Molecular Neuroscience and the MD

[linuxizer]

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Hello again y'all,
I'm in love with molecular neuroscience. My first (fourth-authored) paper is set to be published in a month or two, and I have loved everything I have ever learned about the subject. I'm also pretty sure I want an MD (yearning for patient care, desire to know about more than just the tiny patch of molecules I would study in a PhD program, etc.). So the question is, what specialty best integrates the two? My PI is a Psychiatrist, but I'm leaning towards Neurology. The only other option I see would be neurosurg, but my understanding is that, while you may need research to get into a residency, practicing surgeons almost never do basic science research. I like the work of neurologists that I've read so far, but for the most part it seems more clinically-oriented. Most of it tries to understand the inner workings of the brain (which is ++good), but generally on a structural level rather than a molecular level. So I guess what I'm asking is if you can give me any insight into what's out there besides the limited bit I've read, what most MD(/PhD) researchers in molecular neuro do, and just generally what MD's do in the PhD's world.
Also, on an only slightly-related note, do you apply for neurology residencies separately, or are they fellowships after general IM residency?

Thanks,
Ari

 

[Andrew_Doan]

Consider ophthalmology. My PhD was in molecular and cellular Neuroscience.

Look at these links:

http://webeye.ophth.uiowa.edu/dept/BIOGRAPH/stone.htm

http://www.carverlab.org/

You could study the retina and the genes/molecules regulating ganglion and photoreceptor health and function.

 

[Neuronix]

Speculation on my part is that most MD/PhD neuroscience basic science researchers are going to be neuropathologists. Behind that is probably neurology, then psychiatry. Ophthomology is still good for doing research as well. Neuroradiology is also something to consider. Other options like Neurosurg and ENT exist, but there doesn't seem to be much molecular research in those fields outside of cancer that I see. I would think ENT would be more amenable to reseach than neurosurg.

Typically you apply for neurology residencies right off the bat. It is an IM specialty, so you can do a transitional year in IM and then apply for neurology if you were uncertain. There are certain fellowships you can do that subspecialize you. One example is something like neuro-ophthomology that combined neurology and ophthomology.

 

[coldchemist]

Hey Ari,

Most physician scientists would try to discourage you from going into a physically intensive specialty like neurosurgery if you want to do research. How are you going to keep up the kind of skills and coordination necessary for ANY surgical specialty while simultaneously trying to run a lab? What you'll likely hear is that succesful research-oriented physicians usually go into the "cognitive" specialties (yes, I've actually heard them called that) like IM, path, etc. Sucks, but it's true...

By any chance, do you work for NIMH?

CC

 

[Neuronix]

Originally posted by coldchemist
How are you going to keep up the kind of skills and coordination necessary for ANY surgical specialty while simultaneously trying to run a lab?

You subspecialize in something and do it a couple days a week while working in your lab or a collaborator's lab a couple days a week. There's many people here who do this. Valid criticisms include that you get hemmed in as to what you can do surgically, you'll never be the best at anything you do, and you'll have a hard time convincing the bosses that you shouldn't be doing more surgery.

Strangely enough, ophtho is a surgical subspecialty that has plenty of MD/PhDs and while it isn't encouraged, it isn't particularly frowned upon by the MSTP PDs, like neurosurg would be. I think this has to do with being able to do short procedures and there's plenty of examples of successful ophtho + research MD/PhDs. For ENT I think the same rules could apply, except there's not so many examples running around.

 

[linuxizer]

I've never heard of neuropath, but I guess it would make sense as a place to do research. Haven't considered neurorad either. Both interesting options and more molecular-focused by nature than neurology, I would imagine.

Originally posted by coldchemist
What you'll likely hear is that succesful research-oriented physicians usually go into the "cognitive" specialties (yes, I've actually heard them called that) like IM, path, etc. Sucks, but it's true...
By any chance, do you work for NIMH?
CC

Yeah, but at this point I don't think I would want to do a surgical specialty anyway. Optho is a good idea, but not really what I enjoy working on. Besides eyes are about the only part of the body I'm touchy about seeing sliced open.
I don't work for NIMH, but I may do a year there post-undergrad. My research over the summer was back home in Alabama, and I'm going to start working with someone here (Penn) soon.

