Research Careers as an MD vs MD/PhD

[GrinChem]

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Hello,
I'm an undergrad looking into MD vs. MD/PhD programs. I enjoy research, but I'd also like to practice medicine. I don't care about the pay difference between MDs and MD/PhDs, but I do care about education costs and the time commitment. First off, what sort of research careers are available to an MD, and how much time would be spent practicing vs in the lab? How common are research careers for MDs? How do research-related careers for MDs compare to MD/PhDs? I'm not interested in teaching, but I would if it would allow me to do work I really enjoy. I understand many MD/PhD programs waive tuition, but what other costs are involved in a typical program? What overall cost could I expect for MD vs MD/PhD programs?

I'd really appreciate specific examples, and for any MDs working in research or MD/PhDs, what is your work schedule like? What do you do? Do you think you made the right choice? What factors affected your decision when comparing the degree programs? Any advice for a lowly undergrad trying to make a decision about their entire future?

Thanks

 

[B-Lymphocyte]

I can't really comment on this as you would need the expertise of Neuronix and others. However, have you tried searching for the old "why MD/PhD" thread? I think they had an extensive discussion on there.

Edit: In addition, I know SurfingDoctor is a successful MD only researcher, you might trying asking him

 

[nonamesleft]

The aamc has some info as a starting point. https://students-residents.aamc.org/choosing-medical-career/careers-medical-research/

I would recommend talking to some md and mdphd to see what their experiences are. Depending on the age/how long they've been doing it, the experiences may differ though.

 

[Neuronix]

Career options for MDs and MD/PhDs are not different. Simply put, you don't need a PhD for a lab based research career, but you do need extensive training. A PhD is one common way to get that training, and a combined program allows you to obtain an MD without debt.

Cost in MD/PhD program is simply your time. You're paid a living stipend throughout.

I'm mostly a clinician. There were no research oriented jobs available for me when I finished. I know people working anywhere from 100% research to 100% clinical and everything in between.

You have to make the decisions for yourself. It doesn't matter what I think. My situation as an undergrad was so incredibly unusual, I'm sure it applies to less than 1% of MD/PhDs. Your story is also unique. Gather as much info as you can and make the decision that's right for you.

If you have other specific questions, I'm here.

 

[SurfingDoctor]

Hello,
I'm an undergrad looking into MD vs. MD/PhD programs. I enjoy research, but I'd also like to practice medicine. I don't care about the pay difference between MDs and MD/PhDs, but I do care about education costs and the time commitment. First off, what sort of research careers are available to an MD, and how much time would be spent practicing vs in the lab?

Generally speaking, the research opportunities for MD and MD/PhD are the same. There are no specific pay differences between MD and MD/PhD and it has more to do with rank (ie what level professor you are) and funding grants versus clinical time. The amount one gets to do research is entirely dependent on funding and how much that funding covers effort. Most junior faculty will have about 75% research time covered under grants (K, AHA career development grant, etc). When one obtains and R or R-equivalent, the effort on the grant (and thus research) by the PI is typically reduced to cover other direct costs, namely personnel to do more of the hands on aspects (technician, research assistant, research nurse, etc.) and thus to get oneself more research time, one needs more funding. In my experience, one needs about 2-3 R grants (as PI, co-PI) to get funding for about 75-80% research effort (though in today's world, if you have one R, you're doing pretty good). All other effort, must be made up through other activities, usually clinical, though people can have have administrative effort (usually minimal). The NIH has a salary cap of what how much a grant can pay, and the only way to really boost someone's salary is through clinical activities. Thus, I have never seen people really try to reach high levels of effort on grants because you limit your salary. In general, most people will do about 50 to 70% research with the remaining clinical/administrative.

How common are research careers for MDs? How do research-related careers for MDs compare to MD/PhDs? I'm not interested in teaching, but I would if it would allow me to do work I really enjoy. I understand many MD/PhD programs waive tuition, but what other costs are involved in a typical program? What overall cost could I expect for MD vs MD/PhD programs?

MD-only researcher aren't uncommon, though from a NIH-funding perspective, they are not as funded as MD/PhD. Most of this is likely due to effort though, MD-only K applicants have a lower submission and re-submission rate and thus funding rate, if I remember the data correctly. Again, MD and MD/PhD researchers have the same opportunities career-wise. The overall caveat is as mentioned above, time. The MD/PhD track is longer by several years. Prior to the days of reduced funding, this was offset by MD/PhD forgoing the prolonged times on K and going for Rs. Now everyone goes for K to R and thus the MD/PhD time is longer. That being said, MD-only candidates need some additional training time in residency or fellowship, either through T or F grants, and sometimes K12 and KL2. On the other hand, MD/PhD graduate medical school without debt, so there is no significant financial loss for the extra years of training.

