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

[SurfingDoctor]

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.

Well, in pediatrics and in particular pediatric critical care, few applicants have any publications. Additionally, the PhD usually means the applicants are better critical thinkers (in my opinion). And lastly, they at least have a career plan, even it doesn’t work out for various reasons. In pediatric critical care, many applicants for faculty positions generally only have the 3 P attributes (pink, peeing, pulses... ie a warm body), so a PhD application is usually far above the rest of the pack.

This is just in reference to pediatric critical care though and I don’t doubt different specialities have different bars.

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[tortuga87]

I think my previous post has been misinterpreted/off to a tangent... You can still do a lot of research outside academia and publish as usual. I have my way of doing it via financial independence and computational work, but there are other paths suitable for different personalities. Actually I would say that right now is one of the easiest times to be a gentleman scientist outside of academia thanks to the computer.

I take psychological issue with being a middle manager as described above. I like to be a scientist who does the science. My 10 year old self would not be happy if I told him I would just write grants and teach all day instead of making discoveries. I also want to make at least 500k doing what I want instead of 80k. I find it insulting to work so hard for so long but then live in squalor. Unfortunately that path does not exist in academia so I have to craft my own way. I hear that others are experiencing the same thing, and I’m saying that it is definitely possible but you have to be willing to take the less beaten path. The beaten path is pretty crap anyways.

I’m also not talking about 10M by the time you are 60. I’m saying 10M by 40 by investing in your early 20s. I raised 20k initially by taking 2 years off before the MSTP and living with my parents. There are other ways like licensing as well that I already mentioned.

 

[Lucca]

I think my previous post has been misinterpreted/off to a tangent... You can still do a lot of research outside academia and publish as usual. I have my way of doing it via financial independence and computational work, but there are other paths suitable for different personalities. Actually I would say that right now is one of the easiest times to be a gentleman scientist outside of academia thanks to the computer.

I take psychological issue with being a middle manager as described above. I like to be a scientist who does the science. My 10 year old self would not be happy if I told him I would just write grants and teach all day instead of making discoveries. I also want to make at least 500k doing what I want instead of 80k. I find it insulting to work so hard for so long but then live in squalor. Unfortunately that path does not exist in academia so I have to craft my own way. I hear that others are experiencing the same thing, and I’m saying that it is definitely possible but you have to be willing to take the less beaten path. The beaten path is pretty crap anyways.

I’m also not talking about 10M by the time you are 60. I’m saying 10M by 40 by investing in your early 20s. I raised 20k initially by taking 2 years off before the MSTP and living with my parents. There are other ways like licensing as well that I already mentioned.

nobody is living in squalor dude, best of luck to u on ur path but keep ur judgements about dignity to yourself

 

[Alyssum]

@SurfingDoctor Oh I see what you mean now, thanks for that explanation!

You can still do a lot of research outside academia and publish as usual. I have my way of doing it via financial independence and computational work, but there are other paths suitable for different personalities. Actually I would say that right now is one of the easiest times to be a gentleman scientist outside of academia thanks to the computer.

Where do you acquire your datasets, from public databases like NIH/ENCODE/etc? I assume you must have significant computational background? What are those "other paths" that you're alluding to?

 

[psychacad]

nobody is living in squalor dude, best of luck to u on ur path but keep ur judgements about dignity to yourself

You need to change your SDN poverty line from 300 to 500k

 

[mdphd:)]

Sorry for my confusion — just to get some concrete examples, when you guys talk about MD/PhDs "bailing out" to industry, are you all generally referring pharma/biotech companies like Pfizer, Moderna, Johnson & Johnson?

Do MD/PhDs who switch over to these industry positions usually keep up practicing medicine, or do they leave medical practice behind? If they do keep up medical practice, are they essentially working two separate and independent jobs? (...are there options for medical practice that will let you only work “part time” while you also work a job in industry?)

Also wanted to bump someone else's question from earlier --

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?

 

[Lucca]

You need to change your SDN poverty line from 300 to 500k

just to follow up on this a bit, I decided to use the publicly available UC system compensation to look at a semi-random sampling of 23 adult Heme/Onc faculty at UCSF (I figured Heme/Onc would be a pretty middle-of-the-road specialty -- its not academic Peds subspecialties, but its also not a Surgical sub or Rads), conveniently located in one of the most expensive, if not *the* highest COL part of the country.

I colored them by whether or not they run their own lab, both MDs and/or MD/PhDs and ordered it by faculty rank. The black line is the annual household income estimated to be able to afford a mortgage in San Francisco at the median home price (~1.5 Million dollars).

these incomes are largely higher than most other places just because of the cost of living in the bay, but even a lowly Asst Prof running a lab is going to be able to buy their own home, most likely, in the most expensive part of the country even with their own income alone. This is not factoring in that doctors qualify for mortgages with low to no down payment and generally have better access to credit than the average person.

