Questions from a prospective MD/PhD applicant.

ravupadh said:

Hi there.. I have a few general questions about the physician scientist career route. I apologize if these have been asked before.

1. I know that after you get your PhD a post-doc position is essentially required these days. Can a fellowship or residency that requires research (i.e. molecular genetic pathology) be used as a replacement instead?

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The typical pathway for a MD/PhD is to do an abbreviated postdoc as part of a fellowship.

2. Is it normal to shift focus to research topics (once you get your PhD) that deviate from what your thesis focused on? I know I want to work in the field of gene therapy once I get settled down, but I don't want my thesis to be focused on the topic since I've read on this forum that people who do their PhD in the field take a long time to graduate. Plus, there aren't that many laboratories that focus on gene therapy anyway (when compared to other fields within molecular biology).

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Very few people end up doing research for their career in the same area they worked in for their dissertation.

On the other hand, if your interest is gene therapy, don't rule it out for grad school. There are so many variables affecting how long it takes to finish a PhD, and from what I've seen PhD students working in gene therapy don't take any longer to graduate (and many graduate faster than usual).

3. Is the PhD really necessary to perform basic science research or is a MD/DO sufficient?

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No, it's not necessary but it certainly helps. I've never spoken to a MD/PhD researcher who regrets taking the time got the extra degree, but a common theme among MD researchers I've discussed this with is they'd go MD/PhD if they had the chance to do it again.

Honestly I really don't care about running my own lab as a PI and submitting grant applications. What really interests me is doing the actual research (DNA seqeuncing, gels, etc.) and publishing my results. I really don't want to be the typical PI that sits in his office all day writing reviews and applying for grants.

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Unfortunately, this is what PIs do. I agree that actually being in the lab and running experiments is the best job in science but somebody has to pay the bills, and for most labs that is accomplished by applying for grants. Even if you are somewhere money is not the issue (industry, intramural at NIH), as a PI you will have other responsibilities that will preclude you actually running significant experiments. This is especially true of MD/PhDs, since they will typically have clinical responsibilities in addition to the typical research faculty obligations.

K31 said:

Even if you are somewhere money is not the issue (industry, intramural at NIH), as a PI you will have other responsibilities that will preclude you actually running significant experiments.

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My PI at NIH certainly does have other responsibilities, but he definitely runs significant experiments on his own. Once in a while, he delegates, then does it himself when he gets tired of waiting. Quote one of his postdocs after a lab meeting: "I've never been scooped by my own PI before!"

I estimate that he spends about 40% his work time doing actual research himself. The rest is administrative overhead, meetings, and writing reports, and scientific writing.

ravupadh said:

3. Is the PhD really necessary to perform basic science research or is a MD/DO sufficient? Honestly I really don't care about running my own lab as a PI and submitting grant applications. What really interests me is doing the actual research (DNA seqeuncing, gels, etc.) and publishing my results. I really don't want to be the typical PI that sits in his office all day writing reviews and applying for grants.

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It sounds like you don't want to be a PI. Have you considered getting a master's or PhD and shooting for a staff scientist or industry job? What you describe is pretty much exactly what a staff scientist at the NIH does. To do that you need a PhD, and probably a postdoc; to enter industry, a master's might be better and faster to obtain.

What surprises me is that you ask if an MD alone would work (instead of, would a PhD or master's alone work). Why get an MD/DO instead of a PhD to do research when the MD is not geared towards teaching you to become an investigator? Job security?
The MD can put students into hundreds of thousands of dollars of debt. The type of career you describe pays between 30-60k/year starting salary, typically. (acad research job ~60k starting, industry can vary). It doesn't make sense unless the type of research you want to do is so clinical/translational that you can't do it without an MD (I'm not particularly familiar with gene therapy as a field), in which case, how do you have experience with it and know that it is the field you want to enter? There are some clinical labs which have few staff/minimal overhead/have lab managers to take care of the day to day, but you'd still have to write grants and reviews.

An MD/PhD would take care of some of the debt issues, but most will go on to become PIs. I suspect people will consider you overqualified for a staff scientist position with an MD/PhD. I don't know if there are industry jobs for gene therapy, or the level of education they want. Do you think the process of getting an MD/PhD will match your career aspirations/ personal drive? If you do, then by all means go for it! But, if you aren't interested in running a lab, I would urge you to seriously consider getting a master's and going into industry.

ravupadh said:

Honestly I want the MD/DO degree because I want to participate in translational research and help bring therapies from the lab into the clinic. I don't want to do pure clinical research. However not only that but I do want to spend some time treating patients and not be stuck in the lab all day. I want to do a residency in medical genetics so I can interact with patients (genetics is my forte). I also plan to do a fellowship in molecular genetic pathology, which is mainly laboratory based, and would like to be able to do some of my own research on the side. I don't intend on working in industry but more likely academia. As I've side I really don't have the interest in running a laboratory, but it's nice that PIs actually do benchwork from time to time. I am getting a Masters in Biomedical Science right now if that helps and am working on a thesis. Would this sort of route still require a PhD?

