A LOT of questions about MD/Phd...

[jp92]

Hi...

I am thinking of Md/PhD path since I have passion for both academic research (maybe NOT in medicine though) and clinical practice (this is medicine). I know that it is a LONG and HARD road, but I think I am ready for it.

I have read several threads discussing MD/PhD, but they were mostly MD oriented, not PhD (you will see what I mean by this shortly). To make you answer my questions more easily, I will enumerate my questions.

1. M.D's do residencies and fellowships, and Ph.D's do post-docs. Assuming that M.D/Ph.D program takes 8 years to complete (at best, perhaps), 4 years of residency (pathology), 1 year of fellowship (chemical pathology), AND about 3 years of post-doc (physics), hoa! That is 16 years!!!! I know some folks say that I don't need post-doc, but as I said up there, I do MD/[PhD] because I also want PhD part of it to be in my career. Is it realistic?

2. My dream is to be able to teach in university as a professor (physics) and AT THE SAME TIME work, if possible, in the university hospital (pathology). It is possbile?

3. Now practical questions... People say finishing M.D/Ph.D in 8 years is impossible. Is it really? Even if I ABSOLUTELY enjoy what I will study?

4. Last but not least... I know it shouldn't matter much as long as I do what I want... but how much will I make (in terms of dollars)? I don't expect to earn 300K~500K as doctors in private practices do, but I just wish to make decent amount fitting my many years of education.

Thanks for reading this, and I will expect good answers!

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[Maebea]

People say finishing M.D/Ph.D in 8 years is impossible. Is it really? Even if I ABSOLUTELY enjoy what I will study

The average is 8.2 years, so a good number finish in 8 years. In the past five years, we have even had a few finish in 6 years. I would not count on 6 years, especially if your PhD is in a discipline that requires a lot of non-medical coursework. Non-biological PhDs often do not get to take advantage of course substitutions and waivers that MSTs get in disciplines like Cell Biology, Neuroscience, etc. For a PhD in physics, an 8 year MSTP is possible, but 9 may be more probable.

 

[nothingman]

Welcome and I'll answer a few that I feel qualified to answer.

1. M.D's do residencies and fellowships, and Ph.D's do post-docs. Assuming that M.D/Ph.D program takes 8 years to complete (at best, perhaps), 4 years of residency (pathology), 1 year of fellowship (chemical pathology), AND about 3 years of post-doc (physics), hoa! That is 16 years!!!! I know some folks say that I don't need post-doc, but as I said up there, I do MD/[PhD] because I also want PhD part of it to be in my career. Is it realistic?

Chemical pathology fellowship and physics postdoc? That sounds pretty specialized/intense! I have a biophysics background myself and would recommend a PhD/postdoc in molecular biophysics if your interests are so diverse. It helps you see the lay of the land from multiple scientific perspectives, and the projects can be pretty cool in an interdisciplinary sense.

Back to your question: my understanding of how these play out in most patient care, non-path specialties (e.g. med onc, peds GI) is that your fellowship basically turns into a postdoc (1 year clinical, then 2 but usually more like 3-4 in lab). In pathology and a few other specialties (e.g. rad onc), there are programs that let you get started on a postdoc type project in residency, but I will leave the pathology details to those in the know.

The bottom line is, yes, you should typically count on 5, but more often 6-7+ or more years of training post-PhD to get a faculty job. Pathology may be a bit faster than many of the other specialties. Regardless, this is a darn long time. Also realize that at this age family considerations begin to enter the picture for a lot of people, and you will probably be working very intense hours and making in the mid five figures for these years. This is not necessarily a deal-breaker, but something to plan on and be aware of.

2. My dream is to be able to teach in university as a professor (physics) and AT THE SAME TIME work, if possible, in the university hospital (pathology). It is possbile?

Probably so, but I imagine this would be physics as it relates to something in medicine - electron microscopy etc. comes to mind. Keep in mind that most medical school faculty have relatively light teaching loads based on how they are hired. Much fewer people hold arts and science positions with significant teaching responsibility and practice medicine at the same institution. These are more humanities/history of science types.

3. Now practical questions... People say finishing M.D/Ph.D in 8 years is impossible. Is it really? Even if I ABSOLUTELY enjoy what I will study?

Absolutely doable. This is probably the national average right now if rounded to the nearest one year. The time has been creeping up for a number of reasons in the past decade or so.

