Why is the PhD so special?

[UCSFdreamin]

Now that I've got your attention with that somewhat inflammatory title, I'll take a step back. Of course, the training to PhD and MD/PhD programs is unique. But, if someone did med school without the PhD, it seems that they could acquire a considerable amount of research experience before the end of fellowship and save themselves the 3-5 years of (relative) youth before they're independent.

For instance, one could fit research in their MD curriculum (summers, ~10 hours a week during semesters when possible...etc). It wouldn't likely result in a first author nature paper, but it could be a fruitful experience in the context of traditional 4-year education. That could be followed by a residency with heavy research requirements and a fellowship, which often includes 18 months of protected research time. If you are entering medical school with some papers under your belt already (especially first author), would you really be so much less competitive along the way that you should delay post-graduate education by ~4 years for that PhD? that is, if you have as many papers as the average PhD, does having the degree give you >3 years worth of advantage?



I'd love to hear thoughts.

Here is an outside article that includes some discussion on the topic: http://www.nextgenmd.org/vol3-4/md_phd.html

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[calvinNhobbes]

I have worked with MDs that have the research experience you outlined. They are, in general, horrible basic science researchers, and sub par at best compared to some one with a PhD when it comes to any kind of research. The MDs I know who do basic science on the same level as a PhD have spent 3+ years dedicated solely to research (taking 1-2 years in med school for research plus another 1-2 during residency, and then 1-2 during fellowship). At that point you are at the same time commitment as a PhD so it would expected who have the skills and experience to compete.

Most MDs have no idea what goes into being an excellent researcher, just like most PhDs have no idea the sacrifice it takes to be an excellent clinician.

 

[gbwillner]

I have worked with MDs that have the research experience you outlined. They are, in general, horrible basic science researchers, and sub par at best compared to some one with a PhD when it comes to any kind of research. The MDs I know who do basic science on the same level as a PhD have spent 3+ years dedicated solely to research (taking 1-2 years in med school for research plus another 1-2 during residency, and then 1-2 during fellowship). At that point you are at the same time commitment as a PhD so it would expected who have the skills and experience to compete.

Most MDs have no idea what goes into being an excellent researcher, just like most PhDs have no idea the sacrifice it takes to be an excellent clinician.

There are good MD only researchers. But they tend to be 1: older since they trained before MSTP existed and used considerable amounts of free time and sabbaticals to get their research experience and 2: have done significant post-doctural, research-only time.

I am in a heavy science residency program, where most residents do some research. Little of it is basic science, and most of it takes little scientific understanding beyond "sensitivity" and "specificity."

 

[Shifty B]

Now that I've got your attention with that somewhat inflammatory title, I'll take a step back. Of course, the training to PhD and MD/PhD programs is unique. But, if someone did med school without the PhD, it seems that they could acquire a considerable amount of research experience before the end of fellowship and save themselves the 3-5 years of (relative) youth before they're independent.

For instance, one could fit research in their MD curriculum (summers, ~10 hours a week during semesters when possible...etc). It wouldn't likely result in a first author nature paper, but it could be a fruitful experience in the context of traditional 4-year education. That could be followed by a residency with heavy research requirements and a fellowship, which often includes 18 months of protected research time. If you are entering medical school with some papers under your belt already (especially first author), would you really be so much less competitive along the way that you should delay post-graduate education by ~4 years for that PhD? that is, if you have as many papers as the average PhD, does having the degree give you >3 years worth of advantage?

You're points are almost exactly right. You can achieve a lot of the benefits of doing an MD/PhD through other paths, such as research time during medical school, research oriented residencies, doing multiple fellowships, etc. You have to look for basic science experiences, if that's what your into, and may have to work a little harder, because those skills don't come easy. By not doing a PhD, you may get into your job faster with the more specific skills you need.

The benefit of an MD/PhD is that you have a predefined path that you can follow, with a lot of guidance. You don't have to work as hard to find the experiences you need. On the other hand, you'll do a lot of things which are totally useless (PhD courses, qualifying exams, etc).

