MD vs MD/PhD

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hopefulscientist

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Hey all,

I realize that this thread has been posted a lot, though I'm facing a bit of a dilemma. I'm having a very hard time deciding whether I want to pursue solely an MD or an MD/PhD. I know I absolutely want the MD (I have had great shadowing experience), although I've also been working in a lab for a few years now and very much enjoy science. I would love to both clinically practice and maintain a lab, however, I'm aware of how limited research funding is right now. My main issue is spending eight years getting a dual degree and then finding out that I cannot do much with the PhD that I will have worked so hard to get. Furthermore, I am having difficulty deciding because I also want to have novelty in my profession for the rest of my life (hence the PhD). For those individuals who are currently in an MD/PhD program or have matriculated from one, what is your experience with funding and benefitting from the dual degree, both respect to treating patients and having regular novelty?

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In topics, as in not doing the same procedure or coming up with the same diagnosis each day.
 
In topics, as in not doing the same procedure or coming up with the same diagnosis each day.
As a point of fact, the average academic specialist physician will have much less variety in his/her daily clinical life than a non-academic physician. The PhD (or lack thereof) has nothing to do with it.

Here's an example. A very personal one.

I have a PhD. I have a mediocre pub record. I have a couple of active clinical grants and am PI on a few clinical trials including 2 IITs but gave up the bench (reluctantly, but realistically) a few years ago.

3 days a week I'm a community oncologist (employed by a University...it was a PP group bought by the University 7 or 8 years ago). But one day a week I'm an academic GI oncologist, at the University. With the cool kids. Here are my schedules from 2 random recent days in each setting.

Community:
3x HER2+ breast cancer on neoadjuvant chemo
3x ER+ BC on adjuvant endocrine therapy
Adjuvant rectal cancer chemo
2x Small Cell lung cancer (1 first line, one 3rd line)
Small cell cancer of small intestine
Follicular Lymphoma
Colon cancer f/u
Giant cell osteoclast tumor of the pancreas (WTF?!?!)
Undifferentiated sacral fibrosarcoma
Metastatic angiosarcoma
Recurrent grade 2 glioma

Academic:
3x metastatic colorectal cancer
2x metastatic anal cancer
3x metastatic liver cancer

Which do you think has greater variety?
 
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I agree. Community-based practice has much more variety. Some community guys still do AML induction, etc in addition to all the solid tumor stuff. I can't think of a single academic scenario (except public hospital, perhaps) where that is likely to happen. The "variety" in academics is the trial work, etc.
 
I agree. Community-based practice has much more variety. Some community guys still do AML induction, etc in addition to all the solid tumor stuff.
I just have to say that, while I see this in my area (but not my group), I think this is crazy flakes. It makes me sick to my stomach.
 
gutonc - sometimes patients refuse to go to an academic center; AML in the community (with great support) isn't like ... giving FCR to an 88 yo!
 
gutonc - sometimes patients refuse to go to an academic center; AML in the community (with great support) isn't like ... giving FCR to an 88 yo!
This is the key. I love and respect the onc floor nurses at my community hospital which is the designated "Oncology Center of Excellence" for a 5 hospital local chain. I'd personally drive an AML patient to the local academic MC before suggesting they receive induction chemo there.

Just because you can do something doesn't mean you should.

But to get back to the OP...if you want a varied clinical experience in any specialty other than pathology, academic medicine is the last place you want to be.
 
Would I still be able to perform high caliber clinical research (and be trained well enough to do it) with an MD or would I be much better prepared to do both clinical work and some research on the side? I like research, though I do not want a career in it, maybe do it on the side to supplement my clinical work.
 
There is nothing in life where you are doing "high caliber" work "on the side".
I guess my next question is then, if I want to do clinical research (translational medicine) alongside with my clinical work, will a PhD significantly benefit me? If I would like to work alongside with a lab, but not have my own lab (I'd rather spend my time treating patients than writing grants all the time), would it be worth it to spend 2-5 years getting a PhD or would my time be better put into getting clinical experience and then collaborating with people who do have the training I need to develop novel treatments?
 
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Would I still be able to perform high caliber clinical research (and be trained well enough to do it) with an MD or would I be much better prepared to do both clinical work and some research on the side? I like research, though I do not want a career in it, maybe do it on the side to supplement my clinical work.
You don't need (and shouldn't waste your time on) a PhD to do clinical research.

If by "on the side" you mean "devote 50-75% of my time to" then yes, you can do this. You will also likely be doing some very specific, focused clinical work as well.
 
So are MDs adequately trained to do clinical research? As in there isn't too steep a learning curve? (I've already been conducting undergraduate research at my university under a PI who treats me like a post-doc, so I have some experience with scientific critical thinking)
 
You do need additional training to perform strong clinical research as a physician. This can be learned "on the job" in a fellowship or in some targeted programs (ranging from several weeks to a year). You do not need a 4-5 year PhD for clinical research.
 
Okay, thank you! If I have more questions, I'll be sure to continue on in the thread. I'm starting to feel more for the MD, though you know, life choices.
 
Well. To put in another viewpoint here, I would just like to say that there is no way I would have come up with the ideas for the translational research I'm doing without a strong background in basic science. I wouldn't have had the background knowledge to have the ideas in the first place, and if by some miracle I had come up with them, I wouldn't have had the laboratory skills to put them to the test.

