MSTPs: PhD work compatible with Global Health Care Delivery???

[MSTPbound]

---

Members do not see this ad.

Hi guys,

I just came back from a relief trip to a small province in Haiti on the Haitian/Dominican border; I was there to interpret and assist with 500 physical examinations for school and orphanage children. Suffice it to say that it was a rather transformational experience, and has left me a little bit confused about my direction vis-à-vis MSTP study.

I have always envisioned that what ever direction I end up following in medicine and research, I would more or less dedicate “half” of my career to bench research and academic medicine in the States, and the other “half” to global health care delivery, to the tune of MSF-type work.

The trip to Haiti left me wondering whether I should reconsider my PhD direction. While this may sound a little premature, here’s why it’s not: as I’ve suggested in previous posts in this and other forums, I’m planning to do my PhD work on the P.Chem side of biophysics because, well, that’s what I like. In order to do that though, I have a number of upper level math courses to finish, and that’s what I’ve been planning to do for the rest of this year. If I decide otherwise, I might consider shifting gears in terms of how to best spend the rest of the year.

I can’t say I have just one question, so here’s a bundle of questions I would really appreciate feedback about:

1. Would it make more sense to pursue PhD work that would more readily translate into Global health care delivery, e.g. Microbiology or (DARE I venture to suggest it…) Anthropology (consider Paul Farmer’s example)?
2. Do you know any other physician scientists who do this kind of work as a central focus of their career? If so, how has their PhD work contributed to their career?
3. (Related to question #1) Do you believe molecular medicine has the potential to offer substantive benefit to the needs of the poverty-stricken? If so, how?

Thanks everyone!!!

-MSTPbound

 

[gbwillner]

1. Would it make more sense to pursue PhD work that would more readily translate into Global health care delivery, e.g. Microbiology or (DARE I venture to suggest it…) Anthropology (consider Paul Farmer’s example)?
2. Do you know any other physician scientists who do this kind of work as a central focus of their career? If so, how has their PhD work contributed to their career?
3. (Related to question #1) Do you believe molecular medicine has the potential to offer substantive benefit to the needs of the poverty-stricken? If so, how?

-MSTPbound

1- Not really. You'll eventually get sick of the day-to-day basic science project. There are a few places you can do a translational PhD- but in reality you are wasting your time. Just get the MD, and get your arse back to Haiti doing what you want to do. If you opt for the PhD you will be looking at sodium-potassium channels or something, and you will really be streching things to make it relevant.

2- Only one, and he never got a PhD.

3- Maybe someday. I bet you'd find it much more fulfilling to work primarily with your patient population and use other people's research and apply it to them. Don't need a PhD for that.

 

[MSTPbound]

1- Not really. You'll eventually get sick of the day-to-day basic science project. There are a few places you can do a translational PhD- but in reality you are wasting your time. Just get the MD, and get your arse back to Haiti doing what you want to do. If you opt for the PhD you will be looking at sodium-potassium channels or something, and you will really be streching things to make it relevant.

2- Only one, and he never got a PhD.

3- Maybe someday. I bet you'd find it much more fulfilling to work primarily with your patient population and use other people's research and apply it to them. Don't need a PhD for that.

I see your point. I guess the issue for me is one of reconciling what I want/like to do with what I feel I need to do; perhaps the only way to do that is to consider them two separate pursuits and accept that each is limited by engagement in the other (of course, I thought that's what being a physician-scientist was all about).

I guess I was curious whether anyone sees a middle ground.

 

[Circumflex]

I really don't see much middle ground. I think that molecular biology can help impoverished nations in the form of vaccines, genetic engineering for crops, etc. But, to make those kinds of contributions, you will need to focus your efforts in the lab. That is where the PhD in Microbiology would come in - but that would be to prepare you for a career in basic science.

It sounds like you are more interested in a career in Public Health. I say just go for the MD, maybe do an MPH (not necessary), then focus your career in residency/fellowship. That gives you more time to figure out what you want to do. Maybe you could work with the CDC or WHO. If you want to do the basic science, then you can always do some kind of post-doc experience.

 

[Dr.Watson]

.

