Ugh. The lectures on neurobiology have been pretty interesting, but the corresponding chapter in the textbook is drier than sand. Time for a break.

I made a series of posts last May discussing my decision to quit work and pursue medicine. At the time, I was fully committed to becoming a clinician — the type of physician most people interact with at hospitals and clinics. I still want to do clinical work, but going to school has opened my eyes to the possibility of doing medical research as well.

One of the reasons why I left my old job was that it was utterly uncreative. For the most part, the business of implementation and maintaining solutions is a copy-paste affair, and any real brilliance is deeply hidden. I didn’t like the fact that I was basically repeating someone else’s work, slightly modified if at all different, and getting paid for it. I wanted to do something more difficult and integrative, as well as something that would stir up my inner passions. Clinical medicine is undoubtedly more rewarding and more challenging than IT work, and most clinicians are given novel situations on a regular basis. But just how novel is it? How varied are the treatments, and how much can a physician innovate in a clinical setting?

Without digging beyond the superficial, my gut reaction is to say “not much.” In a clinical or hospital setting, doctors are counted on to cure disease reliably, which doesn’t leave a lot of room for new or untested treatments. While every patient is unique, requiring attention to detail and slight differences in the approach of care, I believe that clinical care also has some “copy/paste” aspect to it. Of course, advances in medicine would introduce new therapies on a regular basis. But at the heart of the matter, most of the work would involve using someone else’s solutions slightly modified to suit the individual. Sound familiar?

To me, the big downside to doing pure biomedical reasearch would be a lack of interaction with patients. I want to see that my work is having a real and direct affect, and there is no more explicit display of success or failure than the fate of the patient. But wouldn’t it be great if one could develop new therapies for disease? Rather than, say, using existing chemotherapy techniques to fight a tumor, how rewarding might it be to develop a new form of therapy, try it on a patient, and directly observe its effectiveness? Not only would one be involved in patient care, one could potentially find an entirely new treatment. That would be far more rewarding to me than simply treating (and hopefully curing) a long list of patients. It’s analagous to treating the cause rather than the effects, or the disease rather than the symptoms. I could think of no better or more important contribution that I could make to society than a new way to save lives. So why not go for it — why shouldn’t I work towards an MD-PhD?

Well, for starters, reality is not so willing to accept the rose-colored vision that I espouse above. For one, it’s a lot of work. In addition to the traditional four-year program, MD-PhDs require some time to research and defend a thesis. The most aggressive timeline for obtaining both degrees is about 6.5 years, but most students seem to do it in at least seven. Furthermore, there’s no guarantee that research will result in a revolutionary new discovery. The specificity and relatively obscurity of most research groups won’t automatically lead to a cure for cancer or HIV. A scientist would have to be in the right place, at the right time, with the right knowledge and determination, to put everything together into something significant.

There’s also the reality that research and clinical work are probably more likely to conflict than supplement each other. Someone who is committed to research will not have much time left over for patient care, while a dedicated clinical physician won’t find it easy to work in a lab. I don’t know how or where the balance is struck, or if there even is a balance at all. I would be disappointed if I didn’t work with patients after medical school.

Finally, there’s the reality of getting into this kind of program and seeing it through. NIH offers funding through their MSTP program for some schools to take on formal MD-PhD candidates when they first apply. MSTP pays for school tuition and also provides a stipend, so this would be ideal; unfortunately, most MSTP-funded schools accept something like five students per year. My nontraditional situation, coupled with a lack of formal research training, would make me a poor candidate. Most school do offer PhD funding by itself, though; this might be a reasonable option. The other related issue is time. I’m already a few years older than the typical medical students, and taking time to receive a PhD won’t make me any younger. Is it worth the extra time, extra accrued interest on my loans, and extra workload?

These are all questions I plan to answer relatively soon. I want to take on some part-time work (paid or unpaid) in the spring semester. Preparation for the MCAT in April will keep me pretty busy, but it’s absolutely crucial that I form a stronger idea of how much I want to pursue research. Georgetown’s medical school is on campus and seems to have a reasonably sized research department, so I guess I’ll start my inquiries over there.

But that can wait until after the holiday. Happy Thanksgiving, everyone!

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