Obviously whatever your prior experiences are will inform your approach to whatever you do next. Perhaps if I hadn't done the PhD I would have had some other equally enriching, but different, type of experience that would have informed my work in other directions.

But I have to say I do notice a very distinct difference between my approach and the approach of other people at my level who have MD + research fellowship. Their research fellowships focus on clinical approaches and (at least from my perspective) their research scopes are narrower and more strictly guided by whatever their mentors are doing. (Of course that may be a more practical approach in the long run, because it is easier to get funding if you are an obvious and direct apprentice to someone who is already a big shot in a given field. It gives you credibility by proxy with reviewers and they are more likely to give your proposal a pass because they assume your mentor knows what he is doing. So, pros and cons either way of course.)
 
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Well. To put in another viewpoint here, I would just like to say that there is no way I would have come up with the ideas for the translational research I'm doing without a strong background in basic science. I wouldn't have had the background knowledge to have the ideas in the first place, and if by some miracle I had come up with them, I wouldn't have had the laboratory skills to put them to the test.

Obviously whatever your prior experiences are will inform your approach to whatever you do next. Perhaps if I hadn't done the PhD I would have had some other equally enriching, but different, type of experience that would have informed my work in other directions.

But I have to say I do notice a very distinct difference between my approach and the approach of other people at my level who have MD + research fellowship. Their research fellowships focus on clinical approaches and (at least from my perspective) their research scopes are narrower and more strictly guided by whatever their mentors are doing. (Of course that may be a more practical approach in the long run, because it is easier to get funding if you are an obvious and direct apprentice to someone who is already a big shot in a given field. It gives you credibility by proxy with reviewers and they are more likely to give your proposal a pass because they assume your mentor knows what he is doing. So, pros and cons either way of course.)
Are they still able to do good science? Also, when you say they are able to get better funding, what kind of percentage? Like 20% (still kinda rough), or around 40-60%?

Also, unrelated questions, after looking over many forums based on the MD/PhD dilemma, I have noted that I can always transfer into MD/PhD if I want up to two years in, do you all have any idea of acceptance rates for in-school medical students to in-school MD/PhD programs?
 
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Every field has deepness in their science. To indicate that clinical research does not require a PhD only shows the current perceived state of the art. There are PhDs in Translational Science, Epidemiology, Biostatistics, etc. The body of knowledge and critical thinking that those PhDs provide you allow to excel in clinical research. Who knows what the landscape would look like in 20 years for NIH funded clinical research? Would it require the level of expertise that a clinical research PhD provides you?

Get the tools, training and credentials that you need before age 35-40, after that you still have 30 -40 years of professional life expectancy to use them... (I know easy to say because it was way easier when I did it).
 
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Every field has deepness in their science. To indicate that clinical research does not require a PhD only shows the current perceived state of the art. There are PhDs in Translational Science, Epidemiology, Biostatistics, etc. The body of knowledge and critical thinking that those PhDs provide you allow to excel in clinical research. Who knows what the landscape would look like in 20 years for NIH funded clinical research? Would it require the level of expertise that a clinical research PhD provides you?

Get the tools, training and credentials that you need before age 35-40, after that you still have 30 -40 years of professional life expectancy to use them... (I know easy to say because it was way easier when I did it).
Could you please describe clinical research? How is it different from bench research and clinical care? Also, I'm planning to do MD only now, but with a masters in something and/or a research fellowship. Might I as well do a PhD or do you think this prepares me more adequately (although of course not to the level of a PhD) for clinical research?
 
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Describing clinical and bench research as different entities is often done. However, biology is a continuum from fundamental biochemical and molecular processes to human behavior. The reason for a different research toolkit has to do with the complexity of humans, requiring big data points, multiple missing values, etc. as compared to paired research experiments in reductionist approaches that more easily give you reproducible answers than in more clinical fields. All of these approaches are complementary but require different skill sets and, perhaps, even personalities.

see for example: https://www.ctsacentral.org/educati...petencies-clinical-and-translational-research
 
I think I need to point out that clinical research and translational research are NOT the same thing. There may be some overlap. Translating basic science concepts to to patient care (translational research) probably does greatly benefit from a PhD because you may still be doing hard core science, albeit with a clinical bent. Clinical research can be as mundane as a two arm clinical trial on 500 patients with drug X vs. Drug Y. It can be using immunohistochemsitry Z on disease entities alpha vs. beta. It could also be cooler, like observing outcomes in patients with some novel therapy. Anyway, point is that they are not the same.
 
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Are they still able to do good science?

I mean yeah, these are all smart people working with very experienced mentors. From my perspective the questions they ask are somewhat limited in creativity, mostly comparing established interventions and/or doing work that is a direct offshoot of an existing project by the mentor. Perhaps that sounds elitist. I wouldn't say it to anyone's face. I'm sure people have thoughts they wouldn't tell me about my work.

Also, when you say they are able to get better funding, what kind of percentage? Like 20% (still kinda rough), or around 40-60%?

I don't know how to answer your question using percentages. The percent salary coverage you get from a grant depends on how you allocate the budget. I can say that personally I have had a terrible time trying to get money out of the NIH, which tends to be the source of the largest grants. My impression is that the NIH is extremely conservative with their funding, and tends to favor established investigators and their proteges. I have had better luck with foundation grants, but these are typically much smaller. As I said, the people who are hewing closely to established lines of investigation are likely to have the last laugh on me when I give up on research for lack of funding and bail out for the greener pastures of private practice.
 
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