Tell me if I'm being stupid.

[_ian]

So, I've been looking at PhD programs to apply to, and I'm really starting to reconsider it.

I love research, and as a starry-eyed 3rd year undergrad, I'm pretty sure it's what I want to do with my life. Of course, it also scares the hell out of me, especially since I think my best fit would be academia. It also doesn't help to read posts on these forums that say "Do MD or MD/PhD -- never do PhD." Eek.

The research I am drawn to is in developmental neuroscience, neuropsychiatric/neurodegenerative disorders, and learning and memory. All of these have very direct ties to medicine. I'd say a good 50% of the PIs of the labs I've marked for closer inspection have either both degrees or just the MD. This implies to me that I'd be a good fit, and that the MD could be beneficial.

As you can see by my registration date, I've long considered medicine and MD/PhD programs. I thought I'd finally made my decision, but damn it, I'm waffling again. This fact alone makes me think I should just apply MD/PhD, and if it ends up being a waste of my time, oh well... at least I can know I didn't miss an opportunity.

I'm wondering if this is stupid because at this point, I can live without being able to practice medicine. I don't need the MD to do the work I want to do, but I can see how it would help... if my interests were in something less clinically relevant, this wouldn't be a question. At this point, the MD is more or less a big failsafe on my big plans, and from the outside looking in, I feel like four years of grueling work is worth that (plus residency, of course), since I do think I'll enjoy practicing medicine as well, just not as much as I'll enjoy research. My only options right now are the MD/PhD and PhD.

What do you guys think?

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[Circumflex]

I can live without being able to practice medicine. I don't need the MD to do the work I want to do, but I can see how it would help... if my interests were in something less clinically relevant, this wouldn't be a question. At this point, the MD is more or less a big failsafe on my big plans, and from the outside looking in, I feel like four years of grueling work is worth that (plus residency, of course), since I do think I'll enjoy practicing medicine as well, just not as much as I'll enjoy research.QUOTE]

Based on what you wrote, my advice is to do a PhD only. I can tell that you have a true spark/passion for research. Going through all the hoops of med school will be grueling for you and will probably be miserable for you. Med school is difficult enough (psychologically, emotionally, socially) for people who love medicine.

I am in my last year of the MD/PhD and I do not regret my path, but I love medicine and I love basic research. Getting an MD as a fail-safe is not a good idea. From what I can tell, you have not done much research and will not be taking the MCAT this April. So, you will have to wait at least a year, but will only have 1 year of research while others applying for MD/PhD programs have more. So, that's 1 year extra past undergrad. Then, 7-9 years of MD/PhD, followed by 3-6 years of residency/fellowship training. So, minimum of 11 years after undergrad, you will be done with training.

If you go for the PhD, you graduate next year, spend 5-6 years getting your PhD, do 1-2 post-docs for 3-6 years, then go for a faculty position. So, the time spent in training is a little shorter, but not much. The difference is that after your first 2 years of PhD (learning general information), you can concentrate on your field (area of interest). Then, you get to go to work everyday working on something that stimulates you, that you love learning about.

The same cannot be said for med school. You are constantly taking big exams, taking the 3 USMLE exams (day-long exams for licensing), doing clinical rotations that do not interest you, getting little sleep on some rotations, then applying for residency, and doing the same all over - exams once a year, board exams. It is great if you love what you are doing, but you have to love it or you will go nuts.

You can have an extremely rewarding career with a PhD. Like my colleagues say, "We get paid to read about what we want and do cool experiments."

 

[_ian]

I actually have three years of research and a publication already. You are right that I will be waiting a year to apply for MD/PhD programs, since I will not be ready by this summer. Thanks for your thoughts.

 

[chirurgino]

Don't do both degrees. It's painful enough to get them both when you REALLY want to get them, and it sounds like your heart is not really into the medical half of it. Remember that after you finally get both degrees, the MD will essentially be useless letters after your name unless you also enlist for an additional 4 yrs (for neurology) or an additional 7 yrs (for neurosurgery).

 

[Vader]

I agree with the above. Although it is honestly tough to go the straight PhD route these days with extended postdocs, the ever-increasing bar for attaining faculty positions, decreased grants, etc, I believe that it is still probably the best route for you, given what you wrote.

