MD/PhD v PhD

[kingrumak]

For those of you that have either completed or are near the completion of your MD/PhD program, do you have any regrets and would have instead chosen one degree or the other if you could start the process over?

I love research and have been wanting to conduct research on the genetic and neurological underpinnings on autism for many years now. I have shadowed several doctors and am slightly interested in patient care but do not feel that I have enough passion for it to justify the dual degree.

I am well aware of the benefits that the MD/PhD program brings as far as translational research goes but I feel that the emergence of HHMI Med into Grad initiative programs and other clinical fellowships for PhD students will help bridge any gaps that I may have by forgoing the MD/PhD path. If any of you guys have had experience at one of these HHMI programs I would love to hear about it.

Any thoughts would be appreciated.

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[dl2dp2]

Very rarely do people regret doing the MD. People commonly regret NOT doing the MD. It's very hard to get a sense of what autism is like without having practical experience seeing and treating these patients. That said, some basic scientists can spin a very good tale to sell their research to autism funders.

Given how NIH funding is decreasing, adjusting to inflation, and the continuing excessive number of PhDs being trained every year, anyone who's interested in translational research should consider MD/PhD the gold standard. In fact, I see the very real possibility that in 20 years almost everyone who does disease oriented research would be MD/PhDs. Given your topic of interest is very strongly translational, I very strongly recommend against doing only a PhD.

Let me say it more plainly: it will be easier, sometimes by a very substantial margin, for you to be a full time researcher studying neuroscience and genetics of autism if you are an MD/PhD and finishing a full psychiatry and child psychiatry fellowship, compared to a PhD finishing a postdoctoral fellowship. You will have broader geographical flexibility, higher salary and more offers. Furthermore, the backup options are substantially better for the MD/PhD, with a possibly 3x or even higher salary differential.

Furthermore, during your training your goals more likely than not will migrate. There is a non-trivial possibility that you would want to discard your current interest in autism in favor of a more lucrative specialty or another specialty such as pediatrics or OBGYN that's better aligned to your interest and personality. Without doing the MD (i.e. not the HHMI pathway without the 3rd year clerkships), you have no familiarity with a broad range of clinical careers, some of which may very be very appealing to you. The advantage of doing a PhD is just not there (? save 1-2 years?) except for very compelling personal reasons (family location restrictions, etc.)

 

[gutonc]

I'm going to disagree with @sluox on this one (which is weird for me, but whatever).

If you're sure you don't want to be a physician, don't get an MD. It's that simple.

While the wheels are definitely coming off the biomedical research train in the US, there will "always" be room for you to try to carve out space to do your research. You'll certainly be able to do something with a translational component without an MD (although it doesn't really sound like that's your area of interest).

 

[dl2dp2]

If you're sure you don't want to be a physician, don't get an MD. It's that simple.

The problem is, very commonly, like the original poster, college students are dazzled by the possibility of doing "pure science" and "sacrifice" and are "not interested" in becoming a physician for reasons that are oftentimes ulterior ("my parents make me do it, so I'll stick it to them", etc) such that they miss a very real possibility that doing the MD is a very useful, if at times painful, exercise, even if they don't practice one day of medicine after residency. When they say they are "sure" that they "aren't interested", they really don't know what the hell they are saying. They have no idea what being a PhD or MD/PhD is like 10 years down the line.

To me, it's very clearly beneficial to get a full clinical training if you want to be a researcher in autism. Very similarly, it's very clear to me that if you are interested in cardiovascular disease or pediatric oncology you should do an MD, even if you are only interested in the bench aspects (then do a PhD also). The benefits just very clearly outweigh the risks (if any). I don't really see any reason for a college student to not apply to MD/PhDs, get in, and if they eventually decide that MD is not right, drop that part.

 

[gbwillner]

I'm going to disagree with @sluox on this one (which is weird for me, but whatever).

If you're sure you don't want to be a physician, don't get an MD. It's that simple.

While the wheels are definitely coming off the biomedical research train in the US, there will "always" be room for you to try to carve out space to do your research. You'll certainly be able to do something with a translational component without an MD (although it doesn't really sound like that's your area of interest).

Wholeheartedly agree with Gutonc here.

The MD is VERY PAINFUL if you don't even want to be one. I can't even fathom suggesting to someone to spend between 4-12 additional years of training for no other reason that might help leverage their already existing research interests. That's like 3 additional post-docs worth of pain right there.

If you don't want to be a doc, don't do an MD. Period. There are plenty of successful PhD scientists out there- there is no reason you can't be one of them. It may be more difficult for you to make a decent wage, but you'll sleep better at night, knowing that you are doing what you want to do.

 

[dl2dp2]

It may be more difficult for you to make a decent wage, but you'll sleep better at night, knowing that you are doing what you want to do.

I rest my case right here.

 

[kingrumak]

Really appreciate the input. The only thing I "know" at this point is that I enjoy research. I have tasted both success and quite a bit of failure but I find the motivation to get in the lab on a daily basis. You bring up some good points sluox and you are right I am not certain whether the MD path is the right one for me but I don't want to arrive at the conclusion that it is not the right direction for me halfway through my MD/PhD program (assuming I get into one of course).

And I understand that the PhD path is not a rosy one but I don't really think that fear of failure is a valid reason not to pursue this degree.

