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

[dl2dp2]

A 55 year old attending who is 90% research and has 4 R01s cooking at all times in pure basic academic exploratory research is neither wanted nor wanting for a role as medical director.

Right. They'd be eligible for that global head of clinical development role at a mid sized pharma company. Typically 55-year-old attending at Prestige U who has 4 R01s can be a department chair at a middle-ranked academic department.

Also, associate md vs. md vs. senior md are very much a function of company size and can't be flatly compared like that. Senior medical director means very different things at a big 10 vs. mid-size public vs. private startup pharma company.

This is correct. I'm generalizing for simplicity. Global Head of Clinical Development at Merck is probably a pick, if they ever pick from academia, something like Div Chief/Department Head/Named Professor X at Prestige U. Several good examples, most well known is Marc Tessier-Lavigne. At that level there's such a small pool of candidates that what you are looking at is basically organizational size, strategic vision, scientific expertise, etc. The search process is more bespoke.

The emphasis is on connections, clinical experience, and pedigree, in that order. There's even sometimes a bit of a flippant dismissal of academic standards (e.g. "I don't care that you're from Harvard, you work for the bottom line"). You often make better connections and get better experience at top institutions, but I don't think for a second that it's the NIH awards or the basic research publications that are tipping the scales for pharma companies making these hires.

You are painting a picture where there's no common ground between academic and industry research, or academic medicine and private practice, which is false. Of course when you hire you want an overall fit with regard to previous experiences. Once you have tenure at UCSF and two R01s all of a sudden the academic jobs you are eligible for become more attractive--Stanford might want to scoop you to run a newly endowed center, or Yale might want to give you a larger named chair, etc. Maybe a new startup that's opened by a former executive you know from Amgen is asking you to be their CSO. Or maybe your former boss just opened a boutique cancer therapeutic practice in South Florida and ask you to be a partner and willing to give you a 50% raise of the top salary you are offered. So when people make decisions they have more leeway and can up-negotiate their total package. It's not that they stared at your CV and count the number of papers you have in Cell and say "oh THIS is why I'm giving you a job and paying you triple."

LOL, you need to learn the value of #hustle, and the value of "executive presence", etc. There's a lot of implicit content in people's CV that's beyond the h-index.

Any advice for middle of the road career? I’m a resident in the research track to get into IM subspecialty. I have a strong research mentor with R funding and VA funding however there is no institutional t32 currently and I’m a little nervous about what will happen in the way of funding during the research years of this track (80/20 for 3 years based on ABIM). I’ve been told “not to worry” because the chair of medicine is willing to put money into it. But what kind of salary should I be expected to have? Much less than a full clinical resident/fellow? I’ve been told I need to prepare to submit for F grant funding along with other extramural sources like CCFA or AASLD but obviously they all seem pretty lucrative sources of funding to secure..

Write 3 grants a year. I would skip F grants and apply for a K and R series grants, and private foundation grants of similar budget (i.e. between 100k to 1M), if possible. F grants are a waste of time for MDs, IMO. Talk to people who are in charge of hard money budgets (e.g. VA) to see if you can get a % effort covered.

It's better to write an R even if you can't be a PI and submit under someone else, and just draw a budget from that. Find a portfolio of people in your field that have the most grants and "get mentorship" from them. Average out their advice, and do that. R series grants take 1-year minimum from application to funding, so if you are a resident might as well start them now.

Salary is performance-driven. If you get more grants you get more salary. Institutions can float you indefinitely between 70k and 150k+ doing 80% research in IM with no grant support--so it's best to start kissing up to the chair yesterday.

Basically if you write 3 papers a year and 3 grants a year, you are 90% likely to survive at Prestige U. I see mofos do far less than that doing pretty well at Prestige U purely on kissing up to the mafia. BTW this is not some secret advice omg--every chair I ever encountered gave me the same advice, AND it's in literally every slide deck on "career development for X". I really don't know how much more "mentorship" people need. I guess people need more advice on how to kiss up to the mafia when they *can't* get 3 papers and 3 grants in every year. LOL Hire an executive coach.

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[Neuronix]

Any advice for middle of the road career? I’m a resident in the research track to get into IM subspecialty. I have a strong research mentor with R funding and VA funding however there is no institutional t32 currently and I’m a little nervous about what will happen in the way of funding during the research years of this track (80/20 for 3 years based on ABIM). I’ve been told “not to worry” because the chair of medicine is willing to put money into it. But what kind of salary should I be expected to have? Much less than a full clinical resident/fellow? I’ve been told I need to prepare to submit for F grant funding along with other extramural sources like CCFA or AASLD but obviously they all seem pretty lucrative sources of funding to secure..

The idea is that you get paid the usual rate per PGY-X rank. Your research track residency has already committed to that. The goal is to get yourself papers and hopefully grants to go to the next step.

And the next step is where the real questions start--for the next step will you continue as a fellow/post-doc, instructor, assistant professor on a non-tenure track, or assistant professor on tenure track. That's really where guidance and mentorship in your area matters as to which offer and track is best for you.

The "not to worry" because the lab and chair have your back is a good sign. It usually means they'll give you resources in your research track, and if things go well for the next step as well. There's definitely an interpersonal dynamic to that (i.e. sluox's last post), so keep on their good side. Salary is going to be on par with whatever the institution usually hires at those levels. Negotiation is usually not on the salary level, but about which type of position and start-up resources, and here competing offers can be helpful.

Where salary becomes a bigger issue is when you're done the resident/fellow path. Do you sit in a post-doc/instructor position for years when you could be practicing as a full attending and making more money clinically? Do you get paid less as a non-primary clinical faculty member vs. a clinical faculty member? Did you turn down private practice options? But then again, does it make sense to invest in your future to try to go down a research track for personal satisfaction and the chance to become a big shot? If you want more money at any step, do you have time and interest to moonlight and/or consult? Only you can decide on a lot of these things based on you and your circumstances.

 

[CheGuevaraMD]

Science heavily favors the wealthy, just like the arts. I think the disappointment in this thread stems from the U.S. government’s substantial investment in professional scientific education for the middle class. The best and brightest can trickle up from college to a MD-PhD even if they come from nothing. This is not the case for the arts - the middle class have no easy path into this. For MD-PhDs (and PhDs), it’s easy to end up 35 (or 40) and broke. The bait-and-switch drives the disappointment in this thread. At least artists know what they’re getting into.

 

[Alyssum]

Why would I tell them that? LOL Nobody except my accountant knows how much money I make. Nobody except my wife knows how much money I have. You tell people what they want to hear depending on who they are to make them like you.

Do you tell everyone every thought you ever have? What are you a 5 year old? Do I need to teach you to be prudent about expressing your intentions?

Plus, a smart manager knows that I know that they know. My boss knows that I am always on the job market. They expect it. In fact, they want it because if you bring in an offer they can go to their boss's boss and ask for more resources to retain me so that they would get more resources. It's a win-win-win. Basic organizational psychology 101.

LOL!! Yes I regularly go and vent to my chair/PD/etc what I ask anonymously about on the internet. That's how I stay on everybody's good side.
What is your hustle? Consulting for pharma/biotech?

