What will you do with yours?

[Hard24Get]

Wondering what folks are thinking of ultimately doing with their dual degrees, especially those towards the end...

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[dr.z]

Research of some kind and patient care.

 

[Vader]

What, no biotech option?

 

[Newquagmire]

other only? what about wall street?

 

[QofQuimica]

Right now I'm contemplating selling out and becoming a high-level, well-paid executive of a pharm company. Maybe I'll go for my MBA once I finish my MD.

 

[jimbobb23]

Right now I'm contemplating selling out and becoming a high-level, well-paid executive of a pharm company. Maybe I'll go for my MBA once I finish my MD.

I was just thinking of making a post about what are the options for getting out of medicine. I am nearing the completion of my first 7 years and thinking hmmm... 7 more years for residency?

 

[solitude]

I was just thinking of making a post about what are the options for getting out of medicine. I am nearing the completion of my first 7 years and thinking hmmm... 7 more years for residency?

http://query.nytimes.com/gst/fullpage.html?sec=health&res=9A0DE7DB103EF934A15752C1A9609C8B63

Don't do it. All the money in the world wouldn't be worth selling one's soul in order to push money on Wall Street so that the super-wealthy grow even wealthier. Of course, it's easy for me to say as an idealistic 20yo applicant .

 

[Ecthgar]

Maybe I'm just in complete lab burnout, but I'm really thinking that clinical research/clinical medicine is for me. Basic science is just really getting old. I also do some clinical research with my PI, and its way more interesting to me. That, and the NIH funding for basic science research right now is pretty damn depressing.

 

[QofQuimica]

http://query.nytimes.com/gst/fullpage.html?sec=health&res=9A0DE7DB103EF934A15752C1A9609C8B63

Don't do it. All the money in the world wouldn't be worth selling one's soul in order to push money on Wall Street so that the super-wealthy grow even wealthier. Of course, it's easy for me to say as an idealistic 20yo applicant .

You know the saying, don't you? Show me a young conservative and I'll show you someone with no heart. Show me an old liberal and I'll show you someone with no brains.

 

[beary]

I'm a path PGY-1 and graduated from an MSTP in May. When I started the MSTP and during graduate school, I was 100% gung ho basic science. I even considered doing straight post-doc and no residency. But man, it is getting LONG. Right now, I would have to say I'm going to do a path residency and a clinical fellowship, and that's it. I just can't stomach the thought of a post-doc after that, then trying to get tenure, getting grants, etc.

 

[solitude]

You know the saying, don't you? Show me a young conservative and I'll show you someone with no heart. Show me an old liberal and I'll show you someone with no brains.

sad but true

 

[solitude]

I'm a path PGY-1 and graduated from an MSTP in May. When I started the MSTP and during graduate school, I was 100% gung ho basic science. I even considered doing straight post-doc and no residency. But man, it is getting LONG. Right now, I would have to say I'm going to do a path residency and a clinical fellowship, and that's it. I just can't stomach the thought of a post-doc after that, then trying to get tenure, getting grants, etc.

Some naive questions...

Couldn't you do some research part-time during your fellowship and extend that as your area of research?
Won't you still have to worry about tenure, or are you planning to just get a clinical appointment?
What made you change your mind? (e.g. finances, family situation, etc.)

Thanks!

 

[beary]

Some naive questions...

Couldn't you do some research part-time during your fellowship and extend that as your area of research?
Won't you still have to worry about tenure, or are you planning to just get a clinical appointment?
What made you change your mind? (e.g. finances, family situation, etc.)

Thanks!

Hi solitude! Not naive questions at all - something I have been thinking about a lot.

I LOVE research, and haven't ruled it out, but right now I don't see myself doing it. Unquestionably there is a thrill to seeing something, even really small, that nobody has seen before, and thinking of new questions.

I could probably do some research during my fellowship. But, I figure I need about 3 years of solid post-doctoral training before I am ready to be a PI. So again, it comes down to time - clinical training or research training?

I would have to still worry about tenure, even if I got an academic clinical appt. Right now, what I see most likely is to go into private practice. It actually sort of makes me sad to even write that because I have seen myself in academics for so long!

Lots of things contributed to changing my mind. One thing, that is semi-unique, is I have had some health problems that have made me question if I want to spend a billion more years in training. But, I think the larger issues in my mind include just wanting to be really good at something and do it. At the end of my residency/fellowship, presumably (hopefully!) I will be a a very competent pathologist. I don't want to put that on the back burner to pursue a research career.

Another thing, is I feel that in pathology (or any clinical discipline) you can be successful if you work at it. I am very overwhelmed as a PGY-1, but am quite confident that if I keep working really hard I will be able to master the material and be a solid pathologist. I don't have that same confidence about research. I could have really good ideas, but they could be incorrect, very difficult to prove, too expensive to fund, etc. I realize that is part of the thrill and the work of research but I feel like it is "riskier" from a career perspective than clinical practice.

Anyway, just my thoughts! I still definitely get the research bug from time to time, and maybe when I finish my clinical training I will be really healthy and itching to get back into it, at which point I would definitely consider it.