I'd really appreciate specific examples, and for any MDs working in research or MD/PhDs, what is your work schedule like? What do you do? Do you think you made the right choice? What factors affected your decision when comparing the degree programs? Any advice for a lowly undergrad trying to make a decision about their entire future?

Currently, I have about 75% research time, though that has been reduced recently due to the division being short staffed (this will always be true in that the clinical needs of the hospital/division will supersede ones research). I don't have a typical day, but I work about ~9 hour days in the lab (~50-60%, writing (papers, grants), ~20-30% doing experiments, ~10-20% meetings/clerical or somewhere thereabouts). Most of these days are done post-call (my calls are overnight in the hospital). I also do most of clinical time on the weekend (I typically work about 50% to 75% of the weekends per month to maximize time in the lab. I also write and read from home after my kids are asleep. As far as the right choice, I love research. Don't get me wrong, I enjoy clinical time too, but you don't really get to dream up ideas and test them in the clinical setting. You practice the standard of care which generally speaking has a path laid out. Additionally, and this is probably more personal, because we do so many things and offer treatments that really aren't based on science, but random association, and they don't offer cures. But we keep doing them because that's all we know and I find that frustrating. Granted, I don't think I'll invent the next thing since sliced bread, but I maybe I get to challenge a clinical concept with my science, or tackle things from a different angle and I find that very satisfying. And of course, if the NIH coffers dry up for whatever reason, I can always fall back on the MD part and just see patients and continue to make a living. As far as advice, sorry, I don't really have anything specific. I would just say take any and all research opportunities that you can. The more you experience it that better. And if you have that experience (which you should) were you do a project that you are excited about and you work hard, and it becomes a spectacular failure, but despite that, you really, really want to push on and find a new project to explore, you probably want to make research as a career.

 

[cloudstrife2054]

I think MD/PhD has more chances of securing grants and such because of their residency breakdown. They do the same amount of years in residency, but they have a year reduced to do research. The same for fellowships. So you will have training in research and medicine. Also, if you are awarded grants, the hospital will cut down your medical shifts for the duration of the research project. If say you work 50 hours a week and you get a huge grant from NIH, NSF, etc you may work like 20 to 25 hours of medical shifts and the rest will be doing research.

 

[Lucca]

I think MD/PhD has more chances of securing grants and such because of their residency breakdown. They do the same amount of years in residency, but they have a year reduced to do research. The same for fellowships. So you will have training in research and medicine. Also, if you are awarded grants, the hospital will cut down your medical shifts for the duration of the research project. If say you work 50 hours a week and you get a huge grant from NIH, NSF, etc you may work like 20 to 25 hours of medical shifts and the rest will be doing research.

I think the types of residencies you are talking about (PSTP, ABIM, Holman etc.) are a fraction of all residences though. I'm sure there are many MD/PhDs who dropped out of research entirely or were not successful in obtaining a "research pathway" residency and went onto "traditional" residencies. Correct me if I'm wrong.

 

[wholeheartedly]

I think MD/PhD has more chances of securing grants and such because of their residency breakdown. They do the same amount of years in residency, but they have a year reduced to do research. The same for fellowships. So you will have training in research and medicine. Also, if you are awarded grants, the hospital will cut down your medical shifts for the duration of the research project. If say you work 50 hours a week and you get a huge grant from NIH, NSF, etc you may work like 20 to 25 hours of medical shifts and the rest will be doing research.

I don't think the majority of MD/PhDs do these so called fast track pathways, so most aren't benefitting with additional research time and less clinical.

 

[Alakazam123]

Generally speaking, the research opportunities for MD and MD/PhD are the same. There are no specific pay differences between MD and MD/PhD and it has more to do with rank (ie what level professor you are) and funding grants versus clinical time. The amount one gets to do research is entirely dependent on funding and how much that funding covers effort. Most junior faculty will have about 75% research time covered under grants (K, AHA career development grant, etc). When one obtains and R or R-equivalent, the effort on the grant (and thus research) by the PI is typically reduced to cover other direct costs, namely personnel to do more of the hands on aspects (technician, research assistant, research nurse, etc.) and thus to get oneself more research time, one needs more funding. In my experience, one needs about 2-3 R grants (as PI, co-PI) to get funding for about 75-80% research effort (though in today's world, if you have one R, you're doing pretty good). All other effort, must be made up through other activities, usually clinical, though people can have have administrative effort (usually minimal). The NIH has a salary cap of what how much a grant can pay, and the only way to really boost someone's salary is through clinical activities. Thus, I have never seen people really try to reach high levels of effort on grants because you limit your salary. In general, most people will do about 50 to 70% research with the remaining clinical/administrative.


