PhD before an MD ? Jobs for MD/PHDs?

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Does anyone know or know of people who have their PhD's and then decide on getting an MD? If so what were their experiences?

Besides having ure own research lab or clinic, what kind of jobs do MD/Phds end up getting into?

any feedback would be greatly appreciated.

thanks!

Originally Posted by NinaC2006

Does anyone know or know of people who have their PhD's and then decide on getting an MD? If so what were their experiences?

Besides having ure own research lab or clinic, what kind of jobs do MD/Phds end up getting into?

any feedback would be greatly appreciated.

thanks!

I'm a PhD who is now in medical school. There are several other PhD to MDs around here on SDN, and at least one PhD to DO too. What exactly are you wanting to know about our experiences?

Hi,
I just wanted to find out what made u decide to do an MD after ure PhD?

Was the transition from PhD to MD difficult?

I'm contemplating going to medschool but i'm not sure if I'm making the right decision

What kind of jobs do you hope to get after completing medschool/residency?
Also the thought of loans is discouraging......what scholarships are available?

Originally Posted by NinaC2006

Hi,
I just wanted to find out what made u decide to do an MD after ure PhD?

Was the transition from PhD to MD difficult?

I'm contemplating going to medschool but i'm not sure if I'm making the right decision

What kind of jobs do you hope to get after completing medschool/residency?
Also the thought of loans is discouraging......what scholarships are available?

1) I got involved with clinical trials research while I was in grad school. The PI was also a PhD to MD, and he told me that if I wanted to continue doing clinical trials work, I should have the MD.

2) It's a different kind of challenge for sure. I'm not sure I'd say one is harder than the other; they are both hard in different ways. Med school is hard because of the sheer volume that you have to learn. I've just started, so I can't tell you anything yet about what the clinical years will be like, but that's my take on the preclinical work so far anyway.

If you're not sure whether you want to go to med school, you should definitely get some experience in a clinical setting. You'll need to do that anyway if you want to go to med school. Shadow doctors, volunteer in a hospital, etc. so that you can get some sense about whether this is something that you'd like to do. If you decide you do want to go, then you'll need to complete all the pre-reqs (probably not a problem if you're a science PhD) and take the MCAT. It's a long, hard road to apply, so don't do it unless you're absolutely sure that this is what you want.

3) I'm not sure yet. Right now my plans are to stay in academia, but I'd be open to going into industry too. I'm definitely planning to stay in research.

You should count on having to take out loans. Most if not all schools give grants based on need, and some give scholarships based on merit also. It is possible to get a scholarship (I did, actually), but they are MUCH harder to get for med school than they are for undergrad or grad school. Getting scholarships is so competitive that no one should count on receiving one. If you are over age 30 (which I am), some schools will consider you independent for financial aid purposes though, so you may be able to get significant need-based aid. I'm actually not having to take out any loans, but again, this is very uncommon for a straight-MD student.

Originally Posted by NinaC2006

I'm contemplating going to medschool but i'm not sure if I'm making the right decision

What kind of jobs do you hope to get after completing medschool/residency?
Also the thought of loans is discouraging......what scholarships are available?

Med school and PhDs lead to different careers and lifestyles. Most prominently, as an MD you'll have patients. You'll have a responsibility to help others get well. PhDs are commonly college professors and scientists. MDs often have private practices where they take care of a population that is referred to them. In the academic setting, the lines are a little more blurred, which may be what is causing some confusion for you.

A big 'advantage' that MDs have over PhDs is their training and their access to patients. In a research setting, no other profession can get human subjects, and has the personal experience with disease/disease treatment, like MDs.

PhDs have a much more focused area of expertise than an MD. Their lifestyle can be much easier or harder - it depends on how many papers you want to get out, how much grant money you want, and if you want tenure before you're 35. In that sense, they are more flexible than many MDs.

One of the best ways to make the decision is to talk to a PhD and an MD about their careers and what options the degree gave them. Shadowing a doc is another great way to see if patient care is for you.

Havarti666 is a PhD to MD. There's another person, who sometimes posts on the Non-Trad forums, who was an industry PhD for 10-15 years before he decided to become a MD, and their name is Learfan.

Hi,
I just wanted to find out what made u decide to do an MD after ure PhD?

*Primarily because I loved the daily contact with patients, and the ability to make a positive impact on someone's life right away. I felt that if I toiled away in basic science my entire life, I might not ever make a meaningful contribution in the alleviation of human suffering.

Was the transition from PhD to MD difficult?

*Not for me, it was easy. After going through the rigors of grad school you develop a tough skin, that many younger med students don't have. Med school is just about jumping through the hoops, and developing basic analytical skills. The information that your need for your career will mostly be gleaned during residency.

I'm contemplating going to medschool but i'm not sure if I'm making the right decision.

*What is your seed of interest in medical school? It is a huge time committment, and should not be undertaken for any other reason than you can't see yourself doing anything else. You need to volunteer in a hospital to see if it is what you like. Most people's preconcieved notions of what medicine is like are wrong.

What kind of jobs do you hope to get after completing medschool/residency?
Also the thought of loans is discouraging......what scholarships are available?[/QUOTE]

*Jobs include academic medicine, private practice, and pharmaceutical positions, as well as administration. And I disagree with Q that you need a MD to do translational and/or clinical research. Many MDs hire PhDs to run their clinical research programs. Scholarships are very very difficult to come by. Most can expect debt, unless indendently wealthy.

Best,
OtterCreek, M3, PhD

**What is your seed of interest in medical school? It is a huge time committment, and should not be undertaken for any other reason than you can't see yourself doing anything else. You need to volunteer in a hospital to see if it is what you like. Most people's preconcieved notions of what medicine is like are wrong.***

I want to do medicine because i miss the interaction with people. Like you mentioned, knowing that you have the ability to make a positive impact on someone's life and being able to see the effects right away. Research seems so "self-directed" i.e trying to publish in well known journals so that you look good, trying to get tenure, constantly stressing about running a lab and grants......Don't get me wrong I do really enjoy research itself but its so easy to lose the big picture. I want to be able to take bench side basic research to the clinic and actually know how to apply it and do more translational work. Throughout my PhD , there were days when i thought of applying to medschool but i brushed the thought away as i figured i was thinking this way because i was frustrated with my lab project not working etc.

