs teamwork and collaboration to be groundbreaking, but it is funded by individual grants to people (well, technically universities but same idea). Those two things don't jive very well. And so what you are left with is a select few taking large portions of the money to get free labor via post-doc and having their post-docs work to generate data related to their pet project and in the process, squeezing others out who don't have the same resources to produce or collaborate.

I hope the R35 mechanism helps in that regard but most the R35s (even within NIGMS) are to senior investigators and there are a substantial number of "at-risk" investigators and they don't seem to be improving overtime.

What’s Happening With “At-Risk Investigators?” – NIH Extramural Nexus

nexus.od.nih.gov

 

[dl2dp2]

I have collected a bunch of examples of "successes" and "failures". Within the group of "failures", there is a Tolstoyian diversity of trajectories. Vast majority of "failures" of fully trained physician-scientists end up achieving highly successful clinical (academic or private) or industry careers. The predictions of who will exit are often very hard to make at the time of MDPhD graduation. A lot of times what happens is cream-de-la-cream people get offered very desirable industry or clinical jobs early on and exit for that reason--*many* (and increasing number of) examples. So I don't know if these are "failures" at all. Perhaps if they had earlier and faster grant success they would've stayed. Maybe not. But NIH's capriciousness facilitated these exits. I am no doubt that many of these people if they had enough patience and family money they *CAN* survive in academia, if they bothered to do a national job search, compromised a bit on their research vision, blah blah etc. But many just say *but why*...

The bottom line is there are a lot of very successful high impact people who are not operating within the narrow confines of a very poorly designed and inefficient NIH funding system. Nevertheless, it's useful to know the system and prepare yourself--it's useful to know the odds of playing the roulette wheel, but it doesn't make it any less of a dumb game.

 

[Lucca]

Seven years ago private funding (corporate and philanthropy) overtook federal funding in the basic sciences as a proportion of all research funding. Federal government still is the single largest finder of basic science but the trend keeps moving away from that. That reality definitely colors career planning for people still early in training like me. Now, personally as long as someone is paying me to do science I’m excited about and compensating me fairly for it I’m agnostic as to the setting of where I work. So I don’t have anything against industry per se. The leader of the Moderna vaccine project is a physician scientist who left academia for Moderna. Who can argue with the impact their team will have on health and society?

‘that said, the priorities of industry are just fundamentally different. Not wrong in and of themselves, but different. And I’m nevertheless concerned about this trend stimying the pursuit of exciting, risky projects asking fundamental questions because everyone either has to tailor their work towards what industry is willing to fund or will turn a profit or has a 99% chance of generating publications that will ensure NIH actually funds it.

 

[dl2dp2]

‘that said, the priorities of industry are just fundamentally different. Not wrong in and of themselves, but different. And I’m nevertheless concerned about this trend stimying the pursuit of exciting, risky projects asking fundamental questions because everyone either has to tailor their work towards what industry is willing to fund or will turn a profit or has a 99% chance of generating publications that will ensure NIH actually funds it.

I don't think this is the issue. The issue is job insecurity. You can pitch risky projects to either industry or NIH, and most of the time they don't get funded. However, in industry when this happens they will give you a project they think is less risky and you can still work and make money. In academia, you might have to move or leave for a 50k more or some other ridiculous number because there is just so little excess budget sloshing around in the system. The kind of job academia can guarantee for full-time research without an external grant probably pays around 50-70k. At some point a lot of people would just say it's not worth it to me to pursue whatever questions if I have to live on 70k with two kids in San Francisco, but you can be totes fine if you eat ramen and live alone. Is having a family and living in San Fran "necessary" for all? I would argue no.

And if push comes to shove can you live on that for a long time with two kids in San Francisco? Yes you can, and many do. Many immigrant staff scientist families live for decades like this. But they also don't have an alternative job that pays 350k somewhere in the ether.

It's really important to emphasize that what you end up getting is a *choice* that you make. Choices have consequences, but they are still choices. Nobody FORCES you to do one thing or another. The current environment is such that people feel that they are "pushed out" because of X Y Z, but the reality is that everyone just makes choices.

 

[Alyssum]

Thanks @sluox and others for all your replies! Extremely helpful.

For those entering primary care type specialties, should you expect the same salary as 100% clinical MDs in the department if you're doing 50-80% research?

 

[agp4]

Thanks @sluox and others for all your replies! Extremely helpful.

For those entering primary care type specialties, should you expect the same salary as 100% clinical MDs in the department if you're doing 50-80% research?

I can't speak for every discipline and hospital, but in oncology or pediatrics it would be unusual for research faculty to draw the same salary as clinical faculty. To add insult to injury, as you advance to a PI level role, many institutions will expect you to "cover" part of your salary through grant funding. Maybe I was naive, but I was surprised to learn that.

I think the other commenters are bringing up very valid points, but I also don't want you to be discouraged. Life in academia is hard, probably unnecessarily challenging in many regards. But, it is possible with a combination of foresight and discipline. It has become abundantly clear that the margin for error is narrow, particularly for early career physician scientists. It's critical to find good mentorship and a supportive institution - with that, you have a fighting chance.

