Becoming a Clinician Scientist – Doing a PhD during your medical training

Disclosure: The opinions expressed below are solely those of the author alone and are in no way affiliated with any academic institution or program.

A growing number of medical trainees across Canada are pursuing graduate training in research to better equip themselves for a career as a clinician scientist. In the current competitive funding and job market landscape, graduate training has become an asset for those wishing to pursue an academic career in medicine. Once you have entered into medical school, there are two opportunities to pursue a graduate degree: medical school and residency. Currently graduate training during medical school typically happens in the context of a MD/PhD program and graduate training in residency happens in a clinician investigator program (CIP). In this post I would like to outline roughly how each of these programs work, some of the considerations that should be undertaken before applying and answers to some of the most common questions/concerns around these training paths.

MD/PhD programs first emerged in the 1960’s in the United States and the 1980’s in Canada. While these programs take on a variety of formats, in essence they all allow for the pursuit of a PhD sometime in the middle of a Doctor of Medicine program, typically beginning after the first or second year of pre-clerkship training and allow for the completion of both degrees by the end of the program. In addition to providing the administrative framework to pursue both degrees within the context of one program, a key feature is financial support throughout the program duration. The vast majority of programs provide a stipend that continues throughout both medical and graduate training to reduce the financial burden of taking on the additional years of education.

Pursuing a PhD in residency, which has now been formalized in the Clinician Investigator Program (CIP) in Canada, has been the more traditional route of obtaining graduate training in medicine. Most CIP trainees begin their graduate training in between the 3rd and 4th year of residency training and the program allows for the pursuit of a PhD, Master’s degree or post-doctoral experience. This program is administered by the Royal College of Physicians and Surgeons of Canada although the actual delivery in some aspects varies depending on the institution.

Now that we know how these programs work I think the next most important question is why should I do a PhD during my medical training when many faculty that do research only have an MD? I usually offer two main considerations. The first is that doing a PhD is not so much about what you need to get hired for a job, but rather attaining the training that you believe you require to be successful. The current medical research climate is a competitive one, grant success rates are at an all-time low and there is considerable pressure on clinician scientists to shoulder a great deal of clinical work. Long story short, if you want to convince a department head/funding agencies/your clinical colleagues that you should be spending a significant amount of your time doing research, you better be pretty good at it. Furthermore, I would suggest that you take a look at new hires in the departments that you are interested in and see what sorts of training they have. I believe that in the near future a PhD level of training will be essential in most areas of health research. Some additional advice I would give to younger trainees is “Can you imagine your career WITHOUT research?”. If the answer is yes, and you don’t feel unsure about your answer, my personal opinion is that the MD/PhD program or CIP program is probably not for you. Undertaking a PhD is a fairly challenging experience that adds a significant length of time (anywhere from 3 to 6 years of additional training, not to mention a potential fellowship later on) and the stress and pain that comes with research cannot be understated. That being said, as someone who love research, the program has been an unbelievable experience for me.

If you are still reading perhaps you are convinced that one of these programs are for you, the next question is, CIP or MD/PhD? This is a fairly personal decision that should be undertaken after a great deal of consideration. My rule of thumb advice for trainees is to do the training whenever THEY feel ready to do it. If you have an area of research that you are passionate about and are ready to dive in, I would highly suggest the MD/PhD program. If you think you are interested in research but don’t feel ready to do it yet, perhaps defer the decision to the CIP program. There are many successful researchers who have done the two different pathways so I believe it comes down to personal interest/preference.

Finally, I would like to conclude by hopefully clearing up a few common questions. One typical argument with the MD/PhD program is that you undertake research training before you have decided on your clinical specialty. Thus, some people believe that if you do not pursue a related specialty your PhD training will be a “waste”. I usually present two arguments to this statement: 1) The most important thing about a PhD is not the specific details, but rather learning how to ask the right questions and how to test a well-designed hypothesis. The actual techniques of one’s graduate work will be outdated the moment you defend your thesis, so I do not personally buy into this argument. You will be able to apply your PhD brain to whatever field of study you decide on. 2) By having this training early on in your career, you will go through the end of medical school and residency with a research lens which you can then use to identify the types of questions which you may want to pursue in your career. The final bit I would like to say is that financial considerations should not factor into your decision at all when deciding between the two programs. The money works out to be very similar despite what many people will tell you. While in the CIP program you get paid as a resident, in the MD/PhD program you will usually get paid for the entire duration of the program. If you do the math there is little financial difference between the two.