What Questions to Ask Youreself: MD-PHD vs. MD

[Wolverine2017]

After reading a half dozen MD vs. MD/PhD posts, I wanted to put up my own dilemma since I don't think what I saw really addressed my doubts. I want to be a physician, that much I know. However, I also have a fundamental appreciation of basic science and the steps it takes to bring us closer to a better treatment for all patients, and towards extending our knowledge as a species. Given these dichotomy of interests, I think MD or MD/PhD would be ideal (I don't think I have narrowed enough interests to do a masters and be an effective scientist).

I am hesitant to apply to MD/PhD basically because the 80/20 rule. I want to be a clinican equally as passionately as I want to be a scientist, and it frustrates me that the typical MD/PhD life doesn't match that. So I guess, Question #1 --> Is 80/20 canon, or is there more variation. Closer to 50/50. I expect research will demand a different sort of time than being a clinician.

I think my ideal life schedule would be the following - is this MD or MD/PhD?:

Morning ------------------- Afternoon​

Monday: Clinic ---------------- Research/Lab/Writing
Tuesday: Research/Lab/Writing -------------- Research/Lab/Writing
Wednesday: Clinic -------------- Clinic
Thursday: Research/Lab/Writing --------------- Research/Lab/Writing
Friday: Clinic ----------------- Research/Lab/Writing
Saturday: Clinic ----------------- (OFF)



Question #2 --> Would there be time for adovating and volunteering? Maybe I am just an dingus, but I would also like to work in a poorer inner city (Cleveland, Baltimore, Cinncinatti). Is it possible to fit this stuff in? Again, I think being a physician is more complex

Question #3 --> My chances. I think I am a significantly better medical applicant than MD/PhD applicant. Although I have done 9 months of clinical research and 2 years of lab research, I have mostly worked in the role of a technician or data miner. I have a 3.98 GPA, Cell and Molecular Biology Major, and am planning on taking the MCAT in a month. I have no clue where the hell I am going to get my science LORs since my smallest science class was around 200 people. Further, my PI is a PhD who I am nervous about the strength of his LOR - again because I worked in more of a tech role. I am not sure I convinced him I am a budding scientist. I am also considering switching to a Chemistry lab working on ncRNAs, which will officially make my relationship with my PI more shaky (his lab is closing in 4 months so I am trying to get out to do an Honors Thesis ASAP)


Sorry for the long post. Please don't hate me if I put this in the wrong place.

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[Lawpy]

1. 80/20 rule is about right for MD/PhD. 50/50 is best served as an MD-only researcher, plenty of which are very successful

2. Unlikely. An MD/PhD student would most likely be too busy to be in the clinic and spend much of the time focusing on lab work/grantwriting etc. A desire to focus more on the clinic and save lives is characteristic of MD student.

3. It'll be difficult but you can try

4. So far it looks fine but i can't say anything more without the MCAT score. Your research background looks shaky and unfocused to be aiming for MD/PhD especially since you are concerned about your PI LORs which are critical.

Honestly, it looks like you are much more interested in the clinic/patient side of medicine with a desire to focus on research. MD-only is the best way to go with a focus in academic medicine.

 

[claduva94]

"I want to be a physician where I am in clinic and on rounds kicking ass, saving lives, and taking names" isn't really something any realistic med student believes they will do and to be honest that isn't enough of a "why medicine?" If that is all you have I suggest a straight up PhD.

 

[HybridEarth]

I know a few MD PhDs who do 60/40 splits with clinic and research. However, the research is not wet lab stuff, which takes considerably more effort in most cases. You'll need a really solid team to manage a 50/50 schedule doing wet lab research while seeing patients. Do note that as a lab PI, you'd probably be running very few experiments yourself

 

[Krupke]

I had a similar dilemma at one point, but I would say for you to take a gap year to do research and see what you think then. You don't seem to really have too much research experience. You should see if you like doing stuff like reading the literature, planning the experiments, being in a lab-time full-time before you commit to the PhD. I think you might also run into trouble getting into funded MD/PhD programs if your only research has been as a tech

If you do really well on the MCAT, with your GPA, you'll be in a good position to get into a good academic MD school though

Edit: I decided MD only because all the MD/PhD students I work with want to be researchers with clinical work tacked on, whereas I want to be a clinician who contributes to progressing the med field through research

 

[Wolverine2017]

"I want to be a physician where I am in clinic and on rounds kicking ass, saving lives, and taking names" isn't really something any realistic med student believes they will do and to be honest that isn't enough of a "why medicine?" If that is all you have I suggest a straight up PhD.