 

[SurfingDoctor]

Thanks @sluox and others for all your replies! Extremely helpful.

For those entering primary care type specialties, should you expect the same salary as 100% clinical MDs in the department if you're doing 50-80% research?

I can’t speak to primary care, but generally speaking, no person doing research in the early stages is gonna be making what a 100% clinician is gonna be making. I am my divisions only NIH funded researcher and have consistently made 10Ks less than my clinical partners at 40% research effort. Maybe at the full professor level you can surpass, but I’d bet not even at the associate level (though that’s just a hunch).

Salary from clinical RVUs >>> Research salary (which has an NIH cap)

 

[Neuronix]

Job market varies a lot by specialty. I could not find a research job or fellowship in my specialty so I took a 100% clinical non-tenure job in academics. I have been fighting to get time and resources to do research ever since. I'm about 50% clinical at this point. In giving up clinical volume, I have foregone significant amounts of clinical bonus over the years.

The thought of bailing to private or industry has crossed my mind many times. Private sees my PhD, large numbers of publications, grant funding history, etc and does not want to hire me ("too academic"). Also, we have a bad job market so it's a serious fight for quality jobs anyway. Industry is very small in this specialty and opportunities are not there.

When considering your specialty make sure you have a clear path to your goal. Sure I'm in rad onc which has a notoriously bad job market now, though it wasn't this way when I applied. Some other specialties that are not procedural like pathology and ped onc also have terrible job markets. So my advice is to make sure you have mentorship in your specialty of choice and clear expectations set before going down your path.

 

[SurfingDoctor]

Unfortunately... the end result is do you care more about income or research (compared to other MDs)? The bottom line as a physician-scientist is you can't have both so you have to choose which is more important to you.

My general philosophy is to keep doing research at a relative lower pay (which I do enjoy) till the NIH (or whoever) tells me I can't... then work as many RVUs to send my kids through college and retire.

In talking with my chair who was an older MSTP student who eventually became a chair but has been subjected to that reality... that was his advice as well...

 

[Alyssum]

And so what you are left with is a select few taking large portions of the money to get free labor via post-doc and having their post-docs work to generate data related to their pet project and in the process, squeezing others out who don't have the same resources to produce or collaborate.

Would you have any advice on how early career clinician scientists can do to survive if they're just starting out as new PIs and don't have the same resources or depth of experience as more well established senior investigators?

 

[SurfingDoctor]

Would you have any advice on how early career clinician scientists can do to survive if they're just starting out as new PIs and don't have the same resources or depth of experience as more well established senior investigators?

In the early stages... all you can negotiate is time. You can negotiate support (ie RAs) but with direct salary cost to you (they ain't gonna pay you more to hire a RA). The other general caveat as a physician-scientist... no matter what stage... is find a boss on your side who believes in your goals.

If a division chief is willing to give you protected time and start up and they want you to succeed... take it... even if your salary is less than your clinical colleagues in comparison. Likewise, if you are a recruited physician-scientist, make sure whoever your boss is (department chair, dean, etc.) believes in your scientific and academic mission. If you have allies... you can get significant leeway to prove yourself and your potential success. If your boss doesn't believe in you or you don't portray effort... you are more likely to fail.

 

[Neuronix]

I used to call my group the "beg, borrow, and steal lab". Lab is definitely not the right word since that implies dedicated space, and until recently I was never dedicated any space besides my office.

I used to just send the students to Home Depot for "lab supplies" and reimburse out of my pocket. I'll probably get back to that one of these days. Having a full clinical load and trying to design experiments and write papers and grants nights and weekends sure does get tiring though. As I get older and have a family I'm not sure that I have the energy for it anymore.

 

[Lucca]

Unfortunately... the end result is do you care more about income or research (compared to other MDs)? The bottom line as a physician-scientist is you can't have both so you have to choose which is more important to you.

My general philosophy is to keep doing research at a relative lower pay (which I do enjoy) till the NIH (or whoever) tells me I can't... then work as many RVUs to send my kids through college and retire.

In talking with my chair who was an older MSTP student who eventually became a chair but has been subjected to that reality... that was his advice as well...

Don’t Chairs make much much more money than like clinical faculty not in administrative positions with a smaller clinical load (replaced with admin duties of course). Not saying every MSTP is going to become a chair, but that’s a damn good position to be in financially at that point in your career innit.

I’ve seen the other way at my institution. Lots of faculty who do end up being successful in research abandon clinical duties altogether and go 100% research, if they are in a basic science TT position. They will probably make much less than their clinical colleagues forever but they are able to keep doing research. That’s likely much much less common than the scenario you describe though...

 

[SurfingDoctor]

Don’t Chairs make much much more money than like clinical faculty not in administrative positions with a smaller clinical load (replaced with admin duties of course). Not saying every MSTP is going to become a chair, but that’s a damn good position to be in financially at that point in your career innit.

I’ve seen the other way at my institution. Lots of faculty who do end up being successful in research abandon clinical duties altogether and go 100% research, if they are in a basic science TT position. They will probably make much less than their clinical colleagues forever but they are able to keep doing research. That’s likely much much less common than the scenario you describe though...

