Is MD/PhD a waste of time if I want to do anything less than 80% research?

[Jabeno]

Sorry if the title seems like a hyperbole, but I'm starting to wonder if MSTP is right for me. I'm just finishing my first year of med school and I ended up liking clinical medicine a lot more than I thought I would (we do short rotations during first year in my school). I really like doing research (lab work, stuff like that), but I've always been wary that I would hate being a PI- i.e. writing grants all day and just looking for money, tons of reading and writing. I've talked to several MD/PhDs who are very frustrated with how hard it is to find money, that they just feel like fundraisers, and how that negatively impacts their practice.

So now I'm wondering if I even want to do research later in my career. I'm fairly certain I don't want to do 80/20 (the only model anyone says will have a chance of being succesful), I think i'd like to do 50/50, if at all. If this is the case, would I be wasting my time doing a PhD? I'm pretty sure I wouldnt mind doing 4 years of research now, but I know that there are a lot of cons with being out of med school for 4 years. For what it's worth I'm interested in neuroscience research and neurology practice, and I've heard a PhD really doesnt help much with neurology residencies (due to low competition). Any perspectives from mroe seasoned people would be greatly appreciated.

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[URHere]

I can't tell you if the MD/PhD path will be a waste of time in your situation. What I will say is that you are likely to change how you feel about your ideal future career as you progress through your training.

As an MS1/2 I could see myself having a purely clinical career. As a G1-2, I was dead set on academia. When I got to G-3, I thought I was going to go into industry (if I didn't just run away entirely), and when G4 hit I was back on the academic research bandwagon. As an MS3, I realized that I wanted the 80/20 split but got somewhat depressed over how difficult it was going to be. We'll see how I feel this year.

All I'm saying is that you may not know exactly what kind of research balance you want at this point (even if your feelings are very convincing right now). Don't make any big decisions quite yet.

 

[Jabeno]

I can't tell you if the MD/PhD path will be a waste of time in your situation. What I will say is that you are likely to change how you feel about your ideal future career as you progress through your training.

As an MS1/2 I could see myself having a purely clinical career. As a G1-2, I was dead set on academia. When I got to G-3, I thought I was going to go into industry (if I didn't just run away entirely), and when G4 hit I was back on the academic research bandwagon. As an MS3, I realized that I wanted the 80/20 split but got somewhat depressed over how difficult it was going to be. We'll see how I feel this year.

All I'm saying is that you may not know exactly what kind of research balance you want at this point (even if your feelings are very convincing right now). Don't make any big decisions quite yet.

That does sound a lot like me, and I usually seem to enjoy whatever I am doing at the time. I agree I don't want to make a big decision right now, but I also feel like continuing in the program is a big decision in and of itself.

 

[Neuronix]

If you weren't second guessing your decisions, I'd be worried about you. Give it more time.

 

[catzzz88]

It depends on the specialty. All are unlikely, but some might consider 50/50 depending on the director.

Derm or Dermpath you might be able to do 50/50

Pulmonary & Critical Care you might be able to do 50/50...

I am learning more and more that I need to start with my general research goals and then pick a specialty from there. For example, surgery is practically out of the game for me because 80/20 research in surgery is all but unfeasible.

 

[Jabeno]

If I ended up not doing any research, would the PhD be of any benefit to me, e.g. regarding residency applications or job applications? Hearing about how many MD/PhDs end up not being able to do research for whatever reason makes me a little nervous and makes the think the MD/PhD process is just a huge gamble.

 

[Neuronix]

If I ended up not doing any research, would the PhD be of any benefit to me, e.g. regarding residency applications or job applications?

PhD often helps for residency, though it's somewhat specialty and program specific. It's not a guarantee of whatever you want, and med school performance is still more important. It's not worth 4 years of your time just for that purpose. A year would suffice.

Hearing about how many MD/PhDs end up not being able to do research for whatever reason makes me a little nervous and makes the think the MD/PhD process is just a huge gamble.

It is. It depends too on how much you're willing to give up. There are several $50-$100k/year fellowships to consider or I could take a 300k/year (to start) clinical job. Which one will you pick when you're 35+ years old?