I only meant that as citation of something I have loved while being given the opportunity to be in the hospital. You have never gotten that rush? Thanks for your feedback!

 

[Wolverine2017]

I had a similar dilemma at one point, but I would say for you to take a gap year to do research and see what you think then. You don't seem to really have too much research experience. You should see if you like doing stuff like reading the literature, planning the experiments, being in a lab-time full-time before you commit to the PhD. I think you might also run into trouble getting into funded MD/PhD programs if your only research has been as a tech

If you do really well on the MCAT, with your GPA, you'll be in a good position to get into a good academic MD school

What did you decide and how did you end up making that decision? Did you take a gap year?

 

[Krupke]

What did you decide and how did you end up making that decision? Did you take a gap year?

I added an edit to my post as you were responding, sorry about that

But I'm on my 2nd gap year now and will be starting med school in the fall

 

[Wolverine2017]

I really appreciate your input. I think that is a awesome distinction to make. I feel as if MD-------MD/PhD-----------PhD is a spectrum. I have met people with an MD/PhD who lay closer the MD and met others who said "I probably could have just done a PhD and been happier". I am definitely on the other side.

 

[claduva94]

I only meant that as citation of something I have loved while being given the opportunity to be in the hospital. You have never gotten that rush? Thanks for your feedback!

Briefly. It is very romanticized and you see ultimately that it is only a small part of what medicine is. It's a rush. But it doesn't change the fact that you AREN'T saving lives. You are just elongating. And once I made that admission it became a lot less flashy.

As a side note, every MD/PhD student I have talked to regrets it simply because there are few things you cant do with just the MD, the opportunity cost is not in your favor, and as a whole it doesn't end up as expected (people are excelling as just MDs and PhDs. Excelling in both would just take too much time).

 

[Cyberdyne 101]

@Lucca, donde estás?

 

[URHere]

I may just be old and jaded, but there is honestly no MD/PhD "canon" these days. With research funding as abysmal as it is, most MD/PhDs I know have chosen 100% clinical careers, or careers where they spend trivial time on clinical projects. Sure, there are some MD/PhDs living the dream and running labs with their R01 awards, but they are the exception, not the rule.

Because of that, I think that the MD/PhD path is only for people who really really really want to put the time into research...and that means more than 50% if you want to do anything of value. When it comes down to it, if you aren't willing to make research the bulk of your career when you're a starry-eyed premed, you have little to no chance of coming through the gauntlet of your training as a successful physician scientist. Even if you're the most committed person imaginable, you're likely to fail...but at least you have a chance.

**Note: I am currently interviewing for residency positions and have been told by a frustrating number of program directors that they consider research a waste of time. As a result, this post may be overly cynical.

 

[Satire5Texul]

If I can offer you my two cents from a lab perspective and being good friends with my lab mates who is doing MD/PhD.
First off, its really cool to publish some of the clinical abnormalities under your lab.

The one thing that ticks them off is having your efforts sliced down the middle. At the hospital their opinion is downgraded and has even been verbally reduced to a "half-vote", because their time is not entirely spent in the hospital. So the other physicians felt like bulldozing over her/his contribution simply based on amount of time spent at the job. This is a constant complaint. And a fair one I would say for people who spent their entire days at the clinic.

Tending to patients, during wetlab, is a common running theme. God forbid you are in the middle of a time sensitive experiment. There is extra hesitation and preparation in regards to this - thats what a trained undergrad is for. But they have to fly solo in case you need to leave, so training and extra precaution is a must. Expect to be on the phone in the lab.

They dont discourage the idea entirely, but there is a sense of regret when things go wrong in the lab after months of research. When clinical side gets tough, the wetlab tends to lack and there is a hiatus on the project which further delays publications and has resulted in more stress down the road in an overhaul to meet publishing demands of the lab. These are things every researcher has to deal with, and every doctor on the clinical side of things. The combination though can be exhausting, and like people mentioned, really depends on the type of research. If molecular physics type of deal is your project, mehhh its gonna be tough. Even behavior is extremely demanding ! Some of the protocol calls for 1-6 times a day measurements depending on the project.

