MD/PhD in neurosurgery?

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envidia

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"My experience is that if you really want to get your hands involved in research, then a PhD is the way to go. All the MD/PhDs I've known have been the head of large labs where they juggle a clinical practice, writing papers and getting grants, thus resulting in almost no time spent in the lab. Yes, they do interpret data, and yes they do help write procedures, but they are reliant on PhDs to do most of the research."

I have been browsing through these forums regarding MSTP. I began my college career with a pre-med track, but the spring of my sophomore year I received a scholarship to do research as an undergrad.. My research introduced me to the world of neuroscience, and as cliche as this sounds, I fell in love with it. I spent crazy hours doing research during school as well as in the summer and I have since changed my mind about a straight MD and looking at MD/PhD programs.

The research is a huge part of me and I know for sure that I want to continue it. Having said that, I've also continued my shadowing and found that neurosurgery really interests me (my research deals with spinal cord injuries & cell transplantation). I enjoy the patient interaction and the fact that many of the tools/techniques used in surgery once went through the same research process.

I know that the MD/PhD path is perfect for me. The problem I'm having is how will both degrees factor into my career? I wanted to know, regarding the quote above, how true is this?

Are there any individuals that are pursuing a MSTP in neurosurgery? Or am I just crazy for even thinking that this is feasible (aside from the extra time commitment)? Obviously a surgeon's skill level depends on how often he/she is actually in the OR doing surgeries. So a 20/80 split between the lab and the clinic won't make for a good neurosurgeon. And a 80/20 split for research, that will probably make it really hard to produce any data/results for grants & papers. Right?

I've talked to a few MD/PhD's and I only found one person that came sort of close to this. He does SCI related animal research and at the same time does clinical work and human studies at the Sepherd's center (but no actual surgery/OR).

Can (or has) anybody managed a balance between the lab and the clinic?
Is it too ambitious?

Any thoughts on this?

Thanks!
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Two of my good friends from my MD/PhD program matched at UCSF neurosurgery over the last 4 years. It is totally feasible. You will be working your butt off doing neurosurgery anyway. The PHD will be a huge plus for you when you apply for residency, and will help your career as you pursue funding.
 
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How many PhD-only PIs do most of the research in their labs anyway? It happens to most people when they get to a certain point in their scientific career. The administrative work associated with their status and the writing of grants necessary to finance the lab take priority over personal participation in the wet lab.
 
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gstrub,

I would love to talk to your friends if that's possible. Do they post here?
 
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There is no such thing as a PhD in neurosurgery. The closest thing is a PhD in neuroscience. You might consider working in a lab that works with humans, such as human tissue or even doing intraoperative recording of brain activity. There are a number of labs around the country that specialize in this, which have PhD students working in them. It is unlikely that in this situation you will actually touch the person being operated on during your PhD, so unless you have a specific interest in questions that can be answered with such techniques (e.g. mapping of cortical function), this is not going to give you any special insight into neurosurgery, other than getting to hang around with neurosurgeons, which is not something that most people go out of their way to do. Actual surgery will have to wait until your residency.
 
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Labs can certainly be affiliated with the department of neurosurgery, like my current rotation lab. Due to this affiliation, half of his lab is actually neurosurgery fellows. But the PI also has appointments in other departments, and my guess will be that the grad students in the lab will be getting their degrees in those departments, instead of the department of neurosurgery.
 
envidia said:
Can (or has) anybody managed a balance between the lab and the clinic?
Is it too ambitious?

Any thoughts on this?

Thanks!
Click to expand...

Hmm...

Is it possible? Definitely. Is it feasible? Not so sure...

I know 2 MSTPs that have gone into neurosurgery. One is in private practice and does no research, the other is a 5th year resident and plans on going into private practice and not doing any research. While I am sure there are some who manage to complete training and continue a research career, I'm willing to bet most (probably 85% or so- total guess) will bail.

