Why are you doing an MD and PhD?

Disclaimer: I am primarily focusing on the PhD, but the same ideas could be applied to the situation of someone who is primarily focused on getting an MD

Hello,

My original plan was to attend medical school and become a physician (MD only). I read (mainly on SDN) about how competitive medical school is and what kind of ECs many successful applicants have, so I decided to get a research position to enhance my resume.

I have been working in a neurobiology lab for 4-5 months now and I love it! I thoroughly enjoy the science, the culture/community, and the daily work required... I have concluded that I want a career in research. I also want to do applied research, preferably working on a neurodegenerative disease or something medical that can directly affect someone. However, I am having a hard time deciding whether or not I want to pursue and MD/PhD or just a PhD. I think I would enjoy clinical work (that is the reason I wanted to become an MD, because I think the work would be tolerable), but I don't know if I want to spend an additional 7-10 years just to be able to work in a clinic once-a-week.

Some brainstorming:

I think the MD would help me when trying to develop experiments/ideas for research that will be applied to healthcare/people, but couldn't I just consult a physician when I am lost?

I think I would enjoy working in the clinic, but I don't think the additional time of medical school and residency is worth the diversity of being able to work with patients.

Would an MD help me get a job at a medical school? I would want to be a professor in a neuro department at medical schools, is a PhD just as competitive for these positions?



Anyways,

-What are your reasons for spending the additional time in medical school and residency?

-What do you want to do that a PhD (compared to an MD and PhD) is a disadvantage for? I am mainly talking about academic or research positions, obviously not clinical ones (where a MD is required).

-Do you have any doubts about doing both degrees?

do NOT, and i repeat, do NOT just do a PhD as long as you don't *HATE* medicine.

There is no false economy in this game. You may end up spending 7-10 years in the lab doing a postdoc anyway before you can get a job.

MD/PhD -> job
PhD only -> no job
It really is that simple in this world of 10% R01 funding rate. What you don't realize right now is that it's the 1 day a week clinic that's paying the bills.

Of course, if you can't stand medicine, or your scores aren't good enough, then all this is moot.

sluox said:

MD/PhD -> job
PhD only -> no job
It really is that simple in this world of 10% R01 funding rate. What you don't realize right now is that it's the 1 day a week clinic that's paying the bills.

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A little simplistic, don't you think????

Obviously you could go on and have a very successful career as a PhD only.

I'd suggest you to give yourself more time to decide. Continue to work in the lab to go pass the honeymoon with lab science, stick around to experience/witness the mundaneness of daily work, the frustration of stalled progress and rebuffed paper submission, the administrative duties of your PI and his/her endless struggle to write grants and get funding, etc. After you are in for a while and have seen it all, you perspective will likely change. Ask the big question then, and you'll have a more educated answer.

Wylde said:

-What are your reasons for spending the additional time in medical school and residency?

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My first blog entry mostly covers this. There's a number of nasty diseases in my family that made me think about persuing first medicine and then persuing treatments for those diseases. I figured MD/PhD was the best way to set up a career investigating novel cures for disease.

-What do you want to do that a PhD is a disadvantage for?

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When is a PhD ever a DISadvantage? It could be a waste of time perhaps.

-Do you have any doubts about doing both degrees?

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I have my doubts. I'm not sure how I feel about the world of basic science research after being close to finished my PhD and may want to do mostly clinical work, like the majority of MD/PhD graduates, when I finish all of my training at the age of 37 or 38. If I end up doing this, I do feel that the PhD was a waste of time.

Sluox: If it were that hard to fund/run a lab, wouldn't it be better to get a PhD/postdoc and see if you can get a lab going. If it doesn't work, you can always go to medical school? I realize there is an economic advantage once you have both an MD and PhD, but you also lose 7-10 years of income getting an MD, especially if you aren't going into 100% PP.

Ariodant: Thank you for your words of wisdom! I realize that there will be very frustrating moments in research (I have already botched an experiment or two, very frustrating!) and that it is not as glorious as I ignorantly believe right now.

Neuronix: Thanks for the replies. My question of "What do you want to do that a PhD is a disadvantage for?" was poorly worded, i meant what kind of situations would it be a significant disadvantage to ONLY have a PhD instead of an MD/PhD. By this, I mean research/academic positions and not clinical ones (obviously you need an MD for that).

Thank you for the replies guys.

