Deciding between MD/PhD and PhD

[mtlove]

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I would like some advise from current MD/PhD students. I have long debated doing a PhD or an MD/PhD, and I am currently trying to decide which route to apply to next year. With an MD/PhD, I plan to do mostly basic science and a small amount of clinical work on the side. Medicine really interests me and I enjoy clinical work. I like the fact that I would have more people contact with a small clinical practice if I chose this route verses the PhD only. With the PhD route, you can get more people contact by teaching, but I like the doctor-patient relationship better than the teacher-student relationship. Hence, my interest in the MD/PhD route.

Regardless of my passion for clinical work, I think I may be miserable in medical school. I have a graduate school personality not the typical pre-med personality. I like to think, analyze things, learn, etc. in the graduate school manner and I find it difficult to suppress this inclination. I prefer to memorize as little as possible verses and instead learn the material. I would get annoyed by the pre-meds that would memorize every obscure fact imaginable (such as physics equations that are easy to derive and people with doctoral degrees in physics do not know off the top of their heads). I do well at memorizing if necessary. I understand it is necessary to memorize a lot of material in medical school, and I would be willing to do this since it is a necessity for patient care. I also tend to get annoyed with the pre-meds that have revolved their entire life around getting into medical school (e.g. do activities purely to put on med school application, awards, etc) instead of doing what they enjoy.

For any of you current or formers students in MD/PhD programs (especially those that may have had these fears), if medical school would be a problem for someone with these views.

Thanks in advanced for your thoughts on this manner.

 

[gbwillner]

I would like some advise from current MD/PhD students. I have long debated doing a PhD or an MD/PhD, and I am currently trying to decide which route to apply to next year. With an MD/PhD, I plan to do mostly basic science and a small amount of clinical work on the side. Medicine really interests me and I enjoy clinical work. I like the fact that I would have more people contact with a small clinical practice if I chose this route verses the PhD only. With the PhD route, you can get more people contact by teaching, but I like the doctor-patient relationship better than the teacher-student relationship. Hence, my interest in the MD/PhD route.

For starters, you won't be able to do the "small clinical practice" thing if this means private practice or family practice. It just doesn't work that way- you need to be at an academic center and do research. The most successful physician-scientists are the ones whose patient population serve their research directly. For example (in the IM field), a cardiologist doing research on heart development or an Oncologist studying P53 overexpression in [random] tissue. While in theory you think you can combine two independent careers, in reality you cannot. You will suck at one or the other.

Regardless of my passion for clinical work, I think I may be miserable in medical school. I have a graduate school personality not the typical pre-med personality. I like to think, analyze things, learn, etc. in the graduate school manner and I find it difficult to suppress this inclination. I prefer to memorize as little as possible verses and instead learn the material. I would get annoyed by the pre-meds that would memorize every obscure fact imaginable (such as physics equations that are easy to derive and people with doctoral degrees in physics do not know off the top of their heads). I do well at memorizing if necessary. I understand it is necessary to memorize a lot of material in medical school, and I would be willing to do this since it is a necessity for patient care. I also tend to get annoyed with the pre-meds that have revolved their entire life around getting into medical school (e.g. do activities purely to put on med school application, awards, etc) instead of doing what they enjoy.

You are right. your WILL be miserable in Med school. You just need to learn to deal with it. You will also probably get crappy grades too. It won't really matter in the grad scheme of things. Med school is ALL about meorizing crap. Especially the basic science years. It gets better in the clinics.

I don't really understand the antipathy towards pre-medical students that I've seen in the last couple of days. You should not get "annoyed" at what other people do with their time. Regardless of what function it serves in their lives, that says something about YOU. Medical school is about compassion, just remember that.

 

[Circumflex]

I agree with what gbwillner said. I didn't have a great time in the first 2 years of med school because I hate just memorizing - I wanted to understand why things were, but that is not what med school is about. It is about taking in vast amounts of info in a short period and then trying to really remember the stuff that is relevant to patient care.