 

[URHere]

If I ended up not doing any research, would the PhD be of any benefit to me, e.g. regarding residency applications or job applications? Hearing about how many MD/PhDs end up not being able to do research for whatever reason makes me a little nervous and makes the think the MD/PhD process is just a huge gamble.

Our program had a lunchtime meeting with a group of residency directors last week - nearly everyone in a surgical specialty (and somewhat surprisingly, the representative from rad onc) went on and on about how little a PhD mattered to them. One even said that having a long list of publications only showed them that you'd "wasted your time wisely".

That being said, we've had similar meetings with folks from internal medicine, pediatrics and pathology who have said it isn't unusual for people interested in ultimately pursing research fellowships to have a much different experience when interviewing in their specialties (specific meetings with research mentors, discussions about what it is like to be on the teaching staff at the school, options for balancing research and clinical work, etc). My understanding is that many people at research-focused programs will be looking for their future long-term colleagues during those sorts of residency interviews and this experience has been echoed by several now-graduated students from my program.

As someone interested in Med/Peds and a research fellowship in one or both of those fields, I don't feel like I've wasted my time. That being said, I was terrified of enjoying my surgery rotation for exactly that reason.

 

[LAtoDavis]

Our program had a lunchtime meeting with a group of residency directors last week - nearly everyone in a surgical specialty (and somewhat surprisingly, the representative from rad onc) went on and on about how little a PhD mattered to them. One even said that having a long list of publications only showed them that you'd "wasted your time wisely".

That being said, we've had similar meetings with folks from internal medicine, pediatrics and pathology who have said it isn't unusual for people interested in ultimately pursing research fellowships to have a much different experience when interviewing in their specialties (specific meetings with research mentors, discussions about what it is like to be on the teaching staff at the school, options for balancing research and clinical work, etc). My understanding is that many people at research-focused programs will be looking for their future long-term colleagues during those sorts of residency interviews and this experience has been echoed by several now-graduated students from my program.

As someone interested in Med/Peds and a research fellowship in one or both of those fields, I don't feel like I've wasted my time. That being said, I was terrified of enjoying my surgery rotation for exactly that reason.

Radiation oncology has more PhDs in it than any other specialty, I believe. It sounds like the radiation oncology individual was just getting on board, to me. Maybe I'm just biased after applying to Oxford for a radiation biology degree, but I did ask a lot of residency programs about their opinion on having a doctorate in the field and the reception was very positive; maybe they just heard "Oxford" and become overly agreeable, though?

 

[Stannis_the_Mannis]

Just finished my PhD and to be honest I'm a tad disenfranchised about academic basic science research.

Most PIs seemed more concerned about proving their version of the truth, rather than investigating a clinical or scientific problem.

In the time from when I finished my dissertation and had to go back to the clinic, I became much more interested in clinical research and found the application far more plausible and exciting. If I were to continue research in my career, I anticipate that it will be clinically oriented and my interactions with basic science will be more collaborative, in lieu of having my own lab.

If I in fact do pursue that path, it's difficult to say whether I wasted my time getting a phd. It's easier to make that assessment in hindsight, something applying MD/PhD candidates don't have the benefit of doing. I can say that this was not my intention when I started, rather something I concluded during the process. If the MD/PhD is only worth it if you plan on doing 80/20 track having your own lab then by all accounts I wasted my time.

However I feel that view is far too rigid when judging the success of a training program. Obtaining a PhD allowed me to be fluent in a language that is absolutely vital if I were to be effective in research. Furthermore and most importantly, it taught me proper project design, understanding necessary controls, how to ask the right questions and information/skills with regards to the technology used to investigate said questions. Whether it's basic science research or clinical research, the skills will be vital for the rest of my career.

So in the end if someone wants to say that I wasted my time because I didn't end up doing 80/20, let them because I don't think I did and that's all that matters to me.

PS: I will say that pursuing a PhD only to bolster ones CV and potential residency is a waste of time. You can do similarly beneficial things with your CV in a fraction of the time

 

[Neuronix]

Radiation oncology has more PhDs in it than any other specialty, I believe.