 

[SurfingDoctor]

Science heavily favors the wealthy, just like the arts. I think the disappointment in this thread stems from the U.S. government’s substantial investment in professional scientific education for the middle class. The best and brightest can trickle up from college to a MD-PhD even if they come from nothing. This is not the case for the arts - the middle class have no easy path into this. For MD-PhDs (and PhDs), it’s easy to end up 35 (or 40) and broke. The bait-and-switch drives the disappointment in this thread. At least artists know what they’re getting into.

It’s not easy for an MD-PhD to end up broke. Sorry, but that’s nonsense. I don’t know one broke MD-PhD.

 

[Lucca]

It’s not easy for an MD-PhD to end up broke. Sorry, but that’s nonsense. I don’t know one broke MD-PhD.

on sdn anyone making less than 300k is broke

 

[CheGuevaraMD]

It’s not easy for an MD-PhD to end up broke. Sorry, but that’s nonsense. I don’t know one broke MD-PhD.

Not broke in the long term, but with a net worth close to $0 in your late 30s/early 40s. This is when the anxiety kicks in about the academic path and people have a strong desire to sell out. “Just wait one more year” starts to ring hollow as you get older.

 

[SurfingDoctor]

Not broke in the long term, but with a net worth close to $0 in your late 30s/early 40s. This is when the anxiety kicks in about the academic path and people have a strong desire to sell out. “Just wait one more year” starts to ring hollow as you get older.

MD-PhD with a net worth of $0? Never been my experience.

 

[CheGuevaraMD]

MD-PhD with a net worth of $0? Never been my experience.

Really? Maybe you don’t know many serious students. The best MD-PhDs that I know who did no moonlighting (spent all their time on research and paper/grant writing) have nothing when they come out of fellowship. Especially if they attended institutions in expensive cities and are single.

 

[Alyssum]

Net worth is a combination of income and debt, so it's not as uncommon to have a net worth of zero as you might think... But on the positive side, right after residency/fellowship, it's really not uncommon at all for people who took out large loans with high interest (e.g. MD-only) to end up with serious negative net worth. So I guess having medical school completely paid for makes one lucky in that sense.

 

[ChordaEpiphany]

It’s not easy for an MD-PhD to end up broke. Sorry, but that’s nonsense. I don’t know one broke MD-PhD.

I think the circumstances of most MD/PhDs careers/lives make them less likely to be "broke" at 35 or 40 but it's not necessarily the MD/PhD that prevents going broke. Also, while most MD/PhDs are able to live similar lifestyles, they are not afforded the same security as their similarly-educated peers.

Most MD/PhDs have a few things going for them.

1) Most come from upper-middle class households. So they are far less likely to hold lots of undergraduate debt.
2) Most (today) marry someone with considerable income of their own.

This means that the majority are doing completely fine at 35 on resident/fellow salary. However, if you hold considerable undergraduate debt (a "new" problem for MD/PhDs), you are way behind. If you marry someone with a low-paying career, you will not have a considerable salary in the household until ~37-40 years old. Add a few kids to that mixture and you can easily be very far behind financially.

"Broke" is a nebulous term, but the main appeal of money (in this discussion) is stability/independence. You can live a decent lifestyle with negative net worth just based on the accessibility of credit, afforded by your likely future career earnings. However, you do not have the stability of someone who started making money earlier and has a growing nest egg. If at 40 you are injured and unable to work, you have no savings and no safety net. That will weigh on your psyche, especially once you have a family to support.

So even if MD/PhDs usually make it to retirement just fine, you can't discount the sacrifices made and the relative risk involved in this career. You also can't look at MD/PhDs and assume that their financial situation is entirely indicative of their own career earnings/opportunities.

 

[SurfingDoctor]

I think the circumstances of most MD/PhDs careers/lives make them less likely to be "broke" at 35 or 40 but it's not necessarily the MD/PhD that prevents going broke. Also, while most MD/PhDs are able to live similar lifestyles, they are not afforded the same security as their similarly-educated peers.

Most MD/PhDs have a few things going for them.

1) Most come from upper-middle class households. So they are far less likely to hold lots of undergraduate debt.
2) Most (today) marry someone with considerable income of their own.

This means that the majority are doing completely fine at 35 on resident/fellow salary. However, if you hold considerable undergraduate debt (a "new" problem for MD/PhDs), you are way behind. If you marry someone with a low-paying career, you will not have a considerable salary in the household until ~37-40 years old. Add a few kids to that mixture and you can easily be very far behind financially.

"Broke" is a nebulous term, but the main appeal of money (in this discussion) is stability/independence. You can live a decent lifestyle with negative net worth just based on the accessibility of credit, afforded by your likely future career earnings. However, you do not have the stability of someone who started making money earlier and has a growing nest egg. If at 40 you are injured and unable to work, you have no savings and no safety net. That will weigh on your psyche, especially once you have a family to support.

So even if MD/PhDs usually make it to retirement just fine, you can't discount the sacrifices made and the relative risk involved in this career. You also can't look at MD/PhDs and assume that their financial situation is entirely indicative of their own career earnings/opportunities.

What does the bolded even mean?

I mean, are you guys having a discussion about how educated people can be terrible at managing money? I'm not going to debate that (cause hint, they are) but that's not unique to MD-PhDs.

I know a ton of MD-PhD faculty. They are all fine. People can go on with the woe is me as being a top 10% earner in a wealthy nation, but I find it terribly disingenuous. If people can't live a comfortable life and retire comfortably as a 10% earner income... there are problems that go beyond what degree one has.

 

[dl2dp2]

What does the bolded even mean?

I mean, are you guys having a discussion about how educated people can be terrible at managing money? I'm not going to debate that (cause hint, they are) but that's not unique to MD-PhDs.

I know a ton of MD-PhD faculty. They are all fine. People can go on with the woe is me as being a top 10% earner in a wealthy nation, but I find it terribly disingenuous. If people can't live a comfortable life and retire comfortably as a 10% earner income... there are problems that go beyond what degree one has.

MD-PhD with a net worth of $0? Never been my experience.

This happens. I know a number of "faculty" in their late 30s early 40s who have a net worth close to 0. Typically these are "instructor"/"assistant professor" at Prestige U who are floated strictly on soft money and thusly have a relatively low institutional salary, and don't do much clinical moonlighting.

Keep in mind while you are a fellow/resident there's often no 401k. So a decent number of people don't go out of their way to save up. You are right in that there are other issues involved and people need to do better-saving money, but I think around age 40 your net worth has a certain non-trivial impact on your choice as to whether you stay in academia. OTOH, plenty of the 0 net worth faculty stay in academia and make it work, so it's not deterministic by any means.

 

[SurfingDoctor]

This happens. I know a number of "faculty" in their late 30s early 40s who have a net worth close to 0. Typically these are "instructor"/"assistant professor" at Prestige U who are floated strictly on soft money and thusly have a relatively low institutional salary, and don't do much clinical moonlighting.

Keep in mind while you are a fellow/resident there's often no 401k. So a decent number of people don't go out of their way to save up. You are right in that there are other issues involved and people need to do better-saving money, but I think around age 40 your net worth has a certain non-trivial impact on your choice as to whether you stay in academia. OTOH, plenty of the 0 net worth faculty stay in academia and make it work, so it's not deterministic by any means.

That’s also never been my experience. Every place I’ve trained had a 403b (and if a place didn’t, people can contribute to a Roth). Now whether or not trainees contribute to them is another issue (hence why I said many doctors are not very good at finances).

