MD or MD/PhD

[Seldon]

I'm having a difficult time deciding where I want to go after undergrad and I'm hoping for some advice. For the last couple years, I have been certain that I was going into an MD/PhD program. Lately however, I have been thinking about only going MD.

My question is, as an oncologist, will I be as intellectually fulfilled as a cancer researcher? I'm concerned that I won't have the opportunity to figure out difficult questions and I will be stuck prescribing the same drugs over an over again. I realize that both medicine and research are saturated with minutia, but in broader terms, will I have more opportunities in one over the other.

My other concern is monetary compensation. From what I understand, researchers get payed a pittance compared to clinicians. Will this continue to be true in the future? Does this justify any possible limit on intellectual freedom? I realize that this is a dirty topic, but it is nonetheless important to one's career choices.

Thank you for any and all help.

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[eteshoe]

This is taken from my encounters with oncologists and my personal views (since I too want to be an medical oncologist one day). The PhD is good for helping one sharpen the skills necessary to be a good scientist, but is not necessary to be a PI.

0. Even without a PhD, medical oncology (from what I know) + radiation oncology, still require a hefty research component. Not sure about the surgical specialties, but many of the surgeons that I've met that are PI's tend to have done something equivalent to a postdoc for research experience.

1. How intellectually fulfilled you are in terms of research will be subjective and depend on your research program structure (i.e. how much of your time is divided between clinical and research duties, administrative stuff, etc). Do you need a PhD to be an effective oncologist - not necessarily (you will need dedicated research time to hone your skills but that can come at various points during your training). Many oncologists I know (at academic centers) are usually very intellectually fulfilled since they get to be involved in the cancer bio as well as these huge multi-site clinical trials (so they usually aren't "prescribing the same drugs" forever, they adapt and modify as more research comes out). At academic centers, there's always opportunities to get involved in basic and clinical research.

2. As far as compensation, you won't be broke as a mostly physician scientist, even if you have very little clinical duties. I'm not saying you'll be balling like those top 1% neuro or cardiothoracic surgeons, but you'll make a decent amount of money. And hey if money is that big of a deal to you, you can always increase your clinical duties. I am not a fortune teller so I can't tell you what the future holds, but as a MD-only or MD/PhD oncologist, you'll have have plenty of chances to contribute to the effort to treat, cure, and understand cancer since it's not going anywhere in the foreseeable future.

3. Not sure what you mean about the intellectual freedom.

Hope that gives you some things to consider. Or I may have not helped at all.

 

[Seldon]

Thank you for your help. Just for clarification, you say that most oncologists are engaged in some form of research?

When I said intellectual freedom, I was referring to my concern about repeatedly proscribing the same drug regiment.

 

[eteshoe]

Thank you for your help. Just for clarification, you say that most oncologists are engaged in some form of research?

When I said intellectual freedom, I was referring to my concern about repeatedly proscribing the same drug regiment.

Most of the oncologists working where I am (a large academic medical center) are engaged in some form of research. I do not know if the same is true in private practice.

As far as intellectual freedom - if you go into academic medicine, you have a lot more 'freedom' due to the vast wealth of knowledge that is constantly being pumped out.

 

[sat0ri]

Thank you for your help. Just for clarification, you say that most oncologists are engaged in some form of research?

When I said intellectual freedom, I was referring to my concern about repeatedly proscribing the same drug regiment.

Have you shadowed someone in Hem/Onc yet? Since what is intellectually stimulating is subjective, it's probably best to see it for yourself.

Also, you might be overestimating how much latitude you will have as researcher. There obviously can be a lot of tedium in that, and you tend to focus on something very specific (a specific receptor, a specific drug, etc) that you might find it is less stimulating than you'd find as a oncologist who will be seeing a variety of cancers, resistance-developing cancers, complexities of humans and psychosocial situations, cancers in the setting of variety of comorbitities that can complicate things, rapidly changing treatment paradigms, etc.

It is extremely common for onc's to be involved in research. It is more common for a PhD or MD/PhD to be a PI but it is not impossible for an MD to do this. A big factor is what type of research you would want to do, from basic to clinical. MD/PhD are sought after because often they bridge the two, i.e., translational. There are many ways to be involved in research as well, so a lot of will depend too on if you are happy being an a more auxillary role or if you want to the lead the development and prosecution of an idea.

You'll be more financially secure as a MD/PhD than as a PhD. At this level though, whether you are PhD, MD, or both, you're already on the very high end of the bell curve of income. Hopefully money is not too big a factor for you, because the common wisdom is that if you're in it for that, you're likely to have an unhappy career.

These are good questions and I think a majority of the answer will come from your experiences (shadowing, research), hence it being a "requirement" on your application.

 

[Seldon]

Have you shadowed someone in Hem/Onc yet? Since what is intellectually stimulating is subjective, it's probably best to see it for yourself.

Also, you might be overestimating how much latitude you will have as researcher. There obviously can be a lot of tedium in that, and you tend to focus on something very specific (a specific receptor, a specific drug, etc) that you might find it is less stimulating than you'd find as a oncologist who will be seeing a variety of cancers, resistance-developing cancers, complexities of humans and psychosocial situations, cancers in the setting of variety of comorbitities that can complicate things, rapidly changing treatment paradigms, etc.

It is extremely common for onc's to be involved in research. It is more common for a PhD or MD/PhD to be a PI but it is not impossible for an MD to do this. A big factor is what type of research you would want to do, from basic to clinical. MD/PhD are sought after because often they bridge the two, i.e., translational. There are many ways to be involved in research as well, so a lot of will depend too on if you are happy being an a more auxillary role or if you want to the lead the development and prosecution of an idea.

You'll be more financially secure as a MD/PhD than as a PhD. At this level though, whether you are PhD, MD, or both, you're already on the very high end of the bell curve of income. Hopefully money is not too big a factor for you, because the common wisdom is that if you're in it for that, you're likely to have an unhappy career.

These are good questions and I think a majority of the answer will come from your experiences (shadowing, research), hence it being a "requirement" on your application.

I'm a bit behind on my clinical experiences, though I have had a couple interviews with MD/PhD heme/onc. I plan on having several in the coming months, as I will be spending my summer at the Mayo clinic.

Money is a concern of mine, but my primary concern is intellectual fulfillment.

 

[sat0ri]

I'm a bit behind on my clinical experiences, though I have had a couple interviews with MD/PhD heme/onc. I plan on having several in the coming months, as I will be spending my summer at the Mayo clinic.

Money is a concern of mine, but my primary concern is intellectual fulfillment.

There you go, that's a perfect way to get good shadowing/clinical experience. I did a summer student internship at a hospital-based university and it's a great way to get in some shadowing. I would suggest looking into shadowing Neurology as that is a field with a very high amount of research as well as a Pathologist. There is a lot of research going in Pathology (one reason is that you have great access to human tissues and samples) and it was a great shadowing experience for me. I sat in on quite a few autopsies which was an amazing experience. It's a good way to tie on ~50-200 hours of clinical and your PI at Mayo might be impressed if you show initiative in the lab as well as the clinic. They'll probably have connections for shadowing. Network there too, as these student internships were essentially set up for students like you to figure out exactly what you're getting into and ask all of you questions (even the impolite ones about money).