As always, thanks for the insightful responses.
--Ari

 

[Neuronix]

Pathology has been a very popular specialty for MD/PhDs traditionally and neuropathology is a subspecialty of that. My mentor before I started the MD/PhD program was a neuropathologist, as are the associate directors at Northwestern, among others. The residency is very research oriented and fairly short. It also meshes well with a career in research. One of the biggest labs at Penn, that of Virgnia Lee and John Trojanowski, takes alot of the neuropath fellows. I think Dr. Trojanowski did his residency in neuropath, but now I'm not sure.

Whose lab are you going to join here? Just out of curiosity. My apologies in advance if I already asked and forgot.

 

[coldchemist]

Originally posted by Neuronix
You subspecialize in something and do it a couple days a week while working in your lab or a collaborator's lab a couple days a week. There's many people here who do this. Valid criticisms include that you get hemmed in as to what you can do surgically, you'll never be the best at anything you do, and you'll have a hard time convincing the bosses that you shouldn't be doing more surgery.

Funny you should say that. Today I went to lunch with an MSTP student at UAB who told me he was planning to go into neurosurgery. I asked him how he could do that without anybody getting upset and he said you just have to have an "I don't care what you think I'm capable of doing" attitude. Right after that I interviewed with a neurosurgeon who is a PI in a tumor biology lab...and he said the same thing as the student. So I guess I can begin considering surgery an option again...

 

[Andrew_Doan]

Don't let anyone tell you that it's not favored that MD-PhD grads pursue a surgical specialty. At Hopkins, we've had two MSTP grads match in neurosurg in one year, and then we had two more match in subsequent years.

 

[linuxizer]

Originally posted by coldchemist
Funny you should say that. Today I went to lunch with an MSTP student at UAB who told me he was planning to go into neurosurgery. I asked him how he could do that without anybody getting upset and he said you just have to have an "I don't care what you think I'm capable of doing" attitude. Right after that I interviewed with a neurosurgeon who is a PI in a tumor biology lab...and he said the same thing as the student. So I guess I can begin considering surgery an option again...

Ha. There's a decent chance I know the fellow. Anyway, good to know that surgery is an option if I decide to go that way. Do people who do this basically limit themselves to one or two procedures to ensure proficiency?
I've always heard that MSTPers do well in the match (and since the most competitive residencies tend to be surg, one assumes they do well in surg. matches as well), but I assumed that those that went into surgery simply contented themselves with doing surgical research rather than basic science. I'm sure all of this would be more possible except for that pesky little percent effort blank on NIH grant apps ;-P.
--Ari

 

[tofurious]

I know neuroscience MD-PhDs in all the following specialties

MEDICAL
Neurology
Psychiatry
Medicine
PM&R
Rad Onc

SURGICAL
Ophtho
ENT
Neurosurgery

OTHER
Path
Anesthesia
Radiology

 

[Neuronix]

I forgot about anesthesia, but this brings up an excellent point. Just because you do a PhD in neuroscience doesn't mean you can't change your mind and do something else that's not directly neuroscience for residency. It happens all the time!

 

[Andrew_Doan]

Originally posted by Neuronix
I forgot about anesthesia, but this brings up an excellent point. Just because you do a PhD in neuroscience doesn't mean you can't change your mind and do something else that's not directly neuroscience for residency. It happens all the time!

My friend in neuroscience went into Derm. Keep in mind that many neuroscientists are molecular and/or cellular biologists; thus, we can apply our PhD training to many fields.

 

[linuxizer]

Originally posted by Neuronix
I forgot about anesthesia, but this brings up an excellent point. Just because you do a PhD in neuroscience doesn't mean you can't change your mind and do something else that's not directly neuroscience for residency. It happens all the time!

