Pros/cons MD PhD raddiology

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DrDori

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I am hoping to go for an MD/PhD probably in radiology/medical imaging.. but I am now also considering applying for MD or just PhD only :(

I would like to know what can MD/PhD in this field do that cannot be done by either MD or PhD only..

I have an idea.. but I am looking for more knowledge or experience and answer that gives me a better analysis than my intuition can !

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I am hoping to go for an MD/PhD probably in radiology/medical imaging.. but I am now also considering applying for MD or just PhD only :(

I would like to know what can MD/PhD in this field do that cannot be done by either MD or PhD only..

I have an idea.. but I am looking for more knowledge or experience and answer that gives me a better analysis than my intuition can !

I've worked for one, who was in nuclear medicine - similar field. To be honest, it seems to be a vetting thing. If an adcom from a prestigious uni thought you were good enough, and you completed it and proved you were, administrators respect that. So do funding committees.

That aside, it's been my experience that MD PhDs are groomed for leading studies and departments rather than being on the front lines. They are meant to have a broader, translational knowledge base with which to best guide a study (administrate).

Obviously there's a lot more to it than this but just to briefly answer your question, this is something to consider.
 
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There is nothing an MD/PhD can do that cannot be done by a MD only. A PhD cannot see patients and read studies.

In theory? Possible.
In practice? wtfbbq

Medical school doesn't even start to cover a fraction of what Ph.Ds have to know in their respective field. Of course, physicians can conduct basic research in many fields related to health sciences, but to pretend that they somewhat have sufficient knowledge to conduct extremely intricate and complicated studies/research in a specific like many Ph.Ds do is somewhat ridiculous. Not impossible, just unlikely (considering the astronomical level of training which would be required) and kind of demeaning.
 
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Not impossible, just unlikely (considering the astronomical level of training which would be required) and kind of demeaning.

I guess I'm demeaning myself then :rolleyes:

Most of your time in a PhD program is spent doing labwork. You can do extensive labwork and go on to do research without obtaining a PhD.

Unless pushed, I won't get into how having an MD creates tremendous personal and outside pressure to use that MD to do clinical work instead of research. Having a MD/PhD doesn't change that.
 
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Sort of off topic but I don't want to start a new thread. Neuronix, what do radiology/radonc residency programs look for when considering md/phds?

http://forums.studentdoctor.net/showthread.php?t=776060
http://forums.studentdoctor.net/showthread.php?t=855953
http://forums.studentdoctor.net/showthread.php?t=784934
http://forums.studentdoctor.net/showthread.php?t=830860

Does the PhD and associated research have to relate to radiology or would something like cancer bio or pharmacology suffice? Sorry if this was answered elsewhere.

http://forums.studentdoctor.net/showthread.php?t=873957
http://forums.studentdoctor.net/showthread.php?t=747778
http://forums.studentdoctor.net/showthread.php?t=889680
 
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Most of your time in a PhD program is spent doing labwork. You can do extensive labwork and go on to do research without obtaining a PhD.

You do realize that what you are proposing can be resumed to undergoing the very same training as a MD/Ph.D - except you don't get the degree title?

If we follow your logic, it can go the other way around too.
Non-physician specialists increasingly take patients in private care. Accordingly trained psychologists can already prescribe drugs in multiple states. A Ph.D in pathology could theoretically do the same work as a physician pathologist with appropriate clinical training. Actually, any Ph.D who amasses sufficient knowledge in medicine related to its specific field + specialized clinical training could be as efficient as a physician specialist.
Physicians have never had the monopole of high-level health care.

(And keep the rolling eyes to yourself, your highness).
 
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Unless pushed, I won't get into how having an MD creates tremendous personal and outside pressure to use that MD to do clinical work instead of research. Having a MD/PhD doesn't change that.


Can I push you into going into this?
If you would do it all over, would you still do MD/PhD?
 
Can I push you into going into this?

1) Money (your salary, clinical income far exceeds research income)
2) Money (income, for your department, see above)
3) Money (not having to fight for <10% grant funding rates. If you don't secure multiple high-valued grants, your department will pressure [read: force] you into the clinic])

It is more complicated, but it shouldn't be difficult to envisage why being a doctor can be preferable to struggling for tenure.
 
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If you would do it all over, would you still do MD/PhD?

I still think that MD/PhD is the best path for those who want to combine the practice of medicine with significant lab-based research. However, many of those who start won't end up doing that for a career for one reason or another.

Personally:
If I had to do it over again, knowing what I know now (mainly about myself), would I go MD/PhD? Probably not.

Do I regret going MD/PhD? Not at all.
 
I still think that MD/PhD is the best path for those who want to combine the practice of medicine with significant lab-based research. However, many of those who start won't end up doing that for a career for one reason or another.

Personally:
If I had to do it over again, knowing what I know now (mainly about myself), would I go MD/PhD? Probably not.

Do I regret going MD/PhD? Not at all.

I don't mean to pry, but can you tell me what you learned about yourself that makes you say you wouldn't do MD/PhD again?
 
You do realize that what you are proposing can be resumed to undergoing the very same training as a MD/Ph.D - except you don't get the degree title?