The only thing I would say for people considering a MD/PhD: if you end up doing only one, I would strongly lean towards MD over PhD alone. As an MD, you will make more money, have more opportunities, and through various supplementary experiences you can do almost everything a PhD alone can do. Plus, if you decide you don't like research you can have an excellent career as a clinician and never do research again. With a PhD alone, it's much more difficult to go the other way.

Plus, you have to consider that you might be average or below. The bottom half of md's still have good careers, make a good amount of money, and have fulfilling jobs. The bottom half of PhDs end up working entirely outside of their field of training, struggling in multiple postdocs waiting for faculty positions to come open, or once in a faculty position they struggle to find funding and get promoted. The least successful MDs have it far easier than the least successful PhDs.

 

[Spacedman]

Now that I've got your attention with that somewhat inflammatory title, I'll take a step back. Of course, the training to PhD and MD/PhD programs is unique. But, if someone did med school without the PhD, it seems that they could acquire a considerable amount of research experience before the end of fellowship and save themselves the 3-5 years of (relative) youth before they're independent.

For instance, one could fit research in their MD curriculum (summers, ~10 hours a week during semesters when possible...etc). It wouldn't likely result in a first author nature paper, but it could be a fruitful experience in the context of traditional 4-year education. That could be followed by a residency with heavy research requirements and a fellowship, which often includes 18 months of protected research time. If you are entering medical school with some papers under your belt already (especially first author), would you really be so much less competitive along the way that you should delay post-graduate education by ~4 years for that PhD? that is, if you have as many papers as the average PhD, does having the degree give you >3 years worth of advantage?

unfortunately, what you're describing is what many people with MD/PhDs end up doing anyway: coming in to med school with a couple papers, putting in time during med school, doing a research oriented residency +/- research fellowship. oh, and they also squeeze in a 3-5 year stretch of consolidated lab work in the middle there.

so, unless i missed something, it would seem that having a PhD adds substantially (ie 3-5 years worth) more research experience. given that most MD/PhDs aren't quite ready to run a basic science lab after finishing all of the above, i'm not sure how skipping the PhD will get you closer to your goal more quickly.

of course, there's always that rare med student who "gets" research , and could be successful as an independent investigator with much less formal training. the best MD researchers i've met focus on translational/clinical research and put in their time in other ways, as others have mentioned- extra year during med school, MS/MPH degrees, an extended research fellowship, extensive collaborations with PhDs etc. these people are incredibly motivated, intelligent and generally not focused on basic science. if you want to run a basic science lab, i think you have put in the time at some point- i'm glad i got to do it while someone else was writing the grants and paying my bills.

 

[calvinNhobbes]

The benefit of an MD/PhD is that you have a predefined path that you can follow, with a lot of guidance.

The guidance is HIGHLY variable based on department and advisor. Moreover, the huge benefit of doing a formal MD/PhD over an MD + 3-6 years of research fellowships is the no med school debt. As an MD only, your $200,000+ of debt will still be accruing interest during those research years and you won't be making a clinical salary during that time.

On the other hand, you'll do a lot of things which are totally useless (PhD courses, qualifying exams, etc).

I completely disagree with this. Yes, of course there are some worthless classes in grad school just like in med school, but far fewer for MD/PhDs since you get to pass out of many core classes due to med school. Most of the classes I took in grad school were electives that were directly related to my clinical interests (ortho) including biomechanics and a surgical skills course. Moreover, things like qualifying exams and thesis proposals/defenses are amazingly useful. Example, my med school has oral exam components for each clerkship, which were a breeze after spending years in grad school doing oral presentations and defenses. Eventually you'll have to pass oral boards to be certified as well. It's nice to already have the previous experience with that type of situation. Moreover, I already know how to write and review grants since all thesis proposals had to be in NIH format for my department.

