Academic medicine mentor thread

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DoctorPardi said:
I would be very interested in reading this discussion of creating a student CV. Thanks Tildy as always!
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The most common mistake made for students is to fail to properly document the teaching that they do. This is especially common for residents, fellows and new faculty.

For example, if as a resident you create a 10 minute power point talk that you use for medical students and interns to describe some common clinical management issue (e.g. asthma in the ER), then this is an "enduring material" and it should be documented in your CV.

Another issue in student and resident CV's are scores (MCAT, Step 1, etc). Unless you are working off of a format that requires them, don't include these in a CV. Whether they are good or bad, they are not part of your general CV. They will go elsewhere on an application. People are usually looking at your CV for different purposes than to find scores.

Make sure you document any formal presentation that you do. So, if you give a talk to a local high school, include this in your CV. Later you can be more selective, for now, be inclusive.

For students and the like, I personally would leave off of the CV any "personal" information like DOB and marital status/kids. I see this on a lot of CV's for reasons I don't know. Maybe for senior faculty, but not otherwise. You can give this info out if you want in a different setting.

Farther along comes the issue of maintaining what is sometimes referred to as a "teaching and evaluation portfolio." This is crucial for fellows and new faculty, but it doesn't hurt residents to think about this as well.

What goes in this portfolio? Well, every time you give a talk, someone is likely to have had a chance to evaluate it - get copies of these evaluations. These can be CME scores, they can be on-line evaluations, they can be rotation comments, etc. If you are a resident and a medical student writes in their evaluation of the rotation that Dr. X, the resident was great to work with - get a copy of this if you can and put it in that "folder" you are keeping.

I'm sure I'll think of some other things along the way and can update this. Nowadays, it is best to create a CV and keep updating it every few months - the farther along you are in your career, the more often you'll update it. Initially, put in everything - even if you are only an acknowldegment in a paper - include it as a medical student with a comment about what you did. Later, you can take that stuff out as your name appears on more things.
 
Anastasis said:
Thanks for the reply earlier. 🙂

To clarify on your discussion about CVs, are there any situations where an activity from undergraduate is appropriate to remain on a CV during/after medical school? (Published Research being the most obvious).
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Being social chair for your fraternity/sorority stays on the CV for life 😛

j/k. Even mentors are allowed a bit of humor.

A lot of things you did before med school might stay on your CV, but things that were specific to undergraduate life probably won't.

Anything that you spent a year on that was a job-like activity of importance would stay on at least through residency (Teach for America, etc). So, hamburgers at the student center as a student job won't go on the CV after you start med school, but going overeas for a year to try to create peace would whether it was part of your school experience or not!

Military service stays on the CV forever along with any honors, etc associated with that service. If you were ever part of anything that got patented, that stays on forever too.

In general, put it all on there. What I do is have a "full CV", but for some purposes take out parts. The NIH has a very set format for its CV's (3 or 4 pages, depending on the style used), and some medical schools require faculty to keep a CV in a fixed format. But otherwise, just have one that has everything and then omit parts depending on where it is being used.
 
Anastasis said:
Thanks again!

I've been looking around the internet trying to get a feel for what the basic format of a CV should be. I've found a couple of good websites (http://www.cvtips.com/). I was wondering if you could outline the broad categories we should include on our CVs. (ie. "Education", "Work Experience", "Community Involvement" or something like that) or maybe if you have a website you would suggest. Thanks again! 🙂
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This is well covered in this post from the pharmacy forum FAQ:

http://forums.studentdoctor.net/showpost.php?p=1700990&postcount=24

I wouldn't spend a lot of time worrying about what style of CV while in med school. You'll mostly use it to apply for a few small amounts of funding support that might be available or things like that. Those folks won't care about style. Later you'll be using set forms for the next step in your career. I've listed the usual parts of a practicing academic physicians CV for those who are interested. This is not the more limited NIH format CV that can be gotten from the NIH website, but a general idea of what is included.

PERSONAL

Name: Tildy JRT
Place of Birth: small town, USA
Address: My master's house
Phone: -


EDUCATION

BS -

MD -

PROFESSIONAL TRAINING

Residency
Fellowship, etc

FACULTY APPOINTMENTS/ WORK EXPERIENCES

LICENSURE AND CERTIFICATION

HONORS/AWARDS

GRANTS RECEIVED/PENDING

SOCIETY MEMBERSHIPS

PRESENTATIONS

COMMITTEE MEMBERSHIPS

BIBLIOGRAPHY

A. Peer-Reviewed

B. Articles, letters, monographs, and chapters:

C. Abstracts
 
Although I've focused on med students and residents, many pre-meds have "mentors" and one of the most common things to do is to shadow them. Although this is discussed elsewhere on SDN at times, as it is summer and that is "shadowing season", here is my take on a few things.

First and foremost is that no one has an obligation to let you shadow them. A physician/dentist/optometrist, etc that has you shadow them is taking their time to help you. This means you need to look and act properly. I realize you all think this is what you do, but remember, your standards for these are often not the same as your mentors (or his/her patients). So,

1. Dress appropriately - for guys wear a dress shirt, nice pants (no jeans) and unless told to do otherwise, wear a tie. Even if it's for shadowing in surgery - the mentor will tell you if the tie isn't needed and nice clothes are still appropriate for entering the hospital before changing to scrubs. For girls, dress pants are fine, no showing of any mid-riffs, no shorts, no jeans. For both, be careful about excess piercings, dyed hair, etc. No absolutes here, but if in doubt, don't until you get to know your surroundings.

2. Ask questions, but don't do it right away and limit the questions. The first day you shadow, take a little post-it pad and AFTER seeing each patient, write down what they have and what terms you didn't understand. Away from the patient, ask your mentor at most one question/patient. Then, when you are home, look up what you saw and ask a question or two about it next time before rounds. Never ask questions in front of the patient.

3. Use caution in telling people (or blogging) about what you saw while shadowing. You will probably need to sign a HIPAA form. Pay attention to what the rules are about this. It's okay to tell your friends that you saw a c-section, but don't say that you saw a 23 year old who shot himself in the head on Main Street at 2 pm on May 14th. That's identifiable info.

4. Write a thank-you note after the first shadowing experience.

5. If you discover that you don't much care for what you're seeing, do it a few times and then just tell your mentor that "I really am glad I got to shadow you, but could you help me find someone doing X that I'm interested in to shadow?" They won't be upset and usually can help.

6. Don't pretend to be a doctor, but don't hesitate to help with the same things anyone else would. In other words, open doors for patients, pick up charts that drop and otherwise act like a "mensch".

7. If a patient starts talking to you, then answer them back and be honest. Folks are curious about who their doctor has hanging around them. So, if they ask you, answer them.

8. Last but not least, try to get a sense of the doctors life and role out of the shadowing. It really isn't about the number of HOURS you do, it's about what you see and experience. This comes across on applications.
 
MassTransport said:
Am I correct in the understanding that a majority of academic physicians work at university (aka teaching) hospitals?
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Full-time academic physicians are generally described as those who work for a medical school as their primary affiliation. As such it is typical that they mostly work at teaching hospitals. However, the term "academic physician" can include a large number of folks who spend much of their time in a "private" environment, folks who have office or surgical practices that don't involve residents or medical students, etc. Of course, it can also describe those who do primary research.

In general, those who are identified as "academic" are so identified because they wish to teach or do research, wherever they are. Of interest is that it has become very common for medical schools to hire as faculty and place on the payroll community physicians who staff, via contract, clinics and hospitals in the "community." They may or may not have much in the way of medical students or residents there. Such doctors may mix their time between this community setting and a more traditional university hospital or can be entirely in the community.

Bottom line - the term "academic" can mean a lot of different things to folks these days!
 
qtrlifecrisis said:
Hi Tildy

I am an international student who will be applying in the 2009 cycle. I have a 3.88 GPA from an Ivy, and expect to score at least a 30 on the MCAT, which I took last month.

I've been trying to figure out why exactly I'm applying to medical school. I'm interested in global health and teaching (and have experiences to back my interest). I'm also heavily involved with several social justice and inter-community groups on campus, and will do some economics research (for my major) on disparities in health care for racial and ethnic minorities. I've worked in a radiology lab for the past couple years, and am currently interning with an NGO in my home country that works to empower sex workers to lower their HIV risk.

I also really enjoy cooking (I have a culinary certificate) and have won and judged several Iron Chef-style competitions at my school - this doesn't really have anything to do with medicine, but it's one of the activities I enjoy most and believe merits a mention on my application.

I began to consider med school only a few months ago, and I did not go into my EC's thinking about med school, which is why they seem pretty fragmented. The themes I can see are global health, and social justice regarding underserved and/or marginalized populations.

I think I would like a career in academic medicine that involves a mix of clinical care (probably Infectious Disease-related if I had to choose now, due to my sustained interest in HIV and TB), teaching and research on health care disparities, or something related to global health.

Is this even feasible? Do I even need an M.D. to investigate health care disparities? How common or feasible is it for M.D.s to conduct interdisciplinary research (as I assume disparites/ global health research is)? I would appreciate your thoughts on how I can best reach my projected career goals, and what I can do over the next year to improve my chances for admission.

Thanks for your time.
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There are lots of MDs who investigate health care disparities, do public health research and interventions and work in global health. Some of my best friends do these with or without MPH degrees. I've been known to dabble in this a bit. 🙄

Most folks who do this will end up in academic medicine but it still isn't necessarily an easy career route. Nonetheless it is quite feasible. The decision to go to medical school vs a PhD in public health for example, as with any such decision depends on whether you wish to become a physician. That is, do you want to care for individuals with diseases processes? If not, if you are strictly interested in studying "groups" or designing group interventions, you won't like medical school as you are being trained to care for individuals with health problems in medical school. You'll get some public health training, but not much, in medical school.

Some schools with MD/MPH program might appeal to you in particular.

As far as getting in....well that belongs in the med school admissions thread. 🙄 I would say that although you'll be asked about all the NGO and HIV stuff, don't be surprised if you get asked about cooking the most. I interview lots of folks who have worked overseas with HIV positive folks, but not too many master chefs.🙂
 
ecking said:
Tildy, I want to be a practicing clinician who teaches undergrads or med students. I'm an applying premed right now and I've received numerous suggestions for my PS to specifically say that I want to pursue academic medicine as my current goal since my PS is just beating around the bush right now.