I am just having a debate in my head and am interested in everyone's reasoning for MD/PhD. By the time you graduate from postdoc/residency, you will be in your late 30s. If my career is going to be 80% research, I don't know if I can justify postponing it until my late 30s so that I can have more marketability and a day-or-two in the clinic.

Neuronix said:

It could be a waste of time perhaps.

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Are you not happy about getting your PhD in and of itself? Have you not grown as an individual and analytical thinker? I do not mean to single you out, as I know many people would say exactly what you are saying, but I am curious to know what fuels this mindset?

Working in a lab can be great fun, and being part of a group of specialized intellectuals is an unique experience.

When people state that they backpacked around Europe for 2 years before med school no one ever says, "Oooh, so you didn't become a travel agent? It must feel terrible to have wasted those years..."

Research is an all consuming undertaking with rewards incomparable to those attained through any other means. If for any reason this unpredictable existence called life brings me to a career devoid of research I will not look back and think, "I wish I had not wasted those years." More likely I will reflect on how grateful I am to have had research experiences along the way.

To the OP: I enjoy science and would love to continue doing it. Scientists must apply their efforts to a practical purpose and medicine is where I have chosen to apply my efforts. I hope to become enough of an expert in a field of medicine to apply my skills as a PhD to the improvement of that field. MD/PhD was the most straightforward path to reach this goal and I do not regret choosing this journey at all. (I'm a 5th year...).

I must refuse to answer too many questions relating to how I feel about my PhD. It compromises my ability to give advice on these forums. I have seen repeatedly that after I post anything that seems at all negative, the responses to my posts for the next few weeks and some of my IMs turn into "You're so negative" Neuronix bashing. Only a few people have bothered to see why I might say what I am saying, but most will just write me off as some sort of negative person. Like, somehow when someone has something bad to say they are just negative about everything and everything they have to say can just be ignored.

When it comes to doing my job here, which is being impartial, I want to remain as such and I wish to be viewed as such. If you want to discuss things further, feel free to IM me and I will discuss with you. There are a lot of issues that I have had that must remain private. I also wonder if I say too much how it might affect me when I go to apply for things such as residency, where it benefits one to say "Of course I want to be a researcher!" like all my cohort will do--even the ones who have no desire to continue in research.

I will say that I have not had a good time in the lab earning my PhD. I do not at all feel as a part of a team, but completely isolated within a group of massive egos that have no desire to work together.

I have grown as a salesman, and not at all as an analytical thinker. This bothers me greatly. I pride myself on my honesty and impartiality and am constantly told it will sink my career and that's why I have any problems in my research. This is not science as I imagined it, but is science as is reality. Hide any negative/imperfect data you may have, massage all data/figures to show nothing that may be at all concerning, and package things into a perfect story. Only say things that are very positive about yourself, your work, your lab, your institution, etc etc etc... Even things that might be considered neutral are bad. It's not science, it's advertising, and it's not the career I wanted for myself.

When people state that they backpacked around Europe for 2 years before med school no one ever says, "Oooh, so you didn't become a travel agent? It must feel terrible to have wasted those years..."

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Backpacking around Europe for 2 years is assumed to be and usually is FUN. Getting your PhD is assumed to be and usually is NOT FUN. Doing something not fun for years that doesn't benefit you in the long run=waste of time. If you finish your PhD and you still think grad school was fun, hey, more power to you. I don't know anyone in my cohort of senior grad students and finishing grad student MD/PhDs who would agree.

Neuronix,

I am sympathetic to what you write as I had a similar research experience between UG and medschool. Incidentally, like your current environment, this was also at an ivy. For 6 months I was stressing over admissions for MD/PhD while working with a huge group of negative egos. I dreaded every day at the lab. There were even major problems with my funding source that led to me not getting paid until near the end of the whole experience. I was evicted from my apartment six weeks before I was suppose to move to start medschool. Still...I learned A LOT and can actually credit this experience for much of my success in the lab today--so I could never describe this time as wasted.

I respect how you feel about the whole experience and realize many share your perspective. At the same time, I am extremely grateful to feel the way that I do. I often end a day by sitting on my couch with a smile on my face quietly exclaiming, "I love being a mudphud," "I love science," or "I love neurosurgery." All I can do is hope that this never changes. To those considering applying to dual-degree programs, my experience may be rare, but such experiences do exist.

