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Switching from MD to PhD

Discussion in 'Physician Scientists' started by Marquis_Phoenix, Dec 3, 2008.

  1. Marquis_Phoenix

    Marquis_Phoenix Junior Member
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    How hard would it be to switch into a PhD program after your first year of MD (like switch out entirely)?

    Would it be easier than if you had applied right out of undergraduate, because you'd have a whole year during your first year of medical school to hang around the lab you want to be at, and thereby garner support for PhD admission?
     
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  3. Scottish Chap

    Physician PhD Moderator Emeritus 15+ Year Member

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    There isn't really any switching involved, per se. PhD coursework is generally at a much higher level than the surface approach needed for medical school basic sciences, and I would be amazed if any good PhD program accepted medical school credits in partial fulfillment of PhD level classes (notable exceptions might be pharmacology or physiology PhD programs that require PhD students to take medical pharm/phys etc.).

    Essentially, you would be a start-from-the-beginning-again applicant. Note, however, that some graduate programs will accept the MCAT in place of the GRE--even if it's not advertised--so do ask. From personal experience, PhD programs are much easier to to gain an offer of admission from compared to MD programs, but they are much harder to graduate from. Being a med student for a year should neither hinder not help an application to grad school.

    The one question I might urge you to ask yourself is: will it be that bad to finish another three years of medical school? The MD program gives you a very marketable degree and a professional credential, and you can still do basic science postdocs. with an MD (if you are attending a very expensive, fancy private medical school, forget that point because you'd never repay your loan as a researcher). If you are motivated, research is research and, while the structure of a formal PhD program is nice, I submit to you that it's not essential and there is more than one way to skin a cat.

    Just think about why you want to jump ship before you do it. Good luck!
     
  4. sluox

    Physician 10+ Year Member

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    False. A large number of MD/PhD programs substitute med school classes for PhD course requirements. Although if you want to drop out of MD completely, you might indeed need to follow PhD procedures more strictly. I would say that the breadth of any MD course more than enough to offset the lack of depth, and some MD courses in fact have as much depth (for instance, immunology and microbiology) as a PhD level course. This is a personal opinion though.

    Agreed. Unless you are 100% sure that you don't want to be a clinician AND 100% sure that you want to do high quality science and willing to work your ass off taking the risk of getting nothing back in return, do a PhD only. Otherwise do an MD. And there IS a way to pay back your loans. It's called the NIH loan repayment program.

    In my opinion the vast majority of PhDs are ill equipped to do disease-oriented basic research because their lack of knowledge in clinical sciences. Your training as a strict PhD will likely be very narrow.
     
  5. Scottish Chap

    Physician PhD Moderator Emeritus 15+ Year Member

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    No way. The teaching goals for Ph.D. students and M.D. students could not be more different; one is 10 miles deep and one inch wide and the other is one inch deep and ten miles wide; one requires individual thought and creativity while the other is largely protocol-driven. If you have experienced this (and I'm sure you have based on your comments), you either attended a medical school class with Draconian, severely cruel educational goals, massively exceeding the LCME criteria for teaching medicine, or a Ph.D. class that is far too dilute.

    Be VERY careful with this one. Yes, the NIH LRP is there, but the criteria for funding are rarely met by typical bench scientists. It's intended for general clinical research, infertility research, health disparities research, and pediatric research.....very narrow (http://www.lrp.nih.gov/). That said, a friend who is a Hopkins junior faculty member managed to put a heavy pediatric spin on his basic research to win this award, while a faculty member at a large medical center in Boston where I just interviewed tells me that their physician researchers have been unsuccessful after two attempts. Even if you get the FULL award, it's 70K (better than nothing, right?) and the debt from a private medical school (with compounding interest I should emphasize....) can easily exceed 200K. You simply cannot clear that as an academic scientist without putting yourself and your family (if you have one) through severe hardship for years.

    Maybe. Maybe not. That is a huge, sweeping statement. Unless a physician scientist completes a residency, the clinical years of medical school add almost nothing to a medical research career because you simply have so little experience, and zero independent experience of treating disease. The basic sciences in medical school (as Rxnman nicely points out), including human anatomy and pathophysiology are now taught be several astute Ph.D. programs alongside M.D. students with the realization they provide the necessary clinical framework for a medical research career. The rest, I would argue, can be learned from any medical textbook on an as-needed basis....just like a medical student.
     
