What is the point of residency for MD/PhD?

[Marquis_Phoenix]

There seems to be a disconnect... if one wishes to do basic science research.

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[TheCybermen]

There seems to be a disconnect... if one wishes to do basic science research.

Sure -- but you did four years doing that during your grad school years and it's important to remember that 50% of your education went toward being a clinician in addition to the 50% that went toward being a scientist. These percentages vary based on what kind of practice you intend to establish for yourself (i.e. time in lab vs. time in clinic vs. other combinations) and what sort of expertise you wish to command. At the end of the day, though, as one MD-PhD program director told my group of interviewees this past fall, "We're training you to be physician-scientists. You're not going to be physicians. And you're not going to be scientists. Youre going to be physician-scientists." Talk about hammering a point home.

Anyway, that said, it's important to note that there ARE specialized residency programs that fall under the label of "fast track" where the LENGTH of the residency program is not less, but the setup is a bit different.

For example, a fast track Internal Medicine - Medical Genetics tends to be a five year program. Normally, three years of internal medicine would take place in the clinic, but for MD-PhDs doing the fast track only two of those three (with the third year optional) are spent in the clinic. The third is spent in the lab. The final two years are geared toward integrating your clinic and lab work as part of the post-graduate fellowship program (in this case, Medical Genetics; other combinations are also possible, see FREIDA).

Not all specialties have fast tracks at the present time. Oncology, for example, is still one that requires a 3 year categorical internal medicine residency followed by a 3 year post-doctoral fellowship (again with the time here spent 50/50 clinic/basic science).

Ah, also to touch on a point that does come up often, a residency is NOT required if a career in basic science is what you decide you'd like (i.e. 100% basic science). Simply do a post-doc fellowship as many other PhDs do.

Can anyone else chime in here? I'd be interested to hear what others think.

 

[Dr.Watson]

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[TheCybermen]

In that case, what's the point of the MD if one wishes to do [only] basic science research?

Well the answer to that is simple. Assuming you're referring to the single degree, there is none (at least not in 2007).

 

[Circumflex]

There seems to be a disconnect... if one wishes to do basic science research.

This is true. In response to the question in the thread - I am doing residency because I love clinical medicine and basic science. I enjoy both and I want to sculpt a career that includes both. My career may lean more toward clinical or basic science at various points in my life, but that is the advantage of doing both.

 

[chrisisinnocent]

There seems to be a disconnect... if one wishes to do basic science research.

Because an MD without residency is completely worthless.

 

[Dr.Watson]

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[mdphdhopeful]

well. you do learn medical stuff during the 4 years of med school. that colors the research you conduct. so not pointless

 

[greg12345]

Oh man, do not do the MSTP if you just want to do basic science research, it will kill you.

 

[Hard24Get]

well. you do learn medical stuff during the 4 years of med school. that colors the research you conduct. so not pointless

That's pretty inefficient - 4 years, and for what? There are tons of opportunities for basic scientist to "learn medical stuff" through various training initiatives to encourage cinically-relevant research. If you just want "coloring" this is all you need.

A true physician-scientist practices both clinical medicine and research, because practicing medicine makes it clear what advances are needed and what questions need to be answered, as well as giving insight into the biological processes underlying disease. You can't do this without residency training unless you plan on showing up to rounds and acting like a medical student for the rest of your life.

Obviously, if you have decided you don't want to practice, a residency is similarly a waste of your time, because either way, as medicine advances, you will become further and further away from current clinical issues a physician-scientist would be faced with everyday.

 

[dl2dp2]

Well the answer to that is simple. Assuming you're referring to the single degree, there is none (at least not in 2007).

This is false.

an MD, even without residency, is not useless. I'd venture to say that an MD without a residency is more marketable than a PhD.

remember as long as you finish steps i ii and iii in a reasonable span you can always come back and do a residency later if you have an MD. this is not an option for a PhD.

 

[dl2dp2]

Oh man, do not do the MSTP if you just want to do basic science research, it will kill you.

Again, common misconception.

a 7 yr MDPhD program will not kill you. (Most of the PhDs in biology takes just as long anyway.)

a common PhD with 3 dozen postdocs and low salary and no end in sight, will.

if you can get into a MSTP, go for it. even if you are only interested in basic research, as long as you are interested in some form of translational research, you should do MSTP instead of PhD. Of course, there's no point in doing an MD if you don't care about medical research. In which case this whole discussion is moot.

 

[dl2dp2]

Yeah, that was a rhetorical question.

Don't bother with the MD years if you don't want to practice medicine (ie continue with residency).

there are plenty of options @ my school for people with an MD who didn't do a residency: MBA, law school, i-banking, pharma, public health.

please don't misinform.

 

[Circumflex]

there are plenty of options @ my school for people with an MD who didn't do a residency: MBA, law school, i-banking, pharma, public health.

please don't misinform.

There is no misinformation in Dr. Watson's statement. He/She did not say that there were no options for MDs other than residency. I think he/she meant that if you know from the start that you don't want to practice medicine, then why go to medical school? Why go through the pain of memorizing endless amounts of information, taking tests all the time, accumulating a lot of debt, taking USMLE Steps 1, 2CK and CS, and 3 if you know that you don't want to practice medicine?

 

[greg12345]

I think it is unwise to do the MSTP just because you can or because it is an option. There is really no need for an MD if you are going to do basic science research with a translational bent - there are plenty of PIs out there who do just that and are straight PhDs. Does it help to have the MD? Sure. Is it worth it if that is your career goal and you have no intention of ever taking care of patients? Not in my mind. My 2cents.

Sluox - What phase of training are you in?

 

[TheCybermen]

This is false.

an MD, even without residency, is not useless. I'd venture to say that an MD without a residency is more marketable than a PhD.

remember as long as you finish steps i ii and iii in a reasonable span you can always come back and do a residency later if you have an MD. this is not an option for a PhD.

yes it's possible, but there are many things to keep in mind regarding differences in the track options.

most of the funding goes to PhDs, with significantly less funding going to MDs. additionally, medical school curricula do not encompass the basic sciences the way they did twenty years ago -- it's simply foolish to believe that the same material is learned in medical school and graduate school classes. fundamentally speaking, graduate level coursework is geared toward training of an experimental nature. medical school coursework isn't; it's designed to produce clinicians, not scientists. this is the reason for which credentials are far easier to establish and protect with a phd. established credentials mean grant money. if you don't have the grant money, you can't compete -- they will take your lab and give it to the investigator raking in more dough, period. i'm not opting for phd over md. i'm opting for md/phd over md if the goal is some degree of basic science research years down the line.

if you want the most practical answer possible without an eye toward funding or future flexibility, pursuing the MD/residency/postdoc or MD/postdoc pathway almost always means a longer post-doc before you are ready to start your own lab. completing these years as part of a PhD degree program affords an additional degree in the process, whereas the fellowship does not.

 

[Dr.Watson]

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[TheCybermen]

But if you already know you don't want to practice medicine, there's probably a faster/easier way to get from today to one's future career than doesn't involve four years in a school that's primary purpose is to train practicing physicians (not what you want to do).

cheers.