By percentage, that is often true (See: http://www.nrmp.org/wp-content/uploads/2014/09/Charting-Outcomes-2014-Final.pdf). However, pathology is a close second and is a much larger specialty. Thus by absolute numbers of MD/PhDs, radiation oncology is a distant sixth, with internal medicine being first (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2778489/).

Regardless of the relatively high numbers of MD/PhDs, radiation oncology is not particularly friendly to majority research careers. Research funding, which has generally been bad for about fifteen years now, is particularly bad to the specialty as a whole (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3646925/). There was a time when people used to think that research funding would return and we should still keep training physician-scientists, but that has largely passed. The chairmen who tried to support their faculty to run labs have had a very difficult time as the clinical revenue also got cut back over the past ten years.

Despite there being a radiation oncology research track residency, few programs support it, and most of them offer very limited support for it (i.e. one resident every few years). When you finish, there are very few 80% research positions available. I hope you like lengthy fellowships, though there are very limited options for those as well. Starting salaries as faculty with any serious research component are on par with primary care.

The vast majority of "academic" rad onc positions will not even allow for 50% research. With the current saturated job market, you should be prepared to travel anywhere in the country to get even one day a week of protected time in an "academic" position. In these "academic" positions, even at big name places, writing K grants is often forbidden because they require 80% protected time. Thus, there are less than 10 K grants active in the specialty in the whole country (see last reference), which is a shame considering they are the main early career research grants.

That said, I don't know how much worse it is in radiation oncology these days than other specialties. I respect when people are honest about these issues, and don't just share enthusiasm or tell me what I want to hear without ever offering substantial objective support. When you're junior, it can be difficult to tell those groups of people apart. Thus, the program directors and random MD/PhD posters on SDN can be biasing you one way or another, but when choosing a specialty I encourage you to try to be as objective as possible.

I suspect 80% research physician-scientist career options are bad across all specialties because the first time grant funding rates for MD/PhDs are in the low teens and falling (http://acd.od.nih.gov/reports/PSW_Report_ACD_06042014.pdf). Nevertheless, I suspect the rates of MD/PhDs in "academics" is unchanged or growing. This isn't what you think. Academic hospitals are buying out a lot of the private practices or opening up wildly profitable satellite clinics and employing this generation's "academic" physicians in 80-100% clinical positions (at discounted salaries) with academic titles in "clinician-educator" (or similar) tracks.

 

[Jeffrety]

You can drop out of the MSTP and get your MD. You can also grit and bear it through the program and work as an administrator or in a non academic setting. Your PhD is very versatile and valuable. Don't let it drag your career down.

 

[deleted343839]

but I've always been wary that I would hate being a PI- i.e. writing grants all day and just looking for money, tons of reading and writing. I've talked to several MD/PhDs who are very frustrated with how hard it is to find money, that they just feel like fundraisers, and how that negatively impacts their practice.

I'm fairly certain I don't want to do 80/20 (the only model anyone says will have a chance of being succesful), I think i'd like to do 50/50, if at all. If this is the case, would I be wasting my time doing a PhD?

The most productive PIs hire out staff, postdocs, etc. to carry out their research and spend more of their own time publishing, writing grants, networking, etc. If you don't think that's the life for you, then you should first thoroughly investigate other options or advantages of having a PhD. If none of them appeal to you, you might give some serious thought to changing your training plans. The 50/50 effort model is rapidly disappearing from academic medicine, which is a shame, but that is the trend.

 

[Sir William Osler]

Just to throw in my 2 cents....here ya go. I would avoid MD/PhD unless you are going to be top 0.01% given the current environment for physician scientists. If you are inclined to pad the resume for a subspecialty, then do a year off with an influential member of that subspecialty and do whatever they want you to do. The PhD is not an efficient means to your end. As for people who love research, I recommend either doing a straight PhD or go to business school and forget your passions. I'll reiterate to you that the current research funding environment is at all time lows. There's a backlog of overtrained MD/PhD's and straight PhD's looking for jobs in academics. Unless something changes soon, this will continue to be an issue for the next 7-10 years. Only in specific pockets like Oncology research from the top labs or bio-engineers from labs with PI's with ten's of startups will you find better opportunities and often these are in industry and not academics. The explosion in the NIH 15 years ago has created a catastrophic environment for young physician scientists. The generation above is holding on for dear life and really slowing the development of the younger generation. Heed my warning...trust me I know.