Good luck to you!

 

[solitude]

Awesome, thanks for sharing!

Hi solitude! Not naive questions at all - something I have been thinking about a lot.

I LOVE research, and haven't ruled it out, but right now I don't see myself doing it. Unquestionably there is a thrill to seeing something, even really small, that nobody has seen before, and thinking of new questions.

I could probably do some research during my fellowship. But, I figure I need about 3 years of solid post-doctoral training before I am ready to be a PI. So again, it comes down to time - clinical training or research training?

I would have to still worry about tenure, even if I got an academic clinical appt. Right now, what I see most likely is to go into private practice. It actually sort of makes me sad to even write that because I have seen myself in academics for so long!

Lots of things contributed to changing my mind. One thing, that is semi-unique, is I have had some health problems that have made me question if I want to spend a billion more years in training. But, I think the larger issues in my mind include just wanting to be really good at something and do it. At the end of my residency/fellowship, presumably (hopefully!) I will be a a very competent pathologist. I don't want to put that on the back burner to pursue a research career.

Another thing, is I feel that in pathology (or any clinical discipline) you can be successful if you work at it. I am very overwhelmed as a PGY-1, but am quite confident that if I keep working really hard I will be able to master the material and be a solid pathologist. I don't have that same confidence about research. I could have really good ideas, but they could be incorrect, very difficult to prove, too expensive to fund, etc. I realize that is part of the thrill and the work of research but I feel like it is "riskier" from a career perspective than clinical practice.

Anyway, just my thoughts! I still definitely get the research bug from time to time, and maybe when I finish my clinical training I will be really healthy and itching to get back into it, at which point I would definitely consider it.

Good luck to you!

 

[Hard24Get]

Maybe I'm just in complete lab burnout, but I'm really thinking that clinical research/clinical medicine is for me. Basic science is just really getting old. I also do some clinical research with my PI, and its way more interesting to me. That, and the NIH funding for basic science research right now is pretty damn depressing.

yeah, I originally posted this thread because I charged in thinking only of basic research, but now that I am back in the clinics I see how my phd thinking could drive clinical research and even some potential solutions to public health problems. Sorry for the poll bias but that was all that was on my radar! Of course my mentor expects me to be this great mouse dr, but I think I want to be closer to people. So many options, many of which influence choice of residency... How to choose a path?

 

[Neuronix]

Halfway through the program and I have no clue. BTW, I thought it was interesting that a survey at my program was just completed about the fates of our graduates. ~20% went into private practice! I always thought that number was lower, but suspected it because there's a high private practice rate among those graduating form my lab... Food for thought anyways. I also have seen some MD/PhDs who are still in academics, but their lives are more about generating RVUs and they have very little to no input on research. These always get counted somehow as favorable program outcomes by everyone involved, but should they be? How is that better than private practice?

Of course here on SDN we have nobody voting that they're going to do clinical only (except for beary, thanks for your honesty!), which helps me think that alot of people fall off the path to research + clinical at one point or another.

 

[Ecthgar]

yeah, I originally posted this thread because I charged in thinking only of basic research, but now that I am back in the clinics I see how my phd thinking could drive clinical research and even some potential solutions to public health problems. Sorry for the poll bias but that was all that was on my radar! Of course my mentor expects me to be this great mouse dr, but I think I want to be closer to people. So many options, many of which influence choice of residency... How to choose a path?

I'm 4.5 years into this thing, and I find myself less and less interesed in doing basic research. I guess I always wanted to be an MD first, then a scientist. Basic research does excite me to a point, but like you, I need to see patients and interact with people. One of the hardest things about being in this program for me is the lack of human contact. All of the people around me (in the grad school arena) are either so introverted that you can't speak to them or they literally don't speak english well enough to carry on a conversation. Med school was very very different (obviously)......social events, parties, etc. The graduate students NEVER do anything together......they really have zero comeradarie as a group. I guess at the time I thought all the med school social stuff was kinda tacky, but now I kinda miss it. That, and actual humans to talk to.

 

[1Path]

NON tenure, tranlsational research + clinical duties at a federal agency.

 

[Circumflex]

Ecthgar, I felt the same way when I was in your place. I had many mood swings during the PhD portion. There were times when I just wanted to say "screw it" and get on with med school, but there were other times when I thought I did not want to do a residency, just a post-doc and do cool science (this was when the experiments were actually giong well).

When I went back to med. school to finish up, I was tired of basic science and wanted to get to the business of actually helping people. Now, I am a 4th year, applying for residency, and I miss the science. What I don't miss is all the BS you have to mix in with the science, like exams, being a TA, etc. I'm still not sure what type of career (basic research vs. more clinical duties) I want.

Stick it out and make it work for you - make the experience your own. I found other investigators doing cool, related stuff, and would email to see if they wanted to collaborate (after asking the PI, of course). The biggest thing that helped me was finding one other grad student that I could talk to about science and bounce ideas off of. We would go have a beer or workout and talk about ideas.