I have talked to a few MDs, and they do mention pateint care and "helping people" is overrated in medicine. Others mention that you really don't need the MD degree as such to do translational research...getting work experience in the right labs is sufficient for doing that.

I know I do not see myself as an academic research scientist with my own lab but i want to be in a hospital setting or work for industry.

I've also heard that getting more degrees, just limits you in your job searches...you get overqualified and people don't want to hire you because they'll have to pay you more. Industries also prefer years of work experience.

I did shadow doctors during my undergrad but chose the PhD route...now I'm not sure. i guess i could take my MCATs and see how i do. Just the thought of loans and being stuck in years residency and then working to just pay back the loans....hmmmm

Any suggestions for what to use to study for MCATs, websites where i can find scholarship listings and advice on how manyschools /which ones to apply?

Also did you all know what you wanted to specialize in before u applied? I know it doesn't matter but just wondered...

thanks so much!

I agree about the human interaction aspect...that's my favorite part of medicine. I got tired of sitting at the bench with my pipetman.


Your quote describes me exactly, "I want to do medicine because i miss the interaction with people. Like you mentioned, knowing that you have the ability to make a positive impact on someone's life and being able to see the effects right away. Research seems so "self-directed" i.e trying to publish in well known journals so that you look good, trying to get tenure, constantly stressing about running a lab and grants......Don't get me wrong I do really enjoy research itself but its so easy to lose the big picture. I want to be able to take bench side basic research to the clinic and actually know how to apply it and do more translational work. Throughout my PhD , there were days when i thought of applying to medschool but i brushed the thought away as i figured i was thinking this way because i was frustrated with my lab project not working etc."

MDs saying helping people is overrated is just the natural process of cynicism that overtakes all of us when our expectations don't meet reality. I became deeply cynical about basic research after found out what it really entailed. And i really enjoyed certain aspects of it, and went into medicine even after several 'successful' projects in Oncology research (my doctoral research). but I could never see how these 'successful' projects really meant anything in the big picture.

Medicine is great because the rate of success is much much higher, and you can go home at night not worrying whether your novel results will repeat in time for the next departmental seminar.

In terms of the length of time, medschool only takes four years, and it's a guarenteed success; no suffering if the project fizzles where you have to start over. I look at residency as a job similar to a postdoc, except you get paid $45,000 starting, v. $30,000 for a postdoc. And the workload is no different in the current reseach climate with only the top 10% funded (thanks bush), and one has to work (and stress) even harder during the tenure process.

I took the Kaplan course for the MCAT. Apply far and wide. Having a PhD will bolster your app., but you have to be able to clearly articulate why you want to undertake this career change. I wouldn't mention interest in working for the industry. They are not interested in training physicians who aren't going to take care of patients.



Feel free to ask me any q's!
Best,
Matt.

I left a Ph.D. program and went into medicine, so I might have a light or two to shine on the topic.

First off, I wouldn't worry about getting "too many degrees." If you are a doctor with solid training and a good track record, you will not have a hard time finding work.

One thing that many people fail to realize is that any M.D. can go into academic research if he or she wants to. The pay may be lower than operating a private practice, but an M.D. can still apply for research grants and so forth. Also, not all practicing doctors routinely see patients. Pathologists, for example, are basically applied medical scientists for the most part, and it is not difficult to match a pathology residency at all. Of course there is radiology, too, but it requires a pretty good academic record and an internship year in a more clinical specialty.

I love science, but I just couldn't put up with all of the political leverage needed to be successful. What I couldn't get over was that since your peers decide whether or not your lab continues to receive funding for the most part, absolutely everything you do is both business and personal. Plus it just seems like so much money gets wasted on nonsense (but of course that's just my opinion).

Medical school is different for a couple of reasons. The testing is based a lot more on rote memory than application, and my classmates are a lot more type A in medical school. The cost of the education is much greater, but I at least have the perception that I will be able to make my money back in the long run.

I concur will the Wiz. If I could do it all over again, I would forget the PhD altogether. With a PhD, you can apply for grants and work on your tenure track career. But you can't see or treat patients. With an MD, you can apply for grants and work on your tenure track career, AND you can see and treat patients! One degree does it all .

That being said, not everyone is brilliant enough to pick up all the nuances of basic research without a formal doctoral program, but motivation is the key there.

Wiz: "Plus it just seems like so much money gets wasted on nonsense (but of course that's just my opinion)."

This is my strong opinion too!
Ciao,
OC

I'm going to be contrarian. As a Ph.D. who decided not to go into an M.D. program, I found that the politics and hierarchy in medicine was much worse than the politics I saw in an academic setting. Maybe not so much "worse," but the hierarchy is so much more "important" in many subdisciplines. Sure, I could have gone into research with just an M.D., but I didn't think I could ever do clinically relevant research with a Ph.D. before I was accepted to graduate school. Sure, I don't see patients, but -- as someone who did have M.D.'s work with me in the lab -- I also realize that the time to do research as an M.D. has to be asked for and arduously protected.

The important part was that I saw myself and my role with a Ph.D. in research as being no less an important part of a research team, bringing my background into a conversation that complements the clinical perspective. I learned a lot about the health care system and the humanistic side of medicine without having to go $200K in debt.

As for the human interaction aspect, I still did a whole lot of interacting and networking among my colleagues, superiors, and other students. Research is team-oriented, and while there are times when you will be alone with a timer waiting for the next step, many other times you will be working with others. You have to in order to succeed.

As for jobs for MD/PhD's, there are plenty of possibilities. ScienceCareers.org has a section on that.

I am currently a doctoral student (finishing in May) and I am applying to medical school for the Entering Class of 2007. Feel free to ask me any questions.

Originally Posted by PHD_2007

I am currently a doctoral student (finishing in May) and I am applying to medical school for the Entering Class of 2007. Feel free to ask me any questions.

do med schools like it if you get your PhD first? Like do they weigh that heavily especially if you have done well?

Originally Posted by yadave

do med schools like it if you get your PhD first? Like do they weigh that heavily especially if you have done well?

Holy revival of old threads, batman!

No, med schools don't care if you get your Ph.D. first. The Ph.D. is an interesting extracurricular activity at most med schools and has marginal weight at research-focused med schools.