Would any of you guys suggest applying to both MD/PhD and PhD programs?

 

[Patros]

Really appreciate the input. The only thing I "know" at this point is that I enjoy research. I have tasted both success and quite a bit of failure but I find the motivation to get in the lab on a daily basis. You bring up some good points sluox and you are right I am not certain whether the MD path is the right one for me but I don't want to arrive at the conclusion that it is not the right direction for me halfway through my MD/PhD program (assuming I get into one of course).

And I understand that the PhD path is not a rosy one but I don't really think that fear of failure is a valid reason not to pursue this degree.

Would any of you guys suggest applying to both MD/PhD and PhD programs?

No, that's a dumb idea to be honest. It's much easier to enter the average PhD program than it is to enter the average MD/PhD, so there's no need to do that. Not to mention it'll be a real pain in the butt for your recommenders to write 2 sets of letters.

Ask yourself, if you got into a Hopkins PhD program or random state school MD/PhD, where would you go? If it's the former, then it's the research you care about. If it's the latter, why bother applying for PhD in the first place?

 

[LADuck00]

Really appreciate the input. The only thing I "know" at this point is that I enjoy research. I have tasted both success and quite a bit of failure but I find the motivation to get in the lab on a daily basis. You bring up some good points sluox and you are right I am not certain whether the MD path is the right one for me but I don't want to arrive at the conclusion that it is not the right direction for me halfway through my MD/PhD program (assuming I get into one of course).

And I understand that the PhD path is not a rosy one but I don't really think that fear of failure is a valid reason not to pursue this degree.

Would any of you guys suggest applying to both MD/PhD and PhD programs?

You should absolutely apply, for a few reasons. First of all, MD/PhD (especially MSTP) programs are for researchers. The ultimate goal of these programs is to produce investigators who are capable of conducting translational research. When the NIH reviews these programs for renewal of their (highly competitive) grants, one of the primary scoring categories is whether their graduates are primarily engaged in research 5, 10, and more years after graduation (or completion of residency). The government and university are covering your MD with the idea that it will enhance your ability to conduct cutting-edge translational research. This is not an "MD path" and if you choose to purely conduct research after completion of the program you will be in good company and be considered a success in the eyes of the NIH. That being said, most graduates do complete a clinical residency and take on some clinical duties, which is always an option. If you truly dislike medicine then getting the MD may be painful, but if your goal is to be a top-notch translational researcher then you should not let this dissuade you.

 

[quebaldy]

During my interviews I met some faculty who went through a MD/PhD program but bailed on doing a residency and went right back into research. I also met a few current students who were planning on doing the same. One or two said they appreciated their MD training, but most told me it wasn't worth it and that they should have just done the PhD training alone.

I'm matriculating this Fall so I obviously don't know much compared to the other posters here, but I'd agree with gutonc and gbwillner that MD/PhD is a bad idea if you believe that you'd be unhappy practicing clinical medicine. If you know already that you wouldn't pursue a residency/fellowship, then definitely don't apply MD/PhD; the payoff isn't worth it IMHO.

That being said, I agree with sluox that MD/PhD comes with some unique advantages and opportunities within research. These will be because of your clinical training and skills however, not because you have the letters MD after your name.

LADuck00 is correct in that the goal of MD/PhD training is to produce uniquely qualified scientists who will conduct primarily 'translational' research. The fact of the matter however, is that while most MD/PhDs stay in academics, less than half will stick with the 80:20 basic science research pathway touted by the NIH as the end goal of training.

 

[pithecanthropus]

Med school is loaded with insipid BS, and I presume residency will be similar. It is painful most days even when you like the subject matter, which may not be often. Don't do MD unless you see some sort of clinical practice as part of your future. It's four years of med school and however many years of residency and fellowship that you'll want back when you hit your 30s, and it won't enable you to do much that you couldn't do with good schools and mentors in PhD and postdoc.

 

[Baconbone]

There are plenty of successful PhD scientists out there- there is no reason you can't be one of them. It may be more difficult for you to make a decent wage, but you'll sleep better at night, knowing that you are doing what you want to do.

I thought the question came down to funding and not salary. Certainly getting the MD/PhD makes a difference in salary, but does it make a difference in getting funding for research with a PhD?

 

[kingrumak]

No, that's a dumb idea to be honest. It's much easier to enter the average PhD program than it is to enter the average MD/PhD, so there's no need to do that. Not to mention it'll be a real pain in the butt for your recommenders to write 2 sets of letters.

Ask yourself, if you got into a Hopkins PhD program or random state school MD/PhD, where would you go? If it's the former, then it's the research you care about. If it's the latter, why bother applying for PhD in the first place?

That is what I was thinking. Personally, I feel like I could apply for both programs simultaneously (naturally I would not apply to the same school as both an MD/PhD and PhD candidate) but I wouldn't feel right making my LOR writers to have to write two sets of letters for me.

 

[kingrumak]

I thought the question came down to funding and not salary. Certainly getting the MD/PhD makes a difference in salary, but does it make a difference in getting funding for research with a PhD?

I would say it depends on the proposed project. I can see how an MD/PhD may have the advantage over the PhD as far as some translational studies go (there are probably many exceptions of PhD's with heavy experience in translational research) but for a project that is essentially a basic science research question I cannot see how an MD/PhD would have an advantage over a PhD.

