MD/PhD, or PhD?...

[ILoveToLearn]

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Hello future advice givers,

I hope you can be of help to me.

A little background information:
I am currently finishing up my 3rd year of undergraduate studies in Psychology. However, I have come into college with a full year of credit from AP classes and have already fulfilled my Psychology degree. Next year I will be taking physics, chemistry, biology, as well as a graduate level neurobiology class to round out my transcript. I have participated in Huntington's Disease research for 1 1/2 years. I am currently studying abroad, taking cognitive psychology and neuroscience classes, as well as collaborating with a professor on a research study in which I will be a published author for. I have also came up with a solid (or so I think 😉) research proposal of my own that I will be conducting once back at my home institution. I am also a member of 4 honor societies.

Now the dilemma, I want to pursue Neuroscience, everything about the brain completely fascinates me. However, I am unsure whether to pursue the MD/PhD, or go with a PhD in Neuroscience. In my mind, the former would lead to practicing learned methods and research on patients, as well as perhaps conducting research on the side. It will take about 7/8 years versus 4/5 years, but seemingly give me many more options for a career path. The latter would place me on the front line of up and coming researchers who would be changing the very essence of the science with every new study, but constrict me in that I can not practice medicine. However, I am also a very philosophical person; I have delved into the works of Carl Sagan, Einstein, Richard Feynman and early free thinkers. There is something with knowing how things work in the most basic forms that gives me great joy. I have a deep routed passion and drive for learning. I believe this is what has brought me to this road, a desire to understand how the brain works and processes our realities. The visual system has always been one of my favorite things to study, in recent times, topics such as consciousness and dreaming have come into sight as well. I do enjoy explaining and teaching these topics to friends and family, which would go with the university professor a PhD might lead to. To elaborate on the PhD portion, I am not sure whether I would be more fit for Molecular and Cellular Neuroscience, or Cognitive Neuroscience. Both are intriguing to me. I do have a desire to bring my research into practical application. Also, I have not yet taking the GRE, but plan to do so shortly.

Lastly, although this isn't a deciding factor at all, as loans and scholarships are always available, will these paths be costly to me? It seems most MD/PhD and PhD programs I have looked at will provide a stipend of about $22-27K a year, is this correct? I am also unsure if this is guaranteed through admission, or does it typically require a competitive application (which is also fine).

Any suggestions or advice would be much appreciated...

Cheers-
Eric

 

[Shifty B]

This is a complicated topic that we could talk about all day. However, it would really help me give you useful advice if you answer these two questions:

- What is it that makes you really want to be a physician?
- Do you feel like your career is really going to be missing something if you do not see and treat patients?

B

 

[Freak]

I would say that your line of research would definitely benefit from the extra years of med school (your questions and answers will be more nuanced). Some schools have a crash-course in med school for PhD students (you might think more highly of those PhD programs).

The issue I also have is what Shifty has ... why be a doctor.

FYI, if you are really interested in understanding the basis of everything ... med school will annoy you in many cases, as you simply need to memorize volume rather than understand at times (either because people do not understand the basis or because you do not have the time).


In terms of your Q's ... the stipend numbers are a little on the low side (or maybe my institution is paying a premium for me 🙂 ). In terms of the guarantee, if you get into a top program (MSTP), you are basically guaranteed that stipend ... if you are interested in research, you will generally be looking at one of these top institutions anyways. Some MD/PhD programs fund the PhD without funding the MD (usually no stipend during the MD phase, but tuition remission). There are also some MD/PhD's that fund exactly like the MSTP (but as they are not NIH "sanctioned", they are not called MSTP).

 

[Palaver87]

Hi ILovetoLearn,

You are really similar to me, both in dilemma and interest. This was a very difficult dilemma for me to solve. Should I go to graduate school at somewhere prestigious or apply to MD/PhD were everyone is awesome?

What did it for me was to go the lab websites of faculty who you think you'd want to work with if you went straight PhD. Then look at what the alumni are doing. You will probably come to a decision then

 

[calvinNhobbes]

Do a bunch of clinical shadowing of several different physicians in several different specialities. If you really enjoy the patient interaction, awesome, then consider MD/PhD. If you are bored, think you are wasting your time, or whatever after shadowing multiple different doctors in areas like psych, neurology, IM, maybe even neurosurg, then perhaps clinical medicine is not for you.

 

[RxnMan]

First decision tree should be if you want to work with patients or not. That will determine the necessity of a MD (or a clinical psychology degree, but you didn't really seem interested in that option). Making this decision after direct patient experience (i.e. shadowing) as Shifty suggested is a great idea.

In your case, only if you are sold on getting a MD should you consider going MD/PhD.

 

[alacast]

In your case, only if you are sold on getting a MD should you consider going MD/PhD.