If we follow your logic, it can go the other way around too.
Non-physician specialists increasingly take patients in private care. Accordingly trained psychologists can already prescribe drugs in multiple states. A Ph.D in pathology could theoretically do the same work as a physician pathologist with appropriate clinical training. Actually, any Ph.D who amasses sufficient knowledge in medicine related to its specific field + specialized clinical training could be as efficient as a physician specialist.
Physicians have never had the monopole of high-level health care.

(And keep the rolling eyes to yourself, your highness).

I don't think you realize how in the dark you are. The point is that if you have an MD/PhD, unless you go into consulting, you're options these days are pretty much that you must do residency to make your MD worthwhile. To get into residency, your PhD doesn't help that much as other criteria. Its just a good add on to your application.

In residency and beyond, you are useful to a department if you make money. You make money by doing clinical work. Research takes away time from clinical work and thus there are multiple forces in trying to get you to do more clinical work as you progress throughout your career.

If post-residency/fellowship you still feel the need to be in research, then there are plenty of fellowship options available to get the training you would want. The problem is that in this scenario, you would be giving up very lucrative clinical options to pursue poorly compensated research fellowship. Again another factor forcing you to do more clinical work

If you still feel strongly enough to forgo more profitable options, the research fellowship you pursue will most likely be more in line with your interests at that point in your career and thus your field. At that point in time, you may even be able to do part time clinical work to add to your poorly paid research fellowship. At that stage, you're most likely to make connections for your future research program as well and thus would probably be a good option for many if they still wish to pursue research in the future.

Most MD/PhDs don't end up running labs for the reasons stated above. Its understandable because when you're 35 post residency and you're options are to make money for your family in private practice or struggle with grants and academia, its understandable that many choose the former. Many even with MD/PhDs need to do research fellowships because their PhD is often not in the same field or they want to study a different topic. Then the PhD was spent learning how to do/think like a scientist - I think the point many are making is that you don't need 4 years learning how to do science, but a 1 yr fellowship in medical school should be enough.

There are plenty of people who for the first time picked up a pipette in fellowship after residency and enjoyed it enough to continue on with basic research and become successful. The point is that its difficult to make a decision at age 22 regarding MD/PhD and state thats what you'd want to continue doing at age 35. At least with the MD only option, you will be make that decision probably earlier, and if you end up in private practice anyways then you start earning money 4 years earlier. If you want to end up research, you end up spending the 4 years getting the skills of a PhD with the advantages stated above.

Hope that helps
 
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I don't think you realize how in the dark you are. The point is that if you have an MD/PhD, unless you go into consulting, you're options these days are pretty much that you must do residency to make your MD worthwhile. To get into residency, your PhD doesn't help that much as other criteria. Its just a good add on to your application.

In residency and beyond, you are useful to a department if you make money. You make money by doing clinical work. Research takes away time from clinical work and thus there are multiple forces in trying to get you to do more clinical work as you progress throughout your career.

If post-residency/fellowship you still feel the need to be in research, then there are plenty of fellowship options available to get the training you would want. The problem is that in this scenario, you would be giving up very lucrative clinical options to pursue poorly compensated research fellowship. Again another factor forcing you to do more clinical work

If you still feel strongly enough to forgo more profitable options, the research fellowship you pursue will most likely be more in line with your interests at that point in your career and thus your field. At that point in time, you may even be able to do part time clinical work to add to your poorly paid research fellowship. At that stage, you're most likely to make connections for your future research program as well and thus would probably be a good option for many if they still wish to pursue research in the future.

Most MD/PhDs don't end up running labs for the reasons stated above. Its understandable because when you're 35 post residency and you're options are to make money for your family in private practice or struggle with grants and academia, its understandable that many choose the former. Many even with MD/PhDs need to do research fellowships because their PhD is often not in the same field or they want to study a different topic. Then the PhD was spent learning how to do/think like a scientist - I think the point many are making is that you don't need 4 years learning how to do science, but a 1 yr fellowship in medical school should be enough.

There are plenty of people who for the first time picked up a pipette in fellowship after residency and enjoyed it enough to continue on with basic research and become successful. The point is that its difficult to make a decision at age 22 regarding MD/PhD and state thats what you'd want to continue doing at age 35. At least with the MD only option, you will be make that decision probably earlier, and if you end up in private practice anyways then you start earning money 4 years earlier. If you want to end up research, you end up spending the 4 years getting the skills of a PhD with the advantages stated above.

Hope that helps


Hey thanks for going into some depth about this. Just want to make sure I understand. I think half of what you're saying is that being a physician - scientist is hard because you always have financial incentives to pursue more clinical. This is easily understood. But I believe you're also saying that even if you do want to be a physician - scientist, you shouldn't pursue an MD/PhD. So in the end, are you saying that no one should pursue MD/PhDs? Also, why do you think the programs continue to exist?
 
Its understandable because when you're 35 post residency

35 is optimistic (straight to MD/PhD after college). I won't be able to finish fellowship and get my "first job" before age 40 and I know some of my classmates will not be much younger than that.
 
35 is optimistic (straight to MD/PhD after college). I won't be able to finish fellowship and get my "first job" before age 40 and I know some of my classmates will not be much younger than that.

This may sound silly, and feel free to refuse, but can you briefly list your educational timeline beginning with college graduation? (and perhaps extrapolated into the future?
ie:
Graduate college, 22
MD/PhD, 22-30
Residency, 30-33
Fellowship, 33-34

Really appreciate it
 
Hey thanks for going into some depth about this. Just want to make sure I understand. I think half of what you're saying is that being a physician - scientist is hard because you always have financial incentives to pursue more clinical. This is easily understood. But I believe you're also saying that even if you do want to be a physician - scientist, you shouldn't pursue an MD/PhD. So in the end, are you saying that no one should pursue MD/PhDs? Also, why do you think the programs continue to exist?

