Is it the right path for me?

[supergirl7561]

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Hi everyone!
I know what I am about to ask is really the same question a lot of people have been asking, but I am trying to decide which graduate pathway to take- PhD, MD/PhD, or MD.

I'm currently a sophomore in undergrad studying Biomedical Sciences, but I want to decide soon so I know whether or not I should take the MCAT.

I really want to specialize in genetic disorders, and I know I want to do research of some sort- probably translational. I currently work in a basic cancer lab, and I love research and the scientific process, I just wish I saw a little more direct impact of my research on patients.

My ideal career would be mostly research, but I really want to have some patient interaction, probably 80/20 or 85/15 split between the two. I want to see patients who have genetic disorders and help them manage their disease in the best way possible, since a lot of genetic problems have no cure as of yet. At the same time, I would like to be studying possible cures.

Now to my question- what is the best way to get to that dream job? I have most seriously considered MD/PhD and then I could become a clinical geneticist with a PhD in genetics. But should I just do MD and then a postdoc/fellowship? Or even just a PhD where I could be a sort of consultant to patients and their doctors, I don't even know if that happens (I have even looked at joint Masters in genetic counseling and PhD)?

I like the idea of MD/PhD, I just know it's a LOT of time, and in my lab my PI has a really big stigma against MD/PhD, kind of the idea of "jack of all trades, master of none," which personally I don't agree with. I feel that they bridge the gap between two opposite but both necessary fields, but I don't want to be discriminated against by other researchers because of a dual degree (have you found that to be an issue?). It's just not a choice I want to make lightly.

ANY advice is welcome. Thanks!

 

[Pre-Med Village]

Modern science is so enormous and fast changing that to be effective in research one has to specialize very intensely. Just to keep up in the journals within a very specific research area one has to have a sacramental attitude about everything else that may interest a person and give it up. The most effective modern researchers are good at taking all of their correspondence everyday and throwing 95% into the trash. Very smart people will disagree with the idea of any kind of interdisciplinary work, although folks do have a tendency to impose their own limitations on others. There is a good point to your PIs attitude, which may be based on experience. Your PI has probably encountered too many MD PhDs who may know how to run an SDS PAGE gel but have no clue what it means when the tracking dye is fine but the the bands are smeared or to use Tris Tricine for small proteins and what not. One dopey MD PhD sneezing into a refrigerator full of RNA samples may have been enough to confirm the validity of his or her own choice for the straight PhD.

If you think your research interest will fit better within a teaching hospital than at the NIH or within a university department, then an MD PhD may be beneficial. The MD PhD is better for research that my require clinical trials. The straight PhD is better for preparing a person for benchtop problem solving.

 

[StIGMA]

Hopefully other people who have also experienced this decision can reply.

If you are interested in patient interaction, you should pursue an MD.

Now, do you want to spent 3-5 years further pursuing a PhD? Ask yourself- do you want to be able to fill the shoes of your PI? Do you want to write grants, run a lab, compose journal articles, be involved in the whole research process, etc? If you are interested in research and medicine, but you do not want to be the "grant winner," then an MD supplemented with research, such as a research-based fellowship as you suggested, is the ideal option.

Based on what you wrote, you should be considering MD vs MD/PhD and not the other options that you suggested. Figure this out for yourself to make sure that you want to pursue medicine- shadow doctors across different fields and make sure that medicine is the right step.

If it is, then ask yourself if all of the sacrifices to the MD/PhD are worth it. Let your gut give you an answer. Do you want to do research as part of your career (MD) or as the primary focus of your career (MD/PhD)?

You can pursue an MD and later decide to make research the focus of your career, which is likely a better training option than MD/PhD if the funding was setup that way (MD followed by research at the end of training rather than in the middle). Plenty of MD's have won Nobel prizes.

 

[delirium81]

Your PI isn't totally wrong. It's very difficult to practice both medicine and research and be good at both. This is why most physician scientists typically go for the 80:20 split. A 50:50 split would most likely mean that you were doing both badly. I don't, however, think that someone who was doing 80:20 would necessarily be a "Jack of all trades" who does neither well.

Does your PI know a lot of MD/PhDs? I'm curious about how he came to this conclusion. Maybe you can pick his brain about it. I have heard about MD/PhD programs out there where they'll just push the student through the PhD at the 3 year point no matter what. A lot of these people probably don't graduate with a good understanding of how to troubleshoot at the bench, as JohnWetzel was saying. However, most programs that receive NIH funding, i.e. MSTPs, receive it because they provide excellent scientific training and they don't give out half-assed PhDs.

I don't really think discrimination is a huge problem. If you produce good science, no one really cares which letters you have behind your name. I do hear a lot of snarkiness from PhDs about MDs, mainly because they've had negative experiences working with MDs who have little to no knowledge of bench work, but that's about it. Anyway, it's definitely not a reason to avoid an MD/PhD if that's what you were asking.

Other than that, I agree with what the other posters have said. I think StIGMA's question gets to the heart of the matter: do you want to do research as part of your career or as the main focus of your career. Do as much research as possible and make sure that it's something you really want to pursue. Shadow doctors. Talk to physician scientists and ask how they got there. All of those things should help you in answering that question.

 

[supergirl7561]

Thanks for the advice!! I definitely feel MSTP may be right for me, but I really want to make sure it's the best option, before I spend years doing it (8 years of school, 5 years of pediatrics/genetics residency, probably 2 years in fellowship, so I'd be 37 by the time I finished 😱).

I have no idea where he got these ideas from- I think he's just really old fashioned and believes that PhDs should do research and MDs should do clinical (although he did try to talk one of the undergrads into MD/PhD instead of just MD which she is doing). Not trying to sound cocky here, but I'm pretty good at the research I'm doing, and so I think he really wants to make sure I end up doing that in the future and he's afraid if we do MSTP we would end up mostly clinical. My school also doesn't have the greatest MD/PhD program (we're not MSTP) so I think he's seen a lot of MD/PhD students who are a little all over the place and are trying to rush and get their thesis done, which our university pushes to get that done in 2 years, which is not a lot of time in cancer research. So I think it's a combination of things.

I'm really hoping to better explore my options this summer- I'm currently working in the lab full time, and I am going to go on a medical mission trip this summer to see how I like patient interaction. I'm also probably going to end up doing a summer internship next summer where we spend half of the day shadowing physicians and half of the day in our labs, so it will really help me to work on comparing/contrasting the two fields.