Total time for MD/PhD? 14 years? +Postdoc/residency?

[cellochic]

Hi everyone,

I'm going to be a junior in college in the fall and I became terribly fascinated with the MD/PhD program my freshman year. I want to be a practicing physician also doing research in childhood autoimmune disorders/oncology (or rural medicine). I have been working in labs since my junior year of high school, which fostered my interest in research.

I thought that the total of time for the MD/PhD program was 7-8 years, however I read somewhere else that following the program there is still residency and/or a post-doc at about an additional 6-10 years of schooling. That would be ~14 years total. Is that true? (I'm sorry if this is a repeat question - I have been searching for days on the forums, but have unsuccessfully been able to find an answer.) I know that with an MD degree, you CAN do research, but what is the extent of that - can you be NIH funded? Is that based on your work? Is that based on how popular/innovative your ideas are?

I've also heard mixed reviews about the split between clinical/lab time. Some are able to balance it well, but most end up doing more research (80/20) (clinical/lab). The ones who focus more on medical end up becoming medical faculty. Truth/myth?

Any help, especially that of those who have already earned the degree/career, would be greatly appreciated!

Thank you,
A




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[nothingman]

I thought that the total of time for the MD/PhD program was 7-8 years,

Yes, though at many programs the average and certainly the median are becoming closer to 8 rather than 7.

however I read somewhere else that following the program there is still residency and/or a post-doc at about an additional 6-10 years of schooling. That would be ~14 years total. Is that true?

That is correct, although you are getting increased responsibility as a resident/fellow, and increased pay. It is still training though most would not describe as "school" per se. More like an apprenticeship. And you're usually not allowed to skip!

I know that with an MD degree, you CAN do research, but what is the extent of that - can you be NIH funded? Is that based on your work? Is that based on how popular/innovative your ideas are?

Absolutely, lots of MD-only folks doing successful, cutting edge basic science research. Funding is based on your work/ideas; you usually apply for a mentored training grant following residency (i.e. transitioning from working under someone to working independently), and try to get your own lab going. Your basis for this kind of career would be the typically mandatory basic research years in say a medicine/peds subspecialty fellowship (e.g. medicine residency then adult rheumatology fellowship, or peds residency then peds oncology fellowship). The last two years of these three year fellowships are typically spent mostly in lab.

I've also heard mixed reviews about the split between clinical/lab time. Some are able to balance it well, but most end up doing more research (80/20) (clinical/lab). The ones who focus more on medical end up becoming medical faculty. Truth/myth?

In the past few decades, 80/20 or even closer to 100/0 has become the model for most of the really successful (scientifically) physician-scientists. It appears that for most people, this is what it takes to keep a successful lab going amidst the competition from PhD-only researchers. This is still the traditional pathway in peds/medicine/pathology. However, many recent MD-PhD graduates are now going into fields which have historically emphasized the clinical side, with less established mechanisms to do basic research. How this will pan out in the long run seems uncertain.

Good luck!

 

[cellochic]

nothingman,

Thanks a bunch for answering my questions! You've clarified everything :]

~A

 

[RxnMan]

...I thought that the total of time for the MD/PhD program was 7-8 years, however I read somewhere else that following the program there is still residency and/or a post-doc at about an additional 6-10 years of schooling. That would be ~14 years total. Is that true?...

Most bio-related PhDs are commonly going to run you 5 years, 4 at least. I've heard of one MD/PhD who graduated in six, a few in seven, and the majority obtain thait PhD in eight to nine years. The program websites I've seen are misleading when they say seven.

Add on three years for the common IM or Peds residency, and three to five for post-doc/fellowship (depending on what you do,) you get to 14 - 17 years.

 

[cellochic]

That makes sense. I knew the general time frame was about 7 years, but looking more into it, you both are right - I'm seeing 8-9 years. As far as being in training for a few additional years, after med school time just seems to run together.

Is there any time to start a family in that time frame? I can see marriage perhaps, but even that seems like a hefty responsibility in addition to being in a lab/school all day.

 

[RxnMan]

That makes sense. I knew the general time frame was about 7 years, but looking more into it, you both are right - I'm seeing 8-9 years. As far as being in training for a few additional years, after med school time just seems to run together.

Is there any time to start a family in that time frame? I can see marriage perhaps, but even that seems like a hefty responsibility in addition to being in a lab/school all day.

Listed in order of flexibilty needed to get married and/or have a kid: grad school > med school >>> residency

 

[Towel]

Is there any time to start a family in that time frame? I can see marriage perhaps, but even that seems like a hefty responsibility in addition to being in a lab/school all day.

For what it's worth, most MD/PhDs I knew got married at some point in med/grad school, and a fair number have had kids either while in school or during residency. You can't postpone your life forever. There's certainly not much reason to put off getting married if you're otherwise ready. The rock and the party might just be a bit smaller on an MD/PhD student's stipend.