Its not that you shouldn't pursue MD/PhD, its that you should knowing going into it all the forces that will prevent you from being a true physician-scientist as it was intended.

I'm not sure why the programs exist as they are, i think its great to encourage physicians to be scientists, but I think the current route needs changing.

I think it would optimally entail taking away the MD/PhD program and putting money into post-residency research fellowships with SIGNIFICANT debt repayments. The current ones are for only specific specialties and don't have high enough debt repayment.

I think with this route, applicants would be more mature and know what they want with their life whether it be academia or private practice. The applicant would be motivated not be free money because he/she would be able to make more likely in private practice. As mentioned above, the person who pursues this route would most likely actually become a physician-scientists and therefore would be a much better investment.

In the MD/PhD program, lets say NIH invests ~300K (covering stipend+tuition) over a 8 yr period in one person, but say only 1/4th of MD/PhDs (the actual # is lower) becomes a 80/20 physician scientist as intended...Thats 1.2 million on producing 1 scientist which is a waste. If instead they offer 400K over a 4 year period as part of debt repayment+stipend in a research fellowship post residency, that person is much more likely to end up in an 80/20 academic position because they could've easily made >400K over a 4 year period as PP physician instead of going into research
 
This may sound silly, and feel free to refuse, but can you briefly list your educational timeline beginning with college graduation? (and perhaps extrapolated into the future?
ie:
Graduate college, 22
MD/PhD, 22-30
Residency, 30-33
Fellowship, 33-34
Really appreciate it
phd082803s.gif


Average matriculant age is about 24, not 22. Residency + fellowship is very often 5-6 years, not 4 years. If you take longer during your MD/PhD (9 years) or do a research fellowship during/post-residency, you may be pushed back further. Moreover, some people take time off during the process for personal reasons. Other people switch residencies. It is not necessarily neat and predictable.

I am following the timeline you posted, and if things go well, will complete residency/fellowship at 34. There are people in my program that will graduate the MD/PhD program at 34-35, having spent 5 years after college in other pursuits. No-one is going to be judging you based on your age if you start a little later, but it is important to know what you are getting into time-wise in order to make the right decision for yourself.

(comic from phdcomics)
 
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Hey thanks for going into some depth about this. Just want to make sure I understand. I think half of what you're saying is that being a physician - scientist is hard because you always have financial incentives to pursue more clinical. This is easily understood.

I don't think it is so easily understood to pre-meds. The salary difference to do a significant amount of research within academics is 2 to 3 fold less than your private practice options in many specialties. The salary within research often 2 fold less or more than your more clinical academic options. When I tell medical students about these salary differences the answer I frequently receive is the equivalent of "nuh-uh". It's unbelievably different, and with research funding as poor as it is, things do not seem like they are going to change any time soon.

Further, the job security within these research positions is directly tied to your ability to publish and get grants. Thus, you have a significant risk of failure compared to a mostly clinical environment where all you need to do is take care of patients to do just fine. Even further, you're often looking at extended fellowship/post-doc at $60k/year for another year or two before you can even start looking for research based positions when you can go out into private practice and start making $250k or more.

The frustration component in all this when you are 35 years old is palpable. One wants a decent quality of living. Especially if you have a family in a high cost of living area, you may not even be able to live on the poor salary they are paying fellows or "instructors" (poorly paid limbo land until you can get a tenure track position). Further, many want to be "the boss" as opposed to having grants and protocols rejected and having some review committee (internal AND external to the institution) give you crap about everything you propose. This as opposed to private practice or most of clinical practice where you almost never get questioned. You'd think this was a very ego-centric thing to say, but when you're working 60 - 80 hours a week juggling many different things, and people come after you because you forgot to put one word on a form so your protocol is being rejected or delayed for several weeks... This stuff happens virtually every day and it begins to make you very frustrated.

But I believe you're also saying that even if you do want to be a physician - scientist, you shouldn't pursue an MD/PhD. So in the end, are you saying that no one should pursue MD/PhDs? Also, why do you think the programs continue to exist?

I think todds is making some excellent points. We had a long discussion recently on this topic at http://forums.studentdoctor.net/showthread.php?t=900721 (I'm at post #36)
 
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This may sound silly, and feel free to refuse, but can you briefly list your educational timeline beginning with college graduation? (and perhaps extrapolated into the future?
ie:
Graduate college, 22
MD/PhD, 22-30
Residency, 30-33
Fellowship, 33-34

Really appreciate it

Sure. As was mentioned the average age of matriculation is 24, so for every 22 year old you have a 26 year old (which was me).

26
+8year MD/PhD
+3year residency
+3year fellowship
=40

I was not blind to this coming in, but didn't fully understand the issues (see the link posted by neuronix). MD/PhD is the kind of decision that I view as: I don't regret it (i.e. wake up each day wishing I had made a different choice), but if I could go back I would do MD only.

