Clinical Research: Is an MD necessary?

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Hi - So I am on the fence between pursuing an MD or PhD and would like your insight. I'm uncertain about an MD/PhD since I am a non-traditional student and not the brightest of the brightest.

I had previously done work in clinical research as a clinical research associate and enjoyed the patient contact and advancing scientific knowledge. I am curious as to what are the pros and cons of getting an MD vs. PhD if my career goal is clinical research whether in academia or industry? Also, not sure if this makes a difference but I would prefer a more family-orientated lifestyle (i.e. 9-5). I am particularly interested in regenerative medicine, so what do you believe are the prospects for a MD vs. PhD in this field?

I appreciate all constructive criticism.

I would love an answer to this question--and if an MS degree that offers clinical research opportunities is possible, as well, I would love to know.

The problem is the graduate school programs I find for clinical research tend to be for after someone completes an MD, and those are only MS degrees. I can't seem to find a PhD program that would allow someone to conduct clinical research without an MD!

I guess no one on the board can provide any advice regarding this situation?

I have been looking around a bit, Algophiliac. I agree that it seems that clinical research is reserved for healthcare professionals, but I have noticed that another pathway is by getting a basic science PhD and then gain training via another PhD or MAS program tied with the institution. Or there is also the NP or PA-C to PhD route. Another possible route is through a translational research PhD program. Depending on one's research interest, there is room for biomedical devices and drug trial research in translational research.

From what I've investigated, an MD/DO seems to be necessary if you want complete freedom in clinical research.

When I worked as a CRA, the majority of the hands-on work was completed by myself and the nursing staff with the MD signing off on things. I'm not sure if getting into medical school debt is worth the MD clinical research route. Sigh.

PhDs can and do design, create, and manage clinical trials—especially in the industry. If you look through the profiles of managers, directors, etc. in big pharma., many are PhDs. These are the people behind the scenes running the trials.

If you want to be on the front line of trials—actually managing the patients and not necessarily the trial itself—then I would suggest pursuing an MD.

PhDs can be involved in clinical research but cannot be involved in patient care.

I usually recommend an MD over a PhD. The job market for PhDs is awful. The competition for positions is extreme. The pay and job security, even in the research world, for a MD is far better than for a PhD.

So sure a PhD can do clinical research. But, if you want to work with patients, I'd recommend becoming a board certified physician.

MD/PhD is primarily intended to produce basic science researchers. You do not need, or probably even want, to perform a MD/PhD for a clinical research career. An MD only with research time (1 or 2 years in med school/residency) is sufficient.

Thank you guys for your input. I would agree that a PhD can run clinical research, but of course no patient care.

Does anyone happen to know if there are many PA or NP with a PhD running clinical trials?

How would one begin a clinical research track once in medical school? Are there many MDs that pursue this path? I read from a clinical and translational science PhD website (forgot which school specifically) that <5% of MDs pursue a research career. Also, how is the pay for an MD in clinical research? Would it be sufficient to pay off the medical school loans in a timely manner (e.g. 10 years)?

I really appreciate your feedback, since I am on the fence between applying for MD/DO or PhD program.

Originally Posted by SilentNight

I guess no one on the board can provide any advice regarding this situation?

I have been looking around a bit, Algophiliac. I agree that it seems that clinical research is reserved for healthcare professionals, but I have noticed that another pathway is by getting a basic science PhD and then gain training via another PhD or MAS program tied with the institution. Or there is also the NP or PA-C to PhD route. Another possible route is through a translational research PhD program. Depending on one's research interest, there is room for biomedical devices and drug trial research in translational research.

From what I've investigated, an MD/DO seems to be necessary if you want complete freedom in clinical research.

When I worked as a CRA, the majority of the hands-on work was completed by myself and the nursing staff with the MD signing off on things. I'm not sure if getting into medical school debt is worth the MD clinical research route. Sigh.

Thank you, this is very informative.

My main interests do correlate with both clinical and translational research pathways, but I am having difficulty locating any translational research PhD programs. Would you happen to have further information on these programs?

Neuronix, would you recommend considering an MD/MS or DO/MS program that focuses on clinical or translation research, instead? An MS in the basic sciences may also be beneficial to an MD applicant hoping to engage in future clinical or translational research, but I am not certain if it would be more or less helpful than other options.

