Is it possible to research (PhD) something quite different than your specialty?

[Mdr1985]

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Is it possible and/or at all common to be an MD/PhD who practices a specialty very different from what they research? Seems like it may be better to 'put all your eggs in one basket', but I happen to be incredibly interested in researching cancer treatment, while feeling that emergency medicine (or possibly critical care) is truly where I want to practice. Thoughts???

 

[LizzyM]

That would be odd because generally, one's research informs one's practice and practice informs research. It would be odd to be an expert in the treatment of x and yet not see patients with x.

You'd be trying to keep up with advances in the field of medicine you are practicing while keeping up with advances in the area of research in which you are working. That means twice as much professional development and continuing education as some one who does research and practices in a single field.

It just seems nuts to me.

 

[Morsetlis]

Sure, but who will hire you?

 

[QofQuimica]

Is it possible and/or at all common to be an MD/PhD who practices a specialty very different from what they research? Seems like it may be better to 'put all your eggs in one basket', but I happen to be incredibly interested in researching cancer treatment, while feeling that emergency medicine (or possibly critical care) is truly where I want to practice. Thoughts???

No, this is not common at all. EM tends to be a very clinically-oriented specialty. Unless you're interested in something like sepsis, there are not very many opportunities for basic science research in EM. If you're interested in clinical research, you would need to be able to recruit patients for studies, which you won't be able to do unless you're in a specialty where you're taking care of cancer patients. So if you want to do cancer research, you would probably go into IM with a medical oncology fellowship, or possibly rad onc.

 

[HumbleMD]

Is it possible and/or at all common to be an MD/PhD who practices a specialty very different from what they research? Seems like it may be better to 'put all your eggs in one basket', but I happen to be incredibly interested in researching cancer treatment, while feeling that emergency medicine (or possibly critical care) is truly where I want to practice. Thoughts???

Relax. You're super early. Both your clinical and research interests will evolve over time so don't stress too much.

As Lizzy and others have said, your clinic and research inform eachother. There's no way you'd come up with any brilliant cancer research questions if you aren't seeing cancer patients.

The most peripheral I've seen is a brilliant Peds Nephrologist who is getting into a lot of adult bone research (not completely discordant as Vit D is a kidney issue). She's a super star with 7 RO1 grants by age 45 though, so I wouldn't model my career in the hopes of being like her.

 

[Mdr1985]

Thanks for everyone's thoughts. I figured as much, but wanted to throw it out there since I'd never actually seen it talked about or asked (probably because it's never done).

Another question. . . Is there a heavy research component to hemonc fellowships and/or the profession post fellowship? Would it be of great benefit to do Ph.D/MD for hemonc, or are you going to get a lot of research anyways (and thus, makes more sense to do your research when your done with school and paying back your debt, instead of in the middle of school when you're racking up more debt)?

Would it be accurate to say that many hemonc physicians spend time in a lab researching, then actually take what they have themselves found to patients (through clinical trials, etc.). . . or. . . is it more likely that you have "the scientist" in the lab, and "the physician" in the hospital administering and monitoring what the scientist created?. . . If hemoncs can (and often do) bridge that gap, that would be incredible.

Thanks in advance for your thoughts and insight!

 

[patineurMD]

Another question. . . Is there a heavy research component to hemonc fellowships and/or the profession post fellowship? Would it be of great benefit to do Ph.D/MD for hemonc, or are you going to get a lot of research anyways (and thus, makes more sense to do your research when your done with school and paying back your debt, instead of in the middle of school when you're racking up more debt)?

I won't speak to your other questions because I really don't have a clue, but a lot of MD/PhD programs are NIH funded (MSTP) and both degrees are paid for if you do your PhD between M2 and M3 of your MD. Just a thought!

 

[LizzyM]

MD/PhD programs generally come with tuition and stipend so that one graduates with relatively little debt (perhaps some if the stipend isn't enough to cover one's living expenses). This is meant to encourage physician-scientists to become investigators rather than to need to go into full-time practice to repay a heavy debt.

Heme-onc fellowships often include the expectation that fellows will do research and many of them enter MS programs to learn how to do clinical research (bench to bedside, drug development, study design & analysis, human subjects research, etc). There is funding to cover these MS programs, in full or in part.

As with much of medicine, cancer research is collaborative. Here's one example of a collaborative group:
http://ecog.dfci.harvard.edu/general/intro.html

 

[HumbleMD]

Doing an MD-PhD program for the savings isn't the best motivation to do it (opportunity costs are commonly cited as a reason).

If you see yourself as a serious researcher in the hard sciences, it's a very good idea to have a PhD to be taken seriously by the NIH when applying for grants. If you lean towards clinical research (biostats, translational and observational research, and epidemiology), a master's degree is usually enough. You can often obtain the master's degree as part of your fellowship.

Nearly all fellowship programs involve a year of research.

You can certainly create a practice model for yourself as you see fit, but most serious researchers operate under a 20/80 clinical/research model (which is also what you'd be doing in your first years out of fellowship on K-level research grants).

 

[Brachyury]

Thanks for everyone's thoughts. I figured as much, but wanted to throw it out there since I'd never actually seen it talked about or asked (probably because it's never done).

Another question. . . Is there a heavy research component to hemonc fellowships and/or the profession post fellowship? Would it be of great benefit to do Ph.D/MD for hemonc, or are you going to get a lot of research anyways (and thus, makes more sense to do your research when your done with school and paying back your debt, instead of in the middle of school when you're racking up more debt)?

