What does it mean to practice medicine as a physician scientist?

[steelersfan1243]

I am in my senior year in college, planning on applying to medical school in the upcoming months, but I am having difficulty deciding between MD, MD/PhD, and PhD. I am centered on my future having research involved.
Opinion on each degree:

MD:
From my shadowing of a pediatrician and a family doctor who have their own family practice, I can only see myself getting burned out quick from the redundancy of the job if I was to do pure clinical work. However, I realized the research I want to do must be patient related, making me think the MD degree is what I need. Proving concepts on the benchtop is not as rewarding, as being able to see the direct translation to patients. Also, I could see myself constantly being motivated if I were to work in a hospital. Seeing patients everyday I think would never let me stop continue doing my research, I would be as passionate in my 60s as I were in my early years at 30. However, is this a good enough reason to go for MD? Is using patients as motivation to continue research an aspect of practicing medicine?

MD/PhD:
This path seems enticing, what I like best is it does not close any doors. I do enjoy benchtop research and creating a drug from the lab and trying to take it to clinicals is something I can easily see myself getting loss in.
The MD/PhD could also let me purse the same research I would like to do with a MD. I've read The Emperor of All Maladies and saw countless MD/PhDs being recruited to test out novel and risky new chemotherapy techniques and that would be another aspiration of mine that I would love to do. Again, using patients as a source of science investigation to further advance the frontier of medicine. However, the big drawback is the years needed to commit to MD/PhD. I would not be able to run a lab until I was in my late thirties.....this thought is daunting.

PhD:
PhD has become more and more interest since I learned that they can also see patients and there are plenty of hospitals that employ PhDs. I also like the fact that if I were to choose the PhD route, I would have my pick of locations to attend PhD school (due to overwhelming amount). The idea of going to any of the UC schools is extremely enticing. However, I think PhD is a huge risk. If I were a PhD I would want to go the academia route and I know trying to get a professor tenured position is only getting harder and harder. I see myself spending countless years as a post doc waiting for a position only to settle for an industry position where redundancy is most likely to happen. Also, even if I were to get an academia position, I would want my research to health related. Therefore, I feel as if my competition would be against current MDs and MD/PhDs making the grant process even more stressful. My current PI is going under that situation and even with promising publications has yet to secure a grant. Also, there might be the lack of patient interaction, which I hold key for motivation. And I am not a 100% sure if I want to do benchtop research, as said earlier benchtop research is not as rewarding. If I never really got anything into clinicals (which I understand is rare enough) I can see myself burning out and lose motivation quickly.

I do not know if I deviated from my original question, but for those who got their PhD and went back to MD, why? What is the value of the MD? Do you also see patients as motivation, or do I have the wrong reasons? Any help would be appreciated, please and thank you.

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[StIGMA]

You should spend a few evenings reading faculty pages (PhD, MD, MD/PhD) to see what people really do. The average one of these people will most likely have already done more than you will ever do in your career. You can't predict how successful you will be, so do not use this as a basis for a career decision.

Most people who have PhD's and went back to MD realized they wanted a stable, good income and/or wanted to work with patients. Research and medicine can both suck, but at least with medicine you are mostly guaranteed a reasonable income (hence, PhD > MD).

You don't know what research you want to do, and you are not expected to know this right now. What you need to decide is if you want to be a physician in addition to being a researcher. If you want to practice medicine, go to medical school. If not, don't.

The description of your motivation makes your motivations seem weird/unpredictable/undesirable, FYI. It is more typical to be motivated by doing superior work, being respected in one's field, being competent, not missing something, being the expert, being an excellent teacher, being a humanistic doctor, etc.

 

[steelersfan1243]

You should spend a few evenings reading faculty pages (PhD, MD, MD/PhD) to see what people really do. The average one of these people will most likely have already done more than you will ever do in your career. You can't predict how successful you will be, so do not use this as a basis for a career decision.

I can't, but help feel as if you sense a bit of arrogance of me with this statement. Maybe I should of have phrased my reasoning better, but I do not think I undermine anyone with any of these degrees. Why do you say this, it feels irrelevant?

The description of your motivation makes your motivations seem weird/unpredictable/undesirable, FYI. It is more typical to be motivated by doing superior work, being respected in one's field, being competent, not missing something, being the expert, wanting to be an excellent teacher, being a humanistic doctor, etc.

I hope this again comes from what might be poor wording on my part, but I see these traits as similarities between the three degrees. What I listed are not the sole reasons why I wish to pursue the degree, but what is uniquely different from the other two. Would this make my post make more sense?

