Bailing on the MD to pursue research

[neurotiger]

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I'm a PhD grad in the thick of my M3 year with a decision quickly approaching - residency (which?) or post-doc, and leaving med school asap to pursue a post-doc is a distant 3rd option still in my head. It took me awhile to resolve to finish med school, because I enjoyed the lab and the research mentality and find that clinical medicine doesn't suit me nearly as well. After talking to more than a handful of clinicians and scientists, I've decided to finish med school mostly because of the job opportunities available afterwards. However, even after being back on the wards for 6 months, I am having a tough time feeling good about continuing. I feel like I'm not myself - I hate getting up in the morning, struggle to bring myself to work at home (studying is miserable, though I always used to read papers at night), and don't enjoy getting bossed around, yelled at, and treated like either a gopher or a secretary all day long. I hate doing something halfway, and that's certainly what I am doing on the wards - I am a mediocre med student with minimal enthusiasm. I'm a terrible actress so it's hard for me to fake interest, and when I ask questions, I either get a generic "look it up" or a more puzzled "hmm, we don't usually think of things from that angle."

I guess these are my questions: Do other people feel like this? Do people leave the program in the last 2 years to pursue a research career? Of the people who finish and go on to post-docs, how much is the MD worth?

I'm debating neurology, psychiatry, and path as residency options - all seem viable, though I still lean towards a post-doc after an especially lousy day...

 

[FSAP]

I think you gotta ask yourself how important money and job security is to you. As a PhD you have no clinic to fall back on and your salary will depend entirely on your ability to get grants. If you don't, your institution will have no problem letting you go as most top schools essentially have you go up or you are out policy (at least that's what I was told). Then, you have to go work for a big scientist with a lot of money who can give you a junior faculty spot in his lab or jump to the industry.

I am just a pre-med, so take this FWIW, but I wanted to do a PhD at first, but after talking to my mentors, I got an impression that it was not a good career move in the current climate.

 

[Freak]

Can you do a postdoc followed by residency?

As far as I understand an MD without BC/BE is not worth very much on the market. You want at least 1 year of internship so that you can prescribe.

 

[dl2dp2]

This is very very common. You can refer a few threads down to some of the experiences. The transition from PhD to MD is one of the tougher ones every MDPhD student must have had.

This thread

and

this thread

I'd venture to say that this is even more common amongst neuroscientists, which I identified you as one. Neuroscience, amongst all the basic sciences taught at a medical center, is probably the most intellectually interesting but the least clinically applicable, and is the one discipline most apt to tear MD/PhDs into pieces.

Have you done your neuro/psych/path rotations? Did you hate all of them? I felt rather ambivalent about my clinical rotations as well and my adviser was very keen on pushing me to a straight postdoc. However, I made the executive decision that I no longer want to do basic basic science. You need to do a realistic asessment of how likely it will be for you to have a faculty position in basic science if you skip residency--do you have that CNS paper, or at least Nat. Neurosci. level paper, do you have a clearly articulated, hot topic, do you have the psychological wherewithal to stand the competition in science? R01 funding rate is 8%. Very good junior researchers often write 20-30 grants to get 7-8 funded. Is that the kind of life you want?

If you decide to do a residency, your career prospects widen quite a bit--in fact, in a clinical department, if you want to be a professor, chances are you can be one. Furthermore, I think there are very interesting issues in clinical medicine that are amenable for basic scientific investigation but are ignored because they aren't sufficiently flashy or "fundamental". I eventually did a second rotation in psych and a rotation in pathology, and enjoyed my psych rotation the second time a lot more. Don't rush to any decisions for now, and either way you will reach a decision by the end of this year. Try to relax.

