MD to PhD to BC

[hopefulscientist]

I am very interested in going into radiation oncology as it is greatly in line with my scientific, medical, and research interests (I want to spend 80% of my time doing research with 20% doing clinical work). As my school was not offering a switch into the MD PhD program when it made more sense (between 2nd and 3rd year) and because I have a strong desire to have research be paramount in my career and was offered spots at schools in Europe where earning a PhD would take about 3-4 years, I am already planning to apply to earn a PhD after my MD and before I start residency. I have read many comments about how deviation from the typical path is less tolerated in medicine. Would individuals who have more experience with Radiation Oncology be able to comment on what I want to do? Ideally I will still be doing clinical research during PhD years along with some sort of clinical practice (as well as doing a Human Dx project case every day). I was also considering taking Step 3 before I apply for residency to demonstrate that I still have my clinical knowledge (which I will be maintaining during the PhD program).

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[Chartreuse Wombat]

Programs will be concerned about your clinical competence if you spend multiple years outside of the clinic, especially outside of the US (regardless of your Step scores). You state that you will maintain your clinical knowledge but that is difficult to do if you go years without seeing patients.

I am personally aware of two individuals with a similar pedigree who had enormous difficulty securing a spot despite strong research records. There are lots of MD/PhDs who train at US Medical Schools. There are 300 applicants and most programs need a convenient reason to bring that number down to <100 to look in more depth at applications. It is very easy to screen out non US graduates and I know programs do it. I am not advocating this practice just letting you know that this may make your path more difficult.

 

[hopefulscientist]

So it sounds like the key variable is maintaining clinical skills. I have been working to find opportunities to do something like this (within legal limits considering my future lack of licensing). If I found a way to clinically practice over the PhD years (with perhaps completing intern year before the PhD to permit that), do you feel that would address concerns?

 

[medgator]

So it sounds like the key variable is maintaining clinical skills. I have been working to find opportunities to do something like this (within legal limits considering my future lack of licensing). If I found a way to clinically practice over the PhD years (with perhaps completing intern year before the PhD to permit that), do you feel that would address concerns?

It wouldn't for me. Esp if you decide to practice outside of academics.

Many applications for hospital privileges will ask about periods of >5-6 weeks away from clinical practice once you've left residency. Not sure if that would apply further back to med school, but it may raise a few eyebrows when hospital credential committee sees lots of basi between med school, residency and eventual practice

 

[PointA]

I would recommend taking a year off in medical school to do research or obtain a master's degree and conduct radiation oncology research. This will make you more competitive for rad onc residency positions. Then you can hopefully match at a residency program that has a year of protected research time (many programs offer this now). That would give you two solid years of research exposure and help build your CV for an academic position.

Why do you think you need a PhD? It sounds like you are interested in clinical research and most clinical researchers in rad onc do not have PhDs. I personally know of several MDs in rad onc without PhDs who have R01 NIH funding. I also know of several Holman pathway residents who ended up in private practice. I know it is totally unimaginable to you right now, but you may ultimately decide you want to go into private practice once you've graduated residency. Trust me, it happens. I personally would not recommend going to Europe for a PhD.

 

[radiaterMike]

I am assuming you will be a US medical school graduate ? If so- I would offer a different perspective. Living in Europe for a few years - with a good excuse to do so - is a great opportunity. If your PhD is relevant to oncology I don’t think it would hurt and could help. I agree that lack of clinical exposure would be seen as a potential negative. So you might want to make sure there are opportunities to be in clinic in some capacity. From a radiation oncology program’s perspective - you’d have 1 year of immersion (internship) before starting. That being said - a PhD is something you have to really want to do. Most are longer than 3-4 years- especially outside of an MD PhD program where they won’t credit some of your MD coursework

 

[KHE88]

Do not do the PhD. You don't need it for a 20/80 job. If you were still in college, this would be a different conversation, but it's honestly too late at this point. The potential reward (minimal if any) does not justify the potential risk (enormous of going unmatched due to gap from graduation date). Go straight into residency, and try to land a Holman spot if you can. If you want to spend some time in Europe, this can easily be done in 4th year of med school or residency. Email various universities with radiation departments and I think you will find many quite welcoming to a visiting student wanting to participate in a project. I did, and it was a great experience.

