Almost done but with second thoughts

[GAMudPhud]

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Hi all:

I have been lurking on this site for a while, but I haven't seen anyone with my question. I am finishing up my MD-PhD this academic year, and applying to residency. I did well in my PhD with many publications and am well-liked.

However, I really like clinical medicine and could even see myself doing just that 😱! I am not sure if I want to only give 20% of my time to it. I don't know if I am just burnt out on my project and excited about residency or if there is something more to it. I am currently faced with the option going the research track in residency programs, which is what everyone expects me to do, but should I really do that? I am starting to wonder if I should take the faster track to private practice or something. How do I know if this is a temporary feeling or if being a physician scientist isn't in the cards for me afterall? Please help - I am very confused right now!

Thanks

 

[InNotOf]

I don't believe that being a clinician and being a physician-scientist must be mutually exclusive. I know an MD/PhD at an academic hospital who is primarily a clinician. While she is actively involved in clinical trials and clinical research, her primary responsibility is seeing patients (2.5-3 days/week). As I deliberate over whether I want to do the dual-degree program (i.e., run a lab someday), she points out that, although she doesn't use her PhD as a basic or translational science researcher, she is much better equipped as a scientist to address issues that arise in clinical practice and trials.

Maybe the research track isn't for you, but don't feel bad about it. Are you interested in academia? Private practice?

 

[DogFaceMedic]

I have a similar issue although different path to the same cross road: clinic v research. I like my academic research but will probably not be able to do it unless I'm tied to an academic setting. Still, I very much like being a clinician, and many of our senior colleagues want us to choose one or the other.

So, I'm going to do what I like and see what roads open up. If we do good work clinically or in research, they will make room for us.

 

[CCLCMer]

What about doing clinical research?

 

[RxnMan]

...However, I really like clinical medicine and could even see myself doing just that 😱! I am not sure if I want to only give 20% of my time to it...

...I don't know if I am just burnt out on my project and excited about residency or if there is something more to it...

I always thought this was the litmus test to decide when to submit the thesis! (i.e., My committee and I are physically sick of reading revisions, so the thesis must be done)

...I am currently faced with the option going the research track in residency programs, which is what everyone expects me to do, but should I really do that? I am starting to wonder if I should take the faster track to private practice or something...

A MD/PhD I know went into a field far different than what his mentors expected (not surg, IM, or Path) and burnt some bridges. Something to consider is if you want to go back to the lab, at which point the ties you have will be able to help you.

Also - I thought a lot of the research residencies kept you paid as a resident (PGY - 10, etc.). You could argue that you want to go through a standard residency and set up a lab during a research fellowship to get better pay (70-100k vs 60k). You could also say you don't want to commit to one field of medicine yet - e.g. You like IM, but you don't want to commit to cards, which a research residency may want you to do. You could also say you want to get a full clinical training experience. (Just brainstorming on what to say to your PI, I don't know if they would work well or not).

When I finished my thesis, I was sick of it and I never wanted to go back to the field again. But now, just a year later, I think of the things I could have done with the project.

FYI: Look at the residency curricula before you apply. Some of those (IM at least) research-track residencies include PhD years. Looking through the listings on APSA may also help you decide. Some also allow you to bail out of the program during the research years and "just" finish a standard residency.

 

[MelRoos]

You need to do what it is that you like best. The MD/PhD that came out of my lab before me is an orthapedist in private practice in california now. Hasn't done a lick of research since he left school. If you wanted to be minimally involved, you could be a site for a drug trial, and enroll some of your patients.....
I do clinical research, and it is still research with a lot of time commitments and scientific questions. So perhaps you should try to identifiy what exactly it is about the research that you no longer want to do. I spent some time doing organic chemistry research and hated it- but realized I liked the thought process behind research but liked being with people and not in the lab- hence the clinical research.
It's nice te see patients and feel that you are making a difference- kind of an instant gratification that doesn't happen enough in research. But you're going to be out of it for a bit to do your residency anyway(depending on your program) so you don't have to decide right now. -unless you want to fasttrack your residency (peds or med- get a year lopped off for research..) or do a research residency- but it doesn't sound like you want to do this anyway....
good luck-and make yourself happy b/c you have to live with you everyday!!

