Clinical skill/experience for MD/PhD

[VitaminVater]

Hello everyone,

So as I'm still deciding between going the research MD path or doing the MD/PhD, I was wondering as to which would have an advantage in the clinical setting rather than in the lab.

I understand both the MD and MD/PhD have to go through a residency and eventually specialize, but since the MD would probably learn the skills needed for research WHILE being a doctor and treating some patients, doesn't this have some advantage over the MD/PhD since they'd be taking off 4 years to just be in the lab during the PhD in between the MD?

Also, would a 50/50 to 20/80 in terms of clinical/research be adequate for one to, while doing significant and efficient research, also keep up in the clinical setting and be a great doctor?

I'm already set in becoming a medical researcher, but at the same time I don't want my MD and desire to be a doctor to go to waste if I can hardly see patients or get the regular hospital experience throughout my career. Help in this topic would be greatly appreciated, especially from those already in the field or who know others in the same track.

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[Neuronix]

Read the FAQs.

www.mdphds.org

https://www.aamc.org/students/research/mdphd/

 

[debateg]

For most institutions, basic science research is typically structured 20% clinical and 80% research. That usually means that you spend one month attending in the hospital and the rest of your time is in the lab. Some people also choose to do a half day a clinic a week. You generate some of your salary from your clinical service and the rest of your salary you pay yourself off grants you secure. If you cannot secure grants, you need to make up your salary with more clinical work, which means less time in lab and it thus becomes harder to secure more grants. This is true whether you are an MD/PhD or MD.

For people who do not do basic science research, it tends to be a bit more variable. Some people do the 80/20, some people do 50/50 and some do something in between. It depends on the type of job you secure and the institutional support you get.

Getting a PhD during your clinical training really hurts your clinical training. Don't believe anyone who tells you otherwise. You forget a lot of the stuff you learned during your first and second years of medical school. Many people forget how to take a basic history and physical. For many MD/PhD programs, you return to the third year out of sync with all the other third years. In my institution, that usually is around October while most third years start in June. Your peers have been working in the hospital for 4 months more than you. You are thus far behind in both basic knowledge but also the workings of the hospital. On top of that, the third years started medical school a good 3-5 years after you, and with the increasing competitive nature of medical schools, they are likely on a whole smarter (Step 1 scores are creeping up every year). Of course, the following June, you are far ahead of the incoming third years, but by then, you've already received the grades on most of your clerkships, which are probably the #1 thing residency directors look at. You are thus not likely to be as competitive for most residency programs because you did the PhD. I don't think the PhD really gave me boost big enough to overcome my grades, and my PhD was very productive. You are going to be competitive in the PSTP type residency programs that are looking for future researchers though.

Thus, I feel that getting a PhD makes you have to work significantly harder than everyone else just to be mediocre at medicine. I've talked to some interns, and they say they never really catch up. Of course, some people I know are just superstars and excel at everything, but generally, I think MD/PhDs struggle for some time at clinical competence. Faculty often say that they feel competent, but usually that is after they start their fellowship, which requires knowledge of only a small subset of medicine to be proficient.

The true physician scientist who excels at both medicine and research is quite a rare breed. When you apply for the MD/PhD program, they will extol those people. Once you've been in the program for a while, you realize that you are training to be a scientist who makes a little extra money being a physician on the side. Only if you are incredibly motivated and talented can you truly do both. If you choose to go the physician scientist path, you are going to be told that you are one of those people. The statistics, however, do not bear that out.

If you are dead set at being a stellar clinician and stellar scientist, then I advise you to think seriously about how you want your life structured. How many hours a week are you willing to work? How much vacation do you need? How important is it to you to live in a certain location? Do you plan on having a family? If so, when? These questions are unfortunately very difficult to answer when you are 20 years old and in college, but if you read the boards, you see that they become increasingly important as you get older and are a major reason people drop out. I'm not saying you shouldn't do it; I know several who are successfully balance research, clinical practice, and personal time. They are, however, a very rare breed.

Good luck.

 

[solitude]

For most institutions, basic science research is typically structured 20% clinical and 80% research. That usually means that you spend one month attending in the hospital and the rest of your time is in the lab. Some people also choose to do a half day a clinic a week. You generate some of your salary from your clinical service and the rest of your salary you pay yourself off grants you secure. If you cannot secure grants, you need to make up your salary with more clinical work, which means less time in lab and it thus becomes harder to secure more grants. This is true whether you are an MD/PhD or MD.

For people who do not do basic science research, it tends to be a bit more variable. Some people do the 80/20, some people do 50/50 and some do something in between. It depends on the type of job you secure and the institutional support you get.