 

[kingrumak]

Med school is loaded with insipid BS, and I presume residency will be similar. It is painful most days even when you like the subject matter, which may not be often. Don't do MD unless you see some sort of clinical practice as part of your future. It's four years of med school and however many years of residency and fellowship that you'll want back when you hit your 30s, and it won't enable you to do much that you couldn't do with good schools and mentors in PhD and postdoc.

Strong words. If you don't mind me asking are you currently an MD/PhD student or just straight MD?

 

[LADuck00]

You want a career doing translational research in a disease-specific area. If you have considerable undergraduate research experience and decent grades, then you are the type of student that the MD/PhD program was designed for. Anybody who has gone through medical school will attest to the "boring" lectures and other frequent complaints from the students (some of which are certainly justified), but the bottom line is that there is no replacement for formal medical education and experience when it comes to understanding the diagnosis and treatment of disease. Just as a research fellowship is no replacement for a formal PhD program when it comes to research. It's true that the best will always tend to rise to the top regardless, but that doesn't mean you shouldn't seek out the best training to fit your goals. The NIH has swung away from purely basic research towards more translational studies, such that even basic research often requires a translational component to get funded these days. The time commitment is also not as long as you might imagine. The average PhD at a strong school like Harvard, Hopkins, etc. will commonly run 6-7 years, whereas the average MSTP is 7-8 years total. MSTP graduates tend to get their choice of residency or post-doc, and are sought out in both academia and industry. It gives you an edge and for good reason.

 

[pithecanthropus]

Strong words. If you don't mind me asking are you currently an MD/PhD student or just straight MD?

MD/PhD. I don't regret the MD for what I want to do, but I do think you have to want something clinical to justify it. Med students at my school, maybe most schools, are barely tolerated. It's not something you want to sign up for unless you have a specific end goal in mind to get you through the rest.

 

[URHere]

I'll be honest and say that when I entered my program I was pretty halfheartedly interested in both research and clinical medicine. So far I've been very lucky. I'm a few weeks from the end of my PhD and I still want research to be a component of my future career. At the same time, I've enjoyed most of my time in clinic, and I definitely don't regret the medical portion of my degree thus far (disclaimer: I haven't gone through the bulk of MS3 yet).

However, the main reason why I am glad I chose the MD/PhD path is that the field of research I (somewhat randomly) fell into ended up being one where an MD is incredibly valuable. I'm in a global health field and if I want to collect patient samples abroad or work on a clinical trial, I'll have that freedom because of the MD.

I agree with others here that you shouldn't go the MD/PhD route if you dislike clinical medicine. However, if you think you might like it, I think the potential benefits outweigh everything else.

 

[MedStud!]

I'm finishing an MD/PhD program now and it comes down to one thing. Do you want to see patients throughout your career or not? If the answer is yes, then go MD/PhD. If the answer is no, then go PhD. Spending 7-9 years full time away from research learning how to practice medicine is stupid unless you actually intend on practicing it. We have one person in our program now who almost dropped out because he doesn't want to practice. He was convinced to stay and finish at least medical school but will not be pursuing residency and regrets completely ever doing it because he has wasted so much time he could have been doing research.

If you don't want to practice medicine, then don't waste 7-9 years of your life learning how to. The amount of clinical information you get from medical school is great but the vast majority won't have anything to do with your research. A translational track research program like HHMI has is much better for someone who wants to do research without seeing patients. There are many PhDs who do wonderful translational research.

 

[Neuronix]

does [having an MD] make a difference in getting funding for research with a PhD?

No. I've pulled data to support that statement so many times in the past that I'm getting lazy to do it again. An MD/PhD makes a difference only in salary because you're doing clinical work--taking away from your research time and often not allowing you to basic research at all. MD/PhDs do not have better funding rates than PhDs alone. They do qualify for some small clinical/translational grants that PhDs don't often qualify for, but for the big career making grants the MD makes no difference.

 

[okemba]

I'll be honest and say that when I entered my program I was pretty halfheartedly interested in both research and clinical medicine.

Yeah, I'm right there, right now. Humor me - why did you still apply if you only had a half-hearted interest?

Research and clinical medicine are both kind of okay some of the time, right?

Any thoughts would be appreciated.

kingrumak (is this a Gears of War reference?), I'm basically in the same boat as you right now. It seems somewhat clear that prior posters' answers depend on how much you value having a stable, guaranteed six-figure income, and what your tolerance is for jumping through fiery hoops to get there (and once there).

You do seem to have a real interest in a specific type of translational research though, so the added knowledge itself might be worth it (though your interests will certainly change, unless perhaps they're motivated by an autistic relative or something similar). I've really come to appreciate more and more recently how the difference between good and not-so-good biomedical researchers lies more in their ability to ask good, impactful questions, than with technical proficiency in the answering. Not that the latter is unimportant.

The real question is what the marginal benefit is of MD/PhD over (PhD + HHMI Med into Grad), with respect to research, and whether the extra years justify it. I don't know. If I was interested, though, I would probably make a big excel spreadsheet where I look at the research interests and achievements of 20 translational PhD-only researchers and 20 translational MD/PhD researchers of similar-ages/similar years after receiving degrees, then try and go from there.

