MD/PhD AND surgery?

[EdmondDantes]

In need of some advice --

Are both realistically feasible?

I'm a bit confused right now- I have always been very interested in surgery - but recently, I have seriously been considering a PhD as well. The closest thing I have heard is that some MD/PhDers go into neurosurg, but then most drop the PhD portion and just practice, albeit they are almost 40 when they start!!

I am thinking of juggling a career in teaching and practicing, -- after talking to a friend doing his fellowship, I hear that it is quite possible to still teach 2 days a week or so - this might be a bit idealistic eh?

any thoughts on doing the phD and still going into surgery?? any special considerations? Having a normal familiy life would be tough I imagine...

thanks a lot everyone --

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[njbmd]

Hi there,
Many of my fellow residents are MD/Ph.Ds and I am headed in that direction. I find surgery and research complimentary but it does take some solid time in the OR to hone your skills as a surgeon. Many of the ENT residents here at UVa and a few of the surgery attending physicians have Ph.Ds. All of the faculty does research with the Ph.D faculty doing a bit more research.

As for teaching, most of the MD/Ph.D crowd tends to go toward the academic medical centers. You are going to find that you have to teach if you practice academic medicine. All of our surgery attendings here are great teachers. All lecture and all spend much time with the residents teaching. You don't need to have a Ph.D to teach but a Ph.D will make you more competitive for academic practice but is not a requirement.

Surgical practice is pretty time-demanding. Most people elect to practice surgery as opposed to teaching alone because clincal practice and take many hours each week leaving less for family time. (Remember, as an attending, you are not bound by an 80-hour rule). Surgery is not 9-5 (even with residency hour restrictions) and certainly will be pretty time consuming when you start to practice (attending surgeons do far more than 80-hours). Add teaching time, and you have cut your outside time even further.

Do be aware that even though resident hours have been cut back, the workload has not been cut. You still have to accomplish in 80-hours, what you originally had more hours to do. That means that you have no downtime during residency. Surgical residency is demanding and you may find that even with less hours working, you are working harder and pretty spent mentally and physically at the end of the day. Just make sure that you enjoy what you do.

njbmd

 

[MacGyver]

What do you mean by "they drop the PhD portion when they practice"?

MD/PhDs get teh PhD in medical school, not residency. There are a very few programs in other specialties that offer a combined residency-PhD but I've never heard of one being offered in surgery. Most of those programs are for internal med.

I know that most surgery residency programs require 1 or 2 years of research, but thats not enough for a PhD. Getting a PhD requires coursework, TA work, qualifying exams, and finally thesis work.

I've talked to some PDs regarding this and the consensus is that a program that routinely gives out PhDs in 2 years is not a "true" PhD considering that the national avg for biomedical PhDs is on the order of 5-7 years.

 

[Celiac Plexus]

Actually "most" surgery programs do not require a year or two of research. A fair number of university programs do require +/or encourage research.

As for earning a PhD during residency, generally it depends on how flexible the department is. Some programs will let you stay in the lab for 3 years, and others will let you take a leave and go to a different university to do your research.

I dunno about how PhDs compare between the traditional 5-7 year track vs. the 2-3 year track in med school/residency. It would seem though that it is the research that you do that matters most, and not the number of years that you spend doing it. I would rather spend 2-3 years in the lab and produce something great and useful than spend 5-7 years doing the same thing (a good portion of which is simply slaving away as a TA).

 

[MacGyver]

Its more than just research time though. I would argue that the coursework that PhD students engage in is more thorough, complex, in-depth, and difficult than what the MD students take.

MD courses are generally broad survey type courses.

The fact that some PhD programs (say immunology) require only ONE immuno course (and a survey course at that) for MD students, whereas the PhD student would be taking multiple graduate level immuno classes which are definitely more in-depth is a strange discrepancy.

 

[Airborne]

I don't agree with the statement that unless one spends the requisite 5-7 years in a PhD program, you are not a "true" PhD - As you indicated, much of this time is doing coursework (1/3), TA work (1/3) and research (1/3), albeit these are rough approximations. As an MD/PhD candidate, whether the traditional med school way or in residency, I think that the coursework should be minimal - The TA time is a non-issue since I don't think the MD/PhD should do this, unless one has an interest in teaching science courses in the future (which I doubt many MD/PhD's would.... Thus you are really left with the research time, which in a traditional only PhD program amounts to 2-3 solid years.