While enjoyment of your study is a necessary ingredient for success in grad school, it is far from sufficient. Luck, circumstance, and a committed humanistic mentor play a huge role. The latter factor is critical so do your homework carefully. Sexy, successful and interesting science =/= necessarily happy lab for grad student.

4. Last but not least... I know it shouldn't matter much as long as I do what I want... but how much will I make (in terms of dollars)? I don't expect to earn 300K~500K as doctors in private practices do, but I just wish to make decent amount fitting my many years of education.

As a faculty pathologist at an academic medical center, after your ~5 or more years of post-MD/PhD training with mid five figure salary, my ballpark guess would be in the low to mid 100K range as an attending. Others in the know may correct me here, but I think >200K is seriously unrealistic in that field.

At the moment, it appears that there is a shortage of pathology faculty jobs, although this may change by the time you are looking for work.

One last thing - if you're very focused on science and pathology, and less so on more direct, live, patient care, think carefully about whether or not you will happily endure med school. My guess is that you'll like the first two years quite a bit (anti-intellectual as they may sometimes be), but clinics are a totally different and sometimes miserable beast if your heart is not in it wrt seeing, talking to, and being with suffering patients. Going direct on a PhD track may be a better thing if that is the case, though at the risk of lower job security, and perhaps greater competition for faculty positions (again, not sure what will happen to the MD pathologist job market). Advantage = less time spent in school, and less burnout from med school Just something to think about.

Thanks for reading this, and I will expect good answers!

Feel free to PM if I can help more. Good luck!

Edit: WRT Maebea's post above, I strongly suggest doing PhD part in a med-school affiliated graduate program as opposed to an arts and science graduate program (which is technically doable as well). Typically less teaching/exam-taking load, somewhat faster expected time to graduation, and more medically relevant research.

 

[echosensei]

Re: pathologist salaries. As an Associate Professor, my spouse's base salary is ~$145K. Much less than his private practice counterparts.

 

[echod]

Re: pathologist salaries. As an Associate Professor, my spouse's base salary is ~$145K. Much less than his private practice counterparts.

Could I ask what is the job market for academic pathologists? Is it a little tight as said by the previous poster? How does it compare to other specialties like internal medicine (with specialization), anesthesia, or Rad Onc?

 

[mercaptovizadeh]

Hi...

I am thinking of Md/PhD path since I have passion for both academic research (maybe NOT in medicine though) and clinical practice (this is medicine). I know that it is a LONG and HARD road, but I think I am ready for it.

I have read several threads discussing MD/PhD, but they were mostly MD oriented, not PhD (you will see what I mean by this shortly). To make you answer my questions more easily, I will enumerate my questions.

1. M.D's do residencies and fellowships, and Ph.D's do post-docs. Assuming that M.D/Ph.D program takes 8 years to complete (at best, perhaps), 4 years of residency (pathology), 1 year of fellowship (chemical pathology), AND about 3 years of post-doc (physics), hoa! That is 16 years!!!! I know some folks say that I don't need post-doc, but as I said up there, I do MD/[PhD] because I also want PhD part of it to be in my career. Is it realistic?

2. My dream is to be able to teach in university as a professor (physics) and AT THE SAME TIME work, if possible, in the university hospital (pathology). It is possbile?

3. Now practical questions... People say finishing M.D/Ph.D in 8 years is impossible. Is it really? Even if I ABSOLUTELY enjoy what I will study?

4. Last but not least... I know it shouldn't matter much as long as I do what I want... but how much will I make (in terms of dollars)? I don't expect to earn 300K~500K as doctors in private practices do, but I just wish to make decent amount fitting my many years of education.

Thanks for reading this, and I will expect good answers!

This is a contradiction-filled post. You say you are interested in clinical practice, yet you are interesting in probably the most basic science clinical specialty you could pick, pathology. On the other hand, you say you're not interesting in basic science biomedical research, but rather physics research.

My reading is that you want medicine to be your financial security for you to pursue a physics research career.

Let me just say that you are underestimating both medicine and physics in your post.

