How true is this statement regarding MD/PhDs

[Fish3715]

Hi-

I was researching information about MD/PhDs so I try to determine whether this would be an appropriate path for me and I came across this statement on a message board:

"It is always possible for MDs to undertake research whenever they feel the desire to do so. A PhD is not some kind of a license to do research in the same way as a medical degree is required for licensure to practice medicine."

http://www.medicalgold.com/wwwboard/messages/10789.shtml

Is this true, and if so to what extent (i.e. is there a limit to the amount/type of research MDs can pursue)?

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[MacGyver]

On its face, that statement is right.

However, to imply that the PhD is not helpful for research is BS.

Med school does not train scientists... some MDs manage to do it regardless, but PhD is the gold standard.

I look at it this way. Say you are doing a cross country trek across Australia, and you can either wear tennis shoes (MD) or badass hiking boots (MD/PHD).

Now, you can make the trek either way, but hiking shoes gives you an advantage over the tennis shoes.

 

[Fish3715]

Good analogy. Thank you

 

[PhysicsDoc]

I would think the PhD can matter immensely depending on the field in which you want to do research. For instance, I'm interested in biophysics/bioengineering, a discipline that most MD's probably wouldn't be allowed to touch with a 12-foot pole.

It seems to me that if you're going into an MD/PhD program to get a PhD in medical biochemistry, immunology, etc. that it's just a waste of time -- these fields are so closely associated with medicine that you'd have no problem doing research in them with "only" a MD (in fact, I know several doctors who do). However, if your intended PhD goes 'beyond the scope' of traditional medical education (ie, into physics, chemistry or something of the like), then getting that second degree is not only going to open a whole lot of doors, but will also expose you to new (non-medical/biological/qualitative) ways of thinking which will in the end make you a more inquisitive/productive scientist.

My $0.02, anyway.

 

[coldchemist]

Frick,

I can understand your opinion on this, but don't forget that the MSTP grant was designed specifically for people who want to do biochemical and immunological research. The feds obviously thought that a PhD in addition to an MD would be beneficial to researchers in these disciplines. Sure, there are biophysics and BME graduate programs that include MSTP students, but I think these are the exception, not the rule.

CC

 

[pathdr2b]

Originally posted by frick
then getting that second degree is not only going to open a whole lot of doors, but will also expose you to new (non-medical/biological/qualitative) ways of thinking which will in the end make you a more inquisitive/productive scientist.

This also why future MD's who plan to pursue PhD's in areas close to medicine, need the PhD as well.

I've said it a million times and maybe you have to have been in graduate school to know this, but graduate school is the place you learn to be a scientist, NOT medical school. I imagine if medical school did this well, there wouldn't be grad programs at all.

 

[PhysicsDoc]

Originally posted by pathdr2b
I've said it a million times and maybe you have to have been in graduate school to know this, but graduate school is the place you learn to be a scientist, NOT medical school.

That's the entire point of what I just said. How are you getting a *scientist's* training in a *medical school department* such as molecular biochemistry (this is what biochem depts in medschools are usually called to the best of my knowledge), immunology, etc?

The PhD should be given from a department of *pure science* (chemistry, biochemistry, physics, etc) that has *no affiliation* to the medical school. The whole point of being a 'physician scientist' is that you have a different perspective on the world of research when compared to someone who has spent their (graduate) life inside of medicine. If you don't acquire this perspective, then the entire PhD was for naught, since you haven't really broadened your horizons beyond the scientific training you receive as a MD.

Once again, this is just my opinion... so you can take it for what it's worth.

 

[Neuronix]

Originally posted by frick
I would think the PhD can matter immensely depending on the field in which you want to do research. For instance, I'm interested in biophysics/bioengineering, a discipline that most MD's probably wouldn't be allowed to touch with a 12-foot pole.

I don't see this as being true. I know of two MDs here (one of which I want to do research with this summer) who have primary appointments in bioengineering. One of them just obtained tenure. Their experience in BE has been from undergrad and post-docs or other research experience.

As for the original question, the topic has been beat to death. Concisely, I see the two biggest reasons for doing the MD/PhD as:
1) Cost - You get medical school training and you get paid for it. How useful this medical school training is to a research career is arguable, but the NIH seems to think that it's important enough to spend all that MSTP money on.
2) Learning to be a researcher. You can get this experience without a PhD, but you're going to have to get it somewhere, and it's going to take years regardless.

