Hello all! This is my first time posting, but I've been a lurker on this forum for about a decade.
Background:
I'm an MD/PhD grad on the wrong side of 30 who just wrapped up residency interviews with IM PSTPs and categorical IM programs. I'm interested in one of the three competitive IM subspecialties. I interviewed at several excellent "Top 20" type programs (inclusive or peers of Vandy, Mayo, WashU, etc.). My PhD was moderately productive (5 first author papers in field-specific journals) and involved translationally oriented device development and computational work. (~50% of my time was coding.) I have no interest in traditional wet lab benchwork.
The normal categorical IM track involves 3 yrs of IM and 3 yrs of fellowship (the last fellowship year is often a research year at academic programs). So, total six years + any super fellowships or additional research years. PSTP programs involve two yrs of IM, two yrs of clinical fellowship, and three yrs of 80/20 research (Total seven years + any super fellowships). The benefits of a PSTP include a fellowship guarantee, protected research years, two instead of three years of IM, and a small salary bump at some institutions. You do retain the option to leave the PSTP or apply externally for fellowship just like a regular applicant. Programs like to see trainees get a K or an equivalent career-development award in the last research year leading up to a tenure-track 75/25 research/clinical position. At most programs, if you don't have external funding by the end, you are either appointed to a majority clinical position, or to a low-paid instructorship position (with a 75/25 balance) until you secure funding.
Career goals:
I'd like to have a mixed clinical/research career in academic medicine. I'm also open to working for or collaborating with industry, if the opportunity is right. Broadly speaking, my research interests involve utilizing computational techniques (ie, ML/AI) for applications relevant to patient care. However, I'm struggling on whether I want to pursue the traditional 80/20 physician scientist route (K -> RO1, etc.). Research gives me a lot of satisfaction and I would love to spend most of my time on it, but I worry that the high failure rates, grant pressure, and relatively low salary are unsustainable over the long term. A purely clinical career is not right for me either, so I wonder about whether I would be happier in a co-PI or collaborator role with closer to a 50/50 split (is that even possible?).
Questions for the forum:
1) Would you recommend that I do a PSTP? The advice I've gotten is to only do it if you're fully committed to an 80/20 career, since it's (at minimum) an extra year, and you get less robust clinical training that can limit you if you end up in a clinical career. I would love to have an 80/20 career doing research that will impact patient care, but I'm only willing to give up so much $$, time, and stress to make it happen. The idea of being in my late 30s, unfunded, and spending years struggling in the netherworld as an instructor is not appealing - I want more stability and income. Others that I have met (albeit early in GME training) seem to be all-in and do not express those insecurities, at least not openly. If my mindset is "reach for the stars, and if I fail, I land on the moon", is a PSTP worth it given the downsides?
2) On that note, what options are there to do or at least be involved with meaningful research outside of a traditional 80/20, RO1 PI path? By meaningful, I mean something beyond publishing a few case reports or small retrospective studies here and there.
3) Most of the advice that I hear is meant for those hoping to run wet labs. Logistically, what advantages or disadvantages do dry researchers have in setting up a physician-scientist career? For example, if I am unfunded at the end of a PSTP, not interested in an instructorship, and therefore am shunted to a majority clinical position, is it potentially more feasible to submit grants based on computational analyses of clinical data compared to wet-lab researchers, due to fewer infrastructure and lab upkeep requirements? What about greater opportunities for industry funding?
4) I would love advice on ranking programs, as there are so many factors (location, PSTP vs categorical, prestige of institution, research mentors). For example, how should I rank a program in a city that I would love to be at long term but is a weaker research fit, versus a similarly prestigious program that is the best research fit, but is in a city that I don't see myself long term as faculty? What about a regular categorical track in a great city, versus a PSTP with a good research fit but is in a city that I wouldn't want to live in for 7 years? The fellowship guarantee and ability to do 2 years of IM are nice, but are they worth 7 years? Obviously, I know these decisions are highly dependent on one's personal situation, but I'd love to get some insight on the relative importance of these factors, and how others navigated these situations. How much benefit does the PSTP track really add? For example, I could do 3 years of categorical IM in a location I'm happy at without a guarantee, and still likely be a competitive fellowship applicant.