I mistyped and meant chief, not chair. Even so, I guess I'm not understanding your question. I have personally rarely seen physician-scientists in academia go from clinical duty requirements to 100% research. That is exceptionally rare in my experience. I'm trying to think in my department of 200+ physicians, however many MDs are research only. Excluding the ones who are retired and just kinda hang around for funnsies, I can think of 2. That being said, I do think there are a decent number who leave academia to go work in industry. I don't know those numbers. I think it's still pretty small, but higher than the number of physician scientists who stay in academia and are 100% research funded.

As of the chief who I alluded to, they were an MSTP student, who got the R relatively early in their career. They became chief kinda by accident. If I remember the story correctly, the prior chief was removed due to being inebriated while taking care of patients and there were only 3 or 4 physicians in the division at the time. Anyway, they were able to renew their R, but then the clinical duties and administrative responsibilities superseded the research and the funding was lost. They were able to get another R about 7 years later, but that grant wasn't renewed. Does that person now see less patients and make more money as a chief? Sure. But they are also over 60 years old and still seeing ICU patients. I think their goal was to do 100% research... but that never materialized. They do get to coast a little on their chief position research endowments though, but I think at this point, they just have their eye on retirement and are willing to do whatever to keep the pay checks coming till they are forced or burned out. As the old adage goes:

Granted, I'm in pediatrics so maybe this experience is unique to that field. After all, there are only about 100 K awards per year to pediatric physician scientists in the US and even less Rs, so its a small number of physician scientists at all.

 

[tortuga87]

Unfortunately... the end result is do you care more about income or research (compared to other MDs)? The bottom line as a physician-scientist is you can't have both so you have to choose which is more important to you.

My general philosophy is to keep doing research at a relative lower pay (which I do enjoy) till the NIH (or whoever) tells me I can't... then work as many RVUs to send my kids through college and retire.

In talking with my chair who was an older MSTP student who eventually became a chair but has been subjected to that reality... that was his advice as well...

It seems to make more sense to make as much money as possible while young, then invest that money. Let it grow over time with compounding. Then retire early and go back to research.

Making 500K at 35 years old >>> making 500K at 65 years old.

 

[SurfingDoctor]

It seems to make more sense to make as much money as possible while young, then invest that money. Let it grow over time with compounding. Then retire early and go back to research.

Making 500K at 35 years old >>> making 500K at 65 years old.

Maybe. There's always trade offs.

But there's no retiring and going back to research... not unless you are funding it on your own dime.

 

[psychacad]

I'm wondering about other ways to make things work in the research world besides the usual residency/fellowship/K track.

I am sure this is very specialty-dependent but, in psychiatry, you can potentially quite comfortably fund yourself through part time PP/moonlighting work, can reasonably get to 200k+. That may leave at the very least 50% of your time for research (I'm thinking 10/12 hours of PP/week, plus one or two moonlighting shifts per month), if I'm conservative.

Now with that route you may not end up with your own lab, your grad students/postdocs..etc, but you can still do research, and for some this actually an even better deal (don't have to deal with grants/administration/politics..etc). This probably works best when your work is in silico. What am I missing?

 

[tortuga87]

I'm wondering about other ways to make things work in the research world besides the usual residency/fellowship/K track.

I am sure this is very specialty-dependent but, in psychiatry, you can potentially quite comfortably fund yourself through part time PP/moonlighting work, can reasonably get to 200k+. That may leave at the very least 50% of your time for research (I'm thinking 10/12 hours of PP/week, plus one or two moonlighting shifts per month), if I'm conservative.

Now with that route you may not end up with your own lab, your grad students/postdocs..etc, but you can still do research, and for some this actually an even better deal (don't have to deal with grants/administration/politics..etc). This probably works best when your work is in silico. What am I missing?

^ that is precisely my plan, although via solo telepsych. I have been piloting it in residency.

I think few people do it because it's emotionally hard. The two main issues are (1) loneliness and (2) feeling cheated for working 11 hour days while only being paid for 5 + paying out of pocket to do research.

Those two are occuring in the context of other (less serious) issues including: You lose steam on your third rejection on a paper few will bother to read. No respect or even acknowledgment about your research from others. People do not think you do "real research." Your colleagues think you are schizotypal. Near impossible to get access to protected datasets. You cannot delegate any tedious work. Even your best papers often go years without being discovered. You discover everything you wanted to discover and it's hard to think of something new to work on. No direct mentorship after PhD. Frequent self-doubt because there are few signals of success / failure.

Also, few trainees think this far ahead to develop the mathematical skills necessary to carry out the appropriate type of work. Few also like doing that kind of research that much to be essentially an eternal post-doc.

Definitely doable though. You really need to put your ego aside. I admit I still wince when my colleagues ask me why I'm still in the hospital at 8PM on a Saturday working on something no one understands when my shift ended the day before. I solved the loneliness problem by having a few friends who I work with for some projects. Money issues are solved by learning how to be financially savvy / work your money - see FIRE and medium/long term investing.

