From which specialties do MD/PhDs tend to end up in private practice

[Electricity]

I thought you all might be interested in a large study of US MD/PhD programs that was recently published: History and Outcomes of 50 Years of Physician-Scientist Training in Medical Scientist Training Programs. - PubMed - NCBI

They quote an interesting break-down of the percentage of MD/PhD graduates entering private practice by specialty (from a previous 2014 article by Brass et al.):

Specialties with <20%:
- Pathology (8%)
- Psychiatry (12%)
- Pediatrics (13%)
- Neurology (13%)
- Radiation oncology (15%)
- Internal medicine (16%)

Specialties with >40%:
- Radiology (41%)
- Ophthalmology (44%)
- Dermatology (44%)
- Emergency medicine (46%)
- Family medicine (62%)

Seems to roughly track historical salaries/opportunities in private practice, with family medicine being a major outlier.

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[Neuronix]

We've discussed this before.

To my mind, this distinction doesn't really matter. Most academic positions for junior faculty are mostly clinical anyway. You're not going to be using your PhD in that 80% clinical "clinical assistant professor" position.

What you really want to know is what percentage have serious grants or serious protected research time like 50/50 or more. We don't have that breakdown. I can tell you in rad onc physician-scientists are extremely rare despite the high numbers of us in academic practice.

 

[Electricity]

Sorry if this specific aspect of the article has been discussed before.

Perhaps a more helpful breakdown would be % of MD/PhD's in academia relative to the overall % of academics in the specialty?

I tried 5 minutes of googling to find this data, but didn't have much success. I don't know how much variation there is between specialties on this metric.

 

[Neuronix]

That's ok to bring this up. I didn't really mean it that way. I don't want to stifle conversation and I don't think we mind discussing again.

The point I wanted to drive home is that to me it doesn't really matter how many MD/PhDs are in academia. Academia used to be a place where you saw fewer, more complicated patients and were super specialized in order to build a focused clinical practice that hopefully fed into your research niche. There are some established folks who still have this.

Nowadays, academia is rapidly expanding and taking over or competing with private practices. Most jobs are similar if not identical to the private practice jobs 10 years ago. The academic mission is getting lost in the environment of poor research funding and dwindling clinical reimbursements. For new grads, the options are mostly clinical even within academics.

Therefore the idea of a specialty having more practitioners in academics vs. private practice is meaningless to me. They're rapidly converging to the same thing, with rare exceptions.

 

[SurfingDoctor]

I would disagree that academia sees the same patient population as private practice. It is probably specialty specific, but generally speaking for inpatient-related specialties, the more complex patients are still taken care of more commonly at academic centers compared to private practice. The reasons are multitude (though commonly related to insurance, as the two are tied), but the data supports this.

This is all irrespective of research though. Complex patient with complex needs = costly care. The best way to offset the costs is through billing of complex care. Research has nothing to do with this equation and generally speaking, though it generates revenue to the medical center/university through indirect costs... it is a money losing strategy for hospitals. Certainly, research enterprise offers prestige which accounts for something (mostly medical student/resident enticement and draw of the lay population), but research does not help play the revenues that the clinical enterprise does. Thus, there is more of a shift in academics toward the clinical enterprise and less of the research enterprise because the former makes the hospital bottom line better. That is the reality.