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Want to do research, unsure about MD or MD/PhD

Discussion in 'Physician Scientists' started by SN2ed, May 15, 2008.

  1. SN2ed

    Moderator Emeritus 7+ Year Member

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    Never ventured out of the MCAT forum before, it feels weird. Anyway, I also posted something similar in the Mentor Forum's Academic Medicine thread (well not yet, it's being reviewed by a mod first), but I was looking for some more opinions on my situation. Any help would be greatly appreciated.

    I guess I'll start with some basic information about myself since it may impact your opinion. My research experience began in college with trying to find a successful purification method for a particular protein and lasted a year. I really enjoyed the experience, especially when we had to trouble shoot some of the problems we encountered. I'm guessing my purification project was more like basic science research since we were also trying to characterize the protein along the way. After college, I began doing cancer related clinical research with a doctor near my college. I've been working with him since October and will continue until I, hopefully, make it into med school. Additionally, I have a major in philosophy with a heavy chemistry background. I only missed the chemistry major due to a conflict with P-chem and chemistry senior seminar.


    My main problem is that I have no idea whether I want to do clinical research or basic science research. I've read the descriptions and have experienced both, but I still can't decide. I enjoy both clinical and basic science research for different reasons. Either way, I plan on doing cancer research regardless of whether it's clinical or basic science. The doctor I worked with seemed to have a fairly negative opinion on getting an MD/PhD and said I could easily do research with only an MD. That said, I'm guessing he may be a little biased since he's an MD. The information I've read on here seems to indicate that if I want to do clinical research, I should just get an MD and for basic science, an MD/PhD. Next, I'm really worried about the state MD/PhDs seem to be in due to the lack of funding. However, I know this can change in the future. Lastly, I think it would be easier for me, given my experience and MCAT, to get into an MD program as opposed to an MD/PhD.

    Finally, here's my question, should I apply MD or MD/PhD? I was thinking, maybe it's best to go MD, get some more research in med school in both clinical & basic science and decide from there. Unfortunately, my med school advisor (who admitting to not knowing much about the research side of medicine) said it's extremely difficult to transfer into an MD/PhD program. She told me that it would be easier to go MD/PhD and drop the PhD if I don't like it. I can see how this would be easier, but it seems like I would be doing a disservice to the MD/PhD program by bailing out. Thanks for reading.
     
    #1 SN2ed, May 15, 2008
    Last edited: Apr 13, 2010
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  3. Neuronix

    Neuronix Total nerd
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    I agree with this.

    That may be correct. You'd want to get more basic science research before applying MD/PhD anyways. MD/PhD programs are primarily geared towards producing basic scientists and generally want students who will persue basic science PhDs and have a lot of basic science experience. There are clinical research spots if you're interested, but they are rare and more competitive.

    Sounds like a plan.

    I disagree with this. Besides the fact that you're screwing over a program if you drop the PhD (and hence this is unethical at face), you'd also be wasting your own time working on a PhD you never complete. How easy it is to transfer into a MD/PhD program when you join a MD program depends on the school. We generally take several per year from our MD class here.

    But, you don't need to get a PhD now or ever to persue research. You can take a year out during medical school. You can take time out of residency to persue serious research. You can do research fellowships/post-docs to establish a research career and get more experience later. At no point MUST YOU be doing research. My point is that the MD/PhD is not required if you decide to basic science research, so you're not shutting yourself out even if you don't persue that degree. Given your indecisiveness I would recommend you apply for MD.
     
    #2 Neuronix, May 16, 2008
    Last edited: Jun 10, 2010
  4. echod

    echod Junior Member
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    Check out the Cleveland Clinic Lerner College of Medicine. They're offering free tuition to all students now. Not having any debt will make doing research in the future easier.
     