Pros: can focus on real research (not just grant writing, teaching, admin, politics) + clinical work. Virtually no distractions. Your only enemy is yourself. Much less stressful overall. You set everything period. Easily more money over the long term assuming you get financially well-educated (recommend start in your early 20s). You get to scare the janitorial staff in the middle of the night.

 

[psychacad]

^ that is precisely my plan, although via solo telepsych. I have been piloting it in residency.

I think few people do it because it's emotionally hard. The two main issues are (1) loneliness and (2) feeling cheated for working 11 hour days while only being paid for 5 + paying out of pocket to do research.

Those two are occuring in the context of other (less serious) issues including: You lose steam on your third rejection on a paper few will bother to read. No respect or even acknowledgment about your research from others. People do not think you do "real research." Your colleagues think you are schizotypal. Near impossible to get access to protected datasets. You cannot delegate any tedious work. Even your best papers often go years without being discovered. You discover everything you wanted to discover and it's hard to think of something new to work on. No direct mentorship after PhD. Frequent self-doubt because there are few signals of success / failure.

Also, few trainees think this far ahead to develop the mathematical skills necessary to carry out the appropriate type of work. Few also like doing that kind of research that much to be essentially an eternal post-doc.

Definitely doable though. You really need to put your ego aside. I admit I still wince when my colleagues ask me why I'm still in the hospital at 8PM on a Saturday working on something no one understands when my shift ended the day before. I solved the loneliness problem by having a few friends who I work with for some projects. Money issues are solved by learning how to be financially savvy / work your money - see FIRE and medium/long term investing.

Pros: can focus on real research (not just grant writing, teaching, admin, politics) + clinical work. Virtually no distractions. Your only enemy is yourself. Much less stressful overall. You set everything period. Easily more money over the long term assuming you get financially well-educated (recommend start in your early 20s). You get to scare the janitorial staff in the middle of the night.

Thanks for the insight. You can still potentially work though in a lab environment as long as you can find a supportive PI. Maybe even get paid for it, postdoc level, which ain't bad if you add the extra.

It's a risk no doubt to follow that route, and I agree, there will always be this sort of 'lack of recognition' effect going on. But then again, is there any other reason to do research if you don't love this and can't see yourself NOT doing it? But at least I guess I'm not crazy for thinking it out loud, lol.

 

[dl2dp2]

Thanks for the insight. You can still potentially work though in a lab environment as long as you can find a supportive PI. Maybe even get paid for it, postdoc level, which ain't bad if you add the extra.

It's a risk no doubt to follow that route, and I agree, there will always be this sort of 'lack of recognition' effect going on. But then again, is there any other reason to do research if you don't love this and can't see yourself NOT doing it? But at least I guess I'm not crazy for thinking it out loud, lol.

Your idea has been discussed multiple times on this board, including several more senior PIs who do computational work. I think in general this thought is misguided, even if you are in a flexible specialty like psych.

Yes, you can volunteer to research, but you will find that the system is gonna system, and tends to squeeze in the lowest common denominator. For the tasks you are talking about, the system would prefer to hire a programmer or a postdoc and pay them a third of your stipulated salary rather than hire you as a weird statusless volunteer who's hard to manage. Secondly, unless you are a practicing translational quant and have papers/grants to back it up, people don't trust you enough to write you into budgets or ask you to sign on as a consultant--they don't have to--they have legit collaborators with real NIH funding track record and credentials. There are so many people of a certain degree status (i.e. PhD in a quant discipline) that you'll find that your MD and specialty training becomes dollar by dollar much more valuable.

I don't know why you are against the "traditional" track. Is it that you just enjoy doing computer programming for fun? Realize that while this is fine and good, it's just a different *job* than one of a physician-scientist, so you are sort of on the wrong track for the wrong job. In industry, programmers/engineers can get paid more than in academia, for example, but generally, it's very clear when you migrate towards more of a leadership role, which involves similar skillsets as an academic PI (i.e. mainly fundraising, scientific communication, and project management) and it's a totally different job. If you enjoy the concept of being a PI but have problems with rejections/wasted effort of grant writing, or the "politics" involved, that's a separate issue. When you are a staff scientist, you have less *control* of the *content* of your work. That's the main difference.

To be sure, many quant PIs still have to fill the gap of coding when their employees can't do things fast enough, or make errors, solve problems etc. So the basic skills still need to be there, but the basic skills aren't enough--the skills that are really valuabe is the quant PLUS medicine skills--I know how to do -omics analysis PLUS I'm a subject matter expert in disease X so I know which -omics analyses are relevant and can get community interest to... get a grant... LOL

If you are working at 8PM on a Saturday at a hospital anyway, why don't you work on writing a grant or prepare a meeting with a colleague next week, instead of writing code or pipetting? That's the part that mystifies me. The difficulty in general I find is that people, after a certain age, are *unwilling* to working at 8PM on a Saturday PERIOD regardless of the content of the work.

 

[psychacad]

I don't know why you are against the "traditional" track.

That's a good question.

