Basic science research as an MD only

[thekonny]

Hi,
I'm finishing up my fourth year of med school, I've done a lot of research and at this juncture I think that I want to do basic science research more than clinical medicine. Currently I'm deciding whether I want to go straight into research or whether I should complete a residency or preliminary year first (some people have suggested this as a way of getting back into medicine if I go back on my decision). If I go the research route, would it be very difficult for me to get a postdoc without having done a PhD? Would it make sense to take a year off and get some publications before applying to a postdoc position? Would going through residency training help with getting a postdoc or would it be a waste of time that I can otherwise spend on getting publications? Finally is a research track residency something I would be competitive for as a non MD/PhD? Sorry if the post is disorganized, my thoughts aren't much more organized in my head. Thank you for your advice

Also for reference: I'm at a top 20 med school, I've done about three years of research across 3 basic science labs, mix of honors and high pass on rotations, 255 Step I, 4th author on a nature publication, probably about ~1 year away from getting a decent first/second author publication (though this may require me to go live in France for a year which I don't want to do).

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[Neuronix]

You could probably get a postdoc at this point without any additional training in research. However, you'd be looking at several (possibly even 5+) years of post-doc before obtaining an independent research position. On the other end of that, if you're not very successful in research, it will be very difficult for you to obtain a residency or a permanent independent research position.

Yes you would be competitive for many research track residencies as an MD. The details are a bit residency specific however.

Why do you not want to do clinical medicine at this point? There was a time when MD/PhDs dropped their MDs to start basic research careers and MDs could start very successful basic research labs. Those times are long gone with the funding shortages. Thus, most people, including myself, are going to recommend that you do some type of residency. Pathology is a common choice for those who decide they really don't like direct patient care, and pathology lends itself very well to a research career. The residency not only gives you a clinical backup plan, but also allows you a leg up on the glut PhD-only researchers out there to keep a hand in academics/translational research even if that ultimate outcome is only practicing mostly clinical medicine due to lack of funding.

 

[thekonny]

Thank you for the very good advice. I'm not against direct patient care per se, in fact I thought I wanted to do medicine over science because I saw it as a more social job. I want to go into research less because I dislike medicine, and more because I love basic science. I like that there is a creative aspect to science, and that it is not just algorithms/ pattern recognition. I also like the fact that I'd be working for myself with a somewhat flexible schedule, and I there seems to be just less bull**** involved (aside from grant writing which is better than note writing).

Also, if we ignored my situation for a second, would you not advise anyone at all to go into a purely research position because of lack of funding? (i.e advise against becoming a grad student and getting a PhD.

 

[Neuronix]

Thank you for the very good advice. I'm not against direct patient care per se, in fact I thought I wanted to do medicine over science because I saw it as a more social job.

I felt similarly during medical school. I really didn't like internal medicine because it seemed like there were so many social things medical students and residents had to deal with that impacted medical care but were out of our control (patient social problems like barriers to discharge or non-compliance, conflicts/personalities within the hospital that impacted patient care, etc). As an attending I think it's different, but still, I was disillusioned to some areas of medicine, particularly inpatient care, and I couldn't see myself doing a residency in that area and dealing with it for three or more years. Our school was somewhat alarmed at the drastic decline in medical students choosing internal medicine and used to meet with us during the rotation to try to sell us on it. One of my classmates actually told the program director "All the residents seem so miserable, why would I want to be miserable?" The standard advice was it's just a short period in your life, but I think that's really short-sighted advice because your life is just a short period in the universe.

I want to go into research less because I dislike medicine, and more because I love basic science. I like that there is a creative aspect to science, and that it is not just algorithms/ pattern recognition. I also like the fact that I'd be working for myself with a somewhat flexible schedule, and I there seems to be just less bull**** involved (aside from grant writing which is better than note writing).

There is A LOT of bull involved in research too. Between IRBs, IACUCs, the NIH, institutional bureaucracy and politics, etc... At times it seems worse than clinical medicine. But that's okay. If you like research better than medicine, that's reasonable, and there are some things you listed like more creativity and flexible scheduling that are appealing for research.

Also, if we ignored my situation for a second, would you not advise anyone at all to go into a purely research position because of lack of funding? (i.e advise against becoming a grad student and getting a PhD.

The only person in your situation I would recommend to do a research position would be someone who despises all clinical medicine to the point where they absolutely would be unhappy in any residency. Or someone who is terrible at it or has a criminal record such that clinical practice would not be possible for them. Even those people have some options.

As for undergrads thinking about grad school, I would not advise them to get a PhD in biomedical science unless they are deadset on it. Those are the motivated applicants who are qualified with strong lab experience, have the best chances at the best schools and top labs, and understand the realities of research careers and funding. Those are the right people to get PhDs and they are most likely to succeed.

I met a lot of grad students who went to grad school because they didn't know what else to do in life. It's like picking internal medicine or pediatrics because you can't decide on a specialty. Doing a PhD or a residency is still a life altering and time consuming choice. What I do for undergrads is I assess what they want to do with their lives. For many, I think a master's degree or more time in a lab is reasonable to sort out whether they should be really be getting a PhD, going to med school, getting a master's and becoming a permanent laboratory manager, or something else. Now not all PhDs have a bad job market... For example many types of engineering, clinical psychology, or medical physics, are more reasonable pathways to me. Still, a pure PhD in biomedical science (i.e. not MD/PhD) is not a totally bad choice, but I want people to understand what they're getting into with the job market out there. It would be the same for example in law (there are very few jobs for lawyers also).

