Doctor or Doctorate? To-may-to, To-mah-to?

May 25, 2008 2:39 AM

What does it take to be a doctor (MD)? And what does it take to be a doctor (PhD)? Torn about what path to pursue,

Background: studied psyc in college, am currently finishing up in public health. Obviously, I need a third degree.

My first reading for pleasure books were psychiatric non-fiction. I love psychology. I love psychiatry. I have, at various times, dreamt of being a neurologist, a psychiatrist, a psychologist (clinical, neuro-, or research). I’ve finally figured out that what truly fascinates me is elucidating mental processes by way of studying those with deficits or diseases – we’ve learned a whole lot about memory, for example, from Alzheimer’s patients.

I love people. Really, I do. I love learning, too. I want to find out more about why we do what we do and tell the world. I want to be the next Oliver Sacks. And yes, of course, I want to heal and help (though issues of self efficacy and fear of having someone’s life and/or mental health in my hands are a bit frightening)

Currently am torn between pursuing pre-med studies and doing more research (which I’m not keen on honestly, but that’s another post), trying to decide between clinical psyc. PhD or MD. I have perused the studentdoctor forums but am looking for the opinions of seasoned MDs and PhDs – what place does your profession have for a person like me?

posted by Eudaimonia to work & money (12 answers total)

An MD will take about four years of school (2 of book learning and intensive memorization, and 2 of clinical training), followed by a residency that will vary in length by whatever you choose to go into. For example, internal medicine is typically 3 years. Medical school is a slog, but also a a fascinating experience and a privilege.

Phd varies. The average length tends to be about 4-5 years, though some disciplines (especially lab-based) make take longer. PhDs are often funded, an important contrast to medical school.

The decision regarding one over the other is tricky, and really depends on what you find most fascinating about these fields. If you can imagine yourself getting excited about a research topic and enjoying the privilege of diving into this question in depth, PhD may be a good path for you. If you will love the biology and patient interaction of medical training, MD may be the way to go. I will say, in my experience, the 'white coat' sometimes gets more opportunities, particularly in international research settings.

Personally, I think the combined MD/PhD degrees are one of the best things our country has to offer. Within this program, the federal government (NIH) pays for your med school and you get a stipend for the duration of your combined degree programs. When you finish up both degrees (about 8 years, plus residency) you have the flexibility to decide whether you want to do 100% research, 100% medicine, or some combination. The programs are under the Medical Scientist Training Program.

Regardless, I'd take some time to explore further before you sign onto a 4+ year degree. Follow physicians who work in the areas of medicine you're interested - ideally, follow physicians who also do research in this field. I would also talk to scientists who are doing what you think is the most interesting research (the folks who typify where you'd like to be) and ask them which path they'd recommend for you.

Good luck!
posted by xholisa13 at 6:47 AM on May 25, 2008 [1 favorite]

I’ve finally figured out that what truly fascinates me is elucidating mental processes by way of studying those with deficits or diseases – we’ve learned a whole lot about memory, for example, from Alzheimer’s patients.

That sounds like PhD work to me. I too find neuroscience and the brain fascinating, but practicing clinical neurology is a very different beast; I was surprised at how much I didn't enjoy it.

xholisa13 is right. You need to shadow some docs and see if the MD is right for you. As we say frequently, if you can see yourself doing anything BESIDES medicine, do that first. Medicine is so ridiculously romanticized by the media and lay public it's not even funny.
posted by gramcracker at 6:54 AM on May 25, 2008 [1 favorite]

Do a search on MeFi and read the previous threads on grad school. There is lots of good advice contained in them, including tips on what to expect.

You should also read this two part article before you commit to grad school. It does a good job of explaining that biomedical field has its share of problems, but if you're truly excited about science, you shouldn't let that stop you.
posted by chrisamiller at 8:57 AM on May 25, 2008

There's a severe shortage of "physician scientists"-- MD/PHds who can bring treatments from the lab to the bedside, as they say-- and there are a number of initiatives aimed at making this difficult balancing act easier financially and via mentoring to lure more people in. So you might check out those-- NIH, Dana Foundation, some med schools. I wrote about it a while back here with a guy at Rockefeller; it lists some of them.

There is also a massive shortage of child psychiatrists. I hope there are initiatives aimed at fixing this, but I haven't looked into them. If you are at all interested in kids and brain development, this is definitely much needed.
posted by Maias at 9:18 AM on May 25, 2008 [1 favorite]

I'd look very closely at what aspects of psychiatry/ology you enjoy. You can do research with either degree (and don't even need an Md Phd, unless that's your thing), but the clinical experiences of both are very different. My impression talking to psychiatrists about their jobs at WPIC in pittsburgh was that they did not get involved in a lot of therapy (admittedly, that's a big research institution with a big focus on psychopharmacology), if that's an aspect of psych that you particularly enjoy. Talking to some working psychiatrists and psychologists would be helpful in flushing this out.
posted by deliquescent at 9:50 AM on May 25, 2008

In the four years of medical school, there were perhaps 8 weeks dedicated to psychiatry and they were the easiest 8 weeks of medical school. There is a bit more devoted to neurology, and of course some exposure to neurosurgery. But my point is that if you do decide to go to medical school, you will be spending *a lot* of time studying subjects that you may not be interested in.

