MD neuroscientist

[jerrywheat]

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I want to go to med school. I want to know how the body works and how to fix it/help people(the usual reasons) but in the end translational research on curing cognitive disorders(working memory deficit, AD/HD, alzheimers, dementia) like with nootropics or something like that seems like the thing I'd enjoy the most. Could I take the MD route and still accomplish this?( MD/Phd or Phd would prob be the best but I just really want to go to medical school)

 

[typhoonegator]

You certainly can. A PhD can be helpful, but is neither necessary nor sufficient to perform good research.

 

[Fencer]

You certainly can. A PhD can be helpful, but is neither necessary nor sufficient to perform good research.

For Clinician Scientist with Bench Research:
True, but it will take 3 yrs of post-doc time (equiv. to earning the PhD) to learn the "research trade" after residency, at which point, your clinical skills might start becoming rusty. Review committees will assess whether you can do the proposed work or not, and how good your environment is to support you. For a MDPhD, a few rotations during residency and the 2nd year of fellowship doing 80% research might be sufficient to restart a scientific career, and get a K award. The pure MD route with 3-4 yr post-doc was the route of some of my professors, and a few of my colleagues. However, it is unlikely that it will be the preferred way for clinician scientists now or in 10 yrs. I believe the MD PhD route is the best way to prepare you for a career as a clinician scientist. After all, the PhD is the equivalent to a preliminary license to do research.

For clinical research, you could simply take a Master's in Clinical Investigations during your residency/fellowship, or as an Instructor. There is no absolute need for a PhD.

 

[jerrywheat]

I knew the MD/Phd route would be the best way but I have almost no research background and am applying to medical school right now. I guess I could wait a year, get more research in, and then apply to MD/Phd programs but do you think it would be worth waiting a year to do that?

 

[typhoonegator]

It's all about what you want and where you go. I know at least 5 people with freshly minted K-23 awards and "only" an MD. I also know several MD/PhDs who do not have a K-23/K-21 or a K-08. A K-award is a mentored grant, so the review committee is going to be looking for people who can actually pull off what they say they are going to do, and a well-known mentor with a proven track record in the field will alleviate many of their concerns right off the bat, PhD or not.

I don't have a PhD, but I have had ample opportunities for funding and have been successful thus far. I'm a PGY-6, and I've spent every elective in my residency doing research, in addition to a 1 year research fellowship. Even with the right mentor, you have to establish yourself in the field, and prove that you can accomplish a research goal. How quickly you can do that depends greatly on your chosen subfield, luck, available resources, and amount of time you can devote.

As Fencer stated, if you really want to do hard-core bench science, then great, but you are going to have to put a good amount of time in to prove that you have a handle on things. Or you can just get incredibly lucky and have a bunch of stuff fall on your lap. Or you can be an insightful super-genius. Lab work is hard, unpredictable, and temperamental. Even with perfect technique and intentions, things go wrong, and you start over. This is why the PhD can be reassuring -- it shows that you are a professional at getting beaten down in the lab, and won't run in the face of insurmountable odds. Clinical work has the advantage of being a bit less finicky, and with the right opportunities, you can make a splash a bit more quickly. Again, luck is a factor, but you don't need to raise generation after generation of knockout rats to get there.

I hate the term "translational research", because ever since it became coined, literally everyone is doing "translational work". Who in medical research ever says they are pursuing their interests just for the hell of it? Everything in human medical research has some goal in mind that they are actively trying to bring to the benefit of humanity, or else they would have never gotten funded to do it. The term loses meaning. Within "translational research" there is clinical stuff (bringing new devices, tools, techniques to the bedside) and bench stuff (developing and testing potentially useful tools, identifying new targets, studying animal models, etc.)

If you want to do clinical research, then the MD is great. Maybe combine it with an MPH, MSc in clinical investigation, biostatistics degree, or something of the like. You can do that in less than a year after residency. You can even go without it if things go really well. Then just pour yourself into research from the get-go.

But don't delay medical school for another year, get a PhD, and get all geared up for a research career unless you know for sure that this is what you want to do. If you want that MD, go get it, and make your goals work from there. If you want to get that "license to do research", and you want to spend a lot of time in the lab, learning how to be a bench scientist, then get the PhD. We cannot make that decision for you.

Sorry for the long post.

