Well, first off, I will be getting my M.D. soon and have been working in the lab for a total of 6 months. I am really enjoying it actually. When I was applying to the MD/PhD programs I was actually discouraged from persuing a PhD. "You don't need a PhD," they said, "all you need is your MD." But now, I am about to get my MD and I still have so much to learn researchwise. I'm still really interested in clinical pathology as well, tho. I guess my question has several parts:
I know that I can do research in residency, but as faculty will this training be enough to be comfortable as a PI?
If I choose to be a post doc in the lab, will I be able to have any clinical responsibilities?
I really don't want to go back through school again to pick up a PhD, but now I don't see any other possibility... I thought I was done sitting in class all day long.
The PhD mainly serves as a "protected" time sort of experience to learn experimental science. You feel that you have much to learn mainly because you have only done months of research. Many folks pick up those skills during undergrad research, PhD research, research years during MD training (HHMI cloister program comes into mind), and during postdoc. Whether or not you need every element of this step-wise training is individual. Some folks are quite talented in research and do not need all the steps.
I believe that talent is a crucial component in one's success in research...you either have it or you don't. I know quite a few MD's who don't have PhD's who excel in research mainly because they picked up quite a bit of skills during their postdocs. Some of these special breed of folks may argue that a PhD is not crucial...but hindsight is 20/20, right?
In any case, your accomplishments during grad school are minimal compared to those during postdoc when it comes down to establishing a track record in research towards being an RO1 funded investigator. Much of this is because people pursue a different line of research in postdoc vs. grad school. That's a natural part of the process because as one develops intellectually, one devises a different set of research questions that are of interest to the individual. Old questions become out of vogue and new research problems become the "hot topics". To drive the point home, I published quite a bit in undergrad and grad school...but when it comes time to apply for a PI position, I would have needed to succeed in a postdoc. This is not guaranteed since a lot of research success is luck- and serendipity-driven. If I were to fail in postdoc, I would not be able to rest on my prior laurels to gain a faculty position.
Hence, the postdoc experience is the true test. What you publish in postdoc is most relevant to your transitioning to a PI. Because doing well in science has a lot to do with "being at the right place at the right time", being blessed with this opportunity during a postdoc is paramount. In that vein, in principle, you do NOT need a PhD if you are able to quickly adapt to the scientific frame of thought and rapidly gain the tools and expertise to perform experiments well, publish strong papers, AND MOST IMPORTANTLY, apply for funding. I did not feel that I got adequate experience on the latter during my PhD training...why? Because as I said earlier, a PhD is "protected time". You do not need to worry about getting funding, that's your PI's responsibility. Sure, you can write mini-proposals for training grant but that mainly serves to pay part of your grad school stipend and pad your CV. But in no way is that sufficient preparation for the fierce funding environment that especially exists today.
As for your second question, yes you can do research in residency. But you are a resident to gain clinical knowledge and tools. Most projects you do will be smaller in scale. And this will not be sufficient to transition smoothly to an RO1 funded PI position...unless you're really really lucky and you can function on 2 hours of sleep a night.
If you do choose the postdoc route after residency, I would recommend doing limited service responsibilities. That way, you don't forget what you learned and you can still keep your feet wet diagnostically. However, the problem arises when even this limited service duty interferes with your research.
Now in retrospect, I remember many folks warning me against doing an MD/PhD, even my undergrad PI who was emphatically against my pursuit of a dual degree. He said that I would likely turn out to be "half assed" in science and clinical work if I were to do so. In some sense, I now agree with him, but not completely. I believe that it certainly helps to differentiate one's mind towards a research pathway or a clinical pathway during one's development...the earlier the better. Trying to wear "two hats at the same time" is strenuous and requires a lot of training and responsibility to maintain a top caliber mind in both. Next thing you know, you're 40 when you get your first job. Is that what you want? Rob Weinberg at MIT addressed this in his Cell editorial a year or so ago...even straight PhD's who have undergone no clinical training and straight MDs who have undergone no PhD training, are taking longer and longer to get their first RO1's and their first assistant professorship positions. Because of this, they may be getting these "first real jobs" when they are past their peak of intellectual prowess and creativity. Keep that in mind...that's the one thing that stuck with me after reading his article.
The benefit of having dual training is to be able to identify clinically relevant questions and be aware of a multidisciplinary approach to solving research problems. In that regard, I think the MD is more crucial than the PhD. The PhD provides tools but if you can pick them up during a postdoc, the PhD is superfluous.
