Is a tenure-track professorship a rational goal? Is MD/PhD rational? What non-TT positions exist?

[okemba]

Hey guys. I'm bothered. (I'm also clueless.)

The admissions sell of virtually every official academic source on the Internet is that the MD/PhD is a door into academia.

This portrayal stands in stark contrast with what I see here - the drying up of "real" 80/20 TT positions with lab space and start-up funds.

Assuming the latter is closer to reality than the former... what's the point of the MD/PhD degree? (Serious question; not existential.)

What sorts of non-TT career options exist where you would *actually* benefit from having both degrees? (It's always easy to talk about how having the MD gives you broader perspective, and the PhD gives you rigorous analytical skills, but what *real* added value would there be for one of these positions?)

I just don't really even have a good grasp of what non-TT positions exist.

Clues? Thanks.

---

Members don't see this ad.

 

[gbwillner]

Tenure track is the dinosaur. Most in academia now go into clinical track positions with a smaller amount of start up and protected time. The situation in terms of medicare reimbursement and R01 funding is at it's worst in history. These things tend to be cyclical, so maybe in 5-20 years this crisis ends and funding reverts to what it's been in the past. Or not. Who knows? What's not cyclical is the constant cutting of physician salaries over time. Fee-for-service may be at an end, which would spell doom to all non-primary care specialties.

Industry is another infrequently-discussed possibility, or scrapping all the hard science work and getting a cushy private practice job.

 

[okemba]

I'm a 4th year majoring in BME, graduating in May. I picked BME because I thought it would teach me about electromechanical system design to build MRI machines or work on developing techniques like RNAseq, but... I'm basically a biologist who knows some math and programming. Regrets, but I try not to think about it anymore.


My motivation for doing the MD/PhD instead of just a regular PhD is so that if my research aspirations don't pan out, I don't get stuck in permanent post-dochood (a reason I cannot articulate to my mentors without fear of looking childish). It just feels kind of hopeless. I don't think I can realistically teach myself the EE/CS skills I would need to do what I want to do, I don't want to get stuck as a biology post-doc for the rest of my life, and so I'm turning to MD/PhD as a kind of last hope for me to do research for the rest of my life.

But if I do MD/PhD and "real job" research positions are not available, then I will basically just be a clinician and have wasted time.

I don't want to sound as though I'm not motivated (because I'm more than willing to work myself to the bone if the goal is reasonable).

 

[ratherbefishing]

I'm a 4th year majoring in BME, graduating in May. I picked BME because I thought it would teach me about electromechanical system design to build MRI machines or work on developing techniques like RNAseq, but... I'm basically a biologist who knows some math and programming. Regrets, but I try not to think about it anymore.


My motivation for doing the MD/PhD instead of just a regular PhD is so that if my research aspirations don't pan out, I don't get stuck in permanent post-dochood (a reason I cannot articulate to my mentors without fear of looking childish). It just feels kind of hopeless. I don't think I can realistically teach myself the EE/CS skills I would need to do what I want to do, I don't want to get stuck as a biology post-doc for the rest of my life, and so I'm turning to MD/PhD as a kind of last hope for me to do research for the rest of my life.

But if I do MD/PhD and "real job" research positions are not available, then I will basically just be a clinician and have wasted time.

I don't want to sound as though I'm not motivated (because I'm more than willing to work myself to the bone if the goal is reasonable).

MD->postdoc is another route to consider

 

[OCDOCDOCD]

I'm a 4th year majoring in BME, graduating in May. I picked BME because I thought it would teach me about electromechanical system design to build MRI machines or work on developing techniques like RNAseq, but... I'm basically a biologist who knows some math and programming. Regrets, but I try not to think about it anymore.


My motivation for doing the MD/PhD instead of just a regular PhD is so that if my research aspirations don't pan out, I don't get stuck in permanent post-dochood (a reason I cannot articulate to my mentors without fear of looking childish). It just feels kind of hopeless. I don't think I can realistically teach myself the EE/CS skills I would need to do what I want to do, I don't want to get stuck as a biology post-doc for the rest of my life, and so I'm turning to MD/PhD as a kind of last hope for me to do research for the rest of my life.

But if I do MD/PhD and "real job" research positions are not available, then I will basically just be a clinician and have wasted time.

I don't want to sound as though I'm not motivated (because I'm more than willing to work myself to the bone if the goal is reasonable).

You're not going to sound childish for wanting to avoid post-doc hell. That's a huge concern for anyone who wants to do research, and I've had interviewers who actually brought up the topic themselves (quickly followed by "since you're applying MD/PhD this is less of a concern for you, but still..."). Also, something else to consider is the matter of funding. Even if you land a TT job and make it to tenure, if you lose funding at many schools that means you also lose your salary. So just because you get a TT job doesn't mean your struggle is anywhere near over.

Also, since you sound like a pre-PhD who's started to consider MD/PhD after discovering just how bad the research market is: while doing the MD/PhD to have assurance that you won't have wasted your life in the event you can't land/keep a faculty research position is a common (if not the most common) primary reason for doing the dual degree these days, most programs won't be willing to take someone who hasn't shown a convincing interest in medicine, so keep that in mind before applying.

