The choice: MD or MD/PHd

[Urotsukidoji1]

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I am really interested in being a neurosurgeon and I was wondering if a MD/PHd would be good for that specialty. I know the neurosurgeon has to do a lot of research because the field is constanly being improved through research. I want to know if this is overkill.

 

[duncanfj]

Yes, it is overkill. Neurosurgeons don't need to do work in a research lab to keep up with the field.

 

[surge]

I wouldn't do it for the reasons you described. Just get an MD and do really well. You don't need the PhD.

 

[Neuronix]

Most neurosuregeons do no science research because they are simply too busy with surgery to do research. Clinical research does not require a PhD and MD/PhD programs are geared towards producing basic science researchers.

So I agree with the others who have posted here. Don't waste your time getting a PhD. That time could be better spent.

 

[Doctor&Geek]

To take an opposite viewpoint, I wrote in an earlier post last November:

"Most surprisingly, I've heard that MD/PhD'ers are now part of an educational arms race to get into the most competitive residencies. For example, neurosurgery programs at Duke, UCSF, and Emory now almost require the dual degree, and also at UCSF, it is required that you Publish Scientific Papers, without which you cannot advance in residency standing!"

Also for your benefit, I've listed other threads related to neurosurgery residencies and MSTPs here:

http://www.studentdoctor.net/forums/showthread.php?s=&threadid=39693
http://www.studentdoctor.net/forums/showthread.php?s=&threadid=60735
http://www.studentdoctor.net/forums/showthread.php?s=&threadid=51848

Yours,

Jason

 

[MacGyver]

Jpaik,

you sure about that? you are painting some broad strokes.

Somebody find statistics on all neurosurg residents that hold MD/PhDs. I doubt its anywhere close to the majority, even at places like Duke, MGH, Mayo, UCSF, etc.

Out of all Duke and Emory neurosurg residents less than 50% hold the dual degree. It is far from being "required" as you put it.

 

[surge]

There is also a huge difference between having an MD/PhD and going into a neurosurgical residency (yes, it can be very helpful, make you more competitive, give you an edge in your residency research years, etc.), and doing an MD/PhD just to get into clinical neurosurgery.

Given this individual's motives, I don't think he/she should do an MD/PhD degree.

 

[Doctor&Geek]

Originally posted by MacGyver
Jpaik,

you sure about that? you are painting some broad strokes.

Somebody find statistics on all neurosurg residents that hold MD/PhDs. I doubt its anywhere close to the majority, even at places like Duke, MGH, Mayo, UCSF, etc.

Out of all Duke and Emory neurosurg residents less than 50% hold the dual degree. It is far from being "required" as you put it.

I do admit that this is not my personal opinion, but the hearsay from two MD/PhD students here and also a faculty member here who did his neurosurgery residency at UCSF. I too am looking for data that backs up these statements. What exactly I've been told is that UCSF almost requires the PhD now, and that Duke is moving in that direction. Incidentally, that UCSF residency graduate is a regular MD who devotes a significant amount of time doing basic research, and also took a year off to do research at the NIH prior to entering his 3rd year of medical school.

Couple of points: this trend, I've been told, is a very recent event, and could be that since this is a very long residency, only the first 2-3 years or so of residents might be in this storyline, indeed within the possibility that Duke has less than 50% of its residents being MD/PhD's.

BTW, you come up with those 30 or so names yet?

Given this individual's motives, I don't think he/she should do an MD/PhD degree.

Indeed, you are correct in this statement. If I mistated my intentions, my purpose purely is to provide information that might be useful to an applicant, not to in any way push applicants into MD/PhD programs purely because of residency choice.

I don't even want to do a neurosurgery residency! 😛

Yours,

Jason

 

[noy]

Practicing neurosurgons simply don't have the time time to be hardcore researchers.

The famous 75/25 rule will not work for them - seeing patients 1 day a week is not enough to keep up your skills as a surgeon, and working much more will mean no basic research.

Besides, the time commitment and family disruption alone for surgery is overwhelming - think of what that would do to your research - esp. since most of the research in that field is higher-life animal models.

They are always involved in clinical studies, and publishing all sorts of papers, but nothing that requires the PhD.

That being said, its 'only' 5 years, and there are always folks who will buck the rules :>

 

[Vader]

I think I have answered this one on some previous thread, but here it goes again...

I have heard straight from Dr. Mitch Berger, chairman of UCSF neurosurgery that although a PhD is not required for admission to the residency program, it does help to have some kind of meaningful research experience. It turns out that over half (probably about 75% now) of residents in the program also have the PhD degree, which lends itself to suggesting that the bar, indeed, has been raised.