I'm a PhD grad in the thick of my M3 year with a decision quickly approaching - residency (which?) or post-doc, and leaving med school asap to pursue a post-doc is a distant 3rd option still in my head. It took me awhile to resolve to finish med school, because I enjoyed the lab and the research mentality and find that clinical medicine doesn't suit me nearly as well. After talking to more than a handful of clinicians and scientists, I've decided to finish med school mostly because of the job opportunities available afterwards. However, even after being back on the wards for 6 months, I am having a tough time feeling good about continuing. I feel like I'm not myself - I hate getting up in the morning, struggle to bring myself to work at home (studying is miserable, though I always used to read papers at night), and don't enjoy getting bossed around, yelled at, and treated like either a gopher or a secretary all day long. I hate doing something halfway, and that's certainly what I am doing on the wards - I am a mediocre med student with minimal enthusiasm. I'm a terrible actress so it's hard for me to fake interest, and when I ask questions, I either get a generic "look it up" or a more puzzled "hmm, we don't usually think of things from that angle."

I guess these are my questions: Do other people feel like this? Do people leave the program in the last 2 years to pursue a research career? Of the people who finish and go on to post-docs, how much is the MD worth?

I'm debating neurology, psychiatry, and path as residency options - all seem viable, though I still lean towards a post-doc after an especially lousy day...

 

[Shifty B]

I say finish the MD hands down. I've seen several people in your dilemma, and most go on to finish the MD for a couple of reasons:

1) MD is a big-time credential. Every job you apply for, you can tout your clinical experience and MD credential. Even if you don't have a license (although it may be slightly better to get the license, MD is still there). You have the upper hand over every PhD only applicant, for your ability to interact with other MDs as well as your clinical background. Every grant you apply for will say MD/PhD after your name.

If you quit the MD, then you are probably slightly below PhD only applicants, because they were using the 3 years you were in medical school to get more publications/experience/connections. Also, they won't have your proven track record of being in medical school for 3 years and quitting.

2) Most people don't realize that they don't want to do clinical medicine until after 3rd year of medical school. Follow that up with the fact that fourth year of med school is awesome, and there is really no reason to quit then because you've already done all the hard work. The residency application process is so extensive now that it has eroded almost the entire 4th year of medical school. Expectations are low, most schools have multiple months off, you can miss days during rotations for interviews, you can schedule rotations with minimal time commitments, etc.

After finishing cores and sub-Is, most people I knew took easy electives, blew off entire months for interviewing, then blew off more months just to fool around. Fill your schedule with radiology, pathology, dermatology, and more, and watch how the half-days improve your attitude. At my school this got into full swing around Nov, and most people did absolutely nada from March-June. When I started my residency I hadn't been to the hospital in probably 3-4 months.

Side note about point 2) Don't be fooled into thinking that you should work hard during your 4th year to prepare for your internship (supposing you decide to do a residency). This is ******ed, because it won't help you and you will lose the benefit of #2 above. An old post on sdn put it best when it said,

"Trying to prepare for internship by working hard in 4th year is like trying to prepare for a car accident by banging your head against a brick wall".

Finish the MD! You're already almost to the promised land.

 

[neurotiger]

I appreciate all the advice. In contrast to some of the other posts on this message board, mine wasn't meant to be about struggling through M3 year grade-wise but about realizing that I enjoy research much more than medicine (well, at least more than med school). I groan when I get up in the morning to go into the hospital, but I used to be the first one in the lab. I went to talk to my PI last week on a Thursday afternoon, and realized that 20 minutes in his office got me thinking more than I had the entire week on surgery.

I'm about halfway through my 3rd year, and have ob-gyn, peds, and psych left once I survive the rest of my surgery clerkship. I did neuro and a path elective before I actually started research and liked both of them more or less, so I think there's some hope for me in a corner of clinical medicine. But, I'd be lying if I said I wasn't using it as a way to diversify and elevate my research application over the myriad of PhD scholars out there. Having both degrees makes you interesting, and I'm still debating whether to build my career with a post-doc or short residency/fellowship. And I can't wait to be back in the lab again.

There are a lot of MSTP students at my school who become so burned out by the end of grad school that they can't wait to go to clinic...and when they do, they love absolutely everything. I feel naive now to have expected that. I find being a confused and somewhat-useless med student frustrating, embarrassing, and anxiety-provoking on a daily basis, and I don't envy the residents or attendings their job titles and responsibilities. Things just clicked for me in the lab - I loved the freedom to go after something, to figure out how to do it, to screw up and recalculate, and to argue for what I could reproducibly demonstrate. In clinic, I feel like a ***** for not remembering the second branch of a meandering artery. It's not even the material but the thought processes. And there are a million stereotypes out there about the social habits of lab rats, but don't get me started on the personality disorders of clinicians...

