Weighing my options

[Kyper]

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So let me try and gather my thoughts here as best I can.

So as I type this thread out, I am currently serving as an active duty combat medic in the Army and am currently deployed to Afghanistan.

I am a non-trad through and through. I received my Bachelors in Aviation, which halfway through I began to hate flying planes, but had no real idea where I wanted to go in life so I stuck with it and finished the degree. It wasn't until my senior year of undergrad (I'm 24. Graduated in '12) that I realized I was drawn to healthcare and hard sciences. While I was offered a Warrant Officer slot in the Army to be a helicopter pilot, I waived it to be medic because I figured that I should try healthcare before I decided on it as a career. As I've gotten more into it, I've found that this is definitely my calling.

My original plan was to apply for med school, but for the last year or so I've been having a kinda dilemma because practicing medicine isn't all I want to do. Namely, I've found myself actually most interested in doing research in either Human Genetics or Chemistry and wanting to get a PhD in either field to do research. In addition, I've worked with both docs and PA's alike in the Army and I've been drawn to the PA side of medicine because of all the clinical work they get to do and I feel that working as a PA-C would allow me more flex time to go down to a lab to also work on research.

I know there are physician scientists (Jonas Salk is one of my heroes) but it seems that a lot of them can only do one or the other and can't both practice medicine and do heavy research. I'm really looking at trying to balance medicine out with research and feel being a PA/PhD would be the best road for my choice. I don't think I could do just one or the other. Could someone enlighten me on the validity of this thought process? I'm just trying to get every straight before I commit to anything because I don't want to be sitting down the road in ten years hating my schooling choices. I've done too much of that already.

I don't care about money, I have plenty already and if I cared much about it I'd still be flying planes.
I am just legitimately interested in science and want to learn more about it until I die.
Any response would be appreciated, thank you.

 

[Zenman1]

Do what your heart tells you, not your brain. I got started in healthcare as a medic and now I'm working in BH at an Army post as a Psych NP. I love my job and the only research I do is related to my hobbies. I will read research articles with a jaundiced eye though. Are you considering going PA route through the military?

 

[Kyper]

Do what your heart tells you, not your brain. I got started in healthcare as a medic and now I'm working in BH at an Army post as a Psych NP. I love my job and the only research I do is related to my hobbies. I will read research articles with a jaundiced eye though. Are you considering going PA route through the military?

Yes, I am dropping my IPAP packet this year for Class of 2015 but I am also sending out MD/DO applications (I have completed the undergrad prereqs for both PA and Doc) so as not to limit my options.

That's the big thing though, I'm not sure which one I want. Neither heart nor brain can come to a decision. The logical choice would be Doc simply because even if I end up not enjoying as much as I would've enjoyed being a PA I'd still be at the top of the food chain, but if I cannot contribute to the scientific community as a whole, I'll feel like I wasted a large part of what I wanted to do with life. Somedays I'm gung-ho about med school and other days I can't wait to be a PhD/PA and now that I'm sending out applications, it's getting closer to decision time.

I guess I should wait until I see what I get back, but again, I just don't want to end up regretting every decision I've ever made. I already regret flying planes as a career for any amount of time.

 

[Makati2008]

Both paths are fine but I would shoot for the MD if you want to do research and clinical medicine. Just go into academics where you have x amount of clinical time with y amount of research time. Also your pay would be significantly higher than that of a PA/PhD I assume?

 

[drcrispmd]

Why not an MD/PhD?

 

[Kyper]

Why not an MD/PhD?

As stated above in the first post. It seems that a lot of them can only do one or the other and can't both practice medicine and do heavy research. I'm really looking at trying to balance medicine out with research.

 

[Kyper]

Both paths are fine but I would shoot for the MD if you want to do research and clinical medicine. Just go into academics where you have x amount of clinical time with y amount of research time. Also your pay would be significantly higher than that of a PA/PhD I assume?

I'm sure it would be, but I don't care about pay. I have no debt and even if I did MD/PhD, I wouldn't have any debt after graduating. If I cared about money, I'd still be a pilot.

 

[drcrispmd]

I don't see how a PA would make splitting your time easier unless you did part time urgent care or worked for an MD doing their research. An MD can set their time easier than a PA when it comes to reseaech. What kind of medicine do you want to work in. That should also figure in to whether to do MD or PA. What type of research?

 

[core0]

I don't see how a PA would make splitting your time easier unless you did part time urgent care or worked for an MD doing their research. An MD can set their time easier than a PA when it comes to reseaech. What kind of medicine do you want to work in. That should also figure in to whether to do MD or PA. What type of research?

This. In an academic environment, you are expected to do a certain amount of research as an MD. As a PA you are expected to do clinical work. Grant funding is easier to get and the mechanisms to support you are much more established. The nature of the work is different also. PAs tend to do shift work while MDs do blocks of time supervising residents. The MD blocks tend to be much more conducive to doing research than the shift work. As a PA that does research there are few of us with PhDs. I'm getting ready to head back for my PhD after 13 years. I'm also just getting to the point where I get protected time.

