post-grad training for MD/PhD's?

[superdevil]

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hey everybody, i need some info (what else is new?). i have heard repeatedly that MD/PhD's need to go through some kind of residency to be able to practice medicine in some capacity. as for the research half, are post-docs still necessary? and if so (since i think they are for most applications of the combined degree), does one post-doc appointment suffice? are most post-docs ~2 years (as i have heard)?

i just got to thinking that, if (note: a very large and mystical "if," here) i got the CD, i would be ~30. after a residency (for this post, i'm calling it five years) and just one post-doc (for two years), i would be the ripe old age of 37 by the time i accepted my first "real" job! this is actually a little beyond when i have thought about having kids! holy crap!!!

so, to summarize, what is the 'typical' post-grad training for MD/PhD's, and what do the rest of you plan to do about things such as family life, etc.?

as always, thanks for your input/advice 😉

 

[MacGyver]

postdoc is not necessary.

Very few people do both postdoc AND residency.

Choose one or the other.

 

[Neuronix]

Uhhh, that's not what I've heard. Typically it's residency and fellowship or residency and post-doc for basic science research. Though it depends on your career goals. Someone in the know care to comment?

 

[Primate]

Not nec. in the know, but Neuronix is right. Anecdotally, the residency - fellowship route is much more common (pays better, too). So, MacGyver is sort of right, too. The post-doc AND residency route is unusual, from what I've seen.

I'll be closer to 40+ when I take my first real job (and that's fine).

I have 2 kids and am thinking about more, so it can be done. I even get to spend time with them. 😉

Don't let what you think others think determine what you think. 😉

P

 

[MacGyver]

A post-doc is WAY different than a fellowship.

A residency + fellowship is IN NO WAY similar to a residency + post-doc.

Fellowship is focused on clinical work with a little research on the side.

Post doc is basically 100% bench research.

There's a HUGE difference between the two.

 

[xanthines]

Some schools have a combined post-doc residency (for MD or MD/PhD, obviously!). I think they are mainly pathology residencies where you spend every 4th or 5th week on clinical service during the last 2 years. I think Harvard/ "THE" Brigham allows this.

There's a guy in my lab doing that now (MD only). When he's finished, he'll apparently be board-certified for CP/AP and have completed a post-doctoral fellowship. He's still got a 1.5 years left, so we'll see how that turns out as he's the guinea pig here. He's the first to take this route at this school and the only one so far (i think!).

-X

 

[Adcadet]

Originally posted by MacGyver
A post-doc is WAY different than a fellowship.

A residency + fellowship is IN NO WAY similar to a residency + post-doc.

Fellowship is focused on clinical work with a little research on the side.

Post doc is basically 100% bench research.

There's a HUGE difference between the two.

MacGyver - I see you posting all over the place. You have tons of opinions, which you've formed somehow. I'm assuming most of them are right-on, and it's impressive that you have such a bredth of knowledge about medical training and whatnot. But how do you know that all fellowships are very different than a post-doc? Are you some fellowship director somewhere? Have you done a few fellowships? Not to give anectodal evidence, but I worked with an MD who did a fellowship in clinical pharmacology, which he described as a year spent doing tons of research and very little patient care. I've also talked with a rheumatologist who described part of his fellowship training as being primarily research. So obviously it is not impossible to do research during fellowship. In fact, I'm wondering if there are fellowship programs that are heavily research-based.

 

[Neuronix]

To add to that, I worked in a neuropathology lab over the summer. The two neuropath fellows in the lab had very little clinical responsibility and were looking for asst. prof jobs.

 

[Doctor&Geek]

Programs exist such that you may enter into a specialized research combined residency and fellowship where all of your electives are protected bench research time.

Internal Medicine and Pediatrics are two specialities which have such programs, which vary at different schools and are probably highly selective.

Yours,

 

[Primate]

Not to add to the flogging, but two points:

1) I never claimed post-doc and fellowship were the same (try reading posts before offering opinions)

2) As stated above, some fellowships are very heavily bench oriented (as much as 2 of 3 years just at the bench). Others are, indeed, more clinical. However, not many CDs are looking at those.

So, no, post-docs and fellowships aren't necessarily "hugely" different. It depends greatly on the particular fellowship.

Also, to your earlier post stating that one should do either a post-doc or a residency. This is flat out wrong, at least for a physician scientist. One typically needs some research time after the residency to get back in the swing of things. Also, as mentioned by others, the residency is appropriate training for a translational physician scientist. This is, after all, the (pre)MD/PhD&DO/PhD board.

P

 

[pathdr2b]

Originally posted by MacGyver
A post-doc is WAY different than a fellowship.

This isn't true from what I've seen at the NIH.

 

[superdevil]

thanks for the kick-ass info, guys. i guess the consensus on post-grad training is...that there is no consensus😀

so i guess the residency is a must, and it may be followed by either a post-doc or a fellowship? i like the sound of clinical-based fellowships and/or the integrated post-doc-residency stuff that xanthines and JPaikman mentioned. i like the focus on clinical applications of the CD. most of the stuff i hear regarding MD/PhDs post-grad training and careers seem to fail that classic interview question of "Why both degrees?" it just seems like most of the stories i've heard are heavily biased toward bench research.

thanks, and keep it comin'!

