MD-PhD programs

Pre-Med & Medical School Pre-Med Topics
1

<p>Sorry if this is the wrong forum-I am really curious about these kinds of programs and am hoping that someone can answer my question.</p>

<p>I am currently a HS student who is interested in research (I love research, the thinking involved, just the whole process) and also likes the clinical aspect-helping patients and all. </p>

<p>I want to do both as a career (I know I'm just in HS, but I suppose I will have to make a decision eventually) and I was wondering if having both MD and PhD degrees allows you to do both.</p>

<p>I talked to a Biochem Prof, and he told me that MD-PhD's tend to either research or see patients. Is it really just 1 or the other, because if so, it doesn't make much sense to get both degrees.</p>

<p>I did a little research on the internet, and some people spoke about how you can do both, so I'm a bit confused.</p>

<p>So I guess my question is:
Do MD-PhD's have time to do both research <em>and</em> see patients, or do they have to pick?</p>

<p>Also, I know doctors do research, but it is primarily clinical, not as lab based as PhDs. </p>

<p>Also, I'm also wondering if anyone knows of doctors who manage to do biomedical research in labs and see patients?</p>

<p>Thanks!</p>

2

<p>Yup. It happens. Some are 20/80. Some are 80/20. My D wants to do both of those…and teach. And she has mentors at her med school that do just that.</p>

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<p>D2 wants the same thing as curm’s D. (Since she’s taking a gap year or two–this kid is gonna be 50 before she ever gets a paying job…Oy!)</p>

<p>ecouter-- there are many paths to a MD/PhD. </p>

<p>Some people go to med school first, then go back to earn a PhD.</p>

<p>Some earn a MS or PhD, then attend medical school. </p>

<p>Some (lucky few!) enroll in the MSTP (Medical Scientist Training Program) sponsored by the NIH at a number of US medical schools and earn both at once. </p>

<p>Some medical schools have a MD/PhD program that is not affiliated with/funded by the NIH. </p>

<p>Some people attend a medical school that includes a research year or requires a [non-PhD] thesis for graduation. </p>

<p>Regardless of how you achieve the degree combination, it is a very long journey. Longer than either a PhD or MD alone.</p>

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<p>I am an MD/PhD student at an MSTP school.</p>

<p>As described earlier, the “typical” career is one where you spend 80% of the week in lab and 20% (i.e. one day or 2 half days) in a clinic. The majority of these people are at universities or big academic hospitals.</p>

<p>The beauty of biomedical science is that it is a very wide field with many career “destinations” to end up at and even more paths to get to them. I use the word “prototypical” in the following paragraphs to emphasize that I am talking in generalities and statistical likelihoods, not set paradigms with no flexibility.</p>

<p>I may be biased since this was the main crux of my application essays, but the MD/PhD program is not for students who simply “want to do both.” You are only in HS, so it’s fine to have this opinion now, but while you’re in college, really evaluate not only whether you like research but to some extent what type of research you like. MDs, PhDs, and MD/PhDs all do research and they all do research well. What separates them is mainly the types of questions they’re answering. </p>

<p>The prototypical PhD is your true, bread and butter basic scientist. They’re answering questions like “How does this pathway work? How does protein A interact with protein B? Can I create a better technique for measuring protein A and B interaction?” </p>

<p>The prototypical pure MD does research on clinical outcomes and methods: “How well does our current treatment model work? Does this new treatment model work better? What can I do to improve the efficacy of treatment A? Does that hold for treatment B?”</p>

<p>The prototypical MD/PhD is somewhere between. He uses the knowledge about a pathway that the PhD discovered to better understand how that pathway causes disease (since unlike the PhD, he has at the barest of bare minimums, 4 years of medical training - but more likely has also done at least a residency if not also a fellowship). He then uses that knowledge to help shape future treatment modalities which will be further validated and modified for clinical effectiveness by the MDs. He studies the intersection of disease and science. He studies his patients, not just cells or animal models to help move the field of medicine forward.</p>