 

[MSTPbound]

OP, to answer your questions:
1. If you're ambivalent about the hard science, then just get an MPH - faster! I wouldn't switch to anthropology (or MPH) if you love the hard science side of things. Anything in infectious disease is readily relevant to Global Health, with lots of need and opportunity for translational research.

Ambivalent - absolutely NOT.🙂

2. Those Baylor students are the most recent I've heard about.

Any way for me to get in touch with them? Are they on the forums?

You'll be somewhat trailblazing, but you can make it work.

Sounds exciting, encouraging, and right up my alley.

3. Absolutely. Practical, cheap solutions to various infectious disease problems are vital for the poverty-stricken. Plus, a lot can be done via imaging and diagnostics if biophysics is more your thing. Translating our current medical practices to their situation is a huge issue. I think PhD training can only help.

I really appreciate your opinion on this matter; it's something I plan to take time to consider carefully. Intuitively, it seemed to me like this might be the case (molecuar medicine --> Third World application), but to start coming up with examples of how wasn't so easy to determine.

 

[gbwillner]

There are a couple of current MSTPs at Baylor doing some really amazing stuff with international health and spend a significant amount of time in Haiti. They're focused in microbiology, and specifically in infectious disease.

There is a new Translational biology PhD program at Baylor. It is brand new- there are currently a few MSTPs that have joined this interdiciplinary program. I do know some that are working in microbiology. I have to say, however:

1. It is a new program with NO proven track record. Those students you mention are JUST starting and (IMHO) have accomplished nothing yet.
2. The purpose of the program is to give straight PhDs exposure to clinical research, since they would otherwise never have this exposure. However, as MSTPs, we have the built-in clinical exposure. In this sense I do not agree with MSTPs joining this program.
3. IMHO, this program will not prepare you for a career in science. Translational research is NOT science. Just like Engineering is NOT science. IMHO, the point of the MD/PhD is to train in the basic sciences to LEARN science and then use your medical training to APPLY it. This program focuses on translating other people's research into the clinical setting. It is not about learning but about DOING. I think most of the MSTPs joining this program will be in for a rude awakening when their experiments fail to result in clinical trials or their results are not publishable. What will they have learned? I think most of these students will either join this department and do basic science projects anyway or get frustrated and drop out.

OP, to answer your questions:
1. If you're ambivalent about the hard science, then just get an MPH - faster! I wouldn't switch to anthropology (or MPH) if you love the hard science side of things. Anything in infectious disease is readily relevant to Global Health, with lots of need and opportunity for translational research.
2. Those Baylor students are the most recent I've heard about. You'll be somewhat trailblazing, but you can make it work.
3. Absolutely. Practical, cheap solutions to various infectious disease problems are vital for the poverty-stricken. Plus, a lot can be done via imaging and diagnostics if biophysics is more your thing. Translating our current medical practices to their situation is a huge issue. I think PhD training can only help.

1. I agree here
2. Trailblazing is the last thing you want to do during the PhD (trust me)
3. I agree with your statement, but I feel that this is better tackled by someone finished with their training- not someone who's about to start it!

 

[MSTPbound]

3. I agree with your statement, but I feel that this is better tackled by someone finished with their training- not someone who's about to start it!

Right... which I guess goes back to my original question which was concerned primarily with compatibility of my desired basic science training with career aspirations, i.e. what I plan to do after 7-10 years of preparing for that career.

Sure, I'll likely continue to be involved with relief efforts throughout my MSTP years, but I was just wondering how well I can hope to translate the MSTP training to this aspect of my career goals later on.

 

[Dr.Watson]

.

 

[gbwillner]

Ok, my impression must have been wrong. I thought the student I met were all doing work in basic science labs (microbio, infectious disease) and getting exposure to the translational part. The "translational" part was just a label to include their Haiti work, but it was definitely a basic science PhD at its core.

That quote from me is an over-simplification. I would also hope they get some quality basic science training. The problem is being goal-oriented in research to an extent that if your experiment doesn't work you learn nothing. The one student I have talked to in this program told me that he would not finish his PhD without taking his project to clinical trials. That may sound bold, but as someone who has finished his PhD I find it quite naive.