Also, I know of no instructors in their late 30s/early 40s. Additionally, I don’t know many people who coast of soft money and produce little and aren’t to blame for their financial woes (though soft money usually runs out after a couple of years... well before late 30s/early 40s so again... that seems like an exception not a rule). Most of this again sounds like poor financial decisions that no degree is going to fix.

Now, there are other issues with education attainment and debt, however they go far beyond the scope of this thread because they are not MD-PhD specific.

 

[Neuronix]

Big deal $5k-6k/year in a Roth IRA.

I graduated residency with a net worth of approximately zero at the age of 36. I had no 403b option as a resident. I had minimal moonlighting options as a resident or faculty.

I'm also from a poor background and had undergraduate debt.

I had essentially one faculty job offer in a very high cost of living location after a national job search.

I love these discussions. Sluox is as usual pretty close to right for my experience, though his specialty has a much better job market than mine.

At least I'm paid full faculty salary... If I wasn't I doubt that I'd have children.

 

[Alyssum]

Also, I know of no instructors in their late 30s/early 40s. Additionally, I don’t know many people who coast of soft money and produce little and aren’t to blame for their financial woes (though soft money usually runs out after a couple of years... well before late 30s/early 40s so again... that seems like an exception not a rule). Most of this again sounds like poor financial decisions that no degree is going to fix.

I won't be done with residency until I'm 40 and I'm far from the exception. PhDs are getting longer these days, more clinical specialities are requiring sub-specialization, and the age at which MD/PhDs start medical school is also creeping up as more and more applicants are taking gap years.

 

[SurfingDoctor]

I won't be done with residency until I'm 40 and I'm far from the exception. PhDs are getting longer these days, more clinical specialities are requiring sub-specialization, and the age at which MD/PhDs start medical school is also creeping up as more and more applicants are taking gap years.

I will agree that things are changing from a timeline perspective. I don’t know any 40 year old residents (even MD-PhD, but they are rare anyway), but I suppose its possible.

However, market saturation is becoming a problem... at least in my field. We’ve had discussions about reducing trainees because they can’t find jobs after graduation. In that regard, the MD-PhDs have faired better because even if they aren’t doing science, they bring something different and usually have a better resume.

 

[blissworm]

at the end of the day a clinician that graduates residency/fellowship will always be able to find a decent clinical job that'll allow them to pay off loans, right? can the same be said for the MD PhDs? Reading this almost feels like it's a struggle to find a good job. also, idk how true this is but my dad (a PhD in engineering, not biomed but applicable) says more and more post-docs are stuck in post-doc positions for years because no tenure-track opening is available anywhere.

 

[ValentinNarcisse]

at the end of the day a clinician that graduates residency/fellowship will always be able to find a decent clinical job that'll allow them to pay off loans, right? can the same be said for the MD PhDs? Reading this almost feels like it's a struggle to find a good job. also, idk how true this is but my dad (a PhD in engineering, not biomed but applicable) says more and more post-docs are stuck in post-doc positions for years because no tenure-track opening is available anywhere.

Yes, but for hardcore MD/PhDs that enter PSTPs or only operate in a very niche surgical areas, after failing to secure tenure/R01 funding they may not be comfortable returning to practice as a generalist in their clinical speciality. Keep in mind they may be 6-7 years out from graduating residency at that point. Of course this is far preferred to the job market of PhDs languishing in postdoc after postdoc, but that’s a completely different field entirely.

 

[psychacad]

Yes, but for hardcore MD/PhDs that enter PSTPs or only operate in a very niche surgical areas, after failing to secure tenure/R01 funding they may not be comfortable returning to practice as a generalist in their clinical speciality. Keep in mind they may be 6-7 years out from graduating residency at that point. Of course this is far preferred to the job market of PhDs languishing in postdoc after postdoc, but that’s a completely different field entirely.

Yes, if they decide to forgo any clinical practice. But if they devote up to 20% of their time in the clinic, which is again expected as a PHYSICIAN-scientist, that should be more than enough to keep your clinical skills and go back to practice if needed. This may be somewhat dependent on specialty, but total nonsense in mine. In general I really doubt that this is a problem.

As for PhDs 'languishing in postdoc after postdoc' being a different field entirely? Really? Physician-scientists are primarily scientists and it's more apt to compare them to PhDs rather than full time clinical professionals. The MD brings a lot of leverage and backup options which other scientists do not have.

 

[ValentinNarcisse]

Yes, if they decide to forgo any clinical practice. But if they devote up to 20% of their time in the clinic, which is again expected as a PHYSICIAN-scientist, that should be more than enough to keep your clinical skills and go back to practice if needed. This may be somewhat dependent on specialty, but total nonsense in mine. In general I really doubt that this is a problem.

As for PhDs 'languishing in postdoc after postdoc' being a different field entirely? Really? Physician-scientists are primarily scientists and it's more apt to compare them to PhDs rather than full time clinical professionals. The MD brings a lot of leverage and backup options which other scientists do not have.

I think psychiatry is just vastly different given the absence of any procedures (neurology, some medicine subspecialities fit this bill as well). A cardiologist who is uncomfortable in the cath lab, GI that cannot do advanced endoscopy, or a surgical specialist that no longer does the bread and butter general operations of their field after several years may have difficultly outside of their niche practice that synced with their lab focus. I think the comparison to PhDs is meaningless, because it is a completely different talent pool. Frankly the bar to get into medical school, much less a top MSTP, selects the best performing undergraduates in the country. The qualifications of the MSTP student to their PhD classmates are simply higher in almost all cases. The vast majority of MSTP students would not have gone to a PhD program under any circumstance.

My perspective through this thread has been if we want to continue to attract elite undergraduates to pursue MD/PhD path - the career outcomes and eventual salary need to be rock solid. Otherwise we will continue hemorrhage these recruits to other fields (tech, finance) or to top tuition free MD programs which are becoming more common.

 

[psychacad]

I think psychiatry is just vastly different given the absence of any procedures (neurology, some medicine subspecialities fit this bill as well). A cardiologist who is uncomfortable in the cath lab, GI that cannot do advanced endoscopy, or a surgical specialist that no longer does the bread and butter general operations of their field after several years may have difficultly outside of their niche practice that synced with their lab focus. I think the comparison to PhDs is meaningless, because it is a completely different talent pool. Frankly the bar to get into medical school, much less a top MSTP, selects the best performing undergraduates in the country. The qualifications of the MSTP student to their PhD classmates are simply higher in almost all cases. The vast majority of MSTP students would not have gone to a PhD program under any circumstance.

My perspective through this thread has been if we want to continue to attract elite undergraduates to pursue MD/PhD path - the career outcomes and eventual salary need to be rock solid. Otherwise we will continue hemorrhage these recruits to other fields (tech, finance) or to top tuition free MD programs which are becoming more common.

At the end of the day you are competing for government grants to become a principal investigator at an academic university, so I have no idea why you think your direct competition is "irrelevant". I mean, lol, if you think tech/finance are your competition. In that case, yes of course, don't do MD/PhD. Makes no sense whatsoever.

As for the first point, it's probably why one should be pick a specialty that makes it easier to do a combined clinical/research career. What you mentioned is definitely not an issue across the board.

