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What is the point of the MD/MS?

Discussion in 'Physician Scientists' started by DeadCactus, May 12, 2007.

  1. DeadCactus

    DeadCactus SDN Lifetime Donor
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    I'm just a bit unclear at what kind of career an MD/MS is designed to prepare one for. Obviously, it seems to be a middle ground between MD/PhD, but what benefit does it offer?
     
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  3. RxnMan

    RxnMan Who, me? A doctor?
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    Kinda like your MD gives you unlimited access to patients, a PhD will give you unlimited advancement in research. In my mind, the MD/MS is a good option because (if you work hard and are in a good program) it gives you 90% the skills of the PhD, a structured research learning experience, and dedicated time for experiments, but you don't spend 3+ years in the program like a PhD student would. Assuming you're talking about a thesis-based MS.
     
  4. CCLCMer

    CCLCMer CCLCM Alum c/o 2011
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    I am going to a five-year program that has a mandatory MS-level senior thesis. We have the option to get an MS degree through Case (which requires taking some additional coursework) or an MD with Qualifications in Biomedical Research (thesis but no extra coursework).

    I think the biggest benefit of a program like this is the time savings. Obviously, since we only do 1.5 years of research, we finish a lot sooner than MD/PhD students do. (Here at Case, the MSTP students typically take seven or eight years to finish compared to five years for CCLCM.) Also, if you're interested in doing clinical research (which I am), an MD/MS program might be more amenable to that. A lot of MD/PhD programs focus more on basic science research, especially MSTPs. I'm sure you can find a way to do a clinical research PhD if you really want to, but that's not how most of those programs are set up. If you do want to do basic science, you can do that at CCLCM too though. But I think if you want to be a basic science researcher, it might make more sense for you to get a PhD.

    I assume you're in college and trying to figure out where to apply? I guess the question you have to answer is how much clinical stuff you think you want to do. You can have a mainly clinical career after an MD/PhD if you want, but a lot of them don't. No one has graduated from our program yet (the first class is just starting their fourth year). But anecdotally at least, a lot of CCLCM students want to go into surgical and procedural specialties (possibly with some clinical research) and not bench research. So I think that's maybe the biggest difference. Our focus is very clinical compared to an MD/PhD and very researchy compared to a regular MD. Yeah, like you said, it's kind of a hybrid or middle option.

    What you could do if you're not sure right now is apply to both kinds of programs. If you're applying to the Case MSTP, you might as well apply here too, because it's free to add CCLCM to your secondary. Then you can figure out later which one you'd rather do after you have a chance to visit and see what the programs are like.
     
  5. DeadCactus

    DeadCactus SDN Lifetime Donor
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    Thank you CCLMer, that helped a lot.

    Yes, I still have a year to go before I start applying, but I am trying to figure out what kind of programs I want to apply to.

    My problem is that while picturing what I'd like a typical week in my career to be; the idea of spending 60 to 80% of my time doing basic science research (in biomedical engineering to be specific) and 20 to 40% practicing clinical medicine is very appealing and seems perfect for my interests.

    On the other hand, I want to get involved in things like wilderness medicine, international medicine, Doctors Without Borders, etc. I'm unclear on whether this would be possible as a basic science researcher. It seems like responsibilities involved in running a lab would keep you from being able to take off the time needed to do things like Doctors Without Borders.

    I was looking into MD/MS programs hoping that perhaps they would be a way to still be involved in biomedical engineering, but with fewer responsibilities to a lab and thus more time to do things like Doctors Without Borders, wilderness medicine, etc...
     
  6. CCLCMer

    CCLCMer CCLCM Alum c/o 2011
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    Hmm, I don't know how easy it would be do to things like Doctors without Borders or wilderness medicine if you're a basic science researcher. The bench researchers that I know don't do things like that, but maybe they just don't want to. It wouldn't be a common thing I guess but probably someone has done it before. I guess if you do EM like you were talking about in the other thread it would be easier to do something like that. Maybe you should post in the EM residency forum and ask if any of them do it.

    If you're interested in BME, Case is a school you should look into for sure. Engineering is pretty big here. You can do a PhD in BME through the MSTP or you can do the CCLCM program and get an MD/MS in BME. I know at least one of my classmates is doing the MD/MS in BME. There are several people in my class who were BME majors in college and some who came in with BME masters already. And one of the new M1s starting in July has a PhD in BME already. But like I said before, if you're not sure whether you want a PhD or an MS yet, just apply to both programs and come check them out. The admissions people will even coordinate the interviews so that you don't have to come out to Cleveland twice.
     
