Wondering if MD/PhD is for me

[_ian]

I'm an undergrad entering my sophomore year at Michigan, and I'm interested in neuroscience. I'm not certain precisely what field within the study I intend to go into just yet, but I've been working in a lab that focuses on learning and memory, and it seems like a good fit.

I intend to stay in academia; my goal is to become a tenured professor at a university. Because of this, I'm not entirely sure what use the medical degree would have practically. Right now, I'm deciding between just a PhD or an MD and PhD. I'm quite willing to do the work for both degrees if I am convinced that the extra years to get the MD will help me in the long run. Since my interests lie in research and teaching, I'm uncertain how relevant a medical degree would be to my study. I can't think of many things I want to do that I could do with an MD/PhD that I couldn't with just a PhD.

So, the questions I have are:

1) I'm afraid of post-doc limbo. This has been my driving factor for looking into MD/PhD programs; I am very motivated to work my butt off to get ahead and get noticed in order to secure a nice job as early in life as possible. Would the MD make it easier to land these jobs?

2) How much time commitment should I expect if going the research route? I know 7-8 years for the MD/PhD, but what comes after? Is residency necessary? Should I expect to still do a few years post-doc? Compared to just a straight up five-year PhD program, should I expect more or less time commitment between starting graduate school and landing the job?

3) What rewards in my own education will I see from getting an MD that a PhD won't give me, since I value research over clinical work? I know that most neuroscience PhD programs have little classtime and lots of research experience, so the MD should bridge some gaps as far as general medicine goes, but what in particular can I expect? Right now, since I know so little about medical programs (a year ago, I had no real intentions of even being in a biological science field) I don't know what the MD will offer me as far as personal enrichment.

Thanks for all your help.

- ian

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[Gut Shot]

I don't know what the MD will offer me as far as personal enrichment.

I did my PhD and MD separately, so I hope nobody flames me thinking I haven't been on both sides of this equation. But...

An MD will offer you a great deal. Many would argue that PhD's are being overproduced right now, and I would agree with that. Not just slightly overproduced, either. PhD's are, in general, becoming a dime a dozen.

Because of the limited number of MD and MD/PhD spots, however, these folks are becoming (if anything) more rare. At the very least the number of MD's and MD/PhD's who are willing to dedicate themselves to research are becoming progressively more rare. I believe Andy would agree with me here, and he's going to Harvard. What more convincing could you need?

No matter how you slice it, the money in research tends to be where the rubber meets the road. In other words, money is a lot easier to acquire for practical, clinical research. The problem is that relatively few people are both qualified and willing to do messy, time consuming, practical clinical research. If you are willing to get an MD and prostitute yourself properly, you can bathe yourself in clinical/translational research money, and even run a fair amount of basic research "on the side."

Even if you go straight basic research, having an MD opens up doors to grant funding that PhD's have no access to. If you apply to the NSF, you can always sweeten your grant proposal by bringing on some straight PhD's (like I said, they're a dime a dozen these days, and they'll be frothing to have an MD on their proposals).

Just look at it this way. Research with an MD is like walking into a career fair in a gymnasium. The room is huge and open, and you can stroll around and find a booth that suits you. Doing it as a PhD is more like walking into a long hallway with 75 closed doors. You can open a few to see who is inside, but you have to pick one with limited scope.

My God, my beer is empty. Excuse me while I write myself a prescription...

 

[b&ierstiefel]

I do agree with you, Havarti666. And I too am drinking a nice cold glass of sweet sweet beer! MD researchers are underproduced and PhD researchers are being overproduced. It's sad but true.

Hence, this is my thought about the MD. If your grades and test scores are good and you are in the position where you will easily get into medical school, by all means apply to medical school. I don't give a hoot if you're interested in becoming a physician or not. Feed the admissions community the bull that they wanna hear. Take the spot from the other guy who has lower stats but really wants to "help people." Don't feel one bit remorseful about it!

Go for the MD if you think you can tolerate 4 years of grueling medical school. If you've got the credentials to get you into an MD/PhD program, I would suggest that you apply for it (instead of a straight PhD program) because if you don't, and given the vast advantage the MD degree gives you, it could be a wasted opportunity.