There are a lot of factors for this. One, hospitals will hire you to do surgery, not research. While academic institutions will allow you space and funding to do research, they will constantly pester you to do less research and more surgery.

Two, neurosurgery residency is either 6-8 years depending on where you are. The longer ones tend to allow research. In general, you will be so busy during that time that you will not think about research much. You will be trying hard to hone in your skills, and every minute at the bench/grant writing desk means you are less sharp than you were before. When it's over you may have a different perspective on research and see it as an impediment to your career.

Three, MSTP is on average 8 years, with variance somewhere between 7-10 years, plus the 6-8 year residency. That means that by the time you start a fellowship that allows research in an academic institution, you will probably be 36-40 years old. Right now you are young and ambitions (which is very good IMHO), but you may think differently at that age. Right now you want to save the world, but at 38 you may want to feed your kids and your trophy wife. And let me tell you, starting salaries nearing $1Mil for PP is pretty enticing (my one friend in PP started higher than that!). At that time you will have to decide between a high-paying fellowship of roughly 45-70K/year, possible faculty position (not sure how this works in this field) probably paying you ~250K, or about a million bucks in PP with no research.

Now I don't know all the opportunities that are out there for you, but that is what my friends were faced with, and the result was obvious.
 
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what's the point of doing an MD/PhD if you're just going to wind up in private practice with no research anyway?
 
Can you do it? Sure, no problem, and it would make you more competitive.

Can you do it for 25-30 years (after residency) and keep doing outstanding clinical Neurosurgery and be competitive in the research lab?
Very very very difficult.... Something usually gives.

Either you become the surgeon that every resident loves, because they do the surgery, or you do mediocre research and keep your surgical skills.

A big problem for surgeons is to keep up their skills, and that means operating every week several times a day. When can you read papers, do experiments, mentor students, etc? The technique that NS Depts. do is to hire PhDs and collaborate with them. Well... That is not really running your own lab, isn't it?

When I faced that decision 18 yrs ago, I sided with Neurology, which allows more flexibility to do research.

As usual, there are exceptions to every rule ... but very few.
 
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I'm an MSTP applicant also w/ a heavy interest in NSURG. At Stanford I know of an MSTP student in the NSURG dept, although the "official" affiliation is Program in Neurosciences.

I think you should also keep an open mind that your research interests may change as you gain more exposure to other areas while you go through your med school years.

Having the dual degree will definitely be helpful for residency match though! Stanford traditionally accepts 50% w/ MD-PhDs (regardless of if that was MD-PhD program or degrees earned separately). I think after going through the dual degree program plus residency you have well earned your right to decide if you want to do research or not, and will be much more experienced to accurately to make that decision.

On the other hand, it's not impossible! My PI is an MD-PhD and does both research and clinical practice. :D
 
gbwillner said:
Right now you are young and ambitions (which is very good IMHO), but you may think differently at that age. Right now you want to save the world, but at 38 you may want to feed your kids and your trophy wife. And let me tell you, starting salaries nearing $1Mil for PP is pretty enticing (my one friend in PP started higher than that!). At that time you will have to decide between a high-paying fellowship of roughly 45-70K/year, possible faculty position (not sure how this works in this field) probably paying you ~250K, or about a million bucks in PP with no research.
Click to expand...

I do agree that as I go through the MD/PhD program, I may change my mind. Nobody is really the exact same person 10-15 years down the road. I guess what I am trying to find are people that are trying or perhaps do have that balance between the clinic and lab. It seems from what I've read, there are very few that do (And I'm guessing nonexistent as far as neurosurgery is concerned?). I guess the logistics of it are tricky.

But I do have plenty of time to decide. I don't agree that it would be pointless to do the MD/PhD route, even if I end up siding with either research or surgery. If anything, it would allow me to see both sides of medicine, the practical, clinical side and the scientific side.

Of course, the first step is to get accepted into a MSTP!! I'm looking way too far ahead, but I always like to know what my options will be down the (very very long) road!


