MD/PhD Questions

[Guest brandonite]

I know there are several people around here who are thinking about doing an MD/PhD, so I thought I would bring this up again.

 

I was in Winnipeg yesterday, and I think that I'm leaning towards doing the MD/PhD. The major NRC lab for biophysics is in Winnipeg, and I talked to the director yesterday. He seemed really enthusiastic about having me there. I'm going to talk to the head of the Manitoba MD/PhD program next week.

 

But I know that MD/PhD programs in Canada aren't as established as they are in the US. And I know that it's very hard to combine basic science research (I'm not talking clinical research!) with basic science research.

 

Do most MD/PhD's work through a University? I'm not exactly clear as to how you start back into research after you're done your residency in your given specialty. Do you have to do a post doctorate postion somewhere like traditional PhD's do? The extra three years for the MD/PhD doesn't bother me too much. But if I had to do another five years as a post doc (slave labour ) after five years as a resident (slave labour ) that might change my mind...

 

I know MD/PhD's make less money than regular MD's. And that doesn't really bother me all that much. But does anybody know how much less? Would you get paid at MD levels for the your clinical work, and PhD levels for your research work? PhD's don't make a lot of money, and if I go into a large amount of debt during my MD/PhD, I would be worried about not being able to pay back that debt...

 

Thanks!

[Guest Kirsteen]

Hi brandonite,

 

Many of the answers to your questions hinge upon a number of factors including: what sort of research you'd like to do and what you'd like to do with the MD/PhD once you've got it. There are quite a few career models/avenues for the MD/PhD graduate to pursue.

 

A couple of the major choices that you have to make are whether you'd like to commit to basic science research or some other type of research e.g., clinical, health policy/economics, etc. Next, you have to decide (and you can do this later on, perhaps) what you'd like to do with the combination of research experience and clinical experience. Some MD/PhDs take an academic route, some take a pure research route, some take a purely clinical route. Some manage to very successfully combine all or some of these routes.

 

Ideally, the MD/PhD, with that unique set of tools, may want to be in a place where he/she can add additional value from having both sets of tools. For example, in the research realm, having the deep clinical knowledge base can add extra dimension to your research that may differentiate you from non-clinicians in the research realm. On the contrary, in the clinical realm, some great medical advancements in processes, etc., may be made by the clinician who has the research tools to successfully retrieve the answers to clinical questions.

 

Regarding whether or not you "have to" do a post-doc, again, it all depends on how much you want to focus on the research and the type of research that you're doing. In discussions with one person who is very involved in one MD/PhD program, he suggested that his idea of an archetypical route for an MD/PhD would be as follows: complete the MD/PhD; complete a clinical specialty residency; complete a post-doc; emerge at the other end and make significant advancements within the research and clinical aspects of the chosen field.

 

As to the financial side of things, again it really depends on what you do with your knowledge and how you apply it. For example, a pure lab-based, academic researcher may make a "little" less than a pure lab-based, private sector researcher who secures a position at Eli-Lily, et al. On the other hand, a clinician scientist who proves him/herself among his/her peers via publications and great clinical ability may manage to secure some loftier positions within some outstanding medical facilities. As to combining basic science research with clinical practice, it can be done. I work alongside a fellow who executes this model beautifully: he hires excellent post-docs to run the show at his lab (of course, he provides the overarching direction) while he also runs a very busy, private clinic. Financially, he does just fine.

 

In all, I'd give a lot of thought about what you'd like to do at the end of the day If research seems to play a big part of that picture, then next try to see if the MD/PhD is exactly what you need to get there--it may not be. Depending on what you want to do, there are other research avenues for clinicians, e.g., the Clinician Investigator Program (CIP) and others which allow a certain amount of exposure to research too.

 

Cheers,

Kirsteen

[Guest medwant2b]

Hi brandonite:

 

My impression is--most MD/PhDs work at universities or government funded research institutes. In Canada we don't really have research institutes so you'd be at university. The following link ( www.utoronto.ca/mdphd/graduates.htm ) tells you about where UofT's MD/PhDs ended-up.

