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MD/PhD and specialties

Discussion in 'Physician Scientists' started by Fixed Gear, Apr 28, 2002.

  1. Fixed Gear

    Fixed Gear Highly Acetylated Locus
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    Here's a question for y'all-

    Correct me if I am wrong, but it seems like if you are an MD/PhD, it seems like your only options for specialties are internal medicine and specialties therein (i.e., cardiology, endocrine, neuro, hem/onc). I have yet to meet an MD/PhD surgeon or ER doc. From the standpoint of viewing an MD/PhD as a scientist specializing in translational work going "from bench to bedside" (yes, it's cliched, but it expresses the ideal)it makes sense, but I am wondering what your thoughts are.
     
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  3. ckent

    ckent Membership Revoked
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    Actually, you can go into whatever specialty you want. Radiation oncology, neurosurgery, neurology, ophthamology, and other specialties probably have an equal if not greater number of MD/PhD graduates then medicine. It's helpful if your PhD has to do with the specialty that you are interested of course, but every field needs their own clinician researchers.
     
  4. none

    none 1K Member
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    I have met an MD/PhD ER doc. However...he doesn't do research. He completed the MD after the PhD and a short post-doc that caused him to decide research wasn't for him. He spent quite awhile trying to disuade me from doing the whole MSTP thing too.
     
  5. brandonite

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    Well, it always made sense to me, because the only specialties that I am really interested in are internal subspecialties, and radiology, I guess. I think there is a lot of potential for clinical research in a lot of areas, but if you are doing a MD/PhD, odds are your focus will be on basic science research anyway.

    I'm considering cardiology, oncology (and pediatric oncology), neurology, and radiology.
     
  6. Rumit

    Rumit Senior Member
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    I guess it really comes down to the difficulty of doing something like ER medicine and research. It would be extremely hard to find a basic research field in which there would be much overlap, and you would have to stay up with two fields. This is something that I've heard a lot of MD/PhD's complain about...that they have a difficult time staying up to date on two fields. In my opinion, it's best to minimize this and try to have as much overlap between the two as possible.

    BTW, I would not tell an interviewer that you wanted to do ER medicine as an MD/PhD, unless you really know what you're talking about and have a concrete plan for doing it.

    I hope that was coherent.

    Adam
     
  7. Vader

    Vader Dark Lord of the Sith
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    There are MD/PhDs in every medical and surgical subpecialty. The dual degree in no way limits your options, in fact it broadens them. The majority of neurosurgery residents here at UCSF, for example, are MD/PhDs. Despite the long hours that neurosurg requires, each of them does research and is required to publish. Graduates of the UCSF MSTP have gone on to various clinical specialities, including medicine, pediatrics, radiology, orthopedics, neurology, psychiatry, surgery, pathology, ENT, emergency medicine, and dermatology, to name a few. As you can see, the options are wide open and there is great need of people who can do good basic science research in various clinical subspecialties.
     
  8. xanthines

    xanthines decaying organic matter
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    My surrogate PI is a pathologist MD/PhD.

    -X

    </font><blockquote><font size="1" face="Verdana, Helvetica, sans-serif">quote:</font><hr /><font size="2" face="Verdana, Helvetica, sans-serif">Originally posted by The Mastodon:
    <strong>Here's a question for y'all-

    Correct me if I am wrong, but it seems like if you are an MD/PhD, it seems like your only options for specialties are internal medicine and specialties therein (i.e., cardiology, endocrine, neuro, hem/onc). I have yet to meet an MD/PhD surgeon or ER doc. From the standpoint of viewing an MD/PhD as a scientist specializing in translational work going "from bench to bedside" (yes, it's cliched, but it expresses the ideal)it makes sense, but I am wondering what your thoughts are.</strong></font><hr /></blockquote><font size="2" face="Verdana, Helvetica, sans-serif">
     
  9. Fixed Gear

    Fixed Gear Highly Acetylated Locus
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    Xanthines-

    at my hospital, 99% of the MD/PhDs are pathologists. A lot (from what I hear) of MD/PhDs that burn out go into Pathology because of shorter training time.

    You guys have given a lot of good feedback. There is so much more to an MD/PhD than just a seven year commitment. However, my drive to become one is only greater.

    Peace out
    Mastodon
     
  10. xanthines

    xanthines decaying organic matter
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    I don't know if I necessarily believe A LOT burn-out, although I'm positive some do. Pathology reseidencies are a minimum of 4 years, I think. Aside from surgery, which ones are longer (yes, I know neurosurg is longer, but you can also subspecialize in path, as well)?

    Then again, if you're a patholgist, you (ta da!) have no patients! All you do is look at slides all day, apart from the occassional autopsy. I would imagine it's probably easier to do research and do the "clinical" work together. I work in what's called "The Department of Pathology and Laboratory Medicine" as a lot of Path Depts are called. Seems to me like laboratory medicine and research kind of go hand in hand. Maybe that's why a lot of MD/PhD's go into pathology? Curious as to what you peeps think.