Today's physics PhD is far more requirement-intense than most of the PhD's pursued by MD/PhDs. You will get not approval for courses completed in medical school to transfer over to your PhD. Physics, unlike biology and chemistry, requires a lot of coursework for you to get a broad grounding in the field. You will need to take courses in statistical mechanics, classical mechanics, special relativity, several courses in quantum mechanics, electricity and magnetism, and depending on your research interests, one or more of optics, quantum field theory, general relativity, plasma physics, nanomaterials, condensed matter physics, fluid mechanics, biophysics, cosmology, string theory, etc. You will also need to extensively TA. The qualifying examinations are tough, substantially more so than those grant-application "exams" we take in biology PhD programs. These PhDs take more on the order of 5-6 years rather than 4 years. For a successful career in physics, you need at least one post-doc, but more likely two. Physics is more interested in academic pedigree than medicine (hard to believe, I know). Unless your undergraduate is very well ranked and your GPA and coursework superb (and possibly have good research as well), you will not get into a physics program that is very highly regarded (Harvard, MIT, Princeton, Stanford, UC Berkeley, U Chicago, and a few others). I know very talented people (Imperial college PhD, Oxford postdoc) who then had to do two more post-docs and switch fields from quantum gravity to nanophysics, to get a tenure track position. It's hard.

So for physics you have: 5-6 years PhD + 2 years post-doc (minimal) + possibly 3 more years of post-doc: 7-12 years.

For medicine, you probably already know some of what I have to say. Medical school + residency + fellowship. Pathology is having some struggles now and unless you want to work in the boonies (where there's not likely to be the sort of university where you could do physics) you have to do one or two more fellowships. So these are years of training that will not allow you to do concurrent physics training.

For medicine you have: 4 years MD + 4 years pathology residency (minimal) + 2 years years of fellowship: 8-10 years.

We are talking 15 to 22 years of training! It cannot be overlapped and whenever one career lapses, it suffers. If you drop physics for a minimum of six years (last two years of MD and 4 years of residency), you will suffer. If you drop medicine for six years, you will suffer even more.

In my view, if you like physics and find it mentally stimulating, I would consider doing medicine alone at first, getting established in your career, and then look into private tuition/self-teaching to learn the physics that interests you. Once you get through the graduate coursework (Cohen-Tanoudji, Reif, Jackson, Goldstein, Thorne, etc.) see if you want to continue pursuing this path and look into actually going back to grad school.

On the other hand, if you want to risk it, drop medicine and just go for a physics career.

 

[Neuronix]

This is a contradiction-filled post. You say you are interested in clinical practice, yet you are interesting in probably the most basic science clinical specialty you could pick, pathology. On the other hand, you say you're not interesting in basic science biomedical research, but rather physics research.

My reading is that you want medicine to be your financial security for you to pursue a physics research career.

Let me just say that you are underestimating both medicine and physics in your post.

Completely agreed. This idea of doing very basic physics work and clinical work in entirely unrelated specialties is far fetched at best. The physician-scientist pathway works when there is some synergy between your clinical and research work. So far I'm not seeing any here. Further, teaching undergrads is a major time sink, and to combine that with research AND clinical is pretty much impossible. I don't agree with mercapto's idea of becoming an established clinician then switching to being a physics researcher. While it sounds possible, it's just kind of silly to switch careers when you are a high earning, well established, productive faculty member to being a struggling post-doc.

As for your pay, your pay will be related to what you do. If you are mostly clinical, you will be paid clinical academic medical salaries. If you are mostly research, you will be paid researcher salaries. Do a mix of the two? The pay will be roughly between the two. That is until you bring in very large research grants or patents. I think this is a reasonable estimator for salaries: http://forums.studentdoctor.net/showthread.php?t=817247. But these are private practice salaries. The academic salaries, especially if you are planning to do 50% or more research, are going to be capped at more like that 25th percentile level. Even those seem high to me for academics unless you are talking well established academics, with maybe the chair approaching that median salary.

 

[Ombret]

Everyone is making great points here. It sounds like you need some mentorship from real live people who have followed various parts of the pathway you are describing. You are talking about making some of the biggest decisions of your life. Gather a commensurate amount of information. If you need to spend a year in a lab while you do this--so be it.

Now, none of the things you're proposing are impossible. You could go the MD/PhD route and get your PhD training in biophysics or materials with the goal of getting involved in lab-on-a-chip research. After your clinical chemistry fellowship you would then be well positioned to start a lab developing assays. You could spin off a company to make the assays and get rich.

There are people alive today who have done precisely this but I doubt that any of them mapped this career out from the start. This is impossible; there are too many variables involved, many of which you do not control. Your goals, interests and opportunities will evolve and fortunately, these careers are all relatively flexible.