"Mud Phuds"

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roseglass6370

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sooo...

MD/PhD....

is it worth it?

what's it entail?

how is the workload in comparison to a plain ol' MD?

anyone going to try it?
 
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This is probably going to be moved to the MD/PhD forum soon, but I'll take a shot at answering your questions before that happens.

is it worth it?

That depends on the person. Do you want to be involved with both research and clinical medicine (usually about an 80/20 split in favor of research)? Are you willing to train for at least 7 years and then go through a residency and a fellowship to do it? Are you willing to probably make less money than your MD-only peers even after such extensive training? Do you know the downsides of the research industry (and clinical practice) and are you willing to deal with them? If yes, then it would probably be worth it.

If you don't love research, and you aren't willing to devote your life to it then no, it probably wouldn't be worth it.

what's it entail?

MD/PhD programs typically mean that you go through 2 years of medical school (using your summers for research rotations), then enter the PhD program (3+ years), then return for the last 2 years of medical school. After graduation, most people do both a residency and a fellowship, ultimately moving into a career involving both clinical work and scientific research.

how is the workload in comparison to a plan ol' MD?

During the MD years, the workload is identical, with the exception that there is essentially no break after the first year (summer is devoted to research). During the PhD years, the workload is identical to that of a PhD student: variable depending on how hard the specific student works, how demanding their lab is, etc.

anyone going to try it?

Check out the MD/PhD forum for a ton of current and prospective mudphuds.
 
URHere covered it very well. However, and I could be way off about this, I can't see the real appeal since as an MD you can be involved in a lot of research as well. Perhaps it helps with funding? Or maybe just general knowledge of your area would be more advanced with the 3+ year research in between your pre-clinical and clinical years. I've toyed with the idea, but I don't have a burning question to devote my life to yet, so I'm still not sure.
 
URHere covered it very well. However, and I could be way off about this, I can't see the real appeal since as an MD you can be involved in a lot of research as well. Perhaps it helps with funding? Or maybe just general knowledge of your area would be more advanced with the 3+ year research in between your pre-clinical and clinical years. I've toyed with the idea, but I don't have a burning question to devote my life to yet, so I'm still not sure.

I think this is one of the major bonuses. MD/PhD students generally have a publication or two (at least) by the time they graduate, and because grant applications look heavily at publication records, those with both the MD and the PhD will generally have an easier time receiving grants than graduates with the MD alone. Also, MD/PhD training generally teaches students the ins and outs of research (how to do a grant application, how to choose and tweak a project, how to write a dissertation, etc) that are very helpful and may not be learned as well by MDs who go through a fellowship.

While it is always possible to do research with an MD alone, the path is far smoother for someone with a PhD.
 
When I was doing my applications for med school, I was applying to MD/PhD programs but I wasn't accepted. In retrospect they did me a favor...a huge one. So my disclaimer before I totally s*** on MD/PhDs is that there have been those with generally positive experiences and are satisfied with their choice. And that is because they truly wanted to be MD/PhDs and are willing to give up a very large amount of their time (and salary) studying and training, not because the programs were so good that they were enamored with the prospect of spending 11 years at minimum to become a MudPhud attending.

That said, my biased as hell opinion is that the degree is simply not worth it. You will get the pain of both worlds, the PhD and the MD. As an MD student you'll constantly be humiliated and degraded, but there is a clear end to the humiliation. Don't believe me, just peruse the forums and see for yourself (that horse has been beaten to death many times over on other threads). What I really have not seen described too well, and because it would be out of place on this community, are the experiences of PhD's of which you will share because presumably you are also qualifying for that degree too.

After doing 3 years of straight research at the undergraduate level and fully immersed in that culture with a PI who was also the graduate advisor to the whole dept (i.e. the person running the whole graduate show), you tend to see things that people only getting a passing glance wouldn't normally see. You rarely hear about:

