How to prepare for a career doing clinical trials

[aCellsLife]

Not sure which thread to post this, but since I'm an M2, I thought it should be here

While only having basic science experience applying to med school I always thought I wanted to do oncology clinical research, possibly chart reviews, since I thought it'd give me a lot of flexibility and I had an interest in the topic. I knew a few MD-only doctors in similar scenarios so I applied only to MD. I was waitlisted at a few research heavy schools and ended up matriculating at a mid tier state school. After a summer of doing retrospective analyses, I think I would enjoy doing these types of studies and clinical trials in an academic center down the line, with a variety of clinical/teaching roles too. I have not solicited career advice from research-oriented faculty at my institution yet since I don't know many of them, and the ones I do know and talk to are often busy. Two people I've talked to about this (one PhD, one clinically-oriented MD) have strongly suggested I switch while I still can to the MD/PhD route.

However, this does not make sense to me. An MD/PhD should primarily be obtained to have a combined laboratory and clinical career. I understand a PhD may carry weight in getting academic positions, but I'm very much against using my education solely to get more letters after my name. I understand the potential benefit in getting a biostats/epi PhD for clinical research, but think getting an immunology/molecular biology PhD is overkill and involves many non-transferrable skills to clinical trials, even in cancer fields like immunotherapy/gene therapy. Also, my school does not offer biostats/epi PhD and think switching to the PhD at this stage might be too late anyway. The money factor, by the way, is not an issue to me, since having a fulfilling career is much more important. Time is somewhat a factor for me, but I don't mind spending extra years if that gives me some security in getting an academic position. I would prefer to spend such extra time learning about research design and analysis rather than basic laboratory skills, though.

TL;DR: I'm an M2 trying to understand how to get involved in a research career doing clinical trials as a clinician. I am in a mid-tier MD program and am trying to set my best foot forward to be successful.

With that overly long intro in mind, I have two questions:

1) Is getting a PhD really a game-changer in getting a top tier academic residency/fellowship/faculty position, particularly for researchers doing RCTs? Is this enough for me to reconsider my MD-only path if I'm interested in this? I notice a lot number of MD/PhDs in large multicenter studies I cite for my research, but I understand this could be just due to them having more dedicated research time. I know many researchers choose to get an MS or MPH in fellowship.

Obligatory aside: I don't care about prestige, but would prefer to be somewhere that does a lot of research. Being at my institution now I have learned the difficulties of having small patient sizes in certain studies or not enough research infrastructure in EHR studies.

2) If you are an MD-only researcher, are you more likely than not able to secure funding/do studies only from pharmaceutical companies? I know you need to get drugs for testing somewhere, but I would like to have as few connections to for-profit industries as possible. I really want to do research, so I am fine with sucking it up and not letting the conflicts of interest affect my work.

If my post comes off as naive or disorganized, it's because I really do know almost nothing about this topic, at least from a career perspective. My goal now is to just do well on step, match well in IM, and get a masters in fellowship. I know the answer could be as simple as that but wanted to solicit more people's thought on the topic. Thanks in advance for reading.

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[NickNaylor]

An MD/PhD is not a necessary pre-requisite for research, particularly with clinical trials. There are plenty of MDs who do research primarily or exclusively. You will almost certainly need to get more extensive research experience and make this a particular point of focus in your training if it's the route that you want to go, but a PhD is not necessary. The primary benefits would be having the formal didactic component of developing a research question, generating a hypothesis, and designing a study to test that hypothesis in addition to the actual experience of doing those steps during your training. But you can get that experience elsewhere, especially if you do something like a research fellowship or are otherwise heavily involved in research as a student and resident (which is easier said than done).

One of the faculty here who heads a huge research center at our institution and is on a bunch of big-name research papers in psychiatry "only" has a MD. As far as I can tell, he does absolutely zero clinical care and is primarily a manager at this point. Our department chairman is a MD only and does research exclusively.

 

[Matthew9Thirtyfive]

One of the faculty here who heads a huge research center at our institution and is on a bunch of big-name research papers in psychiatry "only" has a MD.

One of my PIs does 80% research and is “only” an MD as well. He has several patents and tons of papers. The PhD is definitely not necessary if you take the initiative to learn what you need to learn.

 

[Lucca]

I wouldn’t do a PhD to do clinical research and especially not just to get a supposed advantage in the match / obtaining grants. Grant funding rates for MD and MD/PhD scientists are fairly similar based on NIH data, however the proportion of MD/PhDs applying for grants is obviously much higher than MD since most MDs never had any interest in doing so. Practically speaking, if your institution is any good there will be a statistician/Epidemiologist on the grant / paper to help you work out the nitty gritty stuff. As an MD or MD/PhD in the clinical research context the real value you bring is access to patients, clinical knowledge, ability to enroll people in trials — science, like medicine, is a team sport. Now, if you wanted to do the full bench to bedside thing (which very, very few people are able to do nowadays even with an MD/PhD the success rate to that kind of job is 10-20%, there’s a thread about it on the PhysSci board) then a PhD or equivalent level of training would be very useful.

Get as much exposure as possible, consider doing a research year if your med school will fund you, try to match at a major research institution with infrastructure for mentoring aspiring academic physicians and get a very focused MS if you feel you need more training at that point or during fellowship. In terms of the entire physician scientist workforce, about 50% are MD “only” and 50% are MD/PhD, again it’s not so much about the degrees as it is about the training pipeline and access to mentorship, protected time, mechanisms for eliminating debt etc. Especially for clinical research a PhD is not necessary.

Check out the physician scientist board on this website for more info about the different paths/options, or post there to get more advice from people who are doing the physician scientist thing.

 

[aCellsLife]

Thanks everyone for kindly taking the time to respond! There are a few MD researchers at my institution who I know have successfully written grant proposals for clinical projects and still see patients. I think many of the people who have told me that I am not being realistic or taking a risk have also had personal biases/reasons to suggest the PhD route onto me. So, I am very happy to hear that I am not not having delusional aspirations after all. I do know it will not come without its challenges, though, so I appreciate the tips to get as much exposure as possible.

With that said, I'm back off to the M2 grind!