Credential inflation. The MD is all the rave. Stay on top. Keep the advantage. Ensure that you'll be seen as more qualified than the other guy by having something that other guy doesn't. Grab the research community by the balls and don't dare let go. Research is a sink or swim environment...no time for f*cking around. You need to maximize your chance for success. MD/PhD is the ticket!

Andy out!

 

[_ian]

Well, you guys have basically confirmed what I've been hearing already from people, so that definitely pushes me towards MSTPs. Thanks for your input.

Any answers to the second question? Should be an easy one.

 

[b&ierstiefel]

How much time commitment should I expect if going the research route? I know 7-8 years for the MD/PhD, but what comes after? Is residency necessary?

Residency training. And the length of time varies.

Should I expect to still do a few years post-doc?

Yes.

Compared to just a straight up five-year PhD program, should I expect more or less time commitment between starting graduate school and landing the job?

Well, that's the kicker for selling your soul to MD/PhD. It does take more years. However, if you go the PhD only route, you could be finding yourself doing a longer postdoc and perhaps more than one postdoc. You don't typically hear of MD/PhD's doing really long postdocs. They generally have an easier time finding jobs.

 

[Gut Shot]

Well, that's the kicker for selling your soul to MD/PhD. It does take more years. However, if you go the PhD only route, you could be finding yourself doing a longer postdoc and perhaps more than one postdoc. You don't typically hear of MD/PhD's doing really long postdocs. They generally have an easier time finding jobs.

Those few extra years are unfortunate, but they are definitely an investment. The MD brings a level of career flexibility, job security and earning potential that many PhD's will be openly bitter about. I feel for them, but it's supply and demand (and the fact that MD's can pull some clinical duties, however light, in addition to performing research).

 

[b&ierstiefel]

(and the fact that MD's can pull some clinical duties, however light, in addition to performing research).

That significantly bumps up your salary too compared to a PhD researcher. My mentor said it could easily double your salary to do 90/10! That's unfair. That's scary!

So does that mean that doing 80/20 will triple your salary? Surely, I jest.

 

[_ian]

Yeah, right after I made my post earlier, I checked out the public salary record for my university. I looked at all the people with both degrees listed as neuroscience faculty...and the lowest salary for even the assistant professors was still six figures. I'd never even think of going into anything for the money, but that plus the loads of aid that MSTP students get during school sure sounds nice.

I'm definitely leaning towards MSTPs now; I'm going into research because I love learning, so an extra four years of school plus residency isn't that bad, particularly if I can land an excellent job by the time I've finished a fellowship or two.

I just have to get over the idea that I'm closer to third grade than the end of school

 

[Sunflower189]

I read the "fastest paths to tenure" guide that gets posted around here, and it suggests doing the one-year internship deal before bailing for a postdoc. As I understand it, that'll get you a medical license, but you can't use it for much without board certification. Is this a valid time-saver for those of us whose hearts are in basic research, or a good waste of five years?

(in the same position as the OP, but I'm a bioengineer)

 

[Foreigner]

Assistant professors with 6-figures? Sign me up!

I basically agree with everyone else. I am finishing up my Phd, and want to do an MD (if I get myself accepted , so my situation will be pretty similar to Havarti666. But I haven't done both yet, so I can't really say that much on both sides.

Also, be very careful with calculating "time. Yes, they say PhD takes 5 years, but I've seen it take longer even for the hardest working people. It takes a bit of luck, too. Again, as mentioned before, postdocs are not 3 years nowadays - it's more like 5. And you're lucky if you only do one postdoc. And again as mentioned before - PhDs are overproduced....

Good luck deciding!

And, Havarti666 - send some Shiner over here Cheers!

 

[_ian]

"Calculating time" gives me one hell of a headache.

The thing that's been holding me back from committing to the MSTP track is that I'm by nature very motivated and hard working, and I can't help but wonder if I might be one of those lucky PhDs who come right off a fellowship and into an assistant professor position. I just watched a former grad student from the lab I work in get hired by MIT after a post-doc at Stanford... and each time something like that happens, I think "maybe I could do that!"

Then I start reading forums full of people with less ideal experiences and get grounded in reality. What's to say there aren't people out there way more motivated than me? After all, the whole reason I'm not doing neurosurgery is because I can't take a lifetime of 70-80 hour workweeks. I'm motivated, sure, but I want a family and I'd like to have time for hobbies outside of work - like music.