I have more basic science interests, and find it more difficult to justify. But eh. I'll probably still do it. I'm motivated by the location flexibility and salary, to be honest with myself.

Also, some people mentioned getting the MD/PhD then jumping ship and not doing a residency. I mean... you can *do* it, but... ? Idk. I'm not an expert, and maybe it's just selection bias, but to me it seems that the people who do this usually have had very successful PhD research careers.

I talked to one guy (who is a name), who got an MD/PhD then skipped out on residency, and he told me that even though he might be a "failure" by the typical standards, he felt (i) the broad and deep biological understanding that medical school conveys, and (ii) the ability to quickly learn/memorize new information, justified it in his mind.

But again, he is a name. Not your typical researcher... I actually didn't like him very much.


Here is a (PhD-only) alternative scheme that I have been contemplating:

1. Get a management consulting job. This is one of the few industries where you can get a job doing similar work both with a bachelors, and a PhD, and not be overqualified after the fact.
2. After 2 years, leave, and get a PhD for fun and profit.
3. If it seems like it went well enough that you think you can make professor, or you see industry jobs you like*, use your PhD to go do those things.
4. If you don't think the funding climate is good enough for you to become a professor or other academic knight, and biomedical industry is unappealing, return to management consulting.

I know a professor who did this. Except, you know, he's really smart and did well enough to become a professor. Unlike future me, probably.

I don't know. I really would like to be an academic researcher, but I've become very pessimistic recently that the academic market in 10-15 years will be favorable to !(living in the middle of nowhere) and !(perma postdochood).

*Competition for biomedical industry jobs is pretty stiff, and usually not as interesting as academia.

 

[Fencer]

All of the MD/PhDs that I have known in the biomedical industry have a medical license, which requires just an internship. The overwhelming majority have a specialty, both in pre-clinical and clinical R&D. Those in clinical side of things have often jumped ship after practicing for at least 3-5 years, and those pushing into industry management might have even pursued a MBA during those years. Those in pre-clinical development often do a couple of research post-docs within industry.

Because of my positions (ACGMG fellow director and MD/PhD director), and/or perhaps stage of my career (or the fact that I founded a biomedical company), I am approached on a weekly basis by head-hunters companies. The description of the jobs they have, might be biased but they fit the description as above.

 

[kingrumak]

Yeah, I'm right there, right now. Humor me - why did you still apply if you only had a half-hearted interest?

Research and clinical medicine are both kind of okay some of the time, right?



kingrumak (is this a Gears of War reference?), I'm basically in the same boat as you right now. It seems somewhat clear that prior posters' answers depend on how much you value having a stable, guaranteed six-figure income, and what your tolerance is for jumping through fiery hoops to get there (and once there).

You do seem to have a real interest in a specific type of translational research though, so the added knowledge itself might be worth it (though your interests will certainly change, unless perhaps they're motivated by an autistic relative or something similar). I've really come to appreciate more and more recently how the difference between good and not-so-good biomedical researchers lies more in their ability to ask good, impactful questions, than with technical proficiency in the answering. Not that the latter is unimportant.

The real question is what the marginal benefit is of MD/PhD over (PhD + HHMI Med into Grad), with respect to research, and whether the extra years justify it. I don't know. If I was interested, though, I would probably make a big excel spreadsheet where I look at the research interests and achievements of 20 translational PhD-only researchers and 20 translational MD/PhD researchers of similar-ages/similar years after receiving degrees, then try and go from there.

I have more basic science interests, and find it more difficult to justify. But eh. I'll probably still do it. I'm motivated by the location flexibility and salary, to be honest with myself.

Also, some people mentioned getting the MD/PhD then jumping ship and not doing a residency. I mean... you can *do* it, but... ? Idk. I'm not an expert, and maybe it's just selection bias, but to me it seems that the people who do this usually have had very successful PhD research careers.

I talked to one guy (who is a name), who got an MD/PhD then skipped out on residency, and he told me that even though he might be a "failure" by the typical standards, he felt (i) the broad and deep biological understanding that medical school conveys, and (ii) the ability to quickly learn/memorize new information, justified it in his mind.

But again, he is a name. Not your typical researcher... I actually didn't like him very much.


Here is a (PhD-only) alternative scheme that I have been contemplating:

1. Get a management consulting job. This is one of the few industries where you can get a job doing similar work both with a bachelors, and a PhD, and not be overqualified after the fact.
2. After 2 years, leave, and get a PhD for fun and profit.
3. If it seems like it went well enough that you think you can make professor, or you see industry jobs you like*, use your PhD to go do those things.
4. If you don't think the funding climate is good enough for you to become a professor or other academic knight, and biomedical industry is unappealing, return to management consulting.

I know a professor who did this. Except, you know, he's really smart and did well enough to become a professor. Unlike future me, probably.

I don't know. I really would like to be an academic researcher, but I've become very pessimistic recently that the academic market in 10-15 years will be favorable to !(living in the middle of nowhere) and !(perma postdochood).

*Competition for biomedical industry jobs is pretty stiff, and usually not as interesting as academia.

