Researching with MD

[Avicenna]

How conducive is an MD to research?

How viable is it to pursue an MD mainly for research?

Does an MD offer any advantages to a PhD when going into research?

Is clinical work and research mutually exclusive, or can an MD pursue both upon completion of his education? (And if both, would that necessitate both admission to residency and a postdoc program?)

Is a post doc required for an MD to do research? (Major research, not just second/third author at some shoddy journal)

I know the NIH pays off a portion of MD loans upon admission to a post doc program, is there anything that can be done about the rest?

What I'm generally trying to understand is what is the extent to which a physician can pursue research?

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[Sir William Osler]

How conducive is an MD to research?
Nothing is out of reach with an MD-only. qualify for the same grants as PhD's.

How viable is it to pursue an MD mainly for research?
Not efficient use of your time if you are only interested in research. A PhD is a shorter route to a research career. The MD is useful for translational, clinical, or disease-based research. The MD will cost you at least 7 years of clinical training if you do a residency before your postdoc even starts. Basically, you will be 7 years behind the rat-race for basic bench research.

Does an MD offer any advantages to a PhD when going into research?
Yes, the MD opens up some unique grant opportunities such as the K08 NIH grant. MD's have more background in diseases so they can understand the context of their research in a different manner. HOWEVER, this is totally dependent on the individual. Several PhD's have great disease understandings while many MDs do not. But in general this is true. MD's have greater job flexibility and can easily do clinical work if they run out of grants. PhD's are a higher risk degree.

Is clinical work and research mutually exclusive, or can an MD pursue both upon completion of his education? (And if both, would that necessitate both admission to residency and a postdoc program?)
Nowadays, if you are in bench research as an MD, you will be expected to do at least 75% research. If you are in clinical research, it is more variable. More typically, your postdoc will be a part of your fellowship since there are funding mechanisms in place for this type of work at certain academic hospitals. More rarely, you can do a postdoc straight after med school or residency by other funding mechanisms.

Is a post doc required for an MD to do research? (Major research, not just second/third author at some shoddy journal).
Yes. you have to learn to do research during a postdoc. Only rarely would MD/PhD's who have killer PhD's go straight into a faculty position instead of clinical training. This is a more likely path a few generations ago.

I know the NIH pays off a portion of MD loans upon admission to a post doc program, is there anything that can be done about the rest?
you can google NIH loan repayment program. If you do MD/PhD you should have low debt. State school can help.

What I'm generally trying to understand is what is the extent to which a physician can pursue research?
As much research as you desire. Its easy to understand. Imagine spending 7 years learning clinical medicine (med school = 4, residency minimum =3), then you need to learn how to do research either by postdoc or PhD+postdoc (4-5 years vs 7-8 years). To be a MD who also is trained in research, you are looking at double the training as a clinician only MD. One can imagine alot of "weeding out" along the way for MD's who originally thought they wanted to do big research.

 

[Guero]

Guero's additional thoughts to Original Post are beside Original Reply in bold.

How conducive is an MD to research?
Nothing is out of reach with an MD-only. qualify for the same grants as PhD's.

How viable is it to pursue an MD mainly for research?
Not efficient use of your time if you are only interested in research. A PhD is a shorter route to a research career. The MD is useful for translational, clinical, or disease-based research. The MD will cost you at least 7 years of clinical training if you do a residency before your postdoc even starts. Basically, you will be 7 years behind the rat-race for basic bench research.
Agreed.

Does an MD offer any advantages to a PhD when going into research?
Yes, the MD opens up some unique grant opportunities such as the K08 NIH grant. MD's have more background in diseases so they can understand the context of their research in a different manner. HOWEVER, this is totally dependent on the individual. Several PhD's have great disease understandings while many MDs do not. But in general this is true. MD's have greater job flexibility and can easily do clinical work if they run out of grants. PhD's are a higher risk degree.
Agreed.

Is clinical work and research mutually exclusive, or can an MD pursue both upon completion of his education? (And if both, would that necessitate both admission to residency and a postdoc program?)
Nowadays, if you are in bench research as an MD, you will be expected to do at least 75% research. If you are in clinical research, it is more variable. More typically, your postdoc will be a part of your fellowship since there are funding mechanisms in place for this type of work at certain academic hospitals. More rarely, you can do a postdoc straight after med school or residency by other funding mechanisms.
To clarify, if you want to provide any patient care, you must first complete a residency, a minimum of 3 years (e.g., internal medicine) up to 7 (e.g., neurosurgery). Fellowships allow you to subspecialize and/or focus on research, though research is usually synonymous and a required aspect of fellowship training.