In my view, MD/PhD is best for the person who LOVES research and does not love anything else. The second part is actually important. I like research a lot (and think I am pretty good at it), but there are other things I like as well. For me the issue is not how much work I have to do during the MD/PhD, but that the pressure to be productive is greater and does not relent from the day I get that "first job" at age 40 onward. To be a successful physician scientist you have to cut out a lot of other things (of course not everything, but you can't have it all) you may enjoy and value such as job stability, personal health, family time, finances, geographic location, etc. For the person who only loves science (and the ostensible "prestige" of being a big academic) and has few other expectations in life, they feel less pull away from the path. That said, most of my classmates do have other interests (professional and personal) and based on my limited conversations I don't expect many of us will go on to be R01 funded investigators. It seems that Fencer, who posts on here regularly, is a successful physician scientist that is capable of balancing a lot, so you can search his posts for a more inspiring view. For me, I think Neuronix is brave for continuing to raise the visibility of these issues for pre-MD/PhDs. I wish I had understood them better before applying.
 
I don't think it is so easily understood to pre-meds. The salary difference to do a significant amount of research within academics is 2 to 3 fold less than your private practice options in many specialties. The salary within research often 2 fold less or more than your more clinical academic options. When I tell medical students about these salary differences the answer I frequently receive is the equivalent of "nuh-uh". It's unbelievably different, and with research funding as poor as it is, things do not seem like they are going to change any time soon.

Further, the job security within these research positions is directly tied to your ability to publish and get grants. Thus, you have a significant risk of failure compared to a mostly clinical environment where all you need to do is take care of patients to do just fine. Even further, you're often looking at extended fellowship/post-doc at $60k/year for another year or two before you can even start looking for research based positions when you can go out into private practice and start making $250k or more.

The frustration component in all this when you are 35 years old is palpable. One wants a decent quality of living. Especially if you have a family in a high cost of living area, you may not even be able to live on the poor salary they are paying fellows or "instructors" (poorly paid limbo land until you can get a tenure track position). Further, many want to be "the boss" as opposed to having grants and protocols rejected and having some review committee (internal AND external to the institution) give you crap about everything you propose. This as opposed to private practice or most of clinical practice where you almost never get questioned. You'd think this was a very ego-centric thing to say, but when you're working 60 - 80 hours a week juggling many different things, and people come after you because you forgot to put one word on a form so your protocol is being rejected or delayed for several weeks... This stuff happens virtually every day and it begins to make you very frustrated.



I think todds is making some excellent points. We had a long discussion recently on this topic at http://forums.studentdoctor.net/showthread.php?t=900721 (I'm at post #36)


+1. As somebody who is on track to finish fellowship by 34, I probably would not do MSTP if I could time-travel. It has been personally and intellectually rewarding, and I have been very successful at it, but all of the B.S. that Neuronix enumerated is just too infuriating. That, and this: http://www.reuters.com/article/2012/03/28/us-science-cancer-idUSBRE82R12P20120328.
Let's face it folks: the vast majority of academic science is a wasteful government jobs program.
 
I think the loving science part is a key point people need to truly ask themselves. For the pre-meds reading posts from more senior people I hope they are not getting discouraged because we aren't talking up the postive points of the life. Hopefully most of us who did go the physician scientist route love the science enough to put up with the other crud. For the pre-meds keep in mind most of our complaints center around not so much the science but the worries and system drawbacks of doing science here.

Yes we will make less money, yes we will have job insecurity (relatively), yes we will be older then our med peers, less understood by most medical professionals, and subject to cyclic stresses for funding. That is the life, those parts suck. But if you are the candidate those MD/PhD training grants are meant to fund then you are supposed to be willing to deal with it. Same as the NHSC grants for docs to go to underserved areas MSTP or equivalent grants are to support us to maintain the bridge between basic and clinical. Is that bridge still needed, yes, med school curriculum is constantly paring down basic science curriculum which is fine for the majority of students who will never need it. But there must remain the pool of docs who can "translate" between the fields. That doesn't mean everyone has to be in the lab 80%. I think its worth while that even the 100% clinical people from our programs are around in departments to critique and inform the flow of new information coming from the labs and pharma companies.

I liken us to teachers, they put up with problems mentioned above at much sharper financial margins yet we are not surprised when we hear that many still buy class supplies out of pocket. The reason that do it and still do it is along the lines of why we stay in the game. Its because we love what we do.
 
I think the loving science part is a key point people need to truly ask themselves. For the pre-meds reading posts from more senior people I hope they are not getting discouraged because we aren't talking up the postive points of the life. Hopefully most of us who did go the physician scientist route love the science enough to put up with the other crud. For the pre-meds keep in mind most of our complaints center around not so much the science but the worries and system drawbacks of doing science here.

Yes we will make less money, yes we will have job insecurity (relatively), yes we will be older then our med peers, less understood by most medical professionals, and subject to cyclic stresses for funding. That is the life, those parts suck. But if you are the candidate those MD/PhD training grants are meant to fund then you are supposed to be willing to deal with it. Same as the NHSC grants for docs to go to underserved areas MSTP or equivalent grants are to support us to maintain the bridge between basic and clinical. Is that bridge still needed, yes, med school curriculum is constantly paring down basic science curriculum which is fine for the majority of students who will never need it. But there must remain the pool of docs who can "translate" between the fields. That doesn't mean everyone has to be in the lab 80%. I think its worth while that even the 100% clinical people from our programs are around in departments to critique and inform the flow of new information coming from the labs and pharma companies.