 

[ValentinNarcisse]

At the end of the day you are competing for government grants to become a principal investigator at an academic university, so I have no idea why you think your direct competition is "irrelevant". I mean, lol, if you think tech/finance are your competition. In that case, yes of course, don't do MD/PhD. Makes no sense whatsoever.

As for the first point, it's probably why one should be pick a specialty that makes it easier to do a combined clinical/research career. What you mentioned is definitely not an issue across the board.

Fair enough re: PhD competition for grant funding, but this is precisely the attitude that makes the physician-scientist profession select for the independently wealthy who can afford to take on such a high risk outcome in exchange for a significant time and financial opportunity cost. Moreover, while "pick a specialty that makes it easier to do a combined clinical/research career" makes empiric sense, it indirectly means that you do not think it is a priority for physician scientists to exist in surgical/procedural specialties, which I personally feel is a huge loss for biomedical innovation. Respectfully, I think this is dismissive to a whole group of highly talented, excited, and motivated students/trainees who should not have to pass some sort of scientific purity test where they are expected to pursue this pathway regardless of their family or economic circumstances. My bottom line is that the incentives have to be aligned to attract the best and brightest to our profession in a sustainable manner.

Thanks for the spirited discussion, I do think this topic is very under-discussed among trainees, and many (myself included) do not fully appreciate these realities until well into residency. IMO, becoming a physician-scientist is one of the greatest careers that exist, but the pipeline largely broken at the training end point. While I happen to still be surviving, my peers who are truly thriving are those removed from the economic pressures of housing, childcare, and can move freely among high COL places to pursue the best opportunity from a career perspective. For us to just accept the loss of qualified individuals as the status quo, is short sighted. I think the comparison to us being in the top 10% of earners also is not fair, we spend almost 20 years in higher education/training and it is not unreasonable to demand an academic salary commiserate with that.

 

[SurfingDoctor]

Fair enough re: PhD competition for grant funding, but this is precisely the attitude that makes the physician-scientist profession select for the independently wealthy who can afford to take on such a high risk outcome in exchange for a significant time and financial opportunity cost. Moreover, while "pick a specialty that makes it easier to do a combined clinical/research career" makes empiric sense, it indirectly means that you do not think it is a priority for physician scientists to exist in surgical/procedural specialties, which I personally feel is a huge loss for biomedical innovation. Respectfully, I think this is dismissive to a whole group of highly talented, excited, and motivated students/trainees who should not have to pass some sort of scientific purity test where they are expected to pursue this pathway regardless of their family or economic circumstances. My bottom line is that the incentives have to be aligned to attract the best and brightest to our profession in a sustainable manner.

Thanks for the spirited discussion, I do think this topic is very under-discussed among trainees, and many (myself included) do not fully appreciate these realities until well into residency. IMO, becoming a physician-scientist is one of the greatest careers that exist, but the pipeline largely broken at the training end point. While I happen to still be surviving, my peers who are truly thriving are those removed from the economic pressures of housing, childcare, and can move freely among high COL places to pursue the best opportunity from a career perspective. For us to just accept the loss of qualified individuals as the status quo, is short sighted. I think the comparison to us being in the top 10% of earners also is not fair, we spend almost 20 years in higher education/training and it is not unreasonable to demand an academic salary commiserate with that.

While I do agree the pipeline is problematic and is likely not driving the desired outcomes, I think physicians in general (not specific to MD/PhD mind you) have a very hard time rectifying that they can’t go out and buy a Maserati and two houses (this is irrespective of whether society actually thinks they deserve those things as compensation for schooling). I mean, some can afford those things but a vast majority can’t. However, that doesn’t change the mentality and that is far more problematic. The physicians (again not just MD/PhDs) that I see get into massive debt is they didn’t think about their purchases or plan for the future because they thought they deserved more or it didn’t matter how they spent it. I had a new colleague join the division this year who is 7 years my junior buy a house valued 5x more than mine. Now maybe he can afford it, but there are a decent amount of people who get that paycheck and choose to live house poor. Kinda like the NBA player who suddenly gets wealth but doesn’t know how to manage it.

(As an aside, I had another colleague who was a penny pincher and lived in a tiny house. I mean, this dude would buy only things about to expire or on discount. He retired at age 42 or so... kinda, I mean, he drives bakery trucks now but for fun and offers to crunch numbers for the hospital for free... dude was weird, but good at managing his finances. Anyway...)

Again, I think most of the discussion of finances aren’t actually a reflection of MD/PhD training at all and more a reflection of what trainees who become doctors expect and their inability to prepare for financial reality. However, if one is savvy, those outcomes at not set in stone and any degree that ends in MD lives pretty well in this country.

The rest of your post I mostly agree with though.

 

[dl2dp2]

Again, I think most of the discussion of finances aren’t actually a reflection of MD/PhD training at all and more a reflection of what trainees who become doctors expect and their inability to prepare for financial reality. However, if one is savvy, those outcomes at not set in stone and any degree that ends in MD lives pretty well in this country.

Outside of this forum, and a few pseudonymous/anonymous Twitter/blogs (and those focus on PhDs), I don't see any venue where the "financial reality" of a career in science is discussed with any degree of reality. This is one area where the mythical mentorship actually hurts you, because as many examples above, "mentors" 1. don't know wtf they are even talking about (and, figuratively, drive a 10-year-old Toyota in their 60s) and/or 2. have no idea what is outside of academia. Basically, if you want any kind of "reality" you'd have to ask on the internet or have a very broad network in real life, which is difficult if you are PCRing constantly at lab.

I know someone who's a perpetual postdoc who upon some questioning told me that he's financially independent because he bought a bunch of TSLA 3 years ago. My point being, the fact that compound interest, asset allocation, leverage, risk-adjusted return, etc. is not any part of formal medical/graduate training is pretty frightening IMO, as essentially how well you invest (not what kind of job you have) determine your lifestyle after a certain age, and alters the "job market for early-career physicians" substantially. Unlike tech/finance/consulting/law, however, we don't have daily exposure to these concepts at work, so this appreciation doesn't really come naturally. Until about 7 years ago I didn't know why a "stock" is worth any money at all.

 

[SurfingDoctor]

Outside of this forum, and a few pseudonymous/anonymous Twitter/blogs (and those focus on PhDs), I don't see any venue where the "financial reality" of a career in science is discussed with any degree of reality. This is one area where the mythical mentorship actually hurts you, because as many examples above, "mentors" 1. don't know wtf they are even talking about (and, figuratively, drive a 10-year-old Toyota in their 60s) and/or 2. have no idea what is outside of academia. Basically, if you want any kind of "reality" you'd have to ask on the internet or have a very broad network in real life, which is difficult if you are PCRing constantly at lab.

I know someone who's a perpetual postdoc who upon some questioning told me that he's financially independent because he bought a bunch of TSLA 3 years ago. My point being, the fact that compound interest, asset allocation, leverage, risk-adjusted return, etc. is not any part of formal medical/graduate training is pretty frightening IMO, as essentially how well you invest (not what kind of job you have) determine your lifestyle after a certain age. Unlike tech/finance/consulting/law, however, we don't have daily exposure to these concepts at work, so this appreciation doesn't really come naturally. Until about 7 years ago I didn't know why a "stock" is worth any money at all.