Just like any career, being successful in medicine or science means playing the game well. I hate that part, but it is something you have to do to be able to do what you want to do. Sometimes you have to do things you don't like to get to the end result.

Many people have the same doubts/concerns as you. You just have to be honest with yourself about what you want and talk with as many people in medicine and science as you can to get a good understanding of what each entails.

 

[greg12345]

Hey MTLOVE, let me let you in on a dirty little secret: EVERYONE is miserable in medical school. I don't care how much of a gunner you are, no one actually enjoys rote memorizing all the stupid fossa that a particular cranial nerve passes through. Then once you are finally done with the "classroom" you get thrown to the wolves in the hospital where basically you feel like an idiot constantly and are forced to CRAM and MEMORIZE even harder than before because you are trying to pass the "shelf" exams, only this time you are doing it on way less time and way less sleep. But you know what? Medicine is such an amazing career that all the crap you have to go through is worth it, and the journey is actually pretty enjoyable (sometimes even downright fun).

You sound just like me - I absolutely loathe memorizing (anatomy - worst class ever) and couldn't stand 90% of the people I was in class with b/c all they cared about was "Is this going to be on the test? Because I need to know so I can memorize all the right things so I can get good enough grades to be a dermatologist." But I found a good group of people who were actually interested in learning knowledge in order to be a good physician as opposed to learning to get good grades, and we all did well in our classes while having a good time together. I know it may sound hard to believe, but there are always a couple of cool people buried beneath the morass of the pre-med people in med school (your fellow MD/PhDers should also be a good resource for support during med school years - they will have the same approach to knowledge/thinking as you), you just have to find them.

Based on what I understand you envision your career to be (basic science research + minimal clinical time), you sound like a good fit for MSTP training. The MD training adds a lot to your basic science - particularly in the types of questions you ask, the directions you pursue in your research - it really gives you a clinical perspective that a PhD will never have.

 

[greg12345]

Oh yeah, I'm an 8th year finishing up in 2 months waiting for the match if you want to know where I am coming from.

 

[QofQuimica]

You are right. your WILL be miserable in Med school. You just need to learn to deal with it. You will also probably get crappy grades too. It won't really matter in the grad scheme of things. Med school is ALL about meorizing crap. Especially the basic science years. It gets better in the clinics.

I don't really understand the antipathy towards pre-medical students that I've seen in the last couple of days. You should not get "annoyed" at what other people do with their time. Regardless of what function it serves in their lives, that says something about YOU. Medical school is about compassion, just remember that.

Don't be so hard on the OP. Compassion goes both ways. 🙂


OP,

It helps a lot if you pick a school that does not curve grades, or better yet, is P/F. A lot of schools have P/F for the M1 and M2 years now. Look into this; it will make your life a lot less stressful if you pick one of these schools. Also, buy a book about mnemonics and teach yourself to use them. I'm not the world's greatest memorizer either, but these memory tricks have been used for literally thousands of years, and they really help. Finally, keep in mind that there are a lot of things you have to just learn without understanding at first because you just don't know enough yet. I would say that has been one of the more frustrating things for me about the M1 year; I hate going through the motions of things without really understanding why I'm doing or learning them. But as time goes by, you will see things again, and they will make a lot more sense the second time. The upperclassmen have told me how much better M2 year is for that reason, even though it's a lot more work too.

Pre-meds *can* be annoying. Never mind being in classes with them--imagine having to *teach* them. Most of them don't care one iota about chemistry; they just want to know what they have to do to get an A. But these gunners will be the ones who save your a** when you're clueless in med school. I go out of my way to seek out the people who "know it all," and guess what? I wind up learning more too. Even though I gently chided gbwillner, he has a point: instead of looking at these people as an obstacle to your happiness, try to look at them as resources for you. A lot of times, these people actually *are* willing to share their knowledge and help you, if you are humble enough to let them. It's important to recognize that you can't or won't know everything, and you *do* need others to help you make it through, no matter how smart you are. I'm telling you this as a person who began med school already having my PhD. One of my best "teachers" is a classmate who is nine years my junior and fresh out of college. This kid probably loves teaching the rest of us a little too much for his own good, but wow, have I ever learned a lot from him. 🙂

 

[Jorje286]

lol, I agree with so much of what you say. I hate memorizing too, but sometimes you just have to toughen it up.