There are PhD programs more geared toward biomedical research (i.e. at UCSF, we have the biomedical sciences graduate program). If this is your interest, I would seek these out and apply.

You can certainly gain some of the benefits of a medical school education, while bypassing the parts that might otherwise make you miserable. For example, you can audit med school classes, attend grand rounds, shadow physicians in clinics, etc.

If for some reason you happen to end up getting really interested in medicine, you could always do medical school afterward.

Good luck!

 

[move2west]

I too debated for years over MD/PhD or PhD, and I have switched back and forth two many times to count. I almost started a PhD program after college knowing that I would try to switch to a combined program if I decided I needed both (I am really glad I did not do this). We have the same research interests almost identically, and I would agree that it can seem like it would be helpful to have both. However, I think a lot of people from combined degree programs switch to that area of research, and that it may not actually be a necessity to have both degrees. It would depend specifically on your exact research interests, which will probably change over time. I currently work under a MD/PhD in a basic science lab in one of those areas of interest. He commonly states that medical school and the year internship he did was a waste of time, but does agree that the extended knowledge base he has from med school is helpful.

I would strongly recommend that you try to find a fellowship at NIH for a year or two after you graduate, since you will need to take time off. It has been a great opportunity for me to explore which route to take. There are a lot of MDs, MD/PhDs, and PhDs here doing the whole spectrum of medical research, and they all talk regularly. Some labs give do both clinical and basic research. Many of the basic science PIs (such as mine) are fairly laid back and will let you go to the clinical center to get exposure to that clinical research too. After doing this for a year or so, you can probably decide which degree you should pursue. If you cant completely decide befor you graduate college, I would stay for two years so you have ample time to determine which route to do and then you can apply. PM me if you want more info.

 

[physicsnerd42]

What you could also do is start a PhD at a school with a MD/PhD program that is open to accepting people who are PhD students into the combined program. I'm sure there are a bunch of programs out there like that. I know we have a guy in the MD/PhD program here at Dartmouth who started as an Engineering PhD and is now in M4 and just matched into neurosurgery. Also, if you're interested, there's an umbrella grad program at Dartmouth called PEMM (Program in Experimental and Molecular Medicine) that encompasses much of physio, neuro, etc. So, you could find a program like that to start your PhD in since its goal is to churn out researchers who are interested in doing basic science that is more clinically-relevant. If you decided to switch over to the MD/PhD, it might take some work, but you'd have a decent shot at some schools. Just a thought.

 

[Jorje286]

So, I've been looking at PhD programs to apply to, and I'm really starting to reconsider it.

I love research, and as a starry-eyed 3rd year undergrad, I'm pretty sure it's what I want to do with my life. Of course, it also scares the hell out of me, especially since I think my best fit would be academia. It also doesn't help to read posts on these forums that say "Do MD or MD/PhD -- never do PhD." Eek.

The research I am drawn to is in developmental neuroscience, neuropsychiatric/neurodegenerative disorders, and learning and memory. All of these have very direct ties to medicine. I'd say a good 50% of the PIs of the labs I've marked for closer inspection have either both degrees or just the MD. This implies to me that I'd be a good fit, and that the MD could be beneficial.

As you can see by my registration date, I've long considered medicine and MD/PhD programs. I thought I'd finally made my decision, but damn it, I'm waffling again. This fact alone makes me think I should just apply MD/PhD, and if it ends up being a waste of my time, oh well... at least I can know I didn't miss an opportunity.

I'm wondering if this is stupid because at this point, I can live without being able to practice medicine. I don't need the MD to do the work I want to do, but I can see how it would help... if my interests were in something less clinically relevant, this wouldn't be a question. At this point, the MD is more or less a big failsafe on my big plans, and from the outside looking in, I feel like four years of grueling work is worth that (plus residency, of course), since I do think I'll enjoy practicing medicine as well, just not as much as I'll enjoy research. My only options right now are the MD/PhD and PhD.