Most (but not all) Ph.D.-to-M.D. applicants have a change of heart about wanting a research career, and this is why med schools are so suspicious of such applicants. Note: this is usually not a conscious decision, and it is a horrible, cruel, and time-consuming strategy if it is intended to make a medical school application look more competitive.

Originally Posted by Scottish Chap

Most (but not all) Ph.D.-to-M.D. applicants have a change of heart about wanting a research career, and this is why med schools are so suspicious of such applicants. Note: this is usually not a conscious decision, and it is a horrible, cruel, and time-consuming strategy if it is intended to make a medical school application look more competitive.

The variant on this is the MD/PhD applicants that go through their first two years of medical school, and skip the PhD training continuing onto their third and fourth med years... It can be hard to weed these ones out in the application process. In my class we had One out of the Five of us pursue this track. We saw it coming when he/she decided to pursue a clinical elective between years one and two, while the rest of us were doing lab rotations.

Note well: Do not do the PhD as a route to the MD. It will be painful for everybody involved.

I'm a PhD student currently reconsidering...or more like seriously considering for the first time, what my future would be like if I continue down this graduate research path. And not really liking what I'm seeing. This soul-searching should probably have been done before I started grad school, but at this point I want to plan ahead as best I can from where I already am. I've recently starting considering the idea of med school after my PhD (because I'm not sure quitting my PhD is something I want to do), and have perused some of the opinions about this idea on this forum.

I would love to hear more from those who have a PhD and have/are currently getting an MD. Did you find it difficult to go from graduate lab work to studying and classes in med school? Was the application process more difficult because of your PhD? I plan to try and volunteer or shadow in a hospital to get a taste of what medicine is really like on a day to day basis; from what I've read so far, this is basically a requirement to get into a med school? I went from undergrad straight to grad school, and probably will need another year or two to finish if (and that's a big if, as people who do research know) everything goes well. I don't want to spend an eternity in school before I can start actually making a living, but I don't think I'll be happy making a living doing research. Have those who've done a PhD and then an MD found that they're at a disadvantage as far as employment due to their age compared with their MD-only peers?

If you're willing to share your opinions and experiences, I'd love to chat privately as well!

I find medical school, at least the first two years, to be far easier than grad school. I don't have my PhD yet, but my (limited) experience with the grad school administration and faculties has not been as pleasant as with their medschool counterparts.

I'm another PhD->MD. Xiao Yu, I think most of us had thoughts somewhat similar to yours. I think the biggest question you have to answer is why you want to be a doctor. You will find out through your volunteering. Ask yourself if you really want to do this...it's a long road, 4 years of med school (with debt that will be significant) then 3-6 years of additional training.

As for medical school, I didn't find the transition to classes very difficult. I did have some trouble at first getting used to the idea that memorizing was key, as opposed to an in-depth understanding. The biggest transition for me was 3rd year, hitting the wards. It's quite a socialization process, and no matter your previous experience, you will be at the very bottom. Now that I am a 4th year, I can honestly say that I am really happy I made the change from scientist to physician-scientist and that I have no regrets. As a grad student, I sometimes wondered why I even cared about my project, but as a medical student I never had that thought. Medicine is one of the best ways to make a difference and is more rewarding than you can imagine, as long as it's right for you.

Of course now that I have been out of the lab for a while, I find myself thinking about research, cool ideas, and how I will "do both"...it's exciting to have the options and that's what makes being an MD/PhD (or PhD/MD) really awesome. I don't know about any age-related problems with employment.

Originally Posted by BozoSparky

I'm another PhD->MD. Xiao Yu, I think most of us had thoughts somewhat similar to yours. I think the biggest question you have to answer is why you want to be a doctor. You will find out through your volunteering. Ask yourself if you really want to do this...it's a long road, 4 years of med school (with debt that will be significant) then 3-6 years of additional training.

You're right that it's the biggest question. I was mistaken to not ask myself the "why do I want to be a scientist" question after undergrad; the road after grad school into academia or industry is long as well, and I shouldn't have started without realizing I probably wouldn't like the end result. I think a big part of that mistake was my assumption that I wouldn't have to be a scientist if I went to grad school. I obviously was deluding myself; although alternative career paths exist, there are almost always better ways of getting there instead of through a PhD program, and I wonder if having a PhD will necessarily give me an edge in non-research careers. (Although at this point, I'm very hesitant to just quit my PhD program.)

Right now I can say why I don't want to be a scientist and perhaps why a doctor or physician scientist might be a better fit. I dislike the lack of human contact and communication in the daily lab environment. I derive very little personal satisfaction in doing my project (which is basic science, with little to no clinical or practical relevance). The prospect of having to manage or come up with similar projects of my own in the future and sell their virtues to others for funding makes me feel like a fraud. I really enjoy learning about science, reading about new discoveries and teaching others what I know, but actually doing basic science and planning new experiments doesn't give me any joy. I ask myself all the time why I or anyone else should care about what I'm doing. I feel all this, and I can't even say the reason is that my project is currently failing (though of course it could at any moment).

I can live with this for the next few years, but when I've started to think about the future (postdoc, maybe 2 postdocs as is becoming common in the biosciences, then trying for a faculty or staff scientist position and possibly doing research for the rest of my life), I start experiencing something of a panicky crisis. I think I've known that research is not a career I would really enjoy, but went to grad school anyway. Sounds stupid, and it is, but unfortunately I realize this a little late. Hopefully, it's not too, too late...

One small thing that made me think about if I should look seriously at medicine is that I find myself enjoying performing surgeries (my project involves animals), and find myself more interested in and rewarded by the surgical process and how the animals fare afterwards than the experiments and data I get from the surgeries. Of course, I also realize working with animals and people are totally different; I need to collect more information about clinical life before I can actually give reasons why I want to be a doctor.

I'd love to hear any more thoughts or advice from people who've chosen to go for an MD after starting/finishing their PhD. Just to know you guys are out there is encouraging.

Originally Posted by Xiao Yu

I'd love to hear any more thoughts or advice from people who've chosen to go for an MD after starting/finishing their PhD. Just to know you guys are out there is encouraging.

There are several of us. I'm currently finishing my third year, and I basically agree with Bozo. One other tough thing about med school is that you have so much less control over your time, especially during third year. That's not always easy to deal with after you've been in grad school and you're used to being lauded for creativity and responsible for apportioning your own time.