  1. The PI and PhD student who don't get along. Unlike MD school, you're stuck with this person for 4 years minimum...unless you want to change labs and lose all your research and time doing so. Statistically, and from my experience seeing it, only 1/3 of PI and PhD student relationships actually pan out in the long run. And it has more to do with the PI than the PhD student. If the PI genuinely cares about your education, then it'll probably work out. Unfortunately, as was the case with my mentor, she wasn't very well funded because she focused on education more than brute research resulting in less papers which leads to less funding (that's why she was the graduate advisor). Brings me to my next point.
  2. The "pedigree" of the lab determines your future academic post and funding. A well funded, well published lab is a respected lab. Graduates from respected labs rarely have trouble finding a post and securing funding because their names are no doubt on some high profile published papers in top tier journals. Problem: these labs are very impersonal, large, and the PI is probably an ass. Its not uncommon as a student in one of these labs to "see" the PI only once in 3 months. You'll probably only be working with post-docs if you join one of these powerhouse labs.
  3. What happens when your research stalls (and not from a lack of funding...these guys can't take you unless they have funds to support you)? If your experiments are going nowhere and it seems like you've been pissing in the wind for the past 4 months with no progress, what do you do? In medical school you have a date in the calender that keeps you sane, aka graduation day. No such date in PhD land. You're finished when you're finished, whenever that is. And that's determined by your PI...so you better get along with him/her. This leads to the next point.
  4. Hours. Unless you feel like being there till the lead in your pencil runs out, be prepared to put in long, dreary hours. Western blots, transductions, and plating (depending on your model organism), don't happen by themselves. Sure you will become efficient after a while, but its still time intensive.
  5. You got your PhD, now what? You go back to being an MS3. Woohoo! A year long exercise in pain and torment (again, read the posts).
  6. Graduation day as an MD/PhD. Never mind the fact that most of your classmates are now attendings at this point, you get to go on and do residency just like everyone else. PhD won't be of much use to you there.
  7. Now you're all ready to get going. Functioning as a PhD at an institution is being part salesman, part beggar. You have to sell yourself to the academic community while simultaneously begging for money to fund your research. Here's something else they don't tell you. Medical institutions (because I highly doubt you'd seek employment at an undergraduate institution as a mudphud) don't like paying researchers out of their own pockets. They will basically have you draw your salary out of your own grants. And being that you'll be doing close to research 80% of the time, most of your salary depends on your ability to draw funding. No funding = other people's left overs for dinner. All the institution does is provide an environment for you to do your research, for a cut of the grant money. The other thing that'll happen if you're not able to secure money is you'll lose your lab space to other more funded people because you're not producing research and more importantly to the institution, money (which if memory serves that's how medical schools get ranked).
  8. Next point, the funding for research is less that what it once was and will probably continue to diminish. So, you have to fight for a cut of an ever decreasing pool of money. Even the lowly fam med docs who get crapped on by everyone and their mothers don't have to beg for their salaries and some of them do quite decently in the grand scheme of things. Even more frustrating will be to look at your salary and comparing it to people of equal number of post undergraduate medical years training. You'll be lucky if you get on the line at bottom quartile.
So, do I think its worth it? Hell no. I knew most of these things applying into the MD/Phd program, but I deluded myself into believing that somehow the "medical" world was different from the "academic" world. Not so. I'm much happier now knowing I'm only a year away from residency and doing what I want rather than being in a research lab right now mucking about just to tack on more letters to my name. If you want to do medicine, become an MD. If you want to do research, become a PhD. You really can't do both well and not become insane trying.
 
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thanks for the advice. 🙂 very helpful.
 
Current MD-PhD student here. Just thought I'd mention that although Alteran brings up some valid points, a lot of those opinions are a little bit extreme, and I know a lot of upper-year students who are quite happy with the MD-PhD path. Additionally, most of those arguments boil down to either "the MD-PhD is long" (yes, but so is becoming a surgeon, a cardiology fellow, etc.) or "there's a lot of bull**** in academic research" (yes, but there's even more bull**** in medicine, so if you don't have a spine for bull****, both careers may not be a good choice). Finally, and I also mean no offense Alteran, but since you're not an MD-PhD student, how do you have such strong opinions about it?

An MD-PhD is for research training; if you're not interested in research, you'll be miserable doing it, just as someone who wasn't interested in patients will be miserable in medicine. You need to enjoy both to enjoy an MD-PhD.

Here's a little excerpt from an FAQ we're writing for a Hopkins Undergraduate Advising Guide. It's definitely a rough draft, so be gentle, but I think the overall idea is good.


Hopkins MD/PhD Advising Guide Draft said:
Can't I do research with an MD alone?