What is your view on this issue? Will it decrease my chances at smaller schools that tend to produce primary care physicians and not academic physicians?

Thanks in advance.
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Sorry, but I really don't know as I'm not at a smaller primary care-oriented school. In general, I recommend people express an interest in academic medicine but not focus on it wherever they are applying. This isn't that important an issue to adcoms as they know folks will change their mind about specialties and academic vs private. Besides even those primary-care oriented school need faculty to teach so they won't be put off by the idea of academics.

By the way, not too many medical school faculty teach at the undergraduate level. There are a few, but it's not that common.
 
Hello everyone,

I am about halfway finished with my M.D./Ph.D. I will be helping Tildy answer questions about academic medicine from a student's perspective.

Regards,
PP
 
BrianUM said:
I am going to start medical school this fall and have a genuine passion for it. Academic medicne (teaching, research, seeing patients) appeals to me but i am not so sure that the salary will be. From my understanding, beginning assistant professors make about 120 k in Neurology and I have heard stories about cardiology profssors making over 400 k. Is this because of grants or because they recieved a raise? I have no clue how the pay system works in academic medicine.
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There is a large range in salaries in academic medicine just as there would be in private practice. Salaries in academic medicine may be generated partly or even largely from support from grants, but it is also generated by patient care income for those who see patients. A specialist doing procedures may have a greater income than one who does not do procedures. The salary is usually established in a negotiation between the physician and the leadership of their department and may take into account income generated, teaching, research and administrative responsibilties. Seniority, area of the country and amount of clinical responsibilities are all large variables as well.
 
stat3113 said:
Now, I am hoping to enter grad school in biostatistics soon. Then, after 2 yrs, I would like to enter med school. (Basically, if there was a such thing as an MD/PhD program w/ a Biostat emphasis, and if my grades were better, I would have done that.) So upon entering med school, I will have 2 options: 1) terminate my Biostat studies, I will prob have an MS, and I can make good use of my training during my medical career, or 2) try to set up an informal way I can work towards both MD and PhD simultaneously (i.e. 2 yrs med, 2-3 yrs grad school-finish PhD, 2 yrs med- finish MD.)

From your perspective, what reasons would you see for picking 2) instead of 1). If I want to go into research (not so much in theoretical Statistics, but in medical applications of Biostat), is MD/PhD necessarily more advantageous than MD?

Thanks for your advice.
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I'll let Tildy answer your first question about residencies and specialties for research M.D.s, but I wanted to make sure you know that a lot of M.D./Ph.D. programs won't let you transfer in from graduate school. If you want both degrees, you're better off going to medical school first and then applying for the Ph.D., or improving your grades and applying directly to M.D./Ph.D. programs. Biostatistics is an available Ph.D. at some schools; you'll have to look through the M.D./Ph.D. programs and see which ones offer it. I don't think having a Ph.D. is necessary to do biostatistics research, but sorry, I can't tell you how much having one will help you in terms of career advancement.
 
stat3113 said:
So here is what I understand: someone (with an MD, but no PhD) who wishes to go into academic medicine, i.e. teach or research, as opposed to doing clinical work, should go through residency? preferably in IM or something broad? What then? What is the process like and how does it compare to the process for a normal MD who completes residency wanting to go into clinical work?

Now, I am hoping to enter grad school in biostatistics soon. Then, after 2 yrs, I would like to enter med school. (Basically, if there was a such thing as an MD/PhD program w/ a Biostat emphasis, and if my grades were better, I would have done that.) So upon entering med school, I will have 2 options: 1) terminate my Biostat studies, I will prob have an MS, and I can make good use of my training during my medical career, or 2) try to set up an informal way I can work towards both MD and PhD simultaneously (i.e. 2 yrs med, 2-3 yrs grad school-finish PhD, 2 yrs med- finish MD.)

From your perspective, what reasons would you see for picking 2) instead of 1). If I want to go into research (not so much in theoretical Statistics, but in medical applications of Biostat), is MD/PhD necessarily more advantageous than MD?

Thanks for your advice.
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I would pick 2 because if you plan a career in biostats, it is my impression that a PhD is usual and expected as evdence of knowledge and training. It's certainly true that MD's do lots of research without PhD's and you could make a case for competence without the degree. But, I would try very hard to develop a plan to obtain the PhD if that is to be a major part of your career.
 
thedelicatessen said:
I'm going to be starting medical school (MD/MPH) this fall, and I'm interested in working in academic medicine. I have a good amount of benchtop research, which I don't want to pursue, but I am interested in epidemiology and clinical trials. Contributing to the training of new physicians also appeals to me, and I want to be able to see patients too.

How will the MPH help me in academic medicine? I know there are recruiters for normal private practice/hospital jobs, but how does one find a job in academic medicine? Aside from good grades/test scores/passion, what else can I do to get my foot in the door for an academic career? Thanks for answering my questions!
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Really at this point you don't have to worry too much. A medical career with research in epi and clinical trials is certainly possible and a realistic goal for MD/MPH students. But, you won't be focusing your interests until you decide on a specialty and that's what you should focus on for now. Keep in mind as you look at specialties that there are a broad range of possibilities for someone with your interests. Certainly many will end up in family medicine, peds, or EM, but there are plenty of other possibilities too. I would look at your MPH time as a chance to explore career academic options. A lot depends on what school you're at, but when picking a project, try to find one that has a strong medical component or that is being managed by or with folks at the medical school as well as the school of public health.

Once you've gotten towards picking a specialty, it'll be easier to think about getting a start towards academics, but for now, focus on identifying a career choice that you like and that fits with your public health interests.
 
prospectivedoc said:
Hello Tildy

First, allow me to say 'thank you very much' for sharing your insight on this thread. It's been very helpful.

I'm a 28 year-old engineer considering a career change to academic medicine. I'll give you a little background since it's relevant to at least one of my questions: On my current job, I enjoy intellectual stimulation, collaboration with colleagues, and leadership/advancement opportunities. My dilemma, however, is that I would like my work to be more meaningful to me.

I have long been interested in how the human body works and I like the sense of altruism involved in medicine. Also, I have a very scientific outlook on life. I have shadowed a private practice general practitioner and volunteered in a local ICU. Although believe I would truly enjoy the doctor-patient interaction, my impression is that I would find clinical-only work to be too repetitive and lacking in intellectual collaboration. Before investigating a career change to medicine, I had considered pursuing a PhD in Neuroscience. I volunteered in a neuroscience research lab for 6 months but eventually chose not to pursue the PhD because I found long bouts of lab work to be painfully tedious and I was uneasy with the job prospects.

I am very interested in academic medicine (specifically that involving clinical research) as I way to retain the aspects of my job that I enjoy while gaining the personal fulfillment of working in the medical field. I am looking to confirm this interest with more certainty, however, before I quit my job and re-locate for post-bac courses. So, I have a few questions that I believe have not been asked yet in this thread. I've put them in order of priority in case the list is too long.

1) Given my description above, do you believe that academic medicine is a reasonable career choice for me? Would it be unwise to go to medical school if I assume that a career in academic medicine (vs. private practice) might be required for my job satisfaction?

2) How might I get a better ‘feel' of a day in the life of an academic clinician? (Do you have any tips for getting in touch an academic doctor for job shadowing? I'm not getting many responses to my emails.)

3) I am tentatively interested pursuing a career in Internal Medicine, Infectious Disease, or Neurology. In general or with respect to these fields, what is the geographic freedom for academic clinicians? Specifically, what are my chances of landing a job in any given city when it's time to get a job?

4) Can you speak briefly of some of the relative differences between basic science research and clinical research? (Specifically, I'm interested in clinical research as I have participated in basic science research through volunteer work. What career preparation is required? Are they equally common amongst academic clinicians? Is one more highly ‘valued' at AMC's? What activities is a researcher actually doing when he or she is doing clinical research? Any other pros/cons/comments?)

5) I often read comments from academic clinicians who seem very satisfied with their jobs, but recently I saw a statistic recently stating that 20% of academic clinicians are clinically depressed. (search: doctors increasingly despair) Does this align with your experiences and if so what are your thoughts on this?

Thank you for making it all the way through this long post. And thanks in advance for your responses.
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1. I tend to think of myself as a bit sharper than the typical Jack Russell Terrier and I don't get bored with clinical medicine. I take care of very sick patients however, and work collaboratively with a lot of consulting services. In academics, one has a type of clinical/research/teaching balance that I think keeps away some of the burn-out and repetitiveness of clinical medicine. So, I think that academics might suit you. This isn't really what will decide for you whether to go to medical school though. You have to decide if you want to take care of patients as a major aspect of your life. It's a long road to becoming an attending. If you don't like the patient care, you'll hate the road and it won't be worth it. Not that the training doesn't have its downsides, but, it goes a lot better if patient care is something you like doing. Don't focus on the issue of lack of intellectual stimulation, as this can, in my experience, be easily avoided. Rather focus on whether you like patient interactions, want to teach trainees, and wish to do some scientific form of investigation.

2. It may not be easy to get a good sense of an academic life as a premed. First, what you'll see isn't what the day consists of for many academics. That is, you may shadow during a clinical day, but that doesn't reflect the 70-80% non-clinical time. I divide my 70-80% non-clinical time up with a wide range of activities. But although premeds may work in my lab, I may teach them, etc, I've never found a way to really get them the sense of what I do - how can I get a premed to experience the data analysis, manuscript reviewing, etc that compose a large part of my time? So, I think this is tough to "shadow". It's also true that even medical students often have a very distorted view of academics as they see busy researchers working clinically and don't have much of a sense of how they spend the rest of their time.

3. The geographic freedom of both adult and pediatric specialties, as well as neurology is substantial. There is no guarantee of getting just the job you want in the city you want, but the options are great. Really, there's no way to evaluate this much further a full 10-12 years out from when you'll be starting in these areas as an attending.

4. Both basic science and clinical researchers will be writing grants as well as looking at data and reporting their findings. Clinical researchers will spend time dealing with human use boards, managing study recruitment, dealing with subject issues (for example, the basic scientist doesn't have to deal with his cells fainting when their blood is drawn, but then the clinical researcher doesn't have to deal with his cell culture line becoming infected). The clinical researcher will spend a good bit of time reviewing the literature in their area and making presentations of data results. Both areas of reseach are common and both have tremendous value. Respect is what you earn based on the ideas you generate and the way your present them. It is unrelated to the type of research you do.

