MD -> path residency vs clinical chemistry fellowship for a PhD holder

[poten_PhdtoMD]

At a turning point in my career.

My original goal was MD/PhD -> path. A desired career heavy in research/clinical trails, and method/technology development in diagnostics (i.e I want to develop new ways to diagnose from lab). Medical school kept being postponed because of life until my MCAT expired. In the mean time, I was working in industry (diagnostics research). My partner had to move close to family, and I happen to know a postdoc in a university where we are moving. In short, got a PhD offer pretty easily and was a good idea to jump in since this was the best option for my circumstances. In a post-doc now and need to make a decision on career path.

Here is the turning point, my PhD reinforced my desire into path. From day 1 of my PhD, I knew my next step would be an MD. But, maybe there are other routes to the career I want. Plus being early 30s, my decisions need to be a lot more calculated for the sake of my family. So I've been looking into the clinical chemistry fellowship, as an alternative. On paper, it seems it hits on a lot of what CP path has going + a lot more research.

The questions:
What would be the major advantages of MD + path vs clinical chem fellowship for someone who:
- Already has a PhD
- Desires research
- Wants to work in large academic hospitals + industry collaborations
- Interested in an extremely niche clinical practice (primary immunodeficiency)

What would a PhD clinical chemistry fellowship equate to in the job market dominated by MDs? (i.e. will I find a job, if so am I just another tech at that job?)

General question on path: is this career switch compatible with someone with the qualities mentioned above? or is it a complete 180?

Advice/recommendations/(talk me out of medical school at this stage of my life)?

I plan to post this in the nontraditional forum as well, but I think it's more appropriate here for a big picture career perspective.

Any input is appreciated!

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[wholeheartedly]

I was a clinical lab scientist for 8 years at large medical center that had a clin chem fellowship. It was mostly PhDs in the clin chem fellowship. MD pathologists didn’t seem very interested in clin chem or clin immuno. The folks I know from that program have good job opps and are active in research if that’s what they wanted. As hospital lab directors, they were treated equally to MDs except for very specific scenarios that would require a medical license. I can’t speak as much to industry, but that probably depends on the specific role and area. I think you’d have plenty of options.

I’ve had this debate a lot myself. I think if I already had a PhD I would just go the clinical fellowship route.

 

[Spikebd]

At the current moment med school is only worth it if you plan to be a surgeon, cardiologist, GI, or derm.

If you find yourself in med school already and don’t see yourself as able to get one of those specialties, pathology is one of the better fallbacks in medicine. Pathology alone is not a reason to go to medical school, unless you will have absolutely zero debt by the time you finish training.

If you already did a PhD just do your two years and be a Clinical Chemist. No need for path residency. But be nice to the path residents you work with.

 

[mike-sheree]

Don’t get the MD. You will be in stasis for the next 8-9 years, not doing what you know or, apparently, enjoy 95% of the time. From where you are now, considering what you want to do, they would be very expensive, wasted years.

 

[KeratinPearls]

At the current moment med school is only worth it if you plan to be a surgeon, cardiologist, GI, or derm.

If you find yourself in med school already and don’t see yourself as able to get one of those specialties, pathology is one of the better fallbacks in medicine. Pathology alone is not a reason to go to medical school, unless you will have absolutely zero debt by the time you finish training.

If you already did a PhD just do your two years and be a Clinical Chemist. No need for path residency. But be nice to the path residents you work with.

Add Heme onc and radiology too. Psych too according to the cash practices as cited here. But again, you gotta do what you LOVE. There are some hospitalists making bank but you gotta love that stuff to do it day in and day out.

 

[poten_PhdtoMD]

At the current moment med school is only worth it if you plan to be a surgeon, cardiologist, GI, or derm.

If you find yourself in med school already and don’t see yourself as able to get one of those specialties, pathology is one of the better fallbacks in medicine. Pathology alone is not a reason to go to medical school, unless you will have absolutely zero debt by the time you finish training.

If you already did a PhD just do your two years and be a Clinical Chemist. No need for path residency. But be nice to the path residents you work with.

Exploring this a bit more, I am heavily considering medical school because there is a chance I will graduate debt free. Career wise, how will this differ from a clinical chem fellowship for what I want to do (heavy on research and niche clinic practice). Thoughts?

 

[poten_PhdtoMD]

Don’t get the MD. You will be in stasis for the next 8-9 years, not doing what you know or, apparently, enjoy 95% of the time. From where you are now, considering what you want to do, they would be very expensive, wasted years.

You are saying adding those 8-9 years will have minimal addition to what I want to do. What, if any, additions are worth the 8-9 years (path specifically)?

 

[mike-sheree]

You are saying adding those 8-9 years will have minimal addition to what I want to do. What, if any, additions are worth the 8-9 years (path specifically)?

I don’t understand your question.

 

[Granular]

The main upsides of getting the MD and doing a path residency:
1) Probably higher pay in academic medical center path departments (my guess is $100K/year difference); however, I have encountered PhD clinical chemists who make that same as board certified pathologists. I think it depends on academic standing, ability to generate revenue (professional billing vs. research dollars), supply/demand and philosophy of departmental or hospital leadership. Overall, when you factor in the opportunity cost (7 years of not getting a clinical chemist faculty salary while a student and resident), the breakeven point is probably 20+ years in the future.
2) You may get more respect from doctors and other healthcare workers in your academic medical center, at least outside of path. However, within a path department, I think fellowship trained PhDs get essentially the same respect as lab medicine focused pathologists. The ability of PhDs to develop new tests on sophisticated equipment and perform troubleshooting is generally much better than MD-only pathologists, and has significant value in many departments.
3) You may find something in medical school that you enjoy more than path or clinical chemistry. Maybe sampling colon polyps is your real calling, and you'll never know unless you try it out. I view this possibility as the main reason you might want to go to med school.

That being said, I think your best bet is doing the fellowship now, presuming you can get one. Last year, the program at my institution had 50 applicants for one spot. Your assertion that the job market is dominated by MDs is probably wrong. IMO, most clinical chemistry job openings prefer a fellowship trained, ABCC boarded PhD.

 

[poten_PhdtoMD]

The main upsides of getting the MD and doing a path residency:
1) Probably higher pay in academic medical center path departments (my guess is $100K/year difference); however, I have encountered PhD clinical chemists who make that same as board certified pathologists. I think it depends on academic standing, ability to generate revenue (professional billing vs. research dollars), supply/demand and philosophy of departmental or hospital leadership. Overall, when you factor in the opportunity cost (7 years of not getting a clinical chemist faculty salary while a student and resident), the breakeven point is probably 20+ years in the future.
2) You may get more respect from doctors and other healthcare workers in your academic medical center, at least outside of path. However, within a path department, I think fellowship trained PhDs get essentially the same respect as lab medicine focused pathologists. The ability of PhDs to develop new tests on sophisticated equipment and perform troubleshooting is generally much better than MD-only pathologists, and has significant value in many departments.
3) You may find something in medical school that you enjoy more than path or clinical chemistry. Maybe sampling colon polyps is your real calling, and you'll never know unless you try it out. I view this possibility as the main reason you might want to go to med school.

That being said, I think your best bet is doing the fellowship now, presuming you can get one. Last year, the program at my institution had 50 applicants for one spot. Your assertion that the job market is dominated by MDs is probably wrong. IMO, most clinical chemistry job openings prefer a fellowship trained, ABCC boarded PhD.

Thanks for the input. You hit on all the points I needed.