M.D. vs. Ph.D / Clinical Practice vs. Research

[imperfect10]

I am taking pre-med (post bac) classes (age 23), however, I am debating between Research or Practice for a career down the road. I majored in pyschology as an undergrad, and I am interested in cognitive neuroscience, neurobiology, and pharmacology research. Obviously, if I sign up for a Ph.D program (my pre-med courses are still very relevant toward this end), my decision is made pretty much then and there (although there will be many decisions to make thereafter in terms of what positions I go after, what area, what type of institution I work for, and also the possibility of pursuing an alternative career [that still maximizes my knowledge and experience] in something like consulting).

Alternatively, I could go for my M.D. without totally closing the door on a future in research.

I have collected a lot of mixed observations regarding this MD vs. Ph.D or Practice vs. Research debate:

*PI's mostly manage the lab so they are able to practice while producing satisfying research (others do the leg work). Of course, how easy is it to become a PI?

*Doing research after an M.D. is an indirect path. Not only is an M.D. unneccesarry, but the training does not directly prepare you well for the day-to-day of research.

*Becoming a physician seems more forgiving of older "applicants" and starting early seems critical for moving up in research (e.g. getting tenure)

*I will have less control over my place of residence with a career in research.

*Socially, being a clinical physician seems more fun and relaxing. Researchers, in my experience, are cold and somewhat homogenous. Many have independent wealth or are simply science buffs who were destined for this career since building their first ham radio at age six.

OTOH, social connections in clinical settings may feel shallow, whereas research connections may feel more substantive.

*It seems more possible to do an 80:20 ratio of Researchractice, than the reverse (unless you're a PI perhaps). And at, say, 80:20, it seems your income takes a pretty sizable hit (relative to 100% practice).

*There is a lot of pressure to publish as a researcher, and practicing could really slow your study to the point of being obsolescence.

*I'm still a little unclear as to the categories researchers, who exactly employs them, and what the differences are (academic, hospital, or industry). I am interested in cognitive neuroscience, neurobiology, and pharmacology. Intuitively, I would guess that academic research is intellectual ("normal" and "healthy" subjects), and hospital research is clinical (neurodegenerative diseases), and industry is profitable (viagra). But in my experience, these do not seem to be terribly strict boundaries. Furthermore, my understanding is that, ironically, researchers in profit-driven industry are actually paid less than researchers in "epistemic curiosity driven" academic insitutions.

What are the main differences in terms of funding sources, incentives, publication review processes (?), advacement opportunities, and purposes.

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[Lokhtar]

The question is rather simple: do you enjoy research? How much research have you done? Do you enjoy patient care? Have you been in that setting?

Yes, you can be a MD and do research, but unless you want to do clinical research, an MD is really not the most efficient way to do basic research. Go for MD/PhD or just the PhD. You will make less money as a PhD, but you'll be trained to do what you want.

On the other hand, it's important to recognize that there is definitely that pressure to 'publish or perish' in academia. It's not easy being a PI and getting tenure. It's sometimes decades long journey to get that tenure and enough funding to run your own lab. You don't quite have to be building ham radios at six, but you need to have that drive. People with your education and intelligence will likely be making a lot more than you, are you OK with that?

The MD route is more flexible, especially the MD/PhD route, and you can, in the end, do more in the biological sciences most likely. But if your end point is just basic research, the MD is unnecessary. If you want to do translational or clinical research, then it may be the best route for you.

Good luck. The best way to figure this out is to talk to a PhD at your school, and talk to a research-oriented MD or MD/PhD. Plan out your goals. The subjects you mention have lots of good research being done in them, at both the basic sciences level, and the translational/clincial level.

 

[Lukkie]

Imperfect10 see my responses in bold inside the quote. Just as reference I am currently a lab research associate (fancy term for 'lab technician', or 'lab rat') for an MD (several actually) in an academic hospital so hopefully I can help.

*PI's mostly manage the lab so they are able to practice while producing satisfying research (others do the leg work). Of course, how easy is it to become a PI?

This is true. All the MDs I have worked for haven't touched a pipet in years and have technical staff that does the actual grunt work for them. They meet with this staff on some schedule to get updates, give orders and the like. Being a PI is never easy, but at least from my understanding from the MD-researchers I talked to, its not too difficult since "translational research" (look up the term if you don't know it) is getting very popular now and MDs are a natural fit for it.