I liken us to teachers, they put up with problems mentioned above at much sharper financial margins yet we are not surprised when we hear that many still buy class supplies out of pocket. The reason that do it and still do it is along the lines of why we stay in the game. Its because we love what we do.

I'm glad someone on here had a positive perspective. Can any other MD/PhD residents/attendings chime in here? It seems like a lot of the more experienced MD/PhD types on this board are very negative about these programs in general.
 
I'm glad someone on here had a positive perspective. Can any other MD/PhD residents/attendings chime in here?

http://forums.studentdoctor.net/showthread.php?t=842177
http://forums.studentdoctor.net/showpost.php?p=12325154&postcount=1

It seems like a lot of the more experienced MD/PhD types on this board are very negative about these programs in general.

I don't think I'm negative at all. I'm just telling you the reality. Whether that's positive or negative is up to you. Even gbwillner's post linked above will tell you the reality, but he has pointed out several times that he still loves what he does. What I find is that those pre-meds who argue with me the most that I am "too negative" end up being more negative than myself when they are senior MD/PhD students or graduates. But most people who consider themselves "negative" don't really come on here and talk about it, and you certainly won't meet them when you interview.

I do think it's impossible for you to really know whether you're going to want to be a physician-scientist at 35 when you're 22. This is the biggest reason why it might make more sense to have more repayment programs and less upfront training. But as I said before, if we're okay to accept 25-50% attrition from the physician-scientist pathway to being physicians alone, then it's just an expected thing.
 
http://forums.studentdoctor.net/showthread.php?t=842177
http://forums.studentdoctor.net/showpost.php?p=12325154&postcount=1



I don't think I'm negative at all. I'm just telling you the reality. Whether that's positive or negative is up to you. Even gbwillner's post linked above will tell you the reality, but he has pointed out several times that he still loves what he does. What I find is that those pre-meds who argue with me the most that I am "too negative" end up being more negative than myself when they are senior MD/PhD students or graduates. But most people who consider themselves "negative" don't really come on here and talk about it, and you certainly won't meet them when you interview.

I do think it's impossible for you to really know whether you're going to want to be a physician-scientist at 35 when you're 22. This is the biggest reason why it might make more sense to have more repayment programs and less upfront training. But as I said before, if we're okay to accept 25-50% attrition from the physician-scientist pathway to being physicians alone, then it's just an expected thing.

I don't think it's inaccurate to qualify your response as negative, and I'm not saying that it's a bad thing, but this is all semantics; anyway, I'd much rather get honest responses about the trials and pitfalls of MD/PhD programs than what I seem to get out of most people who are made available by these programs, which is always to the effect of MSTP being the best thing since sliced bread.

I really appreciate your candor and willingness to talk about your experience, I'm just wondering if your particular experience is representative of most peoples'. Do you feel like your expectations about MD/PhD were unfairly different from reality? It seems like most of the people that I've talked to who are unsatisfied with MD/PhD are always told what a great field it is, only to find it to require too much work, too little compensation, and a terrible quality of life.
 
I don't mean to pry, but can you tell me what you learned about yourself that makes you say you wouldn't do MD/PhD again?

Sure, although my reasons have already been mentioned. Basically, I could be happy never doing research again and being 100% clinical my entire career. The converse (100% research), not so much.

MD/PhD is the kind of decision that I view as: I don't regret it (i.e. wake up each day wishing I had made a different choice), but if I could go back I would do MD only.

In my view, MD/PhD is best for the person who LOVES research and does not love anything else. The second part is actually important. I like research a lot (and think I am pretty good at it), but there are other things I like as well. For me the issue is not how much work I have to do during the MD/PhD, but that the pressure to be productive is greater and does not relent from the day I get that "first job" at age 40 onward. To be a successful physician scientist you have to cut out a lot of other things (of course not everything, but you can't have it all) you may enjoy and value such as job stability, personal health, family time, finances, geographic location, etc. For the person who only loves science (and the ostensible "prestige" of being a big academic) and has few other expectations in life, they feel less pull away from the path. That said, most of my classmates do have other interests (professional and personal) and based on my limited conversations I don't expect many of us will go on to be R01 funded investigators.

This.

+1. As somebody who is on track to finish fellowship by 34, I probably would not do MSTP if I could time-travel. It has been personally and intellectually rewarding, and I have been very successful at it, but all of the B.S. that Neuronix enumerated is just too infuriating.

And this.

Briefly, I've realized I love clinical medicine more than research. I like the process of research, don't get me wrong, but it doesn't energize me in the way seeing patients does. I strongly agree with vitalamine that MD/PhD is best for those that love research and think seeing patients from time to time could be interesting too, rather than the other way around.

Honestly, I should have realized this coming in. I had lots of clinical experience coming in, and I allowed it to take precedence over my research activities then as well.
 
What a great thread, especially in a forum where admissions is the majority concern.

Unless I misunderstood, a couple of people (mostly higher up in the thread) have implied that clinical departments push physician-scientists toward clinical work that generates clinical revenue, which is what they really want. I think this downplays the importance of faculty tracking. Most departments have several faculty tracks and the track you are on will determine what they want out of you. If you are an MD-PhD type or an MD with research training, and you are brought in on an investigator track, they don't want you to ditch research for clinical work. They want you to become a kickass high-prestige researcher AND to personally assume most of the risks involved (chiefly lower salary and risk of failure). If you succeed, you will feel little pressure to increase your clinical activity, and your department will have no truck with your financial picture because you will be paying for yourself through external research funding. If you do fail, then you may just get the can or you may be invited to switch tracks and pay your salary through clinical activity.