  5. CCLCMer

    CCLCMer CCLCM Alum c/o 2011
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    Ha ha, you stole my line. :p

    Seriously, SN2ed, CCLCM might be a good fit for you. It's a five year research MD program with an option for an MD/MS. You do one summer basic science research rotation and one summer clinical research rotation, and then you do a year-long project with a thesis in either basic or clinical research. Probably most of us will end up doing clinical research, but there are plenty of people doing basic research too. You would have plenty of time to meet potential mentors at the Clinic or at Case before you had to commit to one or the other. Here's the link to the school website if you're interested. http://www.clevelandclinic.org/cclcm/ Or PM me if you have questions.
     
  6. Neuronix

    Neuronix Total nerd
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    Most medical schools will allow you to do this pathway. Though the nice thing about CCLCM is that tuition is covered, only leaving you to loan out your living expenses.
     
  7. SN2ed

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    Thanks for all the help. I'm definitely leaning towards applying MD given your advice and the advice of others.

    In my mind, the MD/PhD spots should go to people that will 90% of the time end up with both degrees. It seems like a disservice to the school and a waste of their resources to take the MD/PhD program and drop the PhD.

    CCLCM sounds really appealing to me. I haven't seen a program like this at the other schools. I will apply there for sure now. There's one small question, with an answer I'm probably overlooking, but what are the differences between the 5-year College Program and the 4-year University Program.

    I'm guessing the 5-year college program is the integrated research program both of you are talking about and the 4-year university program is the typical med school. There isn't another 5-year program, right?

    Thanks again.

    Edit:
    Tildy: I have no problem with working in a lab the whole time. I liked working in my college's lab 9-5 over the summer in college and could easily see myself doing that as a career. I enjoyed working in the lab so much that I continued my lab research throughout the school year and would wander in whenever I had free time.
     
  8. grendelsdragon

    grendelsdragon Synesthetic
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    Hold the phone!


    You received a lot of good advice here, but this decision is far too important to hinge on information you find on a forum. You need to spend more time talking face-to-face with physician-scientists performing basic, translational and clinical research. I'll throw in my 2 cents here as an attending cardiologist and NIH funded basic physician-scientist.


    First. Although the director of NIH (Elias Zerhouni) has repeatedly stated there is a shortage of physician-scientists and the NIH is dedicated to rebuilding its ranks, he is only partly sincere. There is certainly growing support for patient-oriented CLINICAL researchers, but not basic scientists. The overall sentiment is that there is a glut of basic scientists (far too few jobs and resources in comparison to the number of PhDs), and there is a general sink or swim mentality (only the cream of the crop will get funded). This is the sad reality, despite the alarmingly low numbers of junior BASIC physician-scientists. They are given no quarter these days for being a physician also. One reflection of this mentality is that the NIH Loan Repayment Program (LRP) will only reimburse CLINICAL physician-researchers and not basic physician-researchers.

    To get an idea of the general climate for new scientists, take a gander at this article.
    http://sciencecareers.sciencemag.org/career_development/previous_issues/articles/2006_02_03/a_bridge_to_independence/

    Second, do not let the existence of a single program (such as Cleveland Clinic) dictate your career path. There are far too many options and you'll sell yourself short if you have not thoroughly explored the possibilities. Also, a single additional year here or there will not have any substantive impact on a basic science career. The body of work required for a good 1st author publication usually takes several contiguous years of effort.


    The MD/PhD path has the great advantage of having medical school paid for. Otherwise, it may not be the best path for all basic physician-scientists. Because the whole point of being an MD/PhD is to be both a physician and scientist, your research will be discontinuous with clinical training (usually including residency AND specialty fellowship). Most people wishing to be basic researchers will have to start over again after clinical training with additional postdoctoral training. Certainly, this investment in time is easier without being burdened by student loans, but some will find that a productive postdoc may make the additional 4-7 years previously spent on the PhD feel like wasted years. On the other hand, postdoctoral research is far easier without having to worry about med school loans.