    -X

    </font><blockquote><font size="1" face="Verdana, Helvetica, sans-serif">quote:</font><hr /><font size="2" face="Verdana, Helvetica, sans-serif">Originally posted by The Mastodon:
    <strong>Xanthines-

    at my hospital, 99% of the MD/PhDs are pathologists. A lot (from what I hear) of MD/PhDs that burn out go into Pathology because of shorter training time.

    </strong></font><hr /></blockquote><font size="2" face="Verdana, Helvetica, sans-serif">
     
  11. conrad

    conrad Member
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    I'm an MD/PhD student who is planning on doing an EM residency after finishing... There are a number of long reasons but here's the short list:

    1. ED shiftwork leaves protected time for labwork
    2. Want some generalist clinical skills to go with my esoteric basic science specialty

    Not many MD/PhDs in EM out there, and many who are concentrate on clinical research but there are others out there... <a href="http://www.saem.org" target="_blank">www.saem.org</a> has lots of nice info if you're interested in research in EM.
     
  12. I?m a senior mudphud and my take on what?s been written here is this:

    1. MD-PhDs most often, mostly because of historical reasons and presence of infrastructure, match in medicine, pathology and pediatrics. Ophtho, derm, rad onc are only recent trends. In terms of absolute numbers, path or medicine wins but that?s not important. Combined degrees I?ll call them (CDs) go into just about every field. There are two program I know of that study this and publish their data?Wash U and U Penn. Here?s the info for one of them:

    Addressing the Needs of Basic and Clinical Research: Analysis of Graduates of the University of Pennsylvania MD-PhD Program
    Peter Schwartz and Glen N. Gaulton
    JAMA, 281:96-99
    <a href="http://www.ama-assn.org/sci-pubs" target="_blank">http://www.ama-assn.org/sci-pubs</a>

    2. The important number is not the absolute but the relative. One, the percentage going into a field should be in a larger sense of reflection of societal and professional need. But that is hard to measure. The ratio between the percentage of CDs going into a field and the percentage of all physicians in a field indicates a "representation" quotient of sorts. Path has the highest over abundance but med, peds, and neruo and a few others do just fine. Surgical subspecialties do poorly especially plastics as does ob-gyn. Someone more insightful than I am has already looked into this, bone setters of all folks:

    The contribution of MD?PhD training to academic orthopaedic faculties
    John M. Clark , Douglas P. Hanel
    Journal of Orthopaedic Research, 19: 4: 505-510
    (The data analyzed here actually covers ALL SPECIALTIES not just ortho)

    3. Most specialties have realized that we are a valuable commodity and are interested in having us in their programs. Other things being RELATIVELY equal (board scores, grades, aoa, letters), the PhD WILL give you an edge of variable strength (depending on the specialty). In fact, our relative advantage is greater in fields that have a lower representation quotient?ortho, ent, plastics, ob-gyn etc. Also, a course for a faculty gig in medicine may be residency (3yrs/2 if fast track), "clinical" fellowship (1-2yr clinical work + 1-2yr "research", up to 5yrs I believe if you?re doing cards followed by electrophysiology, the big bucks), and in some cases a research fellowship of variable length on top of that before a faculty position. Structured, yes but not easy. Lets look at ortho: 5yr residency 1yr fellowship then faculty. There are some advantages in this although surviving as a research attending will be more difficult in surg specialties.

    4. Myth: pathologists and radiologists don?t see patients.
    Fact: Pathology is not one faceted. If you do clinical path, you can be pokin? more patients than a lot of other docs. Sure, forensics can be lots of dead folks. And surg path can be long hours with lots and lots of surgical samples and slides.
    Radiologists do CT, fluoro, US guided biopsies and aspirations. And who do you think administers the lower GI barium and injects the contrast and starts a code in the CT suite if there is one? Who do you think says "this is going to be uncomfortable" to the patient before placing an intravaginal US probe at 3 am? Again, lots of potential for injecting and poking. And if you?re IR, you?re essentially a minimally invasive vascular surgeon.
    The main source of confusion here is that these folks are doctors? doctors (a urgent consult service of sorts) so they don?t have to round on patients (except IR) and are not responsible for their overall care.

    5. Be open minded and look into a field before dismissing it. Unless you?re one of those really curious or terminally indecisive, you probably don?t know much about what it?s like to 1) be a resident in any given field and 2) be an attending. Oh, and attendings are notorious for knowing little about what attendings in other fields actually do. Example: if a cardiology attending says orthopods only see surgical patients in clinic, give a little smirk because for every surgical patient there are typically10 MEDICALLY or NON treated patients. So, find out more and do what you really want and not what you think you want or what others think you ought to want.

    The end, good bye.
     
