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The Black Hole

To MD or PhD: That is the question

BY SONJA B. | SEP 28 2010

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.

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  1. Derrick / September 28, 2010 at 17:53

    Another factor to consider in the MD-PhD is what line of medicine you are in. Many surgical fields now “require” (i.e. you don’t need it, but a lot of people sure seem to have them) advanced training–PhD/MPH/etc. as well as a fellowship to be in the academic centres. This is often a function of limited resources/jobs available for new grads since jobs depend on OR space. In medical fields, there is a little more room because there is less dependence on the hospital system. There is still the same pressure from the academic medicine world, however.
    And often, these advanced degrees need to be done during residency or post-residency, because it is very much a “what have you done lately” world. In addition, many will say that a PhD should not be done in the same place as your MD, because you need the broad exposure. Since it’s nice to do residency elsewhere, that adds up to a lot of travelling and putting life on hold. Suddenly a 4 year medical degree has become a 7 year residency and 2 year fellowship. Hello 35th birthday, if you’re on the standard timeline.

  2. Charles A / September 28, 2010 at 17:57

    Hi Sonja,
    I enjoyed reading your post. If I could refer to what the pharmacy degree looks like – graduating with a B.Sc.Pharm doesn’t give you a lot of research experience. Most pharmacists engaging in some sort of research have had a hospital residency (only one year, in comparison to the medicine one), which does provide 4-8 weeks of training in research. However, pharmacists find that even that training is insufficient when it comes to really spearheading some important research, and so we have a Pharm.D. degree that prepares pharmacists to do more of a 60% clinical and 40% research role.

  3. Ainsley Clement / September 28, 2010 at 20:53

    I think sometimes, many students are too focused on the PhD or MD because it puts “Dr” in front of your name. I struggled with this for a long time, but learned that you can become extremely successful with out these titles! PhD/MD does not necessarily equal success and for those who put a lot of pressure on themselves, I hope you eventually realize this fact. I have a MSc, a degree that is often overlooked in importance, and believe it or not, has led me to the ‘business side of science’….yet another avenue!

  4. SubC / October 1, 2010 at 16:17

    Great article and it brings up many good points. This summer , I (a postdoc) had a great undergrad summer student working in our group and she was going through the same motions, trying to decide between health science career and a research career.
    With some input (largely positive) from our lab members and her older sibling (an MD/PhD) she finally decided to pursue a career in a non-medical health career with a MSc (with the possibility of a later switch to PhD). Many of the items discussed here were exactly the same ones we had brought up to guide our youngest lab member !
    Keep up the good work !

  5. Sonja / October 3, 2010 at 02:40

    Derrick: you bring up an excellent point regarding the time to complete an advanced degree…. I hadn’t thought of it from that angle, but it sure makes sense that you’d no longer be “current” on all the research in your field after a 7-9 year residency + fellowship…
    Charles: Thank you for your thoughts! I actually talked to a PharmD graduate recently who felt that even that program wasn’t research-intensive enough…. so he’s studying for PhD in Pharmacy now! I suppose the sky’s the limit… sounds like a lot of school though!
    Ainsley: It’s all too true that the MD/PhD titles aren’t the only paths to success, especially at the intersection of the science and business worlds. Having an MSc, I’ve heard, can be pretty ideal in terms of being able to access a wide of jobs in industry….
    SubC: Thanks! And kudos on talking with your undergrad about her career options. I feel like many of us who work as summer students receive little encouragement from our mentors other than to stay in science research. I really don’t think that doing a PhD should be the default choice for life after university. It’s obviously really nice to be encouraged to stay in academic science, if you like the research you’re immersed in (as I did), but I also know plenty of people who have worked on uninspiring projects and in spite of this, been far too shy to admit anything other than wanting to follow in the footsteps of their supervisor.