The two main reasons are 1) to 'cheat' the rat race and avoid the high stake stress/pressure/politics of the grant process and 2) the freedom that second 'model' allows with regards to finances, time and not being tied administratively to an institution, especially after years spent in med school/residency. On a more personal level, I am quite independent minded and now, being close to mid 30s, would not enjoy the hierarchy and supervision model inherent in the T32/K track, up until probably getting your first R. I don't mind being a supervisor myself in the future and would probably like leading a team, but it isn't a requirement either.

But I agree with the gist of your post. I haven't seen any actual evidence that this path leads to a legitimate science career. My interest isn't in coding..etc, but in answering questions and I feel it's a bit of a Catch 22 situation, almost cannot get rid of wanting to tackle scientific questions.

 

[dl2dp2]

The two main reasons are 1) to 'cheat' the rat race and avoid the high stake stress/pressure/politics of the grant process and 2) the freedom that second 'model' allows with regards to finances, time and not being tied administratively to an institution...

1. Why is this high stress and politics? you are applying for grants that have a total budget of between 1-3M over the course of 5 years. That's like super JV budget in private industry. Typical *seed* round budget for a startup. Average series A round is 15.7M.

In what other job sectors can middle management dawdle and not produce value for years like this?

"Pressure" in academia is a complete joke IMO. The pacing also is extremely slow compared to industry. I can't imagine what it'd be like if Softbank or Google Ventures had a 6-12 month turn around for evaluating 6-12 startups (this is your typical study section workload).

You stay in academia to AVOID pressure and time crunch so you can do gentleman science. Why do you think lower-middle-class kids *leave*? This is a game for wealthy kids.


2. As I said above, being a volunteer freelancer gives you much LESS freedom.

 

[tortuga87]

1. Why is this high stress and politics? you are applying for grants that have a total budget of between 1-3M over the course of 5 years. That's like super JV budget in private industry. Typical *seed* round budget for a startup. Average series A round is 15.7M.

In what other job sectors can middle management dawdle and not produce value for years like this?

"Pressure" in academia is a complete joke IMO. The pacing also is extremely slow compared to industry. I can't imagine what it'd be like if Softbank or Google Ventures had a 6-12 month turn around for evaluating 6-12 startups (this is your typical study section workload).

You stay in academia to AVOID pressure and time crunch so you can do gentleman science. Why do you think lower-middle-class kids *leave*? This is a game for wealthy kids.


2. As I said above, being a volunteer freelancer gives you much LESS freedom.

Addressing the points there:

1. This makes it seem like tenure track is chill, which it is not. I do not know of any assistant professor who can "dawdle and not produce value for years" without eventually losing his job. The pay is low though - that's true. Bottom line is if you like writing grants and find research proper somewhat tedious/boring, then academia is a good fit. Some people however prefer lab work and would like to skip the grant part through various means - in silico work, passive side hustles, an MD with appropriate specialty choice.

2. This depends on the PI. But yes, you have to have the emotional stability of a monk to work for a PI as a 40 year old with an MD. Would not recommend actually joining a lab as a forever post doc in general.

 

[dl2dp2]

1. This makes it seem like tenure track is chill, which it is not. I do not know of any assistant professor who can "dawdle and not produce value for years" without eventually losing his job.

Yes, but the timeline with which this happens is *so much slower* vs. something comparable in industry. Tenure track's lack of chillness MAINLY is due to how little and unstably it pays (everyone involved), not the structure of the content of the job on a daily basis. Work pacing of deadlines and evaluations are extremely slow in academia, especially outside of the top programs. Amazon fires a third of its workforce on a YEARLY basis... I can't imagine in the private sector if a boss tells his middle management that his division is eliminated but he gets 3 years of "bridge funding"...LOL no--you get fired, get severance and move the hell on. I think a lot of complaints within academia relate to people who stay in academia have no idea what's like to be in the "real world" and don't think with their heads.

 

[tortuga87]

Yes, but the timeline with which this happens is *so much slower* vs. something comparable in industry. Tenure track's lack of chillness MAINLY is due to how little and unstably it pays (everyone involved), not the structure of the content of the job on a daily basis. Work pacing of deadlines and evaluations are extremely slow in academia, especially outside of the top programs. Amazon fires a third of its workforce on a YEARLY basis... I can't imagine in the private sector if a boss tells his middle management that his division is eliminated but he gets 3 years of "bridge funding"...LOL no--you get fired, get severance and move the hell on. I think a lot of complaints within academia relate to people who stay in academia have no idea what's like to be in the "real world" and don't think with their heads.

That's an interesting perspective that I have not thought about. I still think though, at the end of the day, some people like to perform research, do clinical work and make a lot of money. Academia is not very conducive towards all three of those goals. Research is filled with meetings, write ups, requests, presentations that take a lot of time away from actually innovating. I am a firm believer in less time meeting/discussing but more time doing. The clinical work tends to be supervisory in nature, you can get pigeon-holed into a sub-sub-field, and the pay per hour is significantly less. Institutions also need to spend a lot of money to support their bureaucracy, many components of which you do not derive benefit from.