In the end, it is really about your contributions to science (ie your publications) and developing a sound knowledge of the scientific process (ie research, grant writing, preparation of manuscripts, troubleshooting, etc.) -

As far as MD/PhD's in surgical programs - I think it an extremely valuable asset. Do you need it to be a good surgeon investigator? Absolutely not. Will it help you - definitely. In the end, one should really temper the time it takes to accomplish the added qualification vs. additional time in fellowships, etc.

Having completed my PhD in medical school, and now nearing the end of my CC3 year, I can say that nobody cares if you have it or not. Maybe it will help in the residency application process. I am finding that I am getting way behind in the literature of the field (which may be a good thing, as I plan to enter a field unrelated to my PhD) - Indeed, sometimes I think it would be better to complete the PhD in residency, as you ultimate career path is chosen at that point, you are current and have publications relevant to your chosen field, and may be in a position to apply directly for grant support that are effective at the end of your residency. Sure this is possible with the combined med-school/grad-school route, but I am finding will necessitate taking additional years off in residency to develop your name and establish yourself.

Getting back to the original question, as an MD/PhD, I will be applying this year in a surgical specialty (ENT) and think there is a very good outlook and opportunities for MD/PhDs in surgery.

Regards,

Airborne

 

[MacGyver]

airborne,

I dont think the coursework requirements for MD vs PhD are even remotely similar.

For any given PhD field, MD students take AT MOST 1 course which is a broad survey type course.

On the other hand, PhD students take at least 4 or 5 courses related to that particular field, all of which are more in depth and focused than what the MDs take.

I think a PhD is both about having published specific research in the field which is significant AND having a breadth of experience in the field.

There are indeed college students who have published in scientific journals so if published research was all that should be required for getting a PhD, then you wouldnt even need to enter a PhD program to begin with. You would advocate them getting a PhD even though they have taken no graduate coursework whatsoever?

As for PhDs and surgery, i dont think it makes that much of a difference relative to other clinical fields. There is a relatively large disconnect between the practical work that a surgeon does and the basic science work done in biology/immuno departments.

PhDs are much more valuable in other fields like rads, rad onc, pathology, anesthesiology, and internal med, where the practical work of an MD relies more directly on basic science breakthroughs in the lab.

Surgery relies much more on clinical style research (i.e. which patients benefitted from a new type of surgery) rather than basic science research (factor X leads to improved down-regulation of cytokines) and therefore having a PhD for surgery really doesnt help. Theres no such thing as a PhD in a clinical field; all PhDs are offered by basic science departments.

 

[droliver]

Macgyver,

I would disagree with your assertion that a Phd would not be as valuable for surgery as those other fields. The hottest areas in academic surgery have to do with cyotokines, shock/sepsis pathways, cell-cell signaling, immunology (transplant and otherwise), tumor biology, the genetic basis for surgical problems (atherosclerosis,inflamatory bowel disease,solid organ tumors), stem cell research, and immunomodulation.

The days when your academic career advanced with retrospective clinical papers is long gone. The hottest candidates for surgical chairs of the most prestigious programs are for the most part no longer clinicians, but rather rainmakers for NIH dollars.

 

[southerndoc]

Originally posted by MacGyver
Its more than just research time though. I would argue that the coursework that PhD students engage in is more thorough, complex, in-depth, and difficult than what the MD students take.

MD courses are generally broad survey type courses.

The fact that some PhD programs (say immunology) require only ONE immuno course (and a survey course at that) for MD students, whereas the PhD student would be taking multiple graduate level immuno classes which are definitely more in-depth is a strange discrepancy.

Broad survey type courses? I dunno how traditional medical schools operate, but my school is PBL, and the books we used for pharmacology (Goodman & Gilman), neuroscience (Kandal, Schwartz, & Jessup), and immunology (Abbas) are books that are routinely used for graduate level programs.

However, our training is far less than graduate training. I wouldn't necessarily call it a "survey" course, but I will agree that it's not up to par to what a PhD student will learn with his or her numerous courses tailored to his or her specific field. That's what graduate school is for -- you learn material in more depth than what any other student learns.

As far as you not being aware of any surgery programs offering PhD's, there are quite a few that will allow you to earn PhD's for your research. Generally you are required to spend more time on your PhD than the general one- or two-year research requirement that is part of your surgical residency. Programs like Duke, Beth Israel Deaconess, Vanderbilt, etc. all have PhD tracts for interested individuals. They simply don't hand out the PhD at free will, however. I gathered from your post that is your feeling of how surgery residents get their PhD's.

