PhD AFTER MD!!

[MagicMichaelis]

Hello all,

I have a very unique situation here. Please let any response be a thoughtful retort, and not simply, "You're screwed." I already admitted this is a *unique* situation.

My undergrad degree was chemistry. I was a teaching assistant and research assistant in organometallic synthesis (but I also had a soft spot for biophysical chemistry). It was an amazing subject, but I was dissatisfied with the lack of meaningful "direction" a lot of the grad students and post-docs in my lab possessed. I did not want to be like them. They were so consumed with merely being able to create a compound, but did not know how that compound could exist in society. They published papers with greatly exaggerated "implications" for their compounds, when in reality their compounds would probably never be of any use to anyone. I loved chemistry for chemistry's sake as well, but I knew this cannot pay the bills and therefore wanted to have a definitive area with which to apply my knowledge.

Enter my idea: become an MD/PhD.

I thought this was the best of both worlds. As someone once said, "Physicians don't take scientists seriously, and scientists think physicians are stupid." I felt that as an MD/PhD, I would be both smart and my ideas would be taken seriously.

The problem is that my final resume ended up not being competitive for an official MD-PhD program. I had to make a pressured decision what to do next, and I was competitive for a regular medical degree, so I enrolled myself in medical school. I am currently an MS1.

This is my special situation. How do I become a physician-scientist in basic science (preferably biochemistry, biophysics) from here?

Four scenarious were posited with outside input, and let "MD/PhD job" = some paying position as a physician-scientist:

1.) finish med school--> residency---> [hiatus to work and pay off loans]---> grad school & PhD---> post-doc or "MD/PhD job"

2.) finish med school--->residency---->post-doc [without PhD]--> "MD/PhD job"

3.) finish med school--->immediately start grad school (financially vague: what about med school loans?) ---> post-doc [without residency] --> "MD/PhD job"

4.) finish med school--->post-doc [without residency or PhD]---> "MD/PhD job"

How realistic or accurate are these 4 scenarios? Are there other scenarios I am overlooking?

Also, especially regarding the financial concerns of scenario #3, would an individual with a medical degree who is taking a post-doc position be paid any more highly than the average PhD who take a post-doc position?

Thank you in advance for your responses!

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[K31]

The usual pathway for MDs who decide later that they want to do research is to do a research-intensive fellowship (e.g. a year of clinical training and 2-3 years of research). A benefit of this is that you get paid at your PGY level, which is probably more than a postdoc salary.

But you are still early. Does your school have a MD/PhD program? If so, why not apply--the worst they can do is say no, and then you can move on to plan B.

 

[MagicMichaelis]

No, my school doesn't have an MD/PhD program.

 

[Rumit]

I think doing a residency and then fellowship that has a significant amount of built in research time is a reasonable approach. There are a number of fellowships that allow for this, and some programs even allow you to take a couple extra years of research to complete a PhD as part of the training. I think, typically, the pay is a little bit higher (not much) than NIH minimum for a postdoc.

I'd also seriously consider taking a year off, either between MS2 and MS3 or between MS3 and MS4 to do some research. I believe there are programs at the NIH among others. It'll help you when applying to research oriented residency/fellowship programs and will give you a little more exposure to the research world.

 

[Ombret]

My advice would be to stick with your MD program, get involved in research as a student, try to pick up a research year if that appeals to you and if the planets line up for it, and then aim for a research-friendly residency and fellowship.

If you look around the world of biomedical research you will find plenty of physician-scientists who didn't follow the MD-PhD route. Some came to their research interest late or by accident. Some just started before MD-PhD programs were common. Undoubtedly some just didn't get in in the first place. To their relief, presumably no one cares anymore. So you can have a nice career without doing MD-PhD.

This invites the question of whether success is less likely for those without the benefit of dual degree training. There is a paper out there somewhere, and I tried to find it again but couldn't, demonstrating that the age at first R01 was very similar for MD-PhD and MD-MA trained physician scientists. Age is not the only relevant metric but the point is that the MD-MA group was not hobbled by not having PhD training. They had to get their research training sometime but presumably this was just started a little later in their career.