But it's true that having an M.D. will probably open more doors and will definitely assure you more contact with patients. And of course you will only be able to prescribe medications, order imaging and blood tests, and perform procedures (if those are aspects of neurology and psychiatry you are interested in) if you go to medical school.
posted by Slarty Bartfast at 10:23 AM on May 25, 2008

Funded (not all are) MD/PhD programs are hyper-competitive. The NIH regards paying for medical school for someone who doesn't end up doing top-quality research as a failure and a waste. It's not a grant from the NIH to you; it's a grant to the school, and schools have to competitively renew these grants. Since there is no payback requirement if you drop after the first two years, they really want to make sure that you're not going to do that. Most schools that have this program have between 2-8 slots per year and up to hundreds applying. It's also pretty heavily biased towards basic biological sciences and expects significant research experience as a show of ability and commitment.

Medical school + psych residency will take longer and be more expensive; unlike most physicians psychiatrists do not expect a very high salary (think $120k) to repay the many years of lost labor (4 + 4-5 getting paid doodly squat as a resident while interest on your loans adds up). The majority of that training will be inapplicable for day-to-day counseling and psychological work. Medical school applications themselves are quite expensive. It sounds like you're much closer to the clin psyc. degree. It also sounds like it might be better suited to your goals.

Get some experience working with a psychiatrist or clin. psyc. PhD, because none of us can possibly know how well they suit you. It's a long slog to go through without seeing what's really on the other end.
posted by a robot made out of meat at 11:35 AM on May 25, 2008

Thank you all so much for your input! I just wanted to address points/ add a few things

I have been told at various times that I will be studying things that are only tangentially related to psychiatry, for a number of years. I do think I could handle that, but I don't really know. I guess I'm just trying to figure out what the best path is for my goals/constitution.

In terms of med school, the idea of residency scares me.
Is it as horrifying as they all say? Does "pimping", the lack of sleep, the stress, all that stuff - does it just get too much? I guess I'm just trying to figure out what you really need to make it through med school, residency, all that stuff.

As I said, I'm in public health, and have learned over and over that as time goes on and managed care gets a stronghold, that there is less "art" in medicine and more "business." I guess I'm more interested in the art. I'm interested in the discovery. I just want to figure out which way I simultaneously fulfill these goals while not burning out.
posted by Eudaimonia at 11:48 AM on May 25, 2008

I'm in my 3rd application process. Its expensive, and will only continue to get more so. If you find you don't like PhD work, you can leave. Not so much with over 40k of debt after your first year of med school. I've met a 4th year student who wishes she never got into this mess, but now that she's so deep, she has to keep going. Shadowing lots of specialties will help you out.
posted by senseigmg at 12:09 PM on May 25, 2008

It sounds from your postings that you might want to do research, but only if it will have real world relevance to those who have clinical disorders. I can't speak to med school since I have only secondhand information about it. With regard to PhD studies though, I think there is definitely a program that you will enjoy. It all comes down to who you work with. The choice of advisor will make or break your grad school experience. If you hook up with someone doing tangential research then you too will be doing tangential research. On the other hand, if you find someone trying to take evidence from the lab and apply it to the real world in a meaningful way then I think you can find some measure of joy.

If you do decide to go the grad school route be prepared to do your homework. Get all the information you can on a person before you apply to work with them. Print out their lab website, read their CV, download their papers - really try to get a sense of who they are, what they have done, and what they will be doing in the future. Also, do a lot of introspection about your own interests and desires. If you can match these with someone like-minded already in the field then you will love getting your PhD.
posted by prefrontal at 1:13 PM on May 25, 2008

I’ve finally figured out that what truly fascinates me is elucidating mental processes by way of studying those with deficits or diseases

This is the essence of neurology. With regard to gramcracker's comment, I have never met a med student, including myself, who really appreciated or enjoyed clinical neurology for its myriad pleasures; you have to get good at it before it starts being fun, and no med student is any good at it.

The difference between you and a neurologist is 8 years of sleep deprivation and hazing and, probably, some degree of educational debt. Most neurologists do a yearlong post-residency fellowship these days, so that makes it 9 years - 4 of med school, 1 of medical internship, 3 of neurology residency, and 1 of fellowship. If you do it right, there probably won't be a lot of opportunities for personal growth or other things in your life during that time.

Some neurologists like taking care of sick people too; the rest go into research, and I believe that proportionately there are more research neurologists than any other medical specialty.

Disclaimer: I am a clinical neurologist. However, I think it is one of the best jobs on Earth, at least for me and my talents and my personality. It would take something pretty special to make me consider giving it up.
posted by ikkyu2 at 5:00 PM on May 25, 2008

I'm a 5th year Ph.D. student in microbiology. Based upon your interests, I'd recommend getting an M.D. You'll still have the benefits of direct patient interaction, and you can do as much or as little research as you like. At my institute, there are plenty of M.D. who run research labs because they enjoy that aspect more than clinical work. An M.D. is a more flexible degree in that respect (M.D.s can do basic research, but PhDs can't treat patients), and generally has a much higher earning potential. You don't have to pay tuition during your Ph.D., but it's 5-6 years of making less than 30K a year and then 3 or 4 years of being a post-doc (starts at 37K...salaries are set by the NIH). Both the Ph.D. and the M.D. tracks are long hauls, and both require a lot of work with long hours.

I'd recommend working as a lab tech for a year or so in a neurology department at an academic lab, preferably one associated with a medical school. That way you can get some intimate exposure to both professions and get a better idea of what would be more suitable for you.
posted by emd3737 at 6:52 PM on May 25, 2008