The question becomes: does getting the MD have benefits that outweigh the time spent? Most tell me yes, but I still have this feeling that I can't shake...

::explodes::

 

[QofQuimica]

PhD's definitely don't always go according to plan; I'm finally about to finish, but this is my ninth year in graduate school. (I got my MS and took a little time off, but still, that wasn't the original plan!) Ian, you could try going straight MD in a program like Cleveland Clinic's that is geared toward physicians who want to do research. That way, you're guaranteed at the end of the five years to get out of school, and you'll also have significantly more research training than the average MD student. Check it out: http://www.clevelandclinic.org/cclcm/visitorpage.htm

 

[dl2dp2]

i'm the author of the afore-mentioned "guide for the fastest tenure". search around for it if you want.

take it with a grain of salt, obviously a document littered with hyperboles. But overall i agree with all of the above: PhD is risky. MSTP is a bit safer (but perhaps a bit slower if you were truly the most motivated student.)

i'm glad to see so many mstp students having such angsts just like me...i suppose it's by the nature of such programs that would attract a distinct group of people...i.e. people who want to know EVERYTHING (including music).

To give OP a perspective from a current student: it's hard to go back to grad school after medical school, where everything's nice and structured and there's a high paying job waiting for you at the end of it, even if the road is long. Sometimes I lose sleep thinking how I could possibily squeeze a quality thesis into 3-4 years. How can I ever publish as many papers as many of the lab heads I encounter. Almost EVERY tenure track professor at my school has at least one Nature/Science/Cell paper with dozens of other papers. The situation is perhaps a bit better for biomedical engineering/more theoretical sectors. But experimental biology seems SO competitive. It's hard for even the best post-docs to get an academic job these days in bio.

It's very easy to become disillusioned I think. And you need a certain amount of consistency. There's one kid in our program who discovered a protein involved in HIV resistance in new world primates and got a Nature paper in three years. Will he get tenure track? No...not right now. However, he definitely has the option of matching into a competitive, "lifestyle" specialty. A couple years ago someone graduated from an HHMI lab and now is in a dermatology residency. Will PhDs ever be able to make $300,000-$500,000 wetting people's skin and doing MOHS?

Will they ever want to?

 

[Scottish Chap]

_ian,

I'm going to disagree slightly with what's written above. Firstly, I want to say that I think you are asking some very insightful questions, which is a good thing. It's true that there are different funding opportunities for research when you compare M.D's and Ph.D., but that difference usually does lie in the realms of clinical research. If you are interested in basic research (bench work) which is arguably where all the glory is, I'll be honest and tell you that having an M.D. on paper will confer no advantage whatsoever; the proof will be in your publications and research ideas which are pivotal. When applying for RO1's, the research proposals at the very high end are almost indistinguishable - simply because they are all excellent! If you are good and you only want to do research, having an M.D. will confer no additional advantage. In fact, I would argue that the extra time spent in lab by a lot of Ph.D.'s is what matters since this is where you get the experience (please don't flame me if you're an MD/PhD that spent >4 years in the lab.....I know many of you do). Yes, having an M.D. may 'shave off' a couple of years of research postdoc training and make you eligible for faculty positions a little earlier but, again, if you are good, this will not be an issue at all. If it's the time commitment that scares you, take QofQuimica's advice and look at research-focused M.D. programs like the Cleveland Clinic and Harvard's special M.D. program that lets you do research at Harvard or MIT.

Now...if you actually want to practice medicine as well as do good research, any honest clinician scientist will tell you that both your research and your clinical work will have to be compromised. Any honest person will tell you that to do science at a very high level, you really need to focus on one thing only. Yes, again, there are are very few exceptions. Like it or not, this is reality.