  7. qwopty99

    qwopty99 Optometrist
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    i think MD/MS is a great option for an MD who wants to learn and have the research skillset, but isn't committed necessarily to devoting an extra 4 years to get the PhD
     
  8. Neuronix

    Neuronix Total nerd
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    It all comes down to you getting paid. If you can find some way to get paid enough money to support yourself and your family doing 40% clinical, 60% research, and a few months out of the year in Doctors without Borders, go for it.

    Unfortunately, I don't know how this is possible. You make yourself money in the clinical world by doing lots of procedures or at least logging many patient visits. You have to at least cover the large overhead you create for the hospital and then generate the department/hospital revenue somehow. Malpractice insurance, for example, doesn't care if you only practice a few months out of the year. But, the academic places tolerate (and I do think the right word is tolerate) you if you can do one of the two later paragraphs.

    You have to make yourself money in the research world by bringing in grants. Grants are very competitive to get and this makes running your own lab a near 100% responsibility. Working in someone else's lab is possible, but you can't bring in large amounts of grant money yourself. Is it possible to arrange something? Maybe. I've never seen it myself. That's basic research anyways. Maybe you can do clinical research abroad?

    Meanwhile, who's going to pay you to do international work? Does MSF have part time paid positions? Even their full time jobs as a physician are ~50k/year (http://www.doctorswithoutborders.org/employment/). The guys I see doing these things are also 100% of the time out there and either get paid through whoever they work for, attach themselves to a University by research or being a coordinator or something, or manage to find their own funding for their projects. I guess you could spend your two weeks a year of vacation doing things like this. I'm not saying volunteer work isn't a good thing, but you have to take care of your own first. If you don't generate RVUs, don't bring in large grants, and then go volunteer your time, you'll be completely broke unless you find some rich person to finance you.

    You say you want to do all three. If you can figure out how to get someone to pay you to do all these things, more power to you. Most people have a really hard time doing 2 out of these 3. Maybe if you can choose which 2 out of the 3 appeal to you the most, you can pick the right training without spending your whole life training ;)
     
  9. DeadCactus

    DeadCactus SDN Lifetime Donor
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    Not to reply to my own question, but I noticed this article on the SDN main page and thought it was worth posting in this thread:

    http://studentdoctor.net/blog/2007/05/05/humanitarian-medicine-is-it-possible-in-the-academic-setting/

    Humanitarian Medicine: Is it possible in the academic setting?

    By Student Doctor Network
    Posted on May 5, 2007
    Filed Under Medical (MD, DO)

    By Tildy

    The author is a physician scientist involved in multiple research and training grants internationally including being the principal investigator in two international projects funded by the Fogarty International Center (www.fic.nih.gov).

    Medical mission to the villages of BelizeIs it possible for a US academic physician to spend least several months a year working in a developing country?

    There are many medical students and residents interested in this question. International training programs are increasingly common within medical school and residency curriculums as are global health projects (e.g. www.shouldertoshoulder.org/History.htm).

    It has become a given that a number of young physicians in the US will wish to make a major contribution to international health care on an annual basis. The question is – Can this be done within the medical community, especially within academic medicine?

    In general, the academic world will work with faculty physicians who plan to spend time working internationally. If what one wants to do is take a group of colleagues or students abroad once or twice a year for a few weeks to do primary care health and education, it won’t pose a problem for most institutions and they won’t likely ask for salary support to be provided externally. In academics faculty have a lot of control (usually) over their schedule and a few weeks for something like this is relatively easy to arrange. It helps to notify public affairs at the institution and provide them with pictures upon returning to put in the institutional magazine. I’m only half joking about this. It never hurts to work with public affairs to explain to the public the importance of ones work overseas.

    However, beyond spending perhaps 4-6 weeks each year abroad, making arrangements in any setting, academic or private practice becomes much more problematic. Lets look at some of these obstacles and how they might be overcome.

    Let’s consider:

    1. family
    2. personal finances
    3. legal and licensing issues
    4. research support

    First comes family. Now this may not affect any individual’s situation but it does pose an issue for most people. It is a lot easier to be a med student and assume that ones life will work out so that they can spend 3-6 months traveling each year than to be a parent (or spouse!) and try to actually make this happen.