Getting a PhD during your clinical training really hurts your clinical training. Don't believe anyone who tells you otherwise. You forget a lot of the stuff you learned during your first and second years of medical school. Many people forget how to take a basic history and physical. For many MD/PhD programs, you return to the third year out of sync with all the other third years. In my institution, that usually is around October while most third years start in June. Your peers have been working in the hospital for 4 months more than you. You are thus far behind in both basic knowledge but also the workings of the hospital. On top of that, the third years started medical school a good 3-5 years after you, and with the increasing competitive nature of medical schools, they are likely on a whole smarter (Step 1 scores are creeping up every year). Of course, the following June, you are far ahead of the incoming third years, but by then, you've already received the grades on most of your clerkships, which are probably the #1 thing residency directors look at. You are thus not likely to be as competitive for most residency programs because you did the PhD. I don't think the PhD really gave me boost big enough to overcome my grades, and my PhD was very productive. You are going to be competitive in the PSTP type residency programs that are looking for future researchers though.

Thus, I feel that getting a PhD makes you have to work significantly harder than everyone else just to be mediocre at medicine. I've talked to some interns, and they say they never really catch up. Of course, some people I know are just superstars and excel at everything, but generally, I think MD/PhDs struggle for some time at clinical competence. Faculty often say that they feel competent, but usually that is after they start their fellowship, which requires knowledge of only a small subset of medicine to be proficient.

The true physician scientist who excels at both medicine and research is quite a rare breed. When you apply for the MD/PhD program, they will extol those people. Once you've been in the program for a while, you realize that you are training to be a scientist who makes a little extra money being a physician on the side. Only if you are incredibly motivated and talented can you truly do both. If you choose to go the physician scientist path, you are going to be told that you are one of those people. The statistics, however, do not bear that out.

If you are dead set at being a stellar clinician and stellar scientist, then I advise you to think seriously about how you want your life structured. How many hours a week are you willing to work? How much vacation do you need? How important is it to you to live in a certain location? Do you plan on having a family? If so, when? These questions are unfortunately very difficult to answer when you are 20 years old and in college, but if you read the boards, you see that they become increasingly important as you get older and are a major reason people drop out. I'm not saying you shouldn't do it; I know several who are successfully balance research, clinical practice, and personal time. They are, however, a very rare breed.

Good luck.

Nice post, thanks for your thoughts.

With regards to feeling behind because of a lag in return to clinics, this is why I cannot advise anybody to return to clinics more than one clerkship behind your classmates. If at all possible, return at the exact same time. If you are lagging simply to eke out another paper from your PhD, it is JUST NOT WORTH IT for the reasons nicely enumerated by debateg. If you are delaying return to 3rd yr because of the "crucial" experiments required by your committee, I respectfully submit to you that early on you should stack your committee with MDs or MD/PhD's and make it clear to them that you intend to start 3rd yr on time, experiments be damned. Then stick to your word. If your paper(s) suffers in impact factor, tough--it is simply not worth crappy 3rd yr grades.

In my experience and anecdotally, MSTP students who return to 3rd yr on time or only one clerkship behind tend to do quite well with 3rd yr grades and residency selection. Those who return late, do not. It has gotten to be so pronounced that my med school is now expressly forbidding MSTPs from coming back to 3rd yr more than one clerkship behind. (Of course, it could be confounded by the fact that the "all stars" who would do well no matter what are those who have their act together and return to 3rd yr on time.)

 

[Neuronix]

debateg that was an awesome post that mirrors a lot of my own experiences. I would only quibble:

You are going to be competitive in the PSTP type residency programs that are looking for future researchers though.

maybe. A lot of PSTPs scrutinize your clinical abilities. They frequently do not promise that you will be able to skip a clinical year because they know MD/PhDs can have difficulties with clinical ability due to everything you wrote about. Some PSTPs hedge by taking MD-only people who have less research (say a year out), but are stellar clinically.

Those who return late, do not. It has gotten to be so pronounced that my med school is now expressly forbidding MSTPs from coming back to 3rd yr more than one clerkship behind. (Of course, it could be confounded by the fact that the "all stars" who would do well no matter what are those who have their act together and return to 3rd yr on time.)

For the split clerkship crowd at a number of institutions, we do not really have this option. That is: 3-6 months of clerkships pre-PhD, then 6-9 months post-PhD. We usually come back with those students 6 to 9 months through their clerkships. It was painful, I will agree with you there. But we still manage to match... Usually

 

[VitaminVater]

For most institutions, basic science research is typically structured 20% clinical and 80% research. That usually means that you spend one month attending in the hospital and the rest of your time is in the lab. Some people also choose to do a half day a clinic a week. You generate some of your salary from your clinical service and the rest of your salary you pay yourself off grants you secure. If you cannot secure grants, you need to make up your salary with more clinical work, which means less time in lab and it thus becomes harder to secure more grants. This is true whether you are an MD/PhD or MD.

