PostDoc-to-MedSchool: Am I a Glutton for Punishment?

[Tnmur]

Hello everyone, I am in my 2nd year of a postdoc in a clinically relevant field. I want to become a physician scientist, and work as an academic (i.e., tenure track professor) with my own research laboratory where I can then implement research findings in the clinic and advance patient care. I also want to take what I see in the clinic back to the laboratory and have this relationship where I am living in that "translational" medium. My ideal scenario would be a 70-80% research/academic career with the rest being clinical work.

The trouble I'm having is reconciling with myself whether or not I am running away from the purgatory, potentially-leads-to-nowhere, hopeless postdoc mentality by applying to medical school, or whether I am finally waking up and realizing that as exciting as my research is, I recognize that I am missing that connection with humans and that my contribution ends at a manuscript. I can't "take care" of them and help them improve their outcomes, for instance.

I know I cannot see myself doing anything other than clinically relevant research, and I really would love to intertwine the medical application or research with the basic sciences. To be honest, I really enjoy interacting with participants and I want to improve their lives with my research directly and be responsible for their care. I don't want to simply understand them scientifically, publish, then move on.

At first, the idea of pursuing medical school seemed completely lunatic to me. Until I came to realize that the time will pass anyway, and I'll be 40 one day. Ever since I considered medicine, I haven't stopped thinking about it. Things felt like they fell in place. And now all I can think about is how meaningful my research can be if I can have it directly influencing my care. I truly would find that completely satisfying. I just want to make sure I'm thinking clearly throughout this all.

While I could not find much online regarding other postdocs in my position, I know some of you have been down this path (academic before medicine, through a PhD).

Specifically, my questions to you are:

1) am I being smart by realizing this about myself, and thinking about medical school, before I'm X number of years in a postdoc (when I could have better used that time to get a medical degree)?

2) am I going backwards by going back to school? I'm ~30 years old.

3) on the topic of age, by the time I'm done (residency included), I'll be close to 40. Will universities hire me immediately or will I also need to wait it out as long as one would on a traditional PhD-PostDoc path?

Thanks for any insight!

I can post this under Physician Scientists if that's more appropriate?

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[eteshoe]

I would suggest that you post this under the physician scientist forum since I know there's a couple users who did the non-traditional PhD-(postdoc)-to-MD.

Regardless of all that, if you are considering med school, you'll still have to possess all the typical pre-med qualifications (decent UG GPA, all the coursework, clinical ECs, shadowing, solid MCAT, etc) since the PhD won't count for too much more than an extensive research experience.

If you have a solid UG GPA + decently high MCAT, you could focus on some of the top research heavy med schools, which would typically have a decent appreciation (this doesn't necessarily mean preference) of your academic path thus far.

However, the first thing I suggest you do is shadow a couple different doctors and physician scientists and get a real sense of what the path entails and looks like at the end and really evaluate if you can see yourself putting up with the lifestyle and thriving.

 

[Tnmur]

I would suggest that you post this under the physician scientist forum since I know there's a couple users who did the non-traditional PhD-(postdoc)-to-MD.

Regardless of all that, if you are considering med school, you'll still have to possess all the typical pre-med qualifications (decent UG GPA, all the coursework, clinical ECs, shadowing, solid MCAT, etc) since the PhD won't count for too much more than an extensive research experience.

If you have a solid UG GPA + decently high MCAT, you could focus on some of the top research heavy med schools, which would typically have a decent appreciation (this doesn't necessarily mean preference) of your academic path thus far.

However, the first thing I suggest you do is shadow a couple different doctors and physician scientists and get a real sense of what the path entails and looks like at the end and really evaluate if you can see yourself putting up with the lifestyle and thriving.

Thank you. I'll post it there.
While I have yet to write the MCAT, I have pretty good UG grades, and work closely with physicians on several projects.