MD-only researcher aren't uncommon, though from a NIH-funding perspective, they are not as funded as MD/PhD. Most of this is likely due to effort though, MD-only K applicants have a lower submission and re-submission rate and thus funding rate, if I remember the data correctly. Again, MD and MD/PhD researchers have the same opportunities career-wise. The overall caveat is as mentioned above, time. The MD/PhD track is longer by several years. Prior to the days of reduced funding, this was offset by MD/PhD forgoing the prolonged times on K and going for Rs. Now everyone goes for K to R and thus the MD/PhD time is longer. That being said, MD-only candidates need some additional training time in residency or fellowship, either through T or F grants, and sometimes K12 and KL2. On the other hand, MD/PhD graduate medical school without debt, so there is no significant financial loss for the extra years of training.


Currently, I have about 75% research time, though that has been reduced recently due to the division being short staffed (this will always be true in that the clinical needs of the hospital/division will supersede ones research). I don't have a typical day, but I work about ~9 hour days in the lab (~50-60%, writing (papers, grants), ~20-30% doing experiments, ~10-20% meetings/clerical or somewhere thereabouts). Most of these days are done post-call (my calls are overnight in the hospital). I also do most of clinical time on the weekend (I typically work about 50% to 75% of the weekends per month to maximize time in the lab. I also write and read from home after my kids are asleep. As far as the right choice, I love research. Don't get me wrong, I enjoy clinical time too, but you don't really get to dream up ideas and test them in the clinical setting. You practice the standard of care which generally speaking has a path laid out. Additionally, and this is probably more personal, because we do so many things and offer treatments that really aren't based on science, but random association, and they don't offer cures. But we keep doing them because that's all we know and I find that frustrating. Granted, I don't think I'll invent the next thing since sliced bread, but I maybe I get to challenge a clinical concept with my science, or tackle things from a different angle and I find that very satisfying. And of course, if the NIH coffers dry up for whatever reason, I can always fall back on the MD part and just see patients and continue to make a living. As far as advice, sorry, I don't really have anything specific. I would just say take any and all research opportunities that you can. The more you experience it that better. And if you have that experience (which you should) were you do a project that you are excited about and you work hard, and it becomes a spectacular failure, but despite that, you really, really want to push on and find a new project to explore, you probably want to make research as a career.

How common is your particular outcome of 75% research time though? Would you say it's uncommon?

 

[SurfingDoctor]

How common is your particular outcome of 75% research time though? Would you say it's uncommon?

Uncommon. We are always short staffed and people need to fill in the gaps.

 

[FalconSlice]

2/4 of my committee members during my PhD were straight MDs who did amazing basic science and had built their careers on research. They also did a little clinical stuff here and there. It is not uncommon. No one "needs" to have MD-PhD to be a physician-scientist. You do, however, have to be trained--one way or another--for whatever you want to do. To practice medicine in the US, that means having a medical degree and a license. To do research, all you need is to trick people to give you money to do what you really want to do.

 

[CaliforniaAsian]

2/4 of my committee members during my PhD were straight MDs who did amazing basic science and had built their careers on research. They also did a little clinical stuff here and there. It is not uncommon. No one "needs" to have MD-PhD to be a physician-scientist. You do, however, have to be trained--one way or another--for whatever you want to do. To practice medicine in the US, that means having a medical degree and a license. To do research, all you need is to trick people to give you money to do what you really want to do.

I mean I can vouch for this anecdotal experience as I know MDs who have built careers on basic research, but I think those times are slipping further into the past. Current prospective physician scientists have to look into the future, and the MD only route to a career in basic science seems to only be getting harder and harder.

 

[tortuga87]

MDs can build a basic science research career, but it is much harder because they will have to pay off a few hundred thousand dollars worth of debt. Also, when they do get the chance to do research, they will have to do a research fellowship which usually requires a significant amount of clinical time, so they are never 100% research.

 

[dl2dp2]

MDs can build a basic science research career, but it is much harder because they will have to pay off a few hundred thousand dollars worth of debt. Also, when they do get the chance to do research, they will have to do a research fellowship which usually requires a significant amount of clinical time, so they are never 100% research.

That, and the fact that due to malignant competition at grant review, it's very easy to nitpick your biosketch and be like, oh, this guy didn't publish enough X Y Z in journal A B C, i'll give you an 8 on your candidate section. This is especially when a PhD grades a grant from an MD, because it's just too easy to say that the MD "doesn't have sufficient track record and history of research in this topic."

Some areas are still MD heavy (large clinical trials, pragmatic/community-based research, etc.). Anything that involves lots of humans in one way or another (i.e. even human genetics) will be easier, because you can always spin that your clinical expertise is relevant (which it is!)

I frankly think it may be more fruitful scientifically to allow people with no animal work experience at all to apply for grants involving animals and outsource the protocol execution completely, just like how it's done in human research. But as we all know this is not how it's done. Animal work is not really about rigor and replicability--it's more about crafting the right narrative and developing new technologies.