One important thing though, although probably less important than in a career for medicine, but I do think memorizing is also important for a career in science. You really have to know your info very well to come up with good hypotheses. If you don't know the details of cell signaling for example then you probably won't pose a good hypothesis (in a research related to that domain, ofcourse). If I have the concept wrong in my mind, then please someone correct me. It's also important to have a wide base of knowledge in a lot of things, cause you're going to use that knowledge to propose better hypotheses.

Anyway for your question, it would really depend on whether you think memorizing all that crap is worth the MD/PhD degree. Well in my case, I think it is, and as a biology major, I've done tons of memorization already even though I hate it. So I know I can survive.

 

[mtlove]

Thanks everyone for your advise. I guess my biggest hesitation in getting a medical degree is that thinking is discouraged in the medical education process. Correct me if this is wrong, but I have heard this is the case from current MDs, PhD faculty teaching medical school courses, and graduate students that have taken medical school classes. As jorje 286 mentioned, memorization is important for getting through grad school and establishing a career in science too. In addition to memorization, graduate school emphasizes thinking, problem solving, etc. Suppression of skills such as thinking and problem solving is second nature to me (probably innate reasons for this and my college focused highly on this skill), and I am skeptical about succeeding in medical school because of this. I can memorize as well as most pre-meds, but like many of you said I would rather understand the material and think. Even with studying for the MCAT, I had to learn how to suppress this inclination to think in order to do well on the test.
Recently, my MD/PhD PI has been trying to dissuade me from pursuing the MD for the reason of the lack of thinking involved in the curriculum. He views his time in medical school and residency as a complete waste of time. As you guys know, lots of PIs want to make their students into clones of themselves. My PI is notorious for this, so I must take his advise with a grain of salt.

Are most MD/PhD students similar to me in that they are first and foremost a thinker? Can a thinker do well in the medical curriculum and be happy? For any of you in the clerkship phase of your training, did you have problems adjusting back into the less thinking-focused medical curriculum from the graduate curriculum. My PI claims that all of his HHMI fellows would get in trouble in third year for learning to think like a scientist.

Sorry if this or my previous post was not compassionate enough for you, but I figured I would get a more valid response to the problem by frankly presenting the situation.

Thanks again for your help.

 

[TheCybermen]

Thanks everyone for your advise. I guess my biggest hesitation in getting a medical degree is that thinking is discouraged in the medical education process. Correct me if this is wrong, but I have heard this is the case from current MDs, PhD faculty teaching medical school courses, and graduate students that have taken medical school classes. As jorje 286 mentioned, memorization is important for getting through grad school and establishing a career in science too. In addition to memorization, graduate school emphasizes thinking, problem solving, etc. Suppression of skills such as thinking and problem solving is second nature to me (probably innate reasons for this and my college focused highly on this skill), and I am skeptical about succeeding in medical school because of this. I can memorize as well as most pre-meds, but like many of you said I would rather understand the material and think. Even with studying for the MCAT, I had to learn how to suppress this inclination to think in order to do well on the test.
Recently, my MD/PhD PI has been trying to dissuade me from pursuing the MD for the reason of the lack of thinking involved in the curriculum. He views his time in medical school and residency as a complete waste of time. As you guys know, lots of PIs want to make their students into clones of themselves. My PI is notorious for this, so I must take his advise with a grain of salt.

