To MD or PhD: That is the question

I almost entitled this post, When I grow up, I want to be “what all my friends are”.  Indeed, almost everyone around me, apart from a few sane friends whom I treasure dearly, currently holds the title of either MD or PhD or is in the process of acquiring one or both.

To many life science undergraduates, obtaining a MD and a PhD is the pinnacle of academic achievement, and the golden ticket to your career of choice.  So let’s imagine you’re a starry-eyed student with above average grades, some research experience (perhaps even a publication or two).  You dream of one day becoming a “bench-to-bedside” clinician scientist and leading your own research group and you can probably get into medical school, so why not do a PhD at the same time?
Here are a few questions I’ve grappled with:

1. Do you need the PhD to do the kind of work you want?  As Dave points out in a post on accumulating advanced degrees, it is entirely feasible to be involved in clinical research with “just” an MD with no shortage of excellent role models out there.  Moreover, it depends on what being involved means to you – do you want to have the day to day scientific discovery or would simply attending the meetings of the scientists and giving the clinical context to those meetings be your shtick? While I do not have the personal experience to back this up, I would imagine that for many medical students, having the extra time to pursue a variety of research and other interests (rather than just your thesis project) would give greater balance to your life.
2. Do you need the PhD to feel accomplished and validated as a person?  Making the leap from undergraduate to PhD student must be very difficult because one moves from a highly structured, extrinsically driven program with regular performance evaluations and rewards to one where, most of the time, you alone are responsible for evaluating your successes and failures.  I would guess that if you draw most of your motivation from high grades and exultant praise from family and friends, grad school might come as a bit of a shell shock.

One of my professors recently struck up a casual conversation about Dr. BigShots and how they’ve become amazingly successful.  His explanation was simple, yet enlightening: if you gave these people a free day, during which they could do whatever they wanted, they would, without doubt, go to the lab, do experiments, and read papers.  If your answer is similar, then you’re probably well suited to a career in research.

I got “into research” as an undergrad by sheer stroke of luck.  A co-op position in a great lab within a super department opened up the doors to a world in which people worked on what they were intensely interested in, driven by their intrinsic curiosity about the natural world, and largely unworried by any sense of competition.  What a refreshing change that was after the cut-throat environment of the life science undergrad classes I was immersed in hitherto, the looming burden of conformity, mixed with the feeling that almost every endeavor of everyone’s life was geared towards one goal: to gain admission to medical school.

Full disclaimer: I was every bit that annoying, competitive pre-med student and more; I would plan my days down to the 1/2 hour, I would routinely tell my friends “I’m busy right now, call me in May”, and I went through a three-week exam period eating nothing but pizza and coffee.  I had few academic interests other than scoring highly on exams.

I’m a firm believer that people will make their best contributions to the world if they pursue what captivates them most intensely, regardless of societal expectations.  This can take a lot of courage if you’re immersed in an environment where running an independent research group is assumed to be the aspiration of anyone smart and dedicated.

If I had a free day to do anything I wanted, it would be composed of some mixture of treating patients, advancing medical knowledge, and empowering others to become advocates for change.  I love the process of scientific discovery and relish both the synthetic and analytical skills it is teaching me, but I want to apply these skills to scaling up distribution of health care tools that already exist, rather than to developing new ones.  I have my eyes set on a few Masters of Public Health programs. , which I think are perfect for someone with my interests and goals.  Ultimately, I aspire to become a community medicine physician, my pulse pounding to the rhythm of interactions with diverse groups of people, applied research, education and advocacy.

Like many of my MD/PhD hopeful friends, when I grow up, I want to do research.   But I don’t want to do just research, in only one field.  I’ll happily trade in the dream of one day running my own research group, for a life in which I get to contribute to society in a multitude of ways.
To close, I’d like to pose a few questions to the readers: if you are an undergrad, do you too feel the pressure to accumulate more advanced degrees, faster than anyone else?  If you’re on the MD track, do you wish you had pursued a PhD concurrently?  Why or why not?  If you went down the purely research route, do you feel you’ve been able to maintain a broad set of interests and make steady progress on your research at the same time?  How did you do it?  Please leave your thoughts in the comments section; we would love to read them.