Every other weekend is used to catch up on wetlab stuff I can tell you that.

 

[Wolverine2017]

I may just be old and jaded, but there is honestly no MD/PhD "canon" these days. With research funding as abysmal as it is, most MD/PhDs I know have chosen 100% clinical careers, or careers where they spend trivial time on clinical projects. Sure, there are some MD/PhDs living the dream and running labs with their R01 awards, but they are the exception, not the rule.

**Note: I am currently interviewing for residency positions and have been told by a frustrating number of program directors that they consider research a waste of time. As a result, this post may be overly cynical.

That is interesting. I would just be scared the program I went through would haunt me forever for not churning out publications regularly or being in a lab.

 

[URHere]

That is interesting. I would just be scared the program I went through would haunt me forever for not churning out publications regularly or being in a lab.

At the end of the day, your MD/PhD program will care about what you published during your PhD years and where you matched into residency, they may not even keep tabs on you after that. Your residency program will care where you match for fellowship. Perhaps your fellowship program will care where you get your first faculty appointment. Those are all clinical metrics - there will be many points in your career when only you care about your publication record.

Sure, publications look good for residency programs, but it takes much less time to publish case reports or data mining studies and programs will push you towards that kind of research. (Note, that kind of research is also demoralizing for most PhDs).

The publications matter for K awards, and research-track fellowships, of course...but it can take awhile to get to that point.

 

[Lucca]

You should read some of the threads from the Physician Scientist forum OP, they may supplement some of the answers here and even answer some questions you haven't thought about asking.

Even though I'm fairly confident I will be doing both degrees, I wrestle with this question myself on a weekly basis, especially as my application cycle draws closer and closer.

Here's the best I can do as one of the starry eyed pre-meds @URHere described:

If you feel that you would be satisfied with a purely clinical career with a potentially academic (read: clinical research, teaching, administrative) bent to it then I would go MD only. Based on the very limited insight I have to you as a person in your few posts I would say do not do the dual degree and stick with the MD. Wanting something closer to 50/50, being apparently excited by direct patient care and working through cases, etc the MD/PhD might be unnecessary for you. Furthermore, there are MD-only pathways to becoming a physician scientist and even some MD/PhDs are in favor of those since your clinical interests are already mostly defined by that point and you can start your research career in your intended field as opposed to some other field (which may be the case of you do a PhD).

So why do I currently want both?

First, I want to be a scientist and I want to work on human problems, specifically I want to build on what we know about the mechanisms of disease. That's the physician scientist bit. However, I want to be a very good scientist. I've been in the same lab for about 2 years now and spent about 1 year in another lab. I've seen how PhD students develop from first year to graduation and I feel that the PhD training is actually substantial. The difference between a graduated PhD and a new grad student is pretty huge in terms of organization, intuition, ability to plan, and ability to synthesize new information and find an interesting question to work on. Maybe I've been very fortunate in the labs I've worked. A moment that sticks in my mind is when a graduate student I worked with graduated last semester and he told me that he could probably reproduce his entire PhD in 1 year now that he understands how to put together a research plan and knows how to avoid the pit falls that weighed him down during the first half of his PhD. That's what I want. I want the training to be a good scientist.

Will it be incredibly difficult to find a research-centric career where I can also practice medicine? Most likely yes. Will I be able to do it? No idea, none at all. I am less concerned with the quantity and quality of opportunities available to me than I am with becoming a well-trained scientist. If that means spending an extra 2-5 years in the pipeline compared to my MD + Postdoc colleagues then so be it. I am willing to trade those years for a structured, dedicated (read: no clinical responsibilities getting in the way), intense period of scientific apprenticeship. I love the lab. I love solving problems. I love thinking about the way things work and being able to come up with something totally new. Whenever I make a new insight into a problem or I think of a clever experiment to advance our lab's work (very rare instances) I am absolutely elated. Science is just really freaking awesome, it makes me very happy to be part of it in even a small way along with all of the BS, annoying, inefficient, obtuse or just plain stupid aspects of modern academic science.