Are most MD/PhD students similar to me in that they are first and foremost a thinker? Can a thinker do well in the medical curriculum and be happy? For any of you in the clerkship phase of your training, did you have problems adjusting back into the less thinking-focused medical curriculum from the graduate curriculum. My PI claims that all of his HHMI fellows would get in trouble in third year for learning to think like a scientist.

Sorry if this or my previous post was not compassionate enough for you, but I figured I would get a more valid response to the problem by frankly presenting the situation.

Thanks again for your help.

you bring up an interesting point. i think it's important to bear in mind that while the first two years of medical education are grossly didactic and creativity is seldom rewarded, this is hardly sufficient to fulfill the demands of a clinician's or clinical investigator's education. part of being a physician is problem solving -- viz., opening a large envelope containing several x-rays, ct scans, lab results, medical histories, etc., establishing a differential diagnosis (or, in some cases, a single diagnosis right off the bat), and weighing available treatment options given a patient's presentation. this form of thinking is quite scientific, even though medical practice may often seem rooted in empiricism or anecdotal evidence at best.

i'm not saying the thought process of a clinician and a scientist are the same, however. i'm simply saying that there is a significant degree to which physicians are also "thinkers" (some in certain specialties) obviously more than others) rather than pure "do-ers," if you'll excuse that word.

my two cents.

 

[Circumflex]

Are most MD/PhD students similar to me in that they are first and foremost a thinker? Can a thinker do well in the medical curriculum and be happy? For any of you in the clerkship phase of your training, did you have problems adjusting back into the less thinking-focused medical curriculum from the graduate curriculum. My PI claims that all of his HHMI fellows would get in trouble in third year for learning to think like a scientist.

Sorry if this or my previous post was not compassionate enough for you, but I figured I would get a more valid response to the problem by frankly presenting the situation.

Thanks again for your help.

You have to be careful when you use the word "think." What I meant in my previous post is that in med school classes, you don't have time to study in depth much of what you are learning, because you are studying the entire human body. In grad school, you have time to sit and read, look up the latest papers on molecular mechanisms and new ideas. It is impossible to study medicine in this way when you are in school.

However, after the first year of med school, it increasingly becomes problem-oriented. This is how doctors think. A patient presents with signs and symptoms. You have to think about all the possible diseases it could be, then you have to think about what lab tests, X-rays, physical exam maneuvers, etc. that will narrow your hypothesis and lead you to the problem. So, medicine is all problem-solving - it is just different from the way a PhD solves problems. You don't get much of this in your first 2 years of med school because of limited patient exposure, but in 3rd and 4th years, you are still memorizing clinically relevant material while at the same time trying to develop an approach to diagnosing problems.

I think that some of the "thinking" skils I developed in grad school helped me in my clinical clerkships. In PhD training, you learn how to be critical - examine data and observations, and formulate a hypothesis. This is what clinical medicine entails, just in a different way. The big difference is that as a PhD, you always have time to read and look things up before you do something. In medicine, you don't have as much of this luxury - it's more stressful decision-making. Plus, if an experiment goes bad, you've lost some time, but if you make a mistake with a patient, you have the potential to seriously hurt or kill them.

Bottom line - both MDs and PhDs are thinkers - just in different ways.

 

[Jorje286]

You have to be careful when you use the word "think." What I meant in my previous post is that in med school classes, you don't have time to study in depth much of what you are learning, because you are studying the entire human body. In grad school, you have time to sit and read, look up the latest papers on molecular mechanisms and new ideas. It is impossible to study medicine in this way when you are in school.

However, after the first year of med school, it increasingly becomes problem-oriented. This is how doctors think. A patient presents with signs and symptoms. You have to think about all the possible diseases it could be, then you have to think about what lab tests, X-rays, physical exam maneuvers, etc. that will narrow your hypothesis and lead you to the problem. So, medicine is all problem-solving - it is just different from the way a PhD solves problems. You don't get much of this in your first 2 years of med school because of limited patient exposure, but in 3rd and 4th years, you are still memorizing clinically relevant material while at the same time trying to develop an approach to diagnosing problems.