 

[GAMudPhud]

Thanks everyone for your replies.

Maybe the research track isn't for you, but don't feel bad about it. Are you interested in academia? Private practice?

What about doing clinical research?

So perhaps you should try to identify what exactly it is about the research that you no longer want to do. I spent some time doing organic chemistry research and hated it- but realized I liked the thought process behind research but liked being with people and not in the lab- hence the clinical research.

I actually like academia and research just fine. In fact, in thinking about your responses I have realized what the problem is . I am in exactly the position I was in when I applied to MD-PhD programs. I told them honestly that I wanted to do 50/50 clinics and research. I still want that, is all, and I know it's not practical to have that in traditional basic research. I am wondering about being a co-PI in a translational type lab or something to buy myself more clinical time. I would be interested in clinical research, it just seems to be a whole skill set I don't have. Also, I like molecular stuff, but I would really like to do translational work (ie provide the basic science aspect of clinical trials). It's not that I hate research (although I'm not sure I want to be a PI by myself or write grants all the time), I just like being with patients, too.

To CCLCMer and MelRoos - how can I break into clinical research when I have only basic research training?

It's nice to see patients and feel that you are making a difference- kind of an instant gratification that doesn't happen enough in research. But you're going to be out of it for a bit to do your residency anyway(depending on your program) so you don't have to decide right now. -unless you want to fasttrack your residency (peds or med- get a year lopped off for research..) or do a research residency- but it doesn't sound like you want to do this anyway....

That's just it. I do have an opportunity to do research tracks, which would save me a lot of time if I go into research. But they would be a waste of time if I don't. So I am kind of trying to figure it out before I show up on interviews, etc. I guess I don't want to be out of research entirely, so maybe the research track wouldn't be so bad. I can't see myself dropping out early as RxNMan suggests. Once I start, I don't want to be a quitter.

Also, thanks to DogFaceMedic and RxnMan for the advice. Now that you all have helped me define my question a little better any other ideas for achieving a 50/50 split?

 

[RxnMan]

...To CCLCMer and MelRoos - how can I break into clinical research when I have only basic research training?...

You'll have plenty of opportunities when you go through residency. In fact, many residencies have "scholarly activity" requirements. Most residents dependent on program reqs) will do a lit review or author a book chapter. Some will do/be required to do a research project, and that'll be your chance. Just keep an eye out for good mentors and clinical problems that you run across on the wards.

...I can't see myself dropping out early as RxNMan suggests. Once I start, I don't want to be a quitter...

That's a good sentiment, but make sure to differentiate between doing what makes you happy and doing what only satisfies pride. (I only say this because I've stuck with things much longer than I should have through stuborness ).

 

[Leforte]

I am an MD/PhD who is facing similar career dilemmas. I like the lab, but at the same time, I am not sure I really want to put up with all the BS that goes into being a surgeon-scientist any more. Current R01 acceptance rates are 9% (!!!) and you're competing against full-time PhDs with several post-docs as well as experienced investigators. Alternatively, there are K08's, which have ~35% success rate, but require 75% of your time. Hard to maintain surgical skills with only 1.5 days per week of clinical activities, which would include both clinic and operating.

After a long, long internal debate - I'm giving it up and going 100% clinical. I'll be 36 when I finish residency, and I am getting to the point where I really don't want to play the game anymore and would be just as happy seeing patients, operating, and spending weekends/nights with my family instead of working on grants/papers/etc, wondering where funding is coming from, dealing with IRBs, and all the other BS.

Wonder who else is thinking the same thing?

 

[fantasty]

Also - I thought a lot of the research residencies kept you paid as a resident (PGY - 10, etc.). You could argue that you want to go through a standard residency and set up a lab during a research fellowship to get better pay (70-100k vs 60k). You could also say you don't want to commit to one field of medicine yet - e.g. You like IM, but you don't want to commit to cards, which a research residency may want you to do. You could also say you want to get a full clinical training experience. (Just brainstorming on what to say to your PI, I don't know if they would work well or not).