 

[Brachyury]

For Clinician Scientist with Bench Research:
True, but it will take 3 yrs of post-doc time (equiv. to earning the PhD) to learn the "research trade" after residency, at which point, your clinical skills might start becoming rusty. Review committees will assess whether you can do the proposed work or not, and how good your environment is to support you. For a MDPhD, a few rotations during residency and the 2nd year of fellowship doing 80% research might be sufficient to restart a scientific career, and get a K award. The pure MD route with 3-4 yr post-doc was the route of some of my professors, and a few of my colleagues. However, it is unlikely that it will be the preferred way for clinician scientists now or in 10 yrs. I believe the MD PhD route is the best way to prepare you for a career as a clinician scientist. After all, the PhD is the equivalent to a preliminary license to do research.

For clinical research, you could simply take a Master's in Clinical Investigations during your residency/fellowship, or as an Instructor. There is no absolute need for a PhD.

After you complete your Ph.D., you have two years left of med school, intern year, and then during you PGY-2, you might finally start to step back into lab for small periods of time. During these years, your research skills become rusty: you loose track of what the current discoveries are, and many techniques you use might become obsolete, and the ones that aren't you forget, or no longer do well, because you haven't done them in a few years.

You can do research without a Ph.D., some choose to earn both degrees, other choose not to, but there are successful physician-scientists in both camps. If you don't want to do both degress, look for med school with MD-with-thesis programs (most of them have them), look into research years (HHMI has two of them, NIH has a non-HHMI affiliated year program, Sarnoff, etc), also look into the possibility of taking two years off after undergrad to do research at the NIH (the postbacc program) or tech in a lab at a major med school. All of these, or a combination of them, can give you the skills you need to be an effective researcher without having to earn a Ph.D.

 

[Brachyury]

I knew the MD/Phd route would be the best way but I have almost no research background and am applying to medical school right now. I guess I could wait a year, get more research in, and then apply to MD/Phd programs but do you think it would be worth waiting a year to do that?

This is a big problem; do a search in the Physician-Scientists forum. Think of it this way: you couldn't take a seminar on Proust in the original French if you've never taken French 101; likewise, you need research notches in your belt if you're going to apply MD, PHD. Why? Because programs do not want to waste a valuable seat on someone who might later realize that they don't actually like research. You don't need 10 publications to get into an MD, PhD program, you just need to show an interest and a dedication to research (i.e. at least a year of continuous research).

 

[Fencer]

After you complete your Ph.D., you have two years left of med school, intern year, and then during you PGY-2, you might finally start to step back into lab for small periods of time. During these years, your research skills become rusty: you loose track of what the current discoveries are, and many techniques you use might become obsolete, and the ones that aren't you forget, or no longer do well, because you haven't done them in a few years.

You can do research without a Ph.D., some choose to earn both degrees, other choose not to, but there are successful physician-scientists in both camps. If you don't want to do both degress, look for med school with MD-with-thesis programs (most of them have them), look into research years (HHMI has two of them, NIH has a non-HHMI affiliated year program, Sarnoff, etc), also look into the possibility of taking two years off after undergrad to do research at the NIH (the postbacc program) or tech in a lab at a major med school. All of these, or a combination of them, can give you the skills you need to be an effective researcher without having to earn a Ph.D.

I don't disagree, the question was about which route had the greatest likelihood for success. From the standpoint of a NIH reviewer (this my 8th yr), I expressed my opinion, which was the majority for the comittee when I reviewed training or new investigator grants.

 

[jerrywheat]

I don't think that I want to do hard core bench science, but I feel like those are the people who are central to an invention. I know I want to go to medical school but can I be central to an invention as such? I feel like, with an MD, I might be out of reach of being a central part. Like, "oh, he was only the clinician who used substance x on patient y, he did nothing else" or could it be like "he was the person who came up with the idea for substance x!"

 

[Jorje286]

I think the bottom point is that you need (at least) 6/7 years of research training in order to establish yourself as an independent investigator, whether part of that training is done in a PhD program or in a fellowship. It all will depend on your publication record and you'll need a bunch of publications at prestigious journals to get an R award, given the level of competition. Part of the benefits of doing your research training after completing the medical training is that you'll be paid as a fellow and not as a PhD student, you don't have to go through the hassle and the stress of MD/Phd programs (finishing your PhD to get your MD, with some of the irrelevant classes and the obstacles you might face from your PI or otherwise that prevent you from graduating early...etc), you know exactly what your area of interest is, and you're a lot more independent as a fellow. Furthermore, I think you can take a position as an instructor at an academic institution and generate good revenue from patient care and teaching while at the same time pursuing research projects. Of course the biggest drawback will be your 200k debt, and it's the whole reason why MD/PhD programs were created.