I would agree that either undergrad or medical school needs to do a much better job (nay, any job) of teaching people how to manage money and be savvy about it. You are paying for all this education, but they make you focus on nonsense social science and philosophical subjects to make you a “more rounded individual”... but none of that “education” helps pay bills or prepare for retirement. I had a business minor in college and took a business in medicine course in medical school, but it was way too superficial. We also had one lecture in residency about investing... which was probably the most useful. But most of what I learned about finance was self taught. I am by no means and expert (that’s probably not necessary actually) but I know enough to make sure investments have a good ROI. The absence of more formal training on that subject in schools is kinda ridiculous considering how much time and money I put in schooling. Instead, people either don’t bother to manage their money or outsource their money management to financial advisers who are typically just well dressed grifters.

 

[tr]

For us to just accept the loss of qualified individuals as the status quo, is short sighted.

Honestly, the loss is a loss to the individuals of careers that they wanted, not a loss to the system. There's not enough money in the system to support so many people who want to be scientists, that's why the jobs are competitive and the pipeline is leaky.

However, MD/PhDs who do not become NIH-supported PIs of basic science labs do not end up camping under the freeway and begging for change.
They become full-time clinicians (a job for which there is demand), or take well-paying jobs in industry, or go into academic roles with varying amounts of clinical service, education, and research - all roles that are generally better compensated than that of the basic scientist. Their finances look similar to those of other MDs in those roles, minus the debt, which can cover a wide range depending on the family background, investment savvy, and plain luck as noted by others above.

 

[deleted819639]

Outside of this forum, and a few pseudonymous/anonymous Twitter/blogs (and those focus on PhDs), I don't see any venue where the "financial reality" of a career in science is discussed with any degree of reality. This is one area where the mythical mentorship actually hurts you, because as many examples above, "mentors" 1. don't know wtf they are even talking about (and, figuratively, drive a 10-year-old Toyota in their 60s) and/or 2. have no idea what is outside of academia. Basically, if you want any kind of "reality" you'd have to ask on the internet or have a very broad network in real life, which is difficult if you are PCRing constantly at lab.

I know someone who's a perpetual postdoc who upon some questioning told me that he's financially independent because he bought a bunch of TSLA 3 years ago. My point being, the fact that compound interest, asset allocation, leverage, risk-adjusted return, etc. is not any part of formal medical/graduate training is pretty frightening IMO, as essentially how well you invest (not what kind of job you have) determine your lifestyle after a certain age, and alters the "job market for early-career physicians" substantially. Unlike tech/finance/consulting/law, however, we don't have daily exposure to these concepts at work, so this appreciation doesn't really come naturally. Until about 7 years ago I didn't know why a "stock" is worth any money at all.

As a solidly middle class, first-generation immigrant who one day dreams of doing residency and becoming an academic physician-scientist in a high COL area, what are some examples of "hustling" I could engage in during my 1) MSTP training, 2) residency training, and 3) early physician-scientist training to ensure my financial stability before getting the big grants? Are there books or resources that you would recommend?

 

[ChordaEpiphany]

Big deal $5k-6k/year in a Roth IRA.

I graduated residency with a net worth of approximately zero at the age of 36. I had no 403b option as a resident. I had minimal moonlighting options as a resident or faculty.

I'm also from a poor background and had undergraduate debt.

I had essentially one faculty job offer in a very high cost of living location after a national job search.

I love these discussions. Sluox is as usual pretty close to right for my experience, though his specialty has a much better job market than mine.

At least I'm paid full faculty salary... If I wasn't I doubt that I'd have children.

Understanding finances and investing well is extremely underrated (and necessary for MD/PhDs and PhDs). In my lab a lot of the younger students even call me a broken record or "Old Man ChordaEpiphany" for how often I remind them to open up Roth IRAs/retirement accounts. For non-physicians, the money you retire on is typically at least 50% interest on savings, often more. Physicians are a bit of an exception to this because pay is so backloaded (i.e. most of their earnings come in late career, and that money has less time to grow). $1 invested in your 20s becomes $3-5 in your 60s (adjusted for inflation). Even with undergraduate debt, it still (usually) makes sense to invest, especially if your interest is on hold. 10% average earnings in the market is higher than 6% on student loans (or lower if you refinance). Though of course you need to weigh the amount of loans vs. amount of savings to determine whether it's better to contribute to a retirement account vs. pay off the loans.

Still, even starting with >$20k in undergraduate debt, good investments and budgeting have grown my net worth more than even working part time as a tutor. I was lucky enough to have a virologist talking my ear off in the biosafety hood in February about how big a deal the coronavirus was. I invested quite a bit in Moderna, and that's paid me nearly as much as my stipend this year. However, relying on lottery tickets like that is obviously not sustainable.

essentially how well you invest (not what kind of job you have) determine your lifestyle after a certain age

This I disagree with, unless I'm misinterpreting. While most of your earnings in a lifetime will come from returns on investments, your job determines how much capital you have to throw into those investments, and most people don't differ very much in how they invest. For 95% of MDs, the money they invest is going to real estate or retirement accounts getting ~10%/year on average. If anything, budgeting has a greater effect on total net worth than investments.

A physician making $300k/year with a take-home of $210k and a savings rate of $60k/year will build a large investment portfolio early on. That physician will be doing much better making 10% gains on those savings than someone saving $20k/year even if they can somehow make 15-20%. My investments, through basically sheer luck/Moderna, are up >100% this year. With my meager stipend and relatively small savings, I made significantly less than a typical mid-career physician who made 15% gains in the S&P 500 this year, and the chance of ever having another year like this investment-wise is basically nil.

Honestly, the loss is a loss to the individuals of careers that they wanted, not a loss to the system. There's not enough money in the system to support so many people who want to be scientists, that's why the jobs are competitive and the pipeline is leaky.

However, MD/PhDs who do not become NIH-supported PIs of basic science labs do not end up camping under the freeway and begging for change.
They become full-time clinicians (a job for which there is demand), or take well-paying jobs in industry, or go into academic roles with varying amounts of clinical service, education, and research - all roles that are generally better compensated than that of the basic scientist. Their finances look similar to those of other MDs in those roles, minus the debt, which can cover a wide range depending on the family background, investment savvy, and plain luck as noted by others above.

Hard not to agree with this, though I'd argue that doesn't mean everything is peachy.

From a systemic point of view, ROI on academic research (especially as pharma looks more and more to academia as a pipeline for new therapies) is incredibly high. Providing more funding to the NIH is a win-win-win for academia, industry, and society. Complacency from everyone in the profession is not the way forward, and the normalization of top grads from top 10 universities struggling to find jobs actually doing productive research is concerning.

 

[tr]

Hard not to agree with this, though I'd argue that doesn't mean everything is peachy.

From a systemic point of view, ROI on academic research (especially as pharma looks more and more to academia as a pipeline for new therapies) is incredibly high. Providing more funding to the NIH is a win-win-win for academia, industry, and society. Complacency from everyone in the profession is not the way forward, and the normalization of top grads from top 10 universities struggling to find jobs actually doing productive research is concerning.

Oh, completely agree. I'm obviously all for more money for science. I guess my point was that I don't really think the system is 'broken' so much as it is just underfunded. If there were money available to support a larger number of people doing good science, then we might see less cutthroat competition and wasted effort writing good grants that don't get funded. But I'm not sure there is a good way to rearrange the system so as to fix the leaky pipeline issues; they arise from a simple mismatch between aspiring scientists and the funding to support them.