  6. sluox

    Physician 10+ Year Member

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    Clearly your opinion is conventional wisdom and my opinion is a bit offbeat, but my my experience (at a top program) has been that most grad courses suck compared to med courses. Grad school courses are precisely useless because they are SO narrow. You can read papers on your own, but you can't survey a large amount of information and force yourself to memorize unless you are in a structured, classroom environment. I'd say though the end-result training at my grad school is still superior than the vast majority of schools, because the most important part of PhD is the name and connections of the faculty and the amount of money they have.

    As to whether MD is better than PhD for translational research--an often debated topic. I'm assuming though most MDs will do a residency. The question is, is an MD+residency+fellowship better than a PhD+postdoc at translational research? (these days the two pathways take almost as long.) My answer is a resounding yes. And the answer is validated by the fact that the said MD is about 2000% more likely than the said PhD to get and sustain an academic job. And the money issue is a non-issue, because the said MD will invariably make 30% (or in case of certain specialties, 100%) more than the said PhD, which in a few years will make up the difference in tuition.

    A strict PhD in biological sciences is for suckers doesn't matter how you put it.
     
  7. Scottish Chap

    Physician PhD Moderator Emeritus 15+ Year Member

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    Very interesting. Thanks for your perspective, and input. I'll keep that in mind when I get asked this again. I think you'll make a lot of enemies if you voice your opinion of strict PhDs too loudly. I was once one (making it as far as faculty interviews) and, since you are still in medical school with no postgard experience, I'll respectfully say that I couldn't disagree more with that statement.
     
  8. sluox

    Physician 10+ Year Member

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    This is exactly what's wrong with academia as a profession. People are so afraid of the criticism in the system that they internalize any as such being a personal attack. I did a PhD in biological science AND an MD, and I personally witnessed how the medical profession had protected its professional interest while the scientific community failed to do so. I have seen how the PhD recipients have been abused time and time again, and only be too afraid to "make too many enemies" to speak up. Call it Stockholm syndrome, call it battered wife syndrome, or what have you. I'm sick and tired of people refusing to acknowledge that if there is one thing more broken than the American health care system, it's the American biomedical research enterprise.

    here's a link drugmonkey blog I think is very appropriate, and I quote

    "it seems that there is an idea floating around that harsh public criticism of aspects of a profession necessarily constitutes hatred of that profession and its practitioners and acolytes, and is tantamount to personal insult and libel of individual members of that profession. This pernicious idea needs to be brought out into the open and debunked. Having and expressing strong feelings that a profession, its training system, and even its acolytes and practitioners have flaws is absolutely not inconsistent with devoted, expert, careful participation in that profession and its training system. The idea that the opposite must be true--that those that point out flaws hate the profession, are illegitimate infiltrators, and must be expelled and/or destroyed--is classical authoritarian follower thinking in its purest and most destructive form. It is exactly the same--and just as absurdly false--as "those who criticize the war in Iraq hate America, are traitors, and should be killed". "
     
  9. Katatonic

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    This is a pretty interesting discussion, especially since I've recently decided against applying MD/PhD and just applying to PhD programs. I obviously don't think a strict PhD education is for suckers, but I can also see why some people would think the MD/PhD option is better. It really comes down to personal preference. Personally, I realized I can't stand the idea of seeing patients for two years while I wanted to get on with my REAL job. Soooo, off I go to graduate school.

    Also, where's the data supporting MD/PhD's being 30% more successful in attaining faculty positions, and what is the time scale?
     
  10. Neuronix

    Neuronix Total nerd
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    :thumbup:

    It should be noted that IMO your experience in MD and PhD classes will be wildly different based on school. Most of my grad classes were pretty lousy, and that includes the grad classes I took as an undergrad (most of the Neuroscience graduate school cirriculum there). Medical school information is pretty standardized, though the way it's presented varies a lot both in depth and quality.