Thanks for making it all the way through this! @Neuronix @dl2dp2 @SurfingDoctor
Background:
I'm an MD/PhD grad on the wrong side of 30 who just wrapped up residency interviews with IM PSTPs and categorical IM programs. I'm interested in one of the three competitive IM subspecialties. I interviewed at several excellent "Top 20" type programs (inclusive or peers of Vandy, Mayo, WashU, etc.). My PhD was moderately productive (5 first author papers in field-specific journals) and involved translationally oriented device development and computational work. (~50% of my time was coding.) I have no interest in traditional wet lab benchwork.
The normal categorical IM track involves 3 yrs of IM and 3 yrs of fellowship (the last fellowship year is often a research year at academic programs). So, total six years + any super fellowships or additional research years. PSTP programs involve two yrs of IM, two yrs of clinical fellowship, and three yrs of 80/20 research (Total seven years + any super fellowships). The benefits of a PSTP include a fellowship guarantee, protected research years, two instead of three years of IM, and a small salary bump at some institutions. You do retain the option to leave the PSTP or apply externally for fellowship just like a regular applicant. Programs like to see trainees get a K or an equivalent career-development award in the last research year leading up to a tenure-track 75/25 research/clinical position. At most programs, if you don't have external funding by the end, you are either appointed to a majority clinical position, or to a low-paid instructorship position (with a 75/25 balance) until you secure funding.
Career goals:
I'd like to have a mixed clinical/research career in academic medicine. I'm also open to working for or collaborating with industry, if the opportunity is right. Broadly speaking, my research interests involve utilizing computational techniques (ie, ML/AI) for applications relevant to patient care. However, I'm struggling on whether I want to pursue the traditional 80/20 physician scientist route (K -> RO1, etc.). Research gives me a lot of satisfaction and I would love to spend most of my time on it, but I worry that the high failure rates, grant pressure, and relatively low salary are unsustainable over the long term. A purely clinical career is not right for me either, so I wonder about whether I would be happier in a co-PI or collaborator role with closer to a 50/50 split (is that even possible?).
Questions for the forum:
1) Would you recommend that I do a PSTP? The advice I've gotten is to only do it if you're fully committed to an 80/20 career, since it's (at minimum) an extra year, and you get less robust clinical training that can limit you if you end up in a clinical career. I would love to have an 80/20 career doing research that will impact patient care, but I'm only willing to give up so much $$, time, and stress to make it happen. The idea of being in my late 30s, unfunded, and spending years struggling in the netherworld as an instructor is not appealing - I want more stability and income. Others that I have met (albeit early in GME training) seem to be all-in and do not express those insecurities, at least not openly. If my mindset is "reach for the stars, and if I fail, I land on the moon", is a PSTP worth it given the downsides?
2) On that note, what options are there to do or at least be involved with meaningful research outside of a traditional 80/20, RO1 PI path? By meaningful, I mean something beyond publishing a few case reports or small retrospective studies here and there.
3) Most of the advice that I hear is meant for those hoping to run wet labs. Logistically, what advantages or disadvantages do dry researchers have in setting up a physician-scientist career? For example, if I am unfunded at the end of a PSTP, not interested in an instructorship, and therefore am shunted to a majority clinical position, is it potentially more feasible to submit grants based on computational analyses of clinical data compared to wet-lab researchers, due to fewer infrastructure and lab upkeep requirements? What about greater opportunities for industry funding?
4) I would love advice on ranking programs, as there are so many factors (location, PSTP vs categorical, prestige of institution, research mentors). For example, how should I rank a program in a city that I would love to be at long term but is a weaker research fit, versus a similarly prestigious program that is the best research fit, but is in a city that I don't see myself long term as faculty? What about a regular categorical track in a great city, versus a PSTP with a good research fit but is in a city that I wouldn't want to live in for 7 years? The fellowship guarantee and ability to do 2 years of IM are nice, but are they worth 7 years? Obviously, I know these decisions are highly dependent on one's personal situation, but I'd love to get some insight on the relative importance of these factors, and how others navigated these situations. How much benefit does the PSTP track really add? For example, I could do 3 years of categorical IM in a location I'm happy at without a guarantee, and still likely be a competitive fellowship applicant.
Thanks for making it all the way through this! @Neuronix @dl2dp2 @SurfingDoctor