Kids are more challenging. My colleagues who have kids before or during residency all have a non-medicine partner who could take a big chunk of time off and then work flexibly, if at all. Most of them also waited until residency, since it's much easier to support a stay-at-home partner and kid on a resident's salary (small as it is) than on a student's stipend.

 

[avatarftw]

a

 

[freakusmcgee]

Hi everyone,

I'm going to be a junior in college in the fall and I became terribly fascinated with the MD/PhD program my freshman year. I want to be a practicing physician also doing research in childhood autoimmune disorders/oncology (or rural medicine). I have been working in labs since my junior year of high school, which fostered my interest in research.

I thought that the total of time for the MD/PhD program was 7-8 years, however I read somewhere else that following the program there is still residency and/or a post-doc at about an additional 6-10 years of schooling. That would be ~14 years total. Is that true? (I'm sorry if this is a repeat question - I have been searching for days on the forums, but have unsuccessfully been able to find an answer.) I know that with an MD degree, you CAN do research, but what is the extent of that - can you be NIH funded? Is that based on your work? Is that based on how popular/innovative your ideas are?

I've also heard mixed reviews about the split between clinical/lab time. Some are able to balance it well, but most end up doing more research (80/20) (clinical/lab). The ones who focus more on medical end up becoming medical faculty. Truth/myth?

I'm going to jump in here as a newly-matriculated MD/PhD student 🙂D😀😀) and say: It's true that you can do research as an MD-only, but there are significant advantages to the MD/PhD route.

1. Funding. All good MD/PhD programs give you free tuition for both degrees, as well as a stipend. This is a real boon if you are considering a research-heavy career, because it is a pay cut vs. being a clinical doctor. The less clinical hours you take, in general, the less money you make. Grants help cover you salary, but they are not generous. So if you end up doing a lot of research, the burden of debt is less manageable.

(however, look into the NIH Loan Repayment Programs, which will help you a lot with your debt if you do research)

2. Contacts. One of the biggest skills in academic research is networking. Medical school will give you few, if any, opportunities to do things like go to research conferences and present papers. Which brings me to:

3. Publishing. Part of what you do in graduate school is do a bunch of research and try to get it published. A successful student should have at least a handful of first-author publications after four or five years, which are necessary for:

4. Grant-writing. As a researcher you pay your own way by writing grants, and it's easier to get grant money if you're already published or have pilot work demonstrating your ability as a researcher and the feasibility of your proposed project.

So in other words, what you get from grad school is four or five sheltered years to really learn the ins and outs of research, to learn to write papers and grants, and to meet the people in your field who will help you get ahead. This puts you at a really distinct advantage over MD-only researchers, at least at the beginning of your research career; MD-only researchers, from what I can tell, have to hit residency or practice and immediately hustle as much as possible, trying to write their first grant, get some publications out, et cetera. You also have to make sure you end up in a position where you have some freedom to do research (like a research residency), and those spots are easier to get if you're an MD/PhD.

Of course, that's not to say there are no opportunities to do research as a medical student or that it's totally hopeless; as one of the other posters pointed out, many MD-onlies have perfectly successful research careers. However, what I discovered when doing my own application research was that MD-only research tends to be much more clinically-focused rather than basic. I think it is a lot harder to start in basic research as an MD-only doctor, because your job comprises clinical work. Again, not impossible, but a distinct advantage to having a PhD.

That being said, it is a long haul and not for everybody. It IS possible to focus more on practice as an MD/PhD, but most people don't. IMHO if you want to do that then it's probably not worth the extra training. You should do an MD/PhD if you could see yourself in an academic medical center, doing primarily research but with a significant patient load at times, and likely involved in medical education. If not, then it's probably not worth it.

Oh and one last note, on the question of having a family: my mom was also an MD/PhD and had her kids during her clinical rotations, her residency and her fellowship (me). Her thoughts? "It's not that hard. There is never a GOOD time to have a kid--you just have to manage your time." Oh and did I mention--she was a single mother, too. So if she could swing it, you can too! 🙂

 

[Neuronix]

Oh and one last note, on the question of having a family: my mom was also an MD/PhD and had her kids during her clinical rotations, her residency and her fellowship (me). Her thoughts? "It's not that hard. There is never a GOOD time to have a kid--you just have to manage your time." Oh and did I mention--she was a single mother, too. So if she could swing it, you can too! 🙂

... Welcome to the forum freakus. I'm not trying to give you a hard time here, even though it seems like it. Believe it or not, I do this to everyone.

So I have to ask... How was this possible for a single mother to have multiple children during MD/PhD training?! Did your grandparents do most of the childcare? Or perhaps was there a huge sum of money for a lot of nanny care? This isn't about managing your time. This is about impossibility. I don't want people to get the wrong idea and have unrealistic expectations about what is possible.