<p>As Wayoutwest mom says, it is definitely a long road. 4 years of undergrad, 8 years of MD/PhD, 3-5 years of residency (and another 1-3 years of fellowship if you want to subspecialize), and then you’ll enter the bottom of the Professor ladder, and the average MD/PhD will have their first independent lab sustaining R01 grant at ~40. What’s the benefit of all this training? You have a knowledge/skill set that neither MDs nor PhDs have, you have no debt (if you’re MSTP or a well funded school), and you’re much more competitive in the grant world.</p>

<p>While it is a little out of date now, I highly recommend this book: <a href=“http://www.amazon.com/Complete-Guide-MD-PhD-Degree/dp/1888308168/ref=sr_1_1?ie=UTF8&qid=1319161860&sr=8-1[/url]”>http://www.amazon.com/Complete-Guide-MD-PhD-Degree/dp/1888308168/ref=sr_1_1?ie=UTF8&qid=1319161860&sr=8-1&lt;/a&gt; as well as everything here: <a href=“https://www.aamc.org/students/considering/exploring_medical/research/mdphd/[/url]”>https://www.aamc.org/students/considering/exploring_medical/research/mdphd/&lt;/a&gt;&lt;/p&gt;

5

<p>Thanks for all the responses! They have really cleared it up a bit.</p>

<p>I guess I’d be most interested in doing an MSTP program since the prospect of doing either Med school/PhD and returning afterward during my thirties doesn’t appeal too much to me.</p>

<p>I am still young (feels weird to be saying that), but at the moment, research is something that really captures my imagination. I love the idea of using deaminases to work on preventing HIV. I love how we can really come up with ways to change the world on a molecular level. I also like research that can be translated to real life results, something that actually affects patients. </p>

<p>I’ve talked to quite a few Biochem Profs, and they’ve all told me that research for research’s sake is no longer practical and that it needs to have a real life effect. However, their work is still pretty isolated from clinical applications. </p>

<p>Being an MD is also something that interests me, but I’m not entirely sure if I’m the sort of person who could remain interested in going to work everyday and diagnosing illnesses. I know of the financial rewards that come from choosing medicine, and I also know that it is much harder to match those salaries if you go for a straight PhD. </p>

<p>I guess I have another question now:</p>

<p>If someone does an MD and afterwards research fellowship, do you think that they could still do the same sort of research as i<em>wanna</em>be_brown is describing? </p>

<p>Also, I haven’t shadowed any doctors yet (don’t know if I want to), but am I right in assuming that Medical School focuses more on pathology, like how and why diseases ‘work’, than their PhD friends who deal with it on a more molecular basis?</p>

<p>I talked to a Grad student and she definitely knew a great deal about why B-cell lymphoma worked (overexpression of certain protein etc). I guess I’m not quite clear on what a Med School education provides versus PhD…I know that PhD gives you research background (which I’m more familiar with), MD how to treat patients, but not more beyond that.
I guess I’ll have to talk to more people and read up on it!</p>

<p>I was also wondering, do MD-PhD’s really have time to have an enjoyable personal life, outside of science? I know Medical School is extremely intense, and a PhD equally demanding and while doing both of those is a very exciting prospect science-wise, I also want time to have meaningful relationships, get married, travel a bit etc. It’s a huge time commitment during a pretty important part of a persons life, and I want to be able to enjoy that part of life too! </p>

<p>Finally, I was wondering how do salaries/‘jobs’ work for graduates of MD-PhD programs? Do they tend to work in the lab for most of the week and then some time with the hospital affiliated to the medical center, or do they work in private practices? Also, do most MD-PhD’s gravitate towards academia, or do they work in the industry as well? </p>

<p>Also, how much do they typically earn? As in what range? I know PhD’s, even full Profs don’t tend to make all that much, relative to doctors.
It sounds sort of shallow, but money is also important nowadays-I suppose I’ll have kids to send to college someday too! O_O </p>

<p>I’m forming the conclusion that doing both degrees is extremely rewarding and possibly something that I might enjoy, but will also require quite a bit of compromising.</p>