 

[Neuronix]

Research is rapidly disappearing from academic medicine, which is a shame, but that is the trend.

Fixed that for you.

 

[mercaptovizadeh]

Our program had a lunchtime meeting with a group of residency directors last week - nearly everyone in a surgical specialty (and somewhat surprisingly, the representative from rad onc) went on and on about how little a PhD mattered to them. One even said that having a long list of publications only showed them that you'd "wasted your time wisely".

That being said, we've had similar meetings with folks from internal medicine, pediatrics and pathology who have said it isn't unusual for people interested in ultimately pursing research fellowships to have a much different experience when interviewing in their specialties (specific meetings with research mentors, discussions about what it is like to be on the teaching staff at the school, options for balancing research and clinical work, etc). My understanding is that many people at research-focused programs will be looking for their future long-term colleagues during those sorts of residency interviews and this experience has been echoed by several now-graduated students from my program.

As someone interested in Med/Peds and a research fellowship in one or both of those fields, I don't feel like I've wasted my time. That being said, I was terrified of enjoying my surgery rotation for exactly that reason.

I'm an MD/PhD in med-peds. I know what it feels like to love nearly all of medicine (I liked obstetrics and loved surgery, in addition to loving peds and medicine), but also to want to make a contribution in research. Feel free to PM me with any med-peds questions.

 

[Guero]

I'm an MD/PhD in med-peds. I know what it feels like to love nearly all of medicine (I liked obstetrics and loved surgery, in addition to loving peds and medicine), but also to want to make a contribution in research. Feel free to PM me with any med-peds questions.

I literally LoLd at your username.

 

[Doctor&Geek]

The vast majority of "academic" rad onc positions will not even allow for 50% research. With the current saturated job market, you should be prepared to travel anywhere in the country to get even one day a week of protected time in an "academic" position. In these "academic" positions, even at big name places, writing K grants is often forbidden because they require 80% protected time. Thus, there are less than 10 K grants active in the specialty in the whole country (see last reference), which is a shame considering they are the main early career research grants.

That's a really sad indictment. Wonder what MD PhDs going into Radiation Oncology would say if they knew about this.

 

[Neuronix]

That's a really sad indictment. Wonder what MD PhDs going into Radiation Oncology would say if they knew about this.

Are you telling me that it's better in other specialties? Other specialties are certainly bigger, but I wonder if the research job market is actually any better.

I can tell you that in my case it would have made no difference knowing the truth. I'm a tech guy, I did my PhD in biophysics, and my specialty choice came down to radiology vs rad onc. There was nothing else my PhD was relevant to and no other specialties that particularly interested me. I don't mind practicing clinically 80-100% of the time if I have to. That's not my first choice, but I may not have a choice.

 

[gbwillner]

Rad Onc appreciates the PhD in selecting residents. It is a high-paying specialty. Does it matter if you can't do research as much? It is a great choice for those who are burnt out on science.

 

[Neuronix]

I feel that's a cynical way of looking at things. I didn't do this for the high salary. It is nice to have job opportunities and options. But I still would much rather be doing real science, and I have real ideas for doing that, even if the pay is lower. I know many people who feel the same way, some of whom have foregone significant salary reductions to be in the lab.

 

[gbwillner]

Obviously not everyone sees it that way. I do think it explains the disproportionate number of MD/PhDs in Rad Onc though. It's not a specialty known for robust scientific opportunities. All the Rad Oncs I know from MSTP do exactly zero research, and all but one are in private practice. Some specifically chose the field trying to maximize their profitability, and wanted zero research after med school.

 

[Neuronix]

I disagree. I think rad onc appeals to MD/PhDs because it's essentially like starting residency with a fellowship. Yeah you have that pesky internship to deal with, but you can do a cushy one. Then you have four years of nothing but technical cancer training. Rad onc is heavily literature based, moreso than a lot of other specialties. You start reading and analyzing literature immediately as a PGY-2, which is appealing to MD/PhDs. You start doing procedures and focusing on cancer therapy immediately. In many ways, it's analogous to doing a fast-track med onc fellowship without even having to do the pesky two years of general medicine. The technology of radiation delivery, for those of us into devices and engineering, is really cool.