I put together a sticky post with pertinent links for people interested in PhD-to-MD that might be helpful to you. You can find it here.

Originally Posted by Xiao Yu

You're right that it's the biggest question. I was mistaken to not ask myself the "why do I want to be a scientist" question after undergrad; the road after grad school into academia or industry is long as well, and I shouldn't have started without realizing I probably wouldn't like the end result. I think a big part of that mistake was my assumption that I wouldn't have to be a scientist if I went to grad school. I obviously was deluding myself; although alternative career paths exist, there are almost always better ways of getting there instead of through a PhD program, and I wonder if having a PhD will necessarily give me an edge in non-research careers. (Although at this point, I'm very hesitant to just quit my PhD program.)

Right now I can say why I don't want to be a scientist and perhaps why a doctor or physician scientist might be a better fit. I dislike the lack of human contact and communication in the daily lab environment. I derive very little personal satisfaction in doing my project (which is basic science, with little to no clinical or practical relevance). The prospect of having to manage or come up with similar projects of my own in the future and sell their virtues to others for funding makes me feel like a fraud. I really enjoy learning about science, reading about new discoveries and teaching others what I know, but actually doing basic science and planning new experiments doesn't give me any joy. I ask myself all the time why I or anyone else should care about what I'm doing. I feel all this, and I can't even say the reason is that my project is currently failing (though of course it could at any moment).

I can live with this for the next few years, but when I've started to think about the future (postdoc, maybe 2 postdocs as is becoming common in the biosciences, then trying for a faculty or staff scientist position and possibly doing research for the rest of my life), I start experiencing something of a panicky crisis. I think I've known that research is not a career I would really enjoy, but went to grad school anyway. Sounds stupid, and it is, but unfortunately I realize this a little late. Hopefully, it's not too, too late...

One small thing that made me think about if I should look seriously at medicine is that I find myself enjoying performing surgeries (my project involves animals), and find myself more interested in and rewarded by the surgical process and how the animals fare afterwards than the experiments and data I get from the surgeries. Of course, I also realize working with animals and people are totally different; I need to collect more information about clinical life before I can actually give reasons why I want to be a doctor.

I'd love to hear any more thoughts or advice from people who've chosen to go for an MD after starting/finishing their PhD. Just to know you guys are out there is encouraging.

This is by no means rare. At my school there are several PhD > MD. There's even someone who was an assistant or associate professor at a well known university (I think it was UChicago?) who is starting medical school in his late 40s/early 50s. I relate strongly to your thinking. It sounds to me like you would really feel a lot more gratified by doing clinical medicine than research. Is there a way you could switch the PhD to a Masters? Obviously, that only works if you're just 1 or 2 years into it, but that's another option to consider, since the PhD is quite a bit harder. Of course, it all depends what sort of support your PI would give you in recommendations and how the department would look on that - if they're very hostile to PhD > MS, and especially to PhD > MS > MD, you might need to tough out the PhD and apply after that.

I would caution anyone considering this path to avoid it unless you really believe you can't be fulfilled without direct involvement in patient care. It's not going to be worth it otherwise. Med school is fairly painful and probably especially so for people who have been through a PhD program since they have completely opposite focuses. At least for the first two years, creativity, independent thought and intellectual curiosity are almost actively discouraged.

I finished a PhD in structural biology before med school and am now almost done with second year. I'm excited about clinical medicine and feel it was worth the sacrifice, but it's also much worse in many ways than I anticipated. You really have to be strongly motivated to do clinical work to survive this, I think.

Originally Posted by pseudoknot

...At least for the first two years, creativity, independent thought and intellectual curiosity are almost actively discouraged...

I agree completely. If I didn't have my own research project outside of med school, where I was in control and I explored my ideas, I would have had a much harder time in MS1-2.

I will add one thing though - it doesn't get any better in MS3.

Originally Posted by pseudoknot

I would caution anyone considering this path to avoid it unless you really believe you can't be fulfilled without direct involvement in patient care. It's not going to be worth it otherwise. Med school is fairly painful and probably especially so for people who have been through a PhD program since they have completely opposite focuses. At least for the first two years, creativity, independent thought and intellectual curiosity are almost actively discouraged.

The warning is much appreciated. Sometimes I think it's not even direct patient face-to-face contact that I crave, but hands-on, technical or specialized work (surgery? forensics?) directly related to human health/wellbeing. I'm discovering that animal studies, working with tubes and tests to answer a basic science question that has no immediate practicality, no matter how creative, holds little satisfaction for me.

But careers involving this kind of medically-relevant or practical work all seem to require med school. Or are there PhD careers or other schooling options out there I haven't found out about?

I finished a PhD in structural biology before med school and am now almost done with second year. I'm excited about clinical medicine and feel it was worth the sacrifice, but it's also much worse in many ways than I anticipated. You really have to be strongly motivated to do clinical work to survive this, I think.

Worse as in amount of things you have to learn? Greater pressure to perform? Crazy hours?

Would you mind sharing what about your PhD didn't satisfy you? I'm just wondering if it's similar to what I'm feeling...

Originally Posted by Xiao Yu

But careers involving this kind of medically-relevant or practical work all seem to require med school. Or are there PhD careers or other schooling options out there I haven't found out about?

Well, I think that it's possible for PhD-trained researchers to work on disease models or other more directly medically relevant projects, most easily in collaboration with MDs, but also perhaps by simply learning more about specific human diseases. This is probably more easily said than done. I know there are starting to be some PhD programs that allow you to do an extra year or two where you take some med school classes and spend some time in a clinical setting to help bridge the gap, but I do think that a lot can be done just by caring about the clinical relevance of the basic research one is doing.

However, this may not be helpful for you since you described working on animal models and the like as still being unsatisfying.

Originally Posted by Xiao Yu

Worse as in amount of things you have to learn? Greater pressure to perform? Crazy hours?

I think that the reality of having to memorize all this crap in the first two years is worse than I had imagined. The superficiality of it is appalling, as well as the amount of trivia that has no conceivable clinical relevance (this is worse in the first year). I am also bothered greatly by the model employed by medical education, which is similar to spending two years reading a dictionary before beginning to learn the grammar of a foreign language. None of this has any application yet, which makes it needlessly painful and inefficient. The multiple choice tests and learning from syllabi and powerpoint slides encourage black-and-white thinking and the belief that with a one hour lecture we know everything there is to know about a topic.

