MD/PhD in Pathology

Discussion in 'Pathology' started by DrMeditrina, Jun 4, 2008.

  1. DrMeditrina

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    I am wondering if there are any MD/PhDs around who specialized in path; if so, what sort of jobs did you decide to take?

    For example, are you in research: academic or industry; or practicing as a pathologist: academic or private practice; or other job...

    What view do you have of an MD/PhD in pathology?
     
  2. Aubrey

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    Pathology is one of the medical specialties that has traditionally appealed to MD/PhDs. This is arguably due to the fact that many programs are friendly to folks that want to have some element of research in their training as well as in their future career goals.. that being said, we go into jobs in both PP and academics, doing varying mixes of research and clinical work (or sometimes doing nothing but one or the other).

    Out of the MSTP grads at my institution, path is probably 2nd only to IM in specialty selection, followed by rads. I'm sure somebody has statistics they can dredge up on this.
     
  3. Gut Shot

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    Most MD/PhDs in pathology will still go private practice, although they are probably more likely to go academic/research than their MD-only counterparts.

    This isn't very surprising, as when you reach the end of many years of training, poverty and academic BS, the higher paying grass in the private practice pasture looks far more enticing than the alternative.
     
  4. DrMeditrina

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    What is your impression of an MD/PhD who ends up in private practice?

    I've heard it said, that it would be a waste of time/energy if one aimed for private practice while pursuing an MD/PhD.
     
  5. Gene_

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    If an MD/PhD is going into private practice, and will not be doing research, the PhD is of little use. Whether it was a waste of time is probably best left up to the individual to interpret.
     
  6. docbiohazard

    docbiohazard Highly ranked amateur
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    Well, thats up to the individual to decide for themselves. From the standpoint of the training institution, it was probably a waste of resources (in term of stipends and what not)... but we live in changing times, funding isn't what it once was, and heck, some people burn out of research/academics for various reasons... even just traditional PhD types.

    I would say that, if at the outset, you think you want to do private practice and have no interest in research over the long term, then no, you shouldn't go MD/PhD. For one thing, you'll likely never make it through the program, especially the point at which your friends run off to clinics and you go to the lab. The other reason is that in that case, there truly is no point, you'll likely be miserable, and you're depriving yourself of years of earnings. If you think you might have a slight interest in research, do some on the side or over a summer during med school - there's tons of funding out there, and it won't cost you any extra time towards graduation. You can always go work off your student loans at the NIH if you want...

    DBH
     
  7. LADoc00

    LADoc00 Gen X, the last great generation
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    my experience, about 80% of MDPhDs never use their PhD, dont go into research for more than a year or 2 and end up in private practice looking back on 4+ years of extra hard drinking/partying (or not).

    the remaining 20% of MDPhDs are in research wishing they followed the other 80%.
     
  8. DrMeditrina

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    I hear some awfully negative sentiments toward research.
    I think plenty of well-trained physicians are in research because they prefer to be. Not only MD/PhDs but straight MDs as well.

    Does anyone else feel the pursuit of knowledge alone is worth the dual degree?

    Maybe I should be posting in another forum....but I guess my main point is do any actual MD/PhD pathologists out there regret their PhD training?

    Am I too idealistic in thinking there is something to be gained in the knowledge and training whether or not I decide to pursue research as the focus of my career?

    Do you all bore of reading slides/lab work etc...or does the money compensate for the routine aspects of pathology?
    Maybe pathologists just truly love their work?

    Thoughts?
     
  9. alois

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    Remember, the participants in this group are not a scientifically collected cross-section of pathologists gathered in a non-biased manner and corrected for all of the typical skewing factors. Rather, it is largely self-selected (for example, you seem to be drifting to a more compatible discussion group yourself), reinforcing and non-representative.

    There are plenty of pathologists who do research -- perhaps a higher fraction than for many other specialties -- both with an without a PhD. Most of them are busy at other things and don't show up here to defend their careers and interests.
     
  10. Gut Shot

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    Well, speaking as a participant in this group that is not a scientifically collected cross-section of pathologists gathered in a non-biased manner and corrected for all of the typical skewing factors, it is my general observation (both in my colleagues and myself) that the decision to go private vs. academic often hinges on two important factors:

    1. NIH funding is stagnant, and this has made securing adequate research funding a real bitch. Training in a wealthy, grant-laden lab can really warp one's perspective on the current situation. For a more realistic mental exercise, imagine a single steak dropped into a cage filled with 12 starving wolverines. That sums up research funding nowadays. I hope that changes someday soon, but the pursuit of knowledge has become an obstacle course.

    2. It's a helluva lot easier to be idealistic when you're young, but MD/PhD training is long, and residency/fellowship isn't exactly brief, either. By the time that whole process is wrapping up, the pragmatism that sets in with middle age is looming. All of a sudden it's not just your carefree 24 year old self with a lab bench and a dream. No, it's you with a wife and kids, living in a shoe box apartment, driving an old Civic, still waiting to start saving for college and retirement. Your colleagues who abstained from this whole research endeavor are living in nice houses, taking vacations, buying clothing and furniture, driving cars under warranty and saving for college and retirement. When push comes to shove, can you delay your material gratification any longer?
     
  11. WiseMentor

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    I think that Alois was just suggesting that the collection of viewpoints in this or any other discussion group are not necessarily representative.


    Neither of the two factors you mention should come as news to you as you are finishing clinical training as a pathologist. Part of the responsibility of a PhD advisor is to ensure that her/his graduate students understand the financial aspects of running a lab (the difficulty in getting grants, the process of fund management, the details of hiring and supervising employees). If your advisor kept all of this hidden from you, then s/he did you a great disservice.