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Sounds like you really don't need a PhD. A research intensive fellowship or even a program like the Cleveland Clinic Lerner College of Medicine's combined MD/MS in clinical research would be a better fit. Other programs that may also fit are programs that fund a year off for clinical or basic research training like HHMI, Doris Duke, or NIH's Clinical Scientist Training Program. Your description of your career goals sounds similar to the position of a staff clinician at the NIH (which is the clinical equivalent to the NIH staff scientist mentioned above). The academic position that matches would be something like a research professor which is a subordinate position in another PI's lab and has more independence than a postdoc or technician.

SBR249 said:

The academic position that matches would be something like a research professor which is a subordinate position in another PI's lab and has more independence than a postdoc or technician.

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Wouldn't you usually need a PhD for this?

ravupadh said:

Honestly I want the MD/DO degree because I want to participate in translational research and help bring therapies from the lab into the clinic. I don't want to do pure clinical research. However not only that but I do want to spend some time treating patients and not be stuck in the lab all day. I want to do a residency in medical genetics so I can interact with patients (genetics is my forte). I also plan to do a fellowship in molecular genetic pathology, which is mainly laboratory based, and would like to be able to do some of my own research on the side. I don't intend on working in industry but more likely academia. As I've side I really don't have the interest in running a laboratory, but it's nice that PIs actually do benchwork from time to time. I am getting a Masters in Biomedical Science right now if that helps and am working on a thesis. Would this sort of route still require a PhD?

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I don't have a lot of experience with this, but I'm fairly sure that as an MD you could do this just fine. I suspect that if you're interested in doing research on your own time, any lab would have you. But, I also suspect it'd be largely on your dime as well (obv you wouldn't pay for supplies, but it might be more competitive/difficult to get a title/position/salary for your research). I don't know- any MD researchers might be able to answer this better. You've worked with people in this field; it might be better to ask your mentors these kind of questions instead of SDNers. What kind of degree do they have? Are they satisfied that that degree prepared them? Was it hard to get a job with the degree they have?
I interviewed with a few MDs with similar career trajectories to what you describe, and now I wish I'd asked them more questions about their clinical/research split, etc.

geeyouknit said:

Wouldn't you usually need a PhD for this?

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No, if you happen to join a lab in the school of medicine and your focus is clinically oriented, an MD would be more than sufficient.

ravupadh said:

Honestly I want the MD/DO degree because I want to participate in translational research and help bring therapies from the lab into the clinic. I don't want to do pure clinical research. However not only that but I do want to spend some time treating patients and not be stuck in the lab all day. I want to do a residency in medical genetics so I can interact with patients (genetics is my forte). I also plan to do a fellowship in molecular genetic pathology, which is mainly laboratory based, and would like to be able to do some of my own research on the side. I don't intend on working in industry but more likely academia. As I've side I really don't have the interest in running a laboratory, but it's nice that PIs actually do benchwork from time to time. I am getting a Masters in Biomedical Science right now if that helps and am working on a thesis. Would this sort of route still require a PhD?

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You have described an actually very diverse set of goals and desires regarding your career planning. I applaud you on your proactive thoughts regarding your future career, but I would caution you some in a number of areas.

1. As had been said before, don't pigeon-hole yourself into notion that you should do some type of research for your graduate work and then pursue your true interests later. Be open-minded to the diversity of interesting research out there and when you are pursuing additional training, try to explore as many different opportunities, labs, research areas etc...

2. You really have to define whether or not you want to care for patients. That single question is pivotal in deciding whether to pursue pure research training or medical training either in a combined capacity or as just an MD. Even if you do medical genetics, you will still have to do an internship and usually at least one year of residency in either medicine or pediatrics to actually see patients. So that in addition to medical school itself can be significant amount of time away from research and you will certainly fall behind (trust me).

3. In regard to the gene therapy field. While the bench research is extremely important in making advances in the field, eventually novel therapies must be tested as part of a clinical trial. These type of trials are almost always collaborations between physicians, research scientists, drug or biomedical companies, and hospitals. Therefore one can be at any level and be a critical part of such translational research. The bottom line, is some medical doctor is going to have to take responsibility for administering the therapy and will be responsible for the outcomes (either in whole or in-part). So given that, if you want to be on the fore-front of that type of research and really leading the way, there is at least some impetus to pursue a formal medical degree.

As a side note, many of the current attempts at gene therapy are run by primary medical specialists, either hematologists, oncologists or endocrinologists. There are a limited number of instances, when the primary investigator is a geneticist. Finally, I would put a plug in for pediatrics given that many of the diseases seen in kids are single gene disorders that are more tractable, rather than multiple-factorial or multi-genetic disorders, such as seen with adults.

Good luck!

my 2c