*Doing research after an M.D. is an indirect path. Not only is an M.D. unneccesarry, but the training does not directly prepare you well for the day-to-day of research.
In some regards, sure. Most MDs probably couldn't tell you the specifics behind western blotting or flow cytometry. But they do understand the concepts behind it (immunohistochemistry, cell cycle, etc). It is usually up to the staff to handle the "day-to-day" aspects of research, which is why this staff is usually referred ot as "technical staff", while the MD generally offers a broader goal ( example:: MD: we know in the clinic, drug x helps patients with disease y but we don't know exactly how it works. some people suggested a signaling pathway ABC. Lab Tech: we can probably do a western blot to figure that out... let me dig up some papers to find out which antibodies i'd need).

*Becoming a physician seems more forgiving of older "applicants" and starting early seems critical for moving up in research (e.g. getting tenure)
Not sure what this means. Of the 3 MDs I work most directly with, 1 worked for 6 years between undergrad and medical school, 1 was actually in some paralegal studies before deciding on medical school, and the other was the only typical straight-to-med-school-after undergrad person.

*I will have less control over my place of residence with a career in research.
Yes, but if you do like research so much, I can't see much reason to work anywhere besides an academic setting.

*Socially, being a clinical physician seems more fun and relaxing. Researchers, in my experience, are cold and somewhat homogenous. Many have independent wealth or are simply science buffs who were destined for this career since building their first ham radio at age six.
Research is something you really have to love. You will probably be working longer hours (you have clinic as well as lab responsibilities), get less pay (my PIs claim they can make a lot more if they went into private practice). But to claim they are independently wealthy or science nerds is not accurate imo... just anecdotal evidence, but of those 3 people I mentioined above, only one was even remotely a science buff (and definitely not a 6 year old ham radio maker). One was an aspiring dancer until college.


OTOH, social connections in clinical settings may feel shallow, whereas
research connections may feel more substantive.
I don't know what you mean by this.


*It seems more possible to do an 80:20 ratio of Researchractice, than the reverse (unless you're a PI perhaps). And at, say, 80:20, it seems your income takes a pretty sizable hit (relative to 100% practice).
My PIs have 2 days in clinic, and the rest are spent in IRB meetings, tumor boards, talking to research staff and fellow PIs. 80/20 probably isn't much different than what i'd guess. Although they do have 1 month of the year in 'service' during which they have almost 99% clinical duty.

*There is a lot of pressure to publish as a researcher, and practicing could really slow your study to the point of being obsolescence.
Few researchers are immune from the 'publish or perish' mantra, but the idea of a physician reseracher would be someone who directly ties in his clinical work to the lab bench. I don't think you'd find an Oncologist doing basic research in hip replacement, but a surgeon might. Most physician researchers i'm sure do find a nice balance of research-practice ratio.

*I'm still a little unclear as to the categories researchers, who exactly employs them, and what the differences are (academic, hospital, or industry). I am interested in cognitive neuroscience, neurobiology, and pharmacology. Intuitively, I would guess that academic research is intellectual ("normal" and "healthy" subjects), and hospital research is clinical (neurodegenerative diseases), and industry is profitable (viagra). But in my experience, these do not seem to be terribly strict boundaries. Furthermore, my understanding is that, ironically, researchers in profit-driven industry are actually paid less than researchers in "epistemic curiosity driven" academic insitutions.
All of the MDs in my department are employed by the University (kinda self explanatory). Not surprisingly my University has a hospital which is where I would guess you'd find most MD researchers. Some have worked in industry before. But your whole statement after "Intuitively" is kind of short sighted imo. Academic research would definitely NOT be limited to normal and healthy subjects. I work in an oncology research lab; few people would argue against cancer patients probably being the least 'normal and healthy' patients of all. Yes industry seeks profit, but to limit consideration to drugs like Viagra while ignoring, say Gleevec for chronic myeloid leukemia isn't fair. I can't speak for the pay rate but I would assume its higher in industry.


What are the main differences in terms of funding sources, incentives, publication review processes (?), advacement opportunities, and purposes.
Between PhD and MD researchers? In general both would work for grants. I don't think there would be any differences in the publication review process, beyond the fact that they probably focus generally on different journals (MD researchers might run clinical trials which would publish their results in The Journal of Clinical Oncology (JCO), whereas a PhD researcher might look at particular pathways in cancer cell lines which JCO wouldn't publish but Cancer Research might. These journals probably do have different review processes and clearly different purposes.)

Hope this helps.