This assumes you want to do basic science research. For clinical research (applications of therapies, comparing effectiveness of treatments, etc), no PhD is necessary and the MD/PhD programs are typically not geared to produce this kind of researcher.

 

[PhysicsDoc]

Originally posted by Neuronix
I don't see this as being true. I know of two MDs here (one of which I want to do research with this summer) who have primary appointments in bioengineering. One of them just obtained tenure. Their experience in BE has been from undergrad and post-docs or other research experience.

My guess is that it would be true unless the MD had an undergraduate background in engineering/physics, which it sounds like your acquaintances did.

 

[tofurious]

"It is always possible for MDs to undertake research whenever they feel the desire to do so"

The keyword here is possible. An intelligent and driven MD interested in research can probably do quite well in research. However, the average MD does not have the amount of training a PhD scientist does, similar to how a PhD does not know the ins and outs of a disease as a MD does despite how much time the PhD has spent studying the basic mechanisms of the disease. A combined training program does not give you the license to do either. It trains you to do both, and gives you the skillsets to excel in both. Licensing and ability are two completely different things.

 

[pathdr2b]

Originally posted by frick
That's the entire point of what I just said. How are you getting a *scientist's* training in a *medical school department* such as molecular biochemistry (this is what biochem depts in medschools are usually called to the best of my knowledge), immunology, etc?

What do you think the PhD's, MD's and MD/PhD's are doing in these molecular biochemistry departments, watching the folks in nonmedical school biochemsitry departments run gels and do PCR?

I have have seven words for anyone who needs to see proof of medical school science departments being on par research wise with the rest of the campus - The University of North Carolina at Chapel Hill"

 

[hotRNA]

The purpose of medical school is to teach students to be solution-driven. They are armed with the questions HOW and WHAT. What is the apparent ailment? what caused it? how can one treat it?

The purpose of graduate school has a completely different aim; that is, to teach students to be scientists. A scientist is continually working with the question WHY? On the cellular or molecular basis, why do these correspond to this disease? Why does loss/addition of this (insert biomedical term here) cause disease?

Thus, there is a fundamental difference in the learning processes between getting a PhD and an MD. Thus, to say that getting a PhD in a "medically-related" field is superfluous is a misconception of the process. While the graduate school experience teaches many specific skills, it's goal is higher. Thus, the MD/PhD experiences allows for the combination of the two fields of thought, so as to prepare *physician scientist* that can incorporate the HOW and WHAT and correspond it to the WHY.

In addition, doing BASIC SCIENCE research as a MD can be detrimental unless you are very skilled. MDs are competing against PhDs (and MD/PhDs) for grants. This can be a huge drawback! I bet any science professor you meet no longer works in a lab but spends time writing papers for submission (not a med school course) and writing grant proposals.

So, yeah, you could say a PhD comes in handy!!

 

[PhysicsDoc]

Originally posted by pathdr2b
What do you think the PhD's, MD's and MD/PhD's are doing in these molecular biochemistry departments, watching the folks in nonmedical school biochemsitry departments run gels and do PCR?

I have have seven words for anyone who needs to see proof of medical school science departments being on par research wise with the rest of the campus - The University of North Carolina at Chapel Hill"

Knowing how to do a PCR does not mean you know how to do research. Christ, we did PCR's in my 9th grade bio class in high school (the teacher loaned a machine from the local Univ for a day).

The reason that you should have to get a PhD in a department outside the medical school is simply this: medicine, with an extreme focus on memorization rather than analysis, knocks the capacity for creative thought right out of you. You must realize that 99% of the biological research going on in medschools is probably not innovative, per se, just "here's another gene, let's clone it, let's pcr it and run some acrylamide gels to look at the product". People have been doing this for years, and yes, it's getting us places, but I would hope that if you're one of 300-some federally-subsidized MSTP students in the nation that you've grown beyond the "identify->categorize" simplicity of basic biological research.