 

[southerndoc]

Originally posted by MacGyver
PhDs are much more valuable in other fields like rads, rad onc, pathology, anesthesiology, and internal med, where the practical work of an MD relies more directly on basic science breakthroughs in the lab.

MacGuyver, I have followed your posts on SDN for a long time. You always come across as being pretentious and arrogant.

Perhaps internal medicine could come up with PhD's in rounding.

 

[EdmondDantes]

wow, I did not expect all that - although the input was appreciated.

Actually, I am not planning on doing a biomedical PhD at all - rather something in hist. of med and/or health policy.

My concerns boil down to this:

- What is the avg. age of surgeon - post fellowship etc.??

- Without arguing the worth of medical humanities courses...Mac...

- Is it a bad idea to take a couple years out to get a phd if one ultimately wants to go into surgery? With an approx age post fellowship of being in the LATE 30s...perhaps shorter if those 4+2 programs kick in...

thanks

- oh and my comment about those that "drop" their phd was in regards to those who dont do research as surgeons but just used the md/phd programs to get a free ride through med school - although I think they have cracked down on that a lot

 

[MacGyver]

Originally posted by Geek Medic
Broad survey type courses? I dunno how traditional medical schools operate, but my school is PBL, and the books we used for pharmacology (Goodman & Gilman), neuroscience (Kandal, Schwartz, & Jessup), and immunology (Abbas) are books that are routinely used for graduate level programs.

Sure the books may be the same, but MD courses generally treat those books as reference materials as opposed to the primary sources of information used in the course; they tend to focus on the big picture concepts instead of stuff like designing your own experiments; critiqueing subtle flaws in other research studies, elucidating and thinking about new possible biochemical pathways.

I've taken both MD and PhD courses, and there is definitely more complexity and detail presented in the grad school courses. Thats not necessarily a bad thing; its a time tradeoff. The purpose of medical school is not to produce leading thinkers who will advance the science of medicine (although many MDs are bright enough to make the transition); its about getting people familiar with a common base set of knowledge that you need to practice as part of the profession. The MD is a professional, not an academic degree.

The goals of a PhD are such that you are a de-facto leader and expert in the field after completion. Some MDs can play this role too, but its not the default training pathway of the standard MD curriculum. Certain special curriculums like Harvard HST are a notable exception.

However, our training is far less than graduate training. I wouldn't necessarily call it a "survey" course, but I will agree that it's not up to par to what a PhD student will learn with his or her numerous courses tailored to his or her specific field. That's what graduate school is for -- you learn material in more depth than what any other student learns.

thats why I was arguing above that any program which gives out a PhD for 2 years of research with no coursework required is substantially different than the "normal" PhD.

As far as you not being aware of any surgery programs offering PhD's, there are quite a few that will allow you to earn PhD's for your research. Generally you are required to spend more time on your PhD than the general one- or two-year research requirement that is part of your surgical residency. Programs like Duke, Beth Israel Deaconess, Vanderbilt, etc. all have PhD tracts for interested individuals. They simply don't hand out the PhD at free will, however. I gathered from your post that is your feeling of how surgery residents get their PhD's.

I dont know about surgery, but most other combined residency-PhD programs promise a PhD with "only" 2 years of extra lab work. If surgery is different, then good for them.

hell if 2 years of research work with publications is good enough for a PhD, theres a lot of people (me included) who would have multiple PhDs just from attending college and doing research there.

 

[Airborne]

MacGyver:

I think at this point, we can just agree to disagree.

While I can appreciate your opinions for the MD/PhD who is interested in eventually pursuing 90% of time in research and 10% of time clinically once fully qualified - as many MD/PhD's I know who have one half day of clinic a week and their required 2-4 weeks of ward time per year with the rest spent in the lab, I think there are many different paths an MD/PhD can take, which I think is perhaps the most benefical aspect of the combined degree. The MD in that case does provide an important insight into disease processes...

I will eventually practice translational research. I can definitely say the training I received in my PhD years will support this career path. 6-8 years from now, when I will have finally finished residency +/- fellowships (geez it's depressing to think about that!) the information I will have received from the advanced courses will have long been forgotten and the science progressed dramatically. In the end, however, the insight in to the scientific process, the ability to think and act independently and the always questioning outcomes and protocols to ask "why" will not have faded.