Sure, you can do research with an MD alone. However, the path to becoming an independent researcher may actually be much more difficult.

Basic science research today has become incredibly complex; the laboratory skills, scientific knowledge, and experimental understanding required to do good work are tremendous. Medical school curricula do not do any teaching in laboratory technique or experimental design, and they do a hit-or-miss job in teaching basic science.

Thus, the degree to which medical training prepares you for a research career is field dependent: the more basic the research, the less relevant medical training is. A rough scale of research from most clinical to most basic might be:
1) clinical trials, which involve interacting with patients, lots of paperwork and administration, and applying statistical reasoning to experimental design and analysis,
2) clinical research, involves applying simple laboratory techniques developed by others to interesting pathologies or participating as a clinical liaison in experiments designed by other researchers,
3) translational work, a hot buzzword that represents the combination of basic science and clinical research and is ready to be quickly brought into clinical practice,
4) basic science research, the real nuts and bolts, cells and molecules type of research a cell biologist or immunologist might do.
After a medical education, you will decently prepared to do the first two (after a few crash courses on statistics and experimental design), and poorly prepared for the last one. There has been much frustration over the fact that we as a scientific community do the third type, translational research, so poorly, and the MD-PhD program was created partly to train researchers with the skills to improve our ability to do that kind of research.

If you're interested in basic science or translational research, you will need more training beyond an MD. This can be done formally through an MD-PhD or PhD program, or less formally later in your career following residency. The fact is, your initial research is going to be poor, and its going to take a lot of time to build up laboratory skills, acquire background knowledge, and learn how to design a good experiment. You can do this after residency by joining a laboratory as a post-doc. The advantage of training this way is that you go through medical training earlier and get paid better for doing research. However, at that point in your career people are not going to be as interested in training you, and they're going to want results quickly. You will be competing for laboratory positions with PhD's and MD-PhD's, and while researchers will be interested in hiring you to improve the clinical relevance of their work, they will not give you as much mentoring and room to learn as if you were a graduate student. That is why I say the path to research independance can actually be harder as an MD.
Now, there are plenty of researchers who are living proof that a PhD is not mandatory to do good scientific work. Bert Vogelstein, one of the most-cited scientists of all time and one of the people who first fleshed out our current molecular understanding of cancer, never had formal PhD training. However, bear in mind that just because he had no formal training does not mean that he didn't have to work just as hard after his medical training to acquire the skills necessary to run a lab. Additionally, he and other researchers of his generation come from another era, when the learning curve for doing good basic science research was not quite as steep. Today, an MD attempting to start doing basic science work will face many obstacles.
In summary, whether you need a PhD to do research depends largely on what field you want to work in. The rule of thumb is that the more basic the work, the more likely you'll need science research training. Although this level of training can be achieved within a formal graduate program or informally later in life, budding researchers may actually find it easier and more rewarding to learn research skills from a proven method of acquiring such skills: a graduate PhD program.
 
......Finally, and I also mean no offense Alteran, but since you're not an MD-PhD student, how do you have such strong opinions about it?......

My opinions of graduate life were largely borne out of seeing one graduate student after the other chewed up and spit out like yesterday's trash. And because I worked for the graduate advisor, when she wasn't around or was busy in another meeting the graduate students that were wanting to meet with her would chat with me to pass the time as they waited for her. Eventually after 3 years I got to know all the graduate students in the dept of biology. Most of the problems of graduate life are lab dependent, not program dependent. Points 1-4 pretty much sum up the 3 years of griping and venting of the graduate students to me. Why they would confide in a lowly undergraduate beats me, but I guess they just needed to vent to someone.

I would also like to say that while my completely biased opinion is what it is, I won't actively stop people from entering a MD/PhD program. I'll just tell them its a bad idea and they can blow me off later. People ultimately have to decide what works for them, for better or worse. They key is to not only see the immediate pros & cons, but the long term consequences which aren't apparent unless people tell you before hand. From my vantage point, a future pathologist (fingers crossed), I love the lab. But I always hated the idea of having to beg for money so I can do my job. I also realized how fortunate I was to have the mentor that I had given that so many graduate students were suffering. And I like certainty. I knew I would be done in X amount of time with X amount of suffering (which is standard in any medical school training). I didn't like the fact of having months of no progress because some lab tech didn't buffer the stock solution properly or forgot to add the appropriate concentration of antibiotics to the plates and taking weeks to figure out it wasn't working and even longer to figure out why. But I still applied to it anyways thinking it would be different at a medical institution. It wasn't until I talked with some of the graduate students at my school as a med student that I realized it was no different. If roseglass6370 wishes to pursue the field, that's her right to do so. She should however research it very closely because it is an incredible investment of time and effort.