My username was my Runescape account name when I was about 6-9 years old. It seemed like a cool name at the time now I just use it for the nostalgia. My two younger brothers both have autism (the youngest is a more severe case). When I saw the effects that autism has on individual on a day-to-day basis it really made an impression on me. For a while I have felt that the best way that I can help them and the autistic community at large is through research. So it is unlikely that I will pursue a different avenue of research in my career.

I spoke with my biomedical engineering professor (MD/PhD - no residency) and he basically said in hindsight that he would have pursued the PhD only route. It sounded to me that the MD/PhD process kind of tired him out. He was about 31 years old and said that he did not feel that he had the energy to go through a residency. In the end, he did a post-doc for two years at Columbia and got a professor gig. He currently works on developing high resolution microendoscopes to aid in cancer diagnosis. He also does some other spectroscopic imaging studies for disease diagnosis. He said that the MD part of his degree has benefited him in that it allows him to speak the language of clinicians (which makes collaborations with MD-researchers slightly easier). But, he also said that it would have been possible to obtain this knowledge base over the course of his graduate studies. I have also emailed about 12 other MD/PhDs and of the three that have responded they said that the decision of MD/PhD v PhD basically boils down to your interest in clinical medicine. If see yourself practicing medicine throughout your career get the dual degree. If not, stick with the PhD. At the end of the day they said that do not feel that MD/PhD has any real advantage as far as research funding goes nor does the dual degree make them a better scientist (I have heard that one of the reasons to obtain an MD/PhD is that it provides a researcher with a better sense of how to design his experiments so as to suit clinical needs but this benefit is slightly over-exaggerated in their minds).

 

[okemba]

Fencer posted this in another thread - take a look (mildly relevant).

http://www.pnas.org/content/early/2014/04/09/1404402111

My username was my Runescape account name when I was about 6-9 years old.

- kingrumak

Oh yes... so many years wasted. That black dragon leather range armor was not a good use of my time... lol.

Because of my positions (ACGMG fellow director and MD/PhD director), and/or perhaps stage of my career (or the fact that I founded a biomedical company), I am approached on a weekly basis by head-hunters companies. The description of the jobs they have, might be biased but they fit the description as above.

- fencer

That's very interesting. I was actually talking more about PhD-only industry options; I didn't realize that many MD/PhDs went into industry. More prospects to consider...

So it is unlikely that I will pursue a different avenue of research in my career.

- kingrumak

Makes sense. I hope this won't seem too patronizing or immature (though it probably will, and I apologize in advance), but I always wished I had some life experience like this to give me motivation towards something specific in life. You have your siblings, Dostoevsky had his near-execution, Hofstadter has his language-less sister...

But, he also said that it would have been possible to obtain this knowledge base over the course of his graduate studies.

- kingrumak

This is my feeling as well. I still don't fully understand why the NIH funds MD/PhD programs. I am skeptical that we could not form some committee of MD/PhD, MD, and PhD-only scientists to analyze how their peers' research interests, approaches, and impacts differ, then come up with some sort of systematic way of giving PhD-only people more clinical exposure, coursework, instruction on how to do good translational research, etc., that would cost 10 times less per student than paying for 4 years of medical school. Deliberate practice. It confuses me, as it really doesn't seem that the intention is just to lure top students with a financial incentive.

I have also emailed about 12 other MD/PhDs and of the three that have responded they said that the decision of MD/PhD v PhD basically boils down to your interest in clinical medicine

- kingrumak

You didn't mention who you were emailing, but if you've been emailing professors, you'd probably have a better hit rate with post-docs and residents (or graduate students).

At the end of the day they said that do not feel that MD/PhD has any real advantage as far as research funding goes nor does the dual degree make them a better scientist (I have heard that one of the reasons to obtain an MD/PhD is that it provides a researcher with a better sense of how to design his experiments so as to suit clinical needs but this benefit is slightly over-exaggerated in their minds).

- kingrumak

Hmm. I don't know what to think. On one hand I want to hope what you've heard is true, but on the other hand I know it's all-too-easy for people who are immersed in something to not recognize how big an impact its had on their worldview and research interests. Fish can't tell they're swimming in water, tacit knowledge, sort of thing. And the PhD-only researchers probably wouldn't want to admit that their lack of an MD makes them inferior researchers.

It also hasn't escaped my notice that literally every NIH Director ever has held an MD. Coincidence?

 

[URHere]

Yeah, I'm right there, right now. Humor me - why did you still apply if you only had a half-hearted interest?

I already replied to this via PM, but I'll post here as well in case anyone else finds the answer relevant.

Back when I applied, I had no shadowing experience, and a moderate amount of clinical experience. I was generally bored out of my mind in clinical settings, but I attributed that to the menial tasks I was assigned. Ultimately, I decided to take a risk on medicine because I have always been almost pathologically attracted to new knowledge and I didn't think I would regret the schooling (even if I didn't ultimately like the career).
As for research, I very much enjoyed planning experiments, analyzing data, presenting, and random administrative things…but I hated the in between. I figured that as a PI I wouldn't need to do data collection, so I thought the PhD would be a temporary hassle with long-term benefit.

Ultimately, I don't know if this is what most people would consider "half-hearted", but it seemed that way to me. I honestly wouldn't have been upset if I ended up in different field.