5. I thought that article was a bit sensationalistic. Most academics I know are either happy or have moved rapidly into private practice. Since many if not most will be able to make more money in private practice, if one is unhappy in academics as a physician, then, move on. Most unhappiness comes from the need to battle for grant money. This is true of almost all scientists as we are all working to find financial support for our research ideas. This is tiresome and at times depressing, but it is a necessary aspect of the job.

Hope these thoughts help.
 
First of all, like many terms that we all know what they mean, "academic medicine" is an indefinable entity. In its most usual use, "academic medicine faculty" refers to those holding an advanced (usually but not always a doctoral level) degree whose primarily employment is by a medical school. There are gaps and exceptions in this or any definition. Rather than focus on these, lets consider the three classic "academic" areas and the three classic academic ranks and what they mean.

The three classic areas or aspects of academic faculty work are clinical patient care, education of trainees, and research. There is no fixed distribution of time among any of these three and a fourth related area, administration, can also be considered part of academics. In some, but not all institutions, a distinction may be made such that those who do not do a substantial amount of externally funded research are referred to as "clinical faculty" and have the word "clinical" added to their faculty title as in "clinical professor of medicine". The criteria for this are variable and it is common to move among these designations. The implication of these designations for tenure is also highly variable. Thus, common statements such as "primary clinicians don't get tenure" is totally untrue at many medical schools but may be taken as dogma at others.

The three classic academic ranks of assistant, associate and "full" professor are extremely varied in their use and interpretation. At some institutions, a certain rank (usually but not always associate professor) comes with tenure. At other institutions, these are separate determinations. A more important question is what are the benefits that accrue with advancement between these ranks with or without tenure.

As regards tenure, for physician faculty, this term often holds less importance than for non-physician or at least non-practicing physicians. This is because the "guarantee" of a job, implicit in tenure, is of less meaning to those who are bringing in their salary largely or entirely via patient-care dollars. It should be noted that in many institutions, even "tenure" doesn't really mean a salary. It may mean they can't fire you, but it doesn't always mean that they have to pay you a full time salary if you lose your external funding. At some institutions, certain benefits may only be available to those who have tenure. These can be financial or related to time, such as being permitted to take more time to study and work outside the institution.

Similarly, there are no fixed criteria for moving up the academic scale or in what this movement means. In general, to move to associate professor from an assistant professor requires documentation of successful academic work. If a researcher, this usually means establishment of independence from your original mentor, receiving substantial external funding in your name and publications of a number of papers, including some that do not include anyone "higher" ranking that you. Criteria for non-researchers on "clinician-educator" tracks are even more vague, but generally include having external documentation of your proficiency in education and patient care. Often some type of publication, including education-related, are needed for clinician-educators. In all cases, letters of recommendation would be expected from those familiar with your work, usually people not at your institution. Sometimes these are from colleagues, other times from people who don't know you who are asked to independently evaluate your CV and published work. Achieving associate professor, with or without tenure usually comes with more salary and often with more administrative responsibilities (committees….). It almost always leads to getting new business cards.

To move from associate to full professor usually implies being a well-known person, nationally or internationally, in your field. Again, it is highly variable how this is interpreted, but some institutions will look for things like being asked to give talks or being asked to be a "scholar-in-residence" at other institutions. Almost always, external reviewers will be asked to look at your accomplishments and compare them to a set standard for the designation of "full" professor. Although the tangible benefits of moving to becoming a "full" professor are often limited, it can be a very difficult leap. Some full-time academics spend decades at the associate level as they never seek to have or achieve the level of national and international reputation needed by some institutions for the full professor designation. Other institutions give the full professor designation more readily to those who become section or department heads. It almost always leads to a lot more committee assignments, more meetings, a bit more salary and nice new business cards.
 
healthnut said:
I'm not in my school's MD-PhD program...but just thinking of my options in doing research. I'm in incoming M1.

I'm not sure if my school has faculty conducting research in areas I am interested in. There are other medical schools/research universities in the general vicinity. Do you think it's possible to develop some sort of partnership with those outside of your home institution to do research with?

Also, do you think it's a good idea to set up lab rotations during the M1 year? Is there enough time for this?
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1) I would look for someone at your own school first. It will be a lot more convenient and easier to approach faculty at your home institution. Talk to your student dean and some of the upperclassmen for advice about faculty to approach in your area of interest.

2) I would advise you NOT to do research during your first block or semester of medical school. The reason is that you do not want your school work to suffer due to research. My personal opinion is that if you have never done research before, it is best to wait until the summer after your first year of med school to start. You can probably even get paid to do research at that point. But if you are dead-set on doing research sooner, then at least wait until after you finish your first set of exams so that you have an idea about how much time you'll realistically have to devote to research while you're in classes.
 
healthnut said:
What specialties do the majority of MD/PhD's research and practice in?

Do you know if those interested in a surgical field tend to forego the MD/PhD route due to the length of residency training required for surgery?
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Most of the M.D./Ph.D.s I've met are either pathologists or else in some kind of internal medicine subspecialty. But there isn't any reason why you couldn't be an M.D./Ph.D. in surgery if that's what you really love. So far I've met one surgery M.D./Ph.D. at my school, and he's doing some really neat surgery-related research. There is also an M.D./Ph.D. surgeon who posts on SDN, njbmd. She has a blog that you might be interested in reading: http://medicinefromthetrenches.blogspot.com/
 
FutureERDoc2013 said:
I graduated from undergrad in 2003 and majority of my professors have left. I just recently decided to pursue a medical degree after years of reservations. I would like to have a mentor that will be able to help guide me in my career path but I have no access to a pre-med advisor. What do you suggest?
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Thanks for a question and the chance to come back to one of my favorite threads! If you are still in the early phases of being a premed, then you are in need of guidance in the admissions process. If you are planning on taking classes only at schools without a pre-professional committee or advisor, then you'll need to find someone with that type of information beyond the usual advising routes. If you are in a city with a medical school, then I would contact the admissions office there and ask to make an appointment to meet with someone. Bring a box of chocolates for the secretary (well, just kidding, but the idea is to be nice!) and tell them your plight. They may be more helpful that you'd expect in connecting you with someone that can help you.

I think that at this point, you would also do well with trying to make some on-line contacts. Although an in-person mentor is always the best, try spending some time on SDN and make some PM contacts. Folks who have those ugly little suitcases or the weird handshake below their names are those "known" to SDN and can likely help either guide you or point you to trustworthy advisors.

If all else fails, you can try contacting physicians practicing in your area in a field that you have some interest in. Most will be very nice but many just won't know much about how admissions currently works. You may need to look for some with that type of experience.

Good luck!
 
grendelsdragon said:
Hi Tildy,I am a great fan of face-to-face advice, but I'm very interested in getting an outside opinion. So here goes!I've finished a highly competitive clinical fellowship at a well known US program, and I'm hoping to eventually deveolp a career in academic medicine with a significant effort in the basic sciences. I have recently published a very high profile paper. I haven't been actively looking for a job yet, but my paper has attracted the solicitation of a major insitution for a tenure-track position with full support for 3 years (~ $1 mil package).Unfortunately, I don't get the same love from my own department/insitution, where there are no discretionary monies for recruiting junior investigators. In my own institution, faculty promotion usually comes along with winning a K08 or similar grant, and junior faculty usually work in a mentored capacity for a VERY LONG time until they can pay for their own science/lab with an R01.Despite my current success, I have to admit that I have not made much headway (if at all) into my own independent line of investigation. I fear that once I start a true faculty position, the clock starts ticking, and I will have to develop an autonomous line of research AND get an R01 very quickly in this awful belt-tightening fiscal climate. The flip side is to continue doing science as a fellow (Oh will this purgatory never end!) and develop autonomy in protected time under a mentored grant. Certainly, a K award is portable money, and I could probably move toward independence in ~2 years. I fear that I may not be as desirable in 2 years (without a popular publication fresh in memory) as I am now, and what if such a package as I have been offered recently is not available then?So the basic choice is to bail my institution now and accept a very nice faculty package at a premier university with the risk of crash & burn due to too early an independence. OR stay a fellow (possibly Instructor, whoop-do-doo) for ~2 years longer to develop a self-sufficient line of investigation before springing to autonomy, with possibility of not having such nice offers at the end.Thanks for listening Tildy, and looking forward to your advice!-G
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Hi: Since many or most on SDN are not quite at your level and have not faced this issue, I hope you won't mind me explaining your question a bit for them and a few terms involved. Then I'll try to give you some ideas about what you might consider in making your decision.

Basically, you are finishing your clinical training and have done well at doing research during it. You don't mention a PhD, so I would guess you do not have one, but, it doesn't matter that much to your question. You have been working in basic sciences and done well enough to publish and get a good job offer at a different institution.

In starting research academic careers, the standard path is to try to obtain what is called a "mentored" research award, often a "K" award (there are other similar programs as you allude to), in your case, as a physician, a K08. To obtain a K08, one has to be working with someone in the field who will help guide you towards independence in your research. A K08 is generally 5 years and pretty much only funds the investigators salary, and provides little support for the actual work. It is relatively easier to obtain that an independent research grant (R award, usually R01), but still not easy. Medical schools 😍love 😍 K08s (sorry couldn't resist), because the burden of salary is taken off of them for new faculty. The investigator is guaranteed a job and usually 80% protected research time. The drawbacks to a K08 are that you have to HAVE a good mentor, who can and will guide you. Furthermore, if you are doing a time-consuming clinical field, cheating on that protected time is common. I have known lots of folks who never went onward after the "great start" of a K08.

The alternative, being offered you, is to ditch the K08 (application? not clear where you're at with it) and go right to a faculty position taking the lab start-up package that's been offered. This is a different in that you are being given less time (3 yrs) to be successful, you are going it mostly without the mentoring and you have to both start up and build a lab in those three years.

In the past, the choice would almost always have been to take the startup money and ditch your previous institution. However, with R01 funding being given to about 8-10% of applicants, and with the reality that if you don't produce in those 3 years you will be out the door, it is a much harder route than it was 10 or even 5 years ago.