And as far as the amount of crap present in all aspects of higher education and professional careers, one of my mentor's final parting words with me before I left for med school was the following: "...you know, you don't have to enjoy all aspects of whatever you do. You just have to enjoy it overall."
 
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I've spent the last two hours working to decipher an article here on neuronal recordings. Hard as hell, but I enjoyed every minute of it - very fulfilling. That's why I'm applying to MD/PhD. I can't imagine doing medicine without the research aspects of it.

As for begging for money, at any point that it no longer becomes worth it to you, an MD/PhD can always leave and have a great fall-back career - pure, clinical medicine. The only real difference is the 3-4 years of PhD work in the middle, but if you enjoy it, then what difference does it make if it takes you a few more years to get out of medical school? Especially if those years are debt-free.
 
sooo...

MD/PhD....

is it worth it?

what's it entail?

how is the workload in comparison to a plain ol' MD?

anyone going to try it?

There is a minority of people who thrive doing an MD/PhD. They eat it up and go on to become successful academicians. The key word is "minority."

Matriculate in haste, repent at leisure.
 
I think Alteran's post is pretty much spot on. I can quibble over minor details, but what's the point. If you read that and still want to do MD/PhD, more power to you. If it was a true waste of time (and it's not) it wouldn't exist.

There are drawbacks and he/she hit on many of them. Never say nobody warned you 🙂

and like military medicine, if you are doing it for the free tuition & stipend, you are making a big mistake. You have to do it because you love the work or you'll be miserable.

There's a few major differences between MD/PhD and Mil Med that I want to point out because I don't like them being lumped together. In MD/PhD, you can quit the MD or PhD or both at any time and owe nothing in most cases. Never are you restricted in any way to one residency or career. In Mil Med once you sign, you are in. That's it. For a long time. They even have a very strong hand in where you do your residency (typically with them) and if the residency choice you want is full have fun picking from what's available or putting off residency for 4 years... Don't like mil med? Too bad. You're an MD/PhD and don't like academics? Switch to private practice.
 
because grant applications look heavily at publication records, those with both the MD and the PhD will generally have an easier time receiving grants than graduates with the MD alone.

I'd like to challenge you on this statement. It is often assumed but I have not yet seen any real data to support it.

Here's me quoting myself from one of my posts about 6 months ago:

http://jama.ama-assn.org/cgi/content/full/294/11/1343/JOC50107F3

According to this figure MD/PhDs are pretty much on a level playing field with other degrees nowadays for percentage of first major grants funded (Ley, Rosenberg JAMA 2005; 294: 1343-51). I have seen some data showing that MD/PhDs are more successful at getting their first little K grants funded. Those don't at all establish a career. You need to move up to the bigger grants if you want to have a job in science, and that's where I'm always hearing the most troubles come. Of course, I'll hit this point around the age of 40, when I should be well established in any other profession.

http://jama.ama-assn.org/cgi/content/full/291/7/836/TABLEJOC32232T2

According to this MD/PhDs are no more successful at getting R01s than other degree types (Kotchen, et Al JAMA 2004; 291: 836-43), and these are the main career defining grants. We do also know that MD/PhDs take longer to their first R01 than MD or PhD alone.
 
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Whoops.

Neuro, would it be safe to say that if your passion is in the basic sciences (as opposed to clinical research), an MD-PhD is a benefit over a pure MD?
 
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What about compared to a PhD done during residency/fellowship? Is it safe to say those are generally for clinical research as well, as you simply don't have the time to devote to basic-level research there?

I guess my biggest concerns are twofold:

1) What if the research field I love now is not the one I want to spend practicing in as a clinician?
2) Will all of my knowledge be completely outdated after I complete residency, to the point that I'll be starting from scratch again?

