Very dumb question.

[FutureNeuro328]

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So, I admittedly have a very dumb question (at least, I think it is a dumb one), so please excuse me if the wording on this is poor or the question is in the wrong place. I am in the process of shooting for a combined MD/PhD program (if you are interested in my stats, they are in the physician scientist forum, and I may repost due to the lack of answers and I don't think the question belongs there). During this, I will be pursuing neurosurgery residency, and after that, I will look to pursue a fellowship. I will be roughly 43 years old when this is all done (I am entering grad school at age 27). Does this put me in a bad position career wise being that age and just really getting everything going then?

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[HomeSkool]

So, I admittedly have a very dumb question (at least, I think it is a dumb one), so please excuse me if the wording on this is poor or the question is in the wrong place. I am in the process of shooting for a combined MD/PhD program (if you are interested in my stats, they are in the physician scientist forum, and I may repost due to the lack of answers and I don't think the question belongs there). During this, I will be pursuing neurosurgery residency, and after that, I will look to pursue a fellowship. I will be roughly 43 years old when this is all done (I am entering grad school at age 27). Does this put me in a bad position career wise being that age and just really getting everything going then?

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No, from the standpoint of age that's about what I'd expect. The question I have, though, is why you want to do all this. MD/PhD suggests to me that you're interested in a research-based career; fellowship suggests you want to be clinical. Where do you really want to end up when all your training's done? Extra training programs that don't help you get there are a waste of time.

 

[FutureNeuro328]

No, from the standpoint of age that's about what I'd expect. The question I have, though, is why you want to do all this. MD/PhD suggests to me that you're interested in a research-based career; fellowship suggests you want to be clinical. Where do you really want to end up when all your training's done? Extra training programs that don't help you get there are a waste of time.

Well, I would like to be involved in both in a way. I would like to pursue an MD/PhD because there is a topic I have been wanting to conduct research and testing on regarding cancer for many years now involving bodily nanoparticle colonization. It is a bit much to go into, so I would rather not do so unless I have to. The MD portion comes into play because I later want to go on to be a practicing neurosurgical spinal oncologist (hence the fellowship). I would like to contribute to the fields in both research and hands on. I know, it sounds a bit impractical, but it is what I really want. If you have anything to say on this or any advice for it, I am more than willing to listen.

 

[LizzyM]

MD/PhD programs are meant for people who want to spend 80% of their time in the lab and 20% in clinical service. I do think it would be difficult to be competent at both spinal/oncology neurosurgery and bench research as both are demanding mistresses that will not want you to give any time to the other love of your life. Bench research when you get to the point of having your own lab is not just being competent in the procedures performed at the bench but being skilled in grantsmanship and training/mentoring the next generation of scientists and raising the cash needed keep your lab and your trainees going.

 

[FutureNeuro328]

MD/PhD programs are meant for people who want to spend 80% of their time in the lab and 20% in clinical service. I do think it would be difficult to be competent at both spinal/oncology neurosurgery and bench research as both are demanding mistresses that will not want you to give any time to the other love of your life. Bench research when you get to the point of having your own lab is not just being competent in the procedures performed at the bench but being skilled in grantsmanship and training/mentoring the next generation of scientists and raising the cash needed keep your lab and your trainees going.

Based on your response, I am going to assume that you are suggesting that I choose one or the other, research or practice. If I am wrong, please correct me. With that being the case, could I still get involved in in depth research during a stand alone MD program? On top of that question, when evaluating which schools to apply to, would I evaluate them the same way I would my MD/PhD schools of choice?

 

[LizzyM]

It is possible to do bench research with only the MD. Some MDs do a research fellowship after residency to further hone their skills.

Some state schools are less open to MD-only applications from non-residents (UWashington, for example) but otherwise, the schools you've chosen for MD/PhD are reasonable choices for MD-only.

 

[RandomChance]

I'm currently at a top-ranked research institution and many of the PI's are just straight MD's that have a strong connection to the field. It is very possible to focus on getting into a research-loving MD program, completing your training, and then entering into the research side later-on in your career after you've become more comfortable with the work. If you were obtaining multiple grants or awards like R01's for your department, I'm inclined to think that they would be more than comfortable with the idea of throwing you more bench time.

 

[FutureNeuro328]

It is possible to do bench research with only the MD. Some MDs do a research fellowship after residency to further hone their skills.