<p>Thanks again for all the answers! They have all helped me get a better idea of the experience of MD-PhD. I will definitely look into those books and see if I can get them somehow.</p>

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<p>Could an MD with a research fellowship do the same type of work as an MD/PhD? Sure, they <em>could</em>, but remember, a PhD is at least 3-4 years, a fellowship is never more than 3 years. Many MD/PhDs will do a fellowship as well, and a PhD is typically more basic sciencey than an MD’s fellowship because MD/PhD students only have had 2 years of medical school when they are doing their PhDs.</p>

<p>You’re right that PhD students will know why B cell lymphomas occur, but do they understand how the cancer affects other systems of the body? Do they understand how the treatments affects other systems of the body? Do they understand what happens if one has B cell lymphoma AND another medical condition? Do they understand how non B cell lymphoma drugs affect B cell lymphomas? Do they understand the effect of the B cell lymphoma on the patient’s susceptibility to certain infections? Do they understand what happens if a B cell lymphoma patient gets infected? Do they appreciate what it’s like to live with B cell lymphoma and what sorts of non-biological things affect the progression/treatment of B cell lymphoma? What happens if, in the course of their work, they discover this protein has another role in another system, will the lab be able to switch the focus of their work to branch out into this new area, or will it take them a lot of time to get up to speed in the new field? (This last example is based on an MD/PhD I know who studies ion channels and has thus hopped around from looking at psychiatric diseases, mechanisms of function of taste, and even malaria since the channel is shared by all). MDs who work in that field will know more than just how to treat it.</p>

<p>PhD programs are about learning how to do research. In order to do that, one has to have a very thorough understanding of the field as it is. The most important part of a PhD isn’t what you learn while you’re doing it, it’s that you’ll know what to do next once you’ve learned something.</p>

<p>Medical school is about learning how the body works, how/why things go wrong (diseases), how to identify what is wrong and avoid mislabeling a disease, and how to treat/prevent those diseases once they’ve been identified (and sometimes what treatments to give before it’s identified). This ties into something else you said: Docs don’t just diagnose patients, they also treat them (unless you’re a pathologist or radiologist I guess).</p>

<p>MD/PhDs make more than PhDs but less than pure MDs. MD/PhDs work way fewer hours than MDs and also graduate with no debt if they went MSTP or well funded school. The average medical student graduates with 100-150k in debt. That being said, if one does want to do pure clinical work (this is not your case but for others who may read this) the extra time spent doing the PhD is not worth the emotional or financial investment (MDs get a 4 year head start on real money) to avoid the debt. MD/PhDs typically do not work in private practices since they only work (typically) 1 day/week clinically, and that’s not enough to sustain your own practice nor enough to warrant being hired by most group practices. There are many different schedules and different types of ways to do this. Some do outpatient work at the hospital, some do shifts on consult teams, some do 1 month pure clinical/no research and then the rest of the year is pure research.</p>

<p>In terms of free time and stuff, you pretty much lose a lot once any of those programs start. From my experience, the PhDs seem to have the most free time since they have much more control over their schedules. That being said, in my MD/PhD someone just got engaged this week, and several people live with bf/gfs, with several others in relationships that started between now and when we started. In my med school class, several people have had children, several have gotten married, and many have started relationships. People got to travel for part of the summer after 1st year and will get to again after Step 1. After that though it’s going to be very hard. Staying sane and having lives outside of medical school is becoming much more popular than it ever was (e.g. work hour restrictions for residents/students). You definitely have much less time than you did in college, but there is still enough free time.</p>

<p>I would recommend trying to find books/articles about this since they will have much larger data sets than I or anyone here can speak about.</p>

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<p>You are going to get starved for staying in academic medical center. Financially, it is much more rewarding to do private practice. Don’t regret if you find out that you make half or one-third of a dumbo who sat next to you in the medical school. MD/PHD is simply a bad way to learn medicine unless you truely want to sacrifice yourself and family for the glory of research work. </p>