The fact of the matter is, if you want to treat patients, get an MD. If you want to be a respected basic science researcher as well, you need to put the time in, either doing formal training as a PhD or many years of extra research experiences during your clinical training. There is no short cut.

And finally, if you have no interest in treating patients, don't get an MD!

 

[Shifty B]

The guidance is HIGHLY variable based on department and advisor. Moreover, the huge benefit of doing a formal MD/PhD over an MD + 3-6 years of research fellowships is the no med school debt. As an MD only, your $200,000+ of debt will still be accruing interest during those research years and you won't be making a clinical salary during that time.

Financial benefits definitely help. Adminstrative benefits help as well. Every NIH funded MSTP has some sort of guiding structure to help get you through faster. See your next paragraph. It was that guidance committee that is getting you out of some of your grad classes. It's not always useful, but helps. They will help you set up your rotations and choose a lab. A medical school may have someone to help you with this as an MD student, but maybe not.

I completely disagree with this. Yes, of course there are some worthless classes in grad school just like in med school, but far fewer for MD/PhDs since you get to pass out of many core classes due to med school....

Moreover, things like qualifying exams and thesis proposals/defenses are amazingly useful. Example, my med school has oral exam components for each clerkship, which were a breeze after spending years in grad school doing oral presentations and defenses. Eventually you'll have to pass oral boards to be certified as well. It's nice to already have the previous experience with that type of situation. Moreover, I already know how to write and review grants since all thesis proposals had to be in NIH format for my department.

You must either have 1) gone to the most straightforward graduate school ever, 2) have an extremely optimistic world view that extends to the crap they made you do, or 3) be deluding yourself.

I and many other graduate students spent countless hours on silly forms and meetings. You'll have committee meetings where you talk about what you have done, and your members will argue for 3 hours between themselves about some detail, only to finally have your advisor break in and say it doesn't matter because you've already done the experiments! You'll have to petition to get your course of study approved. You might have to do a master's thesis, or file another petition to get that waived. You'll have to write a pre-proposal and proposal, which sometimes are relevant, sometimes not. You'll redo your presentations because your advisor doesn't like the color of your fonts and slides. You'll petition again to get a course counted for you, because the requirement changed since you started medical school. Writing your thesis will be useful, but that will just lead you to a defense where the outcome is basically predetermined. You'll go through the motions and get experience, but if you didn't KNOW that you were going to pass, you'd better change your defense date!

All in all, I'd say by streamlining all of this crap you could cut 6-12 months out of a typical PhD. Of course, by going through some of this stuff, you are getting general experience that will help you, but MD students do just fine without it.

If you want to be a respected basic science researcher as well, you need to put the time in, either doing formal training as a PhD or many years of extra research experiences during your clinical training. There is no short cut.

True, but his question is can you do it, and which is better.

And finally, if you have no interest in treating patients, don't get an MD!

Of course this is true. However, if you have no interest in treating patients you shouldn't be considering an MD/PhD either. My advice was only intended for people who were interested in an MD/PhD, and theoretically seeing patients.

 

[calvinNhobbes]

It was that guidance committee that is getting you out of some of your grad classes. It's not always useful, but helps. They will help you set up your rotations and choose a lab.

Actually, I had to petition myself, with the support of my advisor, the dean of my gradaute curriculum to get out of the classes. The MD/PhD guidacne committee as you call it was little help. Also, they did not help setting up rotations of choosing a lab either. So your theory is bust in my experience.

You must either have 1) gone to the most straightforward graduate school ever, 2) have an extremely optimistic world view that extends to the crap they made you do, or 3) be deluding yourself.

1) Err, not exactly. My department was an experimental fusion between two schools. Ever changing from year to year.
2) I've never been called an optimist. Sure, when I was doing it I thought it was the biggest waste of time. But now it is amazing how many times people wonder where I learned how to do something and it turns out it was in grad school.
3) or perhaps you are just a pessimist

I and many other graduate students spent countless hours on silly forms and meetings.