That's pretty much where I'm at right now in the decision making process (also a last year MSTP student, deciding between categoric IM and some of the research residencies). I do clinical research so I'm a bit different, but it seems like you can use research elective time in residency and required research time during a clinical fellowship to start your research program. Although, those K awards sound appealing, and I also like the idea that you can get some loan forgiveness (which has been committed on in a different thread).

I actually like academia and research just fine. In fact, in thinking about your responses I have realized what the problem is . I am in exactly the position I was in when I applied to MD-PhD programs. I told them honestly that I wanted to do 50/50 clinics and research. ...

Now that you all have helped me define my question a little better any other ideas for achieving a 50/50 split?

Well, I don't know how realistic this is, but I also like the idea that we have the flexibility to shift our priorities over the course of our career. I'd like to think that someone with a PhD could do 50/50 but the ability to shift that to 80/20 (or 20/80, etc) depending on where they are at in their career. I realize of course that science marches on and that it's difficult to remain competitive in writing grants if you have a "lag". But, I thought that was part of the rationale for getting the PhD (not that it teaches you the final techniques or content that you ultimately need, but instead it teaches you how to answer scientific questions regardless of the setting and/or techniques).

 

[CCLCMer]

To CCLCMer and MelRoos - how can I break into clinical research when I have only basic research training?

You can definitely do a research fellowship as a resident. Basically you would spend a year or two working in a clinical research department, kind of like being a post doc I guess. You can also take classes to teach you how to do clinical research. I am taking a clinical trials class right now through Case, and there are fifteen of us total, of which half are residents and fellows and half are med students. The clinical research classes are available through several universities, it's not something that only Case/CCLCM does. You learn how to do things like write up protocols, submit them to IRBs, consent patients, avoid bias, etc. It's really different than doing basic science research, and you will need to spend some time learning a new skill set. I'm actually getting an MS in clinical trials along with my MD. You probably don't need to do a whole MS, but you could at least take a few classes like these residents are doing.

For the research part, I think you should start with something small, like maybe do a retrospective study first, or help with someone else's prospective trial instead of jumping in with doing your own. That's basically what I did this summer, and I learned a ton. I had some pretty bizarre experiences, like debating the pros and cons of different spending functions with one of the statisticians, and discussing the ethics of consenting a patient who won't admit that she doesn't understand the study with the social worker. Like I said, you need a totally different skill set to do clinical research. 😛 But you will spend a lot of time working with patients--at least I did.

 

[RxnMan]

...For the research part, I think you should start with something small, like maybe do a retrospective study first, or help with someone else's prospective trial instead of jumping in with doing your own. That's basically what I did this summer, and I learned a ton...

This is how I got my start. I had a few years of bench top experience when I got a job in a clinical lab. I took over an existing clinical research project from my predecessor, who did most of the front-end stuff: IRB approval, recruiting subjects, etc. I just did the remainder of the testing and learned the ropes. Then last year I began my own project from the ground-up. It's been a learning process each step of the way.

As a caveat to what I wrote above - resident research is of varying quality. Part of my job was to help residents finish their research requirements, and some do great projects. Others were...passable. It's dependent on the resident's level of effort and on how good the support staff is.

Random hint: if you want to suss a residency program's research program, a good way to do it is by looking at their research. In PubMed, you can go into the "Limits" tab, scroll all the way down to the "Tag Terms" drop-down menu. Select "Affiliation." Then search for the residency's name + department and voila! You have all of the research produced by that department.

...it seems like you can use research elective time in residency and required research time during a clinical fellowship to start your research program. Although, those K awards sound appealing, and I also like the idea that you can get some loan forgiveness (which has been committed on in a different thread)...

I look at those research residencies and think they're great because they cut a year out and they give you a guaranteed fellowship. But the time to attending is the same compared to the clinical path: 6-7 yrs. The breakdown comes to more research time and certainty of fellowship, vs. more money (fellow pay, repayment) but with the risk of not getting a fellowship (assuming you still wanted to do one at that point).