Again, these are just my issues as a preclinical med student. I think that I'll enjoy third year a lot more (all of my third year friends have). I will also say that the work of doing the courses in the first two years is fundamentally very isolating, which is the opposite of what I sought in medicine. I expect that much to improve next year.

I haven't really experienced crazy hours yet. It's hard but it's not THAT difficult so far, except perhaps for neuroanatomy.

Originally Posted by Xiao Yu

Would you mind sharing what about your PhD didn't satisfy you? I'm just wondering if it's similar to what I'm feeling...

I felt like I wanted to see more immediate benefit to people from my work. I am very impatient and found that I was much happier in crisis management situations than working towards long term goals; indeed I think I'd be pretty miserable in some fields of medicine for the same reason. The idea of acute care really drew me in though. I also wanted more extensive connections with people than the small groups in lab research, and I felt like the pyramidal job market and low salaries for academic researchers reflected a devaluation by society. Basically I started to see basic science as a glass bead game. (Maybe I was a little burnt out! I think I made the right choice though.)

Originally Posted by pseudoknot

I think that the reality of having to memorize all this crap in the first two years is worse than I had imagined. The superficiality of it is appalling, as well as the amount of trivia that has no conceivable clinical relevance (this is worse in the first year). I am also bothered greatly by the model employed by medical education, which is similar to spending two years reading a dictionary before beginning to learn the grammar of a foreign language. None of this has any application yet, which makes it needlessly painful and inefficient. The multiple choice tests and learning from syllabi and powerpoint slides encourage black-and-white thinking and the belief that with a one hour lecture we know everything there is to know about a topic.

Spoken like a true MI. "Appalling"? "No clinical relevance"? "Needlessly painful and inefficient"? C'mon pseudo...there is more to being trained as an MD than learning how to take care of patients...those people are called nurses.

Originally Posted by gstrub

Spoken like a true MI. "Appalling"? "No clinical relevance"? "Needlessly painful and inefficient"? C'mon pseudo...there is more to being trained as an MD than learning how to take care of patients...those people are called nurses.

Nurses.

That I criticized medical education, does not imply that I advocate dispensing with it entirely. That is the sort of black-and-white thinking I was complaining about.

I am merely saying that the preclinical curriculum is somewhat excessive in content and taught in a suboptimal manner. Even our school agrees with this to an extent, which is why they are planning to reduce it to 18 months.

Medical education has changed little since the Flexner Report, while much has been learned in the field of adult education. We ought to stop ignoring those advances.

kind of interesting...i'm having sort of a different experience. I liked 1st/2nd year classes, cause it makes me feel smarter all the time. Now I'm on third year after PhD, and it's really painful. Patient care isn't really related to science per se, but most often idiotic drivels. patients don't really get better...etc .

Originally Posted by pseudoknot

I am very impatient and found that I was much happier in crisis management situations than working towards long term goals; indeed I think I'd be pretty miserable in some fields of medicine for the same reason. The idea of acute care really drew me in though. I also wanted more extensive connections with people than the small groups in lab research, and I felt like the pyramidal job market and low salaries for academic researchers reflected a devaluation by society. Basically I started to see basic science as a glass bead game. (Maybe I was a little burnt out! I think I made the right choice though.)

Pseudoknot, do you think having the qualities above would work against becoming an R01 holding PI? Do you recommend someone having those qualities to ditch plans for doing >80% bench basic science research in the future? Or to pursue research that's patient oriented?

Originally Posted by pseudoknot

Even our school agrees with this to an extent, which is why they are planning to reduce it to 18 months.

Just like Penn

Originally Posted by echod

Pseudoknot, do you think having the qualities above would work against becoming an R01 holding PI? Do you recommend someone having those qualities to ditch plans for doing >80% bench basic science research in the future? Or to pursue research that's patient oriented?

Don't worry quite so much yet...you don't really know if you'll like acute care until you actually do it during 3rd year. I kind of find acute care boring. It's all algorithmic--there are eight things to check, and each of these things requires a particular management. Once you memorized the algorithm it's just robotic. Sure you do get to do chest compressions and put tubes into people, but I'm not sure that's what I want to do with my life.

During PhD you sorta feel like life is going really slowly, and nothing is progressing, and even the most patient people can get antsy. The good thing is any medical specialty, even without acute care, is immediate and you live day-by-day. So I don't think the 80-20 break isn't practical for you. And I'd say most of the MD/PhDs don't do strictly basic research.

Just have fun with basic research now. what's most jarring about 3rd year medical school is how little any of that has to do with anything you learned during PhD. You'll find that your interest in clinical medicine will likely change once you get a real dose of reality of real world medicine.

And I would caution the original poster here as well. medicine is not what you think it is. You do save lives occasionally. You see some interesting cases sometimes. But in the end, patients are clients and you are often so busy that there is actually very little connection you build up with your patient, many of whom don't have insurance, don't have good routine care and are disgusting because of it. Your work doesn't have immediate impact more often than not. There is an inordinate amount of paper work involved, and you have to document everything every step of the way. There is little science involved in day to day work. etc. etc. I would follow a general medical team for a month, go to their morning rounds, follow them during call, etc. to get a real taste of medicine before jumping all the way into it.

If you want to work that involves more people and help others, consider consulting, especially non-profit type of consulting in public health, diseases, etc... direct patient care often hinders your effort in helping others. I've heard this from others a lot previously and didn't really get it but until you see how medicine is done you don't realize how true that is.

Originally Posted by sluox

Don't worry quite so much yet...you don't really know if you'll like acute care until you actually do it during 3rd year. I kind of find acute care boring. It's all algorithmic--there are eight things to check, and each of these things requires a particular management. Once you memorized the algorithm it's just robotic. Sure you do get to do chest compressions and put tubes into people, but I'm not sure that's what I want to do with my life.

During PhD you sorta feel like life is going really slowly, and nothing is progressing, and even the most patient people can get antsy. The good thing is any medical specialty, even without acute care, is immediate and you live day-by-day. So I don't think the 80-20 break isn't practical for you. And I'd say most of the MD/PhDs don't do strictly basic research.