The one best to tackle any MD/PhD career question is an MD/PhD done with all training (residency, postdoc, fellowships) doing exactly what one plans to do. Since most of us are going to be trailblazing in defining our careers, it's anyone's guess what's going to be most beneficial. It's my opinion, but I think its doable, OP, you just have to be creative about it. Translating "learning to think like a scientist" or whatever the PhD line is, to your career is possible.

I'm wondering if you've finished the PhD portion of your training? Its difficult enough to do a PhD as it is now- while anything is possible you don't want to make GETTING the PhD so difficult by making things up as you go.

 

[MSTPbound]

It sounds like you are more interested in a career in Public Health.

Well... aren't we ALL interested in careers in "public health"?😉

I say just go for the MD, maybe do an MPH (not necessary), then focus your career in residency/fellowship. That gives you more time to figure out what you want to do. Maybe you could work with the CDC or WHO. If you want to do the basic science, then you can always do some kind of post-doc experience.

I hear you... but I am not interested in doing an MPH and I'm rather firm (even if remotely flexible) in my decision regarding MSTP, having mulled over it for a couple of years. My question is more about the best way to approach MSTP training given my global health interests, not whether to complete a PhD.

 

[Circumflex]

Well... aren't we ALL interested in careers in "public health"?😉



I hear you... but I am not interested in doing an MPH and I'm rather firm (even if remotely flexible) in my decision regarding MSTP, having mulled over it for a couple of years. My question is more about the best way to approach MSTP training given my global health interests, not whether to complete a PhD.

I guess I don't understand the issue. You are sure that you want a PhD, but you don't know in which field you want to specialize.(?) If you see yourself wanting a career combining medicine with basic science, i.e. running a lab, then do the PhD in Microbiology. If you see yourself working out of the country, dealing with international health issues, then do a PhD in Anthropology.

 

[Dr.Watson]

.

 

[Rep the Ville]

Ambivalent - absolutely NOT.🙂



Any way for me to get in touch with them? Are they on the forums?

Hello, thanks for the discussion. Good insights! I'm actually in a similar boat as MSTPBound, and am currently deciding b/w Harvard (with the possibly of Med Anthro) and Baylor. One thing that has helped me a lot is finding students and faculty at the places you are considering and ask them directly whether or not international work during MSTP is feasible in their program. Be frank, and push them to be honest with you too. Not everyone is going to say yes. Skip Brass at Penn told me fairly clearly that it's almost impossible for MSTPs in his program. Also, there are scientists that have made this happen... few, but there's probably some wherever you're going. You should ask them.

The Baylor students have been a huge inspiration for me, and we've been in close contact ever since I left that second visit. If you want to be in contact with them, send me an email! We've committed to try to link as many MSTP who care about serving the global poor together, and I'm sure they'd love to talk with you in more detail! I certainly would.

Again, thanks for the discussion, everyone. It's helped me out a lot. You guys have been great.

P.S. (I've never used one of these smile-y things before). In case you're Irish. Good luck!

 

[haricot]

mstpbound, i have similar interests/desires and have met a number of students and applicants in the same boat. at this point, i feel more committed to a career in global health than to one in academic medicine, but regardless of that, i am totally committed to (and excited about) completing both degrees and seeing where they take me. (it's been a relief to see that there are many students in top programs who feel the same way.)

one approach is to go for an epi (or anthro) phd...the two main drawbacks to that being (1) the difficulty of finding an md/phd program that will take you (there are a number of them, but it's definitely more of a longshot than trying to get a regular md/phd slot), and (2) the fact that you'll be missing out on the science of a bio-related phd (whether or not that bothers you is obviously a personal issue).

the more common approach is the infectious disease route. i looked for schools with good ID faculty and with a history of global health activity in the med school. in the end, your research might be fairly basic in nature, but i don't think it's a bad compromise for those of us who are, as you said, reconciling what we want/like to do with what we feel we need to do. and at the right place, you should be able to make connections and gain exposure to global health initiatives/issues that will help you in whatever you decide to do.

 

[coutecko]

Hi!