 

[Neuronix]

The trouble I'm having is reconciling with myself whether or not I am running away from the purgatory, potentially-leads-to-nowhere, hopeless postdoc mentality by applying to medical school

The problem is that it's not much better trying to do research on the MD/PhD side. Just because you're MD/PhD doesn't mean someone is just going to give you a lab. The funding rates for PhDs and MD/PhDs applying for grants are identical. The MD gets you a stable clinical job, but it doesn't necessarily improve your ability to get a research startup package. In your case, you'll need to be out of research for 4 years of med school plus residency and fellowship (typically 5+ years). It'll be almost like starting over in research when you're done training clinically.

1) am I being smart by realizing this about myself, and thinking about medical school, before I'm X number of years in a postdoc (when I could have better used that time to get a medical degree)?

If you want to be a doctor, be a doctor. But know that this is more of a career change for the next decade than it is an extra credential to help your career in research. You may never be able to come back to research, and you need to be comfortable with that.

3) on the topic of age, by the time I'm done (residency included), I'll be close to 40. Will universities hire me immediately or will I also need to wait it out as long as one would on a traditional PhD-PostDoc path?

You'll typically get a job post-fellowship. Clinical jobs in most specialties are relatively easy to acquire, even in "academics". How much of that job will be dedicated to research will depend on a lot of factors. That's why I put "academics" in quotes. Most academic physician (including MD/PhD) jobs are mostly (if not entirely) clinical in nature.

More info: I haven't written the MCAT yet, but I have a pretty solid UG GPA and I work closely with physicians on projects (in clinical settings oftentimes).

You'll have to study for the MCAT as if you don't have a PhD. The MCAT is basic material in multiple disciplines. There's a lot of gamesmanship in how you approach and take the exam as well. A common pitfall for PhD->MD people is blowing off the MCAT. Be careful of this. You'll need to study for it a couple hours per day for on the order of 3 months.

 

[Tnmur]

The problem is that it's not much better trying to do research on the MD/PhD side. Just because you're MD/PhD doesn't mean someone is just going to give you a lab. The funding rates for PhDs and MD/PhDs applying for grants are identical. The MD gets you a stable clinical job, but it doesn't necessarily improve your ability to get a research startup package. In your case, you'll need to be out of research for 4 years of med school plus residency and fellowship (typically 5+ years). It'll be almost like starting over in research when you're done training clinically.

While I respect the reality of acquiring funding (either as a PhD or MD or MD/PhD), I am not sure that I agree with the reality of giving up research altogether while finishing up my clinical training. From my understanding, most schools push their students to conduct research, and it's especially important during the residency programs that I'm aware of. Also, my plan is to keep in touch with my postdoc supervisor and work during summers to keep my research up. Is this too idealistic, in your expertise?

If you want to be a doctor, be a doctor. But know that this is more of a career change for the next decade than it is an extra credential to help your career in research. You may never be able to come back to research, and you need to be comfortable with that.

I was thinking of it more of a complementary degree. Where both my MD and PhD work together, rather than operating mutually exclusively. Again, am I too optimistic?

You'll have to study for the MCAT as if you don't have a PhD. The MCAT is basic material in multiple disciplines. There's a lot of gamesmanship in how you approach and take the exam as well. A common pitfall for PhD->MD people is blowing off the MCAT. Be careful of this. You'll need to study for it a couple hours per day for on the order of 3 months.

I'm very okay with this. In fact, I know I really need to brush up on my basic sciences. And I look forward to studying for the MCAT actually. I agree with you that the PhD means nothing when it comes to the MCAT, and I am willing to start from square one when it comes to studying. Thanks for the tip.

Overall, thank you for your insight. These are the exact opinions and conversation I was hoping to start with people (although I wasn't comfortable to do it with anyone I know in person).

 

[Neuronix]

While I respect the reality of acquiring funding (either as a PhD or MD or MD/PhD), I am not sure that I agree with the reality of giving up research altogether while finishing up my clinical training. From my understanding, most schools push their students to conduct research, and it's especially important during the residency programs that I'm aware of. Also, my plan is to keep in touch with my postdoc supervisor and work during summers to keep my research up. Is this too idealistic, in your expertise?

You can get a little bit in here and there, sure. Summer between MS1 and MS2, maybe some during MS4. Med school is difficult. Your clinical performance and board scores matter most for getting a strong residency when you're done so that's where the pressure is.