But if you want to do something neuro-related, it looks like Neuronix's original list (neuropath, neurology, psych, neurosurg, neurorad) is best, despite Tofurious' impressive list.
I understand that some things are common across fields, and that a PhD can help for just about everything, but from what everyone's said so far it seems like neuropath or neurorad seems the most similar to the PhD work. Neurology still sounds fun, though.
Anyway, I have years to decide. Thanks for all your help guys.
--Ari

 

[evenstar]

Hi Ari: Just a note, in case you do decide to consider neurosurgery, I worked with a PI during my undergrad who was chair of the Neurosurgery department. He was, himself, an MD/PhD and spent probably 2 or 3 whole days in surgery a week. His lab focuses on molecular mechanisms of stroke; the project I worked on there involved a rat model for cerebral ischemia and looking at NFkB translocation in the brain following hypothermic treatment. There's a lot of molecular biology being done in that lab, so, I'm sure it's possible to do basic science research and be a practicing neurosurgeon (at the top of the field, too). That said, he was an *extremely* busy man, and I'm sure you can expect that sort of lifestyle to be pretty taxing...but as long as you enjoy it!

On an aside, almost all the MD/PhD faculty I have talked with have emphasized that it is not critical at this stage to try and correlate your basic science interests with your clinical interests. It's more important to find areas you are truly fascinated by, and especially clinically, you may not know what those are until you have done rotations. Moreover, by the time you have finished your residency, fellowship, etc., and are ready to start your own research program, you'll probably be at least five or six years removed from your PhD thesis, so chances are you'll be looking at new questions to answer and possibly even a new field or sub-field altogether. So my philosophy would be to enjoy the first couple years of med school, then really find a good thesis lab and advisor in an area that captures your interest. Then go back into clinical rotations with an open mind and determine what specialty you want to pursue based on which clerkship you loved most. If it turns out that you really dislike, say, neurology or path, I think it would make for a really tough career if you chose that specialty anyway just to fit your research interests, unless of course you chose to focus entirely on research and not do clinical work.

So, there's my really long-winded reply. 🙂 But, as you mentioned, you've still got some time to decide. Best of luck with everything!

 

[gujuDoc]

There is also neurosurgery to consider. But it really depends on whether you want to go 7 yrs for MD/PhD and then another 7 yrs for neurosurgery, vs. 4 yrs for neurology.


Also it depends on whether you want to do surgery or stay with the other non surgical neuroscience related stuff.


I suggested neurosurgery, bc I currently do research at the USF Dept of Neurosurgery in Tampa and that is where they have most of their neuroscience department.

Also I know a couple people at my medical school that did neuroscience through the Pharmacology department, but that department doesn't have much MD stuff just PhD stuff. So I would stick with Neurosurgery or Neurology, and maybe as someone suggested looking into ophthamology. Neuroscience is such an exciting field that there are soooooo many directions for which you could go from Neuroscience.

 

[linuxizer]

Also I know a couple people at my medical school that did neuroscience through the Pharmacology department, but that department doesn't have much MD stuff just PhD stuff.

I'm actually currently working in a pharm/psych department, and it sort of works. My PI is MD/PhD, but everyone else on the floor is straight PhD. PI splits time about 45/55 (clinics/lab) and doesn't seem to have any problems with that. The latest grant app which I'm editing emphasizes the clinical/pharmocological relevance of the molecular research we're doing--something which the NIH seems to be moving towards.

Ciao,
Ari

 

[gujuDoc]

Originally posted by linuxizer
I'm actually currently working in a pharm/psych department, and it sort of works. My PI is MD/PhD, but everyone else on the floor is straight PhD. PI splits time about 45/55 (clinics/lab) and doesn't seem to have any problems with that. The latest grant app which I'm editing emphasizes the clinical/pharmocological relevance of the molecular research we're doing--something which the NIH seems to be moving towards.

Ciao,
Ari

Ari,

That sounds awesome!! What is your research on??? At my school most of the neuroscience department focuses on Parkinson's, Alzeimher's, and other aging related research.