I am actually in the exact same shoes as many of you are and it's great to know that there are people out there that are also thinking the same things as myself. I spent 6 months in Africa, not Haiti though, and am having the same doubts. It's kind of ironic to see it from an outside perspective, because it's always easier to give advice to others than to know what you should do yourself. But since I am in your shoes exactly and seeing your post, I am feeling that not doing the MD/PhD is the best way to go.

It is a very difficult decision and one that I am still deliberating, because I've been accepted to some of the top MD/PhD programs in the country - Hopkins, Penn, WashU, etc. But I think one of the most important lessons that I'm learning is that most MD-PhD applicants are good in a LOT of different areas and will excel in whatever they put their minds to. The one trouble they have is learning to say NO. We like being good at things, being on top of things. But I think, for me anyway, that just because we are great at something that is a rare asset to have (doing science), it doesn't mean we have to do it for the rest of our lives. Within myself, I can see the type A personality who enjoys excelling/competing and also a person who has a big heart with the intent of helping the poor (which is what motivated me to do medicine in the first place).

I guess what I am afraid of is being jaded by the whole MD-PhD training experience and not wanting to do anything anymore but to be stable, becuase by the time I'm actually done training...I'll probably be in my mid-30s...and most of the people I've talked to in their mid 30s aren't really concerned about global health in the way that they may have in their early 20s...they're more thinking about which places to take their kids to daycare, etc. If I do the MD only option and do an MPH, I'll be done earlier and perhaps also be more motivated to continue in the global health setting. I dont know if it's just me, but I feel like there is a large difference between the level of jadedness when I've spoken with first year MSTPs and 8th year MSTPs...the former wants to save the world and the latter wants to be more stable/take care of their own needs first/try to survive in the fierce world of academic medicine!

 

[gbwillner]

I dont know if it's just me, but I feel like there is a large difference between the level of jadedness when I've spoken with first year MSTPs and 8th year MSTPs...the former wants to save the world and the latter wants to be more stable/take care of their own needs first/try to survive in the fierce world of academic medicine!

This is a great observation, and it's not just you! We all want to save the world, cure cancer, etc., but actually experiencing the work involved in those pursuits leads to the realization that those dreams will only be fulfilled with the cooperation of thousands of minds and countless years of work. You will, in the end, consider yourself lucky to have one brick in the wall in the fight against cancer. The more you learn, the more you realize how much we don't know, and the more you will look back and think, "man, I was crazy to think I could cure disease (insert disease here) with that half-baked treatment...".

I could give more than a haldful of personal experiences, but I believe this is something we all learn.

 

[MSTPbound]

Hi guys,

I just wanted to thank you all for your contributions to this thread - many of you have PM'ed me, and I will be getting back to everyone by the end of the week either via PM or email - I've even met with one of you in person out here in NYC - VERY enlightening!

Just one more reason why I love SDN, and the Physician Scientist forum so dearly.😍

Take Care!

MSTPbound

 

[anka24]

Saving the world won't and shouldn't happen during the PhD years, but that doesn't mean that you can't pursue your PhD with the still idealistic hopes for the future. There are plenty of ways to keep global health relevant:

Find faculty that cross over between a public health department and basic science. They exist. These faculty will also often have a field site that you can visit during your PhD training.

Or study basic immunology and constantly ask yourself what this means in terms of vaccine development.

Study microbiology of pathogens and ask yourself how any new information you discover can curb transmission rates.

Study the effects of malnutrition on the immune system.

Since you are set on MSTP, I assume that you want to do this because you don't think the medical tools we currently have are enough to combat disease effectively. If you think we have all the tools needed and global health is simply a problem of delivery, then you are in the wrong line of work. But I firmly believe that there is a lot about infectious disease left to learn and it is perfectly compatible with your ambitions in global health.

 

[MSTPbound]

Saving the world won't and shouldn't happen during the PhD years, but that doesn't mean that you can't pursue your PhD with the still idealistic hopes for the future. There are plenty of ways to keep global health relevant:

Find faculty that cross over between a public health department and basic science. They exist. These faculty will also often have a field site that you can visit during your PhD training.

Or study basic immunology and constantly ask yourself what this means in terms of vaccine development.

Study microbiology of pathogens and ask yourself how any new information you discover can curb transmission rates.

Study the effects of malnutrition on the immune system.