PS. future trophy husband ;)
 
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envidia said:
I do agree that as I go through the MD/PhD program, I may change my mind. Nobody is really the exact same person 10-15 years down the road. I guess what I am trying to find are people that are trying or perhaps do have that balance between the clinic and lab. It seems from what I've read, there are very few that do (And I'm guessing nonexistent as far as neurosurgery is concerned?). I guess the logistics of it are tricky.

But I do have plenty of time to decide. I don't agree that it would be pointless to do the MD/PhD route, even if I end up siding with either research or surgery. If anything, it would allow me to see both sides of medicine, the practical, clinical side and the scientific side.

Of course, the first step is to get accepted into a MSTP!! I'm looking way too far ahead, but I always like to know what my options will be down the (very very long) road!


PS. future trophy husband ;)
Click to expand...

Definitely you are very early and will change your mind about specialties many times. It is possible to find the research/clinic balance... but this balance is best achieved in non-surgical specialties. This is the reason most MD/PhDs go into medicine, peds, and path- these give you the most flexibility with your career path.

As far as being a neurosurgery resident and female... quite honestly I've not yet met one. Be prepared to never have children!
 
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gbwillner said:
...As far as being a neurosurgery resident and female... quite honestly I've not yet met one. Be prepared to never have children!
Click to expand...
I have and she didn't. Oddly, she went into neurosurg because the old boy's club didn't let her into ortho. She has since left medicine to run an acupunture clinic! :scared: :hungover:
 
This may just be my opinion, but don't listen to people with the attitude that if you are doing MD/PhD, you HAVE to commit your entire career path to research.

You don't.

Should you like research? Of course...you have to to get through the PhD years without becoming suicidal.

Having the MD/PhD will make you a much stronger residency applicant in any field. If you go through the program and decide plastics or derm or neurosurgery is for you, you will be sought after by the big name institutions. Don't feel guilty if after 4+ years in the lab you decide that writing grants and doing westerns isn't for you and all you want is a private plastics practice. Some MD/PhD students, regular medical students, and even faculty will give you the stink eye for this, but whatever...it's YOUR life and career.

MD/PhD CANNOT hurt you. It can ONLY help. Yes it takes longer (almost twice as long), but it is free also in most cases. You will have a CV 10,000X stronger than 95% of the other applicants. If you decide to have a strong research component in your career you will be positioned perfectly. If not, who cares?

Good luck!
 
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I have spent sometime working in neurosurg research lab during my time in medical school and have worked under a n.surg resident and attending. The attending also has a PhD and is trying to convince us (the med students) to help him run his lab. From a practical perspective, the MuDPhuD calls the shots and directs the research, but spends most of his time in the OR/Clinic. If you are at the appropriate university and large enough lab (with several full-time members committed to your ideas), I think its possible for both, but you will likely have much of an administrative role, such as directing residents in the OR room, after they do 80% of the surgery (open and close), and then stopping by the in the lab for a few hours overseeing the graduate students and post-docs working there as well. IMO, your work environment would be successful at the largest n.surg program possible, so that you share clinic responsibilities with other n.surgeons, freeing up more time for your research fasciculations.
 
I'm applying for NSGY this year as an MSTP. There is a huge role and demand for MD/PhDs in academic neurosurgery. The track doesn't look easy and doesn't have the traditional neurology 10%-clinical/90%-research split. You do spend a lot more of your time in the OR (which I prefer, obviously). I would be lying if I said I knew exactly how I would like to practice academic neurosurgery in 20 years. However, I am hoping to match in a program where I can find role-model academic neurosurgeons who play active roles in research. They exist in numerous programs. So be assured, there is a role for MD/PhDs in neurosurgery.

Envidia, if I were you I wouldn't worry about this neurosurgery thing too much now. You now need to choose whether you want to do science or not. Will you enjoy being a graduate students, doing experiments, and writing papers? If the answer is yes, then go for it. If it's maybe, think twice because there is nothing more disconcerting then your best friends passing you by in medical school while you are in lab. I saw a lot of people drop out because of that. If you decide you want to do science apply and go for it.
 
