Is it worthwhile to do a MD/Phd if my eventual goal is to become a neurosurgeon?

[neofight]

Hi Everyone,

I was wondering what your thoughts are of doing a MD/Phd if my eventual goal is to become a neurosurgeon, especially for someone who's in his early's 30s. I have strong research interests which is why I am considering pursuing the Phd but at the same time, I definitely want to do a neurosurgical residency (if I can). Given that it takes at least 7 years to do the MD/Phd and another 6 years to do a neurosurgical residency, I would be looking at doing 13 years of schooling/training! I'm not looking to work in academia and would look more towards working in industry or government. Plus, I heard that doing the Phd increases the chance of getting into a better residency. (How true is this?) Any thoughts would be appreciated.

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[Tremblez]

Originally posted by neofight
Hi Everyone,

I was wondering what your thoughts are of doing a MD/Phd if my eventual goal is to become a neurosurgeon, especially for someone who's in his early's 30s. I have strong research interests which is why I am considering pursuing the Phd but at the same time, I definitely want to do a neurosurgical residency (if I can). Given that it takes at least 7 years to do the MD/Phd and another 6 years to do a neurosurgical residency, I would be looking at doing 13 years of schooling/training! I'm not looking to work in academia and would look more towards working in industry or government. Plus, I heard that doing the Phd increases the chance of getting into a better residency. (How true is this?) Any thoughts would be appreciated.

From what I have seen of neurosurgery, having the PhD can help you get into a good residency program. Many places are requiring a year or two of research in the residency process. Thus, they would benefit greatly from having an experienced researcher working with their facilities. And I have to say that neurosurgery is the most amazing specialty. That being said, you are actually going to be spending 7 years in residency (don't forget the internship year). I also wonder where the neurosurg fits into the picture if you plan to go into industry/govt. It is nearly impossible to practice in the specialty AND have meaningful involvement in research projects. If you don't plan to do anything clinical with your neurosurg training, I would recommend avoiding 7 years in one of (if not the) hardest residencies. You may find yourself a wary and bitter 48 year old. Just my two cents. If it is what you absolutely want, and you think it will give meaning to your life, by all means, give it a shot.

 

[DarkChild]

in addition to the above - certain neurosurgery programs take MD/PhDs almost exclusively. e.g. UCSF.
secondly, most neurosurgery programs have 2 years of research time - the PhD would give you a huge head start...

 

[Neuronix]

I would try to dissuade you from neurosurgery. I want to be a neurosurgeon and I am a big advocate of the neurosurgery + MD/PhD route. I have even argued face to face with MD/PhD program directors who think that MD/PhDs should not become neurosurgeons.

However, neurosurgical residencies are now mostly 7 years. Add that to 7 - 8 (I'll say 8 for purposes of discussion) of MSTP and you're looking at a LONG TIME. So that would be 15 years. Say you apply for next year and you are currently 31 years old. That will put you at the age of 47 before you are out of residency! You should also expect to do some sort of fellowship/post-doc at the end for faculty positions.

Now you did say you want to work for government or industry. How do you plan to practice neurosurgery in a government or industry setting? I don't understand how that's possible. What I think you really want to do is neurology. By doing a MD/PhD then going into neurology residency, you can investigate processes relevant to neurosurgery without as long a residency and with good industry prospects. Still you would be about 43 years old coming out of residency though...

As for your last question, MD/PhDs tend to get any residency they want if they come from a decent program (any MSTP), a decent lab, and have a good publication record as a graduate student. For neurosurgery, MD/PhD or a MD from a top medical school is almost required, especially at the prestigious programs. For neurology, it's not as bad, but still the prestegious programs (UCSF, Mass General, Hopkins, etc...) are going to be very hard to enter without a MD/PhD or top-tier MD (and even then you may want to do a HHMI research year).

In any case, I look forward to your response. I really don't like to criticize, but I'm curious how you would justify the time required for neurosurgery to go into a place where it seems you could not use those skills?

 

[neofight]

Thanks for your responses!

Neuronix, I am interested in going into research for the first few years after residency and, afterwards, going into practice. I know that it might seem "better" to do a residency after working in government/industry but from what I was told, if I am interested into going practice... I should try to do a neurosurgical residency upon completing an MD versus doing so after taking a few years off to work in government/industry. I'm also aware I could get into research with an MD only (as that's my current plan) but that it would be a bit more difficult. The added plus of getting an MD/Phd as mentioned above is an increased likelihood of getting into a prestigious neurosurgical program so I'm also wondering if this reason alone is also worthwhile for getting the MD/Phd. Also, why do program directors dissuade MD/PhDs to not become neurosurgeons?