 

[Ecthgar]

Ecthgar, I felt the same way when I was in your place. I had many mood swings during the PhD portion. There were times when I just wanted to say "screw it" and get on with med school, but there were other times when I thought I did not want to do a residency, just a post-doc and do cool science (this was when the experiments were actually giong well).

When I went back to med. school to finish up, I was tired of basic science and wanted to get to the business of actually helping people. Now, I am a 4th year, applying for residency, and I miss the science. What I don't miss is all the BS you have to mix in with the science, like exams, being a TA, etc. I'm still not sure what type of career (basic research vs. more clinical duties) I want.

Stick it out and make it work for you - make the experience your own. I found other investigators doing cool, related stuff, and would email to see if they wanted to collaborate (after asking the PI, of course). The biggest thing that helped me was finding one other grad student that I could talk to about science and bounce ideas off of. We would go have a beer or workout and talk about ideas.

Thanks, I appreciate the encouragement. I guess I'm starting to see a faint glimmer of light at the end of this road and it makes me want to be finished up even more. That, and seeing all my old med school classmates as interns this year.

 

[mjs]

Phase I: collect degrees.
Phase III: profit.

 

[MrMunkily]

I plan to become a plumber after graduation.

 

[Celeritus]

For those of you who are considering clinic-focused careers after completing the MD/PhD: do you feel the program was worthwhile?

Similarly, for those midway through MD/PhD programs who are reevaluating their focus on basic science: do you feel the PhD (experience, or credential) is/will be still worthwhile?

This is a topic I am very interested in, especially given the high number of private practice MD/PhDs (as Neuronix mentioned). We often hear a great deal about how clinical training informs one's activities as a research scientist; how well does PhD training inform (or otherwise augment) one's clinical skills (and/or career)?

Of course, by no means am I suggesting one use a (MD)PhD program as a means to bolstering a clinical career - I'm simply interested in the perspectives of those who have pursued combined training in good faith but found themselves in (predominantly) clinical domains.

 

[Myempire1]

I totally understand the emotional roller coaster of grad school. I have no idea what I will end up doing. I go back and forth. However, before I chose to to sit in an office, beg for money from the federal government, and make under $45/hour for the rest of my life, I want to see what other opportunities are out there. There must be many opportunities out there that I have not seen. How does one get into consulting/research for pharma while still doing some patient care?... my program is very academia oriented so it does not expose us to the pharma side of things.

But I have a while before i defend, so I guess I will figure this out later....

 

[SaltySqueegee]

Probably be a Co-PI in someone's lab (either basic or clinical;2-3 days/wk), and practice clinical medicine part of the time (2-3 days/wk). Oncology with related research??? At least that's the direction at the current moment.

 

[Circumflex]

I totally understand the emotional roller coaster of grad school. I have no idea what I will end up doing. I go back and forth. However, before I chose to to sit in an office, beg for money from the federal government, and make under $45/hour for the rest of my life, I want to see what other opportunities are out there. There must be many opportunities out there that I have not seen. How does one get into consulting/research for pharma while still doing some patient care?... my program is very academia oriented so it does not expose us to the pharma side of things.

But I have a while before i defend, so I guess I will figure this out later....

I wouldn't worry about this now - you still have the rest of medical school, residency, and fellowship to go through. Things will change a great deal in that time. Most of the pharma "consultants" that I have seen are already well-established in a field - not something you typically jump into right out of training, although working for a pharmaceutical company is always an option.

 

[tr]

I am in the same boat as beary.

I started out as 100% gung ho basic science. I thought odds were I wouldn't even do a residency - just go straight to postdoc. I wanted the exposure to medicine out of personal interest, out of the idea that it would better direct my research, and (I admit) because I'd been told it would be easier to get funding with an MD.

But frankly I am tired of all the garbage that goes with being a basic researcher in academia. I don't really want the stress of having to constantly apply for grants that have only a 10% chance of being funded, of having people rely on me getting them for their salaries and livelihoods, of being constantly worried about getting scooped, and of living in a community of cutthroat maniacs who are perfectly willing to step on each other's necks to make it to the top.

But blessedly, I have found that I also really enjoy clinical work. I am therefore looking forward to residency.

Now, while I'm really burned out of research right now and am happy to be facing some more clinic time, I suspect that the research bug is only resting; so I am making sure to enter a residency program with significant opportunities for research. I like research (if not the research environment). I find it stimulating and fascinating, and I plan to continue to do it for as long as I can (that is, for as long as I enjoy it). But I don't think I was cut out to be a PI. I want to enjoy the journey. Time is not really important to me; money is not really important to me. I just want to be happy. For as long as research makes me happy, I will continue to pursue it. When it gets to be more hassle than it's worth, I may be perfectly happy to be 'just' a clinician. I still see myself as an academic (a clinical professor) though. To be happy, I need a community of intellectually engaged peers. I don't think private practice will be my thing (although you never know).