There is no summer between MS2 and MS3 or MS3 and MS4.

When you finish medical school, you'll typically be dedicated to clinics for several years of residency. You might be able to fit in a year or two of research as a resident or fellow.

One issue that arises is that you don't know where you'll go to med school. You may not have the opportunity to proceed in your current lab or even your current area of research. Then when you're not in the lab full-time... Your skills kind of atrophy and reset. It's very tough to keep it all going.

I was thinking of it more of a complementary degree. Where both my MD and PhD work together, rather than operating mutually exclusively. Again, am I too optimistic?

In a decade, you may be able to do this. Maybe. What you propose is a fine goal, and is what I'd say in interviews for med school and residency. Whether it will actually happen for you is a different question. When you're 40 years old and looking at post-doc *again* in one specific location, will you take the post-doc with the low pay and uncertain future or go to the clinical world, making double/triple/quadruple, living where you want, and with career security? These are the questions we almost all will face. Maybe you will get lucky. Maybe you will dedicate yourself research at any cost. Most of us take the clinical job.

Overall, thank you for your insight. These are the exact opinions and conversation I was hoping to start with people (although I wasn't comfortable to do it with anyone I know in person).

You're welcome.

 

[Meridian32]

Postdoc -> MD -> physician-scientist is not a crazy route and I know people who have done it. However, remember that if you become a tenure track professor at a research medical school who is running a lab 80% of the time and a clinician 20% of the time, you will still be doing bench research 80% of the time. So if you are unhappy with the postdoc and bench research world, going down this route is unlikely to make you happy because you will be living in that world most of the time.

The people I know who have succeeded at this route love bench research. My wife is an assistant professor (PhD, not MD) at a research heavy medical school and loves research. She has people in her lab who do much of the work, but still makes time to do experiments by herself and with lab members. The successful physician-scientists I know enjoy their clinical duties, but love research and running a lab more.

So - this route is not crazy, and there are med schools that actively recruit applicants with your background (e.g., http://columbiamedicine.org/education/3Y_PhD-MD.shtml), but be sure that you really like bench research first.

 

[Mad Jack]

At what point is one no longer acting of their own free will, but rather a victim of academic Stockholm syndrome?

 

[Tnmur]

Postdoc -> MD -> physician-scientist is not a crazy route and I know people who have done it. However, remember that if you become a tenure track professor at a research medical school who is running a lab 80% of the time and a clinician 20% of the time, you will still be doing bench research 80% of the time. So if you are unhappy with the postdoc and bench research world, going down this route is unlikely to make you happy because you will be living in that world most of the time.

The people I know who have succeeded at this route love bench research. My wife is an assistant professor (PhD, not MD) at a research heavy medical school and loves research. She has people in her lab who do much of the work, but still makes time to do experiments by herself and with lab members. The successful physician-scientists I know enjoy their clinical duties, but love research and running a lab more.

So - this route is not crazy, and there are med schools that actively recruit applicants with your background (e.g., http://columbiamedicine.org/education/3Y_PhD-MD.shtml), but be sure that you really like bench research first.

Interesting. Thank you for the info and for your opinion. I still really like research, which is why I don't want to give that up. I just want to see through the completion of my work where I want to conduct the bench work and have it directly affect my patients, while tailoring experiments based on what I see in the clinic. My utopian view would be one where I can seamlessly move back and forth between the two worlds and find a home in the middle ground somewhere. I love basic science and problem solving, but I want to understand and treat the very people I am testing. Not let them go post-publication.

 

[Tnmur]

At what point is one no longer acting of their own free will, but rather a victim of academic Stockholm syndrome?

Are you referring to the idea that once you're in academia, it's hard to do something other than the traditional academic path without feeling some sort of remorse or self-doubt?

 

[Mad Jack]

Are you referring to the idea that once you're in academia, it's hard to do something other than the traditional academic path without feeling some sort of remorse or self-doubt?

Yep.

 

[Tnmur]

Yep.

Love that description.

Could. Not. Agree. More.