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gbwillner said:
Now I don't know all the opportunities that are out there for you, but that is what my friends were faced with, and the result was obvious.
Click to expand...

I've been pondering this situation myself. Should one choose a residency and fellowship with lousy PP options simply so you won't have the temptation to leave research? Seems like strange logic to me, but I hear that sort of logic freequently.
 
F that man...better to choose a field where PP is a possibility. You've pointed out yourself the funding issue.

I used to be gun-ho about transplant. I spent a year with the transplant service. Now I am looking for options with both academics and PP as possibilities, like ENT. Better to have the option in my opinion!
 
Myempire1 said:
However, I am hoping to match in a program where I can find role-model academic neurosurgeons who play active roles in research. They exist in numerous programs. So be assured, there is a role for MD/PhDs in neurosurgery.

Envidia, if I were you I wouldn't worry about this neurosurgery thing too much now. You now need to choose whether you want to do science or not. Will you enjoy being a graduate students, doing experiments, and writing papers? If the answer is yes, then go for it. If it's maybe, think twice because there is nothing more disconcerting then your best friends passing you by in medical school while you are in lab. I saw a lot of people drop out because of that. If you decide you want to do science apply and go for it.
Click to expand...

Even though I started out college thinking I would do straight MD, once I got involved in research, it really changed my career choice. I am still shadowing a neurosurgeon (MD only) and I love the experience...but if a patient were to come in with a spinal cord injury...the most he can do is stabilization and a dose of methylprednisol. That would be very frustrating. Of course, a cure for paralysis isn't exactly something I could achieve in my lifetime, but the research is promising and is a huge reason why I want to pursue it.

Myempire: It would be wonderful to talk to a "role-model academic neurosurgeons who plays active role in research." I wonder where are these individuals?
 
envidia,

If you look up my old posts, I sounded almost exactly like you at one point in time. I was convinced I wanted to be in surgery, probably neurosurgery, and a lot of that had to do with family reasons (read my blog for more info).

I ended up doing my research in a Radiology lab and will be applying for Radiology residency soon. I never imagined this would be the case, but I am happy where I am now. Pretty much everyone else I know who started thinking they wanted to do neurosurg switched off that track. For me, the reason was I just realized that I have no desire to spend the rest of my life, every waking hour, in a hospital. Residency in neurosurgery is brutal, usually over the 80 hour week work rules, and 7 years long. You won't be done that training until you are in your mid to late 30s, and even then life won't particularly get easier for you, especially in a field like neurosurgery. Maybe you have no problems giving up the rest of your life to your career. I thought that was me. I worked my *** off for many years through undergrad to get here and figured I would keep doing that. I didn't think I would, but then I fell in love once, got my MSTP stipend, started travelling, developed hobbies, and started working hard again in the stressful environments of the lab and hospital. I realized there's more to life than a constant struggle just to keep your head above water. I plan on making this a future blog post, but honestly, balance really is something most people need in their lives and research + surgery isn't conducive to that balance. Surgery on its own is not, which contributes to its ~25% dropout rate at face.

I don't post to be discouraging. I never want to discourage someone from their path or their dream. Maybe you will be an academic neurosurgeon someday. Maybe you will be a private practice Radiologist. You are a pluripotent stem cell and have to make that decision for yourself. But you won't make that decision for many years.

There's a tremendous stereotype against MSTPs going into surgery. You can see it in this thread. So my advice for you is two-fold:

1) Keep your mind open. Do MSTP because you love medicine and research. Don't do it because you definately want to do Neurosurgery in medicine and related research.