 

[Lucca]

Oh, completely agree. I'm obviously all for more money for science. I guess my point was that I don't really think the system is 'broken' so much as it is just underfunded. If there were money available to support a larger number of people doing good science, then we might see less cutthroat competition and wasted effort writing good grants that don't get funded. But I'm not sure there is a good way to rearrange the system so as to fix the leaky pipeline issues; they arise from a simple mismatch between aspiring scientists and the funding to support them.

I think the BWF funding MD only physician scientist pathways at various institutions is a step in the right direction. That said I am afraid of negative bias against MD-only physician scientists in the basic sciences. Maybe their grant hit-rate is the same, but I can't help but feel their peers / institutions will not find them as attractive for hiring given the comments I've heard from faculty at various institutions...Time will tell how the BWF pipelines are able to succeed or fail comparatively.

Another good step is shortening preclin to a single year, esp with step 1 going p/f. I don't regret taking gap years -- regardless of how poor a financial decision they are in the long run for physicians -- because I had a fantastic time, learned a ton, and got to be an independent adult for 2 years prior to jumping back into the academic grind of being a student which is somehow both infantilizing and just as stressful as being an independent adult. But I do regret spending 2 years on preclin instead of one.

 

[ChordaEpiphany]

Oh, completely agree. I'm obviously all for more money for science. I guess my point was that I don't really think the system is 'broken' so much as it is just underfunded. If there were money available to support a larger number of people doing good science, then we might see less cutthroat competition and wasted effort writing good grants that don't get funded. But I'm not sure there is a good way to rearrange the system so as to fix the leaky pipeline issues; they arise from a simple mismatch between aspiring scientists and the funding to support them.

Morbid, but more discussions like this one might actually help with the competition. In today's environment, being an independent NIH-funded investigator is a tough gig with a much smaller salary than basically any other position that requires similar education/experience. It's almost infinitely harder than it was even 20-30 years ago, with most PhD candidates now not even considering the pathway unless the stars align during their graduate studies.

A lot of the competition in academia is actually a function of extremely effective recruitment strategies to the field (or, more accurately, little education about other pathways). Many people consider being a professor to be the "peak" of the profession, but a lot of that is just culture. Because all roads run through academia, it is the most obvious and most visible pathway, so it gets a lot of competition. However, like @sluox has stated accurately in this thread, being a mid-tier professor may not even be the most impactful place for your talents/training, and a lot of that has to do with limited funded going to universities ranked <50 in total NIH funding.

 

[tortuga87]

A lot of the competition in academia is actually a function of extremely effective recruitment strategies to the field (or, more accurately, little education about other pathways). Many people consider being a professor to be the "peak" of the profession, but a lot of that is just culture. Because all roads run through academia, it is the most obvious and most visible pathway, so it gets a lot of competition. However, like @sluox has stated accurately in this thread, being a mid-tier professor may not even be the most impactful place for your talents/training, and a lot of that has to do with limited funded going to universities ranked <50 in total NIH funding.

I summarized the above idea with the more jarring term "propaganda" in a previous post. A lot of the posts in this thread also implicitly assume that leaving academia means you are no longer a real scientist. I think COVID highlighted again that industry research is very important, if not more. I would argue that being a university PI is not a "real scientist" because you focus on grants and managing students. Many exit the path for this reason as well, not because of money. This position was reinforced when I talked to research faculty during the pandemic who just sat at home and wrote fiction. These "scientists" could not do any science without their graduate students and post-docs.

------------

Three grants per year? lol I have 100s of ideas per year and only 2-3 pan out. I cannot imagine how long it would take to go through one hundred ideas if I had to also manage students, write grants, go to meetings, etc. I would get stuck believing this one idea was the best because I wrote a fictional grant about it and spoke to a lot of people when in fact the idea was just garbage like the other 99; garbage deserves to be in the trash ASAP.

Again, just get rich and then you can do whatever you want. Getting $10 mil is not hard. There are people worth 100s of billions, and you are telling me you cannot even get $10 mil? Stop creating an artificial compromise between money and science. Yes, the path is not paved out for you. If it was, it would be harder because everyone would know what to do. The impossible attitude is just fairy dust and also a component of the propaganda.

 

[psychacad]

I summarized the above idea with the more jarring term "propaganda" in a previous post. A lot of the posts in this thread also implicitly assume that leaving academia means you are no longer a real scientist. I think COVID highlighted again that industry research is very important, if not more. I would argue that being a university PI is not a "real scientist" because you focus on grants and managing students. Many exit the path for this reason as well, not because of money. This position was reinforced when I talked to research faculty during the pandemic who just sat at home and wrote fiction. These "scientists" could not do any science without their graduate students and post-docs.

------------

Three grants per year? lol I have 100s of ideas per year and only 2-3 pan out. I cannot imagine how long it would take to go through one hundred ideas if I had to also manage students, write grants, go to meetings, etc. I would get stuck believing this one idea was the best because I wrote a fictional grant about it and spoke to a lot of people when in fact the idea was just garbage like the other 99; garbage deserves to be in the trash ASAP.

Again, just get rich and then you can do whatever you want. Getting $10 mil is not hard. There are people worth 100s of billions, and you are telling me you cannot even get $10 mil? Stop creating an artificial compromise between money and science. Yes, the path is not paved out for you. If it was, it would be harder because everyone would know what to do. The impossible attitude is just fairy dust and also a component of the propaganda.

Sounds nice in theory, but I haven't seen anything convincing how you could put that in practice though.

Will respected journals take work that is not affiliated with any institution and without the backing of a funded PI? Seems doubtful to me, particularly with the amount of politics involved. Will your work be recognized? And if it isn't impactful, or at least attempts to be, what's the point of doing science? Would you ever be able to put big ideas that may need some decent funding into practice? Not to mention that you have to struggle with data scraps that probably have already been analyzed to death. Sounds doable as a part time hobby but not for serious work. I'd love to be convinced otherwise.

 

[ChordaEpiphany]

I talked to research faculty during the pandemic who just sat at home and wrote fiction.

Tell me about it. I wrote an R01 for my PI on repurposing our technology for COVID. Before I even set pen to paper we knew the idea was 5-10 years from translation. Yeah, that's helpful. It was just a money grab.

Again, just get rich and then you can do whatever you want. Getting $10 mil is not hard. There are people worth 100s of billions, and you are telling me you cannot even get $10 mil? Stop creating an artificial compromise between money and science. Yes, the path is not paved out for you. If it was, it would be harder because everyone would know what to do. The impossible attitude is just fairy dust and also a component of the propaganda.

I mean... getting $10 million is hard? If getting $10 million were easy, everyone would be doing it. Further, getting $10 million while developing the skills to be an effective scientist is not at all easy. The closest thing to this approach would be J. Craig Venter. Even he was a professor before he branched from academia, and is not even considered to be that much of a scientist (more a visionary/innovator). There's a reason there are far fewer people like him than there are professors. It's very, very hard to get rich and then do science.

 

[tortuga87]

Sounds nice in theory, but I haven't seen anything convincing how you could put that in practice though.