Getting a PhD in a non-medical department exposes you do a different field of science, and more importantly, a different way of thinking. In my opinion, THAT'S the point of the MSTP program: so you can have the capacity see things where typical medical researchers simply can't. Say, for instance, you get that PhD in computer science and you're looking at the gene structure of drosophila. This is a nice thing for medical researchers to print onto a poster and put it on a wall (I think it was actually a pull-out in Science recently), but they really can't make any sense of it as a whole. Nevertheless, you, as a computer scientist, realize that it might be possible to model this system algorithmically, set out to do so, and end up discovering the interrelation between certain genetic pathways (hypothetically speaking, of course), when pure medical researchers weren't even going in the right direction. Ideally, MSTP students will be able to bring a different perspective to a difficult situation, not just more of the same.

 

[pathdr2b]

Originally posted by frick
Knowing how to do a PCR does not mean you know how to do research.

I'm so glad you cleared this up for me

As a person with an advanced degree from a non medical school department (Chemistry), I don't know why I'm wasting my time having this discussion. But I can assure you that here at the NIH and at Harvard, Penn, and Hopkins, there are many, many, many departments in medically focusd areas doing a lot more than cookie-cutter scientific research. FYI, it's called translational research and I've personally worked in a lab (Pharmacology) that went form the bench to clinical trials in about 2 years time.

This is a nice thing for medical researchers to print onto a poster and put it on a wall (I think it was actually a pull-out in Science recently), but they really can't make any sense of it as a whole.
You may want to mind your comments young man, as you may end up working for one of us "bakers" one day. Also keep in mind that not too distant future adcom members are on these boards too.

So my question to you is since you think so highly of medical education, why don't you stick with just getting a PhD? It doesn't sound like you have too much respect for the training.

 

[hockebob]

frick,

i'm really not sure there's any difference in the type of learning between a so-called "pure science" graduate department and one that is associated with a medical school. i point to harvard's division of medical sciences as an excellent example of this. fundamentally, there is no difference in the way courses are taught or the material is presented in the department of genetics at DMS and the department of molecular and cellular biology on the cambridge campus (even though one is a pure science dept. and the other associated with a medical school).

i think you're confused and/or assume that anyone getting a phd from a graduate department associated with a medical school is doing so in a field like anatomy, where memorization is key and the learning process is very similar to medical school.

however, there's a significant difference between, let's say, "immunology" and "molecular immunology", the former being a descriptive, physiological understanding of the immune system and the latter being a critical and scientific understanding of the cellular and molecular events that underlie such physiological processes.

basically, what i'm trying to say is this:
because a particular graduate program is associated with a medical school, does not, per se, mean that it adheres to the philosophy of general medical eduation.

just look at the other departments of DMS:
biological chemistry and molecular pharmacology
pathology
cell biology
microbiology and molecular genetics
systems biology (new!)
neuroscience
virology
immunology

regards,
- aaron

 

[PhysicsDoc]

Originally posted by pathdr2b

So my question to you is since you think so highly of medical education, why don't you stick with just getting a PhD? It doesn't sound like you have too much respect for the training.

I honestly don't think MSTP students should end up focusing on clinical stuff: if you want to do this, you should go the MD-only route. There are myriad reasons for this, among them the fact that doctors who practice clinically on a day-to-day basis will have a much better intuition with respect to recognition/diagnosis of disease, etc. So, in other words, MSTP should be for those persons who want to go into research and FOCUS on research, but who also want to be able to apply their research clinically.

The medical education is something I'm interested in because it will give me a good grounding in anatomy/human biochemistry while actually exposing me to the clinic, where whatever research I do might eventually be put to use. I've personally got no intention of pursuing a residency after completing the program (if I end up applying to/getting into one), since residencies should be for *practicing, clinical doctors*, not researchers. If you want to emphasize clinical work in your medical life, with research as a side-job, why not just get the MD? Unless you devote yourself *fully or near-fully* to research, whatever you accomplish will probably be trivial and nothing more than self-aggrandizing.

But back to the point... the reason I want the MD-part of the MSTP program is that so I have a good foundation in the biological sciences and that I have a good understanding of exactly what occurs in a clinical setting. For instance, one of the projects I might possibly be interested in is the design of an artificial retina; to do this, one would not only need an understanding of the biological side of things, but an understanding of the quantitative (physical) sciencesas well. Further, to comprehend how such a device might be deployed in the clinical setting, a person would need to have experience with clinical work in their past, ie, the procedures and intricacies of surgery and the emotional impact something like this could have on the patient and his/her family.