So, in your case, you need to really think about your work and whether you are prepared to 1) move physically, 2) set up a lab, 3) produce novel results, 4) write an R01 application that usually needs to be revised at least once, and, 5) be happy and not kill yourself from overwork.

My guess is that for most folks, the best solution at this point is to stay put (the million won't go that far...), get established and develop an increasingly novel area of research that can get a K08 and head to R01 territory. Then leave. This is especialy true if you have a good mentor at your current institution.

Probably not what you want to hear, but the likely best choice in the current grant era. The instructor label will probably get turned into asst. prof if you have any success pretty quickly and you will have a lot more cushion, especially if you have a mentor at your current institution that you respect and can help you.
 
moomix906 said:
hi Tildy, this is a terrific thread - I was wondering if you knew of or could elaborate on opportunities to integrate human rights advocacy and humanitarian work in crisis regions into an academic career. I'm interested in becoming an infectious disease specialist working at a university teaching hospital, but I'm also strongly interested in becoming majorly involved in a situation such as Sudan/Uganda/Tibet - is there any room for that in between teaching/research/clinical care? Thanks a ton for your advice!
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Hi:

I have addressed much of this in an SDN front page article a while back.

http://studentdoctor.net/blog/2007/...icine-is-it-possible-in-the-academic-setting/

In addition to the points in this article, I would offer a few other thoughts:

First, if you do not already have it, consider obtaining an MPH somewhere during your training (it appears from your other posts you may be doing this already). This will be very helpful as you move into this type of work. There are several programs well known for international projects, but the training in epidemiology and general public health will be helpful from any institution.

Second, do not be too concerned early on about what field of medicine you want to practice. There is room in international health for virtually all types of practioners to make a contribution, including some that might not be so obvious. Identify the area of medicine of interest to you. Although many with a strong pull towards relief work will end up in emergency medicine, family medicine or (adult or pediatric) infectious diseases, this is by no means a complete list of the areas in which people train who work in public health internationally.

During your medical training, try to obtain a breadth of international experiences if possible, even if some are short. This will help you sort out your clinical interests.

In general, it is easier to be involved in "routine" projects overseas such as operating a clinic that you visit for a few weeks twice a year (as an example) than trying to participate in "crisis" intervention. Although many physicians did pack up quickly to help after the tsunami, it was a challenge to arrange and is not something that one can plan on as the basis for a career internationally.

Good luck!
 
panacea333 said:
hi tildy

i wrote my queries to you 5 days ago , today i cant find my post here on the forum
i desperately need your advise to make right decision in right time , can i write in again

regards......
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Panacea - your previous question was cross-posted into the physican scientist forum where it was better suited. In addition, SDN does not permit multiple postings, including into the mentor section. In this case, I have no particular knowledge of the medical genetics field and I think you will get the best answers in those forums. A physician who specializes in genetics is often someone who has completed residency in pediatrics or sometimes internal medicine and then done a fellowship in medical genetics. They may or may not have a PhD.

Finally, I encourage you to post using entire words and sentences following basic grammar and punctuation rules. I could not respond to your post and others may have trouble because of the difficulty in understanding your questions. Regardless, I'm afraid I cannot help you further but hopefully others in the physician scientist forum can do so.
 
A common question is whether the research academic faculty spends enough time practicing medicine to maintain their clinical skills. Put another way, is a patient who sees a physician that spends the majority of their time doing research missing out on getting care by the best possible clinician?

First of all, as a scientist, I wish to note that I am not aware of any data on this topic, and I wouldn't believe it practical to obtain data. There are just too many covariates to do a meaningful study.🙂 Second, I fully recognize that there are huge individual variations in how much time one needs to spend practicing at any given specialty to maintain ones skill.

Still, the question is important and as an academic who sees patients and provides medical care, I am obligated to evaluate whether I think I am maintaining my skills. Furthermore, this evaluation has relevance to a wide-range of issues in terms of part-time practice situations.

Since we are acknowledging that this is a personal, non-evidence based perspective, I will describe my time fraction spent clinically. Since completing my training about 2 decades ago, I have spent approximately 75-80% of my time doing research and about 20-25% of my time doing patient care. My research does not provide me with any particular patient experiences that are relevant to maintaining my medical care skills. I am not involved in surgery, but I do perform "procedures" in the clinical field. I continue to do medical procedures, both those I do and as the direct supervisor of trainees doing them. I work regularly both with academic physicians who have a schedule like mine and clinical faculty who spend a much greater percentage of their time on direct patient care. I also am very familiar with the practices and skill-set of non-academic physicians in my specialty.

In looking at the effects of a very part-time clinical practice, I would look at two main areas of competence. The first is that of actual procedure skills. Remembering that I am not in a surgical field, I still need to evaluate whether I can perform technical procedures as well as those who do them more often. Also, how is my guiding of trainees learning these procedures affected by my part-time practice?

The second area is that of clinical knowledge. That is, am I able to keep up on the latest treatments, diagnostic approaches and the like while focusing the majority of my time thinking about different research issues. How can I keep up on these when most of my time is not spent seeing new patients?

Well, with regard to the first, honestly, I don't see that as an issue at all. Again, I don't know how much time a surgeon must spend operating to keep their skills up, but in my area, involving some fairly precise skills, part-time is plenty. You just don't forget the things you learned in training and I've seen folks who hadn't done some procedures for a year or more go right at them with no problems. In general in academic medicine we are going to do fewer procedures ourselves as attendings because we are surrounded by trainees. Maintaining skills requires conscious effort, but, in my field this is not an issue at 25% clinical time (or thereabouts).

The second issue is much more difficult and requires more attention. Medicine is rapidly evolving and the fewer patients you see, the less aware you'll be of the latest care changes. The solution here is that one has to make a substantial effort to go to teaching conferences and even more so, to "case" conferences, morbidity/mortality conferences, morning reports, etc. Interact with trainees as they discuss new and difficult cases and what is being done. During ones clinical time, pay real attention to what the more clinically oriented folks are doing and whether it is a "fad" or really evidence based. Recognize that this is an issue and that just being a "professor" does not mean you are up-to-date on everything in your field.

Of course, reading the medical literature for the latest insights is important, but in many ways, part-timers and academics have as much or more time than primary clinicians for this. Many of us are also experienced at evaluating the statistics in scientific research and evaluating the quality of published research. What we have to make a greater effort to do is to pay attention to the actual clinical practices as they are updated and developed and to be a part of the committees and groups reviewing clinical practices in our area. This pulls from the research time, but is a must.

On the whole, I am comfortable with the idea that 20-25% clinical time in my specialty, and I believe, in most or all non-surgical specialties is adequate. Actually, I'm not convinced much more % time is needed for surgical specialties, but I would defer to a surgeon on that point. The effort must be made to make the clinical time worthwhile - see the sickest patients, follow what the trainees are being taught, and continue to attend as many conferences as possible.

In the future, whether for personal or academic reasons, part-time academic practice (and private practice) will become increasingly common. Debating the appropriateness of it is less important than teaching trainees the skills needed to make the most of part-time practice and ensuring that they maintain a full skill set.
 
gmoneytalks said:
Dr. Tildy,

I'm a mechanical engineering PhD student transitioning to medicine. The primary reason for my transition is the typical want to help people. However, I could see myself later on in academic medicine conducting research as well as providing patient care.

I understand that animal experimentation studies are needed in the field of medicine and that I will use drugs and techniques that require experimentation on animals. However, direct experimentation by me on animal subjects is not something that I will do.

I guess my question to you is is there any research out there that won't upset my ethics? Thanks so much. 😀

-G
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In general, there is research done on humans - either experimental or epidemiological, research done on animals as models and research done entirely on cells or other non-animal types of tissue. These classic type of categories have a large amount of overlap, especially in an era in which "knock-out" mice have become a key component of genetic research.

Mechanical engineering related work, as I'm sure you realize is often "device" related. In general these devices are tested in animals and then move to humans. Finding a niche in this area is difficult I think without having been part of the animal side of the work. I am interested if others have more knowledge than I do about this.

There are more alternatives within human research however. This includes metabolism research, usually done in humans, pharmacology related research, etc.

In general, I would say that it is a challenge to avoid any animal experimentation in a medical research career. It is not impossible however, and I personally would recommend that you look towards clinical research as the route of choice. I'm open to posting the comments of others though.
 
Tildy said:
In general, there is research done on humans - either experimental or epidemiological, research done on animals as models and research done entirely on cells or other non-animal types of tissue. These classic type of categories have a large amount of overlap, especially in an era in which "knock-out" mice have become a key component of genetic research.

Mechanical engineering related work, as I'm sure you realize is often "device" related. In general these devices are tested in animals and then move to humans. Finding a niche in this area is difficult I think without having been part of the animal side of the work. I am interested if others have more knowledge than I do about this.

There are more alternatives within human research however. This includes metabolism research, usually done in humans, pharmacology related research, etc.

In general, I would say that it is a challenge to avoid any animal experimentation in a medical research career. It is not impossible however, and I personally would recommend that you look towards clinical research as the route of choice. I'm open to posting the comments of others though.
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Consider cognitive neuroscience. You can do some pretty fascinating and cutting-edge research on human subjects using functional brain imaging without ever touching an animal. An engineering background would be very useful background for brain imaging research, which involves a lot of computerized image analysis and statistics (though, admittedly, few moving parts). The best part is you get to study the mind-brain, which is really exciting. This sort of research is highly relevant to psychiatry and neurology.
 
Tildy said:
In general, there is research done on humans - either experimental or epidemiological, research done on animals as models and research done entirely on cells or other non-animal types of tissue. These classic type of categories have a large amount of overlap, especially in an era in which "knock-out" mice have become a key component of genetic research.

Mechanical engineering related work, as I'm sure you realize is often "device" related. In general these devices are tested in animals and then move to humans. Finding a niche in this area is difficult I think without having been part of the animal side of the work. I am interested if others have more knowledge than I do about this.

There are more alternatives within human research however. This includes metabolism research, usually done in humans, pharmacology related research, etc.