I dont want to negate the level of sacrifice and time it takes to get an MD/PhD...specialist training...postdoc...and then end up in this position, but just to put the discussion about incomes in this thread into some more easily relatable context. Obviously, it's also harder if you have debt to pay off to stay in academics / research if you're coming in with a second mortgage level of debt, but most MD/PhDs will have much much less debt than their Md counterparts.

Notably, at least at UCSF MD and MD/PhD Asst. Profs tend to make 50-80k more per year than PhD only Asst Profs, likely due to additional clinical responsibilities. These incomes do not include incomes outside of what the UC system pays these faculty (so excludes income from consulting, investments, trust funds, what have you). If people are interested, I could try to do this for UCLA and UCSD health too.

 

[Alyssum]

Sorry for my confusion — just to get some concrete examples, when you guys talk about MD/PhDs "bailing out" to industry, are you all generally referring pharma/biotech companies like Pfizer, Moderna, Johnson & Johnson?

Do MD/PhDs who switch over to these industry positions usually keep up practicing medicine, or do they leave medical practice behind? If they do keep up medical practice, are they essentially working two separate and independent jobs? (...are there options for medical practice that will let you only work “part time” while you also work a job in industry?)

Bigger companies, start-ups, anything. I'm not the most knowledgeable about this and have never worked in industry, but for people I know who did, they stopped practicing medicine but still kept their licensing up to date, so that they could return to clinical practice if they wanted. I'm sure you can still practice on the side as well if you want to (many clinical specialities can be done as a part time job). I've been advised that options in industry are more abundant and desirable if you complete a residency (so that you can take medical director type of positions). You're generally looking at clinical or translational research, early stage technology development, CSO type of work.

I'll leave you to others with more experience to answer your question better.

 

[dl2dp2]

Sorry for my confusion — just to get some concrete examples, when you guys talk about MD/PhDs "bailing out" to industry, are you all generally referring pharma/biotech companies like Pfizer, Moderna, Johnson & Johnson?

Do MD/PhDs who switch over to these industry positions usually keep up practicing medicine, or do they leave medical practice behind? If they do keep up medical practice, are they essentially working two separate and independent jobs? (...are there options for medical practice that will let you only work “part time” while you also work a job in industry?)

Also wanted to bump someone else's question from earlier --

The latitude of industry transition is fairly broad for MD/PhD, especially a well-respected program, depending on the content of the PhD. Usually large pharma, but also small/midsized pharma, tech companies, health insurance, financial services (healthcare finance, etc).

In general the actual day to day practice of medicine is minimal, but most of the roles that require specialty training (and is therefore comeptitive in terms of salary/responsibility to academia) will demand clinical expertise. You can't design a heme/onc trial or do safety monitoring or do medical affairs without knowing and "practicing" heme/onc. The main difference is industry doesn't pay below your grade or expect you to do scut work.

The kind of hustling you can do really depends on your specialty choice and can vary WILDLY, even between different institutions. You need to figure out what specialty you want first.

just to follow up on this a bit, I decided to use the publicly available UC system compensation to look at a semi-random sampling of 23 adult Heme/Onc faculty at UCSF (I figured Heme/Onc would be a pretty middle-of-the-road specialty -- its not academic Peds subspecialties, but its also not a Surgical sub or Rads), conveniently located in one of the most expensive, if not *the* highest COL part of the country.

Your analysis is valid and follows expectations. However, I would say Heme/Onc is one of the better-paying specialties in academia, and even then junior faculty are being paid at a minimum 1/3 less than their private counterparts. A full professor at UCSF would typically a national leader in field X, so if they transitioned to phrama (most likely scenario), or to a regional center to run a clinical group, they would likely get paid 500k+.

200k a year in the Bay Area is tough. Yes, you MIGHT be able to buy a 1.5M condo (at a very high DTI), but your lifestyle would be very cramped.

 

[Lucca]

The latitude of industry transition is fairly broad for MD/PhD, especially a well-respected program, depending on the content of the PhD. Usually large pharma, but also small/midsized pharma, tech companies, health insurance, financial services (healthcare finance, etc).

In general the actual day to day practice of medicine is minimal, but most of the roles that require specialty training (and is therefore comeptitive in terms of salary/responsibility to academia) will demand clinical expertise. You can't design a heme/onc trial or do safety monitoring or do medical affairs without knowing and "practicing" heme/onc. The main difference is industry doesn't pay below your grade or expect you to do scut work.

The kind of hustling you can do really depends on your specialty choice and can vary WILDLY, even between different institutions. You need to figure out what specialty you want first.


Your analysis is valid and follows expectations. However, I would say Heme/Onc is one of the better-paying specialties in academia, and even then junior faculty are being paid at a minimum 1/3 less than their private counterparts. A full professor at UCSF would typically a national leader in field X, so if they transitioned to phrama (most likely scenario), or to a regional center to run a clinical group, they would likely get paid 500k+.

