Current MS1 considering MD/PhD... Is this the path for me?

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Hello all,

I am currently an MS-1, and I have been considering pursuing an MD/PhD well before I got into medical school. I ended up not applying to MD/PhD programs at the time due to a host of issues. Nonetheless, my experience and passion for research seemed to have come across while applying as my interviewers asked me why I didn't apply to MD/PhD programs.

As I'm going through my first-year of med school, the enormous memorization required makes me realize how much I miss thinking like a scientist. Career wise, I know that I want to conduct basic science research, and I intend to follow the 80/20 model. My dream is to apply for an NIH R01 grant and run my own lab and occasionally see patients during the week. It's not that I hate patient care (I actually enjoy working with patients and empathizing with them), I just enjoy research a lot more. I have also secured a summer research program at my school, and I recently got a co-author publication (IF=6) and will have 1 or 2 more publications this year hopefully.

I'm still thinking about applying internally to my school's MD/PhD (non-MSTP) program because I think that I could benefit from a long-term, protected research time to learn how to work (and think) on my own and learn some advanced skills/lab techniques. However, I have heard from some MD's and PhD's (and even an MD/PhD friend) that it's not necessary to do both and to stick with the MD and do some research training later in residency/fellowship or afterwards. Additionally, I am currently 27 years old (I was a nontrad back then). Assuming 4 years for the PhD portion, I would start residency at 35. I read a recent thread here about starting an MD/PhD in the late 20s, and personally, I'm not concerned about the age--I look and feel young, and I have no intentions of starting a family anytime soon. Also, the level of graduate training at my school is decent, but not world-class or anything. I mention this because I have heard that the reputation of the PhD school and PI are really important later on. However, there are a couple of PI's here that I've looked up that do research in my field of interest, have active grants, publish regularly, and have given major talks at national conferences. While I have experienced the ups and downs of research and am comfortable with the idea of experiencing failure all the time, I don't know if I'm talented enough to be in research. I went to a national conference last year, and was just amazed at the number of bright people out there doing extraordinary work. It also doesn't help that I'm just an average medical student, although I attribute that to my lack of enthusiasm for memorizing everything thrown at me in class.

I know that alternative pathways for me to become a basic physician-scientist include doing year out programs (HHMI, NIH MSRP, etc.), research residencies/fellowship (that include protected research time), or a post-doc after fellowship. However, I feel that these are super competitive for me, especially the year-out programs.

So after doing all my research, I'm still confused if pursuing an MD/PhD is right for me. I admit that occasionally after shadowing a private-practice doctor, I feel comfortable with "just being a doctor." However, the desire to ask the big questions and understand the why and how still strongly motivates me to pursue a research career.

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There are a lot of issues here, and I can't really type it all up. The key to your question is buried in the "host of issues" that prevented you from getting the MD/PhD in the first place.

Just speaking from the other side of all this: running your own lab is not nearly as glamorous as you think. It's not really about "ask the big questions", as much as trying to compromise as little as possible your own vision so that your line of research meshes well with "institutional needs" and "funding priorities", and building "strategic collaborative relationships." The reason for this is that nobody really agrees on what the right "big questions" are to be asked given a limited pot of money, and who gets the money really depends on your ability to convince people that your ideas are feasible, your team is qualified, and your skills are adequate. Persistence is also a huge part, because 9/10 of your R01s will be rejected. Furthermore, because big questions also cost big money, the model is being pushed towards collaborative, multisite cost sharing/contract agreement (i.e. DOD model) as opposed to investigator initiated "cottage industry" model. This means that you will have a smaller control of the details of your research in the years to come.

At this point, <10% of PhD awardees in biomedical sciences in the US eventually gets an R01. I personally don't really think it matters significantly if you do a PhD or not, to be honest, and your training track decision has very minimal causal relationship with your eventual success in getting an R01.

Also, just came from some meetings with high levels at NIH: it's likely that the funding enivornment for science in the US is going through a sea change. Most likely by the time you graduate R01s will not be the only, if not even the most of your funding sources. Given the huge variation in the pitches for specific funding agencies, you should think of the job of a lab head as one of a versatile fund raiser and a COO of a small non-profit that conducts biological research, as opposed to a "scientist" in a classic sense. It turns out this is actually a much better fit for me than being a classic scientist, but your milage may vary. It's still possible to be a scientist in a classic sense by working at specific places like Janelia Farm/Broad Institute, but I would never do it given the monumental opportunity cost (easily >$150k a year depending on your subspecialty of choice) and significant limitations on rapid translation of basic results to the bedside.
 