2) Don't mention neurosurgery on your personal statement or at your interviews. That stigma of someone wanting to go into surgery will follow you to many of your interviews. Even bringing up the possibility of being a surgeon MSTP will bring out attendings like Fencer (no offense!) who will turn the rest of your interview into bashing surgery + research. It happened to me at almost every school, and I can't recommend it to anyone. Keep your mind open and say you like Neurology and Neuropathology to those who ask. They're more MSTP friendly and will open more doors for you in research, at least for now, working in labs with Neurologists and Neuropathologists if not as PIs, but as collaborators.

I know there are role model neurosurgeons at my institution. I e-mailed several of them about lab rotations or to meet with them to talk to them. The PIs never once responded to me. Many of the labs in Neurosurgery were full or underfunded and the PIs were almost completely unavailable to their students. The MD/PhD graduates of my program who went into Neurosurgery were too busy in their residencies to find time to even meet with me for a cup of coffee.

Good luck
 
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Neuronix said:
I've been pondering this situation myself. Should one choose a residency and fellowship with lousy PP options simply so you won't have the temptation to leave research? Seems like strange logic to me, but I hear that sort of logic freequently.
Click to expand...

???

PP is an option in ALL fields. Other than peds, PP pays pretty well (in medicine subspecialties, Rad-onc and path) in MD/PhD-heavy fields.

The problem isn't that PP isn't an option, but that research really isn't an option. I have a friend who is finishing his plastics residency and is regretting his decision to go into plastics because no one will give him the dedicated research opportunities he wants. Them's just the facts- if you are a surgeon, you have to be mostly/entirely a surgeon. If you are in other services (consult or medicine), you can regulate how much time you dedicate to your clinical practice.
 
gbwillner said:
PP is an option in ALL fields. Other than peds, PP pays pretty well (in medicine subspecialties, Rad-onc and path) in MD/PhD-heavy fields.
Click to expand...

I disagree with this part. The difference in pay between a 100% clinical life and 100% research life varies wildly between specialties.

The private practice pay in many medicine subspecialties is nowhere near 2x the pay you get doing 100% research. Look at Hematology or rheumatology for examples. In many subspecialties of Neurology it is the same. There are many more examples (peds is a good one), but I'll leave it at that. I really don't know for Radonc or Pathology, though I see how in Pathology many people set themselves up in residency for training that is often thought not to be "marketable". I imagine you could do plenty of research in dermpath, but is that a fellowship taken by many going into 100% research?

In Radiology the difference is roughly 3x or even 4x between 100% research and 100% clinical. Many surgical subspecialties are the same. So really, who pressures those individuals to do 100% clinical work or private practice? It seems to me part of the pressure is put on by the person themselves to make more money for their effort. Part of the pressure seems to be coming from the hospitals--as certain subspecialties bring in the excess revenue to keep many hospitals afloat. You will lose money for every patient you see in many specialties at the hospital with which I'm most familiar, so I imagine there's not as much pressure to do clinical work since grants will bring more money.
 
Neuronix said:
Pretty much everyone else I know who started thinking they wanted to do neurosurg switched off that track. ........... There's a tremendous stereotype against MSTPs going into surgery.
Click to expand...

I agree with these statements. I have already gotten grief numerous times from MSTP-affiliated academic physicians and administrators for my career decision. I also kind of agree with Neuronix's comment about interviews: i would recommend emphasizing that you want to study Neuroscience. There is no need to lie about you interest in neurosurgery, but I would leave your door open at this point.


Oh and as far as where to find NSGY role models, I don't know yet first hand. Residents have told me where to look but I have yet to do my away electives.
 
@gbwillner trophy wife? not everyone on here is a man.. thank you for your OTHER insight though, interesting.
 
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There is ample feedback and great points made here that need no elaboration on my part. However, with the help of @Neuronix, I'm specifically working to make more visible and accessible the alternatives to traditional dual degree paths when pursuing a career as a physician scientist, regardless of one's surgical or medical specialty orientation/intention. As previously stated, though, it is indeed more difficult for surgeons to maintain a balance between bench work and surgical demands, as the surgery generates more revenue for the hospital and/or practice. Anyway, I've posted several resources and anecdotes in this thread. I hope you and others find it helpful. Good luck and best wishes!
 
gbwillner said:
Hmm...