    For many people, it will be best to spend 6 months to 2 years working internationally early in a career (see www.bayloraids.org/corps and www.doctorswithoutborders.org/volunteer/field/ as examples) than to make it work throughout a career. With that initial experience faculty are prepared to work within their career goals (e.g. a tenure track) to develop a more usual 4-6 weeks/year international travel schedule once interests and research areas are established.

    It is also easier to do frequent travel at a later stage of ones family life and career. Teenagers and older children are often much more amenable to a parent being gone for a few months than small kids. It is still not easy, so for those who have or plan to have a family, this is an important issue. Better to think about it up-front and recognize the challenges than just assume that ones loving spouse and 2 children won’t mind living in a place without many amenities for 6 months at a time each year.

    Small girl in remote village of BelizeThe second issue is personal finances. Someone has to provide a salary for each person while they are working abroad. In academics, faculty can find institutions that will work on this but it is not easy and there is no guarantee that faculty will be able to get their institution to provide 100% salary while working only 50-75% of the year. It is possible to work out a system in which one works intensively before traveling each year (clinics, night-call, etc all have to be considered) or have specific funding for the overseas work that will support the salary of those who go.

    However getting international agencies to fund a large amount of salary for an American physician is exceptionally hard to arrange (albeit not unheard of). The team from the US may be willing to work for less than full salary, but the university has its needs too such as clinic and night-call coverage and must pay health insurance, malpractice and life insurance and provide office space throughout the whole year. Again, this is doable, but will involve some challenging negotiations.

    It sounds easy to say that if a faculty member usually does 5 months each year of hospital work, they can just do them back-back over 6 months and then go off to see the world! This is a lot harder to do in reality and even then doesn’t account for the other tasks that will be left undone during that time such as committee meetings, teaching classes, etc.

    Third are technical issues including licenses and working with the foreign government. If an American physician is going overseas for a long-term arrangement, or trying to set up a clinic somewhere, they’ll need to think about these issues.

    I’ve never obtained a medical license in another country, but I’m told it isn’t always easy. Malpractice concerns may not really exist in some developing countries, but they exist in a lot more places than one might expect. The faculty will need to consider how the government might feel about an American setting up shop there. In some areas the Americans could be seen as competition for the local doctors and this could pose issues. As in the US, the more urban the practice, the more likely one is to have a problem.

    Language issues are likely greater in a rural setting. I have seen physicians in The Gambia who were from Cuba and spoke only Spanish, working in a country where the health care system was almost entirely conducted in English, and the people spoke only Mandinka (en.wikipedia.org/wiki/Mandinka_language). Not much communication going on there! But if truly rural, what about spending several months every year without much electricity, potable water and the like? Remember, the locals mostly don’t want to work there either – same issues as rural health care in the US.

    Last is the issue of exactly what one is going to do there academically (teaching and research) and who is going to support the actual work that is being done. If it is a pure clinical practice, the American physician will need to find money to support the building, staff, and medications. I know academic physicians who spend much of their time while in the US fund-raising for their overseas clinic. If it is research-related one will have to go after grants and deal with ethical issues that are considerable. These grants can come from foundations, from companies, or from governments.

    If one has a background in public health, this will help. Research-related grants in international health, especially from governments are not easy to obtain. US funding agencies often focus on the needs of the underserved in the US and overseas agencies may not be enthused to fund an American working abroad in this area. They may be more focused on large international groups and projects. One needs to find a niche, a unique research area based on ones training and skills. These exist (tropical medicine, HIV, nutrition, etc), but one needs to have a track record of research or work for someone who does.

    American physicians and scientists can consider working on pharmaceutical trials. However this too is challenging. Clinical research has to be done under “Good Clinical Practice” www.fda.gov/oc/gcp guidelines, which isn’t easy to do in many settings.

    In summary, we are at a time of tremendous interest in physicians from the US working overseas in clinical care settings and in education and research. Short-term projects can be readily accomplished and contribute substantially to the health-care of some of the world’s poorest people.

    However, for an American academic physician to spend a large portion of their time overseas doing medical care and research remains very challenging to arrange. Medical students and physicians-in-training should have a realistic understanding of the obstacles they face in this area and develop realistic personal and professional goals.
     

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