August 2013

Going M.D./Ph.D. vs. going 100% Ph.D.

Author’s note: This article, which was adapted from a post on my blog, was conceived after a student who has a strong interest in a research career in neuroscience asked for my advice. Thus, it was written with someone who is more interested in research than clinical care in mind. 

I will begin by saying that a research career is absolutely possible with an M.D. alone, but I think it’s not a very advisable route, considering the out-of-pocket expenses and lack of formal training in forming and answering scientific queries.
 
As you may know, the stated goal of most M.D./Ph.D. programs is to create physician-scientists who aim to do 80 percent research and 20 percent clinical time. Therefore, they are well-suited for people with a strong research interest rather than a primary interest in care.
 
What’s more, clinical time can be defined in a number of ways. With an interest in neuroscience, for example, you could use your M.D. to become a neuropathologist and help the clinical side by analyzing patient samples without having to interact directly with patient populations if you prefer.
 
If you’re deciding between an M.D./Ph.D. approach and a Ph.D. approach, the M.D./Ph.D. programs may be somewhat more competitive, but they are not significantly more difficult than M.D. programs if you have a strong research background.
 
Below, I’ve outlined what I think are the key considerations in deciding whether to go for a dual degree or a single degree.
 
Pros of an M.D./Ph.D. program 

  • • Career security: Clinicians always will be in demand, regardless of the research funding climate.
  • • Grant demand: An M.D. lends a clinical credibility to research proposals that often makes grants more attractive to funding institutions.
  • • Institutional demand for physician-scientists: At the faculty and postdoctoral phase, you will be a more desirable candidate in many cases if you possess the versatile education of a physician-scientist.
  • • Flexibility: This applies both during and after the program. Most M.D./Ph.D. programs do not require you to pick your program right away. This means that you can enter wanting to be a neuroscientist and change course to become a biochemist or pharmacologist if your interests change. After the completion of your program, you can continue into residency with or without a research emphasis; you can proceed directly into a postdoc and become a pure scientist that just happens to possess a background in clinical medicine; or you can take a still different course in industry, government or consulting. Related to this, it’s worth noting that you avoid some of the turf battles between M.D. clinical scientists and Ph.D. translational researchers if you decide to work with patients or patient samples, because your education will give you substantial authority in both realms.
  • • Better understanding of clinical problems: There are an infinite number of research questions to be asked. There is a finite amount of time in a career. With a medical education and regular access to patient populations, you’re more likely to understand the questions relevant to improving the health and happiness of the population. This point is less relevant if your passion is fr pure scientific understanding, but it was a factor that drove me toward this career path.
stock photos of researchers and a stethoscope
Cons of an M.D./Ph.D. program 
  • • Length: An M.D./Ph.D. program will take eight years on average, compared with a Ph.D. program, which ought to be done in five to six years.
  • • Purity of purpose: There’s only so much time in the day. It’s impossible to be all things to all people, and choosing a single doctoral degree gives you license to focus on your research with fewer outside concerns.
  • • Program availability and admissions: It’s still competitive to get into natural science Ph.D. programs, but there will be more slots available for Ph.D. programs than for dual-degree programs, so you stand a better chance of attending a more elite institution or one that’s better suited to your needs.
  • • Opportunity costs: It’s worth considering that the extra time and mental energy spent in developing a clinical foundation could be poured directly into developing your research career. It is possible that choosing a Ph.D. program rather than a dual-degree program could lead you to become better versed in your area of study sooner, giving you an edge over a less-focused person.

An important consideration is that your decision isn’t set in stone, either. Some M.D./Ph.D. students begin as Ph.D. students and transition into the program. Other people attend medical school or graduate school after completing another program if their interests have changed. Still others begin as M.D./Ph.D. students and drop half to become a medical or graduate student during the process when they discover that the rest doesn’t appeal to them as much as they thought.

Cody WestonCody Weston (codylweston@gmail.com) is an M.D./Ph.D. student at the Penn State College of Medicine neurosurgery department. Read his blog at thetenofswords.wordpress.com. Follow him on Twitter at @cody_weston.

 

Faculty Perspective

The evolution of biomedical science and you

The choice of whether to pursue an M.D./Ph.D. versus a Ph.D. presupposes a sincere desire to incorporate research into a future career. However, there are many additional factors that must be considered when weighing these two options.
 
One of the most important issues to consider is the evolution of biomedical research and how the two training paths will affect one’s competitiveness in the biomedical research workforce of the future.
 
Whereas biomedical research has had a longstanding tradition that relies on investigator-initiated research in individual laboratories, there is now a shift in the nature of biomedical research that increasingly involves team-based, large-scale, translational initiatives with an emphasis on the significance of the research in terms of the development of new therapies and improved treatment of diseases.
 
Based on this, it is important to assess future career options in terms of the roles that a given career will have in the evolving biomedical workforce. This should include an assessment of the necessary knowledge-based and skill-based competencies that will be important for future career success.
 