Btw a program director at one of the programs where I interviewed told me that the 'dirty little secret' of the MSTPs is that overall, 50% of their graduates end up doing no research whatsoever. And you can understand why, really. If you told any man on the street you chose to make $90K and work 80 hours a week with no job security (as young untenured faculty) when you could be making $250K to work 60 hours a week with total job security (as an attending in private practice), I think he'd be more than a little confused.

So anyways, by that light Neuronix's 20% isn't sounding too bad (although it's still early, I bet a few more will drop off the back of the wagon over the next decade or two).

 

[solitude]

Very interesting perspective. Great thread!

I am in the same boat as beary.

I started out as 100% gung ho basic science. I thought odds were I wouldn't even do a residency - just go straight to postdoc. I wanted the exposure to medicine out of personal interest, out of the idea that it would better direct my research, and (I admit) because I'd been told it would be easier to get funding with an MD.

But frankly I am tired of all the garbage that goes with being a basic researcher in academia. I don't really want the stress of having to constantly apply for grants that have only a 10% chance of being funded, of having people rely on me getting them for their salaries and livelihoods, of being constantly worried about getting scooped, and of living in a community of cutthroat maniacs who are perfectly willing to step on each other's necks to make it to the top.

But blessedly, I have found that I also really enjoy clinical work. I am therefore looking forward to residency.

Now, while I'm really burned out of research right now and am happy to be facing some more clinic time, I suspect that the research bug is only resting; so I am making sure to enter a residency program with significant opportunities for research. I like research (if not the research environment). I find it stimulating and fascinating, and I plan to continue to do it for as long as I can (that is, for as long as I enjoy it). But I don't think I was cut out to be a PI. I want to enjoy the journey. Time is not really important to me; money is not really important to me. I just want to be happy. For as long as research makes me happy, I will continue to pursue it. When it gets to be more hassle than it's worth, I may be perfectly happy to be 'just' a clinician. I still see myself as an academic (a clinical professor) though. To be happy, I need a community of intellectually engaged peers. I don't think private practice will be my thing (although you never know).

Btw a program director at one of the programs where I interviewed told me that the 'dirty little secret' of the MSTPs is that overall, 50% of their graduates end up doing no research whatsoever. And you can understand why, really. If you told any man on the street you chose to make $90K and work 80 hours a week with no job security (as young untenured faculty) when you could be making $250K to work 60 hours a week with total job security (as an attending in private practice), I think he'd be more than a little confused.

So anyways, by that light Neuronix's 20% isn't sounding too bad (although it's still early, I bet a few more will drop off the back of the wagon over the next decade or two).

 

[Circumflex]

I'm feeling the same way as beary and tr. I'm in my last year of med school, applying for path residency. I had many of the same feelings - I loved my time in the lab - considered no residency, just post-doc.

For me, this career path has been such a roller-coaster. It was exciting starting the PhD portion. Then, it seems like nothing is working, and I thought about scrapping it and just going back to med school. Then, finally, things started coming together and it was so exciting getting cool data. I was having such a great time that there were times that I didn't want to stop and go back to third year. I have always held on to the dream of being the translational physician-scientist, bringing new ideas in basic science to relevant clinical problems. But, it is hard to hold onto that dream the older I get.

It is tough working your #$$ off for 8 years, then look at starting residency. I would not trade my experience for anything and I look forward to new roads, but it is interesting to see how your perspective changes along the way.

 

[tr]

It is tough working your #$$ off for 8 years, then look at starting residency. I would not trade my experience for anything and I look forward to new roads, but it is interesting to see how your perspective changes along the way.

Totally. I remember thinking (young and naive as I was), "job security? How mundane, who cares about job security? I wanna find out how the universe works, man!"

Seriously, the thing about being a doctor is, you can do it! Once you're into med school, if you want to finish, you can! The big weedout is before med school; after that, there are plenty of jobs and $ to go 'round. A few people drop out, but it's not because they couldn't make it, but because they chose not to (or because life threw them a curveball for whatever reason).

But research? You never stop struggling. There's always the next grant renewal, the next paper, next next next. No matter how far you've come, you could always fail. (I know of a 50-something tenured prof who lost his grants and committed suicide.) And there will be fifty brilliant, driven, starving postdocs clawing at each other to have your spot. I guess that's part of what makes it exciting, but it's also exhausting and d@mn scary too.

 

[Hohenheim]

Wall Street sounds nice...and plumbing too.
Me - I always fancied myself a stand up comic with an MD PHD doing a show called "Laughter the Best Medicine"

 

[Jorje286]

Damn. You guys paint such a gloomy image of science.

That's really a shame considering it's even coming from people who really love science. I guess something must be done for this stupid system? But like someone said, science is just risky. It's costly (in grant money) and you could end up nowhere with no results.

tr, I feel the same way now as you did, that I want to discover the brain, consciousness and stuff. If (and that's a big if) I get into an MD/Ph.D program, I'm basically planning combining both.

 

[tr]

Damn. You guys paint such a gloomy image of science.

That's really a shame considering it's even coming from people who really love science. I guess something must be done for this stupid system? But like someone said, science is just risky. It's costly (in grant money) and you could end up nowhere with no results.

tr, I feel the same way now as you did, that I want to discover the brain, consciousness and stuff. If (and that's a big if) I get into an MD/Ph.D program, I'm basically planning combining both.