The research residency sounds good, but it appears (to me, right now) to be more grad student abuse - delayed gratification, dependence on advisors, lack of autonomy - so that an institution can maintain a constant workforce.

 

[noplacelikehome]

Good to see this. Kinda nice see something that isn't strictly interview related! (not that this doesn't have some interest to everybody anyway...)

 

[GAMudPhud]

I am an MD/PhD who is facing similar career dilemmas. I like the lab, but at the same time, I am not sure I really want to put up with all the BS that goes into being a surgeon-scientist any more. Current R01 acceptance rates are 9% (!!!) and you're competing against full-time PhDs with several post-docs as well as experienced investigators. Alternatively, there are K08's, which have ~35% success rate, but require 75% of your time. Hard to maintain surgical skills with only 1.5 days per week of clinical activities, which would include both clinic and operating.

After a long, long internal debate - I'm giving it up and going 100% clinical. I'll be 36 when I finish residency, and I am getting to the point where I really don't want to play the game anymore and would be just as happy seeing patients, operating, and spending weekends/nights with my family instead of working on grants/papers/etc, wondering where funding is coming from, dealing with IRBs, and all the other BS.

Wonder who else is thinking the same thing?

I think you hit the nail on the head. Most of us started in MD-PhD programs when research was having a heyday - sure, you had to write grants, but the funding rate was MUCH better and it seemed rejection was predicated only on sub-par work. But these days, the well is drying up. Part of that is that there were too many PhDs doing research just for research's sake and not necessarily looking to contribute to human health, the other part is politics.

In either case, things are much harder now. My PI had 5 R01s and 20+ people when I joined the lab, now she was no R01s 🙂eek🙂 and is surviving off of collaborative grants, with only 7 or so people left. And, in general, clinical work is so much easier than research, and I am lucky to have found a field I enjoy. Maybe the reason I am unsure what I want to do is because I am unsure about the research climate. If it stays like this, I can't see myself trying to put together a struggling lab and writing grants 24/7 under the pressure of my technicians and post-docs having mouths to feed at home. 🙁

 

[GAMudPhud]

That's pretty much where I'm at right now in the decision making process (also a last year MSTP student, deciding between categoric IM and some of the research residencies). I do clinical research so I'm a bit different, but it seems like you can use research elective time in residency and required research time during a clinical fellowship to start your research program. Although, those K awards sound appealing, and I also like the idea that you can get some loan forgiveness (which has been committed on in a different thread).

What thread? What loan forgiveness? Tell me more... You got your PhD in a clinical arena? I didn't even know you could do that

Well, I don't know how realistic this is, but I also like the idea that we have the flexibility to shift our priorities over the course of our career. I'd like to think that someone with a PhD could do 50/50 but the ability to shift that to 80/20 (or 20/80, etc) depending on where they are at in their career. I realize of course that science marches on and that it's difficult to remain competitive in writing grants if you have a "lag". But, I thought that was part of the rationale for getting the PhD (not that it teaches you the final techniques or content that you ultimately need, but instead it teaches you how to answer scientific questions regardless of the setting and/or techniques).

That's true. I know I could step away entirely and come back, I just don't know whether I could achieve that 50/50 while also having my own lab. I'm also a little disillusioned as to how disparate clinical stuff and research is - I really want to be a translator... ah well, we will see

 

[GAMudPhud]

Good to see this. Kinda nice see something that isn't strictly interview related! (not that this doesn't have some interest to everybody anyway...)

Yeah, we current MD-PhDs should be chatting it up more. And we should stay after we graduate! I forgot to give a big shout-out to LeForte for being around to post (BTW love the name - I knew you were ENT immediately)! 😀

 

[fantasty]

What thread? What loan forgiveness? Tell me more...

http://drslounge.studentdoctor.net/showthread.php?t=449968

You got your PhD in a clinical arena? I didn't even know you could do that

PhD is in epidemiology, mostly doing clinical epi / pharmacoepi work. Intent is to continue this work and more focused clinical research in my clinical discipline. Not a wet lab person at all, though.