I, too, did my Ph.D. first before applying to medical school but I took a few unusual steps along the way. I did a postdoc in basic research and in a clinical specialty concomitantly (clinical chemistry) because I liked both clinical work and research. As a Ph.D., one option you might consider is to become board-certified in the subspecialty of pathology, clinical chemistry. This will open up almost all the doors that an M.D. would if you want to do clinical/translational research (I became involved in biomarker discovery and proteomics). In fact, most Ph.D. clinical chemists do clinical/epidemiological and translational research. This added credential after your Ph.D. adds around another 60 grand to your salary, though I was not focused on the financial aspect at all. My Ph.D. took 3 1/2 years and my postdoc (clinical plus basic) took 2 years. After this two-year postdoc., I (and my colleagues who chose the same path) became eligible for faculty positions right away. I was offered positions (assistant professor of pathology) at both places I interviewed at (private medical schools in PA and CA). In addition, since you will be working in laboratory medicine, you'll have a fair understanding of human pathophysiology. The only thing you won't be able to do is lay hands on a patient. If you are a people-oriented person like I am and you still love basic and clinical research, then I would urge you to aim for the M.D./Ph.D. program as it will save you so much time and money and give you the credential that you'll need to interact with and manage patients.

Overall, I would say this: it's great to listen to everyone's advice on this but if you follow your heart, you won't go far wrong. If you truly want to be a researcher and you are not interested in being a physician at all, I would just commit yourself to a Ph.D. Remember, getting accepted to medical schools is great (I was, of course, delighted to have this privilege) but if you only do an M.D. and you have to pay for it, you're essentially adding on another ten years to your training when you consider the time that medical school, residency, and fellowship take. Ten years, Ian! You can do a lot with that time and it's a tough commitment if you are not sure. If you go the M.D./Ph.D. route, just realize that you will probably end up picking one or the other and that's fine. I'm not a particularly talented test-taker and I honestly don't think I performed wonderfully at everything (that's not false humility either) but, like you alluded to, I just worked incredibly hard at every stage of the process, I tried to be nice to folks, and I followed my heart. Frankly, for success in research and in many things, this is pretty much all that is needed. It's easier if you're in a supportive environment but you'd be surprised what you can accomplish if you are doing what you really love to do. I only came to the U.S. six years ago so I was not eligible for M.D./Ph.D. programs. I think these programs are wonderful, but, if I could do it all over again, I doubt I would not change a single thing..... Just my 2 pennies worth.

 

[_ian]

Can you explain how you become board certified without an MD or DO? I didn't even realize that was possible before your post..

 

[Gut Shot]

Can you explain how you become board certified without an MD or DO? I didn't even realize that was possible before your post..

One can become a PhD in certain areas of clinical laboratory medicine, such as clinical chemistry or microbiology. You would most likely end up working in a large hospital or academic medical center.

I found Scottish Chap's post to be interesting, and certainly warranting a clarification or two. Ian, all the experiences you read on this forum, or hear from individuals are, by definition, anecdotal. If you look back at the careers of any group of scientists, be they MD, PhD or MD/PhD, you will find examples of triumphant success as well as dismal failure.

My reading of your original questions, however, boiled down to this: what can an MD do for you and what will it cost? I stand by my opinion that and MD can do a helluva lot for you. Naturally, however, it's contingent upon your own attributes and goals. I felt that was kind of obvious from the get go.

The cost, in terms of time, is a tricky issue. There are some whiz kids out there who jam through grad school in 4 years (or less), blast through a postdoc and are tenure track. They are in the minority. I think it's much more realistic to assume that PhD and one postdoc will consume about 9-11 years.

Combined degree, say 8 years, plus residency/fellowship. There are certainly research heavy residencies out there, some with fast-track programs towards academic careers. Four or five years of that, you're in to the tune of 12-13 years. I'm the last guy to be flippant about some years of your life, but like I stated earlier, it's an investment. It's not for everybody, to be sure, but it can certainly open doors for you.

 

[b&ierstiefel]

I had a similar type of response all lined up. Havarti makes a good point about the anecdotal description of experiences. All of us, regardless of which stage in our careers we may be in, have had our share of successes and failures. It is easy for myself and others to consolidate our successes and say things along the lines of, "this is how you gotta do it." But upon looking at the bigger picture, there are more than several ways to achieve a common goal.

I too stick by my notion that the MD is great for opening up doors and giving you options. Of course, the most elegant way to go through life is a linear straight shot, in which case, options are useless. As you go through life, you will have a clearer idea of what your ultimate goal will be and as you are closer to realizing that goal, your need for having options, options, options will become less and less.