I hear this thrown around a lot, but I'm unconvinced. Can people give some arguments for why an MD/PhD is an inferior move, compared to a straight PhD, for someone who's interested in solely medically-related research, but doesn't want to see patients? I'm sold on the MD and patient care for my personal career, but I would think an MD might be a useful experience for a straight researcher in many ways.

I'll only be starting an MSTP this fall, so I may be ignorant of some of the realities of medical school. Is the primary argument that it's just 4 years of wasted time? Perhaps someone could even be undecided on patient care, and only make their determination during clerkships. Surely we wouldn't have called the MD a waste then; it would have been a valuable learning experience, if an inefficient one. Let's assume that the person who doesn't want to do patient care doesn't do residency (or is that a bad assumption?).

Of course, RxnMan said "In your case", so is there something about the OP's particular situation that made you suggest this?

 

[Freak]

Alacast ... the issue actually becomes when is enough med school enough ... residency is only 3 more years, and then hey maybe a fellowship would not be too bad of a move. This is primarily motivated by the relative stability of the medical job prospects (even with healthcare reform and associated scares, I do not think they are hitting <10% renewal rates and the tenure issues PhD's face).

By the time you are done, you have added the better part of a decade on to your training. Med school is somewhat similar to a conveyor belt ... it is almost too easy to keep on moving in the same direction it is going.

The final issue is that as you get older, your tolerance for doing things you are not "interested" in becomes much less. Your peers are generally in careers that they enjoy and if you are not having "fun" doing what you are doing, you will hate the process (~4 years for each degree is a long time to hate something). Also at some point you probably get married/have children. Then the pressures to win bread and such are even higher.


I do agree that med school, especially for the "clinical/translational-type" researcher is very useful, but I wonder if career-wise, these individuals might not be better served with more efficient methods of gaining the same experience.

 

[Shifty B]

I hear this thrown around a lot, but I'm unconvinced. Can people give some arguments for why an MD/PhD is an inferior move, compared to a straight PhD, for someone who's interested in solely medically-related research, but doesn't want to see patients? I'm sold on the MD and patient care for my personal career, but I would think an MD might be a useful experience for a straight researcher in many ways.

I'll only be starting an MSTP this fall, so I may be ignorant of some of the realities of medical school. Is the primary argument that it's just 4 years of wasted time? Perhaps someone could even be undecided on patient care, and only make their determination during clerkships. Surely we wouldn't have called the MD a waste then; it would have been a valuable learning experience, if an inefficient one. Let's assume that the person who doesn't want to do patient care doesn't do residency (or is that a bad assumption?).

The main reason that an MD/PhD is not that great for someone who is interested in pure research, which Freak alluded to, is time. In medical training I would argue that there are about 2 years of information that would be useful to a future researcher who isn't interested in clinical practice. The problem is, these years aren't contiguous, or even all in medical school! To me, the years including important information are probably the entire MS3 year, the first half of the internship, and the first half of the R-1 year.

The problem with the MS1 and MS2 years is that there really isn't anything in them that can't be found in a book. Their sole purpose is to get you a good score on step 1 and make sure you have some basic skills (i.e. physical exam skills) and information when you show up the first day of MS3. I would almost argue that the MS1-2 years aren't even relevant to your career in medicine, let alone science.

MS3 might actually be useful. You really learn how the system works, how doctors get their information about patients and make decisions. You learn which information is important and which is a waste. You learn which areas are ripe for research, and which avenues of research would be irrelevant to clinicians.

MS4 is a waste, because it's only purpose is to give you enough time to take electives, vacation, and interview.

If you stopped here, you would have spent 4 years to get maybe one year of useful information. In research, you're only as hot as your last paper, and quite frankly that extra 4 years would be better spent getting more papers in better journals. Not to mention there would be no gap between your PhD and a postdoc, when your skills are getting rusty, your ideas are getting old.

If you keep going in a residency with the plan of going into research only, it's again about 1 year out of 4 that are useful.

 

[RxnMan]

I hear this thrown around a lot, but I'm unconvinced...

1) An MD is a lot of work, especially if you're not going to use it.
2) An MD is pretty inefficient as an academic credential outside of a medical department.
3) An MD is worthless within a medical department without a residency (unless you have gobs of funding).
4) Residency is a b**** in of itself, and more so if you don't plan on using that training.
5) MD + residency is a ticket to an unrestricted medical license, better insight into disease, better understanding of the constraints of medical care, and better patient access (in addition to being able to care for patients). If you need only peripheral contact with patients (need human samples, want to test your drug in humans, etc.), why not collaborate with a MD instead of spending 4 + 3-7 years getting an MD + residency?

For the OP, he's set on at least a PhD. Patient care will probably be a sizeable component of his career path if he goes MD/PhD. If he was set on a MD, then he has nearly all the time in the world to decide whether and when to get research experience.

