<p>I heard that MD/PhD's spend 80% of their time dealing with research/lab issues/grants/etc. and 20% treating patients.
One prof whose course I'm taking right now finished her MD/PhD from Yale but all she does is working in a lab and teaching courses. She doesn't work as a doctor at all.
If you're going to be just teaching and researching, then what's the point of going the MD/PhD route?</p>
<p>Thanks.</p>
<p>Well it comes with perks such a free tuition. It also enlightens you because it creates the bridge between treating patients and searching for cures for detrimental diseases that plague humanity.</p>
<p>Are pre-med clinical experience and/or volunteering really that important for MD/PhD applicants?</p>
<p>Doctor Doctor! Research w/ publications are very important, right after a 30+ MCAT.</p>
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It also enlightens you because it creates the bridge between treating patients and searching for cures for detrimental diseases that plague humanity.
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<p>Blazinyan is on the right track with this; though certainly, it's not for "enlightenment" or "better understanding", per se. It is a total waste of time to do an MD/PhD if you just want patient/clinical contact.</p>
<p>An MD/PhD is well-suited to doing translational research; in other words, "bridging the gap" like blazinyan said between basic research and clinical research. I believe it is also easier to get permission for performing various studies on human subjects, and all in all, to run a lab.</p>
<p>Agreed. Plus clinical research is less time-consuming (in terms of daily and weekly devotion), whereas bench work is very time-consuming and it also depends on what you experiment is, the field you are working in, if you work with animals, tissue, cells, etc. Many factors come into play. Also bench research is more expensive, in terms of buying supplies, paying co-workers (if your the head of the lab), writing grants, etc. Bench research also doesn't pay that much. An avg. scientist makes like 60-80k if they are lucky, if money matters to you. It is ultimately your choice, but as everyone on this forum always says: don't do it because you have to or someone is pushing you, etc, but do it because you want to and because you want to help society.</p>
<p>I disagree with Blazinyan on the salary issue of physician-scientists. M.D.s and M.D./Ph.Ds working in academia make fairly competitive salaries with physicians in private practice if you also consider some of the perks involved such as tuition benefits for family members, retirement plans, travel opportunities. In general, they will make more than Ph.D.s even if they are doing mostly research as they can either supplement their income with clinical activity or if they are successful researchers, they will be paid on a scale similar to clinical faculty. They are paid very well if they work in industry, particularly if they have an established academic career beforehand.</p>
<p>I would say that to pursue a M.D./Ph.D. one has to have a strong interest in science and research, and be seriously considering that track for a career. The Ph.D. program itself typically adds four more years of training. If you then add on a post-doctoral fellowship after residency to do research, you are probably 5-7 years behind your clinical colleagues in terms of salary. On the other hand, if you are doing what you love, it may not be that critical. Eventually, it does eventually even out. M.D./Ph.D.s who do exclusively clinical medicine probably made that decision as a default one-either they realized later in life they did not want the stress of writing grants or they were not successful in getting them.</p>
<p>Salaries for medical researchers are largely capped by the maximum NIH will pay for salary on a grant. For some fields of medicine this is within the average income of practitioners anyway. So the researchers can make as much as people in full time clinical practice. On the other hand, for physicians in high income fields, say cardiac surgery, the NIH cap is a small fraction of the income of full time surgeons. So, if they do research, they give up the extra compensation they would have generated if they spent their time in the OR rather than the lab.</p>
<p>Get an MD/PhD for similar reasons to getting a PhD: because you want to do research. The MD opens doors to areas of research that are difficult to enter with a PhD alone, provides some security - you can see more patients if you enter a dry spell in grant funding- and some people find the combination of clinical work and research more appealing than research alone.</p>
<p>afan,
Some institutions pay salaries in excess of the NIH guidelines. Other specialties, such as GI, cardiology, and surgery also typically pay higher than the guidelines. However, the NIH will only pay maximum of around 180K per year. The cap is what NIH will pay the physician-scientist, not what the institution will pay. The institution or department can supplement particularly if the physician provides some clinical service. Physicians in academia also can supplement their income by giving lectures and collecting honoraria, consulting for companies, providing expert testimony in malpractice cases, writing books/articles, etc.</p>
<p>Some institutions do supplement the income of such physicians, but the higher one goes in income, the harder that is to do. Consider two cardiac surgeons. One earns $600,000 doing full time clinical work. A good income, but nothing spectacular for a successful person in that field. The other does full time research and brings in the NIH cap of $186,600 in salary support from grants. Yes, there is nothing in NIH policy to prevent the medical school from making up the difference from other funds, but where is that $413,400 supposed to come from? The other clinical surgeons? If there are four of them, will they really sit still for a $100,000 pay cut so their colleague can "play" in the lab? Now pick a more reasonable figure for a high powered cardiac surgeon with a bustling practice- $1.2M. How long can any medical school pay that kind of money against only $186,600 coming in?</p>
<p>Medical schools can supplement the income for SOME researchers above their NIH revenue, but only by paying others less than they generate in clinical income. As these gaps get larger, these productive clinicians diffuse out into the community, and the medical school loses them altogether. The larger the gap between average income and NIH cap, the fewer people there are who do primarily research. So medical schools have lots of internists who do primarily or full time research, but few invasive cardiologists and nearly no neurosurgeons.</p>
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Physicians in academia also can supplement their income by giving lectures and collecting honoraria, consulting for companies, providing expert testimony in malpractice cases, writing books/articles, etc.