Some residencies are classified as Physician Scientist Training Programs, wherein you're guaranteed research time, resources, and mentorship. They're extraordinarily competitive, some with guaranteed sub-specialty fellowship placements (e.g., Internal Medicine>Hematology-Oncology Fellowship), and some without, but instead offering additional, mentored research time following clinical residency time (e.g., UCSD does a great job of explaining these concepts). I did entertain a debate on whether one is competitive enough for such a residency with an MD vs MD/PhD. I can post that here, too, if there's enough interest.

Take home point: If you're interested in providing patient care, an MD is necessary. If you're solely interested in research, as stated above, a PhD is more efficient.

Is a post doc required for an MD to do research? (Major research, not just second/third author at some shoddy journal).
Yes. you have to learn to do research during a postdoc. Only rarely would MD/PhD's who have killer PhD's go straight into a faculty position instead of clinical training. This is a more likely path a few generations ago.

I know the NIH pays off a portion of MD loans upon admission to a post doc program, is there anything that can be done about the rest?
you can google NIH loan repayment program. If you do MD/PhD you should have low debt. State school can help.
I disagree, but only in terms of the terminology chosen here. A "post-doc" is a very specific form of dedicated research time and mentorship without clinical responsibility. An MD can utilize various alternatives to a post-doc, starting in medical school, to avoid necessitating a traditional post-doc. For instance, some of the options I outlined above, where you're combining practice with research. However, yes, additional training after obtaining your doctorate, no matter what that doctorate might be, is necessary to continue developing the skills, networking, understanding, and innovative thinking to become an independent and successful investigator.

What I'm generally trying to understand is what is the extent to which a physician can pursue research?
As much research as you desire. Its easy to understand. Imagine spending 7 years learning clinical medicine (med school = 4, residency minimum =3), then you need to learn how to do research either by postdoc or PhD+postdoc (4-5 years vs 7-8 years). To be a MD who also is trained in research, you are looking at double the training as a clinician only MD. One can imagine alot of "weeding out" along the way for MD's who originally thought they wanted to do big research.
Here's a very useful link describing degree statuses of physician scientists over many years, and as you scroll down, correlative success at achieving funding:
http://report.nih.gov/workforce/psw/chapter_3_main_data.aspx#figure3.2

An additional point to be made is the flexibility of an MD vs PhD if unsuccessful in research. If you're not successful as a PhD by persistently securing funding for your research, your options are a little more limited than an MD that can stay in academia by becoming a Clinician Educator or by switching to practicing medicine. My PhD peers have lamented this fact, exemplifying industry (which they wanted to avoid in the first place) or teaching at a liberal arts university as their only options outside research. Conversely, there are academic MDs I've met that have warned me about making that same switch in academic medicine, though, hinting that it's a risky career move because a third switch and an attempt to transition to practice is seen as a red flag by private practices. I'll leave that as is to avoid an unrelated tangent, as these explanations should sufficiently answer your original line of questions.

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Guero's Summary:

The take home of my elaborations are that you should consider seriously the life you want for yourself. I've been working on a thread that will continue to grow, delineating the pros and cons of MD/PhD, MD/master's, and MD physician science. Each path of education has its pros and cons. Each path must be individually considered. As you'll find, despite one's bias, they're all equally valid and useful paths. One additional, major factor in deciding which path to pursue will depend on the discipline in which you choose to speacialize. Clearly, if you're into radiation oncology and the research therein, it might be better for you to pursue an MD/PhD. There's an ongoing debate about that, actually. @Neuronix may be able to paste that reference.

I hope this helps. Please feel free to post additional questions or contact me personally. However, please be forewarned that my medicine phase is currently very busy and nearing USMLE (licensing) exam preparation time. I may not reply fast. But I will reply.

Thanks for reading and good luck to all,
G

P.S. Please excuse typos, will return to proofread.

 

[Guero]

Format failed, more information pending.

 

[gutonc]

Format failed, more information pending.

Use the "quote" function. It's up there in the toolbar, 4th one from the right in a dropdown menu. Select the text you want to quote, hit the button then type away. It's non-intuitive and it took about 6 months before I figured out that's where it was.

 

[Guero]

Use the "quote" function. It's up there in the toolbar, 4th one from the right in a dropdown menu. Select the text you want to quote, hit the button then type away. It's non-intuitive and it took about 6 months before I figured out that's where it was.

That wasn't the issue. Neuronix and I are developing a sticky. That was referring to the material I'm about to paste to my next post. Thanks, though.

 

[gutonc]

That wasn't the issue. Neuronix and I are developing a sticky. That was referring to the material I'm about to paste to my next post. Thanks, though.

Oh...sorry. Wasn't clear. But your reply to Sir William Osler was unreadable.