200k a year in the Bay Area is tough. Yes, you MIGHT be able to buy a 1.5M condo (at a very high DTI), but your lifestyle would be very cramped.

certainly, academics / research will never pay what private practice or industry does. My point is really that for those of us making the decision between career paths it's not "indentured servitude" vs "vast riches" but "a very comfortable middle or upper class lifestyle depending on the area" vs "vast riches".

and you can get a 3/4 bedroom house in SF for 1.5 M. Yes, it's the same Sq-footage you could buy where I grew up for 250-300k, but it's not like a 1 bd room condo either (the bay being the bay I'm certain there are 1-bedrooms going for that much though...). I'm not advocating people move to the Bay to stretch their dollar, for most a faculty job in the midwest will "pay more" even if the dollar amount is lower.

but point taken about heme/onc. What specialty would you choose if you wanted to get a middle-of-the-road estimate?

 

[Alyssum]

The heme/onc salaries listed are right around what I would expect... if one is being paid at the NIH cap for 80% research and ~250k for academic clinical medicine, then 180*.8+220*.2 lands you around 200k. I'm sure these things also vary a lot depending on specialty norms, whether you want to stay on the coasts, whether you have grants to bring with you, etc.

 

[Alyssum]

for most a faculty job in the midwest will "pay more" even if the dollar amount is lower.

My limited view from what I gather is that those offers have generally been higher while the cost of living is also lower.

 

[dl2dp2]

certainly, academics / research will never pay what private practice or industry does. My point is really that for those of us making the decision between career paths it's not "indentured servitude" vs "vast riches" but "a very comfortable middle or upper class lifestyle depending on the area" vs "vast riches".

and you can get a 3/4 bedroom house in SF for 1.5 M. Yes, it's the same Sq-footage you could buy where I grew up for 250-300k, but it's not like a 1 bd room condo either (the bay being the bay I'm certain there are 1-bedrooms going for that much though...). I'm not advocating people move to the Bay to stretch their dollar, for most a faculty job in the midwest will "pay more" even if the dollar amount is lower.

but point taken about heme/onc. What specialty would you choose if you wanted to get a middle-of-the-road estimate?

I agree with most of your points. It is psychologically tough to be “okay” with 200k when “people you know” are making 500k. But in principle you can do fine, and we all know the formula to do it. It’s a bit cramped and you can’t be NW 10M at 60 but you can be fine. As I said many first gen immigrants do great with less in the Bay Area. It’s not rocket science.

 

[ChordaEpiphany]

Notably, at least at UCSF MD and MD/PhD Asst. Profs tend to make 50-80k more per year than PhD only Asst Profs, likely due to additional clinical responsibilities. These incomes do not include incomes outside of what the UC system pays these faculty (so excludes income from consulting, investments, trust funds, what have you). If people are interested, I could try to do this for UCLA and UCSD health too.

I appreciate this analysis, however I have a few criticisms for this.

1) MD/PhDs make considerable sacrifices in life. I haven't even made it to residency, and my partner (who will likely make >$200k by 40 and makes $100k out of school) thinks medicine is "basically slavery." I obviously don't feel that way, but this profession has objectively worse working conditions than most other careers with similar overall earnings. Hour-for-hour, with training included, MD/PhDs are not making what others are making.

2) You have neglected the time value of money. MD/PhDs Consider two career trajectories. One makes $100k at 25 and increases ~$4k/year to $250k by 65. The other is an MD/PhD making the typical salaries of residency/fellowship/what you've shown for professorships. Imagine the first career is able to save/invest $30k/year until 30, then saves/invests 20% of income until retirement. The MD/PhD saves/invests nothing in school, 10% of income in residency/fellowship, and 20% of income as an attending. The first career trajectory has over twice the net worth of the second by age 65. Income is literally less than half the picture.

3) As @sluox pointed out, these are national leaders in the field. It's not unreasonable to think that top doctors could command top salaries. Top businessmen, lawyers, financial analysts, entertainment personalities, etc... are all commanding 7 figures and sometimes much more.

I agree we should not whine and complain about making $200k+, but keep in mind there's a lot more to earnings and lifestyle than salary.

 

[Lucca]

I appreciate this analysis, however I have a few criticisms for this.

1) MD/PhDs make considerable sacrifices in life. I haven't even made it to residency, and my partner (who will likely make >$200k by 40 and makes $100k out of school) thinks medicine is "basically slavery." I obviously don't feel that way, but this profession has objectively worse working conditions than most other careers with similar overall earnings. Hour-for-hour, with training included, MD/PhDs are not making what others are making.

2) You have neglected the time value of money. MD/PhDs Consider two career trajectories. One makes $100k at 25 and increases ~$4k/year to $250k by 65. The other is an MD/PhD making the typical salaries of residency/fellowship/what you've shown for professorships. Imagine the first career is able to save/invest $30k/year until 30, then saves/invests 20% of income until retirement. The MD/PhD saves/invests nothing in school, 10% of income in residency/fellowship, and 20% of income as an attending. The first career trajectory has over twice the net worth of the second by age 65. Income is literally less than half the picture.