I think that some of the "thinking" skils I developed in grad school helped me in my clinical clerkships. In PhD training, you learn how to be critical - examine data and observations, and formulate a hypothesis. This is what clinical medicine entails, just in a different way. The big difference is that as a PhD, you always have time to read and look things up before you do something. In medicine, you don't have as much of this luxury - it's more stressful decision-making. Plus, if an experiment goes bad, you've lost some time, but if you make a mistake with a patient, you have the potential to seriously hurt or kill them.

Bottom line - both MDs and PhDs are thinkers - just in different ways.

👍 Great great points. It's true about why memorizing in medicine is more important in science. It's important to know your info very well in science, but you still have the luxury to sit down and dig all the relevant info on a particular topic when doing some project. In medicine however, you can't tell the patient to sit and wait while you dig up his symptoms.

Also, my impression is that a lot of integrative and inductive thinking is involved in medicine, so scientific and clinical thinking do have some stuff in common. You need to make something of all the symptoms and info you're getting about a certain case, and I guess that wouldn't be that different from the scientific approach to analyze your data and find something cohesive in there.

To the OP, I'm not sure why are you so worried. I mean certainly those two years of studying medicine won't kill your critical thinking skills. After all, you'll be getting back to the PhD. Memorizing sucks, but you just have to toughen it up, and if you think you can get through it, I don't see why you should be worried.

 

[greg12345]

In medicine you have the potential to think and problem solve as much as you do in science. In science you have a hypothesis that you test with a series of experiments. Medicine is the same way - your patient presents with a chief complaint of symptom x and you hypothesize that he most likely has disease y, with diseases a,b, and c also being possibilities. Now to test your hypothesis, you ask certain questions that either support/disprove the hypothesis, you examine the patient and look for certain signs that either support/disprove the hypothesis, and you order certain tests that will either support/disprove the hypothesis. Now the critical thinking in science is picking and choosing the right experiments to do to prove your hypothesis...same thing in medicine. You could ask every question possible, examine every possible body part, and order every single test possible - but the smart doctor who can think fast will be able to get to the correct hypothesis with a minimal amount of time (and fewest lab tests) by picking and choosing the right things to focus on or test.

Now for either science or medicine there is a certain foundation of facts that you must simply know in order to test your hypothesis. You can't elucidate a signaling pathway downstream of a receptor if you don't know what a kinase is, what phosphorylation is, what an SH2 domain is, what JAK/STAT is, etc. These are simple facts that you must learn (or dare we say, "memorize") in order to be able to test your hypothesis. Same thing in medicine - there is a core group of facts that you must simple learn (or memorize) in order for you to be able to ask the appropriate questions, examine the appropriate body part, and order the appropriate tests in order to prove your hypothesis. The unfortunate thing in medicine is that the HUMAN BODY IS LIKE TOTALLY COMPLICATED so there is A LOT of facts you have to learn in order to build your foundation. The 1st 2 years of medical school attempt to build some of this foundation to the point where you can at least have some ability to test your hypothesis once you get to 3rd year med school. The longer you are in clinical medicine, the more and more solid your foundation becomes, and the better and better you get at quickly proving or disproving your hypothesis about what disease a patient has. Sure, it can get mindless when it is just another rule out MI and you know exactly what to do, but every once in a while a patient starts going down the tubes in the MICU and holy cow HE IS NOT FOLLOWING THE RULES OF WHAT A PATIENT IS SUPPOSED TO DO ACCORDING TO YOUR TEXTBOOK and even the attending is puzzled out of his mind and you start calling consults right and left to figure out what is going on and then guess what....you gotta REALLY REALLY REALLY THINK like crazy to try to figure it out because your patient is dead in the next 12hours if you can't figure it out...and that's why clinical medicine kicks butt.