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There are a lot of issues here, and I can't really type it all up. The key to your question is buried in the "host of issues" that prevented you from getting the MD/PhD in the first place.

Well, I chose not to apply to MD/PhD programs in the first place because of a few of the issues I brought up in the OP like feeling unsure if it was the path for me, age (at the time I felt too old), and also I felt that my stats weren't competitive enough. I know that the common question about internal applicants is "Would we have accepted this student if they had applied directly?" From what I know about the program I am at now, I shouldn't have a problem gaining internal admission into the program.

Anyways, thanks for your reply. I understand that being a PI is a lot about what you've described: grant-writing, organizational management, etc. and not much about pipetting stuff and running experiments. I'm absolutely aware about current funding issues. My PI has been having R01 grant problems for a while now. But I'm still interested in a research career. I guess I just have to keep thinking about this.

I hope other members here can chime in.
 
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Additionally, I am currently 27 years old (I was a nontrad back then). Assuming 4 years for the PhD portion, I would start residency at 35. I read a recent thread here about starting an MD/PhD in the late 20s, and personally, I'm not concerned about the age--I look and feel young, and I have no intentions of starting a family anytime soon.

I will bet you four years of med school tuition that you will change your mind. This pathway takes forever. I hate to crush your dreams, but IMO you are too old to go down this road.
 
I will bet you four years of med school tuition that you will change your mind. This pathway takes forever. I hate to crush your dreams, but IMO you are too old to go down this road.

Thanks for your opinion...
 
Thanks for your opinion...

I am being totally honest with you. If you don't want the advice of people who have been around the block, don't ask for it.
 
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Um, I was seriously thanking you for your opinion. Perhaps the sincerity didn't come across in an internet post.
 
There are a few students in my program who started in their later 20s. Doesn't seem to be too big of a deal to them. Just depends on what your life goals are. Then again, I'm in the middle of the program myself, so maybe some more time will make me more bitter. There are all sorts of selection biases governing who posts here, which is something to keep in mind. Flip side is that the positivity bias that you'd see in real life is less strong too.
 
There are all sorts of selection biases governing who posts here, which is something to keep in mind. Flip side is that the positivity bias that you'd see in real life is less strong too.

I have no idea what you mean by this.

But here's my controversial rant of the day. I think everyone starting on the MD/PhD pathway is either crazy or ill-informed. There is no tangable reward to this pathway, unless you're a masochist. You can expect many years of hard work, low pay, and little respect. Even if you do extremely well, you will make much less than your MD-only colleagues in private practice. But most people don't do extremely well, and you end up banging your head into a wall for much of your life for no objective reward.

I'm getting to see now that people succeed for the wrong reasons, and not succeed for the right reasons.

If your goal is to live up to your family's expectations by becoming an academic faculty member with an MD and PhD, that prestige is a relatively easy thing to obtain. There are plenty of mostly clinical, "academic" jobs out there where you can look prestigous, do retrospective or purely analytical research that is easy to do, and have residents/fellows to do your bidding so that you feel knowledgable and powerful. These jobs don't pay as well as private practice partnership (25-50% less in my field), but they're usually better than the poor sucker in the lab (another 25-50% less). You also got an expensive, prestigious medical school education for free. WINNING!

If your goal is to make an actual impact by maintaing a basic science research lab and making a real impact on disease, that is extremely difficult. You have to live with the constant knowledge that you may fail in this endevaor due to factors completely out of your control. The IRB, IACUC, and other committees are constantly trying to keep you from doing anything, and funding is practically non-existent. No matter how talented you are, grantsmanship is a game that you might not win. You can't just relax like your colleagues while figuring that you will end up with something, somewhere in PP or academics. No, you have to constantly sit around wondering if there might be that one job that might hire you as an assistant professor this year, and shotgun grants hoping that one might get funded. If you're lucky you get to choose "safe" projects so that you get to keep your lab, and hope maybe that the one project you have that actually might make an impact actually works. But it sure is hard to hit a home run when you're bunting all the time. In attempting all this, you continue to have less job security, less pay, less job stability, and more hard work than the person in the paragraph before me.