There are certainly good reasons for doing an MD/PhD and then following with a neurosurgery residency. This pathway is obviously not for everyone and only for those who are extremely dedicated to both patient care and research. Most neurosurgeons who conduct research, focus on areas that relate directly to patient care.

However, increasingly, there is emphasis on increasing the number of basic researchers (PhDs, MD/PhD, and MDs) in neurosurgery departments. Often through collaboration, a neurosurgeon can keep up his/her skills and participate in basic research. There are obvious advantages to this setup, as one can gain access to live human neural tissue. For example, there are collaborations set up here at UCSF in which human neural stem cell biology is being studied in basic models using ressected tissue.

I strongly believe that the PhD trains you to think like a scientist and to have the right approach to asking questions and investigating sophisticated biomedical problems. These are things one just doesn't acquire through conventional medical school training. So I don't believe getting a PhD is "overkill" at all if one plans to go into academic neurosurgery with a strong emphasis on research.

 

[psyuk]

i know an md/phd graduate who is now doing neurosurgery residency. his work rate is just insane. i searched his name in pubmed, and he published 3 first author papers in his first year residency. so there's an advantage to get an md/phd because to echo vader this person whose interest lies in academic neurosurgery probably would not have published those papers if he had not gone through the proper research training. lastly neurosurgeons are extremely bright people, so most are able "squeeze" in the phd degree.

 

[Airborne]

I'll disagree with previous posters - it does not take a Phd to gain access to human neural tissue- merely an insight into the disease process is necessary, which can easily be obtained with an MD degree.

As far as NS resident's being extremely bright - I'll have to agree that they are indeed so. As are Dermatology, ENT, Ophtho, Orthro, CVS, Plastics and a large majority of other pathways (incidently, NS is on the lower end of these, as concerns Board Scores and the like).

The ultimate question is what does a NS do in daily practice? Is it to answer an enigmatic basic science question or to do a routine lumbar laminectomy? While some do the former, I can assure you that most do the latter - the remuneration is much better.

So, while it sounds cool to say, Joe Bloggs, MD, PhD, Neurosurgeon - remember that aside from the 2 mintues of the day that you are actually saying this, the rest of life passes by.

If an MD/PhD a requirement for admission to an NS program - I wouldn't know. But, if that is what you are comtemplating and you know that clinical medicine is your career path - you are wasting your time. Your 4 years in a PhD program are better served doing bore holes and laminectomies.

While I appreciate others comment's into this - I expect that insight will only come from those at the tail end of the combined degree - indeed more so those with both degrees in the final years of residency (of which I am not).

 

[Vader]

Airborne,
You are certainly correct in saying that it does not take a PhD to gain access to neural tissue. However, it does not take an MD to gain access to neural tissue either. There are several PhD investigators I know of here at UCSF that have obtained tissue for electrophysiology recordings, immunohistochemistry, in situ hybridization, and other techniques looking at structure and function of the human brain.

Not everyone opts for maximal remuneration. Some folks are interested in academic careers that will allow them to pursue basic science research in addition to clinical pursuits. The point is that if one is so inclined, this is a viable and legitimate pathway. While individuals should have a realistic sense of what lies ahead, I do believe that individuals should not be discouraged, especially by those who haven't walked the same path.

Honestly, no one I know at least in my program is doing the MD/PhD because having the extra letters "sounds cool". There are a few individuals interested in pursuing neurosurgery after earning their MD/PhD. I would in no way cast their pursuit of the PhD in addition to the MD as unnecessary, as this is helping them work toward their goals in doing something they enjoy.

I can assure you that the PhD degree is NOT a requirement for the neurosurgery residency program here at UCSF. I don't know about other programs, so I won't comment.

I agree with you though that doing the PhD with full knowledge that you will have a sole clinical career is not the right thing to do. MD/PhD programs are for those with a strong interest in both medicine and basic research.

 

[psyuk]

Originally posted by Airborne

The ultimate question is what does a NS do in daily practice? Is it to answer an enigmatic basic science question or to do a routine lumbar laminectomy? While some do the former, I can assure you that most do the latter - the remuneration is much better.

agreed. but those who do the former are more academically inclined and more likely to have phd's than those who do the latter. so basically we are all in agreement with the fact that it IS a waste of time get the phd if your sole interest is in clinical medicine.

 

[stephew]

While an MD pHD is an accomplishment, more than 90% practice only one or the other making it a practical waste of time... except for the free education which is nothing to sneeze at. Furthermore you can do lab work without a PhD if you do some lab time in residency as an MD.

 

[Neuronix]

Originally posted by stephew
except for the free education which is nothing to sneeze at.

