MD/PhD careers -- Academic Medicine vs. Clinical Medicine

[Repo Man]

Some of the program webpages that I've looked at for different schools stress that the MD/PhD program is aimed at producing researchers and teachers ("academic medicine"), I'd assume as opposed to clinical physicians ("clinical medicine"). As much as I want to pursue this program to further my knowledge in a subject I love, is it wrong that my goals are to be a clinician primarily and a researcher secondarily? What are your takes on the academic vs. clinical issue?

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[tacojohn]

Some of the program webpages that I've looked at for different schools stress that the MD/PhD program is aimed at producing researchers and teachers ("academic medicine"), I'd assume as opposed to clinical physicians ("clinical medicine"). As much as I want to pursue this program to further my knowledge in a subject I love, is it wrong that my goals are to be a clinician primarily and a researcher secondarily? What are your takes on the academic vs. clinical issue?

I could be wrong but I think it might actually be academic verses industry. Academic research departments love to look down their noses at industry research and generally want to see their graduates going to academic institutions rather than pharmaceutical companies and the like. Nevertheless, there's a lot of money out there in industry for PhDs and MD/PhDs that you'll never find in academia.

 

[Repo Man]

But it wouldn't be out of the question for me to pursue the program and still treat patients afterward like an ol' MD would do?

 

[ThatOne]

It wouldn't be out of the question, but you should have a very good answer as to the reason you are doing the MD-PhD if all you want to do is treat patients like a straight MD would. There are arguments made that the PhD skill set will enhance a doctor's ability to treat patients, but it is a lot of money from the government and school, a lot of time on your end, and a whoooooole lot of work, so your reasoning needs to be extremely cogent.

Also, keep in mind that most physician-scientists say that if you want to do research at all, it has to be the primary thing you do (80%-20% research-clinical split is what I have frequently heard). With the amount of time that needs to go into grant writing and the competitiveness of obtaining a grant, it's really hard to run a lab otherwise. Of course, there are options such as being a "co-PI" etc, but even with those options I don't think you could flip the ratio to 20:80 research:clinical.

 

[Repo Man]

Ah ok, thanks for the insight, ThatOne.

Perhaps I should elaborate. I am an exercise science major and I want to continue graduate studies because I enjoy the subject and it would offer opportunities beyond just the MD degree (and I'm leaning toward orthopedics with a sports medicine specialty at this point, although I agree that it may be too early to say for sure). For instance, one of my professors is a health advisor on the US Olympic Committee and also conducts medically-related research at our university. Graduate education in kinesiology, biomechanics, or exercise physiology would really just enhance my total knowledge of sports medicine, sports injuries, prevention, etc., as well as set me up for other endeavors.

So in addition to having a practice and treating patients, I'd also like to perform research and work with other agencies, although I do see your point about the time split. I always thought I'd spend a few years after graduation working solely as an orthopedist and treating patients, and as I got older, I would move into research and professional work primarily while spending less time treating patients.

 

[tacojohn]

It wouldn't be out of the question, but you should have a very good answer as to the reason you are doing the MD-PhD if all you want to do is treat patients like a straight MD would. There are arguments made that the PhD skill set will enhance a doctor's ability to treat patients, but it is a lot of money from the government and school, a lot of time on your end, and a whoooooole lot of work, so your reasoning needs to be extremely cogent.

Also, keep in mind that most physician-scientists say that if you want to do research at all, it has to be the primary thing you do (80%-20% research-clinical split is what I have frequently heard). With the amount of time that needs to go into grant writing and the competitiveness of obtaining a grant, it's really hard to run a lab otherwise. Of course, there are options such as being a "co-PI" etc, but even with those options I don't think you could flip the ratio to 20:80 research:clinical.

Excellent points. In my view, unless you specifically want to to MD/PhD type research, it's basically pointless to have the dual degree. From the school's perspective, one could make the same argument: unless you specifically want to to MD/PhD type research as a career, they probably won't be all that interested in spending all of that money to support you for all of those years. When it comes time for the NIH to review their program (which happens periodically), it will reflect negatively on them (and hence their chances of renewing funding) if many of their graduates don't follow a research career path.

I have yet to meet an MD/PhD who really does any real clinical work. Some might walk through the clinics occasionally but they don't actually do the nitty-gritty stuff with patients. Grant writing seems to me to be basically a full-time job.

 

[Circumflex]

So in addition to having a practice and treating patients, I'd also like to perform research and work with other agencies, although I do see your point about the time split. I always thought I'd spend a few years after graduation working solely as an orthopedist and treating patients, and as I got older, I would move into research and professional work primarily while spending less time treating patients.

First of all, academic and clinical medicine are not mutually exclusive. The goal of the MSTP is to combine basic science research with clinical medicine to produce more advances in diagnostics and treatments. It is meant to train scientists. Like another poster said, to be competitive in obtaining grants from basic science research, your main focus needs to be the lab, but many MD/PhDs still have some clinical duties (just not as many).

From what you've written, it sounds like you are more interested in doing clinical research. In this case, I would not do a PhD. First of all, to have a career that incorporates basic science, you will have to do a post-doctoral research fellowship after residency/fellowship to be competitive for NIH grants. You can't go into straight clinical practice, then pick up the basic research as you get older (you can, but it is extremely rare). But, you can do this with clinical research.

 

[holodynamics]

First of all, academic and clinical medicine are not mutually exclusive. The goal of the MSTP is to combine basic science research with clinical medicine to produce more advances in diagnostics and treatments. It is meant to train scientists. Like another poster said, to be competitive in obtaining grants from basic science research, your main focus needs to be the lab, but many MD/PhDs still have some clinical duties (just not as many).

From what you've written, it sounds like you are more interested in doing clinical research. In this case, I would not do a PhD. First of all, to have a career that incorporates basic science, you will have to do a post-doctoral research fellowship after residency/fellowship to be competitive for NIH grants. You can't go into straight clinical practice, then pick up the basic research as you get older (you can, but it is extremely rare). But, you can do this with clinical research.

I am interested in going back to my country (India) after my MD or MD/PhD in the US. Has anyone heard of cases where MDs or MD/PhDs get funds from the US to conduct may be clinical trials in a different country? With this view in mind is MD preferred over MD/PhD?

Also, are residency and research fellowship both needed to combine research into practice?