 

[Primate]

Well, if you like the sound of a clinicially based fellowship, think twice about the MSTP. The residency itself is clinical. The fellowship is used (by the combined degree types) to get back into research. If this doesn't sound like fun, perhaps you should think long and hard about the combined degree. It really is alot of hassle to do clinical work (much better to get the MD and boooooogie).

Just sayin'

P

ps - the residency isn't a must, especially if you want to go wet-bench exclusively, but it is by far the most common way to go.

 

[Sonya]

residency is a MUST if you ever want to see a patient and call yourself the patients doctor (I mean, if you want to treat people). If you don't want to treat people, it's not.

"Fellowship" refers to post residency training.

Typically, this is a specialization. For instance, I could do a residency in internal medicine, and do a "fellowship" in cardiology, or urology, or many others. Or, I could do a residency in ENT, and do a felloship in inner ear balance disorders.

Now, fellowhips could also be "research fellowships" that is, i can do a residency in whatever, and do a fellowship to do relevant research in that specialty. In this case, the fellowship could be similar to a post doc.

I have to admit, i haven't started medical school. Haven't done residency, fellowship, post doc, or anything. But, i've talked to every single (well that's an exageration) knowledgable willing physician I encountered about what these terms/methods of research were.

Sonya

 

[Primate]

There are many clinical fellowships that include a research component. Some are VERY heavily weighted towards research. I know this from experience (lab-mates and such).

Your second example of a "fellowship" is actually a post-doc (MD's do post-docs as well).

Don't know if this is good news or bad (or nothing) for you.

P

 

[Vader]

Perhaps I can help clear up some of the confusion...

Most graduates of MD/PhD programs go on to do residency.

Depending on choice of specialty, you may want to go on afterward and do a clinical fellowship. For example, if you want to be an oncologist, you would do an internal medicine residency followed by a heme-onc fellowship.

Many clinical fellowships require or provide time for bench or clinical research (often a year or more), especially those at the major academic medical centers.

A postdoctoral fellowship can involve bench laboratory research.

Some residency programs allow "fast-tracking" which provides protected time during residency for laboratory research (in a way a combined residency-postdoctoral fellowship), and reduces the total time spent in training.

Some major academic centers have new molecular medicine fellowships that are geared toward the goals of physician-scientists, providing funding for research during clinical fellowship. This helps reduce the total time and provides a nifty source of programatic and financial support.

There are K-series training grants available for young physician-scientists, which are basically mentored postdoctoral fellowship awards that provide funding for salary, supplies, and a technician. One would typically apply for these during fellowship.

Very few physician-scientists come straight out of a clinical residency as a principal investigator, and the above pathways are available options to those inclined to do both clinical medicine and basic research.

Hope this helps. 😀

 

[dl2dp2]

Vadar,
I have a question.

My impression is, MDs who chose the NIH post-doctoral program (late boomer programs) can go on become PIs immediately after this program. Does this tend to be true?

If this true, then I don't see any advantage of doing MD/PhD as far as to save time.

 

[Vader]

I think the NIH postdoctoral program for MD researchers is an excellent one and has produced many successful scientists. However, a large number of these people historically ended up doing solely basic science, without clinical practice. To practice, one has to do a residency.

There is a great need to encourage interest in both basic and clinical research among MDs, as there is a well-documented shortage (and decreasing) of physician-scientists.

Though MD/PhD programs provide the most extensive training available, there are simply not enough MD/PhDs out there to cover the vast need for biomedical research.

If one is interested purely in research and "saving time" as you put it, then the MD + NIH fellowship route seems attractive. On the other hand, the MD was not designed to prepare one for research, while the PhD is for this purpose. There are biomedical research PhD programs available in which students take courses in physiology and tissue biology, which gives them some of the perspective of their MD counterparts. And again, if one wants to practice medicine, he/she has to do a residency. So the MD + NIH fellowship person would still have to invest those years.

 

[superdevil]

the residency isn't a must, especially if you want to go wet-bench exclusively

i suppose i just don't know any better (wouldn't be the first time), but this still seems like squandering the potential of having both and MD and a PhD. yes, yes, i realize the NIH wants to produce 'basic science researchers,' but where's the integration? the innovation? if one does not do any type of residency/ clinical work, then why get the CD? to have a better parking space than the PhDs??? feel free to elaborate.

Some residency programs allow "fast-tracking" which provides protected time during residency for laboratory research (in a way a combined residency-postdoctoral fellowship), and reduces the total time spent in training.

very cool and very helpful. this seems to be what i'm looking for (at this given moment, anyhow), and i hope these programs gain some momentum.

 

[Primate]

I stand by the statement that a residency isn't a "must" if one wants exclusively wet-bench.

Your point is well taken - the MSTP has an "M" in it for a reason. I'm just pointing out that for those inclined toward only the bench, the residency isn't a pre-req. to get a job.

P

 

[Neuronix]

Originally posted by superdevil
if one does not do any type of residency/ clinical work, then why get the CD? to have a better parking space than the PhDs??? feel free to elaborate.

People change their minds as they go through CD programs. Some decide that they really don't want to see patients and are much happier doing research. Since the third and fourth year are spent with patients, some don't figure it out until then. If that's the case, it's perfectly reasonable to not do a residency and go for a research position.