It just makes sense to me to build your own job customized as close to 100% you as possible (under practical constraints of course). Yes, there is a sacrifice of pride, prestige. But those are far less important to many people than time for research proper, seeing the patients you want to see and having nice things.

 

[psychacad]

That's an interesting perspective that I have not thought about. I still think though, at the end of the day, some people like to perform research, do clinical work and make a lot of money. Academia is not very conducive towards all three of those goals. Research is filled with meetings, write ups, requests, presentations that take a lot of time away from actually innovating. I am a firm believer in less time meeting/discussing but more time doing. The clinical work tends to be supervisory in nature, you can get pigeon-holed into a sub-sub-field, and the pay per hour is significantly less. Institutions also need to spend a lot of money to support their bureaucracy, many components of which you do not derive benefit from.

It just makes sense to me to build your own job customized as close to 100% to you as possible (under practical constraints of course). Yes, there is a sacrifice of pride, prestige. But those are false less important to many people than time for research proper, seeing the patients you want to see and having nice things.

Curious, in that model, would you just work on your own? And if so, who will take your work seriously and publish it with no backing of an institution/funded PI?

 

[tortuga87]

Curious, in that model, would you just work on your own? And if so, who will take your work seriously and publish it with no backing of an institution/funded PI?

Yes

I just submit and publish normally because journals in general take papers regardless of your affiliation

 

[blissworm]

Sorry, i am jumping in here because reading through most of this thread terrified me, good reality check (I am a mere 19 and have 'big' dreams. Too big, it seems). What is the physician scientist market like in ID?

It seems physician scientists are just...scientists. Just tenure track faculty doing research who have an extra degree and have access to clinical data. What is the point of getting an MD/PhD rather than just a PhD if you want to do research? I am so confused now.

Is my goal to do clinical work 20-30 hours a week and then have my own lab space and a tech/post doc or two doing medical micro research unrealistic and naive? Is there a 'crash course' to what MD/PhD life is like? It looks like I have an overly romanticized view of the physician scientists world

 

[agp4]

It seems physician scientists are just...scientists. Just tenure track faculty doing research who have an extra degree and have access to clinical data. What is the point of getting an MD/PhD rather than just a PhD if you want to do research? I am so confused now.

It's okay to be confused! Many of us figure it out as we go. The truth is that no two physician scientists have the same career balance, and many of us evolve during our careers to settle into whatever research/clinic/life balance works for us and our institution. The benefit of a dual degree is the versatility. I chose to do a MD/PhD because I wanted to do research that "mattered", and I was terrified of ending up in a career studying phosphorylation of a random worm protein (this isn't meant as a takedown of PhD's or worm biology - basic science is the cornerstone of medical research). As I went through med school, I wound up really enjoying specific parts of the training, which led me to a fellowship in pediatric oncology. And, clinical observations during fellowship led me to the research questions that I now study.

Is my goal to do clinical work 20-30 hours a week and then have my own lab space and a tech/post doc or two doing medical micro research unrealistic and naive? Is there a 'crash course' to what MD/PhD life is like? It looks like I have an overly romanticized view of the physician scientists world

20-30 hours a week is probably a lot, but there have been the rare physician scientists who have done it. What you have to understand is that 20-30 clinic hours on paper translates into 40 hours in reality (thanks to insurance paperwork, medical documentation, and care coordination). Most of us, at least early on, try to keep our clinical load to an average of 10 hours/wk.

Anyway, please don't give up on your dreams on account of this thread. Life as a physician scientist is often complicated (and sometimes weird), but there are advantages and disadvantages to having both degrees. In the end, you'll have to decide if the extra time and hassle of clinical training is worth it to you.

 

[blissworm]

It's okay to be confused! Many of us figure it out as we go. The truth is that no two physician scientists have the same career balance, and many of us evolve during our careers to settle into whatever research/clinic/life balance works for us and our institution. The benefit of a dual degree is the versatility. I chose to do a MD/PhD because I wanted to do research that "mattered", and I was terrified of ending up in a career studying phosphorylation of a random worm protein (this isn't meant as a takedown of PhD's or worm biology - basic science is the cornerstone of medical research). As I went through med school, I wound up really enjoying specific parts of the training, which led me to a fellowship in pediatric oncology. And, clinical observations during fellowship led me to the research questions that I now study.


20-30 hours a week is probably a lot, but there have been the rare physician scientists who have done it. What you have to understand is that 20-30 clinic hours on paper translates into 40 hours in reality (thanks to insurance paperwork, medical documentation, and care coordination). Most of us, at least early on, try to keep our clinical load to an average of 10 hours/wk.

Anyway, please don't give up on your dreams on account of this thread. Life as a physician scientist is often complicated (and sometimes weird), but there are advantages and disadvantages to having both degrees. In the end, you'll have to decide if the extra time and hassle of clinical training is worth it to you.

That really helps a lot. I think I should take time and contact current MDs and MD/PhDs in ID to see which lifestyle and balance is better for me!