Oy, I'm discouraging the newbies.

Seriously, science is amazing and there is nothing else I would want to do. There's unfortunately a lot of cr@p to wade through, but every field has its downsides. Everyone complains. Research is exciting and engaging if occasionally stressful, and medicine is fun and a pretty sweet deal when you think about it.

I guess I am just saying that I am pretty glad I have the option to do clinical work, which is also enjoyable as well as being more secure and providing more autonomy than basic research. That's all.

There's only one piece of advice I have for you guys who are applying. If you don't get into MD/PhD (which I still think is the best deal around for someone who is really interested in biomedical research), do the MD only. Do not do the PhD only. The difference in ultimate flexibility is enormous.

Btw, while I'm being all depressing, is anybody else here kind of bummed by the way all your classmates are looking all old and fat? I'm like, d@mn, we are freakin' middle-aged! First year med school was so long ago! Argh!

 

[gonogo]

http://query.nytimes.com/gst/fullpage.html?sec=health&res=9A0DE7DB103EF934A15752C1A9609C8B63

Don't do it. All the money in the world wouldn't be worth selling one's soul in order to push money on Wall Street so that the super-wealthy grow even wealthier. Of course, it's easy for me to say as an idealistic 20yo applicant .

Hey solitude, that was a really fascinating article. To all of you future physician-scientists, I encourage you to read it. I'll finish my MD-PhD in a year and a half and I'm myself debating what I want to do. Does anyone here have a good clue of how to start in consulting/investment? It seems to me that scientists can do well in that. However, I wonder if there's a lot to risk. I mean, it can't be that easy.

 

[dl2dp2]

tr, you are awesome and sorry for resurrecting this thread.

i'm a 4.5 year mstp and working for a high profile lab. and i agree completely with the whole just do an MD, don't ever do a PhD thing, as I've said many times in other threads.

the thing that's confusing me now though, is that i have a really weird percept of how hard science actually is. Sometimes i see how hard it is to get a paper into a prestigious journal, the years and years of labor, the perfectionist bosses, the reviewers, the grants, etc. But then sometimes I see those so-called "brilliant" postdocs and PIs and I was like, WHAT?? How STUPID can you be?! I mean, even the best labs, the Nobel winning labs, produce crappy data and stupid papers. Horrific papers get on Nature/Science routinely just cause they have famous names.

Sometimes I wonder if I can GAME the system, then I'm smart enough to actually do something quality. But that thought itself is depressing on many levels. I mean if so and so has such crap postdocs and crap papers can still get a HHMI...or maybe I'm being too harsh...then perhaps I have a solid shot you know?

I dunno. Very ambivalent right now. Very confused about what I want to do.

Oy, I'm discouraging the newbies.

Seriously, science is amazing and there is nothing else I would want to do. There's unfortunately a lot of cr@p to wade through, but every field has its downsides. Everyone complains. Research is exciting and engaging if occasionally stressful, and medicine is fun and a pretty sweet deal when you think about it.

I guess I am just saying that I am pretty glad I have the option to do clinical work, which is also enjoyable as well as being more secure and providing more autonomy than basic research. That's all.

There's only one piece of advice I have for you guys who are applying. If you don't get into MD/PhD (which I still think is the best deal around for someone who is really interested in biomedical research), do the MD only. Do not do the PhD only. The difference in ultimate flexibility is enormous.

Btw, while I'm being all depressing, is anybody else here kind of bummed by the way all your classmates are looking all old and fat? I'm like, d@mn, we are freakin' middle-aged! First year med school was so long ago! Argh!

 

[Dr.Watson]

tr, you are awesome and sorry for resurrecting this thread.

i'm a 4.5 year mstp and working for a high profile lab. and i agree completely with the whole just do an MD, don't ever do a PhD thing, as I've said many times in other threads.

the thing that's confusing me now though, is that i have a really weird percept of how hard science actually is. Sometimes i see how hard it is to get a paper into a prestigious journal, the years and years of labor, the perfectionist bosses, the reviewers, the grants, etc. But then sometimes I see those so-called "brilliant" postdocs and PIs and I was like, WHAT?? How STUPID can you be?! I mean, even the best labs, the Nobel winning labs, produce crappy data and stupid papers. Horrific papers get on Nature/Science routinely just cause they have famous names.

Sometimes I wonder if I can GAME the system, then I'm smart enough to actually do something quality. But that thought itself is depressing on many levels. I mean if so and so has such crap postdocs and crap papers can still get a HHMI...or maybe I'm being too harsh...then perhaps I have a solid shot you know?

I dunno. Very ambivalent right now. Very confused about what I want to do.