Scottish Chap raises a good point about RO1s since he's closer to have experienced this than any of us--it is ultimately the quality of the science and the proposal that leads to funding, MD or no MD. I would like to supplement his comment regarding grant funding though. Many PIs do not rely solely on RO1s for funding their research. If they did, a significant fraction would be **** outta luck when they don't get their RO1s renewed and they fail to secure new RO1s. There are other grants that can fund labwork and help the PI establish a stronger and stronger track record. And of these grants, I am sure that there are some where MD wielding researchers get first dibs. Clinical research or less clinical research grants...it's semantics. The important thing is that you need to get the money to fund your work and your lab members' salaries.

Again, the more degrees you have, the more options you have. Is it worth the extra years of training? That really is up to you. For me, getting the MD was palatable (overall) even though the clinical phase of my training left a sour taste in my mouth. On a similar vein, you'll never detest something unless you experience it first hand.

 

[Scottish Chap]

Can you explain how you become board certified without an MD or DO? I didn't even realize that was possible before your post..

http://www.aacc.org/abcc/rules_abcc_cert.stm

 

[N-Surge]

<snip>
3) What rewards in my own education will I see from getting an MD that a PhD won't give me, since I value research over clinical work? I know that most neuroscience PhD programs have little classtime and lots of research experience, so the MD should bridge some gaps as far as general medicine goes, but what in particular can I expect? Right now, since I know so little about medical programs (a year ago, I had no real intentions of even being in a biological science field) I don't know what the MD will offer me as far as personal enrichment.

Thanks for all your help.
- ian

Rewards? Taking care of other people, the rewards are limitless.

Enrichment? It is more about enriching the lives of others rather than oneself, IMHO.

Perhaps you already see things this way. However, I simply wanted to do a 180 regarding your wording of the rewards and enrichment. =)

With respect to how a study towards the MD will benefit your research endeavors, Medicine will give you a global view of the human condition that a study towards a PhD alone will not, IMHO.

In the end, it is more about what you have to offer Medicine.

Sorry if this was abrasive. The best advice I can give you to help answer some of your questions is to work in the clinical setting. If you aren't in a clinic as a volunteer then change this.

 

[solitude]

This is a great thread, but I haven't seen anybody address this question:

Would it be a good strategy for one interested in only basic science to do an MD/PHD but then completely skip out of clinical training and just do a postdoc? Would the MD be good for perspective, or just a waste of time?

 

[ears]

This is a great thread, but I haven't seen anybody address this question:

Would it be a good strategy for one interested in only basic science to do an MD/PHD but then completely skip out of clinical training and just do a postdoc? Would the MD be good for perspective, or just a waste of time?

If one knew ahead of time that one was only interested in clinical science, then MD/PhD is almost certainly a waste of the time in medical school. Med school is long, and while it's somewhat scientifically somewhat interesting, it's not particularly good training for becoming a scientist. And it can be pretty painful, even if you're really into it. It's almost certainly torture if you're not.

Many MD/PhDs have another decision point on finishing their PhDs: do they want to finish their MDs as well, or write off their medical education? I think probably the benifits to their scientific career of having MD after their name more or less balance the extra two years, but it's really a wash.

But four years is definitely too much medical education if you're not into medicine for its own sake.

 

[Reimat]

This thread has focused on whether an MD is useful for a researcher- how about on the flip side, is the PhD worth it for someone who wants to practice medicine to some extent? I love research- but I also love patient care and practicing medicine. It seems to me that the original purpose of MSTP programs was to train MD's to do research- I guess for me, I can't imagine putting in 4+ years of life to earn an MD if all I was planning on doing was clinical research. Especially when that 4-9 years of medical schooling are during the most creative years of a person's life. I may just have gotten the wrong idea, but I'm left with the impression that many people on this forum intending to pursue dual degrees don't have much interest in medicine? Therefore, in people's opinions, who is the "ideal" MSTP canidate.

 

[_ian]

If you want to spend the majority of your time practicing medicine, I don't think you need a PhD. You're not locked out of research by getting only an MD, but you are locked out of practicing by getting a PhD.

 

[tr]

This is a great thread, but I haven't seen anybody address this question:

Would it be a good strategy for one interested in only basic science to do an MD/PHD but then completely skip out of clinical training and just do a postdoc? Would the MD be good for perspective, or just a waste of time?