Anyway, that's my update - trying to hang on to finish med school, weighing neuro/path/maybe psych residencies vs post-docs - and sneaking in to the lab to work on papers and strike up interesting conversation whenever possible.

 

[strangeglove]

Keep in mind that even if you don't have a strong interest in clinical medicine, and are not interested in opening a practice/being a clinician educator, you can always put up a shingle and make some money, even as a full-time researcher. I know from personal experience that you can make $2000 or more for 24 hours of work on a Saturday as a moonlighter. This requires the bare minimum of skills that you acquire in residency, and is intellectually very low-key, if mind-numbing at times. This may mean one less day spent writing a grant/doing an experiment/attending a conference, but you and your family will be happier, and you will feel less of a failure when your grants/papers get rejected (which they inevitably will; it happens even to the best of us).

This also brings to mind some of the pitfalls of having a very successful PhD: if you work with a high-output, successful advisor and publish many high profile papers with him/her, you will feel that science is a lot of fun and will derive much of your self-esteem from it. When you hit M3 year after such success, you go from being the cat's meow to being the low rung on the totem pole, which can feel like a demotion. In this context, it often becomes easier to fantasize about a successful and fulfilling career as a scientist than a career as a respected and skilled clinician. The point is, you don't have to be the best clinician to get something out of it. This is very different from science, where to get much of anything out of it, you really have to excel.

 

[URHere]

From what you've written, it sounds like the aspect of M3 year that you really hate is feeling overtaxed and underqualified for what you are doing as a clerkship student. Although I haven't reached that stage of my training yet, I imagine that this transition can be extremely difficult for MD/PhD students - they leave their thesis projects with memories of working relatively independently to become experts in their given fields, only to fall into the frustrations of MS3 year, where your learning is nowhere near independent or complete.

I don't think that feelings like you have described are unusual, but I do get the impression that most of the problems you have found with clinical medicine may be the result of your current frustrations. My suggestion would be to try to separate your frustrations over doing things halfway from your actual feelings about the practice of medicine. Do you still enjoy seeing patients? Do you enjoy the diagnostic process and the general environment of clinic? Is anything left of the motivation that once drew you to medicine? Keep in mind that the nebulous facts that are truly important will ingrain themselves into your brain in time, and that all specialties are a little bit different in terms of how much treatment is based on key-word reflex and how much is based on medical literature and clinician thought. If it isn't medicine that you are truly unhappy with, it would be a shame to abandon medicine now because you do not enjoy your role as a third year student.

 

[dl2dp2]

This is very different from science, where to get much of anything out of it, you really have to excel.

I kind of disagree with that. I don't think a lot of science being done is necessarily excellent--but either they are basic, necessary catalogue kind of research or for whatever other, sometimes political reason they get funded. And whether something's "excellent" is so amorphous. If you judge based on the prestige of the institution and the prestige of the journal, the impact factor the citations, it can be unfair for a variety of reasons. If you judge based on scientific merit, that in itself is very subjective, especially when it comes down to the question of what's worth doing and what isn't. I'm sick of this CV comparison business--it becomes a beating the Joneses kind of exercise.

I think from the perspective of the researcher, if he/she's having fun doing it and the pressure of funding isn't too much of a hassle, then he/she gets something out of it. Always striving for that high profile breakthrough, especially in basic science, might be asking for too much of many of us. My advisor, who has been very successful throughout his basic science career said, regarding neuroscience, roughly--"only 5% of the research is really worth doing, but without the other 95% as support, that 5% wouldn't be possible," and "the only worthwhile point of science is to have fun."

And while R01 funding rate is still at an all time low, there are ways to "do research" in a pure sense without being a lab head who needs to manage these grants. Often this compliments very well with a clinical career.

 

[Neuronix]

If it isn't medicine that you are truly unhappy with, it would be a shame to abandon medicine now because you do not enjoy your role as a third year student.