    I think also PhDs in certain areas have well defined information they are supposed to cover. PhDs in other areas (such as mine for example in Biophysics) are a big question mark, and this only adds to the variability.
     
  11. sluox

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    I promise this is the last cynical post of mine on this thread. Perhaps I need to qualify my statement a little bit. A bio PhD is for suckers "on average", and I would caution anyone who choose this path to think long and hard about the possible ramifications in their future, and talk to a few current grad student/postdocs before jumping onboard.

    In reality, obviously, things are very complex. Is a bio PhD from Harvard with multiple Nature papers better than a MD/PhD from podunk state in securing a faculty job? Of COURSE. But on average, even an MD/PhD from a mid-tier school is competitive with an average Harvard PhD in terms of getting K-grants, securing the best postdocs, or getting faculty jobs. Why? Because of the MD--MDs make their own money so the departments get more from an MD than a PhD. The 1 day a week patient interaction that you loved to piss on so much in the end props up the entirety of the rest of your career.

    As far as statistics, the exact data is not available, but anecdotal collection of evidence is abundant. Recently there is an article in Science about the outcome of one Yale class of MCB 10 yrs after PhD. only 1 out of 8 or 9 is on the tenure track. I think this number is fairly representative. Meanwhile, most of the MD/PhD tracking series that I'm aware of count somewhere between 60-70% of graduates going into an *academic* medicine position. This is about 1000% difference. Of course, about half of those positions are mostly clinical...

    At the end of the day I think almost everyone who ever debated between MD/PhD and PhD should probably do MD/PhD. (The other part of story isn't the same. MD vs. MD/PhD is a much more complex calculus.) If you were never interested in diseases/patients, why would you even consider MD/PhD in the first place? And if you care about disease/patients, why wouldn't you do an MD? if you go into a strict bio PhD program with the hope of becoming a career researcher, you need to be aware of the fact that the three most important things in research are
    (1) money
    (2) money
    (3) money
    MD gives you money, PhD doesn't. The rest follows. There are no MD/PhDs I know who regretted doing the MD, even when they skipped residency. There are plenty of PhDs who went back to medical school. MD/PhD = 7 yrs. PhD = 6. It's your life. Be very very careful.
     
    #10 sluox, Dec 4, 2008
    Last edited: Dec 4, 2008
  12. Katatonic

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    Thanks for the info about that Yale class. I had read a similar article in either Science or Nature a couple months ago about how hard it is to get Tenure anymore, and the level of dissatisfaction amongst postdocs is incredibly high.
     
  13. BNSN

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    The chairman of the department that I do research in as an ungraduate once walked in on a meeting between my postdoc and I and we started discussing a PhD path versus MD path. The chairman said when he is looking to hire people, he can give MDs a huge premium in salary because if the MD eventually faills at getting grants, he can just switch them over to clinical duties that pays for itself.

    So...yeah. It really is just the simple economics of it, not anything to do with the MD training versus PhD training. If we were looking at it from a purely scientific perspective, I think PhD training is obviously superior (with the obvious caveat that some PhD classes can be bad, etc...).
     
  14. RxnMan

    RxnMan Who, me? A doctor?
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    What a good post. I agree with you, and I believe that, for one interested in academics and being a funded researcher, a bio PhD is for suckers. Are there folks doing research with a bio PhD? Sure, and if the stats I've seen are true, most of the NIH dollars are going to PhDs. But hidden within that are several facts:

    1) there are many more proposals being generated by PhDs than MD/PhDs and MDs
    2) those PhDs are doing many more post-docs to get to the same place a MD/PhD or MD is after a fellowship
    3) Bio PhDs are in the 6-7 yr range + 2-4 two-year post-docs
    4) The PhD process, in general, is pretty exploitive, has no fixed end-point, and depends upon a certain percentage of survival of the fittest.

    The comment about switching MD faculty to clinical duties if funding runs out is true (actually a detriment at times), but only for those completing a residency. W/r/t MD vs. MD/PhD, you can look at my decision (admittedly difficult and ongoing) in the FAQ section.

    To the OP, there are a number of degree programs (BioEng and certain Bio come to mind) that incorporate the pre-clinical MD curriculum into their PhD degee.
     

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