Residency programs heavily expect applicants to do at least clinical research before starting. That is seen as promising by MD/PhD applicants. I certainly thought "well boy if they like clinical research, I bet they'll love this highly technical stuff I want to apply to radiation therapy!" I was wrong. But I didn't learn that until after I applied. I think most MD and MD/PhD applicants fail to recognize that the vast majority of research in the field is retrospective clinical outcomes research, and basic science opportunities are limited. To me it seems that most MD and MD/PhD grads fail to realize that "academics" does not mean "research". I think the MD/PhD programs conflate these two issues with how they report MD/PhD outcomes both in advising and in the literature. As long as you're in academics, you're seen as a successful graduate. MD/PhD outcomes are reported simply as "academics". You mostly interact as a student with "successful" MD/PhD graduates with labs within major academic centers. But academics does not actually mean significant protected time for bench or translational research. Those jobs are very difficult to get nowadays.

Nevertheless, there are *some* basic science opportunities. I certainly applied thinking I would do a basic science research oriented residency (with 18 months protected time) and would move into a basic science position after graduation. Those positions do exist. They're just few and far between, and there's not enough of them for every MD/PhD applicant and graduate.

I keep asking repeatedly in this thread if things are really any better in other specialties, and still nobody answers me. I certainly know my share of med onc MD/PhDs, and the vast majority do not have basic science labs.

 

[gbwillner]

Things ARE better in other specialties- specifically the lower paying ones. It all goes back to paying yourself from grants. I know lots of IM, Peds, and Path MD/PhDs with labs. Some (many) have minimal clinical responsibilities. In general, however, times are tougher for everyone in every field. Although it's hard to get your own lab with start-up in Path right now (and IM), I am certain it is far easier than in surgery, Rads, Rad Onc, etc.

 

[Doctor&Geek]

Ditto Gb.

 

[Guero]

I'd like to add a little to the answers regarding other specialties put forth by @Neuronix Although @neusu & @mmmcdowe would likely be far better suited to elaborate on this than me; I haven't seen any legitimate bench labs in neurosurgery thus far. All labs headed by MD/PhDs and MD-only or MD-master's physician scientists that I've seen in NS have all been involved in clinical research (e.g., retrospective studies, surgical approach studies, outcomes research, clinical trials, etc). That's not to say that the bench labs don't exist. It's just an anecdotal generalization to add to the sample. Furthermore, many neurosurgical MD/PhD residents that I've met along the way have admitted that they'll likely pursue private practice.

I've seen many similarities among general surgery attendings regarding the clinical vs bench aspect, and one bench lab run by Helsinki's transplant chair (MD/PhD).

FWIW, I hope that helps quench a little of your curiosity, @Neuronix. But I imagine you already suspected all that. Anyway, thanks for all of your help over the years.

-G

 

[Guero]

Neurosurgery can be good for MD/PhDs, though there's a lot of disgruntled people in that specialty too. People who run bench labs in that specialty include:

• John Sampson at Duke - cancer vaccines guy, tons of NIH grants and high impact publications; but, he did train with a Nobel Prize winner who invented tons of drugs
• Murat Gunel at Yale - genomics guy, tons of NIH grants; but, I'm not sure his research is bench work

Some other faculty at Harvard and Stanford likely qualify. I don't think those guys "made it" as physician-scientists because they went into neurosurgery; it's probably just that being a hyper-competitive workaholic helps you succeed clinically and scientifically.

I doubt there's anybody at the resident/junior attending level in any specialty who feels completely secure.

Always nice to see names along with examples, thanks. But yeah, they generally seem to be the exception. And those that do make it are of an insanely high caliber.

 

[becomingdoctor]

MD PhD isn't only about the degree, it is about the training. Some MSTP will choose to focus on clinical practice while others choose to do 100% research (eg. Tom Rando from stanford). Don't let a degree hold your back.
I have to say that most of the MDs have little training in science, even in academic center. On the other hand, most of the research PI don't care about clinical care either. Mdphd is a good balance of the two.