I had one meeting specifically related to my thesis research for 1-2 hours every 6 months. As far as extra forms specifically related to getting the degree, that took a couple hours a day for about a month at the end. Can't say it was really that big of a deal.

You'll have committee meetings where you talk about what you have done, and your members will argue for 3 hours between themselves about some detail, only to finally have your advisor break in and say it doesn't matter because you've already done the experiments!

Never happen to me. My advisor and I would have a pre-practiced game plan going into it. My experimental plan was well laid out years/months in advance due to my proposal (see below)

You'll have to petition to get your course of study approved. You might have to do a master's thesis, or file another petition to get that waived.

Never had to do any of this.

You'll have to write a pre-proposal and proposal, which sometimes are relevant, sometimes not.

Every grad student during the second year wrote an R01 style proposal for their planned thesis. It gave me an excellent road map to follow and discuss with my committee the entire time. Not to mention I the experience of grant writing.

You'll redo your presentations because your advisor doesn't like the color of your fonts and slides.

Never had that problem. Blue background, white text, arial. Pretty standard. Plus this applies to ANYONE doing research and presentations, not just grad students.

You'll petition again to get a course counted for you, because the requirement changed since you started medical school.

It took me a few hours of work to petition out of four classes. Not a big deal.

Writing your thesis will be useful, but that will just lead you to a defense where the outcome is basically predetermined. You'll go through the motions and get experience, but if you didn't KNOW that you were going to pass, you'd better change your defense date!

I knew people that didn't pass their defense, or who passed with so many stipulations they were going to be there for months finishing. But I didn't have this problem due to excellent communication with my committee. However, it is this "working until it is finish" mentality of the PhD that puts it above those just doing a year or two of research to get experience. You learn alot more and push yourself when you are personally responsible for the outcome.

I must also say, the ability to forcefully but respectfully communicate with superiors has been extremely helpful in the world of academic medicine. My "maturity" was mentioned extensively during my third year evals, mostly due to the fact I was not shy or intimidated when talking to faculty.

All in all, I'd say by streamlining all of this crap you could cut 6-12 months out of a typical PhD.

Sure, if you cut out ALL the classes. But then again you could say the same thing about med school, undergrad, residency, etc, etc. I just made sure to take classes I knew would be useful, or ones that had the reputation of being so easy they would be minimal work. The paper work you complain about that is SPECIFIC to the PhD (things like IRB, IACUC, and other research related forms are relevant to anyone doing research not just grad students) really is minimal and if you ask the various admins for help there will practically give you idiot proof step by step instructions.

True, but his question is can you do it, and which is better.

All I have to say is, not having any debt is AWESOME! Having the financial freedom to switch the direction of my career relieves so much stress it is amazing. Sure you can do meaningful research as an MD only, but it will either be clinical only, or you will need to spend 3+ years (ie. a PhD) away from clinical duty learning how to do good basic science research. Or I suppose the final option is collaborate with a PhD and get tagged on to some of their research.

 

[Shifty B]

Dude. All I can say is that you had an awesome PhD. I would say that your experience is outside the norm. Well played!

Oh, and on the spectrum I fall somewhere between a pessimist and a realist. And the bit about no debt is a big one.

Congrats!

 

[calvinNhobbes]

Dude. All I can say is that you had an awesome PhD. I would say that your experience is outside the norm. Well played!

Oh, it wasn't all rainbows and butterflies. It was probably the most frustrating 5 years of my life. My lab was infamous among the department for the layers and layers of bureaucracy. We had lots of adminstrators that wielded what little power they had with the zeal of a communist dictator. There were some days that I thought it would be less painful passing a kidney stone than trying to get some PCR supplies ordered!

But this was a lab specific thing, not a PhD student specific thing. We had muliple residents doing research in our lab that had to put up with the same crap as all the grad students, in fact one resident quit several months into their research year cause they couldn't deal with it, and they were a gen surg resident!

But as one of the residents told me, if I survived that political quagmire for 5 years, the wards would be easy, and they were right!