MD/PhD, Residency

[Vincit qui se vincit]

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I've been a long time reader of these forums, and although I've read thousands of threads, I still get anxious when I think about the process of achieving my long-term career goals. So, I'd really appreciate anyone's insight into my situation and if my "plan" makes sense or needs refining.

Although it's difficult to visualize my life 20+ years from now, I can say that long term I'd like to combine academics and private practice. I'm primarily interested in pharmaceutical and tissue engineering (i.e. drug development and delivery systems, scaffolds, synthetic tissues, etc) and surgery. I do have more refined interests then that, but I realize that I can't make any informed decisions about residency until I do my rotations and electives. In that same vein, my specific research interests will vary depending on the patient population and procedures I'm involved with, which I'm also okay with.

I really enjoy the clinical aspects of medicine and can't see a career that doesn't involved hands on work with patients. I also really enjoy research and the idea of developing novel treatments for the patients I'm working with. So, combined with the MD, I've planned to pursue a MSc/PhD focused on the more "chemical" aspects of biomedical engineering. I've identified two interested supervisors, one who's involved in synthesizing polymer scaffolds for the treatment of cerebrovascular disorders (Biomedical Engineering department) and the other who's involved in synthesizing biological active compounds and their receptor affinity (Chemistry department). At this point I'm more interested in developing skills, and I think I'll develop more skills doing graduate work in chemistry. There's also a lot of flexibiltiy for MD/PhD students at my university, and I could easily take additional courses in synthesizing polymers and tissue engineering. I'm also mildly deterred by the biomedical engineering department, because most supervisors in this area are surgeons, which is great, but they also state outright that they don't have a lot of time for graduate students. As a final note, both supervisors I mentioned are directly involved with other physicians and clinical research as well, so I think that provides a nice balance.

I mentioned earlier that I'm interested in private practice and academics, which is very true, but I'm aware that there are probably only two surgical specialties that would easily accomodate that goal: plastic surgery and ophthalmology. I know how competitive those residencies are and as I mentioned before, I don't know if I'd enjoy the clinical aspects of them, so for now, we'll say that combining private practice and academics is reverie.

Anyway, fine details aside, does my trajectory make at least some sense long-term. In your opinion.

Thank you for reading.

 

[Elixir6]

My two cents: Anything is possible. I think most people agree it is difficult to do surgery and 'real' bench research at an academic center, let alone a private practice. Plan to shack up with a full time researcher (i.e. a PhD). Being a physician - esp a surgeon - takes a lot of practice/experience so don't expect to be working as high a volume or complicated cases as your colleagues who spend 100% of their time in the OR.

Second, I would be wary of going into a lab with limited mentorship or two supervisors that are not completely on board with a narrow project and well defined plan. If you go into a lab with limited mentorship don't expect to publish in Cell or Nature.

 

[Vincit qui se vincit]

My two cents: Anything is possible. I think most people agree it is difficult to do surgery and 'real' bench research at an academic center, let alone a private practice. Plan to shack up with a full time researcher (i.e. a PhD). Being a physician - esp a surgeon - takes a lot of practice/experience so don't expect to be working as high a volume or complicated cases as your colleagues who spend 100% of their time in the OR.

Second, I would be wary of going into a lab with limited mentorship or two supervisors that are not completely on board with a narrow project and well defined plan. If you go into a lab with limited mentorship don't expect to publish in Cell or Nature.

Thank you for your input!

I definitely see value in having a supervisor who is both interested in, and has time for, graduate students.
I know both of the supervisors I mentioned quite well, and they both care about their graduate students success and try to make as much time for them as possible. However, there are only so many hours in a day, and one of these supervisors who is also, in this case, a sub-specialized neurosurgeon has a responsibility to his patients first and foremost (the way it should be). So, I think I'll heed your advice and instead choose a supervisor who's main priority is research and mentorship.

