Med school and then what?

[Guest Liana]

Maybe someone can help me.

I *think* I want to go to med school! I want to work in disease control, maybe neuroscience, and I definitely want to do my PhD. But having worked in labs previously, I can't really see myself just being a grad student lab rat. I want to be able to apply academic research in an actual clinical setting - like maintaining a research lab and clinical practice together. Can someone tell me, is this a viable option? Do universities frown upon potential future academics from "taking away" spots from bona fide practitioners (especially those students with their eyes exclusively on academic medicine), or is it okay to admit you'd like (as of now, anyway) to go into academic medicine?

 

I'm not *totally* sure what specific region of academics I'd like to get into, but I feel like I want to do my MD in addition to a PhD to actually gain the context of what I'm studying, and have some application to patients.

[Guest Ian Wong]

Academic medicine is a perfectly reasonable goal, and one that is in short supply everywhere. Without the research component of medicine, we'd still be treating people with leeches and blood-letting. Check out the MD/PhD thread below for some people's thoughts on the possibilities of combining clinical work with research.

 

Ian

UBC, Med 3

[Guest aneliz]

Liana, you're story sounds almost exactly like mine. I am a fourth year student and I am also interested in doing academic medicine although I am far from *totally sure* what exact area of medicine I want to work in. I have applied for meds for Sept and probably have a decent chance of getting in. However, I am also considering waiting to go to med school, doing my masters first and then applying to a combined MD/PhD program. If I don't get into meds this year my decision will be made for me. If I do get in it might be a hard choice. It will be pretty hard to turn down a med school acceptance just to do a masters - and I think that a lot of people would classify me as insane. However, I don't know how feasible it is to do a PhD AFTER an MD. (I really don't think that I want the stress of a combined MD/PhD program without having done a masters first.) Any thoughts anyone??? Anyone else considered this? I know most people look at grad school as the consolation prize rather than an equal alternative.

 

Ahhh.... life is so complicated.

[Guest strider2004]

Many physicians have a research lab along with their clinical practise and this can be done without a PhD. I plan to be involved in research(albeit epidemiological) during my clinical years.

 

Doing a PhD after an MD is rare in some specialties, but common in others. In neurosurgery for instance, most neurosurgeons have used part of their residency to complete a MSc or PhD in that area. A residency in Community Medicine often grants you a MSc in Public Health/Epidemiology.

 

I suspect that the difference you might observe between an MD and PhD is basic science vs clinical. It's easier for an MD to use medical records to look at patient outcomes.

 

You don't necessarily have to do a MSc to do an MD/PhD. Usually your PhD program is a different project than your MSc project because you can't use the same work for both(it's already published under your MSc work). The only benefit of doing a MSc first is to prepare you for the workload of a PhD and really, who wants to do it twice?

 

A researcher(potential supervisor) once told me that it's easier to go to med school and choose grad school than it is to go to grad school and then chose med school. He said if I get into med school, go there and if I still wanted grad school, if would always be waiting for me. It's not so with med school. Getting in one year doesn't always mean you'll get in the next year(luck of the draw). I got into med school and yes, I chose that instead of grad school.

[Guest UWOMED2005]

As far as I've seen, there is absolutely no bias against doing an MD with the goal of going into research. Some schools seem more interested in training academic physicians than others, but on the whole your goal should not hurt you. Also, if you're truly interested in Academic medicine only, you probably wouldn't even have to complete residency (I'm sure there's someone else who could provide more insight into this.)

 

The problem with doing an MD first and then a grad degree is quite simply $$. You can easily rack up $100,000 in debt doing an MD here in Canada, and carrying that debt load while trying to survive off grad student grads would be cumbersome at best. Usually upon graduation from med school, most banks require you to start paying off the full loan and not just interest - which could put payments into the $10,000/year range. It might be easier to do the PhD/Masters first - you can usually get funding to make ends meet while doing the grad degree (tuition AND living expenses) then tackle medical school. If you were do the same in reverse order (MD then PhD) you'd have to worry about your accumulated debt from the MD while doing the PhD. Of course, I've heard of a number of MD grads doing research, so there must be ways of getting around this.