 

[Neuronix]

The goal of any MD/PhD program is to produce at least academic physicians and many want to produce academic researchers who spend at most 20% of their time doing clinical work. In the first place, if you want to enter private practice, that's not what MD/PhD was created for and certainly do not tell MD/PhD program directors that is your goal. You will be cut immediately.

It's not better to do a residency after working in government/industry and I'm still not sure why you would want to be there. Both of these institutions are going to be looking for someone to commit for the long-term, which you would not. You can certainly do research as an MD-only, but I agree the MD/PhD is ideal for doing research. But it doesn't sound like you want to do research for the long haul? I guess I'm a bit confused.

As to why MD/PhD directors are against neurosurgery in general, is because it's difficult to balance clinical responsibility in neurosurgery and research. Surgery requires at least 1 - 2 days per week to keep up skills and a patient base, while being a NIH-funded PI requires more than full-time work itself. An option for many MD/PhDs now is to be a co-PI (or research associate), doing research some days of the week and practicing some days of the week, while letting someone else bring in the money. Many programs are not cool with this however, as they want to produce people who will LEAD things. It will be impossible to have an important research lab AND practice several days a week. The other option is to focus primarily on clinic and do some clinical research, but again, that's not why the MD/PhD programs were created and directors are against this.

Besides, you are going to have a much shorter career than most. While this is not something that will immediately handicap you, you really have to think about when you will want to retire. Further, for the long plan that you are proposing, are medical schools and residency programs want to commit all the time and money to training another neurosurgeon?

I still think that the only good place for the MD/PhD neurosurgeon is academia. There you can do research AND practice medicine, and you cannot do both in any other setting. After neurosurgery training you will want to both, as to leave either research or medicine after that will seriously handicap your career in either.

 

[surge]

I am another aspiring MD/PhD neurosurgeon.

There really isn't much more I can add - I couldn't agree more with what the above posters have said.

The reason I wouldn't suggest you do an MD/PhD isn't your age - it's the fact that you are interested in things that are not only different from what an MD/PhD is intended for, but for which the MD/PhD is simpy unnecessary if not counterproductive. Yes, it would help you get into a top neurosurgical residency. But that's about it, and that is possible without one.
If I were you, I wouldn't put myself thru the MD/PhD process, but would rather work on getting into a top medical school (most neurosurgeons by far are still MD only), perhaps one like Yale that is very research intensive (they give you an option for a free 5th year to do a thesis).

Whatever you decide, good luck to you.

 

[pathdr2b]

Originally posted by Neuronix
It will be impossible to have an important research lab AND practice several days a week. The other option is to focus primarily on clinic and do some clinical research, but again, that's not why the MD/PhD programs were created and directors are against this.

I currently work for an MD/PhD at the National Cancer Institute that has clinic (urological oncology)3 days/week and does research (epidemiology) 2 days/week. She is a highly regarded scientist (per the assistant DIRECTOR of NCI) and as nontenure track, publishes about 2 papers/year. And I almost forgot to mention that she went the MD/PhD route in her early 30's and is now in her 50's or so

The research I plan to pursue as an MD/PhD student is very clinically focused (cancer epidemiology/molecular pathology). None of the adocms I've discussed my plans with had problems with this as a PhD focus and in fact have been very supportive.

 

[Tremblez]

Originally posted by Neuronix
I still think that the only good place for the MD/PhD neurosurgeon is academia. There you can do research AND practice medicine, and you cannot do both in any other setting. After neurosurgery training you will want to both, as to leave either research or medicine after that will seriously handicap your career in either.

Not to say that this idea is impossible in academia; but I find it to be somewhat of an overestimation of the role of neurosurgeons in academia. The chair of Neurosurgery here at Rochester is an MD/PhD, and I don't believe the jobs of clinical practice and training residency have ever left him with enough time to perform significant basic science research, but rather a limited collaboration in clinical research. However, I have never had the impression that he regrets or lacks appreciation for the value of the PhD degree in his training for a career in academic medicine.

 

[Neuronix]

She must not have to write grants and try to pull in funding since she is at the NCI. Otherwise I don't see how she would have enough time to administrate a lab, publish, and bring in funding. Which is fine, this is the sort of thing I'd like to do. As for her age, fine, but she still didn't have to go through neurosurgery. Her residency was not as long, and now she must be fairly established.

Cancer epidemiology and molecular pathology are fine. But, if you tell most adcoms you want to spend your time 90% clinical and 10% research in an actual interview, you will catch flack for it. If you say 50/50 that way, that will be fine, depending on the place I find.

In response to Tremblez, you make sacrifices to become the chair of a department. He probably spends more time in administration. That's fine. There are neurosurgeons doing research + clinical... There's several at UChicago (McDonald, Penn, etc...), one at Penn (McIntosh), and one at UMaryland, just to name a few. There are plenty more, and it's a matter of balancing.