 

[Guero]

This is the beginning of a sticky detailing alternative options to the traditional dual degree paths* to prepare for a career as a physician scientist.
*Medical Scientist Training Program (MD/PhD); Institutional MD/PhD programs; and numerous MD/master's options.

Introduction:

In becoming a physician scientist, the most important aspects that prepare you as a successful applicant to residencies and fellowships that further shape you for the ultra competitive career of a physician scientist are developing the skill sets to master methodological protocols and inter-laboratory collaboration/networking, improving your mental capacity to devise, efficiently execute, and eloquently disseminate your results, and most importantly, developing the keen ability to justify and secure funding for your research. I'll say this early, funding is key. Graduating from a Medical Scientist Training Program (MSTP; dual MD/PhD degree program, fully tuition waived with living stipend provided by NIH) or non-MSTP MD/PhD program alone isn't by default sufficient or a guarantee that one will meet all of these goals. Some graduates of these programs, even top tier, will never see a career as a physician scientist and instead choose to enter clinical or private practice. That's fine for many, but a disappointment to those passionate about research and dedicated so much time working toward that goal. So one must carefully choose which path s/he chooses, based on life circumstances and a great deal of planning. I'm here to help you find the non-MSTP and non-MD/PhD options that don't involve adding a master's degree, yet another option that MANY of my mentors and colleagues chose. That said, I'm not discounting a master's degree during residency or fellowship as my career progresses.

My own story:

The take home of this entry is that there are alternative paths to Medical Scientist Training Programs (MSTPs) and MD/PhD programs to becoming a physician scientist. There are unique reasons to pursue each path. This is my brief story of why I ultimately chose a non-MSTP, non-MD/PhD, and (for now) non-master's degree physician scientist path:

I did a great deal of professional clinical and volunteer bench research before coming to medical school, resulting in a first author pub, several coauthored pubs, a first author oral presentation at a national neurological conference, all with a bachelor's degree, and numerous other oral and poster presentations before even finishing undergrad. So as a late medicine bloomer starting in my 30s and misjudging my competitiveness while applying, by the time I realized I was competitive, I felt that the time commitment of an MSTP transfer, difficult in its own right, was beyond what I needed to begin my physician scientist career. My current school offers a non-MSTP [non-NIH financial supplements] MD/PhD program, which only gives you stipend and tuition waiver for graduate phase, charging full fees during medical phase, not to mention lack of expertise and eminence.

But I knew that I still wanted to become a physician scientist. I did lots of research before starting medical school to find research opportunities and found the Howard Hughes Medical Institute's (HHMI's) very competitive Medical Research Fellow program. I searched high and low, EARLY, to find potential labs and mentors. I was ultimately accepted to my second choice at a top 10 institution during my M1 year. The program begins by completing an initial summer phase at an institution and with a mentor of your choosing to ensure that you show promise, productivity, and get along well with your potential lab. I completed it quite successfully and now reapply based on those summer results and evaluations to take a year off to do the meat of my fellowship, which I’ll complete after I finish M3 to accommodate my fiancée's academic schedule. However, most students choose to do this between M2 and M3, which I highly recommend. You'll be better off clinically to continue M3 to M4 in a seamless fashion. During M4, I’ll apply to residencies with heavy research emphases and protected research time (hopefully urology if my Step 1 results are competitive enough) and then a fellowship (neurourology is the current hope).

All that said, I still wish I knew earlier that I was competitive enough for MSTPs and pursued that pathway from the beginning. It’s what I always wanted, but never thought I was good enough based on my MCAT. It wasn’t until I was accepted to my top choice medical school as an out-of-state (OOS) regular MD student, a school that would’ve charged me $375k for cost of attendance, that I contacted their MSTP and was told that I “should’ve applied; we’d have definitely offered you an interview.” :/ The tuition waivers and stipends of the MSTP would’ve helped me greatly. I was already in immense debt from private university tuition and private loans before starting med school (>$150k before starting medical school, albeit with partial scholarship) that still haunt me today. They’re freaking charging me despite being in school because they’re private loans, not federal. So please do take that however it may apply to you.

*Caveat: If you decide late, you can still apply to the HHMI year-long without having done the summer trial phase.

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Now on to your options.

I'll be honest, securing funding will take you the furthest in your career. When you apply for research oriented residencies, fellowships, and/or junior physician scientist faculty positions, the reviewers now look at funding more heavily than your publications or even the impact of those publications. For instance, one seminal paper in Nature with no record of securing funding was once sufficient, but now looks much less palatable than an applicant that has several low impact papers, or even none, but has a record of securing multiple training grants or other financial awards to conduct research. This is straight from the mouths of my attending physician scientist and post-doc PhD mentors at a top 10 institution that have sat on these committees.