Will respected journals take work that is not affiliated with any institution and without the backing of a funded PI? Seems doubtful to me, particularly with the amount of politics involved. Will your work be recognized? And if it isn't impactful, or at least attempts to be, what's the point of doing science? Would you ever be able to put big ideas that may need some decent funding into practice? Not to mention that you have to struggle with data scraps that probably have already been analyzed to death. Sounds doable as a part time hobby but not for serious work. I'd love to be convinced otherwise.

As I mentioned before, most journals take papers regardless of affiliation. I have done this and still do this. Papers are judged based on quality of content, and most are moving towards double blind reviews in my field which is great. Grants are a different story.

Work is recognized but takes longer since you are not actively promoting it.

New datasets are uploaded all the time that have not been "analyzed to death."

I am not sure about the last question, since I never do science that requires a lot of money/resources.

 

[SurfingDoctor]

There is also a complacency that doesn't exist in older physician-scientist generations who didn't feel the competition...

I actually had a more senior physician-scientist the other day question why I was gathering data myself. Their question to me was "Why can't you get someone else to get that data for you"...

Needless to say... that's not the mentality of success...

 

[tr]

I summarized the above idea with the more jarring term "propaganda" in a previous post. A lot of the posts in this thread also implicitly assume that leaving academia means you are no longer a real scientist. I think COVID highlighted again that industry research is very important, if not more. I would argue that being a university PI is not a "real scientist" because you focus on grants and managing students. Many exit the path for this reason as well, not because of money. This position was reinforced when I talked to research faculty during the pandemic who just sat at home and wrote fiction. These "scientists" could not do any science without their graduate students and post-docs.

------------

Three grants per year? lol I have 100s of ideas per year and only 2-3 pan out. I cannot imagine how long it would take to go through one hundred ideas if I had to also manage students, write grants, go to meetings, etc. I would get stuck believing this one idea was the best because I wrote a fictional grant about it and spoke to a lot of people when in fact the idea was just garbage like the other 99; garbage deserves to be in the trash ASAP.

Again, just get rich and then you can do whatever you want. Getting $10 mil is not hard. There are people worth 100s of billions, and you are telling me you cannot even get $10 mil? Stop creating an artificial compromise between money and science. Yes, the path is not paved out for you. If it was, it would be harder because everyone would know what to do. The impossible attitude is just fairy dust and also a component of the propaganda.

@tortuga87 I am really curious what field you are in that you can do impactful work with only the expertise of a single individual? Even the lowest impact papers usually require the combined expertise of at least several different people.

I'm assuming it's something computational, but if you are the quant person, don't you also need collaborators with domain expertise and the ability to generate data?

 

[tr]

That said I am afraid of negative bias against MD-only physician scientists in the basic sciences. Maybe their grant hit-rate is the same, but I can't help but feel their peers / institutions will not find them as attractive for hiring given the comments I've heard from faculty at various institutions...Time will tell how the BWF pipelines are able to succeed or fail comparatively.

Nah that's irrelevant. There is pretty much only one factor that overshadows everything else in new faculty hiring: Do you have grant money in hand? If yes, you're in. If no, you better have something else really good going for you (like multiple first author SCN papers or a really good relationship with the chair). The letters behind your name are irrelevant by this point. The advantage of the PhD is it gives you early protected time and scientific education to publish the papers that will allow you to get the funding. The degree itself is just a blip in the rearview mirror.

 

[tr]

A lot of the competition in academia is actually a function of extremely effective recruitment strategies to the field (or, more accurately, little education about other pathways).

Well, that's intentional, because cheap grad student labor is required to keep the system running, but isn't the most exciting career sell. "Here, we'll take your youth and optimism in exchange for five years of 60-hour weeks in the lab at minimum wage with crappy health insurance, existing at the total mercy of the PI who runs your life, after which you will have served your purpose to the scientific enterprise and will be on your own to find suitable employment."

Somehow I don't think that proposal would be good for keeping the pipettes clicking.

 

[dl2dp2]

Three grants per year? lol I have 100s of ideas per year and only 2-3 pan out. I cannot imagine how long it would take to go through one hundred ideas if I had to also manage students, write grants, go to meetings, etc. I would get stuck believing this one idea was the best because I wrote a fictional grant about it and spoke to a lot of people when in fact the idea was just garbage like the other 99; garbage deserves to be in the trash ASAP.

Again, just get rich and then you can do whatever you want. Getting $10 mil is not hard. There are people worth 100s of billions, and you are telling me you cannot even get $10 mil?

Right, this sounds like a psychological issue more than a scientific one. If you are vacillating between I can't filter my 100 ideas into 3 grants a year, and I should focus on making 10M... it sounds like fairly classic all or nothing thinking.

Story for stories sakes:
I know people who made 10M a year [unusually quickly, typically by their early 40s] through ventures and other means (i.e. running funds, being a senior executive, running a highly lucrative law/medicine practice, etc.) Nevertheless, if you have a team up and below, it always starts with being a middle manager, which is what your run of the mill PI is--being a middle manager at a non-profit with a fairly small budget. Being an effective middle manager is all about 1. setting realistic milestones; 2. deliver effective results; 3. managing expectations with budget and personnel constraints. If you don't like these things, don't be a PI.

Slowly making 10M (by mid-late 50s) does not require running a team and is run of the mill in high-level professional circles: being a high-end solo specialist, high-level technical expert/consultant, etc. with a corresponding total comp generally capping out at ~ 500k. These jobs don't exist in research academia/non-profit. Similar jobs in academia top out around 100k a year. A senior mid-career tech consultant/specialist physician can make more than most of the mid-tier dept chairs, and enjoy similar/higher quality prestige in the public eye. For a garden variety MD/PhD in a cognitive specialty, the formula to make 10M by 60 is straightforward and is practiced in real life often but rarely talked about at "career seminars": make 250-300k, save 200k a year for 20 years. This is tough if you are a solo breadwinner, but is *trivial* if your spouse also makes 300k. I've said in a different thread, the best investment you can make, outside of your own education, is to find a spouse with a good career and invest in that career. This is especially true for women but is now increasingly true for men. There is a *reason* mainstream corporate development now emphasizes gender-equal development--over the lifetime of a career, these results are the most profitable/productive for everyone involved.

Upon some reflection, I believe one of the most profitable things I did was to do a lot of online dating in my mid-20s. Someone asked if I have a side gig: I don't need a side gig. My spouse makes similar/more than I do. My side gig is to create efficiency in the household such that we are maximally leveraging our expertise outside.

These are larger trends that are being applied to the career development of translational medical scientists, with their various pros and cons. You should read Elizabeth Warren's "The Two-Income Trap". These ideas are somewhat trivial on paper but they do require a degree of "unconventional" thinking: it's much rarer, for example for women to make a lot of money. But if you don't think that the women you married CAN make a lot of money, you are missing a big portion of long term strategic planning.

 

[ChordaEpiphany]

"Here, we'll take your youth and optimism in exchange for five years of 60-hour weeks in the lab at minimum wage with crappy health insurance, existing at the total mercy of the PI who runs your life, after which you will have served your purpose to the scientific enterprise and will be on your own to find suitable employment."

To be fair, my health insurance is excellent. My small business-owning roommate dropped his jaw when he heard I had no deductible, $10 co-pay for all things mental health (including psychiatry), and a $100-max OOP for specialized surgical procedures or ER visits.