In response to the original poster, I will graduate medschool with the combined degree 1 week before my 31st birthday, and will most likely be an attending surgeon (after fellowships) at 38. Is it a long road - Yes. But I have thoroughly enjoyed taking the path thus far, although the CC3 year has been painful .

I would not consider the MD/PhD soley to get a "free ride" through medical school. The extra 3-5 years spent in research as opposed to attending salary can easily pay your medical school loans many times over. You should have a true desire to incorporate research in your eventual career, and have weighed the benefits and costs with attaining the PhD in addition to the MD.

Regardless, it's a lot to consider.

Best of luck.

Airborne

Incidently, many foreign PhD (UK, Australia, etc.) grant PhD's after 3-4 years - the coursework is minimal and you learn what you need to be an expert in the field. Of course, with these programs the student is funded by the government and the PI has not paid the student for the advanced coursework, nor the student need to augment their salary with TA money - I suppose it could be argued that the large amount of time spent in a PhD is "payback" to the PI for this paid time unrelated to research.... Of course, that is up for debate. But having worked well with these scientists, I can say they are fantastic and many are brilliant, even if they don't have a "true" PhD.

 

[vuillaume]

I'm not quite sure what you all are arguing about. First, in terms of coursework, it isn't which textbook a med student or grad student uses, it's what's not in the textbooks and coursework that distinguishes doctoral level training from the exposure a med student gets. The point of a PhD is to develop a scientist that can assimilate the current state-of-the-art (which is rarely in the textbooks) and then conceive of and complete an independent project that contributes to the current literature. Therefore, many PhD programs require something like two first author papers in peer-reviewed journals as a baseline requirement before you can defend. Whatever discipline you choose, it's the ability to critically read papers, and critically develop an experimental strategy to answer a question that (hopefully) distinguishes a PhD.

I'll be honest. Even at the top academic surgical programs I've been exposed to, the quality of research that residents embark on, and the clarity of their experimental strategies lags behind what a seasoned doctoral candidate can do (unfortunately this observation can often be extended to their PI's). I'd point out that the American Board of Surgery expects 5 years of clinical training to be the minimum needed for a competent general surgeon. Equally, a similar number of years is necessary to develop a nascent scientist.

In surgery, very few people are willing to invest the years to be rigorously trained both in basic and clinical science. It really isn't worth the "free ride". And we frankly don't need that many surgeons who are cross-trained.

Still, academic institutions need both. Interviewing at the Brigham, Zinner told me that he fills his stables with "Clydesdales and thoroughbreds". The Clydesdales represent the guys who really know how to operate, while the thoroughbreds are the guys who can integrate clinical observations into cutting edge research. Progress in surgery grinds to a halt without both.

The point is: the letters PhD behind your name are not merely an honorific. With the time and effort it takes to get one on top of an MD, here's hoping that you do something with it.

The greatest synergy produced by both MD-training and PhD-training is that it combines the breadth of clinical training with the specificity and experimental orientation of PhD training. If that sinks in, that's an invaluable resource. I've seen pure PhDs flail with phenotyping a knockout mouse model because they haven't had exposure to physiology and pathology. Equally, I've seen pure MDs flail because they don't understand experimental methodologies well enough to answer the question they're asking.

No matter what, doing both is a challenging road.

 

[otohnsmdphd]

Airborne,

you sound exactly like me, only one year later. I'll probably see you in Seattle if you come out to interview at our program (UW). I agree with your MD/PhD comments (being an MD/PhD myself), and feel that MacGuyver doesn't have a firm grasp on the whole issue, perhaps because he isn't MD/PhD? anyway...

 

[MacGyver]

Originally posted by Airborne
I can say that nobody cares if you have it or not.

Getting back to the original question, as an MD/PhD, I will be applying this year in a surgical specialty (ENT) and think there is a very good outlook and opportunities for MD/PhDs in surgery.

Regards,

Airborne

These are contradictory statements. On one hand you seem to be saying that the PhD is irrelevant to any field of medicine you want to go into, and on the other hand you seem to be saying it does give you a boost for ENT.

Which is it?

 

[FunnyBones]

EdmondDantes,

First, it is doable; there are others before us who have done it and more that are trying to do it. Among Penn MD-PhD grads in the last two years, we've had at least 3 for ENT, 2 ophtho, 2 neurosurg, 1 g surg and 3 ortho.