Thank you; your advice is another reflection of the more optimistic suggestions I have received, and my thoughts as of late; I am currently exploring research possibilities in molecular immunology/immunobiology, virology, etc... with many more questions to ask and many more people to talk to.

Since you are set on MSTP, I assume that you want to do this because you don't think the medical tools we currently have are enough to combat disease effectively.

I don't disagree - however I think this statement is a somewhat gross overgeneralization of what I perceive the problems to be, especially with respect to health care in developing nations, even if admittedly one aspect; more on that below. It is also an inadequate statement of my reason for pursuing MSTP. I believe that probing fundamental biological questions is the underpinning of biomedical progress. Most of the questions are still unanswered - in that sense, the tools we currently have at our disposal are necessarily limited - and our biomedical arsenal will probably "never" be complete. I just have profound desire to join the ranks of the often unsung heroes who undertake the challenge of asking and resolving these questions - and MSTP seems to me the best way to do this (and prepare for a, hopefully, long and productive career of doing this) while pursuing a degree in medicine.

If you think we have all the tools needed and global health is simply a problem of delivery, then you are in the wrong line of work.

Again, we have nowhere near all the tools... but the reality is that Haiti remains the poorest country in the Western Hemisphere and, as a result, suffers from possibly the most extreme of basic health care needs this side of the planet. Most of the children I helped treat, for example, suffered from a plethora of maladies that are practically unheard of in the developed world. Articles I have recently read considering similar situations in other nations in Latin America, Africa, the Far East, etc., reveal similar trends. In this sense, while the problem is not "simply" one of delivery, delivery remains a HUGE issue, and this was not something easy to ignore, despite my inclination toward basic science. Reconciliation of these matters is what got me into this whole mess in the first place.

But I firmly believe that there is lot about infectious disease left to learn and it is perfectly compatible with your ambitions in global health.

I am really starting to believe this... spending time at sites like the following is reinforcing that belief:

http://www.fic.nih.gov/about/index.htm

 

[scdjpc84]

Paul Farmer actually came to talk here in Cincinnati last night and Sunday night, and I asked him your very question, since I was curious about the same issues for my own career track. I know this'll sound a little cliché, but he basically advised not pursuing a course or changing course, especially for the PhD, if you're heart's not really in it. Passion is what makes efforts like his and PIH's sustainable in the long run. So do what you'll love, even if it seems unrelated like biophysics, and not because you think it'll better translate into global health impact. He also said, if you're truly passionate about international health as well, you can find a way to apply your skills and training in your own way.

One needn't necessarily go into molecular medicine or microbiology since there are a myriad of people already working with PIH and other NGOs in all sorts of disciplines seemingly unrelated. Just look at what Jim Kim and Ophelia Dahl have done; and, in addition to Dr. Farmer, we heard from the CEO of DanAdams Pharmaceuticals, Dr. Yaw Gyamfi (whose NPR story is here: http://www.npr.org/templates/story/story.php?storyId=4983182), Kathryn Thompson (head of AVOC), and Dr. Lisa Cahill (professor of ethics and theology at BC), all of whose work has contributed significantly to global health from their respective disciplines.

I guess if you're looking up to Paul Farmer along the anthropology track or global health track, I wouldn't suggest following him to the T if you're not going to be happy and passionate about it. Just remember one of Jim Kim's quotes from Mountains Beyond Mountains: "If Paul is the model, we’re f*cked."

(by the way, if you're interested I posted some clips from his talks on both nights on YouTube, including one where he calls me out on the YouTube posting. Just search "Paul Farmer" and they should show up.)

 

[Kraazy]

AWESOME thread! I'm aiming for MD/Phd as well, and want to focus my work (clinical and research) on international health. My plan for the moment is to do the PhD in epi; I have a background in bio, and it seems like a good compromise btn science and more "fluffy" policy/anthro stuff. Honestly, though, at this point, I feel like I could do the PhD in anything from microbio to hardcore health policy.

Question to current MSTPers: can I apply to Epi MSTPs (I'm about 80% sure I'll stick to epi) and decide to switch to another field durgin MS1 or MS2? I know traditional MSTPs don't always have to choose a specific field outright.