Its possible to do this as a PA but much harder. You would either have to luck into a position where you could do both or get a part time job as a PA and a part time job in research. Also consider as a physician you come out differentiated, where as a PA the differentiation occurs after PA school. You spend the first 2-5 years getting good at your field. After that you could consider dropping back and doing research (and most of this will be workforce or non bench research). On the other hand someone who does a MD/PhD will usually be given some research opportunity during residency and most likely department support (if you have a good track record) once hired.

If you want to do clinical medicine (especially in a variety of fields) then PA is a great career. If you want to do research (especially hard science) then its not a very viable route.

 

[Kyper]

I don't see how a PA would make splitting your time easier unless you did part time urgent care or worked for an MD doing their research. An MD can set their time easier than a PA when it comes to reseaech. What kind of medicine do you want to work in. That should also figure in to whether to do MD or PA. What type of research?

For medicine I was looking into either ortho or endocrine. Research fields for genetics would be functional genomics or human genetics. For something like micro I'd want to focus on cell life cycles, apoptosis, and the like.

 

[MedStud!]

I typed the below response before reading the entire thread... so I'm echoing what others have said above:

I'm finishing an MD/PhD program now and definitely intend on both seeing patients and doing translational research. Both can absolutely be done well and I know several physician-scientists that do both basic science and are writing clinical trials... and being successful in both. That being said... it is more difficult in certain specialties to do both successfully, namely any surgical specialty because it requires you to be in the OR so much. The vast majority of MD/PhDs that I see get stuck only doing clinical work are surgeons. Otherwise, how the time is split up depends on your specialty and you (AND YOUR FUNDING!). Some inpatients specialties will have it split up where you serve as an attending for two weeks several times a year. During those two weeks you will likely not be in lab... but other than that you are pretty focused on research. Ambulatory specialties may give you one or two clinic days a week and you are in lab the other three days. Some specialties like pathology can allow you to do your work in the office. Generally, the more time you spend in lab the less you get paid because you aren't bringing in money by seeing patients or doing other clinical work. Some people will carry heavy clinical loads and still have successful labs... but they don't see their family. One phrase I have heard about being a physician-scientist is "Clinical Excellence, Research Excellence, Family... Pick Two." That is not entirely true because I know people that have all three... but the "Clinical Excellence" part ends up being in only on specific disease site or process.

As far as going PA/PhD... I'm not sure what to advise about that route. I've never seen it done before. One of the advantages to having an MD/PhD and board certification in a specialty is that you can use your expertise in that field to direct your research in the lab. You would certainly get a good breadth of human pathophysiology in PA school but it won't be near the depth you would get from board certification. Also, if you manage to get into an MSTP then you will have tuition paid for and a yearly stipend. But... you must be competitive enough to get into medical school of course. Be sure to apply widely regardless because MSTP spots are even more competitive, and you will absolutely have to have some prior experience in research to even be considered. I had to do two years research full time after undergrad in order to be considered.

Do you just want to work "in" someones lab or do you actually want to direct the research? Be forewarned that investigators don't really hire people to split time between clinic and lab. If someone hires you to research, then they will want you in the lab full time. So if you want to split your time as a PA/PhD or MD/PhD you would have to be the primary investigator and have the funding to justify it. If that is truly your goal... be sure to look heavily into whether or not a clinical department would even hire you to split your time as a PA/PhD. If you have a ton of grant funding... anyone will hire you bottom line. But most people don't have funding in this currently awful environment and end up needing some start up funds. If someone is a board certified MD and they fail at obtaining funds... they can stick you in the hospital or clinic to bring in money in the meantime. My gut tells me they might not be as excited at keeping an unfunded PA around so be sure to look into the viability of that route.

 

[MedStud!]

Also... you don't absolutely need the PhD to do research as an MD, so if you do not have prior research experience I would actually advise against applying to MD/PhD. You won't get any interviews and it will simply delay your MD application. But you will have to put the time in during your summers doing research and then you could apply to research track Physician Scientist Training Program residencies that include research and fellowship (PSTP).

One more thing... send your application out as soon as AMCAS opens. Return your secondary applications within 24-48 hours. I can't even stress how important this is. It could be the most important thing you do for a successful application.

 

[MedStud!]

You should consider USUHS among your schools. You would probably be a shoe in as an Army medic. They also have an MD/PhD program... but the payback after you graduate might make it difficult to continue research unless you can get a military research position.

http://www.usuhs.mil/graded/doctoral.html

 

[Kyper]

I am also applying to USUHS but I'd doubt being a shoe in. USUHS is more competitive then most civvy schools. And I never really considered doing research without a PhD. Didn't think MD's really had time to do any at all.

 

[MedStud!]

There are tons of MDs that do heavy basic science research... probably just as many as the number of MD/PhDs; if not more. That is an important thing to understand about doing basic science as a career... it really doesn't have much to do with whether or not you have a PhD. It has to do with FUNDING. If you are an MD/PhD with no funding, you won't have time to do research because they will stick you in the hospital/clinic to pay your salary. MDs can definitely do research... but they have to put in the time to be trained in science by spending their summers in med school doing research, doing research in residency and then during fellowship. Then, if they can get published and get grants they can justify a career in science. If not... they go back to the hospital and never see the lab again.