Doing an MD and then not doing a residency is the equivalent of giving up your MD training and almost starting over again from undergrad. I'm not saying it's a wrong choice for everyone, but you'd either have to be totally unwilling/ineligible to proceed further in medicine for it to make sense to me. Yes, I considered it too. My post-doc advisor (an MD/PhD who is 100% research) told me "doing an MD/PhD without doing a residency is ******* stupid." I agree with him now. The reality is that I found a residency I actually love. At this point I have no problems leaving research behind because the clinical practice is more enjoyable than I expected and the research side is so daunting. But my residency (radiation oncology) is likely something you were never exposed to and is so different from typical medical practice, that I had little idea about it until I was a fourth year medical student. There are many residency choices like that. I advise you to explore your options thoroughly, and really think about all the specialties available to you as a well qualified medical student. Once you've decided on a residency choice, then decide how best to tailor your future for a shot at a research career.

 

[catzzz88]

I want to add my thoughts in here and ultimately push for the residency. I am not sure what kind of research you are interested in doing, but I am interested in solid tumor oncology and pathology, so here is my reasoning. My plan is to finish med school, finish residency (in a clinical field like neuro, derm, or internal medicine), and then apply for an academic position at a university to run my own lab while still having 1 day a week of clinic (or less). Here is why:

My boss is a perfect example of an MD only who does mostly research. He has clinic for 4 hours a week as a dermatologist, which supplements his salary by about $200,000k (dermatology) and simultaneously gives him access and control over clinical samples that he collects for the clinical trial.

In my opinion, patient samples are the most sacred kind of data that a translational researcher can get his/her hands on. These samples have (1) driven our research to be highly translational and discovery based, (2) brought other collaborators to our door wanting to utilize the samples, and (3) have given by boss the ability to grow as an investigator as he grows his tissue bank.

Without going to residency, you will only have the power of the PhDs only without the added opportunities and perspective presented to researchers who have an MD and can work in the clinic. Over time, my boss was asked to be the co-director of the melanoma clinic and he has also been asked to be the head PI on some new clinical trials (which is huge). Keep in mind that we do basic research, not clinical trial type research, so this is an opportunity that will expand our sample bank and make the lab grow even more.

Finally, the fact that my boss sees all of the patients on the clinical trial has brought fresh perspective to the complexity of the clinical research we do. Patients are not wells in a 384 well plate... They are complex and multidimensional and we cannot control for every aspect of their life. So, when radiology labels a patient as a progressor, but my boss took samples from a lesion on his arm that actually responded to the clinical trial drug by shrinking, we have information about that patient that slips through the cracks of the clinical trial and we can alter the way that we assess that lesion. Without that connection to the patient, our research would be more difficult. The concept of putting a name to a face has not only made the research more rewarding for me, but it has added a new layer of complexity and diversity to the samples in a way that benefits the data as a whole.


So, that's my perspective and that's why I plan on finishing residency and doing cutting-edge translational research without a PhD.


Obviously impulse if you are thinking of doing

 

[thekonny]

Thanks to you both for the well thought out solid advice. You guys have sold me on residency. Also great point on the access to clinical samples catz, I hadn't thought about that. I think I'm going to apply to internal medicine research track programs in that case. Are these going to be much harder to get than regular internal medicine residency spots? My adviser told me to do 10-15 schools (I will be applying to upper tier programs, but not the absolute top ones), should I do more? Also does a list of schools that offer this track exist somewhere?

 

[Neuronix]

Thanks to you both for the well thought out solid advice. You guys have sold me on residency. Also great point on the access to clinical samples catz, I hadn't thought about that. I think I'm going to apply to internal medicine research track programs in that case. Are these going to be much harder to get than regular internal medicine residency spots? My adviser told me to do 10-15 schools (I will be applying to upper tier programs, but not the absolute top ones), should I do more? Also does a list of schools that offer this track exist somewhere?

http://web.archive.org/web/20100610203445/http://homepage.uab.edu/paik/rr.html

This one is a few years old now. I can't find any newer/updated links.

 

[QofQuimica]

Thanks to you both for the well thought out solid advice. You guys have sold me on residency. Also great point on the access to clinical samples catz, I hadn't thought about that. I think I'm going to apply to internal medicine research track programs in that case. Are these going to be much harder to get than regular internal medicine residency spots? My adviser told me to do 10-15 schools (I will be applying to upper tier programs, but not the absolute top ones), should I do more? Also does a list of schools that offer this track exist somewhere?

I know I'm late to the discussion, but just wanted to reiterate the advice you've already gotten and confirm that you're doing the right thing by applying to residency. You will never be more competitive for residency than you are right now as an American med school senior. Taking a break between med school and residency will make it very difficult to get back into clinical medicine later if you decide you want to practice down the road after all. In contrast, once you're BE/BC, you can stop practicing and go into full-time research with much less resistance.

As for how many programs to apply to, unlike med school, it's super cheap and easy to apply for residency. When I applied in 2011, I paid less than $500 to apply to 35 programs, and there were no secondary fees or applications to fill out either. So sure, apply to your 15 upper tier programs, and since you're interested in an academic career, throw in another 10-15 "absolute top tier" programs too. With your strong grades and Step 1, you'll likely get invites from many of those programs, and in the whole scheme of what your med school education has cost you, are you really going to chintz out on like $200 worth of app fees now?