3) As @sluox pointed out, these are national leaders in the field. It's not unreasonable to think that top doctors could command top salaries. Top businessmen, lawyers, financial analysts, entertainment personalities, etc... are all commanding 7 figures and sometimes much more.

I agree we should not whine and complain about making $200k+, but keep in mind there's a lot more to earnings and lifestyle than salary.

I can appreciate all that but those are choices I made for myself in applying to med school in the first place. I’m just asking for us to get a grip when lifestyle discussions come up and be honest about what we’re actually talking about, instead of resorting to hyperbole. All these pointless comparisons: where is there any evidence in our economic system that effort and sacrifice are adequately rewarded? Nowhere. Plenty to complain about, but it’s not a productive career prospect discussion, to me anyway.

 

[ChordaEpiphany]

I can appreciate all that but those are choices I made for myself in applying to med school in the first place. I’m just asking for us to get a grip when lifestyle discussions come up and be honest about what we’re actually talking about, instead of resorting to hyperbole. All these pointless comparisons: where is there any evidence in our economic system that effort and sacrifice are adequately rewarded? Nowhere. Plenty to complain about, but it’s not a productive career prospect discussion, to me anyway.

That's extremely valid. Effort and sacrifice are absolutely not rewarded. I do think it's worth noting that almost no one talks about money this way outside of financial circles or specific financial discussions. Any discussion of salary without discussion of saving/investment opportunity is unproductive and misleading for those who are weighing their options moving forward. These same arguments are made by people who claim doctors make too much money without acknowledging the ~10 years of compounding investments doctors miss out on compared to other career tracks.

Yes, we all came into this with an understanding that we would make less money than our purely clinical counterparts, but I'm not sure if we realized just how much less, because wealth is derived from investment opportunity far more than salary. The primary wealth we lose as MD/PhDs is measured in time and loss of compounding interest, not a 1/3 lower salary.

 

[tr]

3) As @sluox pointed out, these are national leaders in the field. It's not unreasonable to think that top doctors could command top salaries. Top businessmen, lawyers, financial analysts, entertainment personalities, etc... are all commanding 7 figures and sometimes much more.

No no. Top lawyers working in lucrative areas may be making 7 figures, just like MDs in high-end procedural specialties in private practice.
The salary for a professor at a law school is much, much less - likely around the same range as for med school professors, or less perhaps.
A brief Google search reveals the following document:

https://law.yale.edu/sites/default/files/area/department/cdo/document/cdo_law_teaching_public.pdf

"As reported in a recent SALT salary survey, the range of median base salaries for assistant professors is approximately $72,100 to $138,108. Associate professor (pre-tenure) median salaries range from $87,718 to $152,220. For tenured professors, the median range is $102,622 to $198,519"

Academics don't pay in any field. You are trading money for intellectual freedom, and for lifestyle, to an extent.

The black line is the annual household income estimated to be able to afford a mortgage in San Francisco at the median home price (~1.5 Million dollars)

**Er, who thought you could buy a $1.5M house on a $200K salary? That's... not sound financial judgement.
Additionally, below is what you get in San Francisco for $1M plus. Read it, young'uns, and prepare your applications to high-quality universities in the South and Midwest.

15 modest-sized houses in San Francisco with huge price tags

In San Francisco, 81% of the homes cost $1 million or more. Here are some of the smaller homes that are on the market for mega bucks.

www.insider.com

 

[SurfingDoctor]

just to follow up on this a bit, I decided to use the publicly available UC system compensation to look at a semi-random sampling of 23 adult Heme/Onc faculty at UCSF (I figured Heme/Onc would be a pretty middle-of-the-road specialty -- its not academic Peds subspecialties, but its also not a Surgical sub or Rads), conveniently located in one of the most expensive, if not *the* highest COL part of the country.

I colored them by whether or not they run their own lab, both MDs and/or MD/PhDs and ordered it by faculty rank. The black line is the annual household income estimated to be able to afford a mortgage in San Francisco at the median home price (~1.5 Million dollars).

View attachment 325969

these incomes are largely higher than most other places just because of the cost of living in the bay, but even a lowly Asst Prof running a lab is going to be able to buy their own home, most likely, in the most expensive part of the country even with their own income alone. This is not factoring in that doctors qualify for mortgages with low to no down payment and generally have better access to credit than the average person.

I dont want to negate the level of sacrifice and time it takes to get an MD/PhD...specialist training...postdoc...and then end up in this position, but just to put the discussion about incomes in this thread into some more easily relatable context. Obviously, it's also harder if you have debt to pay off to stay in academics / research if you're coming in with a second mortgage level of debt, but most MD/PhDs will have much much less debt than their Md counterparts.

Notably, at least at UCSF MD and MD/PhD Asst. Profs tend to make 50-80k more per year than PhD only Asst Profs, likely due to additional clinical responsibilities. These incomes do not include incomes outside of what the UC system pays these faculty (so excludes income from consulting, investments, trust funds, what have you). If people are interested, I could try to do this for UCLA and UCSD health too.