My department, to its credit, is also making a big push towards actually setting people up with employment. We have a new T32 that requires an internship in industry. Things like this are also why it remains a top 10 department in the field when the university is nothing to write home about. For all the bad things I hear about getting a PhD, I do think our leadership here is excellent. Grads either go on to post-docs in top-top labs or shuttle into industry pretty seamlessly. Everyone I know is pretty satisfied with their placements. That is all to say, there are ways to do this without exploiting your grad students.

 

[psychacad]

the best investment you can make, outside of your own education, is to find a spouse with a good career and invest in that career.

OK, but picking a partner for the sake of your career is probably a line too far for some.

 

[dl2dp2]

OK, but picking a partner for the sake of your career is probably a line too far for some.

Why? Women do this ALL THE TIME. Why can't men do it too? Unconventional thinking. Maybe you need to do more Diversity and Inclusion training.

 

[psychacad]

Why? Women do this ALL THE TIME. Why can't men do it too? Unconventional thinking. Maybe you need to do more Diversity and Inclusion training.

Priorities in life and all. I'm just saying, there are things in life that for some supersede saving 200k a year and making 10 million dollars. I'll pass on the training, lol.

 

[dl2dp2]

Priorities in life and all. I'm just saying, there are things in life that for some supersede saving 200k a year and making 10 million dollars. I'll pass on the training, lol.

Right, like marrying a beautiful bimbo who serves you dinner on a silver platter. Or, less tongue in cheek, insisting (or, encouraging) that your capable wife drop out of the workforce and be a SAHM. It could be worth 10M, to each their own. Policymakers put a number on things, I (as the middle manager) do the math and tell you what the numbers are. Everyone has to make their own choices.

 

[Alyssum]

However, market saturation is becoming a problem... at least in my field. We’ve had discussions about reducing trainees because they can’t find jobs after graduation. In that regard, the MD-PhDs have faired better because even if they aren’t doing science, they bring something different and usually have a better resume.

Absolutely. I doubt there'll be any reduction in the number of trainees, for the reasons @tr mentioned. I'm thankful that resident slot numbers are capped in this country. There is not an equivalent of this mechanism for PhDs.

Out of curiosity, what do you usually find to be better about their resume...? Seems that MD/PhDs have far less time to accumulate publications than people who are PhD-only, though it does seem slightly easier for physician scientists to acquire early career grants.

Honestly, the loss is a loss to the individuals of careers that they wanted, not a loss to the system. There's not enough money in the system to support so many people who want to be scientists, that's why the jobs are competitive and the pipeline is leaky.

I think @ValentinNarcisse's point is that you're no longer retaining the best talent for the job at the early career stage, but rather those who simply have the most capital to weather long "training" periods of lower wages.

The students in college who are the most driven with the most extensive research experience are not doing PhDs these days, but rather going to medical school where little, if any, of their research skills will ever be utilized. My peers who switched to clinical work entirely because they couldn't see themselves doing longer residency/fellowships to ultimately compete for diminishing federal grants were way more talented than I ever was. As you said, the alternative career options outside of academic research for MD/PhDs are fabulous. Doesn't it cost something like $1 million dollars in taxpayer money to train a MD/PhD?

 

[Alyssum]

Upon some reflection, I believe one of the most profitable things I did was to do a lot of online dating in my mid-20s. Someone asked if I have a side gig: I don't need a side gig. My spouse makes similar/more than I do. My side gig is to create efficiency in the household such that we are maximally leveraging our expertise outside.

These are larger trends that are being applied to the career development of translational medical scientists, with their various pros and cons. You should read Elizabeth Warren's "The Two-Income Trap". These ideas are somewhat trivial on paper but they do require a degree of "unconventional" thinking: it's much rarer, for example for women to make a lot of money. But if you don't think that the women you married CAN make a lot of money, you are missing a big portion of long term strategic planning.

LOL. I think I was the person who asked. Thanks for sharing the secret! Have to agree with what you said.

 

[ChordaEpiphany]

OK, but picking a partner for the sake of your career is probably a line too far for some.

I think the point @sluox was making was that supporting your spouse's career is as important, financially, as supporting your own. Or maybe he meant you can nab yourself a sugarmama if money is that important. I think either interpretation is technically correct, but the former is more palatable.

FWIW, "engineer" to "med student" was like flipping a switch on dating apps. Women are doing this for sure. I even had a few women lose interest after a few (pretty decent) dates when we finally got around to my career trajectory. A lot of women think it's finish med school and then start making $300K+. Is the solution for men to develop the same superficial tastes based on money? I don't think so, but I don't have any business policing how other people choose a partner.

Out of curiosity, what do you usually find to be better about their resume...? Seems that MD/PhDs have far less time to accumulate publications than people who are PhD-only, though it does seem slightly easier for physician scientists to acquire early career grants.

MD/PhDs, age-for-age, definitely have a less extensive publication profile than PhD-only counterparts. I wonder if it's actually easier for MD/PhDs to get career grants, or if the numbers just look better. MD/PhDs are a more talented pool than PhD-only, so being in the top 30% of MD/PhDs could be way harder than being in the top 20% of PhDs. You can look at high funding lines for F30s vs. F31s or higher success rates in getting K-grants, but also remember that there are tons of PhD-only students who were never in the running for the MD/PhD pathway (or even the MD-only pathway). I think it's a wash, and if you really want to do research, starting a PhD directly out of undergrad (or staying entirely in academia) is probably the way to go.

My peers who switched to clinical work entirely because they couldn't see themselves doing longer residency/fellowships to ultimately compete for diminishing federal grants were way more talented than I ever was.

True for me as well at the undergrad to MD/PhD stage. A lot of it just came down to simple organization and work ethic. Sure, I could score 99%-ile+ on the MCAT and set the curve on exams, but publishing prolifically, especially as an undergrad, requires an entirely different set of skills. I did not have those skills. A lot of those kids who could work their way in with the grad students, organize their workflow, catch on to new techniques quickly, and generate data wound up just going to med school MD-only. They have no intention of doing research beyond what is necessary for advancement. They just didn't want to be finishing up residency at 40. Can't say I blame them one bit. This career loses a lot of talent to the miserable training pathway. I'd actually rather it be more competitive, but quick to toss you aside and tell you to pursue something new.

 

[psychacad]

I think the point @sluox was making was that supporting your spouse's career is as important, financially, as supporting your own. Or maybe he meant you can nab yourself a sugarmama if money is that important. I think either interpretation is technically correct, but the former is more palatable.

FWIW, "engineer" to "med student" was like flipping a switch on dating apps. Women are doing this for sure. I even had a few women lose interest after a few (pretty decent) dates when we finally got around to my career trajectory. A lot of women think it's finish med school and then start making $300K+. Is the solution for men to develop the same superficial tastes based on money? I don't think so, but I don't have any business policing how other people choose a partner.

Yes, you're right, who are we to decide what is right and what is wrong? But as I mentioned, for some, picking a life partner to maximize your $ investment down the road and make millions might be a step too far. I'm not sure I would actually recommend that, but this is where values come in and they are personal. I think all sorts of people do it, men, women, straight, gay or bi, with importantly varying degrees depending on life circumstance..etc.