Jdelighted Hughes had been assured by mentors and peers that he was a favorite for a super-competitive dermatology residency: he had a dual degree from Harvard University, experience as a clinical researcher at a tech startup from health and a CV with nearly 40 publications and four patents. Yet during Match Week in March, he failed to land a residency slot, with 7.1% of fourth-year medical students in the United States.
While many in his position were upset, Hughes said he was relieved. His part-time job at a startup had pushed him into the industry. Match’s push was all he needed to embark on this new path. Now he could give up the long hours and low wages of residency for a comfortable lifestyle in industry.
From the start of medical school, Hughes had dreamed of eventually founding a biotechnology company that could sell drugs, devices, and diagnostics at low prices, while practicing medicine to inform his work in industry. His vision for the transition from academic medicine to industry put him in good company. Out of 2,969 new PhD recipients. in the life sciences surveyed in 2020, 43% said they had engaged in employment in industry or business – a jump of 10 points from 2015, according to the Survey of Earned Doctorates, administered by the National Center for Science and Engineering Statistics. Only 37% said they would continue their education, down 9 points from 2015.
With both an MD and a Ph.D., Hughes is one of those graduates ready to leave academia. Her story shows why so many others have made the same choice.
After dinner one night in 2020, Hughes’ wife Melany Park, newly in her third trimester, said she had an upset stomach. When she went to the bathroom, she realized that it was more serious: she was losing blood rapidly, after her placenta, which had nourished her fetus, broke away from inside her uterus. Park was rushed to hospital for an emergency C-section, and at 29 weeks their daughter Isla was born prematurely. She spent the next two months in the intensive care unit.
Park and their daughter recovered, but the medical crisis changed how Hughes viewed residency and how to balance his career ambitions with his family. Isla needs a list of specialists, including a neonatologist and an occupational therapist, to help ensure she meets her childhood developmental milestones. So Hughes narrowed his residency selection to five programs near their home in Massachusetts and other cities with appropriate early childhood services and where his wife could find work as an architect.
He knew he was taking a risk, especially as a candidate for dermatology, a specialty that nearly 20 percent of U.S. applicants don’t fit. But now, in his thirties, with a dependent wife and child at home, if he couldn’t do his residency on his own terms, Hughes was fine with not going at all. “The Match system forces despair in people,” he said. “I didn’t want that lack of control.”
Hughes applied to medical school because he wanted to have a direct positive impact on someone’s life. As a child, he watched his father take care of his grandmother, who struggled to breathe as emphysema destroyed the airways in her lungs. After getting his master’s degree, needing a job and a place to live while he applied to medical school, Hughes became a live-in caregiver himself after responding to an ad on Craigslist, posted by a man with multiple sclerosis. In the second year of his doctoral program, Hughes resumed that role, this time with Park, his then-fiancée: at Harvard, they lived with and cared for Jack L. Strominger, a renowned immunologist.
It was this same desire to help others that drove him to embark on the long and exhausting path of medical training. During his freshman year at Harvard, he worked in a lab that developed Seq-Well, a cost-effective and portable way to analyze gene expression in cells. With all the tools he needed in a Black Pelican suitcase, he traveled to South Africa, the first of many countries on six continents he would visit to share the technique, which helped galvanize scientific research. , especially in places with limited resources.
Inspired by this work, he decided to pursue a doctorate in immunology in addition to a medical degree. Hughes was encouraged by Strominger to pursue the “big” science questions that fascinated him – like how the immune system fights tuberculosis or how cells mutate in metastatic cancer.
Hughes said while he enjoyed his time in the lab, fatigue set in: he spent long hours refining lab techniques, writing papers and traveling to share research globally. . As he was weary in the final stages of his PhD, he heard about a company called nference, a local health tech startup. He applied for and got a job as a clinician-scientist there to help support his family during his medical training. “It was a breath of fresh air,” he said.
He found that he was drawn to industry, more than to work in academic medicine. He felt a weight on his shoulders when he thought of a life without the hustle and bustle of publishing research, winning grants, and winning academic promotions. In exchange for 80-hour work weeks as a resident doctor, he planned to be home to watch his toddler grow. He also considered that an industry salary would provide a much more decent salary: for an entry-level position, he was offered more than four times the median resident salary.
“Money seems simpler, compared to the currencies of authorship, attribution and credit in academia,” Hughes said. Plus, the startup felt team-oriented in a refreshing way. He was especially pleased that the mission of his job, which uses AI to analyze health records, aligned with what motivated him to apply to medical school in the first place: to improve patient care.
When news arrived on the third Monday in March that Hughes had not matched residency, he felt no pressure to rush for the remaining spots. He was offered a vacant clinician-scientist position at a dermatology residency on the West Coast, but turned it down. He said he would have felt selfish if he had picked up his family and moved them across the country. He thought of the two lanes ahead of him. In industry, he felt he could still have a positive impact that would help the work of frontline healthcare workers, and he could still tackle challenging and exciting scientific questions. He therefore chose to move into a full-time position as a clinician-scientist at nference.
For Hughes, no door remains closed, but he says he would struggle to apply for residency again. He recently met Strominger, both mentor and recipient of his care. Unsure of Strominger’s reaction, he told him he planned to turn to industry. Now retired from the lab, Strominger gave Hughes his blessing for the next leg of his journey.
Even in his 90s, you could still find Strominger in the lab, asking new research questions, looking at slides under the microscope, and having his eyes light up when he learns something new. He had a career rich in history: he won the Lasker Prize in 1995 and trained directly or through lineage most immunologists at Harvard.
But for Hughes, “that kind of career never looked exactly like what I wanted,” he said. “Now I have the opportunity to redesign my life and help others redesign their paths as well.”