Not to take away from your post but one of my former colleagues was married to a neurosurgeon, they had no kids and they had to live in Stanford’s co-mortgage housing to be able to live in something that wasn’t a condo.

People also need to realize that the real estate is very skewed in California and household income does not equate to owning a home. In fact, if you move there as opposed to having always lived there, the property taxes for the same piece of real estate differ vastly and often an impossible barrier to owning a home (hence the Stanford co-mortgage thing).

Again, no MD/PhD doing research is gonna be broke, but the California (and the Bay Area real estate markets) are not good examples of how a physician can afford anything except as a Pediatrician who happens to marry into a multi-billion dollar company.

 

[Lucca]

Not to take away from your post but one of my former colleagues was married to a neurosurgeon, they had no kids and they had to live in Stanford’s co-mortgage housing to be able to live in something that wasn’t a condo.

People also need to realize that the real estate is very skewed in California and household income does not equate to owning a home. In fact, if you move there as opposed to having always lived there, the property taxes for the same piece of real estate differ vastly and often an impossible barrier to owning a home (hence the Stanford co-mortgage thing).

Again, no MD/PhD doing research is gonna be broke, but the California (and the Bay Area real estate markets) are not good examples of how a physician can afford anything except as a Pediatrician who happens to marry into a multi-billion dollar company.

point taken. not to beat a dead horse since i think we all agree here on this pt, i do think we also all like looking at graphs. Here's a similar semi-random sampling of 13 research and clinical faculty in various adult medical subspecialties (but not heme onc this time) at the University of Utah, which also makes all of its faculty compensation packages publicly searchable. The median home price in Salt Lake City is ~ 400k, compared to 1.5 Mill in SF and 3.1 Mill in Palo Alto.

 

[Neuronix]

You make it sound like you have all this choice of where to become faculty. I applied all over the country for both residency and faculty positions and essentially matched in a place that was unexpected and then had one offer for a faculty job afterwards in a very HCOL location. You're looking at $1 million minimum for a house without a big commute.

Housing costs remain a serious issue for my family and I. It's not like I can just move to Salt Lake City to get away from it.

I do have a friend who offered me a private job in the SF bay area if I wanted to bail to private practice. I looked at housing in the suburb I'd be working in: $2 million was the cheapest 3 BR house on the market. I politely declined. I don't know how people do it--a lot of family money, older people who have owned for many years, side hustle, never owning, etc.

 

[psychacad]

No no. Top lawyers working in lucrative areas may be making 7 figures, just like MDs in high-end procedural specialties in private practice.
The salary for a professor at a law school is much, much less - likely around the same range as for med school professors, or less perhaps.
A brief Google search reveals the following document:

https://law.yale.edu/sites/default/files/area/department/cdo/document/cdo_law_teaching_public.pdf

"As reported in a recent SALT salary survey, the range of median base salaries for assistant professors is approximately $72,100 to $138,108. Associate professor (pre-tenure) median salaries range from $87,718 to $152,220. For tenured professors, the median range is $102,622 to $198,519"

Academics don't pay in any field. You are trading money for intellectual freedom, and for lifestyle, to an extent.



**Er, who thought you could buy a $1.5M house on a $200K salary? That's... not sound financial judgement.
Additionally, below is what you get in San Francisco for $1M plus. Read it, young'uns, and prepare your applications to high-quality universities in the South and Midwest.

15 modest-sized houses in San Francisco with huge price tags

In San Francisco, 81% of the homes cost $1 million or more. Here are some of the smaller homes that are on the market for mega bucks.

www.insider.com

The Bay Area is a bit of an outlier though. Manhattan prices without reasonable alternatives. In the northeast you can afford your dream suburban house on 200k if that's what you want, and still have a reasonable commute in major metro areas (and we're assuming here that partner is bringing literally $0). I believe it's the same thing in SoCal and in the NW.

At the end of the day everything has a price. You can get your 400k job doing a purely clinical job, but the trade off is no science. If that makes you happy, great. No one is living in hardship or squalor to make it as a physician-scientist. It's a decision we're all free to make. It's all about perspective, and I agree that the real issue here are comparisons and a sense of lost opportunity, as well as probably a lot of guilt tripping.

 

[Spacedman]

The Bay Area is a bit of an outlier though. Manhattan prices without reasonable alternatives. In the northeast you can afford your dream suburban house on 200k and still have a reasonable commute in major metro areas (and we're assuming here that partner is bringing literally $0). I believe it's the same thing in SoCal and in the NW.

At the end of the day everything has a price. You can get your 400k job doing a purely clinical job, but the trade off is no science. If that makes you happy, great. No one is living in hardship or squalor to make it as a physician-scientist. It's a decision we're all free to make.

or, or, or....you can get your 400k, do science, live in a beautiful and absurdly high COL area, and rent. To paraphrase absolutely everyone else, there are many options with an MD/PhD, and oftentimes you have to sacrifice something... but it's hard to know what the dimensions are early in your career. For the trainees, think broadly about your ultimate choice of specialty. As in any market, there are undervalued opportunities out there, but information doesn't exactly flow freely. Forums like these (actually, just this one) is the only one I've found where people post remotely useful career planning advice for MSTPs.