Would it be accurate to say that many hemonc physicians spend time in a lab researching, then actually take what they have themselves found to patients (through clinical trials, etc.). . . or. . . is it more likely that you have "the scientist" in the lab, and "the physician" in the hospital administering and monitoring what the scientist created?. . . If hemoncs can (and often do) bridge that gap, that would be incredible.

Thanks in advance for your thoughts and insight!

To echo and to add to other posters, with income based repayment's public service forgiveness, the financial benefit (if any) to an MD, PhD really no longer exists.

You've tapped into something with your post: if you want a research career (i.e. basic) having a Ph.D. is one way to do it. However, it is also possible to have a research career if you have an extensive research background doing a mix-and-match of the following: research in college, maybe tech for a year or two after college, research during med school, a one-year research fellowship during med school, research during your residency/fellowship, and post docing while you are a junior faculty member.

In academic medicine, unlike private practice, physicians can sub-specialize. For example, at an academic hospital, there are heme/oncs who only do lung cancer and there are some that only handle sickle cell. In many of these cases, physicians will treat a sub-group of patients and their research is dedicated to that sub specialty. One of the reasons why you want to have similar clinical and research interests is that as you read papers and go to conferences in either research of clinical medicine, this knowledge will improve your clinical and scientific practices. In general, yes, the research you do can be applied in clinic. It is important to note that not all physicians with research careers have basic labs: some only do clinical research, and others do a mix of the two.

 

[HumbleMD]

To echo and to add to other posters, with income based repayment's public service forgiveness, the financial benefit (if any) to an MD, PhD really no longer exists.

You've tapped into something with your post: if you want a research career (i.e. basic) having a Ph.D. is one way to do it. However, it is also possible to have a research career if you have an extensive research background doing a mix-and-match of the following: research in college, maybe tech for a year or two after college, research during med school, a one-year research fellowship during med school, research during your residency/fellowship, and post docing while you are a junior faculty member.

This is almost never done by MDs. K9/R00 grants (which fund a "post-doc") are too competitive in the basic sciences without a PhD. If you want a serious research career you need to have funding. And if you want to have funding, you need NIH grants. And if you want NIH grants you wil invariably need some extra letters after your name and some coursework under your belt. 1 year research fellowship in med school are to "try out" research and see if an academic career interests you. A Master's degree will serve you much better if you believe research is where you want to go.

If the OP is a competitive applicant and serious about basic science research and academic medicine, then there is no replacement for the MD/PhD degree. The MD-only running around with R01 grants and their own lab is a rare and difficult find.

 

[Brachyury]

This is almost never done by MDs. K9/R00 grants (which fund a "post-doc") are too competitive in the basic sciences without a PhD. If you want a serious research career you need to have funding. And if you want to have funding, you need NIH grants. And if you want NIH grants you wil invariably need some extra letters after your name and some coursework under your belt. 1 year research fellowship in med school are to "try out" research and see if an academic career interests you. A Master's degree will serve you much better if you believe research is where you want to go.

If the OP is a competitive applicant and serious about basic science research and academic medicine, then there is no replacement for the MD/PhD degree.

Unless you are doing an MS in clinical research, biostats, or public health, and MS in basic research is antiquated and will not help you (i.e. unlike an MBA or MPH, an MS in basic research does not give you a unique skill set that others do not have)

In terms of postdocing, you would be on a T32 that starts in fellowship and continues through junior faculty status, and during junior faculty status, you apply for a K-award

OP, talk to MD, PhD and MD-only basic research faculty, and ask them if they regret their path. Everyone has a different opinion, so unfortunately, there is no correct answer. In my experience of talking to attendings, many MD, PhDs regret their decision: they feel that they were in school for too long; by the time they actually had research blocks during their fellowship, it had been over 5 years since they finished their PhD, and many of the techniques and information they learned had become antiquated; another complaint I've heard is that MD, PhDs feel that due to their extended education and a delay in their ability to make an attending salary, they feel that they could have started a family and bought a home sooner. I have met MD, PhD attendings who—in retrospect—are content with their decision, but they are in the minority. On the other hand, I have met MD-only researchers who felt they would have gotten a certain faculty status or grants easier if they also had a PhD, but these--again in my experience--have been the minority of MD-only researchers

At the end of the day, having a PhD does not mean you magically get grants easier: if you have bad research and bad ideas, you will not get funding. The value of the PhD is not the PhD; the value of the PhD is the process and the skills you develop and hone. To clarify, you can’t just do a one year HHMI fellowship in med school and expect to one day have your own lab. Rather, becoming a researcher is a process of learning, mentorship, and publishing, and to reach that goal, there are multiple paths

 

[ToldYouSo]

Roderick MacKinnon (noble prize winner) spoke at my school last semester and he specifically said that he thought it was better to just get a PhD if research is what you want to be doing. Granted he has an MD (no PhD) and he doesn't seem to be doing too badly XDDD But I wouldn't count on winning a nobel prize.

 

[Lil Mick]

If you want a substantial practice, don't go into an MD/PhD program. You can't do your research and academic duties while spending 50% of your time working in EM (doubt they'd let an ER doc do the 1-4 days a month practicing that most MD/PhD wind up doing).

Most people wind up in a specialty that at least tangentially fits their research (if they're basic science or clinical research), or they end up in pathology, where the hours are flexible and one can spend a lot of time on research.