What do you guys think?

lol, it feels like I'm reading my clone. I'm exactly in the same position as you are right now, with the same research interests and similar worries. Personally, I've decided to give MD/PhD a shot, even though the odds are smaller for me. (international students, and I've only done research since last summer). Besides job security and all that, I do think clinical exposure is very important to this research field, and stuff like psychiatry can give you a lot of time to do research. But I dunno if it's the same for you, I do have an interest in medicine and mixing both is great by itself for me. It'd be ideal for me if I can be 70% research 30% seeing patients.

 

[foo]

OK, I'll tell you: "you are being stupid!" (I'm only joking of course)

But seriously... I'll champion the contrarian view...

The first two years of medical school are in my opinion, well structured, basic science, coursework. This is arguably a useful experience for anyone that may want to do only a PhD but is unsure if they want to complete an MD.

If you are accepted into an MD/PhD MSTP program, you can do the first two years of medical school, then work on your PhD, then decide if you want to complete the MD, then decide if you want to do a residency.

Keep all your options open as long as possible, get exposed to the MD basic science curriculum, postpone your decision, and have fun. Beats working for a living. (I'm only half-joking this time).

 

[Dr.Watson]

What you could also do is start a PhD at a school with a MD/PhD program that is open to accepting people who are PhD students into the combined program. I'm sure there are a bunch of programs out there like that. I know we have a guy in the MD/PhD program here at Dartmouth who started as an Engineering PhD and is now in M4 and just matched into neurosurgery. Also, if you're interested, there's an umbrella grad program at Dartmouth called PEMM (Program in Experimental and Molecular Medicine) that encompasses much of physio, neuro, etc. So, you could find a program like that to start your PhD in since its goal is to churn out researchers who are interested in doing basic science that is more clinically-relevant. If you decided to switch over to the MD/PhD, it might take some work, but you'd have a decent shot at some schools. Just a thought.

Based on only anecdotal evidence, switching from PhD to MD/PhD is rather rare and difficult to do at most schools (I've met one). I wouldn't bank on this option unless you've done some very thorough investigation of your school's policies and talked to administrators in both programs. It's a much harder route than applying MD/PhD upfront.

The reverse, MD only to MD/PhD is much more common since you can seemlessly transition into the PhD years after the first two years of med school. I've met quite a few first years applying/reapplying to their school's MSTP on interviews as well as those further up in the program that successful made the transition.

From what you've said, I'd go the PhD route. In the short term, studying for the MCAT is a pain and a much larger time commitment than GREs. Plus, the last two years of med school, intern year, and any residency you complete will be a grueling, boring waste of time for you if you want only research and aren't interested in patient care. Heck, I know physicians that think year 3/4 and intern year are a waste of time because you learn the "important/relevant" stuff in your field in residency.

Since you're taking time off, I suggest you get some more clinical exposure in the fields you're interested in and see if you think those extra years in med school might be valuable and enjoyable to you. If it's not, do the PhD in perhaps a clinical geared program.

Often in MD/PhD interviews, they ask you to pick one or the other if you had to. My impression is that the "right" answer is MD because you can still do good research and reach your goals of being a clinician-scientist, but with a PhD-only you can't ever see patients. If you'd outright choose the PhD, then MST program probably isn't for you. It's not to say that many MD/PhDs don't choose to do one or the other in the end; it's just ideally they want you to do both and be passionate about them (and be this idealistic at the start of the process, if not the end).

 

[_ian]

One thing I should mention... if I get the degree, I will spend some time practicing. My point is that I want it, but I don't need it, and if it isn't going to give me any advantage whatsoever other than to practice medicine, I'm not going to get it. With my current mindset, I could run a basic science lab and teach and be happy with my life... but if I got the degree, I would absolutely use it. I do have some clinical experience, and I have enjoyed it. On top of this, I'm playing the "what-if" scenario, which I overstated a little in the OP, because that's really what has been on my mind...

Regardless... I will step up the clinical experience ASAP and get some direct experience in neurology and/or psychiatry. Hopefully I either really like it or really hate it

Don't do both degrees. It's painful enough to get them both when you REALLY want to get them, and it sounds like your heart is not really into the medical half of it. Remember that after you finally get both degrees, the MD will essentially be useless letters after your name unless you also enlist for an additional 4 yrs (for neurology) or an additional 7 yrs (for neurosurgery).