The second reason is far more practical. One might ask me: why not just PhD? Well I don't think I would be satisfied with just a PhD. I love science but I also love people and working with them and I don't know if the joy of doing science could sustain me past my first (hypothetical) faculty position after which I'll be just another cog in the grant writing and publication apparatchik, especially through the long and protracted periods where interesting and new things aren't happening. Patients are there to provide soluble and meaningful problems and provide a human grounding to my work which I feel will make it more meaningful. Lastly, if you think getting a faculty position with an Md/PhD is hard then try getting one with a Bioscience PhD lol.

In the end, I think Md only is the optimal choice for most people, even science nerds. It might even be the right choice for me. But at this point in my life I believe what I wrote in my post and I believe that it can at least sustain me through that portion of my training. Whether I'll become cynical and bail for PP remains to be seen but the dual degree gives me the best shot at my dream job, I think, so that's something.

 

[neurotroph]

**Note: I am currently interviewing for residency positions and have been told by a frustrating number of program directors that they consider research a waste of time. As a result, this post may be overly cynical.

Can I ask what specialty you're interviewing for?

 

[Goro]

Neither at the institutes (~5) I've been at. MD/PhDs were in the lab, period.

Question #1 --> Is 80/20 canon, or is there more variation. Closer to 50/50. I expect research will demand a different sort of time than being a clinician.

I think my ideal life schedule would be the following - is this MD or MD/PhD?:

Morning ------------------- Afternoon​

Monday: Clinic ---------------- Research/Lab/Writing
Tuesday: Research/Lab/Writing -------------- Research/Lab/Writing
Wednesday: Clinic -------------- Clinic
Thursday: Research/Lab/Writing --------------- Research/Lab/Writing
Friday: Clinic ----------------- Research/Lab/Writing
Saturday: Clinic ----------------- (OFF)

No, only a high schooler or pre-med say this.
Question #2 --> "I want to be a physician where I am in clinic and on rounds kicking ass, saving lives, and taking names" Is this something an MD/PhD student would say? This is how I initially fell in love with medicine. I walked around the hospital and would watch the residents fumble through cases caressed by an attending. They would see maybe 15 patients an hour and it was just terribly exciting


Not at MD/PhD level. You have a lab to run, after all.

Question #3 --> Would there be time for adovating and volunteering? Maybe I am just an dingus, but I would also like to work in a poorer inner city (Cleveland, Baltimore, Cincinnati). Is it possible to fit this stuff in? Again, I think being a physician is more complex

Come back when you have your MCAT score.
Question #4 --> My chances.

BTW, at the places I've been, MD/PhD students had a schedule that ran something like this:

MS1-2
PhD (3-5 years; up to 7 at Baylor)
MS3-4

Total time: 7-9 years. The PhD training part can be either a glorified MS, or an honest-to-Gawd PhD

 

[URHere]

Can I ask what specialty you're interviewing for?

Med-Peds. Granted, you have much less flexibility with electives than with IM or Peds alone, but I applied to research-heavy programs and really wasn't expecting the anti-research sentiment.

To be fair, about 50% of my programs have been very supportive of research and absolutely nerded-out with me on interview day - I was just surprised by that second half.

And...I'm hearing this from some of my IM-only colleagues as well. The PhD (and research interest in general) is mattering less and less, even in fields where it was once valued. It's even worse for those who want to go into surgery, rad onc, etc.

 

[bearintraining]

Neither at the institutes (~5) I've been at. MD/PhDs were in the lab, period.

Question #1 --> Is 80/20 canon, or is there more variation. Closer to 50/50. I expect research will demand a different sort of time than being a clinician.

I think my ideal life schedule would be the following - is this MD or MD/PhD?:

Morning ------------------- Afternoon​

Monday: Clinic ---------------- Research/Lab/Writing
Tuesday: Research/Lab/Writing -------------- Research/Lab/Writing
Wednesday: Clinic -------------- Clinic
Thursday: Research/Lab/Writing --------------- Research/Lab/Writing
Friday: Clinic ----------------- Research/Lab/Writing
Saturday: Clinic ----------------- (OFF)

No, only a high schooler or pre-med say this.
Question #2 --> "I want to be a physician where I am in clinic and on rounds kicking ass, saving lives, and taking names" Is this something an MD/PhD student would say? This is how I initially fell in love with medicine. I walked around the hospital and would watch the residents fumble through cases caressed by an attending. They would see maybe 15 patients an hour and it was just terribly exciting


Not at MD/PhD level. You have a lab to run, after all.

