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MD PhD Guide: On The Road to Medical Science

Medicine and Science

Miles Berger
 
The rewards of medicine come quickly and with relative ease; the rewards of science come slowly and with great difficulty. This, in the words of the director of the MSTP at a top medical school, is the difference between medicine and science. Of course this is a gross simplification, but it contains some measure of truth. Clearly, both laboratory research and clinical medicine require intelligence and hard work, but each has its own additional demands. Medicine also has a large psychological element: put on a shirt and tie and a white coat, and patients look at you with respect. Mentally, much of medicine is pattern recognition: seeing a set of symptoms in a patient, remembering that they constitute a given disorder (which you may recall from a textbook that you read years ago), and then giving the patient the appropriate medication and/or referring them to a specialist. Even if you are able to help a patient only marginally, simply by being a compassionate, thorough and thoughtful physician you will gather much respect.

In contrast, science is largely based on results: where you publish and how often. You can usually wear whatever you like in a laboratory, but only an investigator whose research resolves questions of importance and stimulates further thought and study will be accorded scientific respect. Scientific success, in addition to intelligence and hard work, demands both intellectual creativity and a spirit of delayed gratification and maturity. Unlike clinical medicine, with its emphasis on recognizing patterns of symptoms, science often involves developing new techniques to study unknown phenomena, recognizing connections between previously disparate ideas or fields of study, and having the maturity to wait until a study yields important results. In fact many important scientific discoveries were made after a long period of frustration and tedium.

So if science and medicine are so different, why pursue both in your education by completing an M.D./Ph.D program? There are three main reasons for doing so. First, studying science at the graduate level will make you a better physician even if you do not continuing doing research. Second, studying medicine will put science into a larger perspective and can help motivate your research even if you never practice medicine. Third, pursuing a career at the confluence of clinical medicine and scientific research can allow one to develop clinical treatments and to make scientific discoveries that would be unlikely to result from the work of either a pure clinician or a pure scientist. Physicians with scientific training have the capability to take bedside observations into the laboratory for further study, as well as the reciprocal ability to apply laboratory findings to patient care. In other words, clinical medicine and laboratory research need not be mutually exclusive pursuits: rather, they can be pursued in a synergistic fashion.

However, it should be noted that most M.D./Ph.D. graduates eventually wind up choosing to pursue either laboratory research or clinical medicine as their primary focus, while devoting a minority of their time to the other or to administrative or other concerns. The reason for this is simple: it is difficult to be a good scientist or a good physician without spending most of your time on it. Of course, it is possible to spend 80-90% of one’s time doing research and 10-20% seeing patients. This situation is common for many M.D./Ph.D.s or even M.D.s who run laboratories but have faculty appointments in clinical departments of medical schools. It is difficult to be a good doctor without doing it full time; a doctor who practices only part-time will simply not have the same pattern recognition as one who works full time. However, it is probably more difficult and certainly more rare to spend 80-90% of one’s time seeing patients and 10-20% doing research, if only because it is difficult to get NIH or other research funding while devoting only a minority of your time to research.

Of course, there are arguments against doing an M.D./Ph.D.. First, some argue that since M.D.s can do laboratory research and many M.D.s run highly successful basic science labs, there is no need to do an also obtain a Ph.D. While it is possible to do good research as an M.D., a Ph.D. gives you a broader scientific base, will make it easier to get grant funding in early career stages, and will help you be a better physician because it will give you a better understanding of basic biology. While many M.D.s do good basic science research, also having a Ph.D. certainly makes it easier to do so.

Second, some argue that if you really just want to do research, there is no point in obtaining an M.D. This is partially true: if you really only want to do research, then getting an M.D. is a lot of extra work. However, M.D./Ph.D.s who do research are typically paid better than Ph.D.s, they have an easier time getting faculty positions, and they are typically accorded more respect in general. Additionally, medical school classes contain a great deal of human physiology and pathophysiology that is not taught in typical biology graduate programs; this gives M.D./Ph.D.s a broader understanding of human biology in addition to the specifics of their thesis research.

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