In general, I would say that it is a challenge to avoid any animal experimentation in a medical research career. It is not impossible however, and I personally would recommend that you look towards clinical research as the route of choice. I'm open to posting the comments of others though.
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Tildy asked me to comment on this question, but I don't think my experience will be terribly useful to you, gmoneytalks. For what it's worth, there are lots of organic chemists working in industry doing drug discovery, and that was my plan B if I didn't get accepted to med school. Industry scientists work on teams whose members specialize in specific areas. I'd never have even seen a single cell, let alone a whole animal, as a project chemist. But you don't need an MD to go into pharmaceutical chemistry; an MS or PhD would be the norm. With your background, if you don't like strangeglove's neuroscience idea, I think you might want to consider doing something like orthopedic surgery or interventional cardiology where they use a lot of devices. You might also consider looking into whether there are jobs for engineers at pharmaceutical companies. I have no idea about this, but I wouldn't be surprised if there were. :luck: to you. 🙂
 
MelRoos said:
I was wondering about tips for applying to residency with an acadmic career in mind. I have finished my MD/PhD with my PhD in clinical research- the true bench to bedside with multiple clinical trials, including a doulble blind-placebo controlled etc and have 15 papers on pub med and 5 more in press so far. I know I want to do peds with an endo fellowship and then find an academic position and continue with clinical research. The AAP has multiple tracks for combined research/residency/fellowship, to cut the total time from 6 to 5 years, and I would like to do this. Any tips on how to approach this in residency interviews without trying to seem lazy? Are there also any traps to avoid? All the programs I have applied to have pedi endo fellowships, a large proportion of residency pursuing fellowships, and strong pedi research programs....
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Folks interested in what you are can be a real gem to almost any pediatric residency program. You should be very upfront and tell them your plan and emphasize your interest in transitional research.

Although in general, picking a more academic residency is less crucial for pediatrics or med/peds than some other fields, in your case, I think you will be best served by going to one of the larger academic children's hospitals. They will think you are a saint, not lazy.

Good luck and I recommend f/u to the pediatric forum of SDN.
 
tdjn said:
So I will probably end up applying at the end of this year (08), and I was wondering if I have to do research in straight up Bio in order to apply MD/PhD. I've been looking at profiles on here, and all of you seem to be doing something in Genetics, immunology, molecular biology, etc...

The reason why I am asking is because I've been working at a lab for 7 months... and I should have about a summer and a year's worth of research by the time I apply (2 summers and 2 years by the time I graduate), but it's not biology related at all. The research I deal with is pure Organic/Inorganic Chemistry, and I am currently working on gold/silver ligands that acts as catalysts. I am sure there are some biological implications that could be learned from this kind of chemistry.. but as of now, it just sounds really farfected.

I have a relatively competitive GPA of 3.8 at a top-ten university, and I should do alright on the MCATS, which I am taking in April... along with decent EC's... but it's the research that's bothering me: One, because it's not relevant to biology whatsoever; Two, because I will have had only one year of experience by the time I apply.

I work at this lab for at least 20-25 hours a week, and I should get 1-3 publications in by the time I apply... and maybe a fellowship, if I am fortunate enough... but I still have my worries.

My lab also has a Bio section, where they do deal with genetics, protein trapping, etc... which would be so cool to do, but I feel really committed to this Chemistry research as of now (which I also enjoy). I feel like the best thing to do right now is to stick with the chemistry research, get some publications in, and the fellowship for chemistry... build my credentials in research with that and apply to MD/PhD programs. Afterwards, while I have some free time during my fourth year, gradually get involved in bio research in preparation for med/grad school

Well, that pretty sums up my situation. I am really torn apart right now in terms of what to do in order to apply to MD/PhD programs...I feel like I would be at a somehwat of a disadvantage (if not significant) for not having the necessary research experience... and I would have a terrible time during interviews.. bec. they wouldn't really care about the chemical research that I was doing. And if they did, I would have a hard time showing that I actually wanted to MD/PhD research because of the lack of the bio research experience.

Anyway, I would love to hear your thoughts on my situation.

P.S. I love reading your responses.. keep up the good work🙂
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Hi - I'd encourage you to post this on the Physican Scientist forum as you're likely to get feedback there from people who have done what you've done and then applied. I can't recall interviewing anyone for the MD side of the MD/PhD program who didn't have any biological research experience, but I'm not sure you're chemistry work wouldn't be considered close enough. I think you're likely to be asked about your future plans as much as your past experiences - be prepared to discuss how you'd like to use your research skills and move forward in a biology/biochem research pathway.

Good luck and I do recommend getting the Physician Scientist forum folks to weigh in there.
 
Monarch Kong said:
Hi Tildy,

I am currently applying to medical schools and had some questions about the nature of research in academic medicine. I have done a lot of research in my undergrad years, including 2 summer research internships and over a year of research at my home institution. I decided to apply MD instead of MD/PhD because I wanted my future career to be mostly clinical with research components. One of the things that worried/stressed me about research was the whole grant/getting funded deal. My question is if I wish to devote most of my time to clinical and I have no aspirations of running my own lab, what approaches would I have to integrating research as a part of my career? Also along those lines, if I do not wish to run my own lab, is there any way to reduce my dependence on grants for research? Thank you for your help!
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All research requires funding but there are a number of ways to avoid having to spend your life trying to obtain funding. First, you can do research in which someone else has obtained the support. There are lots of clinical research projects in which physicians assist in many, most or nearly all aspects of conducting the study on behalf of someone else who obtained the funding.

Pharmaceutical research is another area in which if you can demonstrate your ability to conduct clinical research you can participate without writing grants per se.

However, it is fairly difficult to test your own novel ideas without writing grants to obtain support for that research. Ultimately, if you wish to emphasize research in your career, you may find that obtaining funds by writing grants isn't that bad after all.

None of this requires having or directing your own laboratory. Some investigators have their own lab, others make use of the lab resources of others. Some work "in-between" - they may not direct their own lab, but may be comfortable with and work within a lab- actually processing samples, in a lab environment. Again, it's up to you.
 
dantay said:
Hi,

I'm in the process of applying to IM residencies. I'll be finishing up this year from an MSTP, and I plan to stay in academics (doing clinical research). I'm applying to several "PSTP" / ABIM fast track programs, although I'm unsure whether these would be better than a categorical residency for my particular situation. That being said, I only applied to 10 programs, because I'm interested in staying at my home program unless an excellent opportunity arises. However, do you think there is any benefit in applying to programs as "networking" opportunities? Meaning, there are a few places that I know that I do not what to do my residency at, but would probably love to do a fellowship or eventually find a faculty position at. Do people ever form lasting impressions or even collaborative relationships with individuals they meet on the interview trail?
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I think 10 programs is a pretty good sampling myself.

Yes, it is definitely possible to form lasting impressions and relationships on the interview trail, even if you don't go there. I think this is more common at "Advanced" levels - fellowship and faculty, than for residency, but it is possible and might be more likely for MSTP.

I wouldn't go off interviewing anywhere just for that purpose as that is a bit costly and time consuming. However, do make the effort to indicate to researchers in your area at different institutions how interested you are in their work and how even if you don't match there, you hope to have further contact with them down the road.

Networking is a critical skill in academics as with any other area. It isn't "game playing" but is an important part of developing relationships to learn about research at other institutions during an interview. I don't mind interviewees at all levels asking me about my work, as long as I think they are genuinely interested.
 
chemphd said:
Hi Tildy!

Thanks for taking all of our questions- what I've read so far has been really helpful! Now, for my question:

I'm currently finishing up my PhD in chemistry (doing biology) and applying to medical school. The reason I'm making the transition is the result of a confluence of many factors. My research became very biological and I found myself more interested in medically-related problems, I started volunteering at a nursing home, and I realized that working with a variety of people was really important to me. At first I thought I wanted to leave science altogether and focus exclusively on patient care, but I have come to the conclusion that I would really miss research if I stopped entirely.

Things brings us to my dream world. I think it would be amazing to be able to do 50/50 (or some ratio close to that) research (clinical, basic science, translational- I'm all over the place in terms of what I would like to do later. It's all so interesting!) and clinical work. I like teaching as well. I see a lot of people talking about 80/20 in their research/ clinical work balance in either direction, but I think having a more even distribution between the two would be great. Is a blend like this common (or even possible)?
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Well, anything is possible...but not very easy.🙂

There are 2 basic problems with 50:50 time splits. First, is that early in an academic career, training grants almost all require 80% research time to be committed.

The second is that 80:20 or 70:30 really isn't 32 hours research and 8 clinical. That's the way it is for the purposes of grants and the NIH. However, in starting one's career, it's more like 50 hours research and 20 hours clinical (obviously the exact amounts are highly variable).

The reason is that when dividing up your time, the 80:20 split will give you 20% scheduled time on the wards or in clinics. The reality is that this rarely considers conferences, family meetings that run late, etc, etc. Not to mention emergency coverage for your colleagues, etc. Very few junior faculty will only do true 20% time. Oh, they may only spend 20% of their time in the hospital, but that's because they're operating off a 60+ hour work-week or doing some work at home.

The bottom line is that those interested in research academics will need to expect to be spending about 40 hours/week doing research almost the whole year early in their career. You can do a variable amount of time at patient care, but you won't make a laboratory-based research career happen on 20 hours/week, whether that is considered 20 or 50% of your time.

Now, as careers advance a bit, the equation becomes even more murky. What does 80:20 or 50:50 mean in terms of the increasing administrative load? Where does teaching come in?

When we look at the triple threat, as I've said before, no one can do them all equally at the same time throughout their career. In starting ones career, you need to pick two and imbalance them. Usually this means relatively little teaching (and administration) for the first few years and mostly research. Later, more balance and adding the third (and 4th - administration) are more feasible.

Still, if you run a laboratory, as I still do, you'll almost never get away with an average of only 20 hours/week doing research.

Hope this helps. You can have the triple threat career, but it may not be balanced throughout.
 
dantay said:
Thanks - the advice you offered chemphd is similar to what I've heard from other sources, and I've made my peace with the "80/20" split because I really enjoy my research. However, do you think that those doing clinical research are more likely to achieve a more equal balance? My assumption is that maintaining a successful clinical research program would also require about "80%" time (which, as you point out, is not really 80%). Most of the local leaders in clinical research at my school are at least 80% (if not 95%) research, but I was wondering what your take on this was.