So to me there are a lot of different perspectives in the world. I did MD/PhD for what I think are all the right reasons. But I'm not judging the people who do it for the wrong reasons. There are plenty of people who seek prestige, power, control, and money. They play the game and suck up to those their level and their superiors while not caring about over those under them... They say positive things because it looks good to say positive things. Saying negative or realistic things never benefits anyone. People's feelings get hurt and it creates negative impressions about the people saying them. By saying nothing but the positive, it can't possibly hurt them. At best, it justifies their outer facade to the world and to themselves. Maybe it recruits you to be underneath them and support them in their own career. These are the people who tend to be successful in clinical departments in the era of funding decline, not us crazy MD/PhD physician-scientists.

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Someone the other day told me: "people don't do things unless they benefit from it." I was shocked by that, because it's simply not how I live my life. Or maybe I am satisfied with really trivial benefits. How do I benefit from posting on this site? I get some internal satisfaction that someone's listening to me I guess. The compliments I do get from people under me help me to feel good. I like to think that I'm volunteering in a more useful way than a soup kitchen or a hospital. I like to keep my finger on the pulse of my specialty. But, SDN doesn't pay me. I don't put this on my CV, and given what I write on here, I'd be crazy to do so. The major SDN MSTP contributors are in a similar position. So that's the bias you're getting--a bunch of people who aren't playing games, who aren't benefitting by telling you what you want to hear, who are doing things for what are probably the "right" reasons, and can't understand why anyone else would want to do it. That's your selection bias. The people who are playing the game of tenure aren't posting on here. They don't give a damn about you outside of how it could help them. Such is life, which I've had to learn the hard way, repeatedly.

So if you're starting MD/PhD in your early 20s, late 20s, or even 30s, I think you're crazy either way. I'd bet 4 years of med school tuition that you'll never have an R01 grant. I'd be shocked if anywhere close to half of current MD/PhD grads ever get a K grant. Good luck to you if you still want to try--and in my view that has nothing to do with age. You'll fail or succeed to get your major grants and have your own lab before you get too old either way. I don't believe that the pressures I face at age 35 in trying to start my career are going to be any different for someone who's 40 or 45. Some will argue that it's less time for an established career before retirement, but to me that's not the real roadblock to real, meaningful, patient care oriented progress. All it means is that you'll have less time to make it to the top of the game of tenure. About that, I don't care. You might have less money before retirement, but you're going to be making a lot less money anyway so again I don't see it as a major concern.

I tell everyone who applies for the research pathway in my residency program that "we'll support you to bang your head into the wall." I personally think we should keep trying to cure cancer even if most of us are doomed to damage our heads against a wall, and not break through the wall to progress. But there's no reward in failure. So keep banging your head into a wall. It hurts, but maybe you'll break through it eventually. But you probably won't. So back to the clinical world with you. Or maybe you're a terrible clinician who hates patient care and can't get or maintain a medical license so you're stuck banging your head. Or maybe your whole goal is just a presigious, powerful position within a major academic center so you're not really trying at science anyway. Maybe being the boss was your goal all along. Go ahead. I'm not judging any more.
 
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Neuronix, gutonc, and others,

I sense we share very similar MSTP and life experiences, but I have a different perspective. I am currently a 100% clinician who discovered early he could not contend with "game of tenure."

I contend MSTP is still a great opportunity for intellectual challenge and I do encourage youth to investigate. The key questions are these: would you enjoy the challenge of a biomedical PhD and do you want to be a physician?

It is very simple: do you want to spend your 20s doing this? Either you do, or you don't.
 
Agree with Neuronix, these are things you do not discover until you are deep in the program.
 
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Neuronix, gutonc, and others,

I sense we share very similar MSTP and life experiences, but I have a different perspective. I am currently a 100% clinician who discovered early he could not contend with "game of tenure."

I contend MSTP is still a great opportunity for intellectual challenge and I do encourage youth to investigate. The key questions are these: would you enjoy the challenge of a biomedical PhD and do you want to be a physician?