Additionally, the MSTP program opens the door to medical academia... which I am also interested in, I suppose.

 

[PhysicsDoc]

Originally posted by hockebob

i think you're confused and/or assume that anyone getting a phd from a graduate department associated with a medical school is doing so in a field like anatomy, where memorization is key and the learning process is very similar to medical school.

however, there's a significant difference between, let's say, "immunology" and "molecular immunology", the former being a descriptive, physiological understanding of the immune system and the latter being a critical and scientific understanding of the cellular and molecular events that underlie such physiological processes.

I should probably clarify what I'm saying a little... which is essentially that the differences between those departments, to the best of my understanding, are trivial. Biology, as we are very quickly discovering, is the science of what has turned out to be a number of complex systems (on the macro scale) and of proteins; it has thus turned into an inherently quantitative problem. For instance, the two immunology classes you mentioned: while one may be more "scientifically heavy", I'll bet there is still a good amount of hand-waving that goes on with respect to "antibody X binds to virus Y and deactivates it". Since a number of you have already stated that the fundamental question of science is 'why', then answer this: WHY is the antibody binding to the virus? WHY is the virus nonfunctional afterwards? Can the typical med student go and create a thermodynamic model that might corroborate the binding affinity of the antibody? Can they go do an ab initio simulation of the protein wavefunctions to see what favorable chemical interactions are occurring during binding and how the virus structure is changing? The answer is, probably not, and in all honesty that's where I believe the MSTP's should be able to strut their stuff; fields of science that are completely beyond the scope of a traditional medical education.

 

[hockebob]

frick,

as for the purpose of the MSTP, i respectfully disagree. it seems to me that most of what is currently being done in basic biological and biomedical research is outside of the realm of medical education, which really focuses more on diagnosis, prognosis and patient interaction than the general biological mechanisms of disease (the exception, perhaps, being HST).

additionally, i believe that, although there may be great promise, there is also great danger in reducing the problems of biology to chemistry, physics and, ultimately, math... particularly when seeking to apply those theories to medicine. your artificial retina is a particularly interesting example. although, we may be able to understand and reproduce the physical phenomena that yield sight, are we limited in our ability to integrate these advances into medical practice? and, if so, should we not then strive for a solution that, although more qualitative and perhaps imprecise, is more compatible with the current methods of medical treatment?

i guess what i'm really asking is:
where is the line between the esotericism and utility of medical/scientific knowledge?

it may be that, in the not-so-distant future, medicine will be practiced in such a way that allows the intricate understanding of protein structure and dynamics to really affect the well-being of patients, but it seems that until that point we must work within the existing semi-quantitative biological systems to make advances in medical care/technology.

best,
- aaron

 

[PhysicsDoc]

I understand, and it's probably good that we each have different opinions... that way the MSTP program will have all bases covered

 

[pathdr2b]

Originally posted by tofurious
Be careful when you accuse someone else in an accustory tone.Stop the finger pointing.

And why haven't you ask him to do the same? The reality of life is that we're all not here to help people outside of a freind or relative, some of us are here to:

1) get a free education
2) Fullfill Mommy and Daddy's dream for us
3) To get "paid"
4) To have the research world bow down to our almighty MD/PhD
5) And then there's that 1% of us that really hope to do mankind some real good.

So please, stop being so naive.

 

[PhysicsDoc]

Originally posted by pathdr2b
Who said anything about conducting research as a side job? It sounds to me that the ONLY reason you're interested in the combined program is for the prestige and money. How else can you justify your interest in the MD given your critisims? If that is the reason then fine, be man enough to to admit. But don't blindly accuse folks you don't know of having the same selfserving motivations that you do. Some of us really do plan to change the world with our research careers.

If you think it's possible to be both an excellent clinician and an excellent researcher at the same time, then you're the one who is naive. As an MSTP, you will inevitably have to tilt to one side or the other, and it's my opinion that the aim of the program tilts to the research side.

Originally posted by pathdr2b

5) And then there's that 1% of us that really hope to do mankind some real good.