Thanks again.
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Clinical researchers, once established, will likely have a bit less than 80% research time if they are not directing or working in a laboratory. Labs are huge time sinks, and managing one even a bigger time sink. However, clinical researchers are still writing grants, analyzing data, preparing reports, traveling to meetings, etc. Nowadays, many may do some of this from home. Overall, there is a huge range in time spent as "clinical research" is so variable in definition.

However, those who are principal investigators on major clinical trials will spend a good portion of their time doing some research-related task. Usually more than 50%. These people often have some administrative or committee responsibilities as well. So, there are a wide range of ways to divide up the time. Ultimately, most will do as much clinical time as they can - both because the patients need to be seen and it is a source of revenue for the academic department.
 
Hard24Get said:
Hi Tildy,

I think chemphd raised a question a lot of us are interested in. I really appreciate your response to him/her and dantay. Another aspect of this subject I have wondered about is co-investigators. A few PIs at my medical school run labs together. How does this work in terms of grant funding and is that potentially a mechanism of balancing clinical and research time? It also seems like the NIH roadmap is looking to make it easier to have co-investigators. http://nihroadmap.nih.gov/initiatives.asp

Thank you for your time
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Yes, it definitely appears that co-PI's are going to be allowed and I think that is for the good. In my experience the way in which this is most helpful is when a study involves two separate lab groups. Although I know some labs are "co-directed", in most cases, it's a senior person who runs the lab and a junior person who really "runs" the lab. A co-PI isn't optimal here for grant purposes as the reviewing panel will readily recognize the senior/junior situation. Rather, a co-PI is best when a study has two critical components across two labs.

This type of collaborative research is recognized more due to the increasing importance placed on "transitional research" and the overall bench-bedside concept. Clearly, this is a situation where two research groups, that might be very different must work relatively equally in a project.

Now, in terms of your question, yes, it certainly is possible to be a faculty who is part of a lab but isn't running the lab and thus has more clinical time for patient care. This can happen when you are junior and working in an established lab just doing your own samples for your studies but not running the lab. Or, it can happen when you are senior and "direct" the lab, but have a more junior person handling the day to day issues or have a lab tech that is so experienced and trustworthy that it doesn't take much of your time.

Of course, none of this really affects the time taken to write grants, etc. Although having a co-PI, co-investigator, etc can help with this, grant writing is a long process regardless.

So, to summarize, I think the co-PI and new initiatives are great and probably will submit some grants over time that way. But, I'm not sure the effect will to decrease an individual's research time load. Rather, it is to help build collaborations across research groups.
 
Gabujabu said:
Dear Tildy,

I am currently a first year MD student at a school that is quite focused on research. When I was originally applying, I was strongly debating between MD and MD-PhD programs, but I eventually decided to settle on MD for a number of reasons. 1) I wasn't sure what field I was interested in and didn't want to commit to 3-6 years of PhD upfront before I knew that, 2) Knew that I wasn't going to graduate with very much debt so the full tuition wasn't a factor, 3) was intimidated by the idea that I would finish training in my late 30s and hence would have little professional autonomy until then, 4) Had heard of physicians without phds who did their research during/after their fellowship. If I were to go through the fellowship route, what exactly would be the pathway? I'm assuming it would start with MD-residency-fellowship, but what would need to happen after that? Are there postdoctoral fellowships or clinical research training programs specifically for physicians? Also, as a current medical student, would you recommend programs like Howard Hughes, the NIH CRTP, Doris Duke, etc? Thanks!
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Hi - the landscape for training of MDs in research depends a lot upon your field and what background you come into the process with. In general, there are several different NIH-sponsored programs by which MDs can become junior faculty while conducting mentored research. You might look up K08, CSTP and others. The time commitment and details of these vary and vary by institution at times as well. The general idea is that one begins doing "serious" research during fellowship (this is for medicine and pediatrics, in surgery the research is often during residency or in "extra years" during the surgical training) and then moves on with a mentor to do research. The goal of these transitional programs is to have a junior researcher prepared to successfully compete for an individual NIH grant (usually but not always an R01) by the end of the mentored period.

In terms of various programs for medical students to spend time at their institution or another, this is highly variable on the individual. If a person has virtually no research experience and wants a real opportunity to try it out, especially in the basic sciences, these can be great programs. In general, it is not necessary however. I recommend looking into these and talking with local faculty about your specific background and what is offered by any given program. The NIH intramural program is a great experience and can be a launching pad to an academic career, but it isn't the easiest way to spend the time and isn't necessary.
 
spacey said:
Hi, Tildy,

Thank you for the thread. I've been gaining lots of good information from it.

My background is in engineering/ applied mathematics. Currently, I am doing epidemiological studies at a university, while doing a part-time MS in epidemiology. I'd like to perform clinical research, and possibly being a clinician as an academic doctor; however, I am struggling as to whether I should do a MD-PhD, a MD, or just a PhD.

I know you had advised another student that if he/she doesn't want to be a clinician, just do a PhD, and I would like to gain more of your insights regarding the matter.

I have noticed that in epidemiology, while both MDs and PhDs perform epidemiological studies, they (at least those in my department) do different types of epidemiological studies. The PhDs tend to work on projects that are more mathematical oriented/ theoretical based, whereas, the MDs work on projects that are more clinical based. Is it coincidence due to their personal interests, or is it due to limitation of their professional qualifications? ‘cause I thought PhDs have to partner with MDs to perform clinical trials because PhDs don't have the appropriate qualifications to deal with patients. Is it true?

If someone like me, who has a background in applied mathematics but am interested in performing clinical trials, and working in the area of infectious disease control, would it be necessary to obtain a MD?

Regarding being a clinician or not, I am volunteering at hospitals, so I am getting an idea of how I would like to be a clinician, say in infectious diseases, eventually as well.

Thank you very much for help.
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There are no simple answers to this. First, it is important to decide if you wish to provide patient care. If you go the MD route and then infectious diseases/tropical medicine, you will be committing the better part of about 8 to 10 years to patient care or medical training that isn't all that directly related to doing epidemiology research. That is, 4 years of med school, 3 years of residency (medicine or pediatrics) and then variable clinical responsibilities during a fellowship. Then one is likely to continue to see patients throughout one's career.

In terms of the relationship between epidemiological research and the degree one has, I have seen all variations of this. I'm not sure there is that much relationship between the degree and the specific project that is done. However, certainly a PhD in epidemiology would lead you to more mathematical work. Still, as I have seen it, SPSS and the like are equalizers of a sort and with some reasonable training, plenty of MDs are doing large scale epi studies. PhDs will generally have MDs involved in many clinical trials, but of course, MDs will often have PhDs involved in their studies. It's about the background and knowledge more than the degree for the most part in designing and implementing epi studies.

Bottom line is that I think you should keep the shadowing and reading about medicine going. Decide if your interests are truly public health only or if you want a career also committed to individual patient care and evaluation.
 
FoxTrot12 said:
Hi there, and thanks for all the very helpful info! I'm not sure if this question has been brought up on this thread yet, so if it has no need to repeat yourself just point me in the right direction. 🙂

I was at a Q/A session with some Biomed PhDs,MDs, and students from several areas. The issue of MD/PhD was brought up and it seemed like both the MDs and the PhDs felt the combined degree was a lesser version of their own and kind of discouraged people from going that rout.

Any thoughts on this issue, or what it takes to successfully combine the research and clinical sides?
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I think the physician scientist forum is the best place to discuss this. I do not agree that the MD/PhD represents a lesser version of anything. Great institutions do not give out either degree to those undeserving of it. For a large scale debate, SDN offers forums for that!
 
alphaholic06 said:
Hi Tildy,

Thanks for taking the time to answer our questions. I'm currently enrolled in a MD program. I've recently become interested in during clinical research on obesity. I'm also at the point where the OP of this question was. Should try to join the MD/PhD program? I am also considering an MPH with a concentration in epidemiology. I really could use some advice. I'm currently unsure as to what speciality I should pursue. So I'm wondering, would my research goals force into a particular speciality (e.g. endocrinology) or would I still be able to pursue specialties, like surgery, EM, etc? Thanks again for the thread.
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The obesity epidemic is being investigated across a spectrum of disciplines. These include (ie are not limited to...):

-Genetics - Looking for polymorphisms associated with obesity
-Endo - investigation into leptin and a whole range of satiety markers, etc
-Endo - diabetes and complications
-GI - fatty liver and the like
-cardiology - lipid metabolism
-pediatrics - many of the above issues are specifically being investigated in children such as Type 2 DM in children and adolescents
- Exercise physiology
- Behavior sciences
- Food biochemistry
- Population-based epidemiology

and on and on.

I think the key is to find out what you'd like to do and then go from there. A first clinical decision is what specialty you're interested in. IM, pedi, psych are all involved with the various subdisciplines and I'm sure there are others. Surgery is involved related to research on the effects of surgical interventions which have substantial short and long-term morbidities.

So, at this point, I would consider an MPH if you are specifically focused on epi and clinical trials. But you could also wait until you see where your clinical interests take you and then see what further education is needed. I wouldn't rush to switch into an MD/PhD unless you had a strong lab focus and relatively strong interest in basic science.
 
alphaholic06 said:
Would you mind laying out the process for obtaining an academic position? What exactly do you have to do after graduation, during residency, etc?
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Hi - that's a fairly broad question, so let me try to narrow it to a few key thoughts. We'll assume you're talking about non-PhD's or those who don't have extensive research background here. First, during medical school, you don't need to do anything special based on a desire to do academics. Certainly many interested in academics will do some research or look for a more academic-oriented residency, but even that isn't absolutely necessary. Plenty of folks, including me, did residency at relatively non-academic places.

Similarly, during residency, there isn't much "special" that one does. Again, some will get involved in research, others will make an effort to get involved with teaching or become a chief resident. I did some chart-review type research as a resident and wasn't in the top 95% of likely choices to become a chief resident 🙂, so even then, it isn't necessary to focus on academics as a resident.

It is true that some will go directly from residency to an academic position in various specialties, but the common academic teaching and research path is to do a specialty fellowship. It is during fellowship that you'll be expected to seriously get involved in research and begin to develop more teaching skills. At that point, you'll decide if you wish to stay as an academic faculty or go into a non-academic position. This will certainly depend on things like location, salary, etc, but it will also have a lot to do with your feelings about research and teaching. If you've had good experiences with these and want to emphasize them in your career, then you'll be more likely to consider an academic path. At that point, if you decide on academics, you'll interview, etc, just like a non-academic job.
 
medstudentmed said:
Hi. I was wondering if you could talk about the opportunities available to physicians (specifically surgeons--but I imagine it is similar across disciplines) in regards to working primarily at a private practice as well as having faculty appointments at a university. Is this common? What does this typically entail?