    Those of us who have been around for a long time can tell you that grant dollars are cyclical. Yes there have been easier times (but even then the R01 pay line only rarely has crept above 20%) but there was also 1974 -- the year that Nixon impounded NIH money (no doubt, well before you were born). Overall, the system works well, rewarding insight and strong ideas; more money into the pot always make it better.

    If you aren't getting the rewards you need, paired with an acceptable standard of living, then you need to seek a different career. As I sometimes tell students, science is about the search as much as it is about the answer. If you don't find the search rewarding in itself, then it isn't the career for you -- because far more of your time is spent searching than learning answers. Part of the education of a PhD student should be making sure that this is the way you want to spend you time. If your job isn't what excites you every day, what gets you moving in the morning, what keeps you thinking about things in the middle of the night, then you are in the wrong business. You can work in medicine while hating it, viewing it as glorified factory work, but you can't do science like that. Your lack of commitment to it ends up reflected in your productivity, in your thinking and in your work; and the people reading your grants can see this. On the other hand, if you love the work, pour your energy into it and have the intellectual power behind it, then you will succeed.
    -----------------------

    It is unfortunate that people start down a path as long and complex as a double degree without thinking about where they are going. It is hard to do without good advice at the start, yet many people come to these programs too young, fresh from college. MD-PhD programs don't encourage students to view the reality of the career they are choosing because any attrition looks bad on the next application for funding. Thus, students are coming to the end of 6,7,8 or more years of training unwilling to face the future for which they have been preparing.
     
  12. Cloaca

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    There are many MD/PhDs attendings at my institution. Most of them have labs and sign out. And our residency program has a heavy proportion of MD/PhDs - all of whom intend to pursue academic careers - not that intentions always result in actions.
     
  13. Gut Shot

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    Well obviously.

    They did not come as news to me, but there is a difference between hearing the news and living the news. Someone starting the research portion of his MD/PhD program is hearing the news. An MD/PhD finishing his fellowship and weighing job prospects is living it. It should be no surprise that age, experience, and life's inevitable baggage will change one's priorities.

    First off, I was alive in 1974. Not writing R01's, but I was breathing. Second, I've been hearing about this cyclical nature of grant dollars since in started graduate school... in 1995. In the past 13 years the availability of grant money has gone one direction: down. Combined with the chronic overproduction of biomedical PhDs, the situation is going to need more than a cyclic uptick in funding dollars to make it palatable for your typical non-masochist.

    I think we can both appreciate that there are no guarantees in life, and I am very sorry, but in the current environment one needs a good helping of luck (in addition to love, energy and smarts) in order to succeed. There are many talented individuals with good ideas who end up getting the shaft. Were it otherwise we probably wouldn't be having this discussion.
     
    #13 Gut Shot, Jun 9, 2008
    Last edited: Jun 9, 2008
  14. docbiohazard

    docbiohazard Highly ranked amateur
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    Well, that's a very subjective question. The PhD training is long, arduous, and involves a lot of delayed gratification. However, at any institution worth its salt, it will give you a good training to pursue research in whatever fashion you ultimately see fit to pursue it.

    Only you can know your true motivations, life situation, interests, drives and long term goals. There are plenty of opportunities for med students to squeeze in some research. If you're thinking you have interests in research, but not necessarily in being an R01-funded investigator who dedicates a majorty of his/her time to research, you might just want to consider that route.

    DBH
     
  15. Gyric

    Gyric Junior Member
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    A few thoughts from this MD/PhD:

    I think that our “wise mentors” still view the opportunity to pursue an R01 funded career through rose-colored glasses. The reality for someone just starting out is that the average age for a newly funded R01 investigator is up 8 years (and that is in one generation of scientists). I also strongly disagree with the notion that on balance study sections equitably distribute funding based purely on merit. I find Dr. Weinberg’s article “The Lost Generation,” very insightful; he notes that many key advances come from dynamic and energetic researchers at the start of their careers.

    To quote him:

    “These young people represent the cadre of researchers whose vitality we must preserve at all costs. These people are the last who should suffer from a flat NIH budget. Those who lead the U.S. Federal research agencies in Bethesda, Maryland, have lost sight of this simple truth.”

    From your post WiseMentor (suggesting that love of the search, hard work, and intelligence are all it takes to succeed in science), it seems you are out of touch with this reality; but don’t take my word for it, I encourage you to read Robert Weinberg’s article (Cell, Vol 126, 9-10, 14 July 2006), if you have not already.

    So why did science lose its hold on me?

    - Politics, playing this game well is required to succeed and it sucks the fun out of science.
    - NIH roadmap wants BIG projects and in so doing is killing small lab-based investigator driven science … science IS being turned into factory work, at least for many junior investigators (also commented on in Weinberg’s article).
    - Physician-scientist training is predicated on jobs which do not, or should not, exist.
    - Prolonged poverty.

    Sure there are a few pathologists who have labs and sign out cases and this sounds lovely to the starry-eyed MD/PhD student, but the reality is that not none of these individuals that I have worked with (at one of the best research institutions in the world) is anywhere near as competent as a pure diagnostic pathologist (autopsy pathology excluded). I don’t know where they stand in the scientific community, but I suspect their clinical work detracts from competitiveness for grants as well. Also, the new Maintenance Of Certification program makes it clear that the next generation of pathologists can not simply run off to the lab for 95% of their time, drop in on a few Drosophila CME lectures, and then wing-it on sign out days; we will need to continually demonstrate competence by focusing on diagnostic work if we want it to be part of our career.

    Today’s highly trained “physician scientists” quickly realize that they can either be physicians or scientists and that the two careers are more less mutually exclusive. Arguably you should move directly to postdoc training if science is your goal.

    However, I do think research training enhances the skill set of a diagnostic pathologist and I still consider my short MD/PhD training experience, time well spent.
     

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