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<p>True, but we are talking about salary. Full time clinicians do all of these things as well. In fact, they are in far more demand than the researchers. There is much more demand for malpractice consultation from a busy surgeon than from a molecular biologist. Most articles do not pay, and most books do not pay well, compared to money available from other endeavors.</p>
<p>In most areas of medicine such as geriatrics, endocrinology, or rheumatology, etc. there is not much of a gap in salary between academic physicians who are researchers and those who are full-time clinicians. In general, 186K is a very good salary in these areas of medicine whether one is in academia or even in private practice. In the higher paying medical specialties such as GI and cardiology, the gap is somewhat greater. However, in these procedure-intensive specialties, an academic physician can still generate significant income by working part-time and also supervising fellows who do the procedures. Most medicine depts (and sometimes divisions) at major academic centers pool their income and reward on the basis of clinical revenue and overall performance (even in research). If the department gets more recognition and prestige, clinical revenue goes up with more referrals and volume. I think this also applies to departments outside of medicine such as surgery, pathology, etc. I have a friend who is an academic anesthesiologist that spends 75% of his time in the lab and makes 350K. He probably could make more in private practice but I don't think he makes signficantly less his other colleagues in his department. He has several major grants (whereas many of his colleagues have none) and thus brings stature to the department in the eyes of the academic community. He still brings in significant income to the department during the 25% of time he allocates for clinical work. On the other hand, if he were 100% involved in research in the anesthesia department, his salary would be substantially less. However, most academic physicians do not do 100% research. Those who do truly love what they do, and generally are superstar researchers who can fund their entire salary from grants. As M.D.s their salaries will be higher than Ph.Ds but definitely less than their part-time and full-tlime clinical colleagues as Afan has noted.</p>
<p>I also forgot to add that successful researchers who bring in NIH grants also bring in signficant indirect costs to the university, often ranging from 60-80% of the grant amount. So if a highly successful researcher brings in one million in grants per year, the university gets to charge 800,000 for overhead to the NIH. that extra money is supposed to cover the cost of using the lab space and administration, but greatly exceeds it. Medical schools and universities use that money in many different ways that they do not really have to account for (unless you buy a yacht for the President as happened at Stanford a number of years ago). Usually, it goes to put up more buildings, create more lab space so that more investigators can be hired, and more NIH dollars come rolling into the university.</p>
<p>The higher salaries of successful researchers reflect this extra revenue they bring into the university (as well as the prestige factor I mentioned earlier). It could be viewed as a kickback or a reward for bringing in revenue, depending on how you want to look at it. The increased salary would not come from the NIH indirect costs though but rather departmental funds as that would be illegal. In essence, some creative bookeeping occurs. </p>
<p>If you look at the major research universities, revenues in the department of medicine are heavily dependent upon NIH funding and indirect costs. There is not a lot of growth potential on the clinical side as they are competing with private community hospitals for the most profitable patients-those who come in and out for their medical problem. Tertiary care hospitals often take care of truly sick patients or indigent patients, both of whom do not improve the profitability picture. On the other hand, academic hospitals have a social function, and I would argue, responsibility to provide such care. Students, resident, and fellows also benefit from seeing such patients so an academic purpose also is served. The growth potential of expanding the research program of a medical school has no limits except for competition with other universities or congressional caps on NIH research funding.</p>
<p>pmyen, </p>
<p>Good summary of the economics of academic medicine. </p>
<p>Thanks.</p>
<p>Other places where one can work with an MD/PhD-</p>
<p>Translational Research/Clinical Pharmacology Departments in Pharma R&D. </p>
<p>Some companies have these as seperate departments while others combine them into one. Based on preclinical findings, research focuses on understanding the proof of mechanism/ efficacy, related gross and histopath toxicological findings based on preclinical research, investigating cross-species specificity, and projecting exposure levels, dose-response, PK/PD, safety margins, and risk/benefit ratio etc for First-In-Man studies. </p>
<p>Translational teams are deeply involved in advising Preclinical tox and preclin pharmacology groups in designing studies accurately, using correct disease models, and in terminating projects ("killing" drugs) that should not be submitted to FDA as INDs. They function to identify drugs that have the best safety and efficacy profile, ie best chance of making it from IND (investigational new drug/chemical entity dossier) to a successful PoC (proof of concept).</p>
<p>Also, don't forget the FDA and NIH themselves! FDA reviews our submissions (INDs and NDAs), therefore, they hire MD/PhDs as well.</p>
<p>From my MD/PhD colleagues, I hear that the salaries offered by FDA are comparable to those offered by Pharmaceutical companies actually with far less demanding work week! Our work weeks are rarely below 55 hrs/wk in Pharma. If you add to that time spent in International travel.... the hours add up rapidly.</p>
<p>I also need to add that once we identify certain trends of chemistries relating to risks or efficacy, we follow these markers throughout clinical development; ph1 to 2 to 3. So, by the time we have an NDA submission, we have an amassed database of information to guage the risk, efficacy, adverse events in target patient population as well as dosing guidance for hepatic, renal compromised patients, PK and PD drug drug interaction for concomitant meds etc.</p>
<p>Overall, Pharmacology work is exciting work for everyone involved. Once the drug gets to Ph2b, all its behaviors are figured out.....in Ph3, it's just collecting safety/efficacy in a HUGE population.</p>