I wanted to echo this statement, as it's what I keep going in my own head. I also think about just doing post-doc on the bad days. Believe me, I never used to care about grades. Your frustrations are extremely similar to my own, except I don't think you're planning to apply to something very competitive. The competition for a specialty and position to enrich/complement my research interests has turned me into a mediocre med student with exceptional enthusiasm .

In the end I think Shifty B is absolutely right. For me, I plan on writing a novel later in 4th year.

 

[strangeglove]

I kind of disagree with that. I don't think a lot of science being done is necessarily excellent--but either they are basic, necessary catalogue kind of research or for whatever other, sometimes political reason they get funded. And whether something's "excellent" is so amorphous. If you judge based on the prestige of the institution and the prestige of the journal, the impact factor the citations, it can be unfair for a variety of reasons. If you judge based on scientific merit, that in itself is very subjective, especially when it comes down to the question of what's worth doing and what isn't. I'm sick of this CV comparison business--it becomes a beating the Joneses kind of exercise.

I think from the perspective of the researcher, if he/she's having fun doing it and the pressure of funding isn't too much of a hassle, then he/she gets something out of it. Always striving for that high profile breakthrough, especially in basic science, might be asking for too much of many of us. My advisor, who has been very successful throughout his basic science career said, regarding neuroscience, roughly--"only 5% of the research is really worth doing, but without the other 95% as support, that 5% wouldn't be possible," and "the only worthwhile point of science is to have fun."

And while R01 funding rate is still at an all time low, there are ways to "do research" in a pure sense without being a lab head who needs to manage these grants. Often this compliments very well with a clinical career.

Those are good points. However, the ability to advance in an academic research track is determined by output (some combination of number of papers published, profile of those papers, and grants obtained). "CV comparison" is a necessary if unpleasant part of this process. If fun is your primary source of career satisfaction, and you are not so concerned with academic advancement, then hopefully you are comfortable with spending your life as a research associate/postdoc (the exceptions to this are the fun-loving, brilliant, non-conformist, yet highly productive Richard Feynman types - a rare breed). To support a life of fun, it would be helpful to have a steady clinical job. Last I checked, postdocs and research associates make less than many first year residents. Perhaps I am overly concerned with income, but I think it is a valid issue among physician-scientists, who sacrifice significant earning potential for the privilege of having fun.

 

[Shifty B]

I'm about halfway through my 3rd year, and have ob-gyn, peds, and psych left once I survive the rest of my surgery clerkship. I did neuro and a path elective before I actually started research and liked both of them more or less, so I think there's some hope for me in a corner of clinical medicine. But, I'd be lying if I said I wasn't using it as a way to diversify and elevate my research application over the myriad of PhD scholars out there. Having both degrees makes you interesting, and I'm still debating whether to build my career with a post-doc or short residency/fellowship. And I can't wait to be back in the lab again.

Yea, dude, just finish. Being a medical student is ******ed (that's my shout out to Rahm Emmanuel). It's not frustrating because it's overwhelming. It's frustrating because it's so underwhelming. Your role is a total fabrication, which isn't even needed. You may write notes that don't go in the chart. You might get asked a question, give the right answer, just to be told you're wrong, then then have the attending re-explain exactly what you just said. You'll defer someone's rectal exam to be humane, sparing him the 4th exam of the day, and then get chastised for not doing it. (You have a finger, don't you?) You're expected to stay there until you're dismissed, even though there was nothing to do for the last 5 hours.

It's funny too, because the rotations I did the best on were the ones on which I cared the least. Do what is expected, but minimize your exposure. When you're there and standing around doing nothing, you look worse than if you had just gone home. Leave early when possible, avoid useless activities which aren't educational, etc. When your work is done, ask if there is anything else to do and then bail when there is not. Then go home and relax or study.

Internship is better because at least you have a role to play. In some situations, you have the only role. It's a lot more fun and you may like it a lot more.

For me, I plan on writing a novel later in 4th year.

This is an outstanding plan. And during your 4th year, you can do it. Between free time, waiting for flights to your interviews, and time off, do something meaningful to you.