Just have fun with basic research now. what's most jarring about 3rd year medical school is how little any of that has to do with anything you learned during PhD. You'll find that your interest in clinical medicine will likely change once you get a real dose of reality of real world medicine.

And I would caution the original poster here as well. medicine is not what you think it is. You do save lives occasionally. You see some interesting cases sometimes. But in the end, patients are clients and you are often so busy that there is actually very little connection you build up with your patient, many of whom don't have insurance, don't have good routine care and are disgusting because of it. Your work doesn't have immediate impact more often than not. There is an inordinate amount of paper work involved, and you have to document everything every step of the way. There is little science involved in day to day work. etc. etc. I would follow a general medical team for a month, go to their morning rounds, follow them during call, etc. to get a real taste of medicine before jumping all the way into it.

If you want to work that involves more people and help others, consider consulting, especially non-profit type of consulting in public health, diseases, etc... direct patient care often hinders your effort in helping others. I've heard this from others a lot previously and didn't really get it but until you see how medicine is done you don't realize how true that is.

I agree completely here. I had a very similar experience, thinking that I would love medicine going into 3rd year. While I did love interacting with patients and participating in their care, what I found unsatisfying was the feeling that I really was not that important or critical to the patient's care. As a 4th year student I was treated a bit better and occasionally had the residents' and attendings' ear. You'll find medicine is VERY hierarchical, particularly compared to science. At each step, you become more critical/important simply because of how others perceive you. It is actually much less because of the additional knowledge, and more about the perception of your status (i.e. student, intern, resident, fellow, attending) and knowledge. Clinicians make extremely quick judgements, including assessments of the people they work with. Therefore, if it is your style to slowly warm up to new settings/people/etc, you will find medicine difficult. Being quickly adaptable to a variety of situations and presenting yourself well are two of the key aspects of thriving in medicine.

They don't really tell you these things ahead of time unfortunately. It is much more of a sink or swim mentality than even graduate school was, at least for me.

As a graduate student, my research group dynamics got old...for years and years I worked with the same people...I remember telling myself how much I would love medicine - always working with new people.

Then third year came, and as Vader said, it wasn't what I expected. Patient care was great. But, working with new teams nearly every week was painful. I began to dread the constant change. Just when the situation would warm up...time to move on. And the hierarchy was a shock. Asking for permission to leave after all my work was done was particularly degrading. Often, nobody really cares if you are curious...an honest question can get you a presentation due the next day post-call. As for the work, I did best when I operated like a short-order cook - which can be satisfying, but wasn't very intellectually stimulating. In an nutshell, I found 3rd year pretty tough.

But, a few months into my 4th year, things started to slowly change. I honestly don't know if it was that I was treated better, or that I had accepted the environment for what it is. Now, I enjoy the work much more. I am not dreading intern year (actually, the hours will hurt). It's a socialization process that you can't really be prepared for. If you have thick skin, that's great. If you don't, you will by the end of medical school.

Originally Posted by BozoSparky

As for the work, I did best when I operated like a short-order cook - which can be satisfying, but wasn't very intellectually stimulating.

I like your word choice there. Short order cook - that's how I felt at times too. Clinical work is sort of nice in that you see things "get done" but often when you sit down and look at what's "getting done" at the end of the day, it's a bunch of checked boxes that say: D/C patient check, send records check, check labs check, call consult check, etc.

Originally Posted by BozoSparky

Often, nobody really cares if you are curious...an honest question can get you a presentation due the next day post-call.

Yes, it's so very easy to dig your own grave with curiosity like that - future MSTPs going into the clinical years, watch out!

Originally Posted by pseudoknot

...Medical education has changed little since the Flexner Report, while much has been learned in the field of adult education. We ought to stop ignoring those advances.

Yes. While I was going through MS1-2, I really hated "learning the minutiae." I also knew that in order to understand the concepts that link different conditions/organ systems together, you need to have an initial "data dump," which only has coherence in retrospect. With these thoughts in mind, I really think lecture time should be ~18 months long, with no breaks until Step I study time. Maybe make it longer to include some advanced clincal time, but that's it. Then add more didactics during MS3-4 to reinforce concepts.

Originally Posted by sluox

...I liked 1st/2nd year classes, cause it makes me feel smarter all the time. Now I'm on third year after PhD, and it's really painful. Patient care isn't really related to science per se, but most often idiotic drivels. patients don't really get better...etc .

I felt the smartest in med school right around Step I. I controlled what I felt I should learn, I cut the "fat" out of my review, and I felt like I knew the most medicine at that time. Now at the end of MS3, I can't recall most of the interlukins, but I can recognize a lot more clincal entities.

Originally Posted by Vader

...what I found unsatisfying was the feeling that I really was not that important or critical to the patient's care...

Yeah. I didn't go to med school to do "Shadowing, Part 25." This year has been unsatisfying because we do so little and everyone else is doing so much. A lot of the year is a struggle to find ways to contribute competently to the team.

Originally Posted by Vader

...You'll find medicine is VERY hierarchical, particularly compared to science...

I don't know. Prof Emeritus from Haaavard would definitely get more attention at a conference than the junior faculty from Little State U. I'll say that you have a more forgiving audience in science, as in science people generally let you complete your sentence before telling you you're wrong (in a way completely unrelated to your original statement ).

Originally Posted by BozoSparky

...But, working with new teams nearly every week was painful. I began to dread the constant change. Just when the situation would warm up...time to move on...Often, nobody really cares if you are curious...an honest question can get you a presentation due the next day post-call...

I agree here too. I just switched services for the 5th time in as many weeks. Every time you start to understand the flow and get useful, you're off to somewhere else. Curiosity (e.g., questioning sacred cows) is usually met with blank stares, derision, confusion, or by dodging the question. As I stated above, I've learned that the less I care about everything (impressions, getting my notes perfect, doing work all the time or even looking like I care), the better I feel and I enjoy myself more overall.

Originally Posted by RxnMan

I've learned that the less I care about everything (impressions, getting my notes perfect, doing work all the time or even looking like I care), the better I feel and I enjoy myself more overall.

This is so true. I've been on rotations with fellow students who beat themselves up any time a resident isn't "friendly" or the attending barks at them. It's not personal though; you aren't important enough for anyone to waste their time hating you.