Yeah, I'm thinking about the residency as well. I don't intend to do neurosurgery... I'm looking at neurology or psychiatry.

Although it is honestly tough to go the straight PhD route these days with extended postdocs, the ever-increasing bar for attaining faculty positions, decreased grants, etc, I believe that it is still probably the best route for you, given what you wrote.

These are big concerns of mine. Will the MD confer any advantage in any of these, or is it only really helpful to practice medicine? I fully realize that it is a bad idea to get the degree if I have no intentions of practicing, but as I said, I do.

If for some reason you happen to end up getting really interested in medicine, you could always do medical school afterward.

I could, but that sounds awful I don't know that I'd be able to deal with that, to be honest -- for a couple reasons, I don't think I could take on that kind of debt late in life if I intended to use the degree to supplement (rather than replace) my research.

I currently work under a MD/PhD in a basic science lab in one of those areas of interest. He commonly states that medical school and the year internship he did was a waste of time, but does agree that the extended knowledge base he has from med school is helpful.

I am a little worried about this. My interests are all over the place... in my ideal lab, I would be doing research involving both animal models and patients, so I don't think this will become an issue... but that's so far off from now I can't be certain the patients will always play a role.

I would strongly recommend that you try to find a fellowship at NIH for a year or two after you graduate, since you will need to take time off. It has been a great opportunity for me to explore which route to take.

This sounds like a great idea. At the very least, I'll be switching labs at the end of my honors thesis, unless I'm working on another publication. My current lab is only tangentially related to medicine (as in, the grants and publications often talk about PTSD and the implications of our research for it, but our day-to-day focus is animal modeling of emotional learning and memory).

If you are accepted into an MD/PhD MSTP program, you can do the first two years of medical school, then work on your PhD, then decide if you want to complete the MD, then decide if you want to do a residency.

Keep all your options open as long as possible, get exposed to the MD basic science curriculum, postpone your decision, and have fun.

This was exactly my thinking. Take it one step at a time...

Based on only anecdotal evidence, switching from PhD to MD/PhD is rather rare and difficult to do at most schools (I've met one). I wouldn't bank on this option unless you've done some very thorough investigation of your school's policies and talked to administrators in both programs. It's a much harder route than applying MD/PhD upfront.

I've also heard this, and I don't want to try it.

Often in MD/PhD interviews, they ask you to pick one or the other if you had to. My impression is that the "right" answer is MD because you can still do good research and reach your goals of being a clinician-scientist, but with a PhD-only you can't ever see patients.

That seems to be the typical mindset I've seen... someone who wants to do research, but can't live without seeing patients... not someone who could live without seeing patients for the sake of saving eight years. I could lie, I'm good at that. Or come up with a really good alternate answer.

 

[gbwillner]

you are being stupid.

You want to do a PhD- do a PhD. You want to be a PhD and be a doctor- do an MD/PhD. You want to see patients and not do science- do an MD.

Why exactly is this so difficult? You seem to know exactly what you want to do. If you want a PhD only there is virtually no competition and you could go virtually wherever you want. If you go the med-school way- you need to get in line. It will be an extra 4 years of your life for nothing. And you say yourself you don't want to see patients???????

If it's because of funding- good scientists get funded. There is a critical time in your development when this will really be a factor- when you are trying to get a faculty appointment. Training grants are easy to get. People get by doing this- even if the budgets have been cut to pre 1970's levels (not adjusted by inflation).

 

[Vader]

One thing I should mention... if I get the degree, I will spend some time practicing. My point is that I want it, but I don't need it, and if it isn't going to give me any advantage whatsoever other than to practice medicine, I'm not going to get it. With my current mindset, I could run a basic science lab and teach and be happy with my life... but if I got the degree, I would absolutely use it. I do have some clinical experience, and I have enjoyed it. On top of this, I'm playing the "what-if" scenario, which I overstated a little in the OP, because that's really what has been on my mind...

These are big concerns of mine. Will the MD confer any advantage in any of these, or is it only really helpful to practice medicine? I fully realize that it is a bad idea to get the degree if I have no intentions of practicing, but as I said, I do.

In a tangible sense, simply having the MD degree will not help you with securing grants (there is NIH data to back this up). Nowadays, both MD/PhDs and PhDs are having a hard time getting grants. The average age to first R01 has risen to the early 40's for both!

