Emergency medicine as an MD/PhD?

[jd989898]

I'm an M1 in an mdphd program, and I'm interested in emergency medicine. I've heard this can make it difficult to achieve the desired "synergy" from the md and the phd. To those more experienced--is this true, or can EM work well?

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[SurfingDoctor]

I'm not in Emergency Medicine and I didn't get a PhD, but I do basic science research in critical care. If you pick the right question in the right field you can do anything. The good thing about EM (and critical care for that matter) is that you can be jack of all trades, master of none. You want to be in EM, but want to do basic science, you can treat status asthmaticus in your clinical time, and use ova mouse models of asthma in your research time. You want to treat status epilepticus in the ER and study GABA-nergic function in your research time, go for it. Again, it about having the right research question that can be related to your clinical time.

 

[eteshoe]

In which department/program will you be doing your PhD?

 

[jd989898]

In which department/program will you be doing your PhD?

I don't have to decide until after my 2nd year. Are there certain departments in which it's easier to spin projects in the EM direction?

 

[MSTPlease]

One of the skills you should learn during your PhD is how to spin your work. I've seen all sorts of zany PhD/medical specialty combos (e.g. yeast genetics PhD who matched into general surgery, antibody responses to viruses into anesthesia). I could easily make the case for my own PhD being applicable to OB/Gyn, Peds, Medicine (multiple subspecialties for peds/medicine), Family medicine, Path and even Gen Surg. Could probably make the case for Ortho, Psych, Vascular and CT surg and EM if I stretched it. PM&R, anesthesia, rad-onc, and radiology are probably too hard of a sell for me. Here are some EM ones just off the top of my head
Micro - even if you don't study something that sends people to the ER, you certainly learn skills to study things that do
Immuno - asthma/anaphylaxis
Neuro - strokes/seizures/psych(psychotic breaks, suicide, mania)
Developmental - congenital heart and GI defects, osteogenesis imperfecta,
Cancer/genetics - gene regulation can apply to anything
Structural - sickle cell crisis and all the above (everything involves protein structure/function)
Mechanics/engineering - bone fractures, heart conduction, heart contraction, muscle/joint integrity/function
Biochem - drug interactions, toxicology

It's late, I can't think of any other subfields. Depending on how your school is setup, that's easily ~10 different departments and like 1000 different options for projects.

 

[eteshoe]

@MSTPlease pretty much covered everything I was gonna say. I'll just say to keep an open mind since your interests will most likely change in the coming yrs. Shadow a couple different specialties and when you do your lab rotations make sure to hit a few different fields

 

[QofQuimica]

I think a lot depends on what kind of career you plan to have. EM is a very clinical specialty, and it is not one that is traditionally focused on research. Most of the research that does get done by EM departments is clinical and not basic science. And unlike the usual specialties chosen by most MSTP grads (IM, path, etc.), there are not tons of established PSTP type pathways in EM for training basic researchers. EM is also a procedural specialty, and as such, the way you make money in EM is by being in the ER, not by being in the lab. Many departments are also sorely understaffed on the clinical side. So if you aren't wanting to be primarily clinical, you may have difficulty finding a supportive chairman if you aren't already bringing in your own research funding when you go looking for jobs.

That being said, if you are interested in clinical or outcomes research, EM might be a reasonable choice. As others have already mentioned, there is really no area of medical investigation that isn't part of EM's wheelhouse. In addition, selecting a "road less traveled" may be an advantage for you in terms of carving out a niche for yourself when it comes to establishing a research career. If you know any EM researchers at your institution, those would be good people to speak to regarding options.

Finally, I would caution you to keep in mind that specialties, like people, do have "personalities," and there is some truth to the stereotypes that you hear about various specialties. In general, a chaotic, clinical environment like the ER is not the kind of environment that fits with the stereotypical PhD personality, and that's probably also partly why so many MD/PhDs end up choosing other specialties. I agree with the suggestion to spend time shadowing and rotating in many different specialties to try to get a better sense of what you like and dislike in a work environment, both clinically and in the lab. Be sure to talk to lots of EM docs about what they view as the cons of their specialty. I think a lot of people like the idea of working in the ER much better than they like the reality of it, which is why it's so important to understand the downsides of that specialty and not just focus on the "coolness" factor of being in the ER.

 

[K31]

I'm a graduate of an MSTP and now a senior EM resident. My residency does have a strong research program (at least as EM goes). In the interest of full disclosure, although I am going into academics I no longer plan on research being a major component of my career (completely a personal decision, no reflection on my MSTP or residency program).

I agree with Q that there are some challenges to being a physician-scientist in EM that aren't encountered in many other specialties. However, it is possible with work and I think there are some positives that MD/PhDs should consider as well.

Although basic research is rare in EM, I think there are terrific opportunities for translational research. The major areas of interest currently are in critical care and resuscitation, but the relative paucity of established investigators makes carving out a unique niche easier.

Clinical research is the larger area of EM research currently. EM is huge on clinical decision rules and there are several well-established groups running multiple large clinical trials. Note, however, that this kind of research is not what the typical MD/PhD has much experience in.

It is certainly recognized that there is not enough high-quality research going in EM, and there are efforts to change this. Within the last few years the NIH established the Office of Emergency Care Research to help coordinate research in EM (one disadvantage that I hadn't mentioned was funding, as EM research often doesn't fit well into one of the NIH institutes). In addition, there are EM programs with research fellowships (my program has one, for example).

The flexibility of shift work in EM has its advantages too, since as you get funded it's fairly easy to buy down your number of shifts. The established investigators at my program have 50% or less of their time being clinical. On the other side of the coin, EM of course involves nights and weekends and unless yo are very senior you will be expected to do your share.

There does anecdotally seem to be more interest in EM among MD/PhDs, although I'm not sure this is separate from the general increasing interest in EM. Prior to 2010, my MSTP had only had one student match in EM in their 20+ year history, and now matches one about every other year.

I'm happy to answer any questions I can.