    Overall, the path to patient-oriented research is better paved for MDs. They tend to be better funded through clinical and corporate entities, and incremental promotion has well-defined benchmarks. Scientific training for these careers often includes at least an MPH, but those who want to be superior statisticians and epidemiologists usually go for the more prolonged MSc or DSc training in biostatistics or epidemiology, a decision that most people make after medical residency or during fellowship. Many people would choose to not put in additional graduate school time after an MD/PhD. One additional perk for clinical scientists is that they tend to be better compensated (salary-wise) than basic scientists because our compensation packages are often tied with our clinical effort. Those of us trying to stay competitive as scientists try to keep our clinical effort <20%. Patient-oriented researchers often have a more successful chance at productivity with greater clinical effort.


    With all this being said, as a basic physician-scientist, I find the lifestyle incredibly gratifying. For reasons stated above, it is a very difficult path and hard to advocate except for the few who are willing to invest long hours for an initial return that may be quantitatively less than your clinical scientist counterparts. A MD/PhD background will take some financial burden off of you and in the end may make you more competitive for the desirable residencies and fellowships, but it may also make you more unwilling to invest the time for a long but high-yield postdoc, which will be more impactful for a successful autonomous basic-scientist career. You can easily do a postdoc after your MD at any point, but you are likely saddled with student loans, which may not be forgiven through LRP. As you can see, there are no easy decisions here.


    I certainly feel like the privileged few, even in these trying times. I get to see patients and occasionally save lives while also enjoying the rush of experimental biology. You will have to think hard about whether basic research or clinical research is your bag. If you analyze the ranks of medical department chairpersons and academic leadership, many will have basic science backgrounds. So even though the path is difficult, the long term dividends can be worth it.
     
    Wolverine2017 likes this.
  9. achamess

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    Very insightful post grendelsdragon. Thank you!

    For those of us seriously entertaining the idea of becoming a physician-scientist, it is so important to know just exactly what we're getting ourselves into.
     
  10. Newmanium

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    Wanted to also chime in with thanks for that post grendelsdragon - extremely helpful.
     
  11. echod

    echod Junior Member
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    Probably most of us will end up doing clinical research

    Is clinical/translational research what the CCLCM is pushing for? Or is it aiming to train basic physician scientist?
     
  12. Tildy

    Tildy 12 yrs old, feels like 84
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    Thank you for a wonderful post. Please take a look at the academic medicine mentoring thread and feel free to contribute!

    Although I understand what you are saying above, I want to clarify that the Loan Repayment Program has 5 components.

    http://www.lrp.nih.gov/about/5lrps.htm

    Both the pediatric research and the clinical research components must have some "human" tissue, etc involved (See the link for the exact wording), but having had the opportunity to read many of these applications, the connection to what most would call "Clinical research" can be somewhat tenuous. That is, a lot of what is being done is entirely laboratory based cell and genetic research that is certainly pretty close to being "basic science." I certainly think they would reject some projects as being too basic, but I don't want folks to think that a large amount of lab-based research, including pharmacology, etc wouldn't qualify at all.
     
  13. grendelsdragon

    grendelsdragon Synesthetic
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    Hi Tildy,

    Thanks for the clarification and insightful advice as usual.

    Certainly, an LRP application can definitely be nuanced to accentuate the patient-oriented features of an otherwise basic line of investigation. However, there is no questioning that the spirit of the LRP program for Clinical Research is meant for "clinical research" (notwithstanding the other 4 programs).
     
  14. SN2ed

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    grendelsdragon

    Thanks for the great post.

    I'm not going to let CCLCM dictate my career path for the reasons you mentioned, but I thought I should apply to them.

    My indecision about what field of research and what program I want to go into has made me lean towards applying MD. I figure by going this path I can do research in the various fields (basic, clinical, and translational) while working with MD/PhDs, get a feel for what they do, and talk with them about the program. If I decide an MD/PhD is for me, then I would transfer into it. Do you think this is a bad idea?

    Edit: Dang just missed you.
     