It is very simple: do you want to spend your 20s doing this? Either you do, or you don't.
I discovered it after 1y post-fellowship. Still work an academish job, though one without a tenure track requirement (unless I choose that path on my own).
 
ValentinNarcisse --

One can also make that point for all of the medical profession. The gig is always something different then what you thought.

Think the need to be incessantly positive is restricted to the academy?

Don't you think gutonc and I were chagrined when we started clinical practice and had a clinic day with 5 new microcytic anemia referrals, and 5 patients yelling at us, that no, they won't do a colonoscopy?

Where was that on the ASH syllabus?
 
ValentinNarcisse --

One can also make that point for all of the medical profession. The gig is always something different then what you thought.

Think the need to be incessantly positive is restricted to the academy? Don't you think gutonc and I were chagrined when we started clinical practice and had a clinic day with 5 new microcytic anemia referrals, and 5 patients yelling at us, that no, they won't do a colonoscopy? Where was that on the ASH syllabus?
I just ruled out a primary bone hematologic issue, offered them a bone marrow biopsy "just to be sure" (which they also declined) and then discharged those *****s from my clinic. The beauty of being a sub-specialist.
 
OP, I'm not much further down this road than you, and I'm glad that more experienced people have contributed to this thread, but here's my advice for what it's worth. Yes, there are many reasons to be skeptical about whether a research career will materialize down the line. If you'd like to do the MD/PhD, make the decision based only on how much you'd enjoy the research years. There will probably be tough times no matter how good your mentor and project are. When I was an MS-2 I couldn't wait to get into the lab, and although I'm having a very good experience, I'll certainly be relieved to wrap it up and go back to med school. As for the future, I honestly don't think my career options will differ very much from those of my MD-only classmates.

It's rough now because you're cramming the same ridiculous mnemonics into your head as the two hundred people next to you, but if you do MD-only it won't be very long before you can choose to do things that are interesting to you. There are plenty of clinicians out there who want to "understand the why and the how," and they come from all kinds of research backgrounds.

Here are a few questions that I would ask myself:

--Would entering the MD/PhD fund your remaining med school years? If not, I'd consider that a deal-breaker.
--Do you have any idea of what kind of medicine you want to do? In the match, the PhD can be anything from "mild positive" to "possible red flag," depending on the specialty. So your career plans may dictate whether it's better to do a PhD or, say, a specialty-focused research year after MS-3 (no need to preemptively count yourself out for those, by the way).
--Have you done any research rotations with your possible mentors? This will probably help you the most in figuring it out.
 
--Would entering the MD/PhD fund your remaining med school years? If not, I'd consider that a deal-breaker.
--Do you have any idea of what kind of medicine you want to do? In the match, the PhD can be anything from "mild positive" to "possible red flag," depending on the specialty. So your career plans may dictate whether it's better to do a PhD or, say, a specialty-focused research year after MS-3 (no need to preemptively count yourself out for those, by the way).
--Have you done any research rotations with your possible mentors? This will probably help you the most in figuring it out.

My longwinded rant aside, I think this is good advice. I'd like to expand on points 1 and 2 above.

1. If you're leaning towards MD/PhD now and on the fence, apply now and try to get funding starting MS2. Try not to have them charge you two years (MS1 and MS2) of med school tuition if you can help it. If your only option is to go unfunded for the med school portion entirely, I wouldn't do it. I know people who have, and more power to them. But that debt takes away a lot of the freedom later to pursue a *much* lesser paid research career.

2. Try to identify a specialty of interest and do research in that. A PhD in your intended clinical area is almost always a positive if you do well and have a good relationship with your mentor. This can be an advantage to doing the PhD or other similar caliber research during residency/fellowship. I've seen several people obtain PhDs in residency, and they seem to be succeeding in getting jobs and starter grants, at least in the short term. In my experience, these MD/PhDs tend not to be as worn down and frustrated as the combined MD/PhDs. Their PhDs, while shorter, are often more efficient, and often sprinkled with moonlighting to help offset cost and keep a hand in the clinic. Their basic research is usually more tailored and directly translatable into departments and translational grants. It's a good route to consider.
 
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