Sorry for bombarding you with questions. This is just an incredibly difficult decision for me. I know research is what I want to do, but I'm not sure if my path to it should be through the MSTP programs or through doing an extra degree in residency. Both have pros and cons, as far as I can tell (pro for residency - it's in the field I'm sure I love; con - it may not allow me to do the type of research I find fascinating).
 
You can do whatever you want with your life. If you want to spend years in fellowship earning $65k/year banging your head against a wall in research when you could easily triple your earnings (depending on field) doing clinical practice, many academic institutions will have you and love you. Getting your initial funding in these stages is relatively easy. If you want to get all your training there (PhD optional) and launch a research career, there's nothing stopping you from doing basic science. It's even possible (probable?) you can even find a LRP to pay off some to all of your med school loans in exchange.

So why MD/PhD as opposed to MD? It's an argument for another day :laugh: I'm not convinced either way myself.

As for your two questions
1) The argument I hear is, do something basic and general. It's more about learning how to do research than the research itself. I'm not sure I buy that argument personally, but I've heard it enough times that you should strongly consider it.
2) Maybe 😉 It's certainly my concern. I've heard it many times from the fellows in Radiology, but many of them did their PhDs in unrelated fields. So the value of the PhD at the student stage in starting a research career? Uncertain, at least to me.
 
I know research is what I want to do, but I'm not sure if my path to it should be through the MSTP programs or through doing an extra degree in residency. Both have pros and cons, as far as I can tell (pro for residency - it's in the field I'm sure I love; con - it may not allow me to do the type of research I find fascinating).

Just to clarify for you and others. For those doing an internal medicine or pediatrics residency who are MD/DO grads but have an interest in basic or translational science (and some forms of clinical research), the usual approach is to obtain these skills and experiences during your specialty fellowship. This time is built into some of these fellowships (especially in pediatrics) or can be added to others. Then, you will further those skills/experiences in mentored grants (such as K-awards) with which you will start your faculty experience. It is possible to complete fellowship and then go to the NIH or elsewhere to strictly do research, perhaps only moonlighting (this is what I did), but the financial side of this isn't as good as the other approaches.

For surgical residents and some other fields, it is more common to add laboratory years inside the years of the residency training, usually as separately funded years in which little or no patient care is given. Other models exist as well for when to fit this in.

There are also some newer funded models in which extended fellowships and beginning faculty positions are merged allowing for multiple years of highly protected time for research training of MDs.

Although it is possible to do a PhD after residency (or fellowship), right now this is not common and, although I'm willing to be corrected by members of this community, I do not see the advantage of that particular path given the many other options available.
 
Let me add some insight as an MD/PhD in residency training:

1. The MD/PhD experience varies greatly based on person and insitution. I agree that it is NOT worth it if you are doing it for the money- in the end it will cost you more in total earnings. It is definitely worth it if you love research and adding to our wealth of knowledge rather than simply practicing medicine. Few people tell you going in, but being a doctor is just a job. It's like being a mechanic but you work on people and have much more liability. If you love science there is a good chance that medicine alone will be boring for you, and being an MD/PhD is a great choice.
2. There are definite advantages IMHO to MD/PhD over MD or PhD alone if you want to do research. Of course, this is institution and lab dependent. If you do a quality, hypothesis-driven thesis, you will be well prepared for grant writing and project design. You will think like a scientists. You can't really learn this over the course of a short fellowship, IMHO. It's like saying that I know how to be a surgeon because I did a 3-month rotation in surgery. You need to develop your own ideas and earn your place and PhD. If this is your PhD experience, you will be well-suited for a scientific career.
3. I disagree with the several comments about going back to MS3 and being just another scut monkey. I found that the PhD earns you respect amongst residents and attendings, and you may be treated with more respect than your younger, less experienced, and less seasoned fellow students. That was certainly the case with me, with perhaps the exception of the OB/GYN residents.
4. The PhD does help you both in MS3/4 and Residency. Thinking like a scientists helps you better organize yourself and prepare reports. You ask more thoughtful questions and look at problems in a different light. Furthermore, in academic settings you will be highly sought-after. I have already found several attendings throwing projects at me in efforts to collaborate. Research will be part of my already-hectic schedule.
 
that's good info, thanks gbwilner (who is also, apparently, my mother).
 
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