In terms of the MD vs. DO options, could a DO possibly be a worse route to take in terms of research opportunities?

Originally Posted by Algophiliac

My main interests do correlate with both clinical and translational research pathways, but I am having difficulty locating any translational research PhD programs. Would you happen to have further information on these programs?

The problem with a "translational research PhD" is that nobody has a great definition for what exactly is translational research. I like to break PhDs down into basic science and social science because that's easier to define. MD/PhD programs are generally much more basic science leaning. I recommend them for people looking for a majority basic science career. But there are exceptions to this (social scientists mostly, but it's still relatively uncommon).

Neuronix, would you recommend considering an MD/MS or DO/MS program that focuses on clinical or translation research, instead? An MS in the basic sciences may also be beneficial to an MD applicant hoping to engage in future clinical or translational research, but I am not certain if it would be more or less helpful than other options.

Nobody can tell you for sure what your best option is. If you want to have a career that involves more than 20% clinical research (rough estimate), you'll need substantial research experience somewhere in your training. Whether you're best served by one year, a PhD, when that year is, what work it's in, nobody can really tell you for sure. There's no hard data on this. What I generally do is ask pre-meds what their interests are and go from there.

If you're leaning towards clinical/translational research more than 20% of the time, my standard advice is to try for a MD/MS program or other year out programs where you will get some experience (whether that's in social, basic science, or clinical research it's all based on you). Certainly any school will let you take a year out to get an extra degree (MPH, MS 1-2 years, or just a year out for research somewhere), but the question is whether you will get any medical school tuition break for doing this. Most schools you will not, and that's why CCLCM and Pitt's program are great. They force you to do it, but you get a nice scholarship in the process.

If you ask other people you might get slightly different answers because again this is my advice but there are no hard and fast rules.

In terms of the MD vs. DO options, could a DO possibly be a worse route to take in terms of research opportunities?

100 times yes. I get flamed occasionally by the DOs (or caribs) for this sort of talk, but DO programs are geared towards primary care. Their residencies are also geared towards primary care. DOs CAN match allopathic programs, but for big name academic places where you'd get the research training this is a big stretch. A few osteopathic schools are attached to allopathic schools, but otherwise the osteopathic schools have little research on their own. Sure, you can take time out to do research, but the opportunities are not like they would be for allopathic programs.

Wake Forest has now developed a PA/PhD program. Basically, they interviewed a bunch of MD/PhD types, and focused on those who were heavily involved in research. They asked if the MD degree was appropriate, not enough, or too much education for their research purposes.....

Many answered that from a research perspective that the MD was overkill. For clinical practice no, but that if they were primarily focused on research, that perhaps a different education would be better.

Hence the PA/PhD. It's a small program, and the first of it's kind.

Speaking as a PA with a research doctorate, I think it is a good thing. But I would caution, that it's difficult to know how popular this educational path will become however, as most PA's chose PA because they have no interest in conducting research.

Is the program fully funded? I.e. do students get full tuition and fee waiver and a stipend for all years in the program?

To be honest, I don't know those details, but I can certainly find out if you are interested....

Originally Posted by physasst

Wake Forest has now developed a PA/PhD program. Basically, they interviewed a bunch of MD/PhD types, and focused on those who were heavily involved in research. They asked if the MD degree was appropriate, not enough, or too much education for their research purposes.....

Many answered that from a research perspective that the MD was overkill. For clinical practice no, but that if they were primarily focused on research, that perhaps a different education would be better.

Hence the PA/PhD. It's a small program, and the first of it's kind.

Speaking as a PA with a research doctorate, I think it is a good thing. But I would caution, that it's difficult to know how popular this educational path will become however, as most PA's chose PA because they have no interest in conducting research.

I doubt adding the PA gives any real job security in comparison to a licensed MD, nor a competitive benefit when searching for jobs.

I wouldn't say that. My primary research revolves around health workforce, interprofessional dynamics and medical teams. The current demand projections for PAs nationally is far outpacing supply. New schools are starting almost monthly.

Our projections at my institution show flat, steady growth in physician positions, but an additional 1,000 (roughly) PA positions by 2015. How that ties in with research positions in a combined fashion remains to be seen, but I wouldn't simply discount it out of hand.