Second, you will always have to balance and compromise more than others doing fewer types of activities than you.

Third, it won't be easy.

Fourth, there are many ways to be come a physician-scientist and there many ways to become an MD-PhD.

Fifth, don't have a fit trying to make firm decisions based on what has been in the past or even what is going on now. Not only is it impossible to get an "accurate" impression of the current reality in medicine but it's even harder to accurately predict what it will be like--like the weather. My only confient prediction of surgical medicine in 5-10yrs is that there will be some sort of "progress"--but what that will be...we can only wildly speculate. Have yourself a goal--your own personal mini-vision--and go for it; but be willing to modify as thing will inevitably change around you.

Will you be wanted?
As of now, the national leadership in many surgical fields, in the broad sense, are at various stages of wanting more MD-PhD and clinician-scientists; and increasingly so. In general you will be "wanted" as an MD-PhD--I can't think of a surgical field that doesn't feel this way right now. This appears to be working itself mostly bottom up. Older faculty who are struggling to be clinician-scientists are not given as much support as in non-surg departments. Younger fac are starting to get more support and many but not all res programs will consider a PhD as an indicator or committment to academics and thus a bonus.

Is it worth it?
For me it is but only you can make that decision.

FB
Stanford/UPenn MD-PhD/UPenn Ortho/?

 

[JKP]

of a relatively old thread...

 

[geekgirl]

of a relatively old thread...

what'dya wanna know?

 

[Waiting4Ganong]

MacGyver:

Incidently, many foreign PhD (UK, Australia, etc.) grant PhD's after 3-4 years - the coursework is minimal and you learn what you need to be an expert in the field.

I think probably because of different starting points!!

I'm a UK PhD grad. Coming from US undergrad (BIG name) my experience in my major (ie: approx 2yrs out of 4yrs coursework) wasn't taken seriously enough as preparation for a UK PhD until I also did a MSc (1yr coursework + research) to catch up with UK grads (who do 3-4yrs undergrad courses which are 100% subject specific).

The feeling in UK is that US PhDs do coursework to get up up to the standard of a UK graduate in the field then start their research (which is not surprisingly same length- approx 3yrs).

We have Rhoades Scholars coming to our place trying to do a PhD in 2.5-3yrs but the feeling is they are babied/given the cush projects to make sure they get through in time (sounds like the criticisms US MD-PhDs get!).

In addition to starting graduate school at different stages there is also that old story about different standards of HS education meaning we are starting undergrad at different stages. I'll leave that one alone.

My take on this overall is that the end product is the same in both systems. The time for training in the subject is the same:

2yrs US subject specific during ugrad+ 5yrs PhD = 7yrs total to PhD
3-4yrs undergrad + 3-4yrs PhD = 7yrs total in UK.

(all figures rounded obv)

The difference being US undergrads also spend 2yrs on non-subject specific areas during their undergrad work. If this makes them more rounded or just compensates for the differences between high school educational systems is open to debate (but not be me - I don't care!).

The TA thing, as you say though, is just economics.

The upshot of this is I think a 3yrs Research only PhD in the middle of a MD or Residency is perfectly legit. I would expect some to take longer but I'd be worried if lots of people (>5%) were finding it possible to do it in less than 3yrs of fulltime work.

Just my 2c

But having worked well with these scientists, I can say they are fantastic and many are brilliant,

 

[Scottish Chap]

I'm a UK PhD grad. Coming from US undergrad (BIG name) my experience in my major (ie: approx 2yrs out of 4yrs coursework) wasn't taken seriously enough as preparation for a UK PhD until I also did a MSc (1yr coursework + research) to catch up with UK grads (who do 3-4yrs undergrad courses which are 100% subject specific).

The feeling in UK is that US PhDs do coursework to get up up to the standard of a UK graduate in the field then start their research (which is not surprisingly same length- approx 3yrs).

Not sure I agree with this. I have a British B.Sc. Hons from a 'good' university and I found that the course work in my U.S. Ph.D. program(me) was definitely beyond what was covered in my British undergraduate degree....perhaps not in the first semester, but definitely by the time I had finished all he classes and started my research. I think it really depends on the undergraduate institution, the graduate institution, and a number of other factors. The end product from either system, as you say, is essentially the same.

 

[Dr.LeoSpaceman]

 

[837498]

Dang no mercy... saw this thread and it looked interesting :/