I thinks it's more a matter of the more educated you become, the more you realize that the "greats" don't belong on pedestals. They're human, they put out both good and crappy papers, and at some point they had a brilliant insight that they were recognized for--that's it. You realize, heck, I can do this too. The forefront of science isn't this glamorous, elite thinktank of impossibly brilliant people spewing brilliant ideas 24/7. It's a messy environment that you can hold your own in and contribute to. To me, at least, that's kinda scary and disheartening, because I certainly hope that there are people more intelligent than me shaping science. However, especially as MD/PhDs, there really isn't. We're a super-small percentage of the population that not only went to college, but got multiple doctoral degrees. There's not many of us and a lot of us are working in high-impact labs. It's a weird realization to come to (especially when self-confidence as a undergrad/grad student in lab isn't the highest). So yeah, that's my ramble.

 

[dphoenix]

Hey solitude, that was a really fascinating article. To all of you future physician-scientists, I encourage you to read it. I'll finish my MD-PhD in a year and a half and I'm myself debating what I want to do. Does anyone here have a good clue of how to start in consulting/investment? It seems to me that scientists can do well in that. However, I wonder if there's a lot to risk. I mean, it can't be that easy.

I really hate this article - it makes it seem like jumping to the wallstreet crowd with an MD is an automatic in. Truth is that even if you join at the associate level (consulting/banking) you will have to fight tooth and nail with Harvard/Stanford MBAs for the VP and elusive MD (managing director) positions. The MD/PhD credentials are good, true, but if you can't put in the 100 hour weeks and perform up to snuff (or the market is just plain bad) then your career is over. You'll have to learn a lot of new skills: business, excel/powerpoint, softskills, networking - things that are not learned in either med or phd years.

In any case, this is not really a post to discourage alternative paths, just to open people's eyes to it. There's no free lunch and the perceived advantage is not that much (not worth 7 years at least!). The real problem I think is that residency directors are so conservative that if you try out consulting/banking for a few years and then try to come back, you might not be able to match at a good specialty.

 

[TheCybermen]

Damn. You guys paint such a gloomy image of science.

That's really a shame considering it's even coming from people who really love science. I guess something must be done for this stupid system? But like someone said, science is just risky. It's costly (in grant money) and you could end up nowhere with no results.

tr, I feel the same way now as you did, that I want to discover the brain, consciousness and stuff. If (and that's a big if) I get into an MD/Ph.D program, I'm basically planning combining both.

the idea to which the u.s. will awaken at some point sooner (hopefully) rather than later is that there is no more manufacturing arm of the nation's economy. the days of manufacturing ended quite some time ago, and middle-class america has been made to suffer too long under the "blanket" of so-called economic initiatives designed to protect the american worker. it's a mindset issue, and that mindset needs to change.

the american economy rests almost entirely on knowledge and services; whatever rested on "goods" is quickly becoming a memory. among the chief services that the economy provides is healthcare, and as far as knowledge goes, research and development is the iron fist. once the political heavies and higher-ups are made to listen to this fact, it is hoped that the purse-strings will come undone. until then, however, we'll just go on saying "buy american!" and building machines of war to promote laser-guided democracy.

 

[greg12345]

This is a great thread...I can totally identify w/beary, tr, and circumflex. I came into this MSTP stuff all naive and idealistic with the goal of being a basic scientist 85% of the time with the remaining 15% spent seeing patients (give or take 5%). Now as I'm about to finish up my program I've been thinking a lot about my future. Do I love basic science research? Yes. Do I think I could run a decent lab while still seeing patients? Yes. Do I love research enough to deal with the never-ending grind of academic medicine, the politics, the current level of NIH funding, the long hours, etc? I think so, but I'm not totally sure at this point. I absolutely love clinical medicine and would have no problem seeing patients everyday for the rest of my life, and a clinician-educator academic track or an academic appointment with clinical research sounds awesome to me. Heck, even private practice sounds awesome now as well.

 

[QofQuimica]

I agree with the people who said that if you're only going to get one degree, get the MD. It's a lot easier to do research as an MD than it is to see patients as a PhD. I thought about getting a PharmD a few years ago. To me anyway, the pharm curriculum is a lot more interesting than the MD curriculum. But in the long run, I think I'll be better served by having the MD. So here I am slogging through anatomy, histology, and embryology when I could have been studying tox, pharm, and med chem. Sigh.

How important is it to you guys to integrate your research with your specialty? I've been thinking about this quite a bit. I came into med school planning to go into anesthesiology; it seems like the obvious specialty for a chemist. But like many people, I have a constantly changing favorite specialty du jour, and my conception of what is possible keeps expanding. I recently met a very cool MD/PhD surgeon who has a basic science PhD and does basic science research related to surgery. Now I still don't have any intention whatsoever of going into surgery, but like I said, my conception of the possible just keeps expanding....

 

[Circumflex]

How important is it to you guys to integrate your research with your specialty? I've been thinking about this quite a bit. I came into med school planning to go into anesthesiology; it seems like the obvious specialty for a chemist. But like many people, I have a constantly changing favorite specialty du jour, and my conception of what is possible keeps expanding. I recently met a very cool MD/PhD surgeon who has a basic science PhD and does basic science research related to surgery. Now I still don't have any intention whatsoever of going into surgery, but like I said, my conception of the possible just keeps expanding....