Some state schools are less open to MD-only applications from non-residents (UWashington, for example) but otherwise, the schools you've chosen for MD/PhD are reasonable choices for MD-only.

This is good to know! However, I must say that the combined in which I can do both for at least a while still vastly draws my interest more. Would it be reasonable for me to go on with my plan to pursue a combined MD/PhD, but then upon completion of the program, enter residency, complete fellowship and go on to practice or in your opinion, would you see that as useless?

 

[Phile98]

This is good to know! However, I must say that the combined in which I can do both for at least a while still vastly draws my interest more. Would it be reasonable for me to go on with my plan to pursue a combined MD/PhD, but then upon completion of the program, enter residency, complete fellowship and go on to practice or in your opinion, would you see that as useless?

You clearly want to be more of a clinician. It is a bad idea to go for a PhD. Just get the MD, and you can perform research liberally as you wish. Just my 2c.

 

[LizzyM]

This is good to know! However, I must say that the combined in which I can do both for at least a while still vastly draws my interest more. Would it be reasonable for me to go on with my plan to pursue a combined MD/PhD, but then upon completion of the program, enter residency, complete fellowship and go on to practice or in your opinion, would you see that as useless?

It would be very disappointing to your program and could hurt your alma mater going forward in terms of continued funding for the MSTP (MD/PhD) program. If you aren't 100% committed to be a physician-scientist, leave that for those who see that as their life's work.

 

[LilKangaroo]

Not really sure why so many people are saying that you clearly want to be clinical because you want to go into a fellowship. My PI in medical school did BS -> MS -> MD/PhD -> Plastics -> Peds Fellowship. Ran a wet bench lab on for wound healing while doing a ton of surgery. He was also very involved with his family and overall very happy. One of my good friends did MD/PhD -> ortho and is planning on doing a peds fellowship and possibly a foot and ankle fellowship and plans on running a wet bench lab as well. So it’s not unusual or impossible to want to do research and fellowship based practice in a surgical sub speciality. In fact, I think it makes sense to be a clinical expert as well as a theoretical expert in your field. Would be weird to do a bunch of cancer research and have only a small portion of your patient population with the condition you study. Likewise, if you’re a clinical expert you should be keeping up with the science, easy to do if you’re performing it! Goes hand and hand for me.

If you really have the passion for your specific research topic and are sure you want to run a lab, there are lots of advantages to getting the PhD including great mentorship, more time to learn specific techniques and widen your personal repetoire, and more time to get abstracts, etc, which is overall good experience for your future. Also, a lot of fellowships have a research component to them, so I don’t think pursing a fellowship and research are incongurent.

That being said, MDs do run very successful labs, but from what I’ve seen it’s pretty administrative and big picture while hiring lots of PhDs to kind of work out the kinks of the technical part of the research.

I guess back to the original question, I think you can do it and be happy and successful. Lots of MD/PhDs end up becoming primarily clinical, but just because that *might* happen in the end doesn’t mean that all of the contributions to science and medicine you made on the path aren’t incredibly valuable. You also have to be okay with having a lower income for awhile, but really the salary is very comfortable and more than a lot of people are making anyway. You also have to be a master of time management to be able to balance it all, but I’ve seen it been done time and time again, so again, not impossible. Just gotta be disciplined and dedicated.

Good luck to you! Do what feels right, no regrets.

 

[moggat]

It sounds like you want to research one specific question, not pursue a career in scientific investigation. In that case, I really don't think the MD/PhD is going to be the right choice. As everyone above has said, you can conduct research with an MD alone, it's what a lot of fellowships are for. The PhD will teach you how to conduct BENCH research. If you're interested in pursuing clinical research and just one specific question, then stick with the MD only. If you're interested in pursuing bench research, but only for your one interest--still don't get a PhD. PhD training (and postdoc) is about researching what your PI wants and learning how to be a good scientist. Don't get a PhD unless you really want to be a scientist; if you just want to do research, an MD is fine.

 

[HomeSkool]

If you aren't 100% committed to be a physician-scientist, leave that for those who see that as their life's work.

I agree 100%. I actually received a fully-funded MD/PhD offer, then declined it after I did some soul-searching and realized I was seeking the PhD for the wrong reasons. I'm now a clinician involved in clinical research, and I have no regrets about leaving the PhD behind. I got what I really wanted and freed up the MD/PhD spot for someone who'd actually use it.