Trainees and mods - any interest in creating a sticky / private verified subforum / anonymous posting mechanism to share details about career trajectory and finances?

 

[Alyssum]

Read it, young'uns, and prepare your applications to high-quality universities in the South and Midwest.

You make it sound like high quality universities in the south and midwest will automatically want me in return!

Does the availability of research/academic positions follow the same trend as job opportunities for a specialty in general...? As in, if a clinical specialty is in demand, you would expect more jobs to open in academia as well, and vice versa, or there's no correlation?

 

[Alyssum]

To paraphrase absolutely everyone else, there are many options with an MD/PhD, and oftentimes you have to sacrifice something... but it's hard to know what the dimensions are early in your career. For the trainees, think broadly about your ultimate choice of specialty. As in any market, there are undervalued opportunities out there, but information doesn't exactly flow freely. Forums like these (actually, just this one) is the only one I've found where people post remotely useful career planning advice for MSTPs.

Trainees and mods - any interest in creating a sticky / private verified subforum / anonymous posting mechanism to share details about career trajectory and finances?

This entire thread is extremely helpful to me. Really appreciated all the discussions and enjoyed reading them.

 

[Lucca]

or, or, or....you can get your 400k, do science, live in a beautiful and absurdly high COL area, and rent. To paraphrase absolutely everyone else, there are many options with an MD/PhD, and oftentimes you have to sacrifice something... but it's hard to know what the dimensions are early in your career. For the trainees, think broadly about your ultimate choice of specialty. As in any market, there are undervalued opportunities out there, but information doesn't exactly flow freely. Forums like these (actually, just this one) is the only one I've found where people post remotely useful career planning advice for MSTPs.

Trainees and mods - any interest in creating a sticky / private verified subforum / anonymous posting mechanism to share details about career trajectory and finances?

if ppl are interested i can float it with other admins. Technically, the verified physician forums could serve this purpose for people who are residency and above

 

[ChordaEpiphany]

You make it sound like you have all this choice of where to become faculty. I applied all over the country for both residency and faculty positions and essentially matched in a place that was unexpected and then had one offer for a faculty job afterwards in a very HCOL location. You're looking at $1 million minimum for a house without a big commute.

Housing costs remain a serious issue for my family and I. It's not like I can just move to Salt Lake City to get away from it.

I do have a friend who offered me a private job in the SF bay area if I wanted to bail to private practice. I looked at housing in the suburb I'd be working in: $2 million was the cheapest 3 BR house on the market. I politely declined. I don't know how people do it--a lot of family money, older people who have owned for many years, side hustle, never owning, etc.

I would think the approach here would be to buy a cheaper place first and then upgrade when you have the savings. For instance, if your first place costs $1M, your down payment is on the order of $100,000 (doable to save in a year or two for an MD/PhD with minimal debt and a $250K salary, living like a resident). Mortgage would be ~5k/month on a 30 year mortgage, which is just about in range of affordable. Then, if you're making $350K 10 years later, and your investments are adding another ~50-100k/year in growth, you can reasonably upgrade. Maybe add a few years to this scenario to account for closing costs on either end of the deals, but it feels doable, or at least better than throwing away money on rent.

I'd also imagine this becomes way more doable if you've got a second income. Most MD/PhDs I know have well-educated spouses making at least six figures. So I'd imagine a $1.5M home looks a lot less daunting when you're making the initial $250k plus another $100k+ from your spouse.

 

[tr]

if ppl are interested i can float it with other admins. Technically, the verified physician forums could serve this purpose for people who are residency and above

I would be interested. I would be more willing to share personal, university-specific experiences in a closed forum. I don't necessarily want to dox my institutional affiliation to the world at large, indefinitely.

Also, I don't think the verified physician forum serves the purpose. This is a very small group of people with a very specific set of career concerns that aren't of interest to the general population on that forum, and also it sounds like it is useful for people who are still in their MSTPs (i.e., not yet verified physicians) to have access to this type of discussion.

 

[tr]

You make it sound like high quality universities in the south and midwest will automatically want me in return!

Does the availability of research/academic positions follow the same trend as job opportunities for a specialty in general...? As in, if a clinical specialty is in demand, you would expect more jobs to open in academia as well, and vice versa, or there's no correlation?

I don't have data on this but my suspicion is that there must be some effect, because the more in-demand and higher-paid the specialty is, the more powerful the draw away from academics, reducing the competition for those who stay. Just guessing at the numbers, if you would make $230K as an IM hospitalist at a community hospital and $180K in a starting assistant prof job, OK the salary is better outside academics but research/lifestyle/perks mean it's not an unreasonable choice. If you can make $800K in a surgical practice, staying in research with a salary limited by the NIH cap (plus whatever you can pull in with your 20% clinical time) starts to look like an incredibly bad deal. Hence for the few diehards from highly paid fields who choose to stay in academics, I would suspect there is not as much competition. **I could be wrong though, having no direct experience of anything outside psychiatry.