For me, integrating basic science research with clinical medicine is important - it is the reason I did the dual degree. I am in my final year and both my research interest and clinical interest has changed. My PhD research dealt with cardiac development/stem cells/tissue engineering and I envisioned myself going into surgery - even after my surgery clerkship. I enjoyed surgery more than any other 3rd year clerkship, but I really only liked certain aspects (being in the OR, ICU, ER). However, the daily routine of writing notes, orders, managing the medical issues of a multitude of patients was not appealing. At the end of 3rd year, I was frustrated, did a rotation in pathology, and fell in love. I had never considered path before then.

As you know, the most important aspect of PhD training is learning to think like a scientist - asking the right questions and designing the right experiments. I find so many aspects of science fascinating, so I am excited about changing my research focus from cardiac development to some area more relevant to pathology (cancer, etc.).

Bottom line = you can always modify your research or clinical interests during your training.

 

[Dr.Watson]

For me, integrating basic science research with clinical medicine is important - it is the reason I did the dual degree. I am in my final year and both my research interest and clinical interest has changed. My PhD research dealt with cardiac development/stem cells/tissue engineering and I envisioned myself going into surgery - even after my surgery clerkship. I enjoyed surgery more than any other 3rd year clerkship, but I really only liked certain aspects (being in the OR, ICU, ER). However, the daily routine of writing notes, orders, managing the medical issues of a multitude of patients was not appealing. At the end of 3rd year, I was frustrated, did a rotation in pathology, and fell in love. I had never considered path before then.

As you know, the most important aspect of PhD training is learning to think like a scientist - asking the right questions and designing the right experiments. I find so many aspects of science fascinating, so I am excited about changing my research focus from cardiac development to some area more relevant to pathology (cancer, etc.).

Bottom line = you can always modify your research or clinical interests during your training.

I agree. Ideally, it'd be awesome if my PhD research related to my eventual career. However, preferences change. The PhD is about learning how to think like a scientist (at some point I think everyone was indoctrinated with that phrasing). I'm not going to be too upset if I change my planned specialty. It's the post-doc that's important for your career and that's when the research-specialty integration is very important to me and my career plans. Yet until graduation, que sera sera.

 

[greg12345]

I'll bring up a point that I think hasn't been mentioned yet (sorry, didn't read the thread that thoroughly). We are all told when we are picking a lab that the most important thing about a PhD is "learning to think like a scientist" and that while the subject/topic of the research is important, it is not the end all be all. Well....when it comes time to interview for residency (especially if you are fast tracking) what you did your PhD in can kinda "lock" you in for a particular subspecialty. As an example, my PhD is in cancer biology so everywhere I interview everyone assumes I will be doing a heme/onc fellowship, wants me to fast track into heme/onc, extols the virtues of their heme/onc department, etc. The thing is, I will likely not do heme/onc (didn't like the clincal aspect of it) but it is kinda delicate to bring this up during interviews when they are trying to recruit you for future faculty positions in heme/onc!!! Plus if you fast track you have to know basically by the middle of your intern year what you want your fellowship to be in, so most people end up choosing a fellowship based on what their PhD was in...at least from what I have seen with fast-trackers.

 

[Dr.Watson]

Very interesting point, Greg. I don't know anything about fast tracking nor know any people that have done it. Presumably, 'locking-in' depends how clinically/disease-related versus basic science your research is. On that note, do you wish or think you might have benefited from doing a clinical rotation like IM or even a short subspecialty before settling into the PhD years? At what point did you realize the clinical side of onc wasn't for you?

I'm considering going into a disease-related research field. If it'll benefit me to know for sure that I'd want to go into the clinical side for a specialty, I'd love to know how people think the best way to inform myself before 3rd and 4th year if it's right or wrong for me. I know it's not a bad thing to change fields (and know a lot of people that do), but a leg-up on the career path would be nice.

 

[greg12345]

In fast tracking you lose a year of clinical training (from your initial 3 year IM residency, assuming you are going into an IM subspecialty like ID, heme/onc, etc.) and gain a year of research time during your fellowship. For example, a typical pathway for someone pursuing a career in heme/onc in the traditional pathway might look like this:

IM residency: 3 years
Heme/Onc fellowship: 3 years (with ~1.5 years of that time devoted to research)

If I was fast tracking, my pathway would look like this:

IM residency: 2 years
Heme/Onc fellowship: 4 years (with ~2.5 years of that time devoted to research)

As far as I understand it, fast tracking was designed for physician scientists who were going to spend the majority of their time pursuing basic science research, hence their clinical training is shortened while their research training is extended - this allows them to get more data/publications under their belt as they prepare to take on a junior faculty position, fight for grants, etc.