For getting jobs I don't really know the answer, but my sense is possibility in a clinical department, but probably not in an academic department.

However, there may be intangible benefits of going through the medical school experience in terms of possessing a broader view of disease and the clinical implications of your basic research. If doing more applied work (i.e. gene delivery, functional imaging, neuropsychiatry, etc) having a large amount of patient contact from med school and internship could be very beneficial. On the other hand, if you end up studying protein biochemistry in yeast, having patient contact may not only be unnecessary, but might also detract from your research. Therefore in some sense it really depends on what type of research you want to end up doing. If you imagine yourself doing primarily patient-centered research as the lead PI, then it might make sense to get more experience interacting with patients. On the other hand, as a PhD you can collaborate with MDs to work on clinically-oriented projects.

I think you should let your research interests drive your decision making, rather than worrying about "degrees". I would ask myself, "what do I see myself doing in 10-15 years" and strive for the pathway that will lead to that goal. It sounds like you really like research and would go for a career that involves significant research time either way.

 

[Jorje286]

OK, I'm just as inexperienced as you are, so probably my words don't count for much, but I'll make the counter-argument for the sake of it.

I'm not really buying the MD/PhD route is just so much harder than the PhD. Both are really hard. The PhD will take you 6 years to complete, and you'd want AT LEAST 2 years of postdoc before getting your first position. The stories about people in their 3rd and 4th postdocs aren't rare these days either. Yes, residency is tiring and all, but then it would pay you as nearly as what your first job will, so it's not that bad, depending on the field you chose anyway, and like I said, you can incorporate research with your residency training especially in psychiatry. I think in your case and considering your research interests, it's not reasonable to dismiss the MD/PhD because it's "hard." I think the benefits could outweight that, especially that you don't necessarily dislike working with patients.

The whole MD/PhD route was tailored anyway for people who primarily want to be research scientists, but would also want a clinical exposure that they can use in their research. In your research field, a lot of work is based on human subjects, and historically (still today), disorders in the brain, lesions..etc have been very important in constructing our understanding of the brain. So a clinical exposure would be (at least) benefitial. So to put it short, having a lot of love for research and not necessarily medicine doesn't mean you should ignore the MD/PhD. If anything, the admissions committe want to admit people who want to primarily spend their time on research. Ofcourse, the next best step you can do is see how you will fare in a clinical environment. Sorry, I'm not very coherent tonight because I'm tired, but hopefully I passed the point.

 

[Jorje286]

If you are accepted into an MD/PhD MSTP program, you can do the first two years of medical school, then work on your PhD, then decide if you want to complete the MD, then decide if you want to do a residency

That's an excellent point. You'd be spending a lot of time in the first couple of years in grad school in class, so your first two MSTP years are not a waste of time.

 

[MahlerROCKS]

I'm not really buying the MD/PhD route is just so much harder than the PhD

.

Applying to grad school in and of it self is a million times less stressful (and cheaper). Some would argue that MD/PhD's do not necessarily go as in depth in their graduate training as standard graduate students do, (thus resulting in MD/PhD's having weaker theses). However, MD/PhDs have to juggle starting a medical career while pushing out papers and significant research. Personally in my opinion, money aside, PhD's have a much better quality of living that MDs or MD/PhDs

Yes, residency is tiring and all, but then it would pay you as nearly as what your first job will, so it's not that bad, depending on the field you chose anyway

.

Do realize that most MD/PhDs end-up in academic medicine, which is of course synonymous with lower salaries than standard physicians

 

[MahlerROCKS]

To the OP: I will be applying to MD/PhD programs in the near future, thus, take my comments with a grain of salt; there are many people on here who give better and more authoratative advice

I debated for a long time between PhD and MD/PhD, what helped me decided was attending conferences with my perennial summer lab group (and shadowing physicians). At these conferences there would be clinical lectures that the PhDs didn't understand, and then there would be in-depth research presentations that our MD fellows didn't understand. Ultimately, it was the job of the MD/PhD who lead the group to 'translate' for both factions. My experience is that if you really want to get your hands involved in research, then a PhD is the way to go. All the MD/PhDs I've known have been the head of large labs where they juggle a clinical practice, writing papers and getting grants, thus resulting in almost no time spent in the lab. Yes, they do interpret data, and yes they do help write procedures, but they are reliant on PhDs to do most of the research. (If any of this is contrary to anyone else’s experiences, please post!)