No, that's pretty much a waste of time. The tangible benefits of the MD (higher availability of professorships in clinical depts vs basic, eligibility for K08 grants) only come with completion of residency. The perspective is definitely useful but probably not worth 3-4 years of your life.

On the other hand, I entered this process thinking I probably would not do a residency (like you, I was interested mostly in the information/perspective), and now I think I will almost certainly do the residency, not only to get the payoff mentioned above, but also because I have come to believe I might like the option of practicing. Training takes a long time; you're a different person at the end of it. Plan accordingly.

 

[solitude]

tr,

I like your advice. I would think that as an undergrad, it would be almost impossible to be completely sure that one doesn't want to do a residency or practice medicine at all. By doing an MDPHD, one can delay that decision for another like 6 years, until they have morphed into a "completely different person" as you alluded to.

But if I did decide to just skip out on practicing medicine altogether, I am still curious why you think that would be a waste of time. Do you mean that you gained no perspective on basic science based on your two years in med school classes? Or do you mean that the time in the clinic is a waste? Or do you mean that it's a waste to be learning that medical stuff when you can be doing basic science?

Is it common for MDPHD's to skip out on residency and just do a postdoc and then get a position somewhere?

Thanks for your help.

 

[solitude]

I guess you sort of answered those questions in the above post, I just didn't read carefully.

I would still listen if you (or anyone else, for that matter) care to elaborate

 

[tr]

I like your advice. I would think that as an undergrad, it would be almost impossible to be completely sure that one doesn't want to do a residency or practice medicine at all. By doing an MDPHD, one can delay that decision for another like 6 years, until they have morphed into a "completely different person" as you alluded to.

I have to say that I am shocked at how many of the straight PhD students at my institution have mentioned that they are considering doing a full, paid-for MD afterwards.

But if I did decide to just skip out on practicing medicine altogether, I am still curious why you think that would be a waste of time. Do you mean that you gained no perspective on basic science based on your two years in med school classes? Or do you mean that the time in the clinic is a waste? Or do you mean that it's a waste to be learning that medical stuff when you can be doing basic science?

No, you do gain a perspective on basic science. You get a wider framework in which to place your understanding of things, and it is easier for you to pick out problems of eventual clinical relevance. But again, this comes at a cost of 3-4 years, which may not seem like a lot when you are 22, but probably will when you are in the middle of it.

Is it common for MDPHD's to skip out on residency and just do a postdoc and then get a position somewhere?

No, it is rather uncommon, for the reasons mentioned above. A few people do it (someone who just graduated from my institution did it), but as I said, it turns the MD into just a decoration after your name. And it is a decoration that won't help you much. After this point your degree credentials mean much less than your actual achievements (i.e., your publication record). So skipping residency means resigning yourself to the fact that you essentially wasted those 3-4 years.

I think the people who do this usually have both of the following characteristics:

1) They performed extremely well in their PhDs and are confident they will not need the MD boost to survive in academia

2) They really hated the clinical years, to the point that they could not see themselves suffering through a residency.

 

[_ian]

But if I did decide to just skip out on practicing medicine altogether, I am still curious why you think that would be a waste of time. Do you mean that you gained no perspective on basic science based on your two years in med school classes? Or do you mean that the time in the clinic is a waste? Or do you mean that it's a waste to be learning that medical stuff when you can be doing basic science?

As he said, if you skip residency, there are no tangible benefits. You sacrifice four years of your life and end up not being able to practice, not getting any better job offers, not getting any extra grants, not seeing anything extra in your paycheck, etc; meanwhile, people your age with just a PhD will have already completed a fellowship as you're leaving school, so they will probably be in a better position in the job market than you.

As far as educational value, yes, there are benefits, but is broadening your horizons by taking courses outside your interests worth a four year commitment to you? Furthermore, if you don't have any aspirations of practicing medicine before entering medical school, all the patient interaction will be hell.

It's okay to enter the program with the intentions of researching over practicing, but if you really think you wouldn't enjoy being able to practice medicine, I wouldn't try for the MD, because I think it would be more valuable to spend that four years becoming proficient in your particular field of study over going into medical school.

 

[solitude]

Very good answers, thanks. I will let you know what I decide (PhD or MD/PhD) in two years!