On the clinical track, people do tend to feel caught between a rock and a hard place. You are given little time or money for research but are told to be academically productive AND you had better still produce the clinical revenue to cover your expenses. That is a tough situation. People seem to make it work and in exchange for their existential woes, they get a somewhat higher salary and basically pretty good job security. If you are clinically productive but do no research, you may never make associate professor, but you will probably not get fired.
 
What about collaboration between an MD and a PhD as opposed to an MD/PhD?
 
Unless I misunderstood, a couple of people (mostly higher up in the thread) have implied that clinical departments push physician-scientists toward clinical work that generates clinical revenue, which is what they really want.

I will fix that for you the way I see it.

Clinical departments push physician-scientists toward clinical work that generates revenue, which is what they really want.

If you don't generate enough revenue from grants to support your salary and infrastructure, you will be sent back to clinical. While that makes sense, funding is awful and has been for years. So you are competing for a very limited amount of resources that a gigantic oversupply of PhDs are fighting for. Departments aren't as willing to invest in you as they might have been in the past because your chances of success are lower and there isn't as much money going around in general. If funding improves, the plight of the young physician-scientist will improve. Until that happens, that bar is extremely high. Now those trying to recruit you into research will put a sunshiney spin and say "oh it was bad before", "oh this is just a bad time we'll get through". It has been bad for over a decade now.

On clinical track, people do tend to feel caught between a rock and a hard place. You are given little time or money for research but are told to be academically productive AND you had better still produce the clinical revenue to cover your expenses. That is a tough situation.

I have seen this for any track. In these faculty/research tracks you are also given not enough time or money for research, but are told to be academically productive.


I really appreciate your candor and willingness to talk about your experience, I'm just wondering if your particular experience is representative of most peoples'. Do you feel like your expectations about MD/PhD were unfairly different from reality? It seems like most of the people that I've talked to who are unsatisfied with MD/PhD are always told what a great field it is, only to find it to require too much work, too little compensation, and a terrible quality of life.

Experiences vary across the board. There is a lot of doom and gloom among the younger MD/PhDs or the ones who didn't "make it". The ones who are successful love it. It's a bit of a chicken and egg problem there, obviously. Do those whose hearts weren't truly in it less successful or those who were the most dedicated the most successful? Or is it that if you are successful you will love it more than if you try hard and are not successful? I'm sure it's some of both.

As for me, I don't think I really understood the reality. That said, I was ready to take on anything when I was 22. I had grown up poor, dropped out of high school, and worked very hard in undergrad to get somewhere. I saw my family toiling away in menial jobs and didn't want that for myself. But I had never been anywhere except where I grew up and had no idea about the broader world. I was fine at that point spending most of the rest of my life in a hospital or a lab because I didn't know there was any other option except hard work or anything else I'd enjoy outside of my career. Now that I have more exposures and friends outside of the lower class, I realize there is a whole world of opportunities and experiences. I have some serious hobbies that I really enjoy. I like being a physician and I like doing research even more, and I think I've been pretty successful at both. But when it comes down to it I'm not willing to accept a huge salary cut, much more training, much more life instability, very restricted location choices, and longer hours just for the opportunity to keep doing research. I'd rather be outdoors.

So it's not necessarily that I was duped into doing this, it's just that I changed. But I think my experience is very unusual, so very few can really extrapolate from my experience. That said, I agree with vitalamine. I think the physician-scientist life is for people who love being a physician-scientist to the exclusion of just about everything else.
 
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Truly it is hard to know at 20somtheing what you will desire at 40. A fair piece of advise I was given early on was that "right" decisions that you have to agonize over and convince yourself to do are ones that may continue to dig at you later on that decision path. But in retrospect the big life decisions that you made without the agonizing even though they are big ones are an indication of what you truly desire.

Examples of me, taking time off to continue research after undergrad and then abroad almost no second thought. Trying to convince myself to do heme-onc, months of agonizing. While doing a pathology rotation the decision to do path was solidified by week two. Deciding to be in the lab 7 days a week during the PhD, not a second thought. For the first time finding myself looking forward to my days off while doing 6day/wk of clinical work was a good point my wife brought up to me that I did not even register.

I think for the junior people finding good mentors and role models for both life and work balance is the best way to figure out what 40+ yr old you will want. At 20-25-30-35 I have and still want to be my physician scientist PI role models.

I can't stress enough the life balance for making the other hard stuff that comes along manageable. Along the way I maintained other interests, traveled, got married and had a kid. All these things took away from my science and medicine studies and may have cost me points here or there but that is the balance. Those equations are always going to have to be made. Train at top 10 spot vs top 2 spot so your spouse is happier, make 250K vs 150K so you can do something that wont burn you out. Drive a BMW at 40 vs a Toyota at 40. I'm ok with the toyota, an extra 100K would be great but I won't feel too put out at 150K because my family is close to that now we don't have burning wants that we can't afford right now. I love to go for a ride outside when its nice but if my job had me working 4 days a week I'd like the ride on one day but those other two I would love to be in the lab. So if my job was being in the lab 3+ of those work days then half my week would not feel like work.