 

[MichigaNicideM]

I personally was in the exact same situation as you when considering what I wanted to do; however, I came to my understanding in a different manner. I will be doing my PhD in social epidemiology. It ties the "social/human" aspect of medicine to the actual diagnosis/treatment that I'll be doing daily.

However, I will say this: you don't know you'll like Epidemiology/Anthropology until you've tried them. The research is VERY different from the bench stuff (which I personally can't stand). You'll find the the research is often a more direct intellectual excercise: the data is regularly interpretive and abstract, or quantitative and statistics-based rather than physical. If you're seriously considering it, try and work with epidemiologists for a summer or two before applying to an actual program....

best of luck!

 

[dunkindona]

BCM is an *amazing* place to train for anyone interested in combining MSTP with ambitions in public health, international or domestic.

1. First, as a port city in a state with a public health system that struggles constantly with the provision of health care to a burgeoning immigrant population, working in the public sector or with nonprofit organizations in Houston prepares you VERY well to face the social, environmental, and infectious disease challenges seen commonly in the developing world. Through the basic sciences (1.5 years), volunteering or working part-time with relevant groups is eminently achievable. This becomes even more true as you have more "unstructured" time in graduate school. And because our clinical curriculum is so flexible, these experiences do not have to be interrupted entirely during clinical training.

2. The intimate relationship between BCM and the philanthropic community in Houston is absolutely phenomenal. If you already have a vision of how to address problems in global health, there are various avenues through which you can work towards that end as a student. These include competitive institutional service awards (community service award through the med school, BRASS scholarships through the grad school, student leaders in community service grants open to both med and grad students) and our amazing folks in Development and Extramural Affairs, who serve as nodes in strong local charitable networks.

As an aside, one student, to whom a few posts on this list have referred already, has tapped into these resources and I have no doubt is well on his way to becoming the next generation of Paul Farmer. He is young and idealistic, yes. But, I can't begrudge him that, and I do NOT equate either with naivete. He has for the past seven years travelled months at a time to Haiti, often by himself, to make community health assessments and figure out ways in which to intervene which are compatible with the current level of his clinical training. This guy is modest and (as far as by any measure of accomplishment in sustainable public health programs in the developing world) successful. These are the kind of folks you find here - Innovative students with passion and vision who will knock your socks off with their modest admission that being AOA is a difficult goal to justify if an alternative use of time offers even some almost imperceptible (but very real) effect on reducing health disparities.

3. The Translational Biology and Molecular Medicine program is young but already has served as the model for national (HHMI in particular) direction of research efforts on science with direct health implications. The controversy about the pure and applied sciences is one that predates this discussion. There are legitimate historical and philosophical reasons that may motivate one's belief that one or the other serves as the engine for scientific discovery. HOWEVER, I hope most people will agree with me that application does not mean coopting some other person's work. This is NOT the point of TBMM at BCM. It is a PROGRAM (i.e. students in it actually do their PhD work fully in a department of their choosing in addition to being part of the interdepartmental TBMM) that offers students truly joint clinical and basic science co-mentorship. Yes, this is the point of MSTP. But, living this on a daily basis is something quite apart from the support provided by most MSTPs (as far as I know). (I can speak from experience as I am currently shared by a clinical and basic science mentor, learning reams about two different worlds and integrating knowledge from both. I am not doing this through TBMM, but I can definitely see the value in institutionalizing such an auspicious circumstance). For people interested in direct translation of *their* work into clinical outcomes for patients, this is the place to do it. Whether through TBMM or the BCM MSTP with the Rice Bioengineering program (one of the top BioE programs in the country), in particular, there are definitely students and PIs who are specifically interested in exploiting the latest in infectious disease, materials science, etc. to develop affordable diagnostics and therapeutics for resource-poor communities in the US and abroad.

 

[chrsjav]

Hi!

I am actually in the exact same shoes as many of you are and it's great to know that there are people out there that are also thinking the same things as myself. I spent 6 months in Africa, not Haiti though, and am having the same doubts. It's kind of ironic to see it from an outside perspective, because it's always easier to give advice to others than to know what you should do yourself. But since I am in your shoes exactly and seeing your post, I am feeling that not doing the MD/PhD is the best way to go.