 

[QofQuimica]

I'm a PhD-to-MD. The pathway is fairly common. That being said, what direct clinical experience have you gotten so far? If the answer to my question is "none," then the answer to your question is, "yes, you're chasing a fantasy." Which I suspect is the case. Most MD/PhDs don't "seamlessly" do anything. Both research and clinical medicine are full time jobs in and of themselves. To do either well requires FT effort. To do both well is going to be like doing two FT jobs, and even then, there are no guarantees. Funding for bench research in particular is way too competitive for it to be successfully done by physician dabblers. Likewise, researchers who dabble in patient care often aren't very good clinicians. I suggest that you do the following:

First, talk to some MD/PhDs at your institution about what they actually do. You will find that most successful grant-getters do primarily research, while most of the rest do primarily clinical work. Those few that do some of both typically do not apply their research findings directly to patient care unless they are doing specialty-specific clinical research (such as oncologists who are doing clinical trials on chemo regimens).

Second, think about what your real career goal is. If you want to primarily be a bench researcher, then you don't need a medical degree. If you want to primarily be a clinician or clinician scientist (such as running clinical trials), then you do. But again, regardless of whether they have one degree or two, most physicians aren't scientists, and most scientists aren't physicians. You will have to pick one career or the other. Once you do, then the answer to the question of whether an MD/DO is necessary to get there will become clear.

 

[Tnmur]

I'm a PhD-to-MD. The pathway is fairly common. That being said, what direct clinical experience have you gotten so far? If the answer to my question is "none," then the answer to your question is, "yes, you're chasing a fantasy." Which I suspect is the case. Most MD/PhDs don't "seamlessly" do anything. Both research and clinical medicine are full time jobs in and of themselves. To do either well requires FT effort. To do both well is going to be like doing two FT jobs, and even then, there are no guarantees. Funding for bench research in particular is way too competitive for it to be successfully done by physician dabblers. Likewise, researchers who dabble in patient care often aren't very good clinicians. I suggest that you do the following:

First, talk to some MD/PhDs at your institution about what they actually do. You will find that most successful grant-getters do primarily research, while most of the rest do primarily clinical work. Those few that do some of both typically do not apply their research findings directly to patient care unless they are doing specialty-specific clinical research (such as oncologists who are doing clinical trials on chemo regimens).

Second, think about what your real career goal is. If you want to primarily be a bench researcher, then you don't need a medical degree. If you want to primarily be a clinician or clinician scientist (such as running clinical trials), then you do. But again, regardless of whether they have one degree or two, most physicians aren't scientists, and most scientists aren't physicians. You will have to pick one career or the other. Once you do, then the answer to the question of whether an MD/DO is necessary to get there will become clear.

Thank you so much, Q. Your initial posts on this forum were one of the most eye opening pieces I read on the net regarding PhD to MD.

And now, you've left me with much to think about. It is difficult for me to accept the reality of never being able to do relevant research and treat those who need it. The ultimatum I'm left with between an academic or a medical career is a difficult one to deal with.

Thank you again for leaving me with some homework.

 

[Tnmur]

I'm a PhD-to-MD. The pathway is fairly common. That being said, what direct clinical experience have you gotten so far? If the answer to my question is "none," then the answer to your question is, "yes, you're chasing a fantasy." Which I suspect is the case. Most MD/PhDs don't "seamlessly" do anything. Both research and clinical medicine are full time jobs in and of themselves. To do either well requires FT effort. To do both well is going to be like doing two FT jobs, and even then, there are no guarantees. Funding for bench research in particular is way too competitive for it to be successfully done by physician dabblers. Likewise, researchers who dabble in patient care often aren't very good clinicians. I suggest that you do the following:

First, talk to some MD/PhDs at your institution about what they actually do. You will find that most successful grant-getters do primarily research, while most of the rest do primarily clinical work. Those few that do some of both typically do not apply their research findings directly to patient care unless they are doing specialty-specific clinical research (such as oncologists who are doing clinical trials on chemo regimens).

Second, think about what your real career goal is. If you want to primarily be a bench researcher, then you don't need a medical degree. If you want to primarily be a clinician or clinician scientist (such as running clinical trials), then you do. But again, regardless of whether they have one degree or two, most physicians aren't scientists, and most scientists aren't physicians. You will have to pick one career or the other. Once you do, then the answer to the question of whether an MD/DO is necessary to get there will become clear.