Indeed. Could you see coming out of a medical school program to become a basic science researcher at say... $50k/year? You'd be crushed by your 200k+ worth of loans.

Even assuming one does not go do research, which is what many consider the MD/PhD to be good for, the total package is worth something like $325,000 ($35k/year tuition + fees for 4 years, $23k/year stipend with reduced taxes for 8 years). I'll do a few extra years to get a second degree, which I hope will be useful, and get all that pay. Yes, one could probably make more later in their career. But, after loan interest if you were to go MD without support, it's kind of a gamble.

Oh, but I forgot... An MD/PhD is not a REAL PhD! That'll be next out of someone's mouth I'm sure 😀

 

[stephew]

Ive found with past discussions of this topic that many candidates are very sensitive towards this issue; Again, the academic accomplishment is impressive and the financial issues great. My only point that is that its not a requirement to get both degrees to be a physician scientist. In fact the man just made Chairman of our department has only an MD and heads a molecular bio/gene therapy lab here at hopkins. I only believe that people seeking these things ought to know the real -rather than theortical- pluses and minuses.
BTW I am 2 credits short a masters in molecular bio after my name as well.
Stpeh

 

[TTSD]

That is true, the neurosurgeon I've worked with does not have a PhD, only an M.D. yet has published more than 100 papers.

The opportunity for research in neurosurgery is great, and you don't really need a PhD to do it. Just work closely with a University that has an MD/PhD program and steal the students and make them do the monkey work.. literally. LOL

 

[Neuronix]

Originally posted by stephew
Ive found with past discussions of this topic that many candidates are very sensitive towards this issue;

Well you expect them not to be? 😛

Regardless, I find it funny that everyone has their own opinion for how the MD/PhD is best used. Some think it is a complete waste of time. More think it's best for basic science research. Others think it's best for clinical research.

I don't think there is necessarily a right answer. I do think that the NIGMS has seen fit to put out millions of dollars to fund us, and that's good enough for me.

I also know a number of very successful MD-only researchers. Every one of them has recommended to me the MD/PhD path if I am sure I want to make some part of my career medical research. They tell me that medical school in their day cost so much less. Further, they tell me that the temptation to go on to research may be too great when you're staring down a huge salary and being done school after residency.

 

[stephew]

as someone who does a lot of clincal research I have to say that I do think that-money aside to pay for school- a PhD along with an MD is a complete waste of time if clinical research is what you want to continue doing. But that and some change gets you a coffee.

 

[Vader]

The nice thing about the MD/PhD is that it allows you considerable flexibilty by giving you solid training in both medicine and science.

There are a bunch of old threads debating the issue of MD versus MD/PhD. It seems that there will always be the faithful and the doubters.

 

[dl2dp2]

I believe that NIGMS's policy for the MSTP grant is exclusively set aside for people who are in track for a career in basic science (however clinically relevant) research, and quite predominantly in the biological or related natural sciences (i.e. chemistry, biophysics, engineering) . There are some, most likely institutional funding in other deciplines such as anthropology, public policy etc, but I reckon these programs are mostly designed for a career in academic research in respected departments (i.e. economics) as well. I remember reading somewhere that MSTP grants are not designed to train clinical researchers. This makes a lot of sense to me, because the philosophy of a PhD in biochemistry is completely different from that of an MPH, which is essentially the prototypical clincial research training. However, what makes matter confusing is these days there are programs in bioinformatics, biostatistics and other more applied clincial PhD deciplines in which MD/PhD students can do their PhD. These graduates, as I see, are probably going to go into clinical departments.

Does a PhD in biostatistics or bioinformatics have an edge in producing better clincial research compared to a mere MD, or even an MPH? I tend to think so, probably because MDs, without additional training, are generally unaware of some of the cutting edge quantitative methods that can be applied in clincial situations whereas PhDs are taught to be up to date with the latest results, both from the clinics and from computer/quantitative people.

NIGMS's original MSTP grant was *for sure* a basic science grant. However, keep in mind that the competition for an academic basic science position is much stiffer compared to a clinical faculty position (and much less well paid). I think that could be a reason why many MSTP graduates eventually opted for a clinical academic career. And EVEN IF we take that into account, MD/PhD graduates have a higher by per cent success rate of obtaining an academic position (in both clinical and basic science departments) compared to either PhD or MD graduates (NIH survey data). Now is three four years extra time worth the untangible luck of the draw...

I think that at this point MD/PhD programs (as well as MD, and PhD programs) have become so diverse that one can often go to the same destination via several pathways. It's more a matter of personal preference and talent. I can tell you this, a smart, luckier MD would do invariably much better than a dumb and unfortunate MD/PhD, and vice versa.