 

[Lucca]

That really helps a lot. I think I should take time and contact current MDs and MD/PhDs in ID to see which lifestyle and balance is better for me!

In medical school you will get much more exposure to different career paths in medicine and science and will have better context. The first big step is deciding whether or not you want to apply MD/PhD vs MD only. Only way to figure that out is to find out if you love research / want it to be the main focus of your career. If the answer is no, apply Md only.

 

[blissworm]

In medical school you will get much more exposure to different career paths in medicine and science and will have better context. The first big step is deciding whether or not you want to apply MD/PhD vs MD only. Only way to figure that out is to find out if you love research / want it to be the main focus of your career. If the answer is no, apply Md only.

Can you revert to traditional clinical practice after getting an MD/PhD later on?

 

[psychacad]

Can you revert to traditional clinical practice after getting an MD/PhD later on?

Yes, as long as you complete a residency.

Also, this is a very tiny and non-representative sample of physician scientists. So I wouldn't make generalizations from what you're getting on here. Try seeking a mentor in real life you can trust.

IMO, if you really like science, this is a good pathway. The biggest decision you'll have to make is if you see yourself NOT being a scientist down the road.

 

[agp4]

IMO, if you really like science, this is a good pathway. The biggest decision you'll have to make is if you see yourself NOT being a scientist down the road.

Gosh, I was about to say the same thing but far less eloquently!

 

[Alyssum]

Sorry, i am jumping in here because reading through most of this thread terrified me, good reality check (I am a mere 19 and have 'big' dreams. Too big, it seems). What is the physician scientist market like in ID?

It seems physician scientists are just...scientists. Just tenure track faculty doing research who have an extra degree and have access to clinical data. What is the point of getting an MD/PhD rather than just a PhD if you want to do research? I am so confused now.

I don't mean to minimize the struggles of the clinician scientist path, but you have to put people's comments into a bit of context. Compared to individuals who are PhD-only, the job prospects and job security of MD/PhDs are phenomenal in comparison. If you read between the lines, what people are admitting is that when physician scientists shift from research to clinical or industry, the attrition is more or less out of choice (even though it probably did not feel that way to some), because they want better work-life balance or the greener pastures that pay 300k or more rather than staying with the salaries of research/academia. In comparison to that, very few PhD-only holders become independently funded investigators, and available alternative careers are generally not as enticing as clinical practice (in the view of those who don't mind working with patients, that is).

Why stay in research instead of bailing for private practice is a harder question. I think most MD/PhDs want to do research if given the choice, and are willing to make some sacrifices in exchange. It's hard choice for me and I appreciate all the candid replies.

 

[kepler16b]

I don't mean to minimize the struggles of the clinician scientist path, but you have to put people's comments into a bit of context. Compared to individuals who are PhD-only, the job prospects and job security of MD/PhDs are phenomenal in comparison. If you read between the lines, what people are admitting is that when physician scientists shift from research to clinical or industry, the attrition is more or less out of choice (even though it probably did not feel that way to some), because they want better work-life balance or the greener pastures that pay 300k or more rather than staying with the salaries of research/academia. In comparison to that, very few PhD-only holders become independently funded investigators, and available alternative careers are generally not as enticing as clinical practice (in the view of those who don't mind working with patients, that is).

Why stay in research instead of bailing for private practice is a harder question. I think most MD/PhDs want to do research if given the choice, and are willing to make some sacrifices in exchange. It's hard choice for me and I appreciate all the candid replies.

Related, when an MD/PhD shifts from majority research effort to majority clinical effort, there are ample opportunities to stay in academia and do some clinical/translational research and mentor students. In contrast, there are fewer non-tenure track opportunities for PhDs in academia- it's either get a professorship or go to industry. In some ways, MD/PhD training is bet-hedging against leaving the basic science world for the clinical world while still keeping a toe in academia.

 

[tortuga87]

I don't mean to minimize the struggles of the clinician scientist path, but you have to put people's comments into a bit of context. Compared to individuals who are PhD-only, the job prospects and job security of MD/PhDs are phenomenal in comparison. If you read between the lines, what people are admitting is that when physician scientists shift from research to clinical or industry, the attrition is more or less out of choice (even though it probably did not feel that way to some), because they want better work-life balance or the greener pastures that pay 300k or more rather than staying with the salaries of research/academia. In comparison to that, very few PhD-only holders become independently funded investigators, and available alternative careers are generally not as enticing as clinical practice (in the view of those who don't mind working with patients, that is).

Why stay in research instead of bailing for private practice is a harder question. I think most MD/PhDs want to do research if given the choice, and are willing to make some sacrifices in exchange. It's hard choice for me and I appreciate all the candid replies.

FYI going into private practice does not equal bailing on research. It just means you see patients in a practice that is private.

Leaving academia also does not equal bailing on research. It just means you are no longer affiliated with an academic institution.

Making 300K does not equal bailing on research. It just means you make 300K.

There are many places you can do research - pharma, private practice, government, research institutes, think tanks, start-ups, big tech, etc. There are also many ways you can do research. Doing research in academia is *one out of many places of doing research, and one out of many ways of doing research.* Each situation has their pros/cons. You will find yourself with a particular skill set and must customize accordingly.