  15. RxnMan

    RxnMan Who, me? A doctor?
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    SN2ed - You've had some great responses here (grendel's is very good), but I'll add my little piece. I'm going MD-only and I hope to have a career as a scientist and a clinician. I earned a MS prior to medical school and I have a good deal of research experience already, so I decided that I did not need (nor did I want to go through the effort of,) a PhD to get me where I wanted to go. I've done work in both basic science and clinical research, and from my experience, it seems that there's more money and career support in clinical/translational research.

    Can I pilot a lab on my own? No, but I can be a productive member of a research team, and because I also want to practice, that division of effort is a good fit for me.

    In an ironic turn of events, I've decided to apply for year-off programs like Doris Duke and the NIH's CRTP this year because I want more training. :laugh: Take a look at the Research Forum FAQ and you'll see that there are many year-off programs that, while they may not be integrated like CCLCM's program, there are many excellent research training opportunities for MD students.

    In any case, if you have an idea of what you want your practice to be like, perhaps that will help you decide.
     
  16. grendelsdragon

    grendelsdragon Synesthetic
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    Not a bad idea. People undergoing medical training decide to pursue an additional PhD at many different junctures in their careers. One of my close friends decided to do a PhD after clinical fellowship. He ended up with a very nice faculty position at a top medical school with his own lab. Mind you, he also did a highly productive postdoc after his PhD. You can do the math in years of commitment (MD, then IM residency, then clinical specialty fellowship, then PhD, then postdoc). It's a long road. The only major drawback for these types of individualized pathways is that the MD portion is not paid for (a with MSTP), and you have to try for the Loan Repayment Program (see above).
     
  17. CCLCMer

    CCLCMer CCLCM Alum c/o 2011
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    I wasn't suggesting that CCLCM was the only program that could fit SN2ed's needs, just that CCLCM is an option that might be a good fit. It seems like a lot of people who might be interested in the program don't know about it. They either find out about CCLCM on SDN, or else they see the extra box to check on their Case apps. That was how I found out about it too. So even though I do think SN2ed should check out CCLCM as an option, I didn't mean to say that it was the only option or even the best one. I think we agree about exploring all of the possibilities, but you have to know what possibilities exist first before you can explore them!

    Oh, and I thought your post was really interesting and helpful too, grendelsdragon. Thanks for writing it.
     
  18. RxnMan

    RxnMan Who, me? A doctor?
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    I've talked to some fellowship program directors, and their fellows have been able to wipe out their debt in 4 years this way.

    Also, the NIH's LRP are a major source of $$$, but not the only one. You can get loan repayment at the state and nat'l gov't level for primary care specialities (Peds, IM, FM, EM). These are not the cadillac of LRPs like the NIH's, and they are based off of practice, not research, but they they make the sting a little less.

    As an open question to the forum - assume you are a Pediatrician (or IM or EM) and you're doing a research fellowship. You qualify for both NIH LRP and state-supported primary care LRP. Can you stack them?
     
  19. SN2ed

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    Just to give you guys an update. It's now pretty much even between people who say I should go MD and people who said I should go MD/PhD. I've talked with the doctor (MD) I do research with, my pre-med advisor, an MD/PhD student, an MD student, a researcher at UCLA, and you guys. It's split down the fairly predictable lines with the doctor I do research with and the MD student saying MD & my pre-med advisor, the MD/PhD, and the researcher suggesting MD/PhD. Then there's also you guys where if I add up all the people here, the balance would be tipped towards MD. Ugh, here's to hoping I'm making the right choice by going MD.
     
  20. QofQuimica

    QofQuimica Seriously, dude, I think you're overreacting....
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    If you do an MD program now, there's no law saying you can't pick up a PhD later if you decide that you want one. There are plenty of us doing separate degrees. :)
     
  21. jjmack

    jjmack Senior Member
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    if you are having any reservations before you start stay away from MD, PhD programs. They take a very long time and the PhD is not needed for research.
     

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