I am very interested in teaching, but I am also interested in the business side of medicine, and would love the opportunity to own and run my own practice. To what extent can I have it all? Lastly--do Universities typically pay physicians who also own their own practices, or are you basically working for the title (ie. faculty appointment)?

Thanks!!
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Hi - I'll post this so that others can comment as it is outside of my realm of knowledge. In general, it is possible to do private practice and have a courtesy academic appointment, but not usually a full-time academic appointment. The lines can be blurred at times in private, medical-school affiliated hospitals where many of the teaching faculty are fundamentally private practioners, but are teaching medical students and residents on a daily basis. Others could comment about this much more than I can as I am full-time academic faculty and have never explored private practice opportunities.
 
sinephera said:
I agree that having a mentor close enough to meet in person is better, but...

I go to school in the NE, but want to move for residency away from the city I live in now, actually I want to leave the NE completely. But it is so hard to find any faculty that would even entertain the idea that I do not want to go to school here. At best they say they understand but really don't know anyone "out there." Same for their contacts, anyone at meetings, or even specialty organizations.
Any advice?
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This is not an uncommon problem actually. Many faculty, not just in big-name schools on the East coast simply can't understand why any student would want to leave there. They can get upset and not be interested in helping. The best thing to do is to be upfront from the start. Say "I am planning to go to X part of the country." Don't be defensive and don't qualify it with "I really enjoy it here, but I'm sick of snow/rain/fog and the local football team always winning/losing/quitting so I think I might want to....". Just tell them you're going. You don't owe anyone an explanation for that type of life decision.

Now, those who still wouldn't be interested in helping you aren't the sort of folks you'd like to have anyway for the most part. Ask the others things like "Who do you know in X state that might be worth me talking to." or even say "I know you have experience across the country, can you help me find someone in X area of the country to talk to."

If all else fails, you could cold-call/email some program directors in the areas you're interest in and see what happens. Don't be negative about your current school, just tell them you'd like to discuss their program, even though it isn't time (I assume) for matching.
 
dd128 said:
Hi, I want to say thanks for taking to the time to read over our posts!

My question is how to go about approaching someone that I may possibly want to shadow that would then possibly lead into a mentoring relationship? I've recently finished undergrad, but had to work full time through college and didn't have the time to take off for shadowing so I never really pursued it. Now that I have more free time I figured I would try to jump into some. The problem is I don't really know any physicians or how to go about finding any that would be willing for me to shadow them. Is it proper to just look up some doctors in X field in a hospital near me and just try contacting them out of the blue? Other than that I have no ideas 😕
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It is generally best to start with some contacts if you have them. If you are in the same area as you were for undergrad, then you can go back to the university and ask for some contacts. If that isn't practical, then consider who you know who knows someone. If neither of these work, then you are stuck with just contacting folks randomly.

If you must do this, then make sure you have a nice copy of your CV to send along. Pick a range of folks to send it to, include a nice but short cover letter and make sure it is clear how they can contact you. I really don't have a problem with using email for this, others might prefer letters. I wouldn't pester office staff over the phone initially unless you have some contact history with them.

Good luck.
 
Tildy,

I'm an IM intern, and I was wondering about the prospects of obtaining an academic position in internal medicine without pursuing a fellowship. I would love to find some kind of mix between seeing patients, teaching residents, and research (I did a masters before med school, published 2 papers, and enjoyed the work). A few questions:

1. Is it possible to remain a generalist and have a successful academic career in IM?

2. If I want to pursue clinical research at some point, I might envision publishing case reports, working on patient safety improvements, or maybe studying common medicine problems like a less time-intensive approach to alcohol withdrawal or the benefits of emperic abx in COPD flair. Would I be taken seriously in researching these kinds of things or, for example, would it be a significant advantage to be a pulmonologist in order to pursue the COPD question?

Thanks in advance for the advice!
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aPD here. Tildy asked me to pinch-hit. I'm an IM program director at a University program in the Northeast.

The short answer to your question is: Yes, this is very possible. In fact, it's what I'm trying to do.

The long answer is: It depends on many factors.

  1. The atmosphere at your institution -- all academic centers have some mixture of general internists and subspecialists. In some centers, the general internists have a large research focus, and in others it's purely clinical. It's relatively easy to figure out which by looking for publications, or simply asking. Another clear sign of a research focused GIM section is the presence of a GIM fellowship program. The key here is that it is much, much easier to get started in research if you're working with someone who is active and successful.
  2. A GIM Fellowship -- GIM fellowships are available, and they are mostly research focused. All of the above types of research can fit into GIM, and in addition educational research. GIM fellowships are usually 2-3 years and are a great way to jump start a research career, but are not manditory. However, if you want to get a job that up-front has some protected time for research, it's hard to do so without clear evidence of success in research, and that's mostly impossible in your residency, hence the value in a GIM fellowship.
  3. Funding -- getting funding is one of the hardest parts. Much of GIM research doesn't involve costly materials or supplies. However, it does require your time which is costly. There are many grants available to apply for, but again having a mentor who can help you with this (especially for the first) is key.
  4. Publishing case reports is relatively easy. Again, having someone help you with the first few is very helpful. However, most academic centers do not see case reports as evidence for scholarly activity, at least not on their own.

So:
  • You should at least consider a GIM fellowship, especially if you want a large proportion (i.e. >50%) of your time dedicated to research. It's not completely necessary, but gives you a good jump start. Alternatively, a Geriatrics fellowship would give you additional clinical training, lots of research time, and additional board certification and is another good option.
  • If you decide not to do a fellowship (I didn't do one, for example), then your first job is likely to be 100% clinical and busy. You'll need to find a way to gain protected time -- usually by getting involved in whatever you want to do your research in. For example, if you want to look at improving patient safety in your research, you become involved with your institution's patient safety group. Hopefully, after demonstrating your interest, someone will offer to "buy" some of your time. This might make you 80% clinical and 20% academic, and then you dovetail your patient safety work into research (i.e. measure and publish what you do)

If I can help further, feel free to PM me!
 
Hi Tildy,
I greatly appreciate the advice that this forum provides. My question has been partly addressed in some other posts, but sort of obliquely, and I was hoping for a more direct response. I'm trying to decide where to attend med school. I have been accepted to an excellent MD program in southern California, a very good MSTP and an MD/PhD program without a strong national reputation. I am planning on a career in academic medicine and I need to be able to end up back in southern California for family reasons. I have a very strong research background, and I think that getting a PhD is not essential to my success (although certainly helpful). There are certain personal factors that draw me to the least renowned program, but I am concerned about how the school's national reputation might effect my chances of getting into a competitive residency in southern California. I'm am not certain, at this point, what I would like to specialize in, but I want to keep all of my options open. Additionally, if I decided on a competitive IM subspecialty (say Allergy and Immunology), how would my school effect my choices? IM residencies do not seem very competitive, however A&I fellowships are. Would where I do my IM residency be most important for getting into a competitive fellowship? Coming from a less renowned school, would I be able to get into a good IM residency where I want to live and, from there, have a shot at a competitive fellowship? This all assumes equal academic performance at whichever med school I attend, of course. In the end, I guess I'm trying to decide how to balance the strength of a program with personal and family happiness, while keeping all my career options open. Thanks a lot.
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You ask a few questions. I'll try to attack them one at a time.

1. How will an MD, MSTP, or MD/PhD affect your future training (esp as far as A/I is concerned)? The answer is simple -- I would only do a PhD or other research pathway if you truly want a very research heavy career. Many people match into A/I without a PhD, and it sounds like you already have a track record of research success. I would suggest you go to med school where you want to go -- med school is hard, and the happier / more supports you have, the better you will do. Also, it is not uncommon for MD/PhD's to not do as well on the USMLE's -- often because the PhD coursework is mixed in with the MD coursework and you have less time to focus on your MD studies.

2. Will you medical school affect your matching chances? Much less than most people think. Perhaps the absolute top programs will pick only from the "big names", but honestly if your USMLE's are good and you've done well in medical school, you will match in a great univeristy IM program if that's what you want. Doing well (i.e. top 10-20% of your class) is vitally more important than what school you go to. In general, west coast programs tend to match more west coast MD students, but it's unclear if this is an interview bias or simply a desire of "west coasties" to stay in the west.

3. What's important for an A/I fellowship? Residency, and research, in that order. Your MD school will matter only minimally.
 
calimero said:
A fantastic thread, which I wish I'd discovered earlier.

I was wondering if you could comment on the route taken by foreign medical graduates into academic medicine in the US. I am currently applying to internal medicine residencies, hoping to go into academic gastroenterology. I have heard that one's visa status does limit the kind of fellowships that are available (NIH-funded or not), but I am not sure how it affects opportunities for research funding beyond fellowship.

Any help would be greatly appreciated.
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I tend to be cautious about these type of questions as the answers often change with time. There can be limitations related to citizenship status for training grants funded by the US government. See Answer #5 at this link. In general, most research grants do not have a citizenship requirement (or green card) in the US except for various training grants. However, there are no guarantees. Any additional comments by aProgDirector or others are welcome.
 
Doc Henry said:
Hi Tidly

Thanks for all your advice on this forum! I am extremely interested in academic medicine and want to end up at a teaching hospital spending most of my time practicing and teaching, with some clinical research. I was wondering if whether getting my D.O. would make it impossible or much harder to some to obtain a position at an MD school/teaching hospital. I am concerned about this because when I'm through with school I want to end up back in the Northwest and we only have OHSU and UW as far as medical schools with teaching hospitals and both are MD.

Thanks!
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From what I've seen, it makes no difference. It is your residency and fellowship that matter much more than where you went to med school or whether it was an MD or DO (or MBBS, etc) degree that you got. I can't say that there are no schools or departments with a bias, and I can't comment on any particular schools, but I would be very doubtful that it would be a significant impairment in your plans.
 
lacunae said:
Thanks in advanced for the opportunity to ask questions in this forum. This is an invaluable resource. I want to pursue a career in academia as a physician scientist. I envision doing mostly research (translational with a strong basic science component), but I am also interested in having some clinical responsibilities. I am not interested in classical forms of teaching, but I want to mentor students in my lab and in the clinic. I am trying to decide which education route will help my pursue my career goals.