I forgot to ask you, now that you have been down this road yourself, do you find time to pursue "academic" medicine in the form of clinical research?

Also, everyone keeps talking about "bench work". Does that refer to non-human clinical trial work? I'm only asking this because the research I would like to stay in is all human based, non-invasive work. There are lots of basic science work that can be done with humans. Although I am not sure if the term "bench work" applies to this either. As a clinician, I'd have easier access to individuals that would be eligible for these kinds of studies.

So I guess to speak to the point on doing bench work as a physician scientist, it wasn't my plan in the first place to get into that kind of work. I'd much rather do clinical trial type of work, but where I also get to treat people on top of doing clinic trials.

 

[QofQuimica]

There is some overlap, but bench work typically refers to basic and translational projects that are not directly studying human subjects. So, for example, a project using human tissue, say, from surgical path samples, would still count as bench research. Clinical trials, in contrast, involve enrolling human subjects and studying the effects of specific interventions on them (such as medications).

I started out as a chemist (so straight bench work). Along with my MD, I also got an MS in clinical trials. Completely different skill set and career path versus a PhD. If you are interested in clinical research, I would advise you to similarly pursue clinical research training. You don't necessarily have to do it during med school; these programs are open to residents, fellows, and attendings as well. The benefit of waiting to do clinical research training until you're a resident or above is that you will be paid while doing your MS instead of the reverse, which is obviously preferable to having to take out even more loans as a med student.

At the moment, I am doing all clinical and teaching work and no research. That will change next year once I start fellowship. (I took a couple years "off" after residency and have been working as a clinical assistant prof.)

 

[Tnmur]

There is some overlap, but bench work typically refers to basic and translational projects that are not directly studying human subjects. So, for example, a project using human tissue, say, from surgical path samples, would still count as bench research. Clinical trials, in contrast, involve enrolling human subjects and studying the effects of specific interventions on them (such as medications).

I started out as a chemist (so straight bench work). Along with my MD, I also got an MS in clinical trials. Completely different skill set and career path versus a PhD. If you are interested in clinical research, I would advise you to similarly pursue clinical research training. You don't necessarily have to do it during med school; these programs are open to residents, fellows, and attendings as well. The benefit of waiting to do clinical research training until you're a resident or above is that you will be paid while doing your MS instead of the reverse, which is obviously preferable to having to take out even more loans as a med student.

At the moment, I am doing all clinical and teaching work and no research. That will change next year once I start fellowship. (I took a couple years "off" after residency and have been working as a clinical assistant prof.)

Looking back, would you say that your PhD experience helps you with what you do in your career today? Or would you say that having your MD + MS in clinical trials is all you need to be where you are today?

 

[QofQuimica]

Looking back, would you say that your PhD experience helps you with what you do in your career today? Or would you say that having your MD + MS in clinical trials is all you need to be where you are today?

To do my current job, having just the MD would be sufficient. I don't use the PhD at all, except occasionally to bore trainees by busting out with fascinating tidbits like why the "drunk" guy who imbibed of the isopropanol-based hospital hand sanitizer won't get an anion gap metabolic acidosis from it.

 

[OxToCA]

Looking back, would you say that your PhD experience helps you with what you do in your career today? Or would you say that having your MD + MS in clinical trials is all you need to be where you are today?

If you don't mind me borrowing your conversation, I'm doing an MSc specific to clinical trials prior to a translational/clinical PhD & MD, and applying for a grant and stipend increase; I'd like to keep this thread in my post history.

 

[Lucca]

At what point is one no longer acting of their own free will, but rather a victim of academic Stockholm syndrome?

I think it might be a function of how often you drink alone once you are home

 

[Tnmur]

If you don't mind me borrowing your conversation, I'm doing an MSc specific to clinical trials prior to a translational/clinical PhD & MD, and applying for a grant and stipend increase; I'd like to keep this thread in my post history.

I'm OK with it. If it helps anyone, that's great. It's important to open discussion and get different view points.