Medical What does research-heavy specifically mean, and career paths doctors can take to be involved in direct patient care + research?

[Question]

Hello, I'm applying this cycle and I keep seeing this phrase "research-heavy" thrown around for the top 20's and I'm not 100% sure what it means. When people say research-heavy, are they strictly speaking about the admissions process and how much these schools value research in an app? Or is there another meaning in the word "research-heavy" in that all the students these schools accept have some form of interest in research as their medical career i.e after completing their MD, they work in research. I'm interested in research and will be doing it during medical school, but I'm not sure if I want to have an entire career in research after medical school. I'm gauging to see how much I "fit" the higher-tier schools and if I want to go to an institution that pumps out medicinal scientists rather than doctors who focus on direct patient care. Ideally, I'd like to know how the general career "trajectory" of someone who goes to a top 20 differs in those who just go to the regular state school and become doctors involved only in direct patient care.

What are the ramifications on the ultimate career of a doctor if they go to a research-heavy school rather than a regular state school? Thanks!!!

for the record, I'm moreso naive about the potential career paths a doctor takes. If anything, I'd be really interested in doing direct patient work as well as being involved in research as a doctor after it's all said and done. I just don't want to be only involved in research because I'm mainly interested in treating patients. Any information about potential career paths doctors can take to be involved in patient care + research would be soo helpful. thank you so much.

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[GoSpursGo]

When people say research-heavy, are they strictly speaking about the admissions process and how much these schools value research in an app? Or is there another meaning in the word "research-heavy" in that all the students these schools accept have some form of interest in research as their medical career i.e after completing their MD, they work in research.

It's both. People who tend to try hard to go to a highly-ranked research school are more likely to envision an academic career with a research focus, and thus these schools highly value research in the admissions process.

Now obviously, not everyone who goes to a research-heavy school goes on to be a physician scientist--in fact that's going to be a distinct minority from any school. But if you look at the mission statement for most of these "top tier" schools, most of them will have some reference to "training the future leaders of medicine" or something like that; compare to State School X, where the mission is probably something like "training the future doctors for the state of X." It's a different focus, and generally the research-heavy schools are looking for someone who is going to "be somebody" down the road.

All of this said, nobody will decide for you what kind of doctor you're going to be. If you want to "just" take care of patients, that's great--we need great patient care-focused physicians too. But when you're interviewing for these kinds of schools, you should at least indicate that you are open to a research/academic focused career. Keep in mind that research as a physician is probably very different from the research you may be familiar with as an undergrad--not every physician scientist is running bench research, and there are lots of other avenues of discovery that you may find interesting. So just keep an open mind

 

[GoSpursGo]

Is it realistic to do direct patient care as well as be involved in research as a future physician? I'm trying to envision what that would look like. Could you also elaborate on what an "academic-focused career" is in medicine? I'm assuming that means sticking with solely research or becoming teaching faculty at a med school.

I really wonder what career trajectory looks like for students who go into these top schools because for me, med school has always been med school -> residency -> fellowship -> attending. To be a "future healthcare leader", I'm curious to what that actually entails in terms of "the path" / "the goal".

Talk to mentors in the field about what their day looks like. It's honestly difficult to describe, because being an "academic physician" means different things to different people. But essentially everyone is still seeing patients, it’s just that some percentage of your time (literally can range from 5-80%) is focused on something else, either clinical research, basic science research, quality improvement, teaching, etc. Even when you're not taking care of patients, the goal is that whatever you're doing is eventually going to lead to a positive impact on patients. And the career progression is the same, because any residency and fellowship program is going to have an academic/research component to it as required by the ACGME.

Again, remember it’s all about keeping options open, not that they actually expect every single person (or even most) to go on to have an academic career. I was pretty sure when I entered med school that I wanted to "just" take care of patients, and now here I am as one of those weirdos who spends 80% of my time doing research And from a pragmatic point of view, even if you have no intent to stay in academics, going to one of those research-heavy schools will help you in applying to competitive specialties, so at least being able to feign interest in that career path is probably a good idea.

 

[GoSpursGo]

One more question though, if its not too much: could you explain what translational medicine is and if its a genuine research field I could be apart of? I'm not sure if it's just a buzz word thrown around on grants or something I could actually be apart of. I think the idea of it is really cool, but not sure if it's an actual "option".