 

[SurfingDoctor]

BTW, you can have a research career and be an MD only (I myself am one). The caveats are 1) medical school loans and 2) you have to take some extra time on a T32 (or an F32). I don't think medical education really does a good job of teaching to deal with failure and perseverance in the face of it and one needs extra time to learn to overcome those hurdles which can not be accomplished without extra time/training.

On the other hand, I was an attending faster that my comparative MD/PhD colleagues. Depending on the field, that could be quite a bit of earnings.

Needless to say, if one is interested in pursuing research to supplement their career, I think MD and MD/PhD are relatively equal in their success (and I thought the NIH funding data backed that up... but maybe I'm not remembering it right).

 

[ChordaEpiphany]

I must say, this is a troubling thread. It seems the primary problem here is not resource allocation (that will always be limited), but career expectations and the length of the pathway prior to success. Academia is a funnel, and the attrition rate and expected sacrifices are immense. Explaining this should be a part of recruitment. Further, failure should come earlier, not after the "sacrifice" of half a lifetime. So many of the hurdles are equal parts skill and luck, from securing good mentors and research opportunities to getting favorable reviewers. Those who made it through (who will be those who advise students making these decisions) suffer from severe survivorship bias.

Surely we don't actually believe we are whittling down to the "cream-de-la-cream" with this 40 year long process. We are just screening people out through whatever means possible at an excruciatingly slow pace. At the fellow/K-grant level, you've got a cohort of people who were top students in high school, college, and medical school, and who have been successful in research. From there just be more selective with the K-grants and let that be the decider. Let the rest move on with their lives.

Clearly, as @sluox mentioned, the best are often poached by industry anyway, probably largely because this pathway is so long and has no guarantees while industry can offer you an equally meaningful position with a high salary and plenty of freedom and responsibility. The pathway simply isn't achieving the best results in terms of recruiting the top physician-scientists to academia. Nor is it delivering desirable career outcomes to trainees, especially those who fail at the R-grant stage. Letting people "fail" earlier and letting the successful ones start their careers in their 30s is probably in the best interest of everyone. Even without a PhD, the pathway of medicine in the US is far too long, which discriminates against women, minorities, and people who don't have family coffers to dip into.

 

[Alyssum]

Letting people "fail" earlier and letting the successful ones start their careers in their 30s is probably in the best interest of everyone.

How do you evaluate "best" at those earlier stages?
I agree with your assessment... in my very limited experiences, those who I see "survive" are those who 1) stayed single, or had very supportive family/spouse who were willing to relocate with them to whichever area of the country they find a job in and help out with childcare, 2) were less pressured into joining high income specialties, 3) were more willing/able to stay for an extended period of time in a instructor/postdoc position with low pay until opportunities arise, and 4) had well connected mentors and collaborators. Perhaps we should not weed out early, or any time, early stage researchers who lack these assets, but rather ask how the system should be adjusted to better support ALL the trainees that the physician scientist pathway had intended to recruit.

@tortuga87 yes, one can do research anywhere in any way. Yes, each situation very clearly has its pros and cons.

 

[dl2dp2]

I must say, this is a troubling thread. It seems the primary problem here is not resource allocation (that will always be limited), but career expectations and the length of the pathway prior to success ...The pathway simply isn't achieving the best results in terms of recruiting the top physician-scientists to academia. Nor is it delivering desirable career outcomes to trainees, especially those who fail at the R-grant stage. Letting people "fail" earlier and letting the successful ones start their careers in their 30s is probably in the best interest of everyone. Even without a PhD, the pathway of medicine in the US is far too long, which discriminates against women, minorities, and people who don't have family coffers to dip into.

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

 

[Alyssum]

What if one could have something to offer in addition to complaining? For example, if an institution/department guarantees more protected time or better salary support, maybe in return one would be able to achieve or maintain independent funding at an earlier age with higher success rate, which ultimately benefits the institution, no? There are also clearly advantages for at least the image of the department if you can recruit and retain successful women and/or minority faculty. Is it too much to ask for or expect some support and mentoring in exchange?

What's the main hesitation against investing more in early stage physician scientists? Is it because grant funding success these days is so unpredictable that departments cannot recover their investment? The indirects from NIH grants are too low to cover clinician level salaries? Is it that they could replace MD/PhDs with PhDs and get better research output?

 

[dl2dp2]

What if one could have something to offer in addition to complaining? For example, if an institution/department guarantees more protected time or better salary support, maybe in return one would be able to achieve or maintain independent funding at an earlier age with higher success rate, which ultimately benefits the institution, no? There are also clearly advantages for at least the image of the department if you can recruit and retain successful women and/or minority faculty. Is it too much to ask for or expect some support and mentoring in exchange?

What's the main hesitation against investing more in early stage physician scientists? Is it because grant funding success these days is so unpredictable that departments cannot recover their investment? The indirects from NIH grants are too low to cover clinician level salaries? Is it that they could replace MD/PhDs with PhDs and get better research output?

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

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

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

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