<p>Furthermore, the research funding is tightening. Good luck to get that RO1 and tenure. Medical schools are laying off people without grants. MD/PHDs are generally weak on clinical skill because of lack of practice. When you get no renewal of your RO1, which is increasingly difficult, I am not sure what you can do. More office time? No practice group would want a guy caming out of lab bench and who only sees patients once a while. MD/PHD is a gamble. Either you make it big to become a chairman of department in medical school and who never needs to see patients, or you get so involved in research such that you are no longer good at clinical practice, and you will end up to give it up. All it needs is only one or two bad cases you have handled. Alternatively, if you are bad in research and are never able to obtain independent funding, you will be re relayed to see more patients in academic setting with one-third or half the salary of private practice, and suffer being treated as unimportant second class citizen. </p>

<p>MD/PHD is tough and most of the time, a bad choice.</p>

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<p>^ +1, Why spend that much time in school? You are going to be like 35 by the time you earn your first paycheck.</p>

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<p>Thanks for the detailed responses i<em>wanna</em>be_brown! It has definitely given me much more insight into what doing an MD-PhD entails.</p>

<p>I think the time spent in school is a big sacrifice, and something that anyone who does these programs probably takes very seriously. I’m not sure if that would be something that would work for me, though I still am <em>only</em> in HS, lol.</p>

<p>@Underachiever, my uncle (PhD) has told me similar stories, as have other Profs that I was lucky enough to talk to.</p>

<p>Hmm, I think I will try and shadow a doctor so I can see their take on it too.</p>

<p>Thanks again to everyone :)</p>

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<p>To inject a little more reality into your thinking, 90% MD/PHDs do not make it to RO1 funded investigator. The % for female MD/PHD may be even less. Majority of them become collaborators of translational projects. However, if you make it to RO1 PI, a MD/PHD is better off than a pure MD with great clinical skill but not much research in academic medicine, or a PHD with RO1 grant (especially in clinical department), even if you have poor clinical skill. If you get your RO1 renewed without gap, tenure position is almost guaranteed in most of the medical schools including the very elite ones. </p>

<p>No one will consider clinical case study a real research. Those are the products of manufactured academic productivity by someone who has no resource to perform scientific research but needs to pass the grueling review in annual academic renewal process.</p>

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<p>Thank you for providing another perspective, Underachiever. It seems as though it is extremely difficult to ‘make it’ as an MD-PhD, though those who <em>do</em> make it do very well. You seem to know a lot about careers in medicine so I was wondering if you knew if MDs who have done research fellowships can do basic/translational research ( opposed to clinical) and still practice for a few days a week? Also, is that prospect a realistic one? Thanks!</p>

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<p>I do see some MDs who make themselves outstanding research scientists such as Bert Vogelstein, Todd Golub, I Bernard Weinstein and Larry Corsmyer. But those people do not see patients once they established themselves in science. If you see patients 3 days a week, you will get follow-ups and phone calls the rest of the week. There is not much science you can do. Research is a full time job, so is medical practice if you want to be good at it. The only way you can do vigorous research while doing clinical practice is to go to a field of highly subspecailized practice such as hematology, rheumatology, or certain subfields in radiation oncology and pathology, and be in a big medical center with a lot of support and coverage. I think that one can practice 8-12 weeks of medicine a year without compromising one’s science. Anything more than that, you will likely see a decline in research output, and you eventually drop out of research when funding dries out. </p>

<p>Some folks choose to do post-doc after MD, and use the post-doc research as a base to find academic job. I find that approach quite risky. Several years without practice of medicine will make you bad physician. That will limit yourself to be a candidate for pure science position, competing with pure Ph.D. with post-doc experiences. If you work with a big lab, and is highly productive, it will be OK. But if not, it will be quite difficult to find job. After 3-4 years of hiatus, there will be no turning back for pure medicine. </p>

<p>Only science output is not sufficient to get a tenure track job in Medical School nowaday. You need both output and funding (plus connection in many cases) to secure a job. </p>

<p>I also have to point out that a MD/PHD with great clinical skill but not much research will not fare better than a MD with the same thing in promotion. So if you do not make it, there is no advantage to be a MD/PHD.</p>