As for figuring out what to do, eventually you get the hang of that too. Every attending wants you to do something different, and you finally reach a point where you understand that there is *no* one right way to do almost anything. This is what is ostensibly called the "art" of medicine. So basically, your job as a third year is to understand what the attending du jour wants, and do it. The next week you'll have a new attending who wants you to do the exact opposite, and the best way to deal is to just roll with it. In another few days, they will cease to matter in your life anyway.

Well guys, I've got to say, you guys are certainly making med school sound like something to look forward to

For someone who's primarily interested in research, is it worth it?

Originally Posted by alacast

Well guys, I've got to say, you guys are certainly making med school sound like something to look forward to

It has its ups and downs like anything. But especially for those of us who went to grad school first, it's a bit of a culture shock to spend two straight years memorizing random facts followed by at least one more year of following idiosyncratic orders. Plus, the hierarchy in medicine is a lot more rigid compared to what most of us were used to from grad school. That's what we're reacting to.

For someone who's primarily interested in research, is it worth it?

Oh, alacast, you know perfectly well that none of us can answer this question for you.

Originally Posted by alacast

For someone who's primarily interested in research, is it worth it?

I don't think so, but some disagree. You need to be able to answer that for yourself, with conviction.

Originally Posted by alacast

Well guys, I've got to say, you guys are certainly making med school sound like something to look forward to

Oh, it sucks sometimes, but it's not that bad. And contrary to what people say on this board, all the third years I know absolutely love it and are having so much fun (and yes, working long and hard). Grad school isn't perfect either. You just have to figure out what really motivates you. I do think the scientific and medical mindsets are pretty different, which is one of the reasons why the dual degrees don't make much sense to me. (Or maybe that's why they are needed? I dunno.)

Originally Posted by pseudoknot

Oh, it sucks sometimes, but it's not that bad. And contrary to what people say on this board, all the third years I know absolutely love it and are having so much fun (and yes, working long and hard). Grad school isn't perfect either. You just have to figure out what really motivates you. I do think the scientific and medical mindsets are pretty different, which is one of the reasons why the dual degrees don't make much sense to me. (Or maybe that's why they are needed? I dunno.)

We will be sure to bump this thread for you in a year and see how you feel then, pseudo.

All kidding aside, third year *is* better and yes, even more fun than second year. But it has its own aches and pains. If all of your third year friends really do "absolutely love it and are having so much fun," well, they're in the minority and should share whatever they're smoking with the rest of us. Go hang out in the clinical rotations forum for a while if you haven't already. You'd be amazed what kinds of BS some people have to put up with; whenever I feel like complaining, that forum reminds me that I have it pretty darn good compared to a lot of other people.

On that note, time for me to go to bed, because I have to get up at the crack of dawn tomorrow to go pre-round on my patients so that I can round some more with my team for the subsequent three or four hours. FWIW, I will definitely not be picking any specialty that requires more than one hour per day of rounding.

Originally Posted by QofQuimica

We will be sure to bump this thread for you in a year and see how you feel then, pseudo.

All kidding aside, third year *is* better and yes, even more fun than second year. But it has its own aches and pains. If all of your third year friends really do "absolutely love it and are having so much fun," well, they're in the minority and should share whatever they're smoking with the rest of us. Go hang out in the clinical rotations forum for a while if you haven't already.

Q, I've read a lot of threads in the clinical rotations forum. I think people on SDN just tend to complain more than real people. People aren't motivated to start a thread to talk about what a good day they had.

My M3 friends and random acquaintances here haven't loved every minute of every rotation, but I don't think I've met anyone here who didn't prefer M3 to the first two years. Maybe our clinical rotations are just awesome. I don't know.

Will I fall into that category? I hope so and I am optimistic about it. I've worked in nonscientific jobs including the fire service (not as a firefighter though!) and I understand the concepts of taking orders and paying dues. This can be a shock for a lot of people though, especially those with a more direct path to med school.

Originally Posted by pseudoknot

Q, I've read a lot of threads in the clinical rotations forum. I think people on SDN just tend to complain more than real people. People aren't motivated to start a thread to talk about what a good day they had.

My M3 friends and random acquaintances here haven't loved every minute of every rotation, but I don't think I've met anyone here who didn't prefer M3 to the first two years. Maybe our clinical rotations are just awesome. I don't know.

Will I fall into that category? I hope so and I am optimistic about it. I've worked in nonscientific jobs including the fire service (not as a firefighter though!) and I understand the concepts of taking orders and paying dues. This can be a shock for a lot of people though, especially those with a more direct path to med school.

I personally liked 4th year much better than 3rd year. Medicine is about "owning" your patients; for me, the more I take ownership, the more enjoyable the experience becomes. 3rd year handicaps you from being able to take full ownership since at this point you lack the clinical knowledge necessary to care for patients in a safe and competent manner. This handicap (or "sandbox" as some residents refer to it) is a necessary part of the learning curve, but one that is less preferable compared to the increased responsibility during 4th year and beyond. For example, on my 4th year sub-Is I had much more responsibility and direct involvement in patient care as a result of having my own patients, being first call on them, and not co-following with an intern. I know plenty of MSTP graduates who enjoy internship/residency (even at our home institution) much better for the increasing level of satisfaction that comes with being more responsible for patient care. The attendings will actually talk to you and generally care more about your learning more because you are specifically training in their specialty.

I agree that most med students will say they enjoyed 3rd year more than the first two years--during 3rd year you actually apply the basic knowledge you have accumulated to patient care. Perhaps MD/PhD students enjoy the first two years more so than regular med school classmates because we are more interested in the basic sciences and principles underlying the scientific practice of medicine.

Originally Posted by pseudoknot

Q, I've read a lot of threads in the clinical rotations forum. I think people on SDN just tend to complain more than real people...

What? Are you saying I'm not real? If so, then who's writing this response?

I recall that people will talk to others about negative experiences (with a given activity) 9-11 times more frequently than those with a positive one. I know that right now I'm real tired of always being wrong, being cut off, brushed off, or being irrelevant.

