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benefits of PhD (w/ MD)

Discussion in 'Physician Scientists' started by aviary17, Mar 9, 2009.

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  1. aviary17

    aviary17

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    Hello. I am going into medical school this year for a regular MD. My plan after medical school is to teach as a med school professor, round at the hospital to see patients, and to conduct research (hopefully as the PI). I have doctors in the family and doctors who are my friends, and they all tell me there is absolutely no reason for me to get a PhD. They say I can do all I want with a plain MD. I hope this post doesn't offend anyone, I really want to know, though. If what they are saying is the case, then what is the point/advantage of getting a PhD?

    My med school lets me switch to MSTP, so it's not too late if I should switch to also getting a PhD. I really appreciate any input. Thank you for your time.
  2. gstrub

    gstrub Member

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    There are multiple threads on MD/PhD vs. MD alone. Try searching through this forum.

    Briefly, you can conduct research (as the PI) with a MD only. So your friends are correct, you do not need a PhD.
  3. StIGMA

    StIGMA aspiring MD/PhD!

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    Briefly, if you want to conduct research, you need to acquire those skills at some point in your career. You are not taught how to acquire grant money, etc during an MD (for which full-time PhD's are competing directly against you and is a requisite for your professorship). The MD/PhD program helps you by letting you graduate with no debt, which among other things makes a postdoc salary not seem quite so daunting (can you work 2-4 years for 45K with a family/150k+ debt hanging over your head?).

    I have spoken to multiple current MD researchers who said they would either 1) have done an MD/PhD in the first place or 2) stated that MD's will be at a significant disadvantage to MD/PhD's and PhD's when looking for research jobs in the future (you cannot look at the proportion of MD investigators now and pretend it will be the same in 15 years).

    Also, do not pretend it is as easy as pressing a button to hop onto your school's MD/PhD program. There is likely a process, and it is not guaranteed. Moreover, you do not just 'get' a PhD... if you are cut out for the career you intend, you better want to pursue a 4-5 year PhD and know a bit more about that career pathway. ie: 110% research, 20% clinical, + teaching, +administrative ... it is not all glamor, and if you want to see patients mostly, it is not for you.

    An alternative is to do the MD and not be a PI, but rather writeup clinical cases and do whatever else strict clinical/teaching MD's do that I do not know about.
    Last edited: Mar 9, 2009
  4. doctorobvious

    doctorobvious

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    I'm matriculating as an MD student this year, and I am also thinking about switching to MSTP after my second year. From what I have read, you can do research as an MD. However, you will have to pick up research skills and lab techniques very quickly during your fellowship/postdoc. The advantage of the PhD is that it gives you protected time to learn these skills under the guidance and funding of a PI. It would also give you time to publish a few papers, giving you a competitive edge later in your career.

    If you have a lot of lab and research experience already, you might not need the PhD. You could also consider doing a 1-year MS in clinical research. Most schools offer funded programs for students that want to do 1 year of research.

    However, if you don't have a lot of basic science research, the PhD would probably be helpful to your career. Either way, you have some time to decide. Most schools don't require you to apply for MSTP until during your second year. You should try to get involved in research when you start this fall or during the break next summer. This experience would probably help you in making a decision. At least that's what I'm planning on doing.
  5. aviary17

    aviary17

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    OK, thank you. I will search the forum for old posts, too, as suggested. But, if you have the chance, I am still wondering, why would a hospital prefer hire a MD/PhD professor (eg for Biochemistry) over an MD? Is that a standard of some sort?
  6. StIGMA

    StIGMA aspiring MD/PhD!

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    Because it is not the hospital, it is the the university & medical school. They want research money. MD/PhD's on average are better at obtaining research funding than MD's. To get hired and be a PI means you need grants. You are not primarily a clinician if you are doing what you stated in your first post, you are a researcher. A hospital could care less.
  7. GliaGirl

    GliaGirl

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    The kind of career that you are describing is entirely possible as an MD, but from what I understand, you'll be more likely to get the job with both degrees. Also, you'll be starting off with no debt from med school, since tuition is covered.
  8. Neuronix

    Neuronix Super Corgi Away! Administrator SDN Senior Moderator SDN Advisor

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    I challenge you to back up this statement with data. See:

    JAMA -- The Physician-Scientist Career Pipeline in 2005: Build It, and They Will Come
    Ley and Rosenberg
    September 21, 2005 Vol 294 No 11

    http://jama.ama-assn.org/cgi/content/full/294/11/1343/JOC50107F3

    Figure 3 shows very little to no difference in funding rates for grants for MDs and MD/PhDs.