There was just an article in JAMA by Zeke Emanuel, with a spate of letters to the editor in reply, arguing that medical training is too long and could be shortened by 30% at every stage--premed, medical, residency and fellowship. One of his points was that we force fellows to do research even if they are really interested only in the clinical piece. Without taking sides one way or the other, for you the silver lining is that your later training WILL include plenty of research exposure if you want it.

 

[MagicMichaelis]

My advice would be to stick with your MD program, get involved in research as a student, try to pick up a research year if that appeals to you and if the planets line up for it, and then aim for a research-friendly residency and fellowship.

If you look around the world of biomedical research you will find plenty of physician-scientists who didn't follow the MD-PhD route. Some came to their research interest late or by accident. Some just started before MD-PhD programs were common. Undoubtedly some just didn't get in in the first place. To their relief, presumably no one cares anymore. So you can have a nice career without doing MD-PhD.

This invites the question of whether success is less likely for those without the benefit of dual degree training. There is a paper out there somewhere, and I tried to find it again but couldn't, demonstrating that the age at first R01 was very similar for MD-PhD and MD-MA trained physician scientists. Age is not the only relevant metric but the point is that the MD-MA group was not hobbled by not having PhD training. They had to get their research training sometime but presumably this was just started a little later in their career.

There was just an article in JAMA by Zeke Emanuel, with a spate of letters to the editor in reply, arguing that medical training is too long and could be shortened by 30% at every stage--premed, medical, residency and fellowship. One of his points was that we force fellows to do research even if they are really interested only in the clinical piece. Without taking sides one way or the other, for you the silver lining is that your later training WILL include plenty of research exposure if you want it.

My advice would be to stick with your MD program, get involved in research as a student, try to pick up a research year if that appeals to you and if the planets line up for it, and then aim for a research-friendly residency and fellowship.

My school does have research opportunities in the summers, but it's nothing stellar worth bragging to a residency interviewer. Also, being able to take a year off after MS3 to do an external research program seems financially impossible (let alone based, as you said, on luck getting selected to do the program in the first place and if your school would agree to it). How are you supposed to support yourself, especially if you have to relocate far away and have monthly expenses without family support? It seems far-fetched.

So far I emailed three directors of research-based residencies and they all basically told me that I would be severely disadvantaged when applying to these residencies because 1.) the mediocre research available at my school 2). that I would be competing against MD/PhD's, the majority of applicants--and that it was almost certain I would need to take a year off after MS3.

If that's my only realistic option for the research-based residency, taking a year off for research, it seems like it requires putting one's eggs all in one basket.


This invites the question of whether success is less likely for those without the benefit of dual degree training. There is a paper out there somewhere, and I tried to find it again but couldn't, demonstrating that the age at first R01 was very similar for MD-PhD and MD-MA trained physician scientists. Age is not the only relevant metric but the point is that the MD-MA group was not hobbled by not having PhD training.

One might go through 5-7 years in research residency & subsequent fellowship, but to say that person has a breadth of knowledge equal to someone who completed 5-7 years in grad school is not really accurate. They might both be equally "successful," but as researchers they are not truly equal (Nurse practitioners make as much money as some FM physicians, but... so what?).

Definitions of "success" aside, would not those physician-scientists without a PhD still be limited in the types of research areas they could perform? To use an example, a guy wanting to be a physician-scientist in biomedical engineering probably wouldn't get very far with only an MD--even if his undergrad major was BME, correct?

It would kind of be a waste to go through so many years of education to be told I'm not qualified to bring any meaningful investigations in certain areas, to be relegated to some kind of Science Lite.

I just feel like I don't know what to do, that I'm going to regret my decision whatever it is.

How realistic is this scenario: complete regular residency then complete NIH-funded post-doc position in basic biomedical science at a major university leading to some academic position (with the option of officially obtaining PhD with them in the future)? Would I even be able to pay off loans with such a job?!

 

[Neuronix]

If that's my only realistic option for the research-based residency, taking a year off for research, it seems like it requires putting one's eggs all in one basket.

You are being incredibly self-defeatist here. The research job market sucks and has for years. By the time you get to fellowship, you will be required to do research and nobody will want to do it. The only reason most people do research in medical school and residency is to get a good spot at the next level so they can get the highest paying private practice job down the road.