Question #3 --> Would there be time for adovating and volunteering? Maybe I am just an dingus, but I would also like to work in a poorer inner city (Cleveland, Baltimore, Cincinnati). Is it possible to fit this stuff in? Again, I think being a physician is more complex

Come back when you have your MCAT score.
Question #4 --> My chances.

BTW, at the places I've been, MD/PhD students had a schedule that ran something like this:

MS1-2
PhD (3-5 years; up to 7 at Baylor)
MS3-4

Total time: 7-9 years. The PhD training part can be either a glorified MS, or an honest-to-Gawd PhD

Just to say, when I've talked to MD/PhDs they felt they didn't really get the best deal out of either part of the degree, because of the breakdown. The PhD sometimes feel rushed, especially when the program pushes you to be done in 4 years, and most people do a PhD in about 6 in North America (assuming no MSc). From the MD perspective, there can be significant disconnect between what you learned in MS1/2 and now having to be on the wards in MS3/4. This is one of the reasons I'm not too concerned about being older and having gotten the PhD behind me before the MD.

As far as MD/PhDs go - it is true what they say, most people end up being 80% one and 20% the other. However, there are examples of people who have made it work in a more equal fashion. I have a collaborator that is about 50/50 (he's a surgeon), but it is tough and hard work. You definitely need a team of people in the lab that are self-sufficient. You also need to be very good at "disconnecting" and "refocusing" on the task at hand. Clinic days are all about clinic, and ditto with research. This is why having to do any sort of patient-related work on a research day (e.g. calls) can be highly distracting. Ditto for the fact that your head will not be thinking clearly about the research when you're in the middle of a clinic day.

That all said, it can be done. but you need an extraordinary amount of focus and dedication.

Lastly -- I do think there is a benefit to having a MD, even if you end up mostly research. The clinical framework is always useful, and I think subjectively it is easier to get funding than a pure PhD. Having the PhD when you're really only clinical..not sure how useful that is.

 

[Wolverine2017]

Thanks for everyone's input - some was more helpful than others. As just a summary to myself and to anyone who stumbles upon this when trying to make a similar decision...

For me I know I want to conduct basic science research and I know I want to practice as a physician. Both of those fundamentally satisfy what I want out of the next 80 years of my life. I think @Krupke brought up a point I have been mulling over for the past day which I think anyone should considering an MD/PhD should choose - "Edit: I decided MD only because all the MD/PhD students I work with want to be researchers with clinical work tacked on, whereas I want to be a clinician who contributes to progressing the med field through research". With that advice, I think I am leaning towards completing an MD-PhD. The principal interest of mine is to contribute to a broader base of evidence in order to improve the human condition. If I am given 20% of my time to reinvigorate that passion on a weekly basis by treating patients and working with an excellent hospital staff, I will savor that 20% as a way to make me a better scientist.

Again, thanks for everyone's input

 

[Lucca]

Thanks for everyone's input - some was more helpful than others. As just a summary to myself and to anyone who stumbles upon this when trying to make a similar decision...

For me I know I want to conduct basic science research and I know I want to practice as a physician. Both of those fundamentally satisfy what I want out of the next 80 years of my life. I think @Krupke brought up a point I have been mulling over for the past day which I think anyone should considering an MD/PhD should choose - "Edit: I decided MD only because all the MD/PhD students I work with want to be researchers with clinical work tacked on, whereas I want to be a clinician who contributes to progressing the med field through research". With that advice, I think I am leaning towards completing an MD-PhD. The principal interest of mine is to contribute to a broader base of evidence in order to improve the human condition. If I am given 20% of my time to reinvigorate that passion on a weekly basis by treating patients and working with an excellent hospital staff, I will savor that 20% as a way to make me a better scientist.

Again, thanks for everyone's input

The best way to find out is to Work in an academic lab, preferably with MD/PhD or MD PIs for a longer period of time.