For people who do not do basic science research, it tends to be a bit more variable. Some people do the 80/20, some people do 50/50 and some do something in between. It depends on the type of job you secure and the institutional support you get.

Getting a PhD during your clinical training really hurts your clinical training. Don't believe anyone who tells you otherwise. You forget a lot of the stuff you learned during your first and second years of medical school. Many people forget how to take a basic history and physical. For many MD/PhD programs, you return to the third year out of sync with all the other third years. In my institution, that usually is around October while most third years start in June. Your peers have been working in the hospital for 4 months more than you. You are thus far behind in both basic knowledge but also the workings of the hospital. On top of that, the third years started medical school a good 3-5 years after you, and with the increasing competitive nature of medical schools, they are likely on a whole smarter (Step 1 scores are creeping up every year). Of course, the following June, you are far ahead of the incoming third years, but by then, you've already received the grades on most of your clerkships, which are probably the #1 thing residency directors look at. You are thus not likely to be as competitive for most residency programs because you did the PhD. I don't think the PhD really gave me boost big enough to overcome my grades, and my PhD was very productive. You are going to be competitive in the PSTP type residency programs that are looking for future researchers though.

Thus, I feel that getting a PhD makes you have to work significantly harder than everyone else just to be mediocre at medicine. I've talked to some interns, and they say they never really catch up. Of course, some people I know are just superstars and excel at everything, but generally, I think MD/PhDs struggle for some time at clinical competence. Faculty often say that they feel competent, but usually that is after they start their fellowship, which requires knowledge of only a small subset of medicine to be proficient.

The true physician scientist who excels at both medicine and research is quite a rare breed. When you apply for the MD/PhD program, they will extol those people. Once you've been in the program for a while, you realize that you are training to be a scientist who makes a little extra money being a physician on the side. Only if you are incredibly motivated and talented can you truly do both. If you choose to go the physician scientist path, you are going to be told that you are one of those people. The statistics, however, do not bear that out.

If you are dead set at being a stellar clinician and stellar scientist, then I advise you to think seriously about how you want your life structured. How many hours a week are you willing to work? How much vacation do you need? How important is it to you to live in a certain location? Do you plan on having a family? If so, when? These questions are unfortunately very difficult to answer when you are 20 years old and in college, but if you read the boards, you see that they become increasingly important as you get older and are a major reason people drop out. I'm not saying you shouldn't do it; I know several who are successfully balance research, clinical practice, and personal time. They are, however, a very rare breed.

Good luck.

WOW, that was very helpful and informative, thanks a lot. I still have lots to think about until deciding, but that definitely gave me a lot to ponder over.

 

[solitude]

For the split clerkship crowd at a number of institutions, we do not really have this option. That is: 3-6 months of clerkships pre-PhD, then 6-9 months post-PhD. We usually come back with those students 6 to 9 months through their clerkships. It was painful, I will agree with you there. But we still manage to match... Usually

I hadn't thought of this. In that case I think programs should abolish the split clerkships. At my school we have the option of doing one clerkship before starting PhD, and I always advise people not to do it. I do not believe that the PhD research is sufficiently "informed" by the pre-PhD clinical experience that it is worth the tradeoff of returning to med school later than your straight-MD classmates, with all your pre-PhD clerkships a distant memory. In my opinion, this is as true for the split clerkship model of 3-6 months as it is for a single 2-month clerkship.

 

[dl2dp2]

How many hours a week are you willing to work? How much vacation do you need? How important is it to you to live in a certain location? Do you plan on having a family? If so, when? These questions are unfortunately very difficult to answer when you are 20 years old and in college, but if you read the boards, you see that they become increasingly important as you get older and are a major reason people drop out. I'm not saying you shouldn't do it; I know several who are successfully balance research, clinical practice, and personal time. They are, however, a very rare breed.

The role of clinical practice in the 80/20 physician scientist I think is curious. My personal belief is that that 20% should augment your 80% in some way, i.e. a very specialized niche practice that helps developing ideas and connections that leverage your research in a translational way. I think being a basic researcher and attend general ward service 1 month a year is a poor use of that 20%, but the unfortunate reality is that it's sometimes difficult to do very basic research and find a translational bent. Sometimes people like basic research precisely because of how basic it is. But they dislike how little money that makes. This results in this not infrequently encountered, in my opinion somewhat deformed career arrangement--esp. when clinical practice pays a huge amount more.

I think the other consideration is that when you go MD/PhD, the first question is how you can translate your training in a clinically meaningful way. This is again one of those things that's really hard to define in college, because PhDs are usually very basic. Basic, general scientists also frown upon more applied research. As cliche as it is, this niche (translational) is very underdeveloped.