Let's say that there are multiple ways to get to Rome. Some scenic, some direct, some more enjoyable, some more secure...

What is your dream (not mine, hers or his)?

I have enjoyed the ride, and plan to continue doing it ... I written 3 books (one with full page review NEJM), have few dozens of articles, currently funded NIH R-01/VA Merit, tenured, and I take care of patients 50% of my time. I do bench/translational research.

MDPhD is a more secure path to do some research later in life with a higher salary, less risky type of research, less fundamental biology, but more translational (T1) research, while at the same time you can do patient care. I enjoy every bit of it, but would you?

Both Neuronix's and taXi's comments are on target.

Some people realize that they don't want to pursue research or make it an important part of their careers during their long and arduous MD/PhD training. They are likely to see their PhD training as a waste of time or as a character building exercise (and rightfully so). In hindsight, a lot of them would not do the same pathway again given the chance and would not recommend it to others. Sometimes this is because they realize that they don't really like research all that much (since you don't really know what you are getting yourself into until you're there), and other times they are soured to it because of bad circumstances. We are generally young when we start this process, but age and mature during our 7-10 years in the program. Your priorities and perspectives are likely to change in that time.

Others love the scientific process and accept the PhD/research track and would readily do it over again given the choice. Are there politics in science? YES, but that just means you need to learn to play that game. Is the PhD in itself fun? No, but you can still have fun while doing it.

IMHO, the more existential you are, the more you will see the process through to the end and keep your delusional fantasies of making a difference with your research.

.

sluox said:

Again, if you are so concerned about money, don't do PhD. You'll be paid very little ANYWAY. MD/PhD income surpasses that of the PhD-only in general that it is not difficult to catch up that few years.

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I agree

sluox said:

An MD/PhD from a mid-tier school in general has a much better job prospect compared to a PhD from a top school. Those "success" PhDs tend to be the ones with a insane level of commitment to science at the get go, and wouldn't really even come up to these boards in the first place.

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I agree

sluox said:

BE SMART, don't do PhD-only. Leave those to the Indians and the Chinese.

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Ouch! You know better than that. This is offensive despite that I am not Chinese or Indian. I know quite a few MD, MD PhDs, and PhDs of these ethnic groups who are outstanding human beings, and great compassionate physicians or scientists.

gbwillner said:

IMHO, the more existential you are, the more you will see the process through to the end and keep your delusional fantasies of making a difference with your research.

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It is incredibly difficult as a Clinician Scientist to do fundamental research at a Nobel laurate level. However, it is not a "delusional fantasy" to believe that what I have done (or you might be able to accomplish) will make a difference to improve health care or quality of life of a medical condition. Some examples:
a) My PhD work: the concepts developed in my thesis are now considered (20 yrs after) main-stream pathophysiological concepts where disease modification is being targeted. When I started, there were 3 papers with that pubmed keyword, now over 4000.
b) During residency: published the first well documented case report of serious adverse effect of widely used drug in Lancet, that required a reply of the pharmaceutical company, and led to a FDA label change for this medication (still currently in use)
c) During fellowship: published a case cohort study of 10 patient MRI abnormalities who we had followed during my residency, and re-imaged. This was about a subgroup of a relatively common condition (3% of population). The paper led to a NIH multicenter sponsored study of this condition (which relates to my PhD). Results are expected next year.
d) During faculty: while doing clinical work presented large cohorts demonstrating a frequent extent of 2 silent drug-interactions, which only had isolated case reports.
These examples have influenced and improved patient care... not delusional.

Research most often is incremental knowledge. Not outstanding breaktrhoughs. My bench research continues expanding concepts developed during my PhD. We are still far from understanding this.

Wylde, if you love neuroscience. A MD PhD will probably focus your efforts to neuroscience of a medical condition. There are many things that you will enjoy while working hard. The rewards are not delusional. You will have a higher likelihood of successing into academia in a clinical department being a MD PhD than just a PhD. You will earn less than in PP all along, but if it is your dream, just do it!

sluox said:

Those "success" PhDs tend to be the ones with a insane level of commitment to science at the get go, and wouldn't really even come up to these boards in the first place.

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Any regular science/nature/cell/lancet PIs out there who want to second this?

Is "because I am bat**** crazy" an acceptable response to this thread?

PhD for the research, MD to get me some nurses 🙂