And just to put this out there, I had several interviews where my interviewer asked me why I wanted to do the MD/PhD. And not in a "Why a dual degree and not one or the other?" way, but rather a "What the hell are you thinking trying to go into research in this climate?" kind of way. In other words, at half the schools I interviewed at, I had at least one interviewer warn me to turn back now. Maybe that was just a ploy to test how devoted an applicant is to research (or if they're going into the dual degree just to escape the abysmal state of research), but in one case I had an interviewer who explicitly told me she wasn't playing games and that she made a point of warning every PhD and MD/PhD applicant she interviewed about what they're getting into.

 

[dl2dp2]

Assuming the latter is closer to reality than the former... what's the point of the MD/PhD degree? (Serious question; not existential.)

What sorts of non-TT career options exist where you would *actually* benefit from having both degrees? (It's always easy to talk about how having the MD gives you broader perspective, and the PhD gives you rigorous analytical skills, but what *real* added value would there be for one of these positions?)

MD/PhD makes it easier for you to get a TT position and sustain a research career. And should the research career not work out, you can always practice clinical medicine. Clinical medicine is a non-TT career. The PhD does two things. (1) It provides training for doing research. (2) It pays for medical school.

MD/PhD is not a system that necessarily have "added value". MD + PhD isn't more than the sum of its parts from a credentialing perspective. However, having both provide a cushion, a hedge, against uncertain future in academia, funding and other external contingencies. And doing both at the same time saves a lot of money and time.

But if I do MD/PhD and "real job" research positions are not available, then I will basically just be a clinician and have wasted time.

You didn't waste your time. The PhD in itself is not a guarantee that you'll get a TT job to begin with. Unless you have an MD, you can't "just be a clinician." You have to have both in order to be in a trajectory to get a TT job *and* at the same time have the potential of practicing medicine, should it come down to that. Do you see how this works now?

Also, MD/PhDs and straight PhDs have very different trajectories at the post-residency/postdoc stage. Various career development grants are not available to straight PhDs but are available to MDs.

There are various other issues regarding the kind of research you can do, where can you do them, how can you do them, geographical flexibility, prestige, salaries, etc. that are very confusing and you don't seem to be getting a good sense of this right now. My suggestion is to talk to a few clinician-scientists and see if their career is the type you want.

 

[gonogo]

Don't forget the length of training if you go the md/phd route. It's a very long path, especially if you pick a long residency.

 

[Puff-of-Snow Sign]

I'm set to graduate this year from my program and, since it's MS-4, I've had a lot of time to reflect on my choice to pursue this path.

I actually didn't apply directly to MD/PhD programs. Rather, I thought about it, but decided to apply MD-only, got accepted, and decided half-way through MS-1 that I wanted to do the MD/PhD program after all. The reason I did it, at the time, was that I was dissatisfied with the superficial research "experiences" I had up to that point. I was looking into doing research during the summer before MS-2 and just couldn't sell myself that it would add any value to the research "training" I had already received. I wanted to be responsible for my own project, develop it through trial and error, and via that process really learn what it takes to design and execute a research project from obtaining funding to publication. To that end, I probably could've gotten a similar experience had I taken a year or two off for research, but I wanted more credit than even a year at the NIH would've provided.

Now, having completed it and gotten sufficiently far away to forget the trauma of scrambling to write my thesis in time for graduation and return to med school, I feel like I can look back and get a feel for whether I would make the same choice again. To be honest, I don't really know. From a personal perspective, my life would be very different if I hadn't had those years in grad school and had gone on to residency with (maybe) a year off for research, possibly at the NIH. From a career perspective, I might've chosen a very different specialty (which would've impacted my personal life considerably) or, even if not, I might've not received invites from some of the programs to which I applied for residency. However, I would be two years closer to attending salary - a point that is increasingly important to me, as I get older and want to move forward with the rest of my life. I might feel better about my current inclination to just screw it all and go into PP. Alternatively, I might still have the same enthusiasm for research I had before grad school (currently, my enthusiasm is a good deal lower, but not altogether depleted). I think the real take-away was that it gave me time to learn a little about what it takes to conduct hard science, try to become an expert in a particular area, and learn that full-time or even majority-time research is probably not for me. I already was "sure" (as much as one can be) that I wanted to do the clinical side of medicine, but I felt like I hadn't fully explored the research side. An added benefit was that the time I took didn't add to my education debt. In fact, it decreased it, because I was able to get an F30 funded to support my stipend and knock-down my tuition for the last 2 years of med school. So, when I weigh that and the previous point against the opportunity cost of postponing attending pay by 2-3 years, I think it was worth it for me.

I still have aspirations of a TT job or, at least, one that allows a not insignificant % of my time for research. Do I think I'm more likely to get such a job than an equally qualified applicant who doesn't have a PhD? Sure. But I don't think it gives me much, if any, advantage if there's an MD-only applicant whose research is either more impressive or a better fit for a given department in my field.