I also have an additional question: does anyone know neurology residency programs that could grant a PhD? I know UCSD has that option, but I don't know of any other.

 

[typhoonegator]

There is also the R-25 program available at some institutions, which provides for a year of dedicated research time nested within residency, followed by up to 2 years of mentored research after completion of residency. These years after residency don't even need to be at the same institution as the primary mentor (although you do need a site-specific mentor in that case). This provides a framework to help budding clinician-scientists get some experience under their belts, hopefully leading up to a K-award as they transition to junior faculty. The K helps you to maintain protected time to continue your research leading (hopefully) up to that R01. Having the K also makes you more attractive as a hiring candidate, since you are bringing with you at least a small amount of funding.

It seems like a great idea, and I wish the R-25 program had been around when I was a resident.

 

[bluntdissector]

There is also the R-25 program available at some institutions, which provides for a year of dedicated research time nested within residency, followed by up to 2 years of mentored research after completion of residency.

With the two years after residency - are these normally done in the form of a 2-year research fellowship, or can you carry on with the research whilst completing another fellowship (e.g. in movement disorders) at the same institution?

(Sorry if it's a ******ed question.)

 

[typhoonegator]

I'm actually not sure about that. The NIH page probably contains more info. It seems like the program was really designed to be very flexible, so I would imagine that you could nest some of the research within a clinical fellowship (although when doing your research fellowship you would probably have to prove you can devote 80+% of your time to research endeavors).

 

[Head]

In response to the original poster, I would have to say that I agree most with Fencer. I went through the pure MD route and now I'm doing a 2 year research fellowship under a T32 grant post residency training. If you are doing lab research, it's incredibly hard to get anything worthwhile accomplished in 2 years. Usually much of the first year is spent getting up to speed. Trying to get the K-08 at that point is difficult because you don't have much in the way of publications. I'm riddled with med school debt. Yes I can supplement my income with moonlighting, but it's not much unless I want to give up most of my weekends. Frankly, I think I would be much better off if I had gone the MD/PhD route where everything was paid for.

If you are interested in purely clinical research, like Typhoonegator is, I think the answer is a bit different. It's not hard to get some clinical publications cranked out in 2 years and hopefully have enough going for you to get that K-23 (I realize the funding rate is actually less for K-23 than K-08 at NINDS currently). I think the difference is, with the clinical award (K-23) you're competing with other pure MD fellows, whereas with the laboratory science award (K-08) you're competing with MD/PhDs and other scientists.

In answer to blunt dissector's question, there are now many neurology departments that offer the T32. This is a 2 yr mentored research fellowship after residency that tries to transition you to the next level of funding (the K award). It is extremely flexible in terms of what kind of research you can do. You must spend at least 80% of your time doing research. This usually means you'll have one day a week of clinic or something equivalent. You are not paid for this clinical work. You are paid the same as you were as a resident and your clinical work is like free labor for your department (your salary is actually paid by the grant from the NIH).

 

[Enkidu]

OP,
I'm having a hard time interpreting your question, exactly. It sounds like you want to do basic science, but are realizing this while you are in the process of applying to medical school. If this is the case, there are far worse positions that you could be in.

As previous posters have pointed out, there is a well-established career pathway in which residency-trained MDs do 6-7 years of a research fellowship in order to be competitive for an R01 grant. You will likely hear different variations of the number of years required to do this path, there is no perfect answer. These years are years that you will be publishing papers and building a science resume that will enable you to compete for a grant. Depending on the NIH budget, it could take more or less time.

If you have no research experience, then applying to MD/PhD programs is likely out of the question. However, any medical student is able to take a leave of absence after their second year to pursue a PhD. If you succeed in being accepted to your university's MD/PhD program at this time, this will also pay for your third and fourth years of medical school. Otherwise, you will simply matriculate into graduate school as a regular graduate student during your LOA and pay for your third and fourth years out of your own pocket. It would be unlikely for you not to be accepted to your university's graduate school as a current medical student, even without significant research.

The disadvantage of doing this self-funded MD/PhD are obvious. Your medical school debt will likely convince you to stay away from research and pursue more a lucrative clinical practice. This is pretty similar to the situation that you would be in if you did a research fellowship after residency, though.

Whatever path you choose to take, try to do some basic science research in the summer between your first and second years. You may not even like it. Good luck.