I am currently interested in obtaining an MD/PhD, but my application for dual degree programs is not competitive. Historically, I have been a bad standardized test taker, and this was not different with the MCAT. I took the test twice last year and I scored in the mid-20s. I re-took the test in January and received a 29 (w/ 8VR). I have a 3.7 GPA from an unknown LAC (majors in biology/psychology). If I apply for schools this summer, I will have 2 years of part time research during college, a senior thesis project, and 2 years of full time research after college at a research powerhouse). My current project is extremely risky and unsuccessful, so I do not have any pubs. Due to my stats and my lack of pubs, I probably will not be a successful MD/PhD applicant.

I am now trying to decide whether to complete an MD or a PhD (and possibly complete the second degree after). I really want both degrees, so I am having trouble deciding which one to pursue first. I applied to PhD programs this year, and I was accepted to a top 10 grad program that I love. I did not apply to any MD or MD/PhD programs, but I am considering applying to MD, PhD, and a few MD/PhD programs next year.

Do you have any recommendations about which route is the best one to take? Would any of the routes be less of a financial burden? I would have to pay for medical school entirely with loans. Since scientists and physician scientists do not make much money, I am worried about acquiring this amount of debt will prevent me from entering an academic position.

Due to my interest in academic medicine, I do not think I will be competitive for my state medical school (my state does not have a med school but we have spots in another state). The state/school is looking for people interested in being a primary care physician in underserved areas of the state, so I do not think I will be competitive applicant. Hence, it will probably cost me more to get the MD.

Your advice is greatly appreciated.

Lacunae
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Hi - you've brought up a number of issues that are often discussed in the MD/PhD forums. I can give you some thoughts but really only you can answer the key question. That is, "How much do you want to practice clinical medicine?" To me, that is the key, if you would not be happy without medical practice and cannot get into a funded MD/PhD program, then I would recommend going MD or DO first if you can get into a US medical school. Ultimately, while in medical school you'll be able to decide a bit more about career pathways. You might choose to go through medical school and residency and then do research during fellowship. There are other options as well for post training research.

On the other hand, if you are less sure of a medical career and expect to be happiest in a research and education role, then a funded doctoral program might be best. In that case, you can later decide if you wish to return for medical training.

Ultimately, there are pros and cons to any approach. I would start with focusing on your interest in practicing medicine. From there, some clarity might come to your plans.

good luck!
 
Decepticon said:
Hi guys!

I am foreign medical student in Austria expecting to finish med school in fall this year. I am currently both trying to figure out exactly what job I want to have, and what to do to get there. Until recently, I didn't know much about alternate career options besides wrapping up my MD and starting a residency somewhere. Consequently, this thread is of huge value to me, but there are still some things I need clarified, and some options I have that I would appreciate input on.

Short background info: I want to wind up in a job where I can solve puzzles, and where I have the possibility of discovering or developing something new. I found my puzzles in clinical neurology (which I really enjoy reading), but I am not thrilled by comparing patient outcomes, drug effects etc, so I am looking at more basic science.

My problems are:
-I don't have any graduate math, chemistry, or molecular biology skills as of now.
-I don't have any lab experience, I only have short introductory courses taken in med school.
-I haven't done any research during my years in med school.

Therefore:
Should I seek out a professor and see if I can join a research project now in my final 8-12months? Is it worth delaying graduation to get some research experience? (I have freedom to decide for myself when I want to take exams and graduate.)
Will I have an opportunity to enter basic science through neuro-residency?
Is it common to do a post-doc before or after residency? Or do you get into research through "fellowship training" as mentioned previously on this thread?
What decides whether I will get a postdoctoral position or not? Do I need good grades, letters of recommendation, or do I have to have published something as a student?
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Hi - I'm having a little trouble understanding if your questions are specific to research training in the US. I will assume they are. If not, I think you'd be better off posting on the international forum.

In general, starting a research project in the last few months of medical school or delaying graduation from medical school in the US would not be a good idea. Better to wait to do research later in one's career. It is certainly possible to start doing basic science research during residency and fellowship. Lots of folks who never did any basic science have done and continue to do this. Of course, you are behind the MD/PhD's with lots of experience and one can't expect to be a star immediately. But, it can be done although a basic science career for someone with no experience will take quite a few years to develop.

As far as a post-doc, assuming you are referring to a pure basic science position, unrelated to medical training, it is usually the senior scientist in any laboratory. They may have various criteria they will use, but the availability of funding and the degree to which they think the applicant meets their interests and lab needs are the key features. They will usually wish to talk with you before committing to a post-doc and it is always better to visit a lab in person. Letters of recommendation are needed, publications may not be for a post-doc position, depending on the situation.
 
Decepticon said:
Master of Tildy 😉

First: Thank you.

I am considering a career anywhere on the planet, with a skewed preference for the U.S.

I understand that it is not such a great idea to postpone graduation, but the question is why. Seeing as I will graduate and finish the USMLEs so I can be matched in march 09, question is what I will fill my time with from fall 08 -> being accepted somewhere in march 09. What do you think of the possibility of going into a basic science postdoc before residency in the US?

Now, concerning the possibility of doing basic science while actually maintaining some patient contact. It has been said on this thread that even surgeons can do basic science. However, it seems to me after a bit of snooping, that the fields are highly specialized. Where I am at, molecular biologists and chemists do the core pathophysiology research of e.g multiple sclerosis, while the clinical professors are more concerned with stuff they can derive from observing the patients life and medication. Which fields are better suited for combining basic research with patient care? Do you have an opinion on this?
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Well, nothing is absolute and if you can find a good short term research opportunity then it's probably better to do some research than spend time hanging out on the beaches of Southern France. Well, actually....

Seriously, the key is to find a good research opportunity that you think will have some connection to your future, not just something to spend time doing. If you can find that, then it might be reasonable if the financial aspect is practical.

In the US, there is a lot of cross-over in which clinically practicing physicians are doing basic science research. This occurs in almost every field, including surgery. Certainly some fields have a lot of this type of cross-over, such as neurology, genetics, heme/onc and some pediatric specialties such as pediatric endocrinology. It might be worth spending some time on the subspecialty forums of SDN and ask questions in one or two that interest you if you have some doubt. You might be surprised by the breath of specialties, including surgical ones, with basic science researcher-clinicians.

Good luck!
 
shan564 said:
I know for a fact that my GPA isn't good enough to get me into an MD/PhD program (although my MCAT is). If I go for the MD first, is there any point to trying to work part-time to complete a PhD (or even a Master's) later? Or would I be better off investing that time in a good research fellowship? I've also thought about finding an informal program that lets me do part-time research throughout med school (plus a couple of years of full-time research) to complete a PhD.

I'm assuming that specialty also matters a lot to get a good answer to my question. I haven't started med school yet, but depending on my USMLE score, I think I'll probably end up in either pathology, infectious diseases, or something involving the nuclear sciences (i.e. nuc med, rad onc, or radiology).
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My general advice would be to focus entirely on med school for a while and then look at opportunities. There are some medical schools that allow for late entry into MD/PhD programs (with some or all support), others have one year research programs (either formally or just by having you take off a year). At that time, see if you find a mentor/project that you feel is worth the time and then decide if you wish to go in that direction or wait until later in your career to focus on research.
 
shan564 said:
So basically, you're suggesting that a PhD could be significantly beneficial (as opposed to just skipping it and doing a research fellowship at, say, NIH), but I shouldn't worry about it until after I finish the MD... right?

Thanks!
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Well, I'd say, at least wait until you're at a point in your MD/DO training where the school has a research track you can get into and you feel strongly that you want to take time and do research full-time, either for a year or as a PhD student. The pros and cons at that point of doing a PhD or waiting and doing research training as a fellow will depend on your field, your experience and finances. The physician scientist forum has that debate frequently, but there is no one "right" answer for everyone.
 
agrasky said:
Can you please elaborate on working as an academic physician part-time?
You mentioned part-time academic positions in the post "maintaining clinical skills," however, I would like to know more about how common/difficult it is to find part-time academic positions, and if physicians in these positions are able to be involved in teaching, research, and clinical work, or if there is simply not enough time to do all of this?
Thank you!
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Hi - In that thread, I was addressing the idea of folks who wanted to work a part-time job but be within an academic medical setting. These might be folks who have to care for a small child, parent, etc. Some would only want to be part-time for a few years, others might see this as forever. In a private practice setting, such opportunities are common in various specialties via moon-lighting, part-time office hours, etc. Some specialties are easier for this than others.

Within academics, the idea of "part-time" work can be seen as more problematic. After all, it's hard enough to split a full-time job into three tasks of research, teaching and clinical care, how to split a half-time job is even more problematic?

Nonetheless, I see this being successfully done all the time. There is no pattern to it. In some cases, research is put on hold and the part-time academic is doing clinical work and some teaching. This is probably most common since the clinical work brings in the money for the department. It is very hard to do research as a part-timer, although participating and even organizing clinical research is possible. Bottom line is that it can be done, especially if one has a friendly department and the expectation that the part-time person will return or go to full-time after a period of a few years.
I very much expect this to tremendously increase in upcoming years.
 
premedatheart said:
Hi Tildy,

I am a third-year undergraduate student interested in potentially pursuing a career in academic medicine as a medical scientist. After speaking to several physician scientists, I have learned it is common to have a 60-40 split of one's time between research and clinical practice. Given these type of time commitments, how possible would you say it would be for someone in that career path to participate in a program such as Doctors Without Borders, which also requires a significant time commitment? Thank you for your help.

Premedatheart
Click to expand...

You might check out post #51 in this thread and the link to the article about international health and academic medicine. In general, it is certainly possible to do some international work in academics and as a physician scientists. Lots of my colleagues do this. However, programs like Doctors without Borders are usually at least 2 year commitments and so they are usually best done before embarking on an academic research oriented career. Most commonly, I've seen them done right after residency before fellowships, but some could wait until after fellowship. However, it would be extremely difficult to take 2 years off from the midst of a lab based career for something like this.
 
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