    Similarly,

    JAMA -- NIH Peer Review of Grant Applications for Clinical Research
    Kotchen et al
    February 18, 2004 Vol 291 No 7

    In my opinion/experience, the important factors are:

    An MD who has startup funding and research experience will be just as successful as an MD/PhD. The MD will just have to get it post-residency, which includes all the PI mentoring and publications and such. The MD/PhD will have to do this as well! Though one hopes not as much time would have to be spent in this endeavor post-residency. However, the fellows assure me nobody cares how many publications you got during your PhD or what you did for your PhD when you go to look for faculty spots. It's what have you done for me lately. i.e. Get out of your PhD as quickly as possible and move on, you'll have to invest plenty more time later anyway. The MD/PhD will still have to put in a productive fellowship/post-doc to get a research position.

    As for hospital hiring, it IS all about money. If you can get grants, they will hire you. If you are an MD and bring in clinical revenue, you will get hired. It's quite simple. Until someone shows us that MD/PhDs are more successful at getting grants (everything I've read has indicated they aren't), MD and MD/PhD will be equivalent at finding a job. It's not the letters behind your name folks...
  9. StIGMA

    StIGMA aspiring MD/PhD!

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    Here is a slightly more recent article that looks at grant success over a 40yr period, but I'll admit that I am no expert about this topic. I'll look into your articles when I have more time. Pertaining to R01's:

    http://jama.ama-assn.org/cgi/content/short/297/22/2496

    [FONT=verdana, arial, helvetica, sans-serif]The annual number of first-time investigators with an MD only as NIH R01 grant applicants remained remarkably stable over 4 decades. Among first-time applicants, those with an MD consistently had less success in obtaining funding (28%) than either investigators with a PhD (31%) or both an MD and a PhD (34%). Among investigators who obtained a first R01 grant, those with an MD were consistently less likely (70%) than those with a PhD (73%) or those with an MD and a PhD (78%) to obtain a subsequent R01 grant. First-time applicants with an MD were much more likely to propose clinical research (67%) than applicants with an MD and a PhD (43%) and applicants with a PhD only (39%). First-time applicants with an MD only who proposed clinical research were funded at lower rates than their MD-only counterparts proposing nonclinical research (23% vs 29%)..

    From the paper: While individuals with an MD and a PhD were more successful than those with an MD only overall, a similar difference in obtaining funding between those performing clinical and nonclinical research was observed (MD=23 vs 29%; MD-PhD=28% vs 35% success, clinical versus non-clinical).

    So the difference is minor but seems to exist (even in nonclinical research). As Neuronix said, if you are cutout for research and receive good mentorship post-residency, you should be fine. There are other advantages to pursuing the MD/PhD as alluded to in this thread, and there are also disadvantages. Do what works for you.
    Last edited: Mar 9, 2009
  10. sluox

    sluox Copier

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    This kind of data is less useful, because it confuses causality with correlation. I think the stock of MD/PhDs, after years and years of filtering (including at the level where those who are smart but not research-committed go into lifestyle specialties), who in the end apply for an R01, is really pretty high. And yet the gain in performance is STILL only 10%. It sort of makes me wonder...

    A lot of times you ask yourself the question, is it better, does it matter, (your scores, the school you go, the grades you make, the research you did), blah blah The bottom line is EVERYTHING matters, and nothing matters at the same time. You can do "research" with an MD. But do you want to do research at a top 10 school? Do you want to publish in Nature? Do you even CARE about that? If you want to be the best of the best, then the clear choice is:
    go to MD/PhD at the best possible school and do the best possible PhD and do the best possible medical school work...

    If you don't, then respectively, fewer things would matter. That 10% performance gain in K08 is just SO irrelevant...

  11. RxnMan

    RxnMan Who, me? A doctor? Moderator Emeritus

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    I'm a MD student who is going to become a physician-scientist. Do you need a PhD to do research of any type? No. Do you need a PhD to get funding / more likely get funding? Maybe (see the article Neronix cited). Is there some intrinsic value to the "PhD experience?" (see below) I don't believe so.

    The PhD, if done correctly, will give you the ability to conduct a study well, instruct you on how to obtain funding, show you how to publish your work, and so on. But will this be you? There's rampant abuse of students in the graduate system, and funding is perilous. A buddy of mine has had not one, but two PI's leave on him, and now his research is back to square one. Grad students are frequently seen as work horses who are let go only when their PI/committee can no longer keep them, i.e., the student would rather quit than stay on. I don't see any value to being treated like that for an indefinite amount of time (only your committee can tell you when you can graduate). While PhDs are looked upon favorably by PDs (see Charting Outcomes), if you aren't going to do research, it is simpler to earn a high Step 1 than by spending 3-5 years in a lab.