 

Alternatively, you could do the combined MD/PhD program - seems like you've already thought of this or at least it's been addressed.

 

Also - you don't necessarily need the MD to do clinical research. An MD is a lot of work and additional expense if you don't truly need it for what you want to do. While there are certain things you need the MD to do in research with patients, there is the possibility of doing clinical research without the MD. I know two researchers at Dalhousie who do clinical research with "only" a PhD (I mean, without the MD - no denigration on PhDs intended whatsoever!). Once again, someone else should be able to comment more fully on this subject and with more experience than myself.

[Guest blah]

I wanted to add a few comments I just heard at a talk about clinician-scientist as a career option. At my institution, this program is extremely well developed and is well subscribed to; despite the following stats:

 

First the time-line: (best case scenario age at finishing) 18 high school, 22 undergrad, 26 MD, 29 specialization, 30-31 subspecialization (its RARE to be a GP/internist and a clinician-scientist), 34-37 PhD (upper limit is more realistic as it is typical for a basic PhD to take 5+ yrs), 36-40 post-doc, 39-43 scientist-track position.

 

Cumulative earnings are horrible by this age. Clinical subspecialists catch up with many GPs/internists around 38 yrs of age, but MD/PhD clinician-scientists are at about 1/3 total earned by that age. The ages are just an indication of the time line, as they depend on when you start/finish each step.

 

The main point: Unless you are rich/married into money, be a clinician scientist only for an overwhelming passion, that you know is lasting. The (tremendous) costs are time and money.

[Guest Liana]

Thanks for the input!

I was worried that admissions committees might look at me as though I were merely taking a spot away from someone who intended to be a GP. I'm just a bit concerned that my goal isn't well enough defined (for such a decisive goal) because I'm not totally sure what's out there for the MD researcher. I've known two MDs (one had a PhD) who researched, and one was a straight research scientist (the MD), while the other practiced and maintained a lab on the side (the MD/PhD). Are these the only options, or is there some sort of way of integrating both fields into one cohesive practice? (I'm not sure how exactly!!)

 

All I know is that I would like to do research yet also help people one on one (whether palliative or preventative; both entice me), but not necessarily work in clinical trials.

 

aneliz, I know your predicament exactly! I was hoping the medical schools could make the decision for me, but if not I'll probably try to go to a school where I can jump straight to the PhD without the master's to cut back on time. My perspective is that, for most schools, a graduate degree will help me get into medical school, and if I'm doing a lab degree where I'm getting a stipend, I should be able to put aside at least a little bit of money to help offset the cost of medical school (ie, maybe pay for a couple of books, if nothing else). I've also heard that grad school gives you a chance to really think about your life, which may or may not provide me any insight I haven't already determined, but will at least give me time to do some creative stuff (like writing) before I enter the world of no free time. However, I would rather do the MD first because I think I would be more directed in what I would like to study (probably something not quite so hardcore lab-benchy, but something verging on disease control/public health education) and theoretically I may be able to do the degree in a shorter period. I have considered the MD/PhD program, and the stipend of that would certainly help to pay the tuition, but my marks aren't stellar and so I probably wouldn't stand a chance in that route (at least not by initially applying to that program straight from undergrad).

 

Thanks for all of the great, in-depth advice everyone!

 

Good luck on your application, aneliz! Maybe I'll see you at the interviews...

[Guest BennyG]

Dear Liana,

 

Two (sort-of quick) points:

 

1) do not expect your stipend to pay for anything. Only a few departments provide a sufficient stipend to both live on and put away any decent savings. Of course, this depends on what city you live in, and if you live at home with mom+dad, and if you or your family's financial capabilities are good.

 

In Toronto, only one biomedical graduate department offers a stipend that is "high", i.e. $22,000. Subtract tutition, taxes and living expenses (rent, food) from this and you will find not much is left. Other cities are less expensive to live in, but the stipend is not usually $22,000 unless the department has a lot of money.