You can always do an extended fellowship with plenty of research. Unless you just have to have a super competitive fellowship like GI or Cards and/or you have to train at the biggest name places, then all bets are off. The question becomes after 10 years of getting your ass kicked (med school, residency, and fellowship), do you really want to spend several extra years making peanuts or do you want to make several times as much in clinical practice? No matter what you say now, you're not in your 30s and you're not sick of constantly being beaten up, spit on, and living like a student rather than the professional you are working 60+ hours a week forever for a low hourly wage.

In other words, you will have no problem going out and getting the research experience and training later in life if you want it. Seek out your opportunities and use them. We're giving you opportunities at every level in this thread. You keep saying they're not good enough, but it's how people get started. At every stage you will have opportunities if you want them, and you can build a research career if you want to. The question will be whether it's actually worth it. While for most people the answer becomes a gigantic "no", it's a different question.

As for the loan issue, see: http://www.lrp.nih.gov/index.aspx

 

[MagicMichaelis]

Neuronix
7/24/12 3:21AM

"Seek out your opportunities and use them. We're giving you opportunities at every level in this thread. You keep saying they're not good enough, but it's how people get started. "

I'm not saying they're not good enough, I'm playing devil's advocate and saying that I'm not going to be as blase about my secured success as others here-- who have not done the action they're suggesting. I appreciate the responses, but how many of y'all have taken off time from your program in medical school (whatever the program is), found an external research program, did that for years without financial fiascos, then resumed your medical program?

And FYI, the NIH will NOT pay my loans if I take a year off between MS3 and MS4.

They "may" pay at least some part of my loans only if I take TWO YEARS off between Ms3 and Ms4. http://www.lrp.nih.gov/about_the_programs/index.aspx

 

[MagicMichaelis]

7/23/12 3PM Rumit

some programs even allow you to take a couple extra years of research to complete a PhD as part of the training.


Which programs would these be? How can one get a list?

 

[Neuronix]

I'm not saying they're not good enough, I'm playing devil's advocate and saying that I'm not going to be as blase about my secured success as others here-- who have not done the action they're suggesting. I appreciate the responses, but how many of y'all have taken off time from your program in medical school (whatever the program is), found an external research program, did that for years without financial fiascos, then resumed your medical program?

You're posting in the MD/PhD forum. Of course you're going to hear from MD/PhDs. But I know many people who took a year out from medical school to pursue research either at their home institution, another institution, or the NIH. If that's not feasible for your financial circumstances, all is not lost. As I mentioned, you will have opportunities at every level for research. For example, you can do clinical research in your summer time and in fourth year.

Regardless, the most important factors for securing a residency, even a research-oriented one, remain step 1 score and clinical grades.

And FYI, the NIH will NOT pay my loans if I take a year off between MS3 and MS4.

They "may" pay at least some part of my loans only if I take TWO YEARS off between Ms3 and Ms4. http://www.lrp.nih.gov/about_the_programs/index.aspx

The LRP is for fellow or early attending level research. i.e. You can get your loans paid back when you're done with residency and/or fellowship.

 

[soundnin]

My school does have research opportunities in the summers, but it's nothing stellar worth bragging to a residency interviewer.

Also, being able to take a year off after MS3 to do an external research program seems financially impossible (let alone based, as you said, on luck getting selected to do the program in the first place and if your school would agree to it). How are you supposed to support yourself, especially if you have to relocate far away and have monthly expenses without family support? It seems far-fetched.

So far I emailed three directors of research-based residencies and they all basically told me that I would be severely disadvantaged when applying to these residencies because 1.) the mediocre research available at my school...

do program directors really look down on other institutions' quality of research? legit question because that sounds horrible

regarding predoctoral research fellowships that are probably quite competitive... you can "play devil's advocate" all day (to me it seems more like finding reasons not to do something) - if you really want something, you'll work hard to get it.

One might go through 5-7 years in research residency & subsequent fellowship, but to say that person has a breadth of knowledge equal to someone who completed 5-7 years in grad school is not really accurate. They might both be equally "successful," but as researchers they are not truly equal (Nurse practitioners make as much money as some FM physicians, but... so what?).

i think you're putting phd training (or the degree itself even) on a pedestal. i don't really understand the analogy to nurses and FM docs, because if a phd only and a md only both had just secured their first R01 with multiple cell papers in press, they are equal in my book...