The simple fact is, we don't make even close to enough PAs or NPs to meet the coming demand. That is an entirely separate conversation however.

Originally Posted by physasst

I wouldn't say that. My primary research revolves around health workforce, interprofessional dynamics and medical teams. The current demand projections for PAs nationally is far outpacing supply. New schools are starting almost monthly.

Our projections at my institution show flat, steady growth in physician positions, but an additional 1,000 (roughly) PA positions by 2015. How that ties in with research positions in a combined fashion remains to be seen, but I wouldn't simply discount it out of hand.

The simple fact is, we don't make even close to enough PAs or NPs to meet the coming demand. That is an entirely separate conversation however.

I think it is a totally different conversation, having a PA split research and clinical time does nothing to help a shortage.

I am just saying I would guess, but have no data or anecdotes to substantiate it, that a PA/PhD would be much harder to hire compared to an MD/PhD. MDs can still pull more financial revenues. I guess conversely, a PA/PhD would command less of an income to start with.... so I could be very wrong.

As I understand it, an MPH is sufficient for most clinical research. Also, many people do 1-2 year research fellowships within med school and those are more than enough for designing studies, interpreting them, etc.

An epidemiology PhD is even more high-power but probably overkill if you want to do everyday clinical research. Maybe it's useful for more difficult-to-control stuff?

Yeah, it's really hard to know at this point how it will sort out. It's a new thing, and it will take time to see if it catches on, if graduates are working clinically, in research, or some combination. Would be an interesting retrospective study after 5 years or so.

Just wanted to point out that such a program does exist.

Originally Posted by Neuronix

Is the program fully funded? I.e. do students get full tuition and fee waiver and a stipend for all years in the program?

Spoke to a friend who is the director of the PA program there....Yes, they do, pay tuition, stipend, and fee waiver. Currently the program is working with a focus in Molecular Medicine for the PhD.

The director noted that like all programs, Wake Forest is having to cope with decreasing federal research dollars......so far, that hasn't affected the stipends, tuition, etc, but it certainly could in the future if the declines continue.

Wake forest only takes 2 MD/PhD students a year. They seem like a poor school to start a PA/PhD program, especially when their MD/PhD program barely exists. Maybe they have some cutting-edge PA program? This definitely is not a program I will recommend to anyone (PA/PhD) because I have serious doubts about job prospects as an academician. Furthermore, PA programs are typically 2.5 years, right? If the difference between MD/PhD and PA/PhD is one or even two years, the MD/PhD makes more sense (presuming the applicant seeks a career in biomedical research).

Originally Posted by StIGMA

Wake forest only takes 2 MD/PhD students a year. They seem like a poor school to start a PA/PhD program, especially when their MD/PhD program barely exists. Maybe they have some cutting-edge PA program? This definitely is not a program I will recommend to anyone (PA/PhD) because I have serious doubts about job prospects as an academician. Furthermore, PA programs are typically 2.5 years, right? If the difference between MD/PhD and PA/PhD is one or even two years, the MD/PhD makes more sense (presuming the applicant seeks a career in biomedical research).

They are taking 2-3 PA/PhD students at this time per year.

Job prospects are difficult to assess. Most current PAs with PhD's use the doctorate for teaching purposes and not as much for research. With that being said, there are some PAs out there with doctorate level degrees (ScD, DHSc, DrPH, PhD, etc.) who are grant funded and running studies/trials as a PI, albeit, not a huge number. One I know is at the senior VP level with the Lewin Group as a Health Policy researcher.

Will this change moving forward? Possibly...I think the concept is so early that it's too difficult to comment on whether job prospects will be good or bad. Just not enough information at this time.

It's an interesting idea. To me, full-funding indicates that this is a serious program and not just a hacked together thing. I'm not sure how I feel about PA/PhD overall. But thanks for the info.

Originally Posted by physasst

They are taking 2-3 PA/PhD students at this time per year.

Job prospects are difficult to assess. Most current PAs with PhD's use the doctorate for teaching purposes and not as much for research. With that being said, there are some PAs out there with doctorate level degrees (ScD, DHSc, DrPH, PhD, etc.) who are grant funded and running studies/trials as a PI, albeit, not a huge number. One I know is at the senior VP level with the Lewin Group as a Health Policy researcher.