At this point, I think the path I chose was right for me…I just had a hard time rectifying my undergraduate experiences with what the physician scientist life really entailed. I would tell most people that if you think you might like the path, go for it. You don't have to be certain (although you do have to sound like you are in apps and interviews). Just remember to give yourself permission to bail if you ultimately hate it - it's your life and being miserable just isn't worth it.

 

[kingrumak]

Fencer posted this in another thread - take a look (mildly relevant).

http://www.pnas.org/content/early/2014/04/09/1404402111

- kingrumak

Oh yes... so many years wasted. That black dragon leather range armor was not a good use of my time... lol.

- fencer

That's very interesting. I was actually talking more about PhD-only industry options; I didn't realize that many MD/PhDs went into industry. More prospects to consider...

- kingrumak

Makes sense. I hope this won't seem too patronizing or immature (though it probably will, and I apologize in advance), but I always wished I had some life experience like this to give me motivation towards something specific in life. You have your siblings, Dostoevsky had his near-execution, Hofstadter has his language-less sister...

- kingrumak

This is my feeling as well. I still don't fully understand why the NIH funds MD/PhD programs. I am skeptical that we could not form some committee of MD/PhD, MD, and PhD-only scientists to analyze how their peers' research interests, approaches, and impacts differ, then come up with some sort of systematic way of giving PhD-only people more clinical exposure, coursework, instruction on how to do good translational research, etc., that would cost 10 times less per student than paying for 4 years of medical school. Deliberate practice. It confuses me, as it really doesn't seem that the intention is just to lure top students with a financial incentive.

- kingrumak

You didn't mention who you were emailing, but if you've been emailing professors, you'd probably have a better hit rate with post-docs and residents (or graduate students).

- kingrumak

Hmm. I don't know what to think. On one hand I want to hope what you've heard is true, but on the other hand I know it's all-too-easy for people who are immersed in something to not recognize how big an impact its had on their worldview and research interests. Fish can't tell they're swimming in water, tacit knowledge, sort of thing. And the PhD-only researchers probably wouldn't want to admit that their lack of an MD makes them inferior researchers.

It also hasn't escaped my notice that literally every NIH Director ever has held an MD. Coincidence?

I have just been emailing professors at research hospitals and universities who are conducting autism research. You are probably right that I get a better response number with post-docs and grad students but I was targeting a specific group of autism researchers with MD/PhD's (perhaps I should broaden this).

I am currently a junior right now and should be applying this application cycle as an MD-PhD candidate if I choose to go this route. I'll be attending a summer research program at MD Anderson so I hope to get more answers to my question then.

 

[Patros]

Hmm. I don't know what to think. On one hand I want to hope what you've heard is true, but on the other hand I know it's all-too-easy for people who are immersed in something to not recognize how big an impact its had on their worldview and research interests. Fish can't tell they're swimming in water, tacit knowledge, sort of thing. And the PhD-only researchers probably wouldn't want to admit that their lack of an MD makes them inferior researchers.

It also hasn't escaped my notice that literally every NIH Director ever has held an MD. Coincidence?

I'd be careful of throwing around words like "inferior" around. I've never met a PI who would agree that their research skills are inferior solely because they didn't go to medical school. At least as I understand it, MD/PhD programs are meant to train more medically-informed researchers, not superior ones. And if even that much is accomplished is up to debate.

I'm not sure if your use of "literally" is sarcastic, but it is true that lots of NIH lab chiefs and directors are regular MDs. It's not too surprising I think. For one thing, many of the NIH branches, programs, and sections are very clinical in nature, so that MDs are essentially required. Even the basic science labs tend to have a translational focus. And second, you are only seeing the successful profiles. Many of these guys land a tenure-track job in Bethesda (a pretty sweet gig, from what I hear) at an early stage in their career, and stick with it. I suspect for every successful MD researcher at the NIH, there's a MD who left research to pursue a clinical career. So I don't think the correct conclusion is "Getting a MD is good for research," as much as it is "The NIH likes MD researchers."

Also, most of the MD researchers are >60 years old, a legacy of a bygone era. I would bet that in coming years, they will be steadily replaced by MD/PhD graduates. Just anecdotally speaking from my few years in research, I've met multiple MD/PhD grads doing postdocs, but can't remember the last time I saw a MD doing a postdoc.

 

[okemba]

I'd be careful of throwing around words like "inferior" around.

I was using that jokingly. Sorry if that didn't come through.

I'm not sure if your use of "literally" is sarcastic, but it is true that lots of NIH lab chiefs and directors are regular MDs.

Wasn't sarcastic here, as literally every NIH director has/had earned an MD. There's of course tons of chiefs without MDs.

And second, you are only seeing the successful profiles. Many of these guys land a tenure-track job in Bethesda (a pretty sweet gig, from what I hear) at an early stage in their career, and stick with it. I suspect for every successful MD researcher at the NIH, there's a MD who left research to pursue a clinical career. So I don't think the correct conclusion is "Getting a MD is good for research," as much as it is "The NIH likes MD researchers."

I don't understand exactly. If I am seeing the successful profiles, and these successes have MDs, and the NIH likes MD researchers, then this implies... having an MD is good for research, or for organizational planning, or for determining which research questions are worth answering? Why does the NIH like MD researchers?