The take home here is that I recommend you opt for the Howard Hughes Medical Institute (HHMI), National Institutes of Health (NIH), or other path in which you're awarded funds in a peer-reviewed fashion. Finding a lab and mentor with whom you get along and taking a year off or more to do research is also an option, and may land you the skills and productivity necessary for the residency you need to begin securing funding, but has been ill-advised by my mentors. Take that as you wish. They're all options.

I'll be updating these options as I have time to research them. Please send me a PM if any of these links become inactive so I can update them:

A) This is where I claim the most expertise: Howard Hughes Medical Institute (HHMI), a private funded institution specializing in high-risk, high-yield research.

1. HHMI Summer Program (initial research, meant to evaluate mentor-mentee fit and potential)
-->Search for your mentor early! The month you begin school is best. Mentor MUST be an HHMI investigator at this phase.
^^>>Here's the list of mentors openly stating they're willing to accept summer students.
-->Contact several mentors, using 1-3 sentence emails max, and attach your CV--many PIs will ask for letters from previous mentors/labs.
-->Once taken on by a mentor, your application is equal parts mentor and mentee, begin early.
-->Applications are NOT rolling: Take your time with revisions.

2. HHMI Year Program (largest chunk of research, meant to show productivity and fit for research oriented residencies or post-docs)
-->same as above, but mentor "not required" to be HHMI investigator, but still "highly recommended."
-->if choosing a non-HHMI investigator, s/he must currently hold an active NIH R01 grant, demonstrate publication productivity, and be willing to take the time to provide you with sufficient mentorship to achieve your novel, discovery-based project proposal.

B) I'd love to hear from those completing these programs: National Institutes of Health (NIH), our federally funded conglomeration of biomedical research institutes.

1. NIH various short programs (NIEH, summer open to med students; research electives open to rotating M3/M4s)
2. NIH's year-long MSRP (intended for those finishing third year)

--I believe these fall under NIH regulation, but offer their own separate funding opportunities at various medical schools and research hospitals, the regulatory formalities and specifics with which I'm not yet fully familiar. Would also love to hear from someone completing one of these.

3. NIDDK Short-term & Long-term Funding Options as a med student
4. ASBMB Opportunities by State

More will be added as I have time. Please feel free to send me opportunities that you've completed or with which you're familiar. That'll cut down on my own time committments.

I can also add some prose about my own evolving experience using the private funding route. I could also start a rolling "Ask an MD student physician scientist," but don't see that as being as popular or necessary yet. As always, feel free to ask me questions personally, or depending on how Neuronix decides to implement this thread, post a reply.

-G

 

[Guero]

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[gutonc]

I know how to view what you posted. But the way you did it makes it unreadable.

 

[Guero]

I know how to view what you posted. But the way you did it makes it unreadable.

Oh, I'm so sorry. I misunderstood. I've been rushing between bldgs today and have been out of pocket.

I initially thought it was better to have my response right next to the original answers. We used to do that a lot when I was more active before the SDN update that necessitates the pull down. I'll reformat as you suggested. I see what you mean. It'll be much clearer that way, thanks.

 

[Guero]

@gutonc Thanks again. Does that look better?

 

[Guero]

As promised, here's my response regarding whether pursuing a non-dual degree path with the HHMI will suffice if shooting for a Physician Scientist Training Path Residency:

"Do you feel like that year will be enough since a lot of the PSTPers are MD/PhDs? . . . Seems like it's geared toward basic science peeps."

Honestly, it’ll depend on my productivity and nourishment of recommendations and networking during that year. It’s all about showing the PDs a high potential of return on their investment, especially when considering the PSTPs with an intra-institutional subspecialty placement guarantee. Considering what I was able to accomplish in 9 weeks utilizing a novel animal model, I’m confident, with appropriate planning and collaboration, that my likelihood of proving myself worthy is high enough to warrant a shot. And if not, I’ll adjust my career plans accordingly, no sweat. The first step to this plan, though? Step 1 being sufficiently competitive to even think about that path, another reason I’m shooting to begin after M3, wouldn’t want to waste my time applying if I achieve mediocrity on Step 1. A plate of nasty truth I never find palatable…

However, you’re spot-on when making the distinction between basic science and the myriad clinical and translational varieties. Despite the insane competitiveness and downward trend of funding for basic science research we face, it remains the gold standard for PSTPs and the shining star on your CV. The clinical and translational paths are out there, though. For instance, Vandy offers several flavors of those tracks that combine with MPH, or their unique MSCI (master in science of clinical investigation). I think those programs would be a fantastic fit for someone whom basic science is well understood, but not an attractive path, and leans toward clinical and/or translational as more of their schtick.

Cheers!
-G