Definitions of "success" aside, would not those physician-scientists without a PhD still be limited in the types of research areas they could perform? To use an example, a guy wanting to be a physician-scientist in biomedical engineering probably wouldn't get very far with only an MD--even if his undergrad major was BME, correct?

like any job, i think research is better learned by doing than reading textbooks. in science, you're constantly learning and trying to keep up with current literature anyway. so i wouldn't agree that that is correct.

... but how many of y'all have taken off time from your program in medical school (whatever the program is), found an external research program, did that for years without financial fiascos, then resumed your medical program?

as one would expect, most of us in this subforum are in integrated programs and have not, which makes me wonder why you asked this particular question or why you asked the original question in this subforum.

 

[K31]

do program directors really look down on other institutions' quality of research? legit question because that sounds horrible

If the OP is at a school that has no pathway to MD/PhD whatsoever, they may be right to do so. Most schools (even some DO schools) have some mechanism to get both degrees, even if you have to pay for your medical degree on your own.

 

[K31]

But I know many people who took a year out from medical school to pursue research either at their home institution, another institution, or the NIH.

At least in my experience, students who do this do it more to get a leg up for competitive residencies than out of a desire to have a significant research component to their careers. Those few who do want to become physician-scientists end up joining the MD/PhD program--at least at my institution, this happens with some regularity.

 

[Neuronix]

At least in my experience, students who do this do it more to get a leg up for competitive residencies than out of a desire to have a significant research component to their careers. Those few who do want to become physician-scientists end up joining the MD/PhD program--at least at my institution, this happens with some regularity.

The op already noted that an MD/PhD program is not available at their medical school.

 

[eHombre]

You are being incredibly self-defeatist here. The research job market sucks and has for years. By the time you get to fellowship, you will be required to do research and nobody will want to do it. The only reason most people do research in medical school and residency is to get a good spot at the next level so they can get the highest paying private practice job down the road.

You can always do an extended fellowship with plenty of research. Unless you just have to have a super competitive fellowship like GI or Cards and/or you have to train at the biggest name places, then all bets are off. The question becomes after 10 years of getting your ass kicked (med school, residency, and fellowship), do you really want to spend several extra years making peanuts or do you want to make several times as much in clinical practice? No matter what you say now, you're not in your 30s and you're not sick of constantly being beaten up, spit on, and living like a student rather than the professional you are working 60+ hours a week forever for a low hourly wage.

In other words, you will have no problem going out and getting the research experience and training later in life if you want it. Seek out your opportunities and use them. We're giving you opportunities at every level in this thread. You keep saying they're not good enough, but it's how people get started. At every stage you will have opportunities if you want them, and you can build a research career if you want to. The question will be whether it's actually worth it. While for most people the answer becomes a gigantic "no", it's a different question.

As for the loan issue, see: http://www.lrp.nih.gov/index.aspx

^^Truth. Also, OP, there are fellowship programs available (Howard Hughes, NIH, and some disease-specific organizations like Am Diab Assoc, etc) that pay a stipend for a research year during medical school, even at external programs.

Frankly, though, all four of your scenarios seem unrealistic, for all of the above mentioned reasons. I myself have just finished my biochemistry PhD and am entering medical school next month. Grad school was great and all, but I couldn't imagine going back after a residency. Not a good use of time.

Get involved now in research (I'm sure there must be *some* big name at your school, if you're concerned about that), and take the year off during med school so you're sure you want to go that route. Many medical schools actually try to facilitate this for you, and even if yours doesn't, it's not that unusual of a route. At my medical school, something like 20-30% of the class takes a funded year off for research after 3rd year.

After that, try to take extra research years during fellowship to get the necessary research training; some posters have suggested that you could even get the PhD during this time. You'd be earning a PGY salary, which at the fellowship stage is more than double a grad student stipend. Besides, you could always post-doc after the fellowship if you need to. When you have med school loans to pay back and you're 30+ years old, this will all matter a great deal, (though, for the time being anyway, there's always income-based repayment).

Plus, if you don't do a residency, you lose the flexibility of going the part-time clinical route, in addition to the extra earning potential that comes from that.

After all of this, I think it's the fact that you did 4-5 years research that will matter, not so much whether or not you have "PhD" after your name. If you put out quality research in quality journals, you'll be in a good position for a job if you still decide you want to go into the cesspool that is the academic job market .