Not trying to seem combative or anything, I'm just curious.

I would bet that in coming years, they will be steadily replaced by MD/PhD graduates

Probably. Not that I would really know. lol.

 

[Patros]

I don't understand exactly. If I am seeing the successful profiles, and these successes have MDs, and the NIH likes MD researchers, then this implies... having an MD is good for research, or for organizational planning, or for determining which research questions are worth answering? Why does the NIH like MD researchers?

Just so you know, I'm not an authority on anything, this is just speculation on my part. Maybe one of the more experienced members here will be more knowledgeable?

What I meant by successful profiles is that let's say there are a 100 MDs fellows who are applying for these jobs, maybe only 20 of them will get a tenure-track job, and the rest will go into clinical work. Again, just speculation since I don't know the real numbers, but these positions are supposed to be very competitive, so I'd bet most MDs who do research during their fellowships don't stay with full-time research for long. Mainly the few who are fortunate enough to be successful early on will continue with it, at least from what I have seen of the researchers' CVs.

As for why the NIH likes MD researchers, remember that a lot of the research is clinical in nature (oncology, dermatology, endocrinology etc) and deal with patients at the clinical center. These clinical science labs are where you find most MDs, just like any academic medical center's faculty. So in the NIH center I work in, there are 19 clinical "branches" (endocrine oncology branch, HIV-AIDS malignancy branch, etc), of which 17 are headed by MDs or MD/PhDs. There are also 28 basic science "laboratories" (each of which is a small group of PIs and their labs), but only 12 are headed by MDs or MD/PhDs (the rest are PhDs). So you can see that folks with MDs gravitate toward the clinical research (which shouldn't be surprising), while PhDs still dominate the molecular biology labs. Still, I think the MDs are more abundant in the NIH basic science sections than in a university's basic science departments, hence why I agreed that the NIH in particular seems to like MD researchers. Not sure if this answers the "But why does the NIH like MDs?" question, but I don't know how the hiring decisions are made.

 

[haanman]

I'm an MD/PhD student in the second year of my PhD. I also considered going the straight PhD route and had my doubts about the MD/PhD right until I matriculated, but I have no regrets about my choice at all. The clinical side has its frustrations for sure, but even in my limited experience it can be satisfying in ways that are quite different from what research gives you.

I agree with gutonc and gbwillner that if you're absolutely sure you don't want to be a physician, don't do the MD. That said, I disagree that there will necessarily "always be room for you to try to carve out space to do your research" as a PhD. Think carefully about what your contingency plan will be if you're not in a tenure-track faculty position and running your own lab. There's lots of great advice in the thread, but one thing that's missing is a realistic appraisal of career prospects for PhDs. Some statistics:

http://ascb.org/ascbpost/index.php/compass-points/item/285-where-will-a-biology-phd-take-you
https://royalsociety.org/~/media/Royal_Society_Content/policy/publications/2010/4294970126.pdf

"Fear of failure" is actually a great reason to reconsider the career path when the likelihood of "success" is so small. For similar reasons, it seems to me like the "MD/PhD but no residency" option is falling out of fashion in recent years.

My advice: consider the MD/PhD, but before you apply try to find real-life physician and physician-scientist mentors in your areas of clinical interest. Sluox's advice is on the mark. If you find that you have an interest in practicing medicine, you'll have lots of opportunities to define the scope of that practice in ways that make sense to you.

 

[tr]

No. I've pulled data to support that statement so many times in the past that I'm getting lazy to do it again. An MD/PhD makes a difference only in salary because you're doing clinical work--taking away from your research time and often not allowing you to basic research at all. MD/PhDs do not have better funding rates than PhDs alone. They do qualify for some small clinical/translational grants that PhDs don't often qualify for, but for the big career making grants the MD makes no difference.

I just want to point out that these data are not adjusted for the proportion of researchers with the degree who are actually submitting for grants. This group is selected out of the degree-holding group. Most people who apply for large research grants have to expect they have a chance in hell of getting them.

Made-up numbers close to what I remember: If 60% of MD-PhDs are spending the majority of their time in academic research, and 15% of PhD graduates are doing so, and rates of success are similar where the denominator is the subgroup who stayed in academia at all, then rates of success where the denominator is the degreed pool (not the pool retained in academia) are much greater for MD-PhDs than for straight PhDs.

So the MD may not boost your chances among the pool of similarly talented PhDs who were able to stick it out in academia to the point of even applying for an R01, but it sure does boost your chances of making it into that pool in the first place. (Of course this is not, and cannot be, controlled for the talents of the people in the various pools - i.e. it could possibly be explained by greater selectivity of MD-PhD programs comparable to the top 15% of PhD programs.)

Also the capacity to do clinical work boosts your ability to tread water until one of your proposals gets funded. Government funding being essentially a big game of roulette, if you can tread water for a year or two while doing more clinical work and continuing to submit proposals, that improves your ability to persist until payoff.

 

[dl2dp2]

Also the capacity to do clinical work boosts your ability to tread water until one of your proposals gets funded. Government funding being essentially a big game of roulette, if you can tread water for a year or two while doing more clinical work and continuing to submit proposals, that improves your ability to persist until payoff.

Tr! Welcome back!!!