 

[move2west]

I've known have been the head of large labs where they juggle a clinical practice, writing papers and getting grants, thus resulting in almost no time spent in the lab. Yes, they do interpret data, and yes they do help write procedures, but they are reliant on PhDs to do most of the research. (If any of this is contrary to anyone else’s experiences, please post!)

I think this entirely depends on the lab, but I am not entirely clear of your point. From my experience most PIs, regardless of their degree, are not actually in the lab. They spend most of their time writing grants, papers, presentations, etc (PhD, MD/PhD, and MDs alike). Most do not spend time in the lab due to a lack of time. Some love the lab, so they try to take time to actually do the research more than other PIs. NIH is an exception to this rule. I see most of the PIs in the lab on a daily bases, but they do not have to write grants. I work with smaller labs (<15 people), so I am not sure if this applies to some of the really big labs. Regardless, grad students and post docs do most of the research everywhere. There is a basic science lab next to mine that almost entirely consists of MD/PhD and MDs, so in this case most of the research in that lab is conducted by people with a medical degree. The PI is an MD. He does clinical work, runs a residency program, and runs his lab. I see him in the lab at least a couple times a week actually doing research along with everyone else. Again I am not sure exactly what your point was, but hopefully this helps.

 

[_ian]

Yeah, it's probably not worth it. I'd love to have the clinical knowledge, but there are a few things that I've gotten from this topic that make the MSTP make a lot less sense.

- I want the clinical knowledge, and I want to practice, but I don't know that it is worth eight years of hard work to do it... and if I put all the work I would spend in medical school into my research, then barring awful luck, I'll probably end up where I want to be.

- My ideal lab would be hard as hell to set up even in academic medicine... it would take a lot of funding and a lot of postdocs. It won't be necessary to have the degree myself, because I can just collaborate with another lab that is better suited for human studies (like an fMRI lab). I almost certainly wouldn't be doing all of the research myself at that point anyway.

- There isn't all that much time in the day. After sleeping on it, I'm being a little more honest with myself... if I was given the choice between doing the best job I possibly could with research and practicing medicine, then I'd probably choose the research. Hell, I might choose teaching students over practicing medicine. If that's not a huge red flag, I don't know what is.

- I'm going to have to kick ass at what I do to get the job I want regardless of the degrees I have... so the MD doesn't necessarily confer an advantage there.

- My research training might not be as good. Not necessarily because of the nature of the programs, but because I'll probably have a choice of a few top-tier PhD programs and advisors. Assuming my MCAT score is good, I imagine I'll get into an MSTP somewhere, but I can't predict where, and it might not turn out to be the best fit for me.

- I think I just have some big fear of failure. I think of all the doomsday scenarios that will prevent me from achieving my huge goals, and try to think of all the things I can do to avoid them... but getting an MD for that reason really is dumb. I can't imagine myself getting totally disgusted with research, just totally disgusted with (or bombing out of) academia... and there are many other options for me besides medicine. I'm not going to magically avoid any of the problems of academia just by being a board certified neurologist... it just means I have a better job if they fire my ass. Even in the worst-case scenario, there are options outside of research where the PhD is of use.

Thanks for your input, everyone... hopefully I can finally put these lingering thoughts to rest. I'll probably keep having the "what-if" thoughts for a while, but this I'm convinced that the PhD programs are the best decision for me right now.

 

[Dr.Watson]

Even in the worst-case scenario, there are options outside of research where the PhD is of use.

Exactly. Chin-up. Not doing an MD/PhD sounds like a very sound decision for you. Even if academia doesn't work out, I know a lot of very happy PhD's (who are living quite comfortably) in industry or doing consulting work - as just two options. As evil as industry is made out to be by academics, they're the ones that usually make the bench to bedside transition actually happen with requisite money and manpower. Plus it seems like every academic I've met lately has their hand in at least one company if not sitting on the board of a few =).