 

[StIGMA]

none of the places I’ve looked at jobs have been capped at/near NIH max for research effort. I’m sure places do that to argue to pay you less, but it’s not everywhere. In my procedural field physician scientists are more often offered the same total salary (average mid 300s starting) as same level academic clinical colleagues. There are universities that underpay, but you don’t have to work for them unless no other options I suppose. Assoc prof, 80/20 at my uni (top20s major research uni) salary is 500k. Not much upward mobility once at that point though unless take major admin role like chair. Point being in the right fields/places academics can pay well for science without a side hustle.

trick is to be competitive for the 80/20 job out of residency/fellowship and avoid extra postdoc years. Tough to do but it’s doable.

other problem is this stuff is so niche it’s really field/department/uni dependent. I could only advise you well regarding micro details/specifics if you were in my field. I have no clue what other specialties are willing to pay. You need to have an advisor in the field willing to share some of this info with you if it matters to you (and it should) if thinking about very specific speciality choices.

 

[SurfingDoctor]

You make it sound like high quality universities in the south and midwest will automatically want me in return!

Does the availability of research/academic positions follow the same trend as job opportunities for a specialty in general...? As in, if a clinical specialty is in demand, you would expect more jobs to open in academia as well, and vice versa, or there's no correlation?

Academic jobs and research jobs are often disconnected and shouldn’t be equated as the same. Working in academics literally means just that, you work for an academic non-profit. Certainly you may do research, but first and foremost, you are a warm body hired to practice medicine and generate revenues. There are physician scientists position, but they are more rare because they generate less revenue (and are essentially a cost to the institution till you get to the R level) and if your choose specialty is a procedural or higher RVU generating field, they are less likely to be interested in you farting around doing research and writing grants if you can be generating revenue. I’ve had several people hired in my division on a clinical educator or master clinician track who generate no research, just work and moonlight and take extra shifts. They have an academic job but have zero research productivity (and since they generate RVUs... no one cares). They also make more in income cause it’s eat what you kill generally.

 

[Neuronix]

Assoc prof, 80/20 at my uni (top20s major research uni) salary is 500k.

Wow ... You hiring? I mean it is significantly less where I'm at and we're in the same specialty.

 

[Spacedman]

Assoc prof, 80/20 at my uni (top20s major research uni) salary is 500k. Not much upward mobility once at that point though unless take major admin role like chair. Point being in the right fields/places academics can pay well for science without a side hustle.

Pretty sure we're in different fields, but description is quite similar - AFAIK the major reasons this exists in my specialty include 1) brain drain to PP 2) strong billing [see #1] 3) a perverse need by the dean to dominate rankings in every category.

Hence for the few diehards from highly paid fields who choose to stay in academics, I would suspect there is not as much competition. **I could be wrong though, having no direct experience of anything outside psychiatry.

In my experience, yes. Seriously doubt I'd be competitive for a faculty spot at my institution if I were in a more traditionally MDPhD heavy dept. I mean, I'm awesome, but...

other problem is this stuff is so niche it’s really field/department/uni dependent. I could only advise you well regarding micro details/specifics if you were in my field. I have no clue what other specialties are willing to pay. You need to have an advisor in the field willing to share some of this info with you if it matters to you (and it should) if thinking about very specific speciality choices.

This could be a major asset to trainees if set up correctly - I've seen other forums set it up as a mod posts submitted answers to a FAQ under their user to preserve some anonymity

 

[SurfingDoctor]

Wow ... You hiring? I mean it is significantly less where I'm at and we're in the same specialty.

That salary is significantly more than my division chief who is a tenured professor.

Finding a job like that is a complete crapshoot... and also probably unnecessary in the end.

 

[SurfingDoctor]

Somewhat relevant to this topic.

From the 'perfect' salary to keeping up with the Joneses, here's how money really affects your happiness

"The data really suggests that money doesn't work in the way we think," Laurie Santos, a psychology professor who teaches the science of happiness at Yale University and hosts the podcast "The Happiness Lab" tells CNBC Make It.

www.cnbc.com

Now, I’m not suggesting 95K is appropriate (it’s probably okay in some places, but not in others... looking at you San Francisco) but I would say some of the most dysfunctional home lives I’ve seen come with more money. It’s not a given but as The Notorious BIG said... mo money, mo problems.