This whole autism thing is interesting. Let me just share an anecdote, because I'm sort of tangentially glancing at the field from the sidelines... When I was a graduate student about a million years ago, I was at the Gordon Conference at a ski resort, and met a certain dork PhD student from a certain high profile researcher's lab from a prominent West Coast University. At the time my only thought was, what a dork. We were/are about the same age... Since then his name repeatedly appeared in the top journals, and he got a position in one of the best and most coveted named fellowships in a prominent East Coast University, got involved in developing a set of "new", "fashionable" techniques, and now have funding coming left and right from the Simons Simplex and the McKnight and the NIH Pioneer and Burroughs Wellcome...and running a lab of 30 postdocs. And his best tale to date yet is to use his new techniques in autism.

While I'm...having a panic attack staring at someone else's K23...but maybe I'll net more $$ than him this year? Maybe my spouse is hotter? Maybe I should stop trying to keep up with this particular Jones?

So, the moral of the story is, if you really really are narcissistic enough to think that you are gonna be a superstar, then go right ahead and just do a PhD. But if you are like the rest of us mortals and just want to do research for fun, maybe doing an MD and watching your back isn't such a bad idea, even if you get yelled at by your senior resident during MS-3 at times and have to pass Steps 1,2 and 3.

 

[tr]

Tr! Welcome back!!!

Thanks! I'm here because I'm procrastinating from writing my own K23, coincidentally enough. The last time I hung around SDN this much was when I was writing my PhD thesis.
Are you submitting soon?

 

[tortuga87]

Also... I think this hasnt been touched on yet. OP, what exactly do you mean by doing research? Keep in mind that most professors don't really get their hands dirty with primary research. They tend to spend most of their time doing secondary stuff like writing grants, teaching, and attending meetings

Also, how much money do you want to make? Management positions (like being a professor and running a lab) tend to make more

Do you want to be working with students who are learning, or people who already have PhDs?

Other career options are research scientist positions at institutes and industry labs. The former pays less but you generally are allowed to publish. The latter pays more but your discoveries may be kept within the company.

 

[kingrumak]

Ultimately, I want to be managing my own lab at a research hospital. As far as money goes, I just want to have a stable income. Not really factoring money into the equation I figure that regardless of whether I go the MD/PhD or PhD route I'll probably make about the same (maybe slightly more as an MD/PhD) throughout my entire career.

 

[Petypet]

Ultimately, I want to be managing my own lab at a research hospital. As far as money goes, I just want to have a stable income. Not really factoring money into the equation I figure that regardless of whether I go the MD/PhD or PhD route I'll probably make about the same (maybe slightly more as an MD/PhD) throughout my entire career.

It really sounds like you are a researcher and not a physician. Keep in mind, with Md/PhD there is a chance you will have to do significant clinical work while you set up and establish your lab. You don't just graduate, do residency, and have a fully established lab from the get go. Some researchers get significant start up grants, but thats not common place, especially with the current state of funding.

That said, you will make much more as an MD/PhD than straight PhD. Most people don't start off at a large research hospital right out of the gates, unless they get lucky with a science publication. Consider 5-6 years PhD, 3-5 years post doc, and 5+ years as assistant prof. Post graduation, you are looking at a salary of 33-40k as a post doc and 60-75k as an assistant prof. However, as an MD/PhD a lot of your income is due to the clinical side of things.

 

[moose4life]

It really sounds like you are a researcher and not a physician. Keep in mind, with Md/PhD there is a chance you will have to do significant clinical work while you set up and establish your lab. You don't just graduate, do residency, and have a fully established lab from the get go. Some researchers get significant start up grants, but thats not common place, especially with the current state of funding.

That said, you will make much more as an MD/PhD than straight PhD. Most people don't start off at a large research hospital right out of the gates, unless they get lucky with a science publication. Consider 5-6 years PhD, 3-5 years post doc, and 5+ years as assistant prof. Post graduation, you are looking at a salary of 33-40k as a post doc and 60-75k as an assistant prof. However, as an MD/PhD a lot of your income is due to the clinical side of things.

Does it depend on your specialty? I feel like there aren't a ton of openings for smaller specialties like Infectious Disease physician scientists (which is what I want to do). Or does the MD/PhD make it easier to join an existing practice while you set up your lab?

 

[Petypet]

Does it depend on your specialty? I feel like there aren't a ton of openings for smaller specialties like Infectious Disease physician scientists (which is what I want to do). Or does the MD/PhD make it easier to join an existing practice while you set up your lab?

Yes it depends on speciality. For example, in emerg med there are a ton of jobs and the research is new, fresh, and in demand. Very specific specialities are, like ID, I am not very familiar with. I would assume the MD/PhD would make you more competitive but its still a very small field. I know ID at my local university is a very small program, even with a fellowship, and some the faculty double in ID and something else (research wise). I don't know why one would do ID after md/phd only because the reimbursement sucks.

 

[okemba]

Prior to her medical training she obtained a doctoral degree at the University of California, Santa Cruz, studying evolution and development of learning processes in biology and culture in the History of Consciousness program, and then did postdoctoral work in the philosophy and history of science.

http://www.massgeneral.org/research/researchlab.aspx?id=1260

I just stumbled across this lady's recent book and one of her talks on youtube. Maybe up your alley.

She looks really cool.