 

[Hard24Get]

I am an MD/PhD who is facing similar career dilemmas. I like the lab, but at the same time, I am not sure I really want to put up with all the BS that goes into being a surgeon-scientist any more. Current R01 acceptance rates are 9% (!!!) and you're competing against full-time PhDs with several post-docs as well as experienced investigators. Alternatively, there are K08's, which have ~35% success rate, but require 75% of your time. Hard to maintain surgical skills with only 1.5 days per week of clinical activities, which would include both clinic and operating.

After a long, long internal debate - I'm giving it up and going 100% clinical. I'll be 36 when I finish residency, and I am getting to the point where I really don't want to play the game anymore and would be just as happy seeing patients, operating, and spending weekends/nights with my family instead of working on grants/papers/etc, wondering where funding is coming from, dealing with IRBs, and all the other BS.

Wonder who else is thinking the same thing?

I agree with you and GAMuDPhud - times are tough! And most of us have already been poor for so long, the idea of spending extra years doing research for a paltry salary only to apply for a K08 and not get it or never get a R01 is daunting, to say the least. I really love research, but if push came to shove I could do EM full time. It is sad to acknowledge that is even a possibility, especially for those of us going into non-traditional fields (where we are told we are less likely to make it, anyway).

In the end, I will try to get a grant, and try to get involved in translational research opportunities, but I will not spend 4+yrs as a post-doc trying to do it only to fail as others have done. If push comes to shove we could always do consulting for pharmaceutical companies - they are the ones doing most translational medicine, anyway. If the sun comes out later, well - perhaps we can return to the original fantasy. 🙂

 

[MedRower]

Ugh, this is terrible stuff to consider in the middle of applying. but nevertheless.

how viable is an option is big pharma? if you're interested in translational research, it would seem like a good idea, eh? given the hyper-competitiveness of nih grants. in pharma, can you work on what you have the desire to work on? how much choice is there in the industry?

second, is there anything people in power can do? is it just a matter of the # of dollars available? or are there other factors? immigration? competitiveness vs. other countries? etc? what's driving this terrible situation - too many old PIs not retiring? too many people entering phd programs? is that really it? that's crazy! why would anyone want to do this (except us, of course).

 

[QofQuimica]

Ugh, this is terrible stuff to consider in the middle of applying. but nevertheless.

how viable is an option is big pharma? if you're interested in translational research, it would seem like a good idea, eh? given the hyper-competitiveness of nih grants. in pharma, can you work on what you have the desire to work on? how much choice is there in the industry?

second, is there anything people in power can do? is it just a matter of the # of dollars available? or are there other factors? immigration? competitiveness vs. other countries? etc? what's driving this terrible situation - too many old PIs not retiring? too many people entering phd programs? is that really it? that's crazy! why would anyone want to do this (except us, of course).

Hey, fellow Floridian. 🙂 And nice MCAT score, BTW. 👍

My PhD is in pharmaceutical chemistry. I looked into doing an industry post doc when it was looking like I might not get into med school. Basically, you would have less control over your projects than you do when you're in academia. The purpose of a drug company is to make money, and that is what drives all of the science. They do not do research for the sheer joy of discovery. So, you could be working on a project that you find really intellectually stimulating. But then the beancounters could decide, nope, this will never be a blockbuster drug, and they pull the plug on you and put you on something else. The other thing that concerned me about being a PhD chemist in industry is that they seem to have regular rounds of layoffs. Some of my friends from grad school who went into industry have already been laid off and had to find new jobs a couple of times. It's not like things are much better for the ones who went the academia route though; some of those folks are doing five, six years of post doc because they can't find a position. 🙁

As for how to make the grant situation better, I don't know. Stop the war in Iraq and devote even just 1% of those trillions of dollars to NIH research funding?