 

[Alyssum]

none of the places I’ve looked at jobs have been capped at/near NIH max for research effort. I’m sure places do that to argue to pay you less, but it’s not everywhere. In my procedural field physician scientists are more often offered the same total salary (average mid 300s starting) as same level academic clinical colleagues. There are universities that underpay, but you don’t have to work for them unless no other options I suppose. Assoc prof, 80/20 at my uni (top20s major research uni) salary is 500k. Not much upward mobility once at that point though unless take major admin role like chair. Point being in the right fields/places academics can pay well for science without a side hustle.

trick is to be competitive for the 80/20 job out of residency/fellowship and avoid extra postdoc years. Tough to do but it’s doable.

other problem is this stuff is so niche it’s really field/department/uni dependent. I could only advise you well regarding micro details/specifics if you were in my field. I have no clue what other specialties are willing to pay. You need to have an advisor in the field willing to share some of this info with you if it matters to you (and it should) if thinking about very specific speciality choices.

Obviously nowhere near that actual amount for either starting or mid-career salary, but your your advice overall matches up to what I hear IRL (i.e. can expect roughly comparable salary to academic clinical colleagues as a physician scientist). I'm trying to figure out if this could be from selection bias, since the people most willing to share this kind of info in real life are also those who are the most happy with their offers. I'm sure these things are highly specialty dependent too. Will absolutely try to avoid extra postdoc years.

 

[tortuga87]

Somewhat relevant to this topic.

From the 'perfect' salary to keeping up with the Joneses, here's how money really affects your happiness

"The data really suggests that money doesn't work in the way we think," Laurie Santos, a psychology professor who teaches the science of happiness at Yale University and hosts the podcast "The Happiness Lab" tells CNBC Make It.

www.cnbc.com

Now, I’m not suggesting 95K is appropriate (it’s probably okay in some places, but not in others... looking at you San Francisco) but I would say some of the most dysfunctional home lives I’ve seen come with more money. It’s not a given but as The Notorious BIG said... mo money, mo problems.

This may be true on average, but for us higher passive income = more time and freedom to do research.

If you are able to make 250K of extra income to spend on research per year, then that's equal to being a continuously funded with one R01 grant (direct costs) at least moneywise. The problem with grants is they take active work and the money does not compound, so PIs just end up continuously writing them even when they are 50.

 

[Lucca]

This may be true on average, but for us higher passive income = more time and freedom to do research.

If you are able to make 250K of extra income to spend on research per year, then that's equal to being a continuously funded with one R01 grant (direct costs) at least moneywise.

I once joked to my lab mates like 4 years ago that the smart 21st century play to fund basic science is to contract with a big gaming / streaming / content star and use the revenue to fund research.

I know now I shouldn’t have been joking with esports companies valued in the hundreds of millions with tens of millions in revenue.

The Most Valuable Esports Companies 2020

Esports valuations have flatlined to an average $240 million, investors have cooled, and companies are scrambling to diversify.

www.forbes.com

I have a friend from college who is a very popular Internet personality and in their PhD probably making múltiples what their PI does from merch.

 

[Alyssum]

Somewhat relevant to this topic.
https://www.cnbc.com/2020/05/26/how...ay-you-spend-money-affect-your-happiness.html

Adding to what @tortuga87 said, happiness now is also different from happiness in retirement, assuming we all live that long. You need the extra not to use now but for things like kids going to college, other possible future needs, etc.

This could be a major asset to trainees if set up correctly - I've seen other forums set it up as a mod posts submitted answers to a FAQ under their user to preserve some anonymity

Absolutely. I think there's a lot of value to listening to what people have to say anonymously, and also to ask questions that are harder for us trainees to ask overall. In real life I'm generally quite careful not to give the impression to my mentors that I could be leaving research for PP (though of course I'm always looking at different opportunities).

 

[SurfingDoctor]

This may be true on average, but for us higher passive income = more time and freedom to do research.

If you are able to make 250K of extra income to spend on research per year, then that's equal to being a continuously funded with one R01 grant (direct costs) at least moneywise. The problem with grants is they take active work and the money does not compound, so PIs just end up continuously writing them even when they are 50.

I don’t understand what you mean. No one spends their own money to do research. It’s also never been my experience that making more money equates to more free time to pursue personal interests. In fact, it’s typically the opposite. Most people who are high income earners live to work, not work to live.

 

[Neuronix]

No one spends their own money to do research.

You sure?

 

[SurfingDoctor]

Adding to what @tortuga87 said, happiness now is also different from happiness in retirement, assuming we all live that long. You need the extra not to use now but for things like kids going to college, other possible future needs, etc.

Most of that is just a matter of planning early enough though.

 

[SurfingDoctor]

You sure?

I’ve never seen it. I guess I’m colored by my own experiences though. Doing more clinical time to generate RVUs to do personally funded research seems like a self-fulling prophecy.

 

[dl2dp2]

**I could be wrong though, having no direct experience of anything outside psychiatry.

You could be wrong even inside of psychiatry. Many examples.

I could only advise you well regarding micro details/specifics if you were in my field. I have no clue what other specialties are willing to pay. You need to have an advisor in the field willing to share some of this info with you if it matters to you (and it should) if thinking about very specific speciality choices.

Exactly.