I would be suspicious of any physician that says they don't like medicine because it does not require thinking (and then tries to discourage students from pursuing it) they most likely hate dealing with patients in my opinion, or they are in certain specialties that might be mindless. I guess private practice could also be mindless, but at almost any academic center that serves as a major referral center, you will see all kinds of stuff that no one in the world knows what is going on with and you'll have to bust out yer brainz to help the patient.

Take my comments with a grain of salt because I'm going into internal medicine where all we do is sit around and intellectually masturbate all day after we finish our 4 hour rounds.

 

[QofQuimica]

Take my comments with a grain of salt because I'm going into internal medicine where all we do is sit around and intellectually masturbate all day after we finish our 4 hour rounds.

greg, have I told you lately how much I like you? 😀

 

[TheCybermen]

In medicine you have the potential to think and problem solve as much as you do in science. In science you have a hypothesis that you test with a series of experiments. Medicine is the same way - your patient presents with a chief complaint of symptom x and you hypothesize that he most likely has disease y, with diseases a,b, and c also being possibilities. Now to test your hypothesis, you ask certain questions that either support/disprove the hypothesis, you examine the patient and look for certain signs that either support/disprove the hypothesis, and you order certain tests that will either support/disprove the hypothesis. Now the critical thinking in science is picking and choosing the right experiments to do to prove your hypothesis...same thing in medicine. You could ask every question possible, examine every possible body part, and order every single test possible - but the smart doctor who can think fast will be able to get to the correct hypothesis with a minimal amount of time (and fewest lab tests) by picking and choosing the right things to focus on or test.

Now for either science or medicine there is a certain foundation of facts that you must simply know in order to test your hypothesis. You can't elucidate a signaling pathway downstream of a receptor if you don't know what a kinase is, what phosphorylation is, what an SH2 domain is, what JAK/STAT is, etc. These are simple facts that you must learn (or dare we say, "memorize") in order to be able to test your hypothesis. Same thing in medicine - there is a core group of facts that you must simple learn (or memorize) in order for you to be able to ask the appropriate questions, examine the appropriate body part, and order the appropriate tests in order to prove your hypothesis. The unfortunate thing in medicine is that the HUMAN BODY IS LIKE TOTALLY COMPLICATED so there is A LOT of facts you have to learn in order to build your foundation. The 1st 2 years of medical school attempt to build some of this foundation to the point where you can at least have some ability to test your hypothesis once you get to 3rd year med school. The longer you are in clinical medicine, the more and more solid your foundation becomes, and the better and better you get at quickly proving or disproving your hypothesis about what disease a patient has. Sure, it can get mindless when it is just another rule out MI and you know exactly what to do, but every once in a while a patient starts going down the tubes in the MICU and holy cow HE IS NOT FOLLOWING THE RULES OF WHAT A PATIENT IS SUPPOSED TO DO ACCORDING TO YOUR TEXTBOOK and even the attending is puzzled out of his mind and you start calling consults right and left to figure out what is going on and then guess what....you gotta REALLY REALLY REALLY THINK like crazy to try to figure it out because your patient is dead in the next 12hours if you can't figure it out...and that's why clinical medicine kicks butt.

I would be suspicious of any physician that says they don't like medicine because it does not require thinking (and then tries to discourage students from pursuing it) they most likely hate dealing with patients in my opinion, or they are in certain specialties that might be mindless. I guess private practice could also be mindless, but at almost any academic center that serves as a major referral center, you will see all kinds of stuff that no one in the world knows what is going on with and you'll have to bust out yer brainz to help the patient.

Take my comments with a grain of salt because I'm going into internal medicine where all we do is sit around and intellectually masturbate all day after we finish our 4 hour rounds.

brilliant.

 

[Jorje286]

Agreed. Some really great thoughts in this thread for anyone who wants to learn on medicine and science.

 

[solitude]

Agreed. Some really great thoughts in this thread for anyone who wants to learn on medicine and science.

ditto.