 

[evilbooyaa]

I would honestly argue that unless you're very passionate about RADIATION oncology and not oncology, you may be better served going into medical oncology, as a 80-20 research job is not a common occurence any longer, especially within radiation oncology.

What sort of research do you want to do? Bench? Clinical (not sure if you mentioned this just for clinical competency or if that's your real interest)? Regardless, you don't need a PhD to do any of those things.

 

[nkmiami]

I would honestly argue that unless you're very passionate about RADIATION oncology and not oncology, you may be better served going into medical oncology, as a 80-20 research job is not a common occurence any longer, especially within radiation oncology.

What sort of research do you want to do? Bench? Clinical (not sure if you mentioned this just for clinical competency or if that's your real interest)? Regardless, you don't need a PhD to do any of those things.

You dont need a phd to do bench research; take a year or 2 off and work in lab or do fellowship. A bit of a strange post for that reason. It is exceptionally unlikely you will ever work in this field 80/20 at a doctors salary. In terms of obtaining a residency, it is realistic that standards will dive within 3-4 years, and some rather strange people will be coming in...so, it probably wont be a problem if you want to go to Europe or somewhere else and do who know what.

 

[medgator]

it is realistic that standards will dive within 3-4 years, and some rather strange people will be coming in....

And things will come full circle to several decades ago

 

[maruchan]

I agree with @evilbooyaa. If a 80/20 job is your goal, medical oncology is the FAR FAR better choice. The prospects of a 80/20 job in rad onc are virtually nil.

You could potentially explore these options:
- PhD in europe -> IM residency (there will be some concerns about clinical skills, but IM not as competitive) -> heme/onc fellowship
- IM residency with fast track / research track into heme/onc
- IM residency -> postdoc in a lab while moonlighting for a couple years -> fellowship
- IM residency -> heme/onc fellowship -> postdoc -> 80/20 job
- Just get a PhD and go into straight research

All of those options are far better for your stated goals compared to what you outlined.

 

[2014XRT]

The prospects of a 80/20 job in rad onc are virtually nil.

This isn't true. Virtually nil is very different than 'uncommon'

Look - many academic residency programs (excluding non-university programs of course) have 1-2 people working in 80/20 positions. a couple dozen have more than 2.

it's certainly a possibility for well-suited candidates who go through all the steps and have promising research backgrounds. people are hired as physican-scientists every year.

I don't know where you go to med school, but if there's a rad onc department there, it may be worth seeing if there is a physician scientist there - if there is, pick their brain. Do the same for heme onc. SDN crowd doesn't always have the best input on stuff like this.

also important for you to figure out what kind of research you want to do.

 

[maruchan]

This isn't true. Virtually nil is very different than 'uncommon'

Look - many academic residency programs (excluding non-university programs of course) have 1-2 people working in 80/20 positions. a couple dozen have more than 2.

it's certainly a possibility for well-suited candidates who go through all the steps and have promising research backgrounds. people are hired as physican-scientists every year.

I don't know where you go to med school, but if there's a rad onc department there, it may be worth seeing if there is a physician scientist there - if there is, pick their brain. Do the same for heme onc. SDN crowd doesn't always have the best input on stuff like this.

also important for you to figure out what kind of research you want to do.

To some degree it is a matter of semantics, but definitely the prospects of a new resident obtaining a 80/20 position are bleaker in rad onc than in med onc.

I do agree that it would benefit you to pick the brain of someone who has been down that path, especially recently. An older physician scientist might have an outdated perspective.

This thread may also have some insight for you: Holman Pathway career advice

 

[scarbrtj]

If you wanna do battle, go to a war zone. If you want cold, go to Antarctica. If you want to do onc research and be funded, don't go into rad onc. IMHO.