Like Vader said, I can't own a patient as a MS3. On surgery now, my chief tells me that I don't have to pre-round on my patient and I only need to be in the OR. Well, I'd like to be able to take on more patients, and do some of the floor work because my interns are running all over the place, yet they still find time to teach me. But I can't. I take up too much time to fill out paperwork and to write notes that the residents don't let me do much. So I am frequently relegated to standing around. I entered med school so that I could do X to a patient (give abx, do an I&D, suture) and make a difference (treat an infection, decrease pain, close a wound). My level of experience doesn't grant me enough autonomy to do those things (much), so it isn't as satisfying as I'd like (esp since I'm right there at the bedside).

Originally Posted by alacast

Well guys, I've got to say, you guys are certainly making med school sound like something to look forward to ...

If something wasn't hard, it wouldn't be worth doing. Conversely, if medicine was easy, then everybody would do it, and it also wouldn't be interesting to me. But that doesn't mean I like it 100% of the time!

Originally Posted by alacast

...For someone who's primarily interested in research, is it worth it?

As someone who is interested in doing research on humans, it's pretty much the only way to go. As someone who likes prodding people with sharp implements, it's pretty much the only legal way to go.

Originally Posted by pseudoknot

...
I think that the reality of having to memorize all this crap in the first two years is worse than I had imagined.
...

ahhh...the trouble with PhDs and medicine...I really like this Richard Feynman clip.

http://www.youtube.com/watch?v=PsgBtOVzHKI#t=4m03s

I'm sure many of you can relate!

Originally Posted by RxnMan

What? Are you saying I'm not real? If so, then who's writing this response?

I recall that people will talk to others about negative experiences (with a given activity) 9-11 times more frequently than those with a positive one.

You're not as real to me as the people I interact with face to face, no. Your last sentence above (emphasis added) is part of the point I was trying to make.

Originally Posted by RxnMan

As someone who is interested in doing research on humans, it's pretty much the only way to go. As someone who likes prodding people with sharp implements, it's pretty much the only legal way to go.

This "doing research on humans" thing is an interesting idea, but I think it's mostly an illusion. You really can't just experiment willy-nilly with humans anymore except in the context of clinical trials, which are not something that most basic scientists have an interest in and therefore not what I think an MD/PhD would be training you for.

Originally Posted by pseudoknot

Q, I've read a lot of threads in the clinical rotations forum. I think people on SDN just tend to complain more than real people. People aren't motivated to start a thread to talk about what a good day they had.

People on SDN complain about the same amount as real people. As RxnMan pointed out, that's because the people posting on SDN *are* real people. We don't allow bots to join SDN.

My M3 friends and random acquaintances here haven't loved every minute of every rotation, but I don't think I've met anyone here who didn't prefer M3 to the first two years.

This sounds much more realistic, and I agree, as I said in my previous post. However, preferring M3 to the first two years does *not* equate with saying that you "absolutely love it and are having so much fun". Those were your words, not mine, my friend.

Will I fall into that category?

Again, most people do fall into that category. There are a few people like panda bear who preferred the first two years, but they're not the norm.

Originally Posted by Vader

I personally liked 4th year much better than 3rd year. Medicine is about "owning" your patients; for me, the more I take ownership, the more enjoyable the experience becomes. 3rd year handicaps you from being able to take full ownership since at this point you lack the clinical knowledge necessary to care for patients in a safe and competent manner. This handicap (or "sandbox" as some residents refer to it) is a necessary part of the learning curve, but one that is less preferable compared to the increased responsibility during 4th year and beyond. For example, on my 4th year sub-Is I had much more responsibility and direct involvement in patient care as a result of having my own patients, being first call on them, and not co-following with an intern. I know plenty of MSTP graduates who enjoy internship/residency (even at our home institution) much better for the increasing level of satisfaction that comes with being more responsible for patient care. The attendings will actually talk to you and generally care more about your learning more because you are specifically training in their specialty.

I will be doing my first sub-I in a few months, and I am *so* looking forward to that. I just found out yesterday that I got the one I wanted during the month I wanted it and in the hospital where I wanted it, which is not always the easiest to arrange for the late summer/early fall.

Originally Posted by QofQuimica

People on SDN complain about the same amount as real people. As RxnMan pointed out, that's because the people posting on SDN *are* real people. We don't allow bots to join SDN.

I'm going to have to disagree. People on SDN complain far more, in my experience.

Originally Posted by QofQuimica

This sounds much more realistic, and I agree, as I said in my previous post. However, preferring M3 to the first two years does *not* equate with saying that you "absolutely love it and are having so much fun". Those were your words, not mine, my friend.

Q, you're killing me here. Are you a scientist or a lawyer? Look, the bottom line is that in my experience, 95% or more of the comments on SDN about M3 are negative. When talking to actual M3s at my school, 95% of the comments are positive, usually very strongly so. I do know multiple people who have told me they "love" third year and described it as fun.

Anyway, I can't remember now if I'm trying to argue that med school sucks or trying to defend it. Maybe both.

"The mind is its own place and, in itself can make a Heaven of Hell, a Hell of Heaven."

Originally Posted by QofQuimica

I will be doing my first sub-I in a few months, and I am *so* looking forward to that. I just found out yesterday that I got the one I wanted during the month I wanted it and in the hospital where I wanted it, which is not always the easiest to arrange for the late summer/early fall.

Awesome--congrats!

Just a few words of advice for anyone starting sub-Is soon:

On your sub-I you need to be very assertive and talk with your resident at the onset about the level of responsibility you would like to take with patients, including your current comfort level and your goals about where you want to be by the end of the rotation. I did this for my medicine sub-I, which allowed me to rapidly increase my level of responsibility. Since I had a month with the same resident, he began to trust me more and more over time, and gave me progressively more autonomy (though still helpful when I needed help and observing watchfully all the time--he did have to co-sign my orders, after all). It was a great experience. But also don't get discouraged if the team dynamics are not as ideal as this. You can still learn a lot just from being independent, reading up on your patients' problems and focusing on the assessment and plan.

Most residents, as you know, will want you to start with 1-2 patients and then work up from there. If you get overwhelmed, don't be afraid to ask for help--that is what the team is there for! Also, be concise with the H&P and quickly get to the assessment and plan on your patients during presentations--this will make you look forward thinking, more responsible for the management of your patients, and will maximize your learning about management, which is your goal at this stage.

Good luck and enjoy the experience of getting to be an acting intern!