 

[ILoveToLearn]

First, thank you all for your input!

- What is it that makes you really want to be a physician?
- Do you feel like your career is really going to be missing something if you do not see and treat patients?
B

1) To put it simply, I would like to be able to help people, immediately. Also, it would be nice to have a reliable form of work to kind of fall back on, if you will... a steady flow of patients rather than a "publish or perish" lifestyle.

2) I don't. I really want to just make an impact in the field of science. I am mesmerized so much by the brains activities that I want to take this passion and delve deeper into the subject.

Calvin, I will take your advice on shadowing physicians, I think that is a great way to get an inside look on what I would like to do for the rest of my life (quite an important decision).

RxnMan, from your posts I have gathered... if I want to work with patients directly, or want an MD, go for the MD/PhD. If I want to go more research wise, even if it is slightly interacting with patients, collaborate with an MD and go for the PhD? Is this a fair summary?

Shifty B , regarding your view on the time it takes to go through the medical school process, residency, etc. Do you feel I would be better suited getting a PhD, concentrating hard on this and getting deep into my subject and then perhaps learning whatever skills in year 3 of med school elsewhere.

Freak, I can imagine what insight I would get from Med School for my research. However, is this the best/only route to get this insight? As you said, it is a huge volume of information typically memorized, rather than understood and learned. The bit you said about the "conveyor belt" of Med School also scares me a bit. As RxnMan said in the last post, I am set on getting a PhD, I want to do research, I want to uncover things and make discoveries. Whether or not the added MD would aid this, is one question.

My next question, in my eyes, if I did go for an MD/PhD, I wouldn't want to get a general MD, I would want to specialize in something like Neuro-ophthalmology or Neurology. Which I realize now, is a ton more time, combined with the PhD... is this worth it or even a reasonable thought?

I have also gathered that it is more important to get a great knowledgeable and helpful mentor to work under, rather than go into a prestigious school - if the option was one or the other.

 

[RxnMan]

...1) To put it simply, I would like to be able to help people, immediately. Also, it would be nice to have a reliable form of work to kind of fall back on, if you will... a steady flow of patients rather than a "publish or perish" lifestyle....

Clinical medicine = helping people immediately. But there are other ways of helping people that does not entail getting a MD. Police officers help people too.

...2) I don't. I really want to just make an impact in the field of science. I am mesmerized so much by the brains activities that I want to take this passion and delve deeper into the subject...

This response would make me think that a PhD is a better fit for you. I also want to have an impact on my field, but that is because I want to improve my ability to do things - give drugs, suture, diagnose disease - that make people better. Patient care is an intrinsic part of my goal, thus I am getting my MD.

...Calvin, I will take your advice on shadowing physicians, I think that is a great way to get an inside look on what I would like to do for the rest of my life (quite an important decision)...

You really need experience to make this decision. That's why it's essentially a entrance requirement for MD school. And if you find out you don't like it, you'll probably come away with some stories to impress the ladies/men/whatever you prefer at the bar.

...RxnMan, from your posts I have gathered... if I want to work with patients directly, or want an MD, go for the MD/PhD. If I want to go more research wise, even if it is slightly interacting with patients, collaborate with an MD and go for the PhD? Is this a fair summary?...

Since research is your chief goal, realize that PhDs are able to make an impact on science and can do a lot of medical research. To get patient access or samples, they're going to need a MD somewhere down the line. This isn't a big deal because collaboration is the name of the science game. But there's no reason to go through MD + residency (and there's little reason to get a MD without a residency) unless you want to take care of patients. If you want to work with patients and do research, there's many excellent ways to go about this, not just a MD/PhD, as I've posted in other threads.

...Freak, I can imagine what insight I would get from Med School for my research. However, is this the best/only route to get this insight?...As RxnMan said in the last post, I am set on getting a PhD, I want to do research, I want to uncover things and make discoveries. Whether or not the added MD would aid this, is one question...

As a random suggestion, I met Harold Varmus when he was promoting his new disease-oriented PhD program of his. Maybe that's something you could look into. The NIH intramural campus also has a whole "Demystifying medicine" series for PhD students to meet patients and to get acquainted with the clinical aspects of the diseases they study.

...My next question, in my eyes, if I did go for an MD/PhD, I wouldn't want to get a general MD, I would want to specialize in something like Neuro-ophthalmology or Neurology...

These don't really exist as training paths within an MD. You'd have to complete the MD or your MD/PhD and then Match into a Neuro or Optho residency program.