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<p>Underachiever,</p>

<p>Can you provide support for the claim that 90% of MD/PhDs don’t make it to R01 support?</p>

<p>This article: [New</a> Physician-Investigators Receiving National Institutes of Health Research Project Grants, June 13, 2007, Dickler et al. 297 (22): 2496 ? JAMA](<a href=“http://jama.ama-assn.org/content/297/22/2496.full]New”>New Physician-Investigators Receiving National Institutes of Health Research Project Grants) says that 34% of MD/PhDs get awarded an R01 on their first try (with 78% of them being able to renew). Both of those numbers were higher than PhDs or MDs. Unless you’re suggesting that the vast, vast majority of MD/PhDs don’t even apply for R01s, then this article seems to contradict your statement. This article seems a little weird to me, and I know that some question the analysis, but those who question it actually say it’s better than what the article says.</p>

<p>Additionally, MD/PhDs are over-represented on Medical school faculty, particularly at the level of full professor, with 10% of professors being MD/PhDs <a href=“https://www.aamc.org/download/169798/data/10table7.pdf[/url]”>https://www.aamc.org/download/169798/data/10table7.pdf&lt;/a&gt; despite representing only 3% of those with MDs, and who knows what percentage of the total when you include PhDs. <a href=“https://www.aamc.org/download/161868/data/table32-mdphd99-10-web.pdf.pdf[/url]”>https://www.aamc.org/download/161868/data/table32-mdphd99-10-web.pdf.pdf&lt;/a&gt; <a href=“https://www.aamc.org/download/145438/data/grad-by-sch-gender-0610.pdf[/url]”>https://www.aamc.org/download/145438/data/grad-by-sch-gender-0610.pdf&lt;/a&gt;&lt;/p&gt;

<p>I am not saying that it isn’t hard (and it’s probably only getting harder these days) but let’s try to keep our claims as accurate as possible.</p>

<p>I will 100% agree that if we’re talking full time clinician only, an MD/PhD has ZERO advantage compared to an MD, and that the vast majority of MD/PhDs with real “practices” are at big centers and typically not seeing patients more than 1 day/week or as you said, are super specialized. With the growth of hospitalists though, I imagine it will be easier to practice general internal medicine and be an MD/PhD than it has in the past.</p>

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<p>Brown: 90% is not an exaggeration. Most MD/PHDs are hired for their clinical skill. The position starts without lab space or reasonable startup fund. There is no science base for a project. Majority of them would not even reach the stage to attempt an RO1. MD/PHDs hired for tenure-track positions are exceedingly rare because a PHD with longer track record of science productivity is more competitive. An opening of a tenure track position generally attracts over 600 applications, while an opening of a clinical position attracts much less. Some MD/PHDs convert themselves from clinical track to tenure track after their projects get funded. As a clinician, you have to prove yourself worthy of support. I am talking about from 30 years of anecdotal experiences observed in several major US research medical schools. If my memory does not fail me, our department has hired only 2 MD/PHDs starting from tenure-track position in the last 15 years. With exception of several MD/PHD converting from clinical track to tenure track after obtaining multiple funding, all other MD/PHDs are just clinicians- “failed MD/PHD”. The two MD/PHDs who were hired from tenure-track position had multiple years of post-doc experiences in some of the top notched labs in the country and published in the top-tier journals- indeed, well deserved. Now, both left for chairmanship in other institutes. </p>

<p>Yes, there are many MD/PHDs in medical schools, and they are professors (non-tenure). Some nasty schools such as Columbia University put a title “Clinical” in front of professorship to make a distinction (sounds like a yellow star to me). Their positions are renewed annually. When the budget contracts, they will be let go first. There is no pain for medical school to let these people go because they have no funding leverage. Hospital will be happy to dump those big salaries in exchange of cheaper labor. So wake up! When you find yourself good at science and marketable, by all means you should go for it. But if you find yourself struggling in research, please don’t force yourself and have wishful thinking. You still have chance to orient yourself for private practice. You will probably be happier there.</p>