Will this change moving forward? Possibly...I think the concept is so early that it's too difficult to comment on whether job prospects will be good or bad. Just not enough information at this time.

Might the academic job prospects depend somewhat on where one looks for a job? I assume most academic MD/PhDs look for jobs in medical schools or health science centers, correct? In this case, a PA/PhD might find it challenging to compete. On the other hand, if the PA/PhD looked for a position in a science department (biology, chemistry, etc) at the "regular" (ie non-med school) campus of the university, I would assume the PA credentials could make the applicant significantly more competitive than typical candidates. Of course, the obvious drawback is that these positions probably do not come with nearly as much potential support for any clinical research. But there exists the potential for clinical research via collaborative agreements.

Back to the idea of clinical
Research without An MD degree: has anyone looked into Clinical Research Coordinator (CRC) degree?

I think that is actually what the degree is called. A masters level degree I think?

These programs train people to work in pharma companies and help manage all the clinical trials that are running. I don't think it holds too much of the patient contact but would instead include contact with handling all the doctors, technicians etc. that actually run the trials.

I am also interested in fining out the pros/cons of adding the MD especially in radiology and brain imaging.. anyone with firsthand experience?

I'm currently based out of a large clinical research organization, and worked as a clinical research assistant as an undergrad. Some thoughts:

1. The master's programs in Clinical Research degrees designed for MDs / other providers wouldn't be very helpful if you didn't have clinical training. The objective of these programs is to give you a general understanding of the clinical research process and methods to enable you to participate as part of a research team via contribution of your clinical knowledge. However, if you have no clinical knowledge to contribute, the degree is really too general to enable you to provide much other value.
2. With some exceptions, Principal Investigator(s) will have a doctoral degree of some sort. For large-scale medical trials such as a Phase III pharmaceutical megatrial, it is most commonly an MD, with exceptions generally being biostats PhD or similar degrees. For trials of different kinds of questions (e.g., health services research, nursing, nutrition, health behaviors) and in observational studies (i.e., no randomization), there is much more heterogeneity in the backgrounds of the PIs with many disciplines represented.
3. In addition to PIs, there are many other doctorally-trained people who are involved in clinical research and play important roles in designing, conducting, and analyzing studies. For instance, MDs may serve on data safety monitoring boards, adjudicate outcomes, read test results, deliver experiemental care, etc. PhDs from a variety of backgrounds are essential members of the team; almost every clinical research project needs a PhD biostatistican or other quantitative analyst involved, and very often other PhD-trained people from a variety of backgrounds are essential as well.
4. A Clinical Research Coordinator is a professional whose job centers on the execution of clinical research. They do things like regulatory (e.g., IRB), subject recruitment and enrollment, completion of case report forms, etc. In general, people become CRCs either by being a healthcare worker (most commonly RN) first and moving into research, or by coming up the ranks in an organization by starting as a clinical research assistant after a non-clinical undergrad degree. Recently there as been a rise in clinical research coordinator degree programs, but at least where I am, people with this background are in the minority. Most people take shorter (1-2 months) courses instead, either between moving from clinical RN --> CRC, or when getting promoted from assistant. I think most CRCs would agree that "real world" experience whether as a healthcare worker or inside a CRO is more valuable than extensive formal coursework. As CRCs advance in their careers, they can move to positions of increasing responsibility coordinating bigger / multicenter trials, managing teams of other CRCs, etc.
5. If you want a clinical research career without a doctoral degree, there numerous other options besides the CRC track, including masters-level biostatistics, statistical programmers, accounting, legal, medical editors, illustrators, etc. It's a huge field with lots of opportunities beyond what I've outlined here - take a look at job openings at a place like Quintiles to get a flavor for all the people who are involved.

Originally Posted by Algophiliac

My main interests do correlate with both clinical and translational research pathways, but I am having difficulty locating any translational research PhD programs. Would you happen to have further information on these programs?

One place to start looking is with the HHMI Med into Grad Initiative. The goal of the program, as I understand it, is to try to produce more climically-oriented PhDs. They don't like to fund MD/PhD students though.