This isn't a 9-5 job where you can just pick your kids up from daycare. There isn't enough money from just your stipend to be able to afford living, children, and nanny care. As a resident, you'd need two nannies, which you can't afford on resident salary. So what was your mom's trick? Or were these just different times?

 

[cellochic]

Thanks for all your help guys! I'm doing some long hard thinking about all of it. Apparently my research on doing an MD/PhD has come up short/neglected a lot of things I honestly didn't have a clue about.

The whole "Life's a journey, not a destination" quote puts things in perspective, but at the same time not starting my career UNTIL I'm 35 does also! One of my girlfriends is working at UPitt for the summer doing an internship in their cancer center. The grad student she's working with is an MD/PhD candidate who will finish with his residency and fellowship in 2019 doing EXACTLY what I want to do (peds oncology). He loves it, but also won't be starting his career/ finished with training until he's 35.

Although it's not the case, I feel like my post undergrad life will solely revolve around this. Understandable, but the sacrifices seem to be a bit hefty too.

Nothingman: Do I have to have my head my own lab or can I work with partners? The idea of me being the head hancho of a lab is honestly intimidating to me. I enjoy what I do and though I think I am intelligent, I don't feel I'm THAT smart to be able to do that.

Towel: I can see marriage while going through the process, but kids seems like a handful. Maybe the lucky guy that I marry at some point will be just as crazy as I am doing MD/PhD also? :]

Freakus:
Congratulations on your matriculation! I have yet to "meet" anyone personally who is going for the degree. Your explanations have pin-pointed the questions I have had trouble formulating into understandable ideas, though I need some more clarification if you wouldn't mind.

Funding: As for the difference between clinical v. research, approximately what is the salary of someone who solely decides to do research? Or decides to go into academic medicine? Honestly, I'm not in any profession for the money as long as I can support myself. So there is a correlation between having clinical hours and pay even for researchers?

I've been exposed a bit to publishing and grant-writing (not on the level of professionals, but just working in a labs for the past few years) and I'm considering taking a grant-writing/scientific research writing class offered by my school. By the looks of what you've said, this seems like a good idea.

For MDs trying to do research from what I understand from your answer is that it's simply more difficult to get up and running on your own without having all the added experience from a PhD. Gotcha.

Originally Posted by freakusmcgee You also have to make sure you end up in a position where you have some freedom to do research (like a research residency)

I didn't know there was such thing as a research residency...that's looking promising to me. I know it's not the same as going full speed ahead with MD/PhD but at least there are options if I don't get into a program/decided not to go through with it.

However, what I discovered when doing my own application research was that MD-only research tends to be much more clinically-focused rather than basic.

What is clinically-focused research v. basic? I thought research was research!

You should do an MD/PhD if you could see yourself in an academic medical center, doing primarily research but with a significant patient load at times, and likely involved in medical education. If not, then it's probably not worth it.

Maybe I am confusing some things. I thought that if there was an 80/20 split of course there would be a heck of a lot more research going on than dealing with patients. Could you clarify for me the "significant patient load" in accordance with doing research? Would I also be teaching?

Holy moly. And I thought MY mother was Superwoman (two younger kids besides me, being a teacher for special needs + part time weekend job, getting a 2nd degree in nursing, and manning the house while my dad is away on business for months at a time). Props to your mom, and I agree - there's never a right time to have a kid haha. Though I have to agree with neuronix also - I wouldn't imagine a resident salary being able to support kids!

 

[Neuronix]

What is clinically-focused research v. basic? I thought research was research!

Except... It's not. Clinical research requires different training and skills than basic research. MD/PhD programs are almost always set up to produce basic researchers.

Maybe I am confusing some things. I thought that if there was an 80/20 split of course there would be a heck of a lot more research going on than dealing with patients. Could you clarify for me the "significant patient load" in accordance with doing research? Would I also be teaching?

To run a lab you need to devote most of your time to it. Whatever clinical time you squeeze in on top of a full-time lab schedule is what you can do clinically. This roughly works out to 80% research, 20% clinical time if one is doing significant research. The only way to do 50% clinical is to do 100% research and 50% clinical on top of that... Which is what I see from younger faculty trying to establish themselves!

 

[cellochic]

Okay, thanks neuronix. I had to look up the clinical v basic research and wanted to give myself a smack in the forehead because their titles describe exactly what they are. So clinical would be application of whatever (i.e. drug trials) vs. basic which is what I do now in my computational lab. Makes sense!

Trying to do the 50/50 split sounds INTENSE, but then again if that's what someone wants ... :]

One last question (for now anyway): is it imperative to run your own lab? I'm honestly intimidated by that idea...

 

[Neuronix]

One last question (for now anyway): is it imperative to run your own lab? I'm honestly intimidated by that idea...

You can do whatever you want with your MD/PhD. But MD/PhD programs are training you to run your own lab. You go into the program with this intention.