Again, it means different things to different people. It could mean bench-to-bedside research (i.e. directing animal or human correlate studies to lead to a new treatment being tested in a clinical trial) or bedside-to-bench (taking samples from patients enrolled on a clinical trial back to the lab to better understand the mechanisms leading to the outcomes being seen in the clinic). A lot of people do use it as a buzzword, but I would say that most physician-directed research probably falls under the category of translational.

 

[Dral]

Doing true tanslational research to me is coming up with an idea, working on it at the bench, then testing it clinically. This is coming from someone who has a PhD as well though.

I think that doing clinical research is part of the translational research process. So for me, if you could make a Venn diagramm of medical research, translational would be at the intersection of bench/basic science research and clinical research. There can be bench/basic science research that never gets translated to the clinical realm just as there is clinical research that does not need a bench research component to be applied to clinical patient care. Translational is the process when both are involved.

So if you design a blood pressure med, test it at the bench, then apply it through clinical trials; that is translational research/medicine to me.

If you figure out an organic chem formula for a possible blood pressure med, test it out in an animal model, but never do anything with it clinically; that's just bench research to me.

If you do a review of patients taking blood pressure med A vs blood pressure med B (both meds are already FDA approved) and figure out med B is more effective; that's clinical research to me.

 

[TheBoneDoctah]

Would agree with the above. Ill add @AlteredScale for more insight.

 

[PTPoeny]

I think Dral gave an excellent explanation of translational research.

Going back to your question regarding the spectrum of physician career paths involving research we can also talk some more about specifics of what things can look like. While there is a wide spectrum of possible careers there are some more common versus less common paths. If you want to be running a big lab doing basic science or translational research many people have a split of ~10-30% clinical time and 70-90% research. It takes a lot of research time to write grants and papers to support yourself doing research. Basic and translational research also tend to cost more money in supplies. For an outpatient physician this might be one day or half day a week of clinic and the rest of the time in the lab.

If you don't want to get grants to support your research, many people have the opposite with 20% or less research time. While there are exceptions, this set-up is often easier to run with clinical research or implementation research or QI. This might be "protected" time where they are actually scheduled one day a week for research time without clinic or something they choose do during admin/academic time or evenings and weekends depending on their job. These are just some broad generalizations of more common paths with many exceptions out there to be found, but I hope it helps to give you a concrete idea of what some physicians are already doing.

 

[Mr.Smile12]

Concurring with others here, I trained under an MD (co-PI) for my Ph.D. He ran a service in a hospital while also running a research lab. Many of the things he did were translational appropriate, and he was able to get a lot of industry funds to also help us with basic science technology to ultimately develop some diagnostic tools (for those companies).

Heck, no, this wasn't as easy as I made it sound. I've also had many MD's do research fellowships in my labs who clearly had a beside preference, and they ultimately went back to bedside only. The few who stuck through it succeeded because they had community support, mentors, protected time, and professional development to get grants for early investigators to maintain that protected time.

So "research-intensive" schools will likely have some centers where such translational research is occurring and invested heavily. You don't necessarily have to start there, but it helps to get into the culture and the networking once you have open time in the curriculum. Regardless, people who really want to do research find ways to get them with the support of their school for pursuing opportunities off-campus (such as NIH).

 

[AlteredScale]

Not much to add here but I will say that I have attended an undergrad institution UCSD that was a research intensive institution. What I think it means for medical students is that it provides a lot of opportunities to pursue multiple avenues of research whether it is basic, clinical, translational. It means that the faculty members you have will not only provide patient care but push the boundaries of medicine (again that can mean a world of different things). In comparison, there are medical schools that teach you to be a good doctor and/or do well on boards, and that is about it. Maybe there are a few research scientists but they are limited to what they can either because they don't have the resources (because the school won't fund it or has limited funds) as well as the fact that when you are not surrounded by a community of researchers excited in your field it becomes hard to "stand out" because you are in a silo without and discussions through RIP sessions and visiting speakers.

Medical school will first and foremost trying you to be a competent doctor, no matter where that is. Even at UCSF/Harvard/Northwestern they will not shove it down your throat if you say "no thank you" to research and will provide you other opportunities to have a fulfilling career.