When you fast track, you have to formally decide what subspecialty to pursue halfway through your intern year (this is when you apply for your fellowship of choice), when your exposure to clinical medicine is still somewhat limited. Not only that, but a lot of times your choice of RESIDENCY PROGRAM will also be greatly affected by what specialty you want to pursue since most people tend to stay for fellowship where they did their residency (there are always exceptions, but from what I have seen most fast trackers stay at their residency institution to do their fellowship). If you take the top 10 IM residencies in the country and look at the relative strength of their various fellowships, you will see that the strength of a particular fellowship is very institution dependent. For a lot of my fast track friends, they are essentially choosing their residency program based on the fact that that institution has a particularly strong fellowship in subspecialty X or b/c there is a big name PI in that fellowship that they want to do their research with. All my friends who are fast tracking are essentially pursuing fellowships in what their PhD was in.

I guess this is a long-winded way of saying that what your PhD is in CAN matter a lot. Granted, their PhD's were all in pretty disease or field-specific topics, and they enjoyed the clinical aspects of that subspecialty, so it fits and makes sense. Just realize that if you do pursue a PhD in a pretty specific disease/field you can run the risk of getting pigeonholed into a certain subspecialty during the whole residency application/fast track process. That being said, it is no big deal to do a specialty in something different than your PhD...that is what I am planning to do. I know how to think like a scientist and will just use my fellowship to get trained in the particular techniques I need for my field. And obviously some PhDs are broadly applicable (e.g. if you studied cellular signalling or something that is relevant to everything).

 

[greg12345]

To answer your other question, I don't know if there is an easy solution to making an informed decision about what to do your PhD in. We threw around the idea at my institution of having the MSTP students do their IM rotation before going off to grad school, but ultimately scrapped that idea for a variety of reasons. Even though I've been spouting all this stuff about how your PhD topic can have importance later on down the road for career stuff, still the most important thing is getting into a lab with a good PI who will train you to think like a scientist. Obviously you want to study something that is also interesting to you, but finding a good boss and the right training environment is really paramount. If you have found a good lab/boss that does research that is really disease specific and it is so fascinating that you could see yourself devoting your research career to this disease/topic (or at least this general field), it might not hurt to spend a couple of days in the relevant clinic or on the wards just to make sure you don't absolutely hate it.

 

[Vader]

I'm considering going into a disease-related research field. If it'll benefit me to know for sure that I'd want to go into the clinical side for a specialty, I'd love to know how people think the best way to inform myself before 3rd and 4th year if it's right or wrong for me. I know it's not a bad thing to change fields (and know a lot of people that do), but a leg-up on the career path would be nice.

If you have a particular clinical field of interest, it may be of some benefit to do a preceptorship during the graduate school years in that field. My MSTP program gives us some credit for a clinical preceptorship during the graduate years. The requirement is minimal (12 hrs per quarter) and it meant to keep you in contact with medicine and also start to pursue areas of interest. If there is no formal program at your institution, you could always arrange such a preceptorship on your own. I would suggest, however, to keep the time you devote to this minimal, because the focus should still be largely on your PhD and getting through the program.

I would be wary of doing a clinical rotation right off the bat in an area you think you might go into eventually, as you need to do well in that rotation and therefore may not want it to be the very first one.

 

[Dr.Watson]

Vader, Greg - Y'all are awesome! Thanks for the information and I'll respond further when I'm not so busy at work!

 

[greg12345]

Yeah man, I have way too much time on my hands (for the 1st time in 7.5 years) now that I'm essentially done w/4th year and just waiting for the match. I should probably be trying to learn something so I don't kill someone in 4 months.

 

[Gyric]

My mudphud progression:

College: “Wow I love science, medicine seems cool too, plus I am way smarter than all these pre-med whiners.”

Medschool (basic science years): “This is easy and I am getting paid to be here, sweet!”

Grad school (early): “Research is awesome, life in the lab is chill, I love the intellectual freedom, … ooh check out my new knockdown, Nobel prize here I come, blah blah blah.”

Grad school (late): “Research is still fun, publishing is not that hard, academic politics suck, most published work is worthless, … holy crap being a PI is risky … funding dries up, the new chair doesn’t like you, etc and your career is flushed.”

Medschool (clinical science years): “Medicine is tough … some specialties are rewarding, others just suck the life out of you … nice to have old classmates as residents.”

4th yr/interviews: “Having an MD/PhD rocks, I can write my own ticket … heh you know skin is boring as hell but maybe I should consider derm, it seems popular with the other AOA folks … nope just can’t sell out yet, besides I probably will do a postdoc to kick start my physician scientist career … maybe I should fast-track through something … damn, I have no clue what I really want to do.”

Residency (early): “Wow this is challenging … hitting a truly steep learning curve is fun (in retrospect).”

Recruitment by your chairman/famous scientist: “You mean I have to choose basic science and short change my clinical skills or I have to focus on clinical work and not bother with grants, that sucks! I guess I will do a clinical fellowship and then decide.”

Fellowship: “Getting tired of scraping by, first kid is on the way, am being offered 200k+ (starting) private gigs, 300K in a few years.”

>>> attending mudphud … “yeah my buddy (who went into private practice) from residency is coming into town this weekend, bastard told me that he is already set to retire … I have another 20 years if I am lucky.”

Is there really a choice here? It may not seem as clear-cut to you when it is time to finally make it, till then enjoy the journey … I am not sure you can predict where it will take you.