Is it possible? Definitely. Is it feasible? Not so sure...

I know 2 MSTPs that have gone into neurosurgery. One is in private practice and does no research, the other is a 5th year resident and plans on going into private practice and not doing any research. While I am sure there are some who manage to complete training and continue a research career, I'm willing to bet most (probably 85% or so- total guess) will bail.

There are a lot of factors for this. One, hospitals will hire you to do surgery, not research. While academic institutions will allow you space and funding to do research, they will constantly pester you to do less research and more surgery.

Two, neurosurgery residency is either 6-8 years depending on where you are. The longer ones tend to allow research. In general, you will be so busy during that time that you will not think about research much. You will be trying hard to hone in your skills, and every minute at the bench/grant writing desk means you are less sharp than you were before. When it's over you may have a different perspective on research and see it as an impediment to your career.

Three, MSTP is on average 8 years, with variance somewhere between 7-10 years, plus the 6-8 year residency. That means that by the time you start a fellowship that allows research in an academic institution, you will probably be 36-40 years old. Right now you are young and ambitions (which is very good IMHO), but you may think differently at that age. Right now you want to save the world, but at 38 you may want to feed your kids and your trophy wife. And let me tell you, starting salaries nearing $1Mil for PP is pretty enticing (my one friend in PP started higher than that!). At that time you will have to decide between a high-paying fellowship of roughly 45-70K/year, possible faculty position (not sure how this works in this field) probably paying you ~250K, or about a million bucks in PP with no research.

Now I don't know all the opportunities that are out there for you, but that is what my friends were faced with, and the result was obvious.
Click to expand...
You shouldn't have money in mind when choosing medicine. That's not what it's about, it's about doing what makes you feel the best and if money makes you happy then maybe dentistry or real estate agent is best suitable for you.
 
thegermanoncologist said:
You shouldn't have money in mind when choosing medicine. That's not what it's about, it's about doing what makes you feel the best and if money makes you happy then maybe dentistry or real estate agent is best suitable for you.
Click to expand...

You must be new here.
 
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Wonder what specialty envidia ended up doing. It's been eight years this month lol. Lots of great/useful points made in this thread. Since I'm neuro, I've been thinking of neurology/neurosurgery. Met with an md/phd neurosurgeon for second look weekend at the program I'm matriculating into. Other than personality, it was good reading here the explicit words I only felt in my gut why neurosurgery (or any surgical specialty) is not the path for me. Still might try to go into the neurosurgeon's lab since his and his collaborators' research is interesting.
 
there are lots of role models in academic neurosurgery. stanford and UW have R25s dedicated for neurosurgery resident research, UCSF has R01 funded surgeon-scientists (read: surgeons as the PI, not the collaborator). use the NIH reporter on any institution that claims to be an academic powerhouse and there is your objective data on how productive surgeons can be while balancing a full time career in the OR

IMO, medicine as a whole is moving towards increasing specialization and increasing demand for clinical revenue. this isn't unique to surgery. if you want to do research, you need to write grants, but how do you find time to write grants if your chair expects you to run 2 rooms a day 4x a week? personally, i don't want the livelihood of myself and those i mentor (post docs, grad students, undergrads) to depend on how i navigate the inherent uncertainties of research - worrying about low funding rates, manuscript rejections, etc. leave that the the people who want to do it full time.

a quick word on the length of training - a non fast tracked IM dual subspecialist (pulm/CC, heme/onc, etc) will train for 3 years IM + 1-1.5 years clinical fellowship + 2-3 years research fellowship i believe, or about 6-7 years. some nsgy residencies are moving towards enfolded fellowships and nearly all give you some sort of exposure to your subspecialty interest so that post-grad fellowships (if you don't go straight into PP) are only about 1 year.
 
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