Originally posted by stephew
as someone who does a lot of clincal research I have to say that I do think that-money aside to pay for school- a PhD along with an MD is a complete waste of time if clinical research is what you want to continue doing. But that and some change gets you a coffee.

 

[Neuronix]

I agree with everything you're saying sluox. I put that out there because there have been threads on this in the past. It seems that there have been journal articles and a piece from the HHMI suggesting that clinical papers are lacking and that MD/PhDs, with their extended training in science, might improve the quality and depth of clinical science.

There's that whole issue as well of "translational science". I'm still not exactly sure what that entails, but I think it falls in basic science or clinical research and that's why I chose the MD/PhD. I want to be able to take things from basic science to the clinic. Whether that means testing lab animals in new ways (basic research) or trying out new things on patients (clinical research), that's the idea I'm going for.

 

[Nuel]

Besides the humanity and justification clauses attached to the MD/PhD pathway, I see the PhD as "extra" academic achievement, one cool thing to add to the MD.
An MD who does research must go through some training such as post-doc fellowship, or spend lab time during residency, etc albeit we really can't compare this to the traditional "how to think and do science" portion critically emphasized during the PhD training.
A question: "How many people drop out of medical school relative to PhD programs?"

 

[MacGyver]

Originally posted by stephew
While an MD pHD is an accomplishment, more than 90% practice only one or the other making it a practical waste of time...

Speak for yourself, but I know lots of MD/PhDs who do both clinical work and basic science research.

Your 90% number is wrong. What are you basing this on? A sample size of 3 or 4 MD/PhDs in your department?

Furthermore you can do lab work without a PhD if you do some lab time in residency as an MD.

A PhD is MUCH better preparation for a substantial research career than the MD alone.

If you want to devote 50% of your time (or greater) to research, then having a PhD offers distinct advantages over the MD.

If you just want to do research one day a week, then dont bother with the PhD. But I would add that you WILL NOT be a strong researcher because research work is a substantial commitment.

You can absolutely do research with just an MD, but bear in mind that MD/PhD is the BEST preparation for a research career that also involves clinical practice.

 

[vixenell]

Even with the covered tuition and stipend, you'll end up behind, as you will ultimately lose 3-5 years of a neurosurgeon's salary. If you really want the research experience, apply MD and take a year off during or afterwards to work at one of the NIH's programs.

 

[Neuronix]

Originally posted by MacGyver
Your 90% number is wrong. What are you basing this on? A sample size of 3 or 4 MD/PhDs in your department?

When I interviewed at assorted programs the most common thing I heard was: "Given that the best split you can hope for is 80/20 (sometimes 90/10) and that most MD/PhDs are exclusively one or the other, what do you hope to do with your MD/PhD?" Some went so far as to say "that whole 50/50 thing is a pipe dream." You can argue with them if you like. It is a very common piece of "wisdom" that one gets from MD/PhDs. You could probably find better examples of someone who does mix MD/PhD very well, but every one I have seen devotes almost all, if not all, of their time to clinical or research.

Also, to respond to vixenell, academic neurosurgery doesn't pay as well as private practice neurosurgery. One also wonders, will it be as high paid in the future as it is now? You hear all the time "Don't base your career decision based on current salary projections, the reimbursement rates could change." I don't have specific numbers, but I'm willing to bet that if one does do academic neurosurgery, not going for chairman's salary, that the MD/PhD package comes within $100,000 of 3 - 4 years of salary. I'm very interested in specialized surgery myself, and I'm just hoping that there will be a way to make the MD/PhD and neurosurg thing work. I have another 6 years or so to make up my mind.

An added bonus you get from doing MD/PhD and going into something clinical is that the PhD will look really good on your resume when you apply to residencies. Of course, PhDs aren't required for many residencies, but it looks damn good for those top ones if you're gunning for them.

Note that I'm not really defending or arguing for any of these things I'm posting. I'm just throwing things out there for debate. I'm not sure what I believe or what I want my MD/PhD career to be. The things I am certain about is that I am uncertain, the MD/PhD provides significant career flexibility, and I'm getting paid until I figure it out.

 

[MacGyver]

Originally posted by vixenell
Even with the covered tuition and stipend, you'll end up behind, as you will ultimately lose 3-5 years of a neurosurgeon's salary. If you really want the research experience, apply MD and take a year off during or afterwards to work at one of the NIH's programs.

Hell if all you want is research experience, without committing to a career in academic medicine/research, then you dont even need to do the NIH thing you can just do research during the summers in med school.

A 1 year program at the NIH is nowhere close to a full PhD. Its all about the best preparation.

If you want to have a substantial research career, then PhD is not the only way, but it IS the best way to go.