 

Post Doc:

I'm quite sure they don't make you do 5 years of post doc work at a meagre pay if you've got a MD. The post doc deal, to my knowledge, is something you do in the sciences because academic positions aren't so easy to come by. I know it is different elsewhere. Someone I know in engineering got hired by McGill pretty much right after he finished his PhD. As an MD you can make a bundle if you've finished off your residency. Do you really think the brightest and the best will be inspired to do research if it requires a really significant sacrifice? I don't.

 

Salary:

You might want to take a look through the salary disclosure lists for public employees (for Ontario). The lists are hosted by the Ministry of Finance. I was curious about my professors at one point. They have lists for the hospitals and universities. Unfortunately the government site is down at the moment-- but then I guess that shouldn't be so surprising, if the government here can't even make sure the drinking water is safe. :rolleyes

 

Cheers!

[Guest brandonite]

Thanks to both of you.

 

I don't find clinical research all that interesting, to be perfectly honest... From what I've seen, a lot of it is just data collection and analysis. But I do like research, so that's why the MD/PhD seems to fit. And I like interacting with people and patients, so I do want to do at least some clinical medicine. Ideally, I'd like to split my time 50/50 or something like that between research and clinical medicine.

 

I know that's very difficult to do... If I had to, I'd probably make the choice to practice. But I really would like to do both. And I'm pretty dedicated and hard working, so I hope it's possible.

 

I'll graduate with a degree in Physics in a month or so. So, most of my experience with grad school is in Physics, and there, you do have to do 5 years as a post doc at meagre pay. But I suspect that things might be fairly different in the medical realm... Especially since you have the whole residency experience, during which research is possible...

 

Thanks for the tip about the government employee site... I'll check it out. But like I said, money isn't a big deal. I just want to know that I can pay off my student loans and live reasonably comfortably after that.

 

Kirsteen - I want to do basic science research, probably in the general area of biophysics. And like I said above, I want to be involved in both the clinical and research areas. So, like you said, I'm hoping that my background in research will help me be a better clinician, and vice versa. So, I suppose I would probably end up at a University. I suppose a research lab would be better oriented to what I want to do, but like mdwant2b said, there aren't too many of those labs in Canada.

 

So, generally, I think the MD/PhD program is best suited for what I want to do...

[Guest Kirsteen]

Hi again brandonite,

 

Yep, if you'd like to combine and apply your MD/PhD tools, it definitely can be done. The person that I referred to who is currently an MD/PhD and successfully combining the two activities is associated with the university but his lab is based in the hospital. With this appointment, he can lecture within the medical school and potentially take on students for electives within his clinic; yet, his laboratory (basic sciences) still churns out groundbreaking work and on a very regular basis.

 

Another purported bonus to having the MD/PhD and pursuing research is that apparently all the more funding doors swing open when it comes time to write some grant proposals.

 

Best of luck to you,

Kirsteen

[Guest Sarah371]

I know that in certain fields (anesthesia for sure) that you can spend a year working towards your PhD at residency wages during your residency.

 

I would however caution about trying to get a PhD through MD/PhD programs. If you earn your PhD this way it will always be looked at as inferior to the tradition PhD program. Basically because of the time constraints. Also think about the fact that you will lose your class while youo do your PhD making it hard to resestablish yourself when you return to the clinic, (think in terms of study groups....friends etc)

 

Also If you do a PhD after you finnish your residency you get paid something along the lines of 60,000 a year to do it and you are considered further up the food chain (rightly or wrongly) that the average grad student.

 

Anyway good luck with your choices.

[Guest brandonite]

Hmm. Well, I don't think that loosing my class would be such a big problem. I mean, by the time you come back into the third year of medical school, you'll be on the wards anyway, so you don't have much studying to do. I suppose it does put things off a bit, but I'm not too worried about that.

 

I have heard both ways on the PhD. Some people say that it is looked down upon because of the time constraints, but I've also heard that most people don't consider it to be any less of a degree. I've also heard that some people think of MD/PhD's as better researchers because they have that much more of a medical background than regular PhD's. So, I don't know. I suppose I should try and talk to some MD/PhD's about this...

 

Thanks!