Tacky

Some non-physicians think physicians are overpaid. This physician disagrees, but does think that a number of specialties are way overpaid (I'm looking at you radiology, dermatology and some others--you know who you are).

After walking through a university parking lot while on a visit recently, I had these thoughts:
1. If you are in a highly paid specialty, there is no need to drive to work in a late model Ferrari. This is in bad taste in a time of great concern about health care costs.
2. Even if you feel that you need that Ferrari and need to drive it to work, you do not necessarily need vanity license plates that announce you paid for the vehicle by billing for your grossly over-compensated medical service.
3. All of the above is doubly true if you work for an academic medical center.

Part of a dying breed

The DrugMonkey blog is laden with the type of practical, career advice that I wish I had been given early on. I was thinking recently about a post from last year:

So noob, you put in one grant, it didn't get funded and you feel mopey? . . . .
It is not about what anyone else or the "typical" person has done. It is about doing whatever you possibly can do until that Notice of Grant Award arrives.
My stock advice right now is that you need to have at least one proposal going in to the NIH for each standard receipt date. If you aren't hitting it at least that hard, before you have a major award, you aren't trying. If you think you can't get out one per round.... you don't really understand your job yet. Your job is to propose studies until someone decides to give your lab some support.
My other stock advice is take a look at the payline and assume those odds apply to you. Yes, special snoflake, you.
If the payline is 10%, then you need to expect that you will have to submit at least 10 apps to have a fighting chance. Apply the noob-discount and you are probably better off hitting twice that number. It is no guarantee and sure, the PI just down the hall struck it lucky with her first Asst Prof submission to the NIH. But these are the kinds of numbers you need to start with.
Once you get rolling, one new grant and one revised grant per round should be doable. They are a month apart and a revision should be way easier. After the first few, you can start taking advantage of cutting and pasting a lot of the grant text together to get a start on the next one.

And also, in the same vein, this:

In the face of budgets which allow the funding of only a subset (a third? quarter?) of the grants which are excellent and interesting and impactful and all that jazz, review becomes variable. Meaning the difference between making it into a fundable score and just missing a fundable score takes on the appearance of chance. The only way to beat such odds is to give yourself more chances at the game. This means writing and submitting multiple applications (on different topics, of course).

And I was castigating myself: "how come I'm not doing this? I obviously need to submit more applications; why can't I find the time?"

And then it occurred to me: I was thinking this while I was writing a medical clearance letter on behalf of a patient.  And just before that, I was reading about an unusual case I saw in clinic on UpToDate. And I have my half day clinic the day after tomorrow, which, if you include associated documentation, follow-up, reading and responding to patient queries, really takes up a full day. And the month before, I was on the hospital consult service, which breaks up the day and eats up time. On top of that, I have the same responsibilities as DrugMonkey and most of his audience: stay up to date on the science literature, run a lab, write papers and, oh yes, write grant applications.

Another thing about DrugMonkey is that, as far as I can tell, he does not have kids at home. The thing about having kids is that when they're not driving you crazy--which, fortunately, tends to be more than 50% of the time--you want to spend time with them; and your spouse, also. In fact, now that I think about it, by virtue of being single, divorced or old enough to have adult kids, many (most?) of the investigators I know who are thriving in the current environment do not have kids at home.  Hmmm.

Medical students are smart. They can put two and two together: soft money salaries + historically low NIH grant success rates=job insecurity and potential for high stress.  "Fixes" for the system thus far proposed generally involve pumping more physicians into the system through training grants and lower barriers for initial R01 grant awards. Proposed measures seem to never involve increasing downstream job security. Our society idolizes youth. This includes the NIH: trainees and new investigators are loved.  Once you've been sucked into the system and you're trying to get your grants renewed, you're on your own buddy. Think the PhDs reviewing your grant applications or tenure file give a fig that you are a physician-scientist? Think again. Physicians in training--and this goes for MD-PhD students also--aren't blind: they see what is happening.

There: I've solved the puzzle of why medical students are less inclined than ever to do what I do for a living: of why predictions that physician-scientists are a "endangered species" are coming true.