You don't need to be a doctor; all you need is a set of nursing skills to be an altruist. Complicit with becoming a physician is the belief, whether you will admit it or not, that you'd like to get a big salary. (And actually, by eschewing clinical work, I am essentially foregoing that salary, since I would just be working in the realm of academia.)

 

[dl2dp2]

The immediate violation to what you said would be Rod Mackinnon the Nobel prize winner in chemistry who did his reserach in biophysics, but was trained as an MD only.

Degrees don't matter. Research experiences do.

Originally posted by frick
I would think the PhD can matter immensely depending on the field in which you want to do research. For instance, I'm interested in biophysics/bioengineering, a discipline that most MD's probably wouldn't be allowed to touch with a 12-foot pole.

It seems to me that if you're going into an MD/PhD program to get a PhD in medical biochemistry, immunology, etc. that it's just a waste of time -- these fields are so closely associated with medicine that you'd have no problem doing research in them with "only" a MD (in fact, I know several doctors who do). However, if your intended PhD goes 'beyond the scope' of traditional medical education (ie, into physics, chemistry or something of the like), then getting that second degree is not only going to open a whole lot of doors, but will also expose you to new (non-medical/biological/qualitative) ways of thinking which will in the end make you a more inquisitive/productive scientist.

My $0.02, anyway.

 

[coldchemist]

One of the things I love about the MSTP forum is that we generally have the pleasure of avoiding these types of arguments.

Bottom line: Frick believes that the MSTP should do what he thinks it should do regardless of what the rest of us believe (not to mention the CLEARLY STATED goals of the NIH for the MSTP grant). His opinion isn't going to change, neither is the opinion held by the rest of the world...so let's just leave it at that and move on to more important matters.

Like waitlist movement!

 

[PhysicsDoc]

Ugh.

First thing's first, the example someone gave.

http://www.nature.com/cgi-taf/DynaPage.taf?file=/nm/journal/v7/n6/full/nm0601_648.html

Does it sound like MacKinnon devoted half of his time to the clinic? I mean, look at his own description of his work:

"I came from an electrical background, and then slowly using molecular biology we identified parts of the potassium channel, but without actually seeing them we knew it would be really impossible to understand how it worked. At that point I made the decision to study X-ray crystallography and to become good at it."

In other words, it sounds like he was interested in basic science from the get-go, a fact which can be verified by looking at his biography:

http://www.hhmi.org/research/investigators/popups/mackinnon_bio.html

"He completed medical residency at Beth Israel Hospital, Harvard Medical School, and postdoctoral work at Brandeis with Christopher Miller. "

Evidently, MacKinnon *has* received the training that someone in the basic sciences ordinarily might have through his completion of postdoctoral work. And yes, this is an incredible accomplishment, making it the exception rather than the rule; most MD's haven't done postdocs, and most MD's are not suited to do research in the basic sciences (particularly the physical sciences, due to the lackluster education in physics/chem you ordinarily get as a premed -- remember 'physics for life science majors'?).

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Now back to the nature of the MSTP program in general. Here's an excerpt from UCSF's interpretation of the NIH's goals for the program:

http://medschool.ucsf.edu/mstp/program/nih.html

"Graduates of the MSTP differ from most scientists in having had the medical training required to investigate problems of disease in humans. They differ from most clinicians in having had extensive background in the biological, chemical, physical, or behavioral sciences needed to bring the fundamental knowledge and insight of these disciplines into clinical investigation. The majority of the graduates go on to careers in basic biomedical or clinical research."

It certainly sounds like the aim of the MSTP program is mainly to produce researchers. Ask yourself this question: what does the NIH usually give grants for in the first place? Research. Wouldn't it make sense that the money they're pouring into you through the MSTP program is meant to help develop you into a competent *researcher* (albeit with the "ability to investigate disease in humans", hence the purpose of the MD).

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Originally posted by pathdr2b

I really pitty you but more than that, I pitty your future patients of color. I've rarely said this but hopefylly you'll never get the chance to practice on anyone. You're a racist plain and simple.