A little bit of rainbows and unicorns for everyone that we don't mention enough. Yes all that other cruddy stuff happens/ed to me along the way as well, but they have been described by others and I think you have a good idea about what they are about.
 
Truly it is hard to know at 20somtheing what you will desire at 40. A fair piece of advise I was given early on was that "right" decisions that you have to agonize over and convince yourself to do are ones that may continue to dig at you later on that decision path. But in retrospect the big life decisions that you made without the agonizing even though they are big ones are an indication of what you truly desire.

Examples of me, taking time off to continue research after undergrad and then abroad almost no second thought. Trying to convince myself to do heme-onc, months of agonizing. While doing a pathology rotation the decision to do path was solidified by week two. Deciding to be in the lab 7 days a week during the PhD, not a second thought. For the first time finding myself looking forward to my days off while doing 6day/wk of clinical work was a good point my wife brought up to me that I did not even register.

I think for the junior people finding good mentors and role models for both life and work balance is the best way to figure out what 40+ yr old you will want. At 20-25-30-35 I have and still want to be my physician scientist PI role models.

I can't stress enough the life balance for making the other hard stuff that comes along manageable. Along the way I maintained other interests, traveled, got married and had a kid. All these things took away from my science and medicine studies and may have cost me points here or there but that is the balance. Those equations are always going to have to be made. Train at top 10 spot vs top 2 spot so your spouse is happier, make 250K vs 150K so you can do something that wont burn you out. Drive a BMW at 40 vs a Toyota at 40. I'm ok with the toyota, an extra 100K would be great but I won't feel too put out at 150K because my family is close to that now we don't have burning wants that we can't afford right now. I love to go for a ride outside when its nice but if my job had me working 4 days a week I'd like the ride on one day but those other two I would love to be in the lab. So if my job was being in the lab 3+ of those work days then half my week would not feel like work.

A little bit of rainbows and unicorns for everyone that we don't mention enough. Yes all that other cruddy stuff happens/ed to me along the way as well, but they have been described by others and I think you have a good idea about what they are about.

Thanks for the discussion everyone. I just want to pop in with a quick question. Everyone says there are huge financial incentives to doing clinical. But you seem to say that you are making 150K, which to me, is nothing to be sneezed at. That is really high! But maybe you are a senior physician-scientist? Can you or someone else add expected salaries to the timelines? (edit: by timelines, I mean salaries during MD/PhD, during residency, during fellowship, during assistant professorship...etc).

I have always heard that MD/PhDs take a huge pay cut compared to MDs, but I don't actually know absolute numbers. Maybe my standards are a little lower than everyone else's if 150K is considered a "pay cut". Thanks!
 
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Just to clarify I make 30k as a 4th year applying for a path residency. My wife and I make around 100K-150K total. As someone who didn't go straight out of undergrad and has participated in MD/PhD student groups I know a bunch of MD/PhDs who are -4yrs from where I'm at to ones finishing fellowship/postdoc. So I have been privy to a lot of the complaints along the way and similar to this forum we all like to complain to people who know where we're coming from but rarely gush to people who know where we are coming from. As money goes Med school/PhD ~30K if you are at a MSTP, in residency/fellowship/postdoc 50K-60K+ depending on year/program/location/moonlighting. Then the pay varies based on what you go into and what % of clinical work you do but after the first few years you at least breaking 100K in just about any field.
 
There is an AAMC salary survey that should be available in most medical libraries and that makes for interesting browsing. Compare the salaries for basic scientists to those of academic clinicians in your field of interest to get an idea of the size of the difference between them.

In pathology, an assistant professor on the tenure track might make $90K while on the clinical track the same person might make $120K (clearly this varies between regions, institutions and people). So the difference is not massive, but after taxes you have just sent one kid to private school for the year. Plus the tenure track type probably spent three extra years making postdoc money (PGY scale to be generous, so say around $60K) before even being on staff.

In more surgical/procedural specialties the difference will be starker because clinical salaries are higher and there may even be some kind of bonus system.
 
There is an AAMC salary survey that should be available in most medical libraries and that makes for interesting browsing. Compare the salaries for basic scientists to those of academic clinicians in your field of interest to get an idea of the size of the difference between them.

In pathology, an assistant professor on the tenure track might make $90K while on the clinical track the same person might make $120K (clearly this varies between regions, institutions and people). So the difference is not massive, but after taxes you have just sent one kid to private school for the year. Plus the tenure track type probably spent three extra years making postdoc money (PGY scale to be generous, so say around $60K) before even being on staff.

In more surgical/procedural specialties the difference will be starker because clinical salaries are higher and there may even be some kind of bonus system.

Another resource (free online) is the Medscape Physician Compensation Report
http://www.medscape.com/features/slideshow/compensation/2012/public

This latest 2012 edition does have an "academic" category that does not make fine distinctions such as tenure track vs clinical track, but gives some perspective on compensation in academic medicine compared to other practice settings. It also breaks it down by specialties. For example, the average male pathologist (avg of everyone, not just early career) makes 231,000. Average pathologist in a single specialty group practice makes 302,000. As Ombret said, the differences in procedural specialties comparing tenure vs clinical track would be even more striking, but the medscape report does not have the resolution of the AAMC report for comparisons within academic medicine.
 
