Deciding on MD/PhD vs PhD; worried about clinical boredom

[Anandamide]

Hi all,

I'm a long-time lurker that was struck by a comment by Mercaptovizadeh in another thread. I didn't want to high-jack the original thread, so I made a new one.

Link to original thread: http://forums.studentdoctor.net/threads/phd-vs-md-phd.1051658/

I think if you had asked me this question before the MD-PhD, during MS1,2 or the PhD, I would definitely say "do the MD-PhD," but now that I'm in 4th year of medical school and applying to residency, I would say, just do the PhD alone. I find clinical medicine unfulfilling, tedious, and frankly often boring. And I think residency is going to be a frightful agony.

Oh my gosh. Thank you. Seriously, THANK YOU. I have been waiting for someone to say this. I've been going back and forth on the MD/PhD vs PhD question for a while now, mostly because I'm scared I'll end up feeling like this. But I thought I was crazy. How could anyone find clinical medicine dull?

As a research tech, I consent patients, collect their tissue and then run experiments with it back in the lab. I love taking my experiments from the bedside to the bench and back again. Balancing clinical consenting with translational research can be a struggle time-wise, but it's the best kind of struggle. I work around a number of physician scientists (MD's and MD/PhD's), and all of them think I'd be a great fit for MSTP programs. I have the stats. I love to learn, and I absorb new clinical information like a sponge. But then I get bored. Seeing the same set of diseases again and again in different patients is just OK. I don't hate it. In fact, I enjoy meeting new patients and getting to know them. I just don't love clinical work as much as I love research and teaching.

I'm not naive to a number of issues that physicians face today: malpractice suits, frustration with the increasing government regulation and assessment of care, poor insurance reimbursement, drug seeking behavior, rude or non-compliant patients, endless time charting, etc. None of those things particularly bother me; I can deal with them. I'm not keen on the endless exams, work/life balance issues, and constant lack of sleep. But again, I can deal with it.

Does anyone else get bored seeing the same diseases over and over again? Do you get bored following the same diagnostic protocols and the same treatment plans – minus the occasional deviations based on a patient's other medical conditions and lifestyle? How do you deal with it? What keeps things interesting for you? After I mastered scribing, I even found Emergency Medicine to be repetitive, and EM is one of the most varied specialties! In contrast, I don't mind repetitive lab work; I actually find the repetition of manual tasks like that to be meditative.

I agonize over this decision. The MD presents so many advantages. I truly feel that clinical practice provides immense insight into a disease process; that insight, in turn, enables creative and powerful study designs. Every physician scientist I speak with always says that their research starts with the patients. I see PhD's (and even MD's that have given up clinical practice) miss fundamental problems in their human research designs, all because they're out of touch with basic clinical realities. I don't want that to happen to me.

Can I overcome this? Or am I just going to end up bored and bitter if I do the MD? With the glut of neuroscience PhD's, maybe I'm just afraid a straight PhD will leave me in adjunct professor hell....

---

Members don't see this ad.

 

[imMD2014]

You don't seem to have any desire to treat patients...so why do you want to do MD/PhD? You say MD presents advantages - but what advantages are there for you?

Of course, take this with a grain of salt as I'm finishing my MD (and on this forum for someone else). The MD/PhDs that I know felt that their life would be incomplete without seeing patients but they wanted to spend half to most of their time in the lab. They dont want to see patients just so they can make sure they are " in touch with basic clinical realities." They see patients because it is rewarding, because they enjoy the social aspect of medicine - working with their patients as a team, listening to their stories, etc.

I would suggest you get some shadowing experience - probably better to do inpatient so you'll see what it will be like in medical school and residency. Medicine is not a cookbook and my patients do not come to the ED looking like a clinical vignette from the boards. But yes, you will treat CHF and COPD and DKA over and over again (at least in medicine, I'm not sure what specialty you want to go into). Your MD years will be clinically varied enough because you will jump from one specialty to the other, but yes in residency you will see a lot of the same things. Of course this has a reason because your goal is to become a good clinician and you need repetition to do that. But if you don't plan on becoming a good clinician there isn't much of a point.

 

[Anandamide]

Hi imMD2014,

Thanks for the reply.

I do about an 80% bench/20% clinical divide for my current job. I mention earlier in my post, that I very much do enjoy the social aspects of my clinical consenting. I come back to the lab glowing after a pleasant encounter with a patient and his/her family. It’s something that I’d miss tremendously if I only worked in a lab all day. I say this as someone who has met their fair share of very ill inpatients and difficult patients.

I actually have thousands of hours of clinical experience at this point. I easily did a good 1,200 hrs as a scribe, and I saw some cool cases (including a patient with cerulea dolens). For my research tech position, I have met hundreds of patients and I have sat in on their procedures while collecting tissue. During the procedures, I ask lots of questions which the attending physicians kindly answer. They seem supportive of my curiosity, and they’ve repeatedly complimented my work with patients (as well as my work back in the lab). I have way more clinical exposure than the average MD/PhD applicant. Maybe that's part of the problem. I've gotten to sit back and watch so much, but I haven't actually gotten to personally enjoy the rewarding feeling of helping someone get better. I've gotten to experience it vicariously - and it's awesome - but I don't have the pleasure of doing it myself yet. I like my job, but I'm eager to move on with my training at this point.

Oh, and I completely agree with your point that repetition is the key to being a good clinician; it allows one to recognize atypical presentations of an illness.

I'm just worried, because patient care is ultimately my least favorite of the three (research, teaching and care). I enjoy different aspects of all of them, and I love the idea of balancing them all. I'd prefer doing 3/3 to doing 2/3. But if I had to make the decision to give one up - and it would be a very difficult decision to make - I'd still give up patient care. I feel like that's a problem. But several of the senior physician scientists in my department don't see patients anymore. So I cannot be alone in this. Or am I?*edited for spelling

 

[Anandamide]

Pondering on this more, I think I’m fine. Yes, I find research more intellectually stimulating than designing a treatment plan. But designing a treatment plan is just one of many elements of clinical medicine. You don’t have to love every single aspect of a job to enjoy it. I know a boatload of physicians that find charting to be a tedious bore, even if it is important.

For me, clinical medicine is satisfying due to the human/social elements: getting to know patients, working with a team of medical staff, improving someone’s quality of life in a very direct/tangible manner, etc. Somewhere along the line I just got it into my head that “wanting to help someone” was so cliché that I needed to come up with a better reason for doing the MD -- and that’s really sad. Just because it is cliché, doesn’t mean it isn’t essential. Just because my brain craves the constant novelty of research doesn’t mean I should ignore the needs of my heart. I risk becoming bored/bitter by ignoring either need, not by embracing both.

So thanks. I needed someone pull that out of me.

 

[gbwillner]

two specialties will help:

Pathology

Radiology

Both see an array of different and complicated cases on a daily basis. During residency I used to say that the most interesting 1% of cases seen on the floor on any medicine team make up the daily work volume in path.