I edited my initial post a bit to maybe help*

 

[StIGMA]

I can't, but help feel as if you sense a bit of arrogance of me with this statement. Maybe I should of have phrased my reasoning better, but I do not think I undermine anyone with any of these degrees. Why do you say this, it feels irrelevant?

It's not about undermining anyone else (we are both "nobody's" at this point). It's that it is so difficult to be successful (as you describe it, eg: run a lab) that you should not assume success from the outset. Are any of the "dropping off" points worthwhile to you (eg: would you be OK working as a post-doc/research scientist if you can never get a faculty job, would you be OK practicing medicine in a community hospital instead of a university)? One in ten-thousand drugs gets licensed. You should realize that most likely you (and me too) will not be doing something that changes medical practice- and be OK with doing this career even if what you do never makes it into a textbook. As a physician, simply helping patients makes the career worthwhile for most of us.

I hope this again comes from what might be poor wording on my part, but I see these traits as similarities between the three degrees. What I listed are not the sole reasons why I wish to pursue the degree, but what is uniquely different from the other two. Would this make my post make more sense?

Motivation should not be transient. Your should have motivation that will not "[burn] out and lose motivation quickly."

Your goals are admirable- and also unlikely. What are your backup plans along this career path that you are OK with? This is important to consider because perhaps you don't want to end up as a research scientist working on someone else's ideas.

It is worth reiterating: What you need to decide is if you want to be a physician in addition to being a researcher. If you want to practice medicine, go to medical school. If not, don't.

I'd like to comment more on the clinical trial research aspect, but I do not have any experience in that area. Most clinical trial type research does not need PhD training (if you have an MD). I recommend you find people who are doing something very similar to what you think you want to do, email them, and ask if they would let you chat with them for 15-30 minutes (or shadow them for part of the day).

(edited)

 

[steelersfan1243]

Okay, thank you for the post. It was now extremely helpful and I can see the points you were making. I believe this is why I cannot pursue a PhD. If I never received an academia position, no I do not see myself being content as a staff scientist (I want to be on the other side of the benchtop, are most staff scientists glorified lab technicians?). However, as you mentioned, I think both MD and MD/PhD both offer the better backup plans and are a more secure way to get the research position I want.

But this would bring me back to the original question, does the definition of practicing medicine differ from a physician scientist to a clinician? It seems as it should not, how do people who wish to purse research do medicine?

Thanks for all the help btw Stigma

 

[StIGMA]

Does the definition of practicing medicine differ from a physician scientist to a clinician? It seems as it should not, how do people who wish to purse research do medicine?

I hope other people chime in, but my ordinary perspective is that practicing medicine does not change depending on whether you additionally pursue research. To practice medicine, you are going through medical school and residency, and you are learning to be a physician. You are putting the patient first. Even in clinical trials for new drugs, the patient is generally receiving standard or equivalent care (or failed all standard care) before being placed in the trial.

Perhaps the question you are asking is if the type medicine being practiced by physician scientists is more specialized? Most physician scientists pursue a subspecialty, so the clinical practice is in a very defined subspecialty (eg: a neurologist who decides to only see epilepsy patients, or even a certain type of epilepsy).

 

[zimzim11]

From my shadowing of a pediatrician and a family doctor who have their own family practice, I can only see myself getting burned out quick from the redundancy of the job if I was to do pure clinical work. However, I realized the research I want to do must be patient related, making me think the MD degree is what I need. Proving concepts on the benchtop is not as rewarding, as being able to see the direct translation to patients.

I can understand your worry about getting burned out from this but I think that you are a little unable to truly state this until you have shadowed within a specialty that you are truly interested in researching. If you are shadowing a family practice medicine, most likely you would have already known about the diseases you are seeing: diabetes, high blood pressure, influenza, etc. If you are really passionate about studying neurons (for example) then shadow a neurologist or even an epilepsy specialized neurologist. Create an initial interest in what you will be seeing before you dismiss the entirety of medicine all together.

That being said, I agree with StIGMA in that the idea of you being in academia, creating a medicine, and following it through clinical trials is very far fetched. As far as I know, within academia the second you have a possible medical application for your research, the university evaluates it and sells it to the highest bidding pharmaceutical company. You are not really asked for permission since all of your work is the university's property from the get-go.

For the PhD part of your question, a majority of the people who go into industry after their post docs are not settling but rather still getting a promotion. The second that you enter industry you do not suddenly become a tech running thousands of ELISAs, you are valued and paid for your experience and training and put in charge of projects, researching new diagnostic methods, new drugs, and, depending on the company, can be more involved in the translation part of the research itself. I would suggest not only shadowing different specialties in medicine but also looking into the industry field. You seem to have a slightly narrow and pessimistic view towards each profession and simply until you dig deeper into each one you will not be able to tell which you want to pursue.