I definitely appreciate the complexities of combining bench research and surgery. Ideally, I'd like to spend residency and possible fellowship focusing on my surgical skills. I wouldn't want to abandon research by any means, but I understand that surgery is a skill that needs time to develop and be maintained.
I don't know what my theoretical practice as a surgeon-scientist would look like as an attending, but I think that I'll have time to find my niche between now and then. I realize and agree with you that I'll likely have to settle on either performing fewer surgeries or be involved in more routine cases. I'm okay with that.

 

[Flavivirus]

I definitely appreciate the complexities of combining bench research and surgery. Ideally, I'd like to spend residency and possible fellowship focusing on my surgical skills. I wouldn't want to abandon research by any means, but I understand that surgery is a skill that needs time to develop and be maintained.

This statement indicates that you don't appreciate the complexities of combining bench research and surgery enough. It will be extremely difficult to develop enough expertise in research to be able to 1) publish 2) be competitive for funding and 3) eventually become independent, without spending 75-80% of your time in research.

 

[Fencer]

Haven't said that... I know several competent surgeons / basic scientists who have a 50/50 portfolio. There are strategies to be able do succeed with a 50/50 mix; all of them aimed to find niches (clinically and research-wise) with less competition.

 

[Flavivirus]

Haven't said that... I know several competent surgeons / basic scientists who have a 50/50 portfolio. There are strategies to be able do succeed with a 50/50 mix; all of them aimed to find niches (clinically and research-wise) with less competition.

It may be able to juggle a 50/50 portfolio as an established investigator, but when you're trying to get yourself established, especially in today's funding climate, I think it's hard to recommend to someone just starting out that a <50% commitment to research in one's training years will be likely to succeed.

 

[Vincit qui se vincit]

This statement indicates that you don't appreciate the complexities of combining bench research and surgery enough. It will be extremely difficult to develop enough expertise in research to be able to 1) publish 2) be competitive for funding and 3) eventually become independent, without spending 75-80% of your time in research.

Thank you for your response.

I wanted to clarify that I'm only interested in research, in so far that it has strong potential in practical applications. Such as, developing products that can be patented and sold, or used to initiate a private enterprise. Therefore, grant funding and publishing may be an initial part of that process as I go through graduate and medical training. But long term I'm interested in the corporate aspects of research and innovation, by way of investors and private funding. Not to say I'll be successful before even starting my training, just that I'm more interested in entrepreneurship.

In any case, I appreciate your honesty. I do know that I want to maximize my success, both clinically and academically, and if that means during residency adding on more hours every week to make sure my research is successful and published, then I'm willing to put in the work. However, I respect the fact that dedicating 320 hours/month to residency doesn't allow much flexibility; even adding on 80 hours/month for research could reduce my life down to work, research, and sleep. So, I may have to take time off during residency to focus on that, as some of the surgeon-scientists I know have done.

 

[strangeglove]

Most academic departments of surgery etc. will not allow you to have a private practice, but instead will require you to do any billable clinical work for them, from which they will keep a significant portion of what you bill. There are rare exceptions to this in psychiatry and other low-billing specialties, where some (very few) departments will let you have your own private practice on the side that they do not touch. I would not plan your career based on finding such rare opportunities.


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[Neuronix]

Anyway, fine details aside, does my trajectory make at least some sense long-term. In your opinion.

I also really enjoy research and the idea of developing novel treatments for the patients I'm working with.

The second quoted bit, yes. The rest, not really. My recommendation is to find lab work that interests you and keep an open mind. Try to find someone who is very invested in the lab who can mentor you. A good mentor is better than a good project at this stage in your life. If you're really interested in both physician work and research work, then that's all you need for now. Figure out the details of translating the two later. For everyone who wants to be a surgeon coming in, few actually end up doing it for various reasons. So don't commit yourself to anything yet except the goal of developing and improving treatments for your patients within the fields of chemistry and engineering.

I realize that I can't make any informed decisions about residency until I do my rotations and electives.

Sounds good.