I came to a critical juncture in my career in 1969. I was pre-med for the first three years of my undergrad studies at Tufts where the environment was toxic and cut throat. Though I never saw such things, it was rumored that students sabotaged each other’s experiments. In physical chemistry, some students supposedly went so far as ordering the chemical product they were expected to produce in the lab, and adding it to their product, to artificially enhance the yield of their experiments. The exam files in dorms and frat houses mysteriously would disappear the week before finals when everyone was starved for hints on the upcoming exams. The constant pressure, coupled with a lack of confidence in my ability to get through medical school, led me to drop my pre-med and become a biology major. In fact, I took up a dual major in biology and Russian and flourished.
I hated pre-med so much I swore I would never become a doctor. After graduation, I worked as research assistant in a psychophysiology lab running a multi-channel polygraph and doing data reduction. I loved it. But as often happens, the lab director lost his grant, and our project was terminated along with my research job. The department chair knew that I was a good typist and offered me a job as department research secretary for $85 dollars a week. I declined, having worked my way through college as a secretary, knowing that outside of academia I could get a much better salary. I went to an employment agency and, after following their admonition to cut off my shoulder length college girl hair (yes, they actually did things like that in ancient times), got a front desk job at a TV station and also got that higher salary.
I was planning to go to graduate school and applied to several institutions. The following summer, I was accepted by two schools and chose to go to University of California Berkeley to study public health.
My passion in grad school was biostatistics and epidemiology. There were several physicians enrolled in the public health program, physicians who I happened to like very much, and some encouraged me to revisit my decision about medical school. Being the consummate nerdy type, I needed validation, so I went to the career counseling center, took every test – Kuder preference test, the Minnesota Multiphasic Personality test, aptitude tests, sample MCAT ests, etc. Won’t you just guess that “Physician” kept lighting up in my career profile.
Long story short, I applied to both graduate PhD programs and to medical schools. I got into both. My faculty advisor, an MD working in biostatistics and epidemiology told me to get my MD. He said that I would have more control over my career, more flexibility and more credibility. Ultimately, I opted for medical school.
And was that the right choice? The answer for me is a resounding yes. I have had an extremely satisfying and successful clinical practice. But throughout my clinical career, I have been disquieted by the fact that much of medical practice is not based on “fact.” Fact is elusive. Medicine much of the time relies on “expert opinion” or anecdotal experience. Data driven, evidence based medical practice is a relatively new evolution in the science of medicine and my area, women’s health, has lagged behind other specialties.
When I shifted into working in the pharmaceutical industry, the best part for me was the reliance on and abundance of data. I have traded off the “laying on of hands,” the healing work of medicine. Clinical medicine, while a highly integral part of clinical research, is not real life medicine.
While meditating and musing (and searching the web) on this topic, I came across a letter by Jonathan I. Katz, a Professor of Physics at Washington University, St. Louis, Mo titled “Don’t Become a Scientist!”
He states that “Science is fun and exciting…. If you are smart, ambitious and hard working, you should major in science as an undergraduate. But that is as far as you should take it….[that] you should not even consider going to graduate school in science. Do something else instead: medical school, law school, computers or engineering….” He states that there is a glut of American trained PhDs and not enough full time academic jobs to absorb them. PhDs are then relegated to a prolonged academic adolescence dwelling in the limbo of the “forever” postdoc, not permanently anchored anywhere.
So how do you decide on an MD vs PhD? There are 5 questions you should ask:
1. Do you like data better than people? Even if you become a full time medical academic researcher, you still have to transit through the land of the living patient. If you have a social anxiety disorder, stick with a PhD.
2. Are security and income high on your list of needs or wants? An MD provides a far more stable foundation and better prospects of achieving both of these ends. Most medical specialties can be practiced anywhere (save for very high tech specialties that demand the technical resources of a top academic institution). A medical career is extremely flexible and affords you a great deal of mobility.
3. If you have the time and the resources, a joint MD/PhD program offers the best of both worlds. At least 20 percent of my classmates at Stanford Medical School were PhDs when they arrived, or were enrolled in the Stanford joint MD/PhD program. Almost all of them are now highly visible academic researchers.
4. How much time do you want to spend in training? Medical school is 4 years and then you do get a paycheck. While internship and residency monetary compensation is not generous, it is a real paycheck. And many clinical trainees moonlight to supplement their incomes after they are licensed. PhD programs, even with work opportunities like being a teaching assistant, function like feudal estates, and PhDs candidates are tenant farmers, often overworked and underpaid.
So, while it sounds ever so trite, as “two roads diverged in a yellow wood…” I took the one my parents wanted me to take. Did it make a difference? I don’t know. I might have ended up in the same place with a PhD in biostatistics. But I greatly enjoyed my years in practice and my clinical experience has made many aspects of working in clinical research easier. I have seen a wide range of responses of patients taking a single drug. I have encountered the ambiguities inherent in treating subjective symptoms. And I understand the limitations and frailties of humans…as research subjects and researchers.