It is a very difficult decision and one that I am still deliberating, because I've been accepted to some of the top MD/PhD programs in the country - Hopkins, Penn, WashU, etc. But I think one of the most important lessons that I'm learning is that most MD-PhD applicants are good in a LOT of different areas and will excel in whatever they put their minds to. The one trouble they have is learning to say NO. We like being good at things, being on top of things. But I think, for me anyway, that just because we are great at something that is a rare asset to have (doing science), it doesn't mean we have to do it for the rest of our lives. Within myself, I can see the type A personality who enjoys excelling/competing and also a person who has a big heart with the intent of helping the poor (which is what motivated me to do medicine in the first place).

I guess what I am afraid of is being jaded by the whole MD-PhD training experience and not wanting to do anything anymore but to be stable, becuase by the time I'm actually done training...I'll probably be in my mid-30s...and most of the people I've talked to in their mid 30s aren't really concerned about global health in the way that they may have in their early 20s...they're more thinking about which places to take their kids to daycare, etc. If I do the MD only option and do an MPH, I'll be done earlier and perhaps also be more motivated to continue in the global health setting. I dont know if it's just me, but I feel like there is a large difference between the level of jadedness when I've spoken with first year MSTPs and 8th year MSTPs...the former wants to save the world and the latter wants to be more stable/take care of their own needs first/try to survive in the fierce world of academic medicine!

Great post. I feel the same way.

In fact I remember one study which said that researchers tend to publish less significant papers after they've married... which does make sense from a Darwinian perspective. Once you've attracted your mate and started a family, it's probably better to use your time to nurture your kids than to elevate your prestige.

Go with biophysics if you like it. There are an incredible number things you can do in medicine once you know how a molecule looks, functions, and so on.

There's a structural chemistry professor at my school who founded a lab-on-a-chip company that is now unloading $1 CD4 count tests in Africa (free of charge, courtesy of the Gates Foundation), and is also sustaining non-charitable revenue by selling the chips to Western hospitals. PhD's have obviously done more for medicine and public health than the Paul Farmer / John Carter types, which is why we feel the need to pursue research even though we know direct patient care is more rewarding.

It will be tough, but we can do some of both if we really want to. You won't be able to do MSF's six-month stints every year, but there are two-month programs. Maybe you can take some of your lab members with you.

 

[MichigaNicideM]

PhD's have obviously done more for medicine and public health than the Paul Farmer / John Carter types

Paul Farmer is a PhD. Do you honestly think that PhD's have done more for medicine then practitioners? A LITTLE bit arrogant there, don't you think??

 

[Mr. Tee]

Paul Farmer is a PhD. Do you honestly think that PhD's have done more for medicine then practitioners? A LITTLE bit arrogant there, don't you think??

He's MD/PhD and does clinical.

 

[1Path]

Oh and yes, you can take all I say with a grain of salt because I'm an MS0 with years of lab research and an MSTP post-doc who loves to write/talk on the "meaning" of MSTP.

You may be an MS0, but that has absolutely NOTHING to do with your ability to make good points which you frequently do. Some folks simply need to get over themselves......... sorry, I digressed momentarily.

As a person who is also considering an nontraditional PhD and one who regularily thinks about how I can personally make a difference in my chosen goal of decreasing the incidence/mortality of breast cancer in URM populations, I think the OP should certainly speak with folks who have interest and/or experience in epidemiology. There are a TON of misconceptions about this field especially in the MD/PhD forum for example it's not science heavy to which I say take a looksy at the programs at Hopkins and Harvard. Definitely NOT lite on "real" science.

A very close friend of mine is an MD/PhD in Infectious Epidemiology. While shes now is an FP residency, her PhD work was in HPV which required her to at least have a strong knowledge of the molecular biology techniques that were part of her study. One of my mentors is and MD/PhD in Physiology but her career is mainly centered in Cancer Epidemiology and her residecny was in Internal Medicine/Oncology. Her work which includes patient care and epidemiology, also includes bench work which is done by the group she collaborates with.

What I hope these two examples show is that with some effort, you can taylor MD/PhD studies the exact type of work you want to do.👍