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I'm gonna be the odd one out and go ahead and disagree with whoever above who says that it's "regrettable" to get that MDPhD. The NIH MSTP is still the crown jewel of American biomedical research training, and the gold standard for a translational laboratory based career, and, increasingly, translational human subjects work.

Having an MD/PhD, especially one from an MSTP, will open up lots of doors regardless of what you want to do. When you are 20 it's very hard to predict what you want to do, and MSTP is essentially an award you apply for to get your medical school paid in exchange for carrying mentored research. You spend 2-4 extra years (compared to either MDs or PhDs) to get a blank check, a buffet pass to do whatever you want. MD/PhD retains the maximum flexibility of both training. The difficulty of the path of an independent scientist should not be a reason for a regret for choosing MD/PhD because this path is difficult no matter which degree program one chooses. Nobody is stopping you from choosing to become a dermatologist (that is, except yourself).

This is why, contrary to all the doom and gloom in the funding rates and what not, MSTPs are generally getting INCREASINGLY competitive, attracting the very best college graduates nationwide, especially when medical tuition continues its exponential climb. The fact that research careers pay so little is even more reason to get that medical tuition paid for so one has no loans to worry about. This is unspeakably HUGE in your 30s when you a family and a mortgage. Even if you do a high paying clinical specialty, with taxes and interest it still takes a few years of full salary to pay off medical school debt, so the financial advantage of doing MD only is only minimal. So if you are worried that you'll be wasting time and it wouldn't be a good decision for you, there are many other excellent applicants who would gladly take your place. People who are the current MD/PhD students are NOT idiots. This is not like going to a 2nd tier law school.
 
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I'm gonna be the odd one out and go ahead and disagree with whoever above who says that it's "regrettable" to get that MDPhD. The NIH MSTP is still the crown jewel of American biomedical research training, and the gold standard for a translational laboratory based career, and, increasingly, translational human subjects work.

Having an MD/PhD, especially one from an MSTP, will open up lots of doors regardless of what you want to do. When you are 20 it's very hard to predict what you want to do, and MSTP is essentially an award you apply for to get your medical school paid in exchange for carrying mentored research. You spend 2-4 extra years (compared to either MDs or PhDs) to get a blank check, a buffet pass to do whatever you want. MD/PhD retains the maximum flexibility of both training. The difficulty of the path of an independent scientist should not be a reason for a regret for choosing MD/PhD because this path is difficult no matter which degree program one chooses. Nobody is stopping you from choosing to become a dermatologist (that is, except yourself).

This is why, contrary to all the doom and gloom in the funding rates and what not, MSTPs are generally getting INCREASINGLY competitive, attracting the very best college graduates nationwide, especially when medical tuition continues its exponential climb. The fact that research careers pay so little is even more reason to get that medical tuition paid for so one has no loans to worry about. This is unspeakably HUGE in your 30s when you a family and a mortgage. Even if you do a high paying clinical specialty, with taxes and interest it still takes a few years of full salary to pay off medical school debt, so the financial advantage of doing MD only is only minimal. So if you are worried that you'll be wasting time and it wouldn't be a good decision for you, there are many other excellent applicants who would gladly take your place. People who are the current MD/PhD students are NOT idiots. This is not like going to a 2nd tier law school.

I can't find any posts in this thread of someone saying they "regret" doing MD/PhD or that it is "regrettable".

Nevertheless, I completely agree when you say "if you are worried that you'll be wasting time and it wouldn't be a good decision for you, there are many other excellent applicants who would gladly take your place". An important part of this discussion, and it is good that it is visible to applicants, is helping applicants understand the benefits and challenges BEFORE they enroll in a 8-year program. Many applicants ponder a lot about if they can get into MD/PhD and not enough about if MD/PhD is the best fit. I agree that it is a great program...just not for everyone.
 
There is an AAMC salary survey that should be available in most medical libraries and that makes for interesting browsing. Compare the salaries for basic scientists to those of academic clinicians in your field of interest to get an idea of the size of the difference between them.

In pathology, an assistant professor on the tenure track might make $90K while on the clinical track the same person might make $120K (clearly this varies between regions, institutions and people). So the difference is not massive, but after taxes you have just sent one kid to private school for the year. Plus the tenure track type probably spent three extra years making postdoc money (PGY scale to be generous, so say around $60K) before even being on staff.

In more surgical/procedural specialties the difference will be starker because clinical salaries are higher and there may even be some kind of bonus system.

Interesting. So does this mean that as a physician scientist, the salaries are pretty much the same no matter what specialty you choose? Or are there still pretty big compensation differences?
 
Interesting. So does this mean that as a physician scientist, the salaries are pretty much the same no matter what specialty you choose? Or are there still pretty big compensation differences?

There is a range of salaries within specialties and a range of salaries across specialties. It is variable depending on many factors.
 
There is a range of salaries within specialties and a range of salaries across specialties. It is variable depending on many factors.

So does the whole ROAD stereotype apply to MD/PhD? Or is there a different group of specialties that are notorious for higher pay with better lifestyles?
 
So does the whole ROAD stereotype apply to MD/PhD? Or is there a different group of specialties that are notorious for higher pay with better lifestyles?

Any specialty that is well-paid in private practice will be relatively better-compensated in academics. They have to be to attract anyone into academics.

There's still going to be a hit of $100k/year or more the vast majority of the time as compared to PP.
 
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