 

2) Also, if your graduate degree is to be worth anything, you cannot expect to have lots of free time to pursue creative interests. Sure, this is where someone will write back saying they have a friend who does this and that activity - olympic sports, flying to africa to save starving kids, etc. or the friend who only works 3 hours a day and still publishes in Nature, etc. The cold truth is that the majority of graduate students put in a LOT of hours. The only way I and some of my pals put in lots of extracirricular/volunteer/creative hours was by cutting back on our lab time because it was driving us insane. The "world of no free time", as you describe it, does not begin in medical school but actually several months into your graduate program.

 

Believe me when I say I'm not trying to crap all over your good intentions, and I know I'm a bit jaded (read my previous rants), but I do suggest that you consider these two points carefully.

 

Best of luck, Liana.

 

BennyG

[Guest Liana]

Good points BennyG, but don't worry, I'm already aware of them.

 

What I meant by having a lot of time during grad studies, was a lot of time to think. Having done research in the summers, and having worked on projects for school, I understand what this means. Sure, you're in the lab all the time, but a large part of that time you're doing tedious or repetitive stuff that affords you time to think about whatever -- for the grad students who have told me about how grad school gives you a time to really think about what you want to do, this means time to deliberate your future. For me, this is also time for me to ponder some of my thoughts on my writing, as I work. But, you're right, it's not exactly summer camp, and certainly not time to go training for the Olympics.

 

Also, about the money, what I meant by that point was that you might be able to put away a tiny bit of money to contribute to medical school. If I went straight into medicine from my undergrad, I'd seriously be hoping that I could find some lender (government or otherwise) willing to offer me every penny I will need for tuition, books, food, and transportation. I don't expect to put away anything even approximating a portion of the cost of tuition by doing grad school first, but on the other hand, it would offer me a few years where I could at least support what I was doing at that time, without having to go look for another loan. Potentially, I might be able to put aside a few hundred or maybe even a thousand dollars which, I know won't approach the total of my expenses for medical school, would at least be useful if I needed some rainy day cash.

 

But thank you, sincerely, for your input! It certainly does help to put my preconceptions into perspective.

[Guest AniyaSG]

As a grad student, I recieved an NSERC scolarship. This meant that I also got a scholarship from my school that covered tuition. I was left with a good amount to live fairly comfortably, in a student lifestyle. Students without NSERC scolarships often have to borrow to make ends meet. If you have grades good enough to apply to med school, an NSERC shouldn't be a problem, especially if you have some kind of research experience, possibly from an Honours project? I also found that I had TONS of time to play and think while doing my MSc. WAY easier than undergrad, although the hours were occasionnally long (I get things done quick however). I'm managing to put away a good chunk of money by working for 6months (with MSc level salary) in between finishing my grad degree and starting (hopefully!) med school. I do agree however, that if you want to focus mostly on research, don't waste your time on an MD. Do remember that post-docs usually follow a PhD (up to 4 years for some!), and post-doc pay is far from great. And even as an MD, you can combine research and practice, as an aunt of mine does as a clinical microbiologist.

 

Grad school has been fun, and has let me learn a lot about what I really want from my time on the planet. Good luck with your choices!

[Guest Liana]

strider2004:

 

Tell me more about the field of Community Health! This is something that has attracted my eye recently, such that I am seriously considering going into a more Public Health area of research. Epidemiology seems to be of interest to me, although most research that I come across seems too dry and statistical. What sort of opportunities are available to those who study these areas? It seems like I'm feeling my way through the dark for the academic direction that feels right to me, but increasingly, coupling an MD with a focus on Community Health seems to be enticing.

 

In what way does having an MD degree complement the conduction of research in this area? Does this enable you to focus more on a clinical setting, rather than just studying statistics? Is there a way to get into an area of government community health regulation without entering the realm of dry administrivia? I'm struggling to find that oasis of mathematical modeling of disease progress while still remaining close to the disease itself, by helping those who have been infected; or working in disease prevention, by promoting healthy habits in the population. Is there such an area? Is there some way to fuse a medical degree, theoretical research, and potentially governmental regulation (without the tedium associated) or teaching?; am I on the right track?

 

Thanks,

Liana