Lost interest in basic science; what about clinical research?

[RedValerian]

Hi all,

Current MD/PhD student in my clinical years here. After muddling through my PhD (did get multiple papers but secretly hated every day), I sadly realized that I do not enjoy "basic science" whatsoever. And by basic science, I mean very fundamental research that is not immediately relevant to human patients. I just hated the actual experimentation itself, for example pipetting or PCR or cell culture. To me, PIs who do "basic" research and also see patients seem to be doing two totally different jobs, which I hate. In contrast, I have enjoyed clinical medicine so far.

I do very much enjoy data visualization, statistics, genomics, etc. and I'm hoping I can still work towards what I assume would be a career doing some clinical/translational research. Ultimately, my original motivation for going the MD/PhD route was to investigate disease. My overall question is, what does "clinical research" entail and what do I need to have a successful career in this area, with about 20-50% research effort? I'm not necessarily interested in doing trials, but more like something investigational on human patients with a disease. For example, I could gather a cohort of patients with rheumatoid arthritis and do genomics on synovial aspirates before and after receiving a TNF inhibitor (just an example, I know this has been done). Or medical record-based studies looking at multiple chart parameters and correlating with incidence of flares in patients with gout. Are these examples considered clinical research? What kind of additional training do I need for this beyond the MD/PhD? Do I necessarily need a lab and what are funding mechanisms? And how much of a cut to renumeration should I expect if I were to do clinical trials, or human studies, or outcomes research? (Not that that is my primary concern--I do not enjoy reductionist, experimental science no matter how much you pay me--but it seems like MD/PhDs who do basic science suffer a much more substantial cut to their salary than those who do clinical research... why is that?)

Thanks so much in advance! I realize this is kind of a mess of a question, too!

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[ValentinNarcisse]

This research is mainly done by MDs with a full clinical load. You do not need protected time to do this work in the same way a basic science PI does. You should develop relevant skills in statistics and metanalysis. Also, except for very large projects, this research largely is not NIH funded. You will be paying your salary from your RVUs as usual which is why the salary is higher than physician-scientists who have to work against the NIH cap.

 

[Patros]

Clinical research training is often integrated into residency/fellowships (depends on specialty). Both of the projects you described are immunology/autoimmune disorder-oriented, so you might consider, for example, internal medicine + rheumatology fellowship. So in this case, the fellowship will have a research year, during which time you can pursue the kinds of projects you described.

Whether you will need lab space or external grant funding depends on the type of work you want to do. The former project you described (genomics, which I assume you mean DNA sequencing or microarray) might very well require lab space + funding. The latter project on retrospective chart review probably won't require either.

 

[tr]

You can absolutely have this kind of career and if you are good at the grantsmanship game you can also get NIH funding for it. Epidemiological projects using large datasets and clinically focused work of appropriate scope are eligible for R01, R21 funding like anything else. Smaller projects can be suitable for R03. As a fellow/postdoc you can apply for K series. Look at the funding disclosures on papers presenting the type of work you would like to do.

It is pretty hard to do any research at all without some type of protected time. But if the work is integrated well with your clinical work you may not need much, can make do with foundation, internal, philanthropic, etc. You can collaborate with colleagues who run basic labs to complete projects that require omics work etc.

Effects on salary probably depend on your specialty. In my field academic salaries are way lower than private practice so the salary hit comes from staying in academics in the first place. Research time comes out of federal grants at the NIH cap, out of non Federal at your actual salary, which for me are trivially close together. If you do a procedural specialty with high reimbursements you may take a huge financial hit to have this type of career.

 

[dl2dp2]

This is a common pathway and very doable. Keep doing your specialty training and do a fellowship that has lots of mentorship and research time. Then do your usual K->R pathway. In essence, this is similar to the MD -> fellowship w. NIH LRP situation, but as we did an analysis before, the advanced timing of the capital investment makes MD/PhD program still superior as a training pathway.

Pure basic science MD PhD has lower salary, even when they do clinical work, because often there's the additional budget allocated for clinicians who do X% clinical work within the rubric of clinical research. Secondarily, and ultimately, salary numbers relate to market competitiveness. Clinical researchers have an industry competition vs. academia, which basic scientists typically do not. This causes a clinical researcher salary mark up.

 

[gbwillner]

Hi all,

Current MD/PhD student in my clinical years here. After muddling through my PhD (did get multiple papers but secretly hated every day), I sadly realized that I do not enjoy "basic science" whatsoever. And by basic science, I mean very fundamental research that is not immediately relevant to human patients. I just hated the actual experimentation itself, for example pipetting or PCR or cell culture. To me, PIs who do "basic" research and also see patients seem to be doing two totally different jobs, which I hate. In contrast, I have enjoyed clinical medicine so far.

I do very much enjoy data visualization, statistics, genomics, etc. and I'm hoping I can still work towards what I assume would be a career doing some clinical/translational research... I'm not necessarily interested in doing trials.... And how much of a cut to renumeration should I expect.... but it seems like MD/PhDs who do basic science suffer a much more substantial cut to their salary...

Based on this alone I think you would be happier giving up on research all together. All basic science has some sort of clinical relevance, and if you were really interested in that angle you would probably have explored it a bit during your PhD or found a way to incorporate it more. Don't worry- you'll be joining a majority of MD/PhDs who eventually give up on research. You are young and your career is ahead of you- you'll be lucky to do what you enjoy.

 

[Lucca]

Based on this alone I think you would be happier giving up on research all together. All basic science has some sort of clinical relevance, and if you were really interested in that angle you would probably have explored it a bit during your PhD or found a way to incorporate it more. Don't worry- you'll be joining a majority of MD/PhDs who eventually give up on research. You are young and your career is ahead of you- you'll be lucky to do what you enjoy.

is it rly a majority? seems like the outcomes papers have a little over 2/3 still involved in research at some lvl

 

[gbwillner]

I think it may be "at some level" as in an academic appointment, but in terms of applying for grants and running a lab- no way.

 

[tr]

Running a basic science lab with, like, benches and machines and stuff is definitely at one end of the spectrum of research involvement. However there are many people who run research groups that are not a 'laboratory' in a physical sense, but still run on federal funding and conduct research that falls anywhere on the spectrum from clinical to translational to basic. They may use core/shared university facilities or collaborate with people who do run basic science labs to get access to the equipment they need.