 

[MelRoos]

Nice to know there are so many of us!! Some thoughts...to get more training look for a residency at a school with the PhD or MS in clinical investigations. Then you can just take a course or two to flush out any areas you need help with. There are several- colorado, JHU, duke, Case- as already mentioned etc...
If you are doing clinical research for at least two years (the norm for fellowships) you can get the NIH to repay up to 35K a year of any loans you might have- always nice.
After looking onto it- there is now way I would do a research residency that extends the time of the residency ( example- IM at UPENN - 4 years instead fo 3) my impression is that these are for pople who decide they want to do research during medical school and don't have the PhD training. I am going for fasttracking personally- taking a year off of either residency or fellowship- we'll see how it works out but i am getting positive reception to this from both residency and fellowship programs. But to do this you often have to do both at the same institution, so makes matching a little harder.
ANd yeah- sucks we're saving people in other coutries and not the taxpayers themselves-another topic- but other than big pharma there are a tone of other options for funding- example of the month would be the susan koman foundation is you do cancer research, or the ADA for diabetes etc...
tons of options....
good luck!!

 

[QofQuimica]

Are any of y'all planning to do post docs either before, during, or after residency? And for those of you who did separate degrees, did any of you ever consider taking time off during med school to do a post doc if you didn't do one before med school? Anyone else in the know who cares to give their opinions on the subject of post docs for MD/PhDs would be appreciated. 🙂

 

[RxnMan]

Are any of y'all planning to do post docs either before, during, or after residency? And for those of you who did separate degrees, did any of you ever consider taking time off during med school to do a post doc if you didn't do one before med school? Anyone else in the know who cares to give their opinions on the subject of post docs for MD/PhDs would be appreciated. 🙂

I was at the APSA regional and this subject came up in our small group session. A challenge to doing this is that you will be playing catch-up. The MD/PhDs will play catch-up getting back to the clinics for MSIII, and after residency, they'll be playing catch-up again in the research world, especially since it is moving forward so quickly now.

How does this affect you? Our group leader got her PhD prior to her MD. She chose to do a residency (Path) and has gone a more teaching/clinical route. But, had she wanted to get back into research, she told us she would have to do a fellowship, and that is best done as close as possible to the time you want to become an independent investigator.

My current decision, as a "research MD", which may very well not be worth the electrons its transmitted upon, is to do fellowships after residency. The timing is better (above) and you'll be able to bill as an attending, you'll always be able to generate revenue by seeing patients (like in today's funding atmosphere), and you'll have more bargaining power with institutions to set up your lab, etc.

 

[Universe_Explorer]

Are any of y'all planning to do post docs either before, during, or after residency? And for those of you who did separate degrees, did any of you ever consider taking time off during med school to do a post doc if you didn't do one before med school? Anyone else in the know who cares to give their opinions on the subject of post docs for MD/PhDs would be appreciated. 🙂

I currently have no plans of doing a post doc. So far, the (very few) MD/PhD's I have interacted with in the field I'm applying to have advised going through residency, and doing a fellowship afterwards if I feel necessary. Many fellowships have a significant amount of protected time for research, and if you set yourself up with a good mentor, I'm sure this could end up similar to a mini-post doc type experience. As for a post doc before or during med school, all I wanted to do was power through it. These days, most post doc positions seem to drag on for at least 2-3 years (in my field, at least) - your med school would have to be pretty open minded to let you defer that long, and it would be hard to get back into the clinical groove as a third year. I realize this is what the MD/PhD's do, however...Also, imagine things really start coming together for you during the post doc and you have the opportunity for funding or a tenure track job - do you say no and go back to being a student for 2 more years? Or take the job and suck up the time/money spent on 2 years of med school? Seems like a recipe for conflict...

 

[MelRoos]

I am actually doing a post doc this year- but not really by choice! I had health issues, so finished school, but not in time to match last year, so am doing a post-doc by default... perhaps a good example about how the MD/PhD offers you good flexibility - but I wouldn't recommend it as an active choice! I think it would be better to get into residency, and the thing to realize is that the research componant of a fellowship essentailly is a post-doc..
As to the 50/50 I saw above- as far as I can tell, in talking to people, the MOST clinical you can do and be sucessful at research is 40%, although most have told me that really, you should shoot for 20% in contract negotiations.
Yeah it's sad how things dwindle- my lab of 10 PI/CO-PI's and tons of techs is a thing of the past as well....