Q and A

In the previous post, an anonymous reader posted the following question:

There are a lot of people applying for this program for the wrong reasons, like top residency, free medical school and etc... What do you have to say to those that lack the passion to do translational research?



I agree that many people do apply for MSTPs for the wrong reasons; it's also true that people apply to medical school alone, law school, podiatry school, dental school, graduate school, and so on for the wrong reasons. In the case of MSTP students doing so, I have a feeling the decision comes back to haunt them. The problem is this: 1) either you enter such a program, realize the research isn't for you, and then opt out after two years or 2) you go forward with graduate training knowing all along that research isn't for you. Both cases are undesirable. In the first case (two free years of medical school), a big reason for why you were admitted to medical school was that you were an MSTP student, hoping to do research and receive clinical training. If that goes away, what remains? Clearly, if a student had not dropped out before then end of second year of medical school, then research rotations had to have been done; and if this were the case, what does such a student tell residency directors asking what they did for the time between years one and two? "Uh, I was in the MSTP and decided it wasn't for me..." -- that has to be about the opposite of the supposed "MSTP boost" that MD/PhD students are known to benefit from on their residency applications. So while it could be a little bit harmful, the major consequence of dropping out of the dual degree program is the lack of benefit from research training and the distinction it provides you in contrast with the rest of your medical school colleagues.

In the second example (going forward with research with no intention to do it one day), the draw-back is personal and the suffering can be immense. Graduate school - as I am beginning to realize - can be approached from many different angles, and effort varies across a wide, wide spectrum. Poor effort generally means a long PhD, and I would venture to guess it is more common in students who really didn't want to do a PhD in the first place (but liked the idea of having two degrees after their names)
. I can say that I've done the math, and for individuals who choose to suffer through the PhD just for the sake of it, MSTP is not more beneficial financially even in the short-term after medical training is complete. A short time in a middle-of-the-road paying sub-specialty (presumably) outside of academia (since these people sort of swear off research after residency) will make up most of the difference that staying in the MSTP would have offered.

Alas, I'm not exactly answering the question. In the two above cases, I argue that it just doesn't much make sense to be in an MSTP for the more superficial and/or personal suffering reasons. But what to say to someone who lacks a passion for translational research?

I think that is a difficult question. The cynical response to the question would be that a person lacking a passion for translation research is a realist. In many fields, the true promise of translational research is far from reality, and so the absence of "passion" could be a recognition of a lack of feasibility in many areas. On the other hand, a more idealistic response would be this: the future (and don't ask me when, I'm like John McCain on this one, I don't do timetables) of medicine will be translational (read: stem cells, genomic/proteomic medicine...) and to not have some kind of passion is like fatally dooming a career before it starts...or something like that.

More than likely, what I would say to a person lacking a "passion" (and we'll say for research, translational or otherwise) is this: this program is not for you, and figuring it out sooner rather than later will be of great benefit to your career.

This is, of course, not to say that one must have a vision of the future well mapped out prior to entering medical school. In fact, as long as there is some passion for research, the rest can figure itself out. In my case, I find the future to be wide open. I knew I wanted research training, and I felt that there was no way I could have decided between straight medical school and a straight PhD program. Somehow, I will connect the passion for the two together, even though I haven't figured out a plan at this point. So maybe I'll go to an internal medicine + sub-specialty fellowship into postdoc and then look for positions in academics. Or maybe I'll go the surgery route and find ways to be more of a collaborator with persons solely dedicated to research. Or maybe I'll go to residency and then consult for biotechnology companies. Or whatever. The point in this case is that I couldn't imagine my life at this point without medicine or without research. Both are a part of who I am.

I should also add that in today's funding environment of the NIH - shitty - it doesn't hurt to have a researcher's best insurance policy, an MD; when people in my lab/department first mentioned it, I thought they were joking - always poking fun at the med students. But then I realized they weren't kidding. People are getting royally screwed right now because the NIH budget was slashed so that we could (warning: irrational half sentence rant to follow) go fight some stupid war in the middle east. People who have been funded for more than a quarter century on the same R01's not getting the easy renewals they once did, and there has been quite a shake-up in academia. Not to say that there aren't options for straight PhDs, but making it isn't easy and might take post-doc'ing and slave laboring in graduate school that rivals the length and effort involved in obtaining a dual degree. Oh yeah, and medicine is kind of screwed as well. Although some say it's doomed, I would say it's just entering a long and awkward phase of puberty. It's growing male breasts right now, has acne and spotty facial hair, and it gets irrationally upset and needs large amounts of sleep and its experimenting with masturbation (it's kind of screwing itself right now). Being a professional in medicine, research, or both will be better in the future; when that is, and how it manifests, who can say? But I'm glad to be in both.