  13. wgu

    wgu Senior Member
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    Clark, J. M.; Hanel, D. P.; ?The contribution of MD-PhD training to academic orthopaedic faculties?, J. Orthopaedic Research, 19 505-510 (2001).

    I found this article last semester when working on a presentation. From what I recall, it is an independent study of where MD-PhD's ended up w/ graphs and charts. You'll probably need to go through a medical library to access.
     
  14. Universal Coverage

    Universal Coverage Junior Member
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  15. Crazy Carl

    Crazy Carl Member
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    </font><blockquote><font size="1" face="Verdana, Helvetica, sans-serif">quote:</font><hr /><font size="2" face="Verdana, Helvetica, sans-serif">Originally posted by Vader:
    <strong>The majority of neurosurgery residents here at UCSF, for example, are MD/PhDs. Despite the long hours that neurosurg requires, each of them does research and is required to publish. </strong></font><hr /></blockquote><font size="2" face="Verdana, Helvetica, sans-serif">Is there anywhere to find information about what kind of degrees residents have? I'm wondering where else we might see an interesting MD vs MD/PhD balance.
     
  16. none

    none 1K Member
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    What about a medical genetics residency? It would seem that could offer the absolute tightest patient/bench interaction.
     
  17. TechMan

    TechMan Dreams Stuff are Made of.
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    My PI is an MD/PhD Vascular Surgeon. MD from Johns Hopkins, PhD from MIT. He might be one of the most intelligent people i have ever met.
     
  18. Bikini Princess

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    </font><blockquote><font size="1" face="Verdana, Helvetica, sans-serif">quote:</font><hr /><font size="2" face="Verdana, Helvetica, sans-serif">Originally posted by Mr. Burns:
    <strong>Actually, you can go into whatever specialty you want. Radiation oncology, neurosurgery, neurology, ophthamology, and other specialties probably have an equal if not greater number of MD/PhD graduates then medicine. It's helpful if your PhD has to do with the specialty that you are interested of course, but every field needs their own clinician researchers.</strong></font><hr /></blockquote><font size="2" face="Verdana, Helvetica, sans-serif">fyi, many of those residencies start out as internal medicine. Like Mr Burns says though, internal medicine is the starting point for many other residencies..usually the kind of people involved in MD/PhD work (ie oncologists, hematologists, neurologists, pathologists etc.)

    Remember surgeons are mostly just jocks too, especially orthopaedic ones. :)
     
  19. Hope everyone's having a good weekend...

    A few points:

    First, although there may seem to be a good amount of medical overlap between certain specialties, the training processes often do not overlap. Heme-onc, rheum, cards, pulmo etc are fellowships after 2-3 years of internal medicine but pathology, neurology etc are their own separate residencies. In the match they are "catagorical" (leads to specific training in a specialty) versus "preliminary" and "transitional" internships which can then lead to rads, derm etc. Because med and peds are so broad, you do a broad residency first (typically 3 yrs) and then do a fellowship. There are also combined residencies that allow you to be double boarded (ie med-peds, peds-psych etc.) A few specialties are a mishmash and can sometimes stand on their own as residencies or can be a fellowship or part of an "integrated" program. Nuclear medicine can be a categorical residency or a fellowship after internal medicine or radiology. Genetics can be a fellowship after medicine or peds or be part of a combined program. And lets not forget plastics (even surgeons have to abide by biologic principles) which can be a combined program with g surg or a fellowship after g surg, ortho, ent, urology, or oral and maxillofacial surg (omfs). Bottom line is don't worry about this now. Just be broad and explore.

    Second, don't look to just one department or institution in making judgements about number of mdphds etc. Each place has it's own historical perspective. Look at lots of different places and get different opinions. I mentioned this in my previous post, but if you're curious as to what specialties mdphds have been going into, check out the following article:
    The contribution of MD?PhD training to academic orthopaedic faculties
    John M. Clark , Douglas P. Hanel
    Journal of Orthopaedic Research, 19: 4: 505-510
    (The data analyzed here actually covers ALL SPECIALTIES not just ortho)
    Don't forget that the underrepresented specialties are the ones that will be needing more mdphds in the future.

    Third, most surgeons are not jocks (maybe wannabe jocks). In general, they have the reputation of the nastiest attitude but maybe you would too if you had their schedule or had to probe peoples bowels and open their hearts. All specialties bash each other sometines in seriousness but usually in jest. You'll hear renal docs ripping on the surgeons who don't know how to evaluate BUN levels and the radiologist giving attitude to just about eveyone. Oh, and orthopods get grief from all sorts of folks but when they suspect compartment syndrome or osteomyelitis or a skeletal trauma comes in, you know who's in charge. Bottom line, there's a reason they're called specialties. Just find the one you like the most and leave the rest to others.

    MD-PhD 2003
    University of Pennsylvania
     
  20. Original

    Original Ogori-Magongo Warrior
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    Funny Bones,
    your insight is awesome! What residency are you going to do?
     

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