 

[Freak]

The conveyor belt is a good and a bad thing simultaneously. The positive is that you are guaranteed to finish in X amount of time assuming you do X work. The negative is that you are not as free to pursue your own intellectual interests (although even in a PhD I am not sure as to how valid that statement is). The ease of the med school conveyor is that you are essentially guaranteed an reasonable endpoint and your path is relatively carved out. The PhD path is much more tortuous and you are basically trying to navigate through the bush (with the fear that the snakebite of failure will end up killing your career and leave you with little to show).

In PhD land you have to think for yourself and sometimes wander the wasteland that is science following useless leads. Your end goal is undefined and you can never really take a break ... (every day you do not work, you essentially extend your training). If you do not make adequate progress, you can be weeded at any number of stages. You have to beat out your own path and it may (often) lead to a dead end.

In the MD part ... you have huge volumes of information, but oddly, it is finite. The fact that it is finite (even though you would be unlikely to master all of it) is actually some sort of consolation. Your path is relatively well beaten out for you ... that means you generally have a well defined set of responsibilities, so as long as you do what you are told, life is pretty good. Rinse, lather, repeat. As long as you do not royally screw up P=MD.


In terms of the insight, oddly, I would say that I really appreciated the first 2 yrs of med school for that. As I am not clinical yet, I cannot comment as to their relative weight to 3rd yr. I think that being part of patient care will definitely help focus your research on what is relevant. The first 2 yrs gave me a broad scientific foundation from which I can understand most bio-scientific fields (I am at a research heavy institution, so that is probably why).

Other methods of getting similar to what I have would probably be to take "medschool-lite" classes. Depending on how focused they were, you will probably not get the full exposure, therefore you may not make high-level connections as to how your neuropathophysiology is related to a similar issue in renal dysfunction or something. It really depends on how "renaissance" you want to be.

 

[Palaver87]

Also ILovetoLearn

You should also be realistic about the financial side of PhD vs MD/PhD. Who gets more funding for their research?

Moreover, there is more insecurity in getting just a PhD. If you look at the lab websites of alumni from top labs, you can see that many have trouble getting faculty positions. For MD/PhD, this is less so. Can you take the risk with just a PhD? Do you want more security to one day run your own lab?

It is very hard to succeed with just a PhD, success in this case being defined as tenure at a university. The job market is not the same as it was in the past. More people get PhDs now, but the number of junior faculty positions has not expanded as much.

Medicine has patients. patients generate funds that can fund your research.

Well, just saying you should consider this side along with your interests

 

[Shifty B]

2) I don't. I really want to just make an impact in the field of science. I am mesmerized so much by the brains activities that I want to take this passion and delve deeper into the subject.

So, this statement makes me think that you might be better suited going into the PhD programs. You're attraction to discovery and the big picture is not going to be addressed in medical school. You may find it very frustrating in terms of the sort of memorization and rote thinking which are necessary in medicine.

RxnMan, from your posts I have gathered... if I want to work with patients directly, or want an MD, go for the MD/PhD. If I want to go more research wise, even if it is slightly interacting with patients, collaborate with an MD and go for the PhD? Is this a fair summary?

I think I agree with this. If you want to work with patients directly, then you have to go for the MD/PhD. It's the only way for you to be personally in charge of patients. However, if this is not a big deal for you and you are just looking for ways to supplement your research insight, then it's probably not enough.

Shifty B , regarding your view on the time it takes to go through the medical school process, residency, etc. Do you feel I would be better suited getting a PhD, concentrating hard on this and getting deep into my subject and then perhaps learning whatever skills in year 3 of med school elsewhere.

From what you have posted about yourself, I do believe this. This is not to say that the MD portion of an MD/PhD doesn't provide you with increased insight about scientific problems. It definitely does. I just think the cost in terms of time is too high. I think there are a lot of ways to get more insight into medicine.

1) Get your research connected with a clinical MD. For instance, as a PhD student you can probably either choose a lab which already has some collaboration with clinical MDs. Or, if your lab doesn't have that then you can be the one to start it. Once you get connected to the MD, put him on your thesis committee and spend a half day a week in clinic or on the wards with them. See what it's like. Ask questions. Then, use this person's insight to help build your own and guide the future direction of your research.

2) Take courses. Many schools have options where you can actually take mini-med school courses or even sit in on the courses with the medical students. Take advantage of this as much as you can.

Don't get me wrong, I did the MD/PhD route and initially got interested because I thought the degrees were very complimentary, with both helping each other. They definitely are, and I'm happy that I did it because now in my residency I'm more interested in clinical work than I thought I would be. However, if you're convinced that basic science research is your career path, the extra effort and time to get the MD just to give you insight is too high, in my opinion.

 

[GASGEEZER]

I went through a route of Ph.D. then M.D. I thought I wanted to do research after finishing. I did molecular cloning as a graduate student (as a tool). When I had completed medical school, and internship, and started residency, I found that my research skill set were basically obsolete. When I completed my residency, this feeling was even more profound.