    Once I looked past the ego boost I'd get with another degree, I thought about what another 3-5 years would get me. It wasn't enough.

    To be a successful researcher, you need training and mentoring. But there are many ways to do this outside of MD/PhD programs for MD students: year-off programs like this one and the research fellowships to name a few.

    You will meet folks who have had no problems with their graduate program, and that's great for them. As one investigating this path, OP, you should talk to as many people, in as many levels of training, as possible.
  12. Vader

    Vader Dark Lord of the Sith Moderator Emeritus

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    It is uncommon for a graduate student's PI to leave. It is extremely uncommon for two of their PIs to leave. There are no guarantees in life, but this should really be put into perspective.

    There is a great deal of value to the PhD that cannot be paralleled by a research year during medical school. The depth of a 1 year experience is simply not equivalent to a full PhD thesis. In addition, MD/PhD programs are quite prestigious in the eyes of academic institutions/departments and have historically produced a cadre of highly trained physician-scientists that have made important contributions to the understanding and treatment of disease. For individuals who at the outset seek a career doing high-level medicine and science, and finish their training loan-free, there is no better pathway available.

    MD's who do research still have to deal with the trials and tribulations of science, but in a less protected, more time-crunched environment.
  13. RxnMan

    RxnMan Who, me? A doctor? Moderator Emeritus

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    The perspective I was trying to convey was that the student has little to no control over their situation - they are at the mercy of their PIs.

    Don't put words into my mouth - I stated there are other, more benign ways to get research training for MD students, which there are.

    I did not address this point, but as I stated in my opinion above, the ego boost wasn't worth the pain and uncertain work conditions of the PhD.

    Possibly. In the 2005 article, you guys get a lot of money and spend a lot more time in school to generate a cohort with a somewhat higher funding rate.

    And most of you guys go into basic science, if you go into science. Is that what the OP wants?

    I disagree. I am more protected doing research as a medical student than I ever was as a grad student.
  14. DogFaceMedic

    DogFaceMedic Member

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    My experience strongly supports the above as accurate. (Level III evidence?)
    Research funding drives a lot. But, a PhD alone carries NO weight. Rather it is the kind of PhD. A biochemist PhD will get finding over an MD for biochemistry research. An ER MD will get funding over a physiologist for clinical research. Comparisons based on generalizations are weak.

    The amount of time to earn a PhD for someone interested in clinical research -- i.e., with patients -- is not worth it.

    If the purpose is to get a PhD to build up an ego, then the person will be another disillusioned old goat, whining about funding and jealous of MD's driving more expensive cars. (I really had one of these in anatomy.)
  15. Vader

    Vader Dark Lord of the Sith Moderator Emeritus

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    There are also other bottom-lines besides funding rates that we just do not have data on, to my knowledge. For example, publication number and impact factor, promotions, career satisfaction, etc. It would be interesting to see these comparisons done, or if someone has this data, to see what it shows.

    I agree, in graduate school, the student is ultimately at the mercy of the PI and committee members. The PI obvious has a vested interest in having you stay in the lab. Therefore, it is important to select a PI that will be supportive of your goals and understands that you have more training ahead. Most committees do not exist to torture students. You need people on your committee that are supportive of you and your career goals (which should be made apparent from the onset) and that are willing to stand up to the PI and say "yes, this question is sufficiently addressed... let's move on" when necessary.

    In my graduate program, I was able to select the committee members. I tried to select individuals who would be rigorous scientifically and help guide my project and who would also be supportive of my goals. I was quite up-front with them about my goals and I think this helped move things along more quickly. That isn't to say that there weren't trials and tribulations, but it did help me feel more empowered ultimately. Part of graduate school teaches you to navigate the scientific world and to deal with failure/rejection.

    For those seeking careers in basic science, I have seen that the postdoc after MD route can be very stressful and anxiety provoking, as there tends to be much more at stake with less preparation. It is certainly an important and valuable goal to encourage physicians to enter research careers, and I completely support loan repayment programs and other designed to encourage research careers. However, for those individuals from the outset interested in basic research careers with a component of clinical work, the MD/PhD pathway provides the best training possible.

    I agree completely that if the OP intends to pursue a career in clinical research, the PhD is unnecessary and will not provide sufficient benefit to justify the costs. However, even in the clinical research arena, there is a growing movement to encourage additional training, such as a masters in public health or formal training in biostatistics/epidemiology. Therefore, although one can potentially do any type of research with an MD, the additional training and credentialing provided by formal degree programs provides many benefits over less formalized approaches.

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