Nice job pulling the race card when you can no longer make a cogent argument (for the record, I had no idea as to the nature of your ethnicity when I made that post; it just seemed to be a common example of 'altruism' which people liked to cite). Maybe you should go read some of my other posts about AA. You'll end up concluding that it's actually *you* who's perpetuating the racism in this country because you utilise race to compensate for your personal inadequacies (of course, racism *did* exist here in the first place but as a country we've tried hard to get rid of it; ironically, it's the minorities who keep bringing it back up). Not that this isn't common -- look at all the obese people who want to sue the fast food chains -- but I suggest that you go look in the mirror sometime before you start throwing your troubles onto someone/something else.

This will be my last post in the thread.

 

[dreamaloud]

So I have a more concrete question to ask, so I don't get involved with all the philosophical stuff going on.

Can you do an MSTP in say physics, since that's what would be interesting if you're going into radiology or radiation oncology?
Or to do MSTP, do you have to be a bio-something or bio related in some way? Are there actual rules for what you can and can't do your phd in?

 

[coldchemist]

It really depends on the school. Some schools, especially those with separate campuses, will only allow you to work with a researcher that is conducting research on the medical campus. This might mean that you would not be able to work with a pure physics mentor; on the other hand, there are other bio-disciplines (like biomedical engineering) that might be just relevant and a bit more interesting to people interested in radiology.

In addition, there are schools that will let you study in any department as long as you are able to justify it.

 

[dl2dp2]

yes, though it does depend on the school (at columbia, for instance, yes, I know this is true at rice/baylor and a few other schools.)

i think the more pertinent question is why would you want to do a phd in physics? considering the fact that the phd degree usually starts out with one or two years of course work in quantum, E&M and mechanics, most of which is useless for your research but required for the degree, i recommend instead do a degree in a bio dept and go work for a faculty instead. (example, there are a number of biochemistry phd students who work for Steve Chu at stanford, using his trademark laser methods without having to do all the uesless physics coursework.)

Of course, if you think calculating the Clebsch-Gorden coeffecients and the levi-civita tenor would somehow contribute to your career in radiology...then be my guest (although, David Kleinfeld at UCSD seemed to think that QM is somewhat useful especially in imaging when i talked to him...i don't know if i agree with him )

Originally posted by dreamaloud
So I have a more concrete question to ask, so I don't get involved with all the philosophical stuff going on.

Can you do an MSTP in say physics, since that's what would be interesting if you're going into radiology or radiation oncology?
Or to do MSTP, do you have to be a bio-something or bio related in some way? Are there actual rules for what you can and can't do your phd in?

 

[Gut Shot]

Dear Fish,

To return to the original question, yes, the statement is true. This does not mean, however, that a Ph.D. is not a useful thing to have.

I finished my Ph.D. and started med school in 2001. Did it help me get in? Probably. Has it helped me during med school? Absolutely. Is it nice to have those extra letters after my name? Damn straight. Was it worth it for me? THAT is the question.

When all was said and done it took me almost 6 grueling years to finish my dissertation. The benefits of it have to be placed in the context of the sheer investment of time and effort that I put into the process. In the end, I'm not sure I would do it the same way again. For me personally it may have been better to work for a couple of years before applying to MD programs.

In my opinion there is just no generic answer to the question of MD vs. PhD vs. MD/PhD. Based on the number of excellent MD researchers (and department chairmen) I know I'd say that an MD isn't really going to hold the motivated individual back from a research career. Besides, you can experience 95% the agony of 4+ years of graduate school by doing about 2-3 years of a post-doc or research-oriented residency. And the pay is better.

 

[pathdr2b]

Dam, over 1100 views! This topic is hot, hot, hot!

 

[Fixed Gear]

Nice catch on the Simpson's quote. It's funnier the way you had it- that it shares an acronym with Harvard(HUMS), so thanks for showing me.

 

[Neuronix]

I received a PM earlier about this thread, and I agree with it. This petty bickering and these personal attacks need to end. It's bad enough when it's private but it's even worse in public. I'm closing this thread and I just demolished all the posts in the thread that had to do with this flame war. I apologize for not doing something about this thread sooner. I've been very busy and I didn't realize how out of hand it had gotten.

If you have a problem with someone in a thread, do the mature thing and IGNORE THEM. You can add them to your ignore list so you don't have to read their ridiculous or inflammatory posts.

PS: The funniest thing to me is all of the second accounts that have posted in this thread. Don't worry, I'm not telling anyone