The M.D./Ph.D. track provides critical training that enables individuals to effectively bridge issues pertaining to the current state of medicine with initiatives in biomedical research in a bidirectional manner. Ideally, the knowledge gained through M.D./Ph.D. training facilitates one’s ability to inform basic biomedical research initiatives based on recognized needs in the clinical arena and conversely to translate the findings from biomedical research into improved therapies. Thus, M.D./Ph.D.s have the unique ability to engage in team-based, translational research based on their foundational training in human physiology and biomedical research.
 
Those who pursue the Ph.D. also play an important role in team-based, translational research by virtue of their intensive training in one or more theoretical or technical aspects of biomedical science. The Ph.D. track affords them the opportunity to specialize in a theoretical area of science and to gain additional in-depth experience in one or more areas of technology, such as bioinformatics or high-throughput analytical approaches that are being used more extensively. Thus, Ph.D.s can contribute to team-based, translational research initiatives based on their expertise in a particular area of biomedical science as well as through their expertise in advanced technologies that are critical for promoting the evolution of biomedical science and the practical translation of knowledge into therapies.
 
Regardless of whether one chooses to incorporate aspects of medicine or technology into a research career, there are essential competencies that will be required in either instance, including excellent oral and written communication skills, the ability to work with and manage others in a team, professionalism and a solid ethical foundation.
 
Taking time to think about the evolution of biomedical science and how you will fit into that process will play an important role in helping you make the right decision.

Louis JustementLouis B. Justement (lbjust@uab.edu) is the associate director of the Medical Scientist Training Program and a professor in the microbiology department at the University of Alabama at Birmingham.

 

Faculty Perspective

Plenty of options for students with all degrees of interest in research and medicine

There are many different careers for physician-scientists and many different ways academic physician-scientists combine research, patient care, teaching and administration. The percentage of time spent in each activity typically changes throughout a career. Most of us who are interested in science and medicine actually would find a number of different careers to be rewarding and enjoyable. With this in mind, it might be useful to approach the question of which type of degree to pursue as follows:
 
For students who have always aspired to practice medicine but did not enjoy research in college, going to medical school makes the most sense. There are a number of opportunities to do research in medical school, and it is good to do so both to give research another chance and because research experience makes a person a better doctor.
 
Students who never have had an interest in medical practice but always have been curious about how things work (health) or do not work (disease) should pursue a Ph.D. If they want to conduct biomedical research and want some training in clinical medicine without devoting all the years required to become a practicing physician, there are Ph.D. programs that provide clinical education for their students (e.g., the Howard Hughes Medical Institute Med into Grad Programs).
 
Students who are scientists at heart and who have a high, moderate or unknown interest in clinical practice are best suited for M.D./Ph.D. programs. These programs provide rich, integrated courses of training and protected time to develop research and clinical skills.
 
There are some rare individuals who have a seemingly innate understanding of how to do research successfully and typically have significant research experience and accomplishment. For them, an M.D. program with additional research in medical school and especially during a residency or fellowship might make sense.
 
Finally, there are the so-called late bloomers, people who train as physicians or as scientists and then discover that they are interested in the other career or a combined career. There are numerous pathways for late bloomers to pursue alternate or combined careers and a number of training programs and funding mechanisms for doing so. As with all major life decisions, it is advisable to discuss the options with as many people as possible who are actively engaged in the different possible careers.

David EngmanDavid Engman (d-engman@northwestern.edu) was director of the Northwestern University Medical Scientist Training Program from 1995 – 2011 And is a pathologist-scientist combining clinical diagnostic molecular biology and basic and translational research in tropical parasitic diseases.

 

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1 Comments

  • As a grant reviewer over nearly 20 years of my careers, mostly for the NIGMS and NSF, with an emphasis on the MD/PhD programs in the Cellular and Molecular Biology Training Grant Review Groups, I have some observations. Since it is very difficult to discern the success of an MD/PhD Training Grant program from documents, I was fortunate enough to have site visited most programs and to evaluate student growth and conclusions as well as mentors' expectations and observations.

    Here are some of my observations:
    1. Applications to the joint programs were viewed by both medical and research mentors as among their very brightest students (and colleagues).
    2. Students often found themselves in a schizophrenic existence. Medicine to them was conservative, intuitive and an art form. Science was more deductive reasoning and data driven with a tolerance for error as an experiment can be repeated.
    3. The dual workload made it clear that long hours were involved and that it was really only possible, with rare exceptions, to stand out in a single discipline, i.e. medicine or science.
    4. The sort of division of labors cited above, 80-20%, was the expected outcome for most of these students.
    5. A casual observation was that many, but not all, MD/PhD graduates tended to continue their research efforts for the next several decades, only to be utimately left by the wayside as knowledge and technology overcam their interests. It was not uncommon for these graduates to lack sufficient scientific breadth to adjust their research efforts to truly new directions.

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