S8E3: MD or PhD? Choosing the Right Path in Medicine and Research

Laurel: How are we sounding now, Chloé? Good. Great. All right. So I was thinking of how to say, "I am still Laurel," and the first thought that came to my mind was, "I persist as Laurel," which does feel accurate in some regards. I'm joined by two good friends, one of whom is familiar to the audiences of "Bundle of Hers." Hạ, do you want to say hi really quick?

Hạ: Hi, everyone. It's Hạ.

Laurel: And then we also have a dear friend of mine, Hannah. Would you want to introduce yourself?

Hannah: Hi, I'm Hannah. I am a postdoc in Laurel's lab, or the lab that Laurel is also in.

Laurel: Yes, I cannot claim ownership of the lab, although I do think there is some precedent in Hannah and I are the snack czar and social czar, respectively, for our workplace lab. And therefore, there is a lot of power with those decisions. Yes.

Hạ: What are the best snacks that you've brought in?

Hannah: I mean, I have my favorites, but I also make most of the decisions. And if those are not received well . . . But I recently brought in a big bag of HI-CHEWs that include a mystery flavor. I think it's pink lemonade. And I'm sorry if that's the same in every bag and now the mystery has been spoiled for anybody to buy them in the future.

Laurel: I am a big fan of HI-CHEWs and pink lemonade, so I think that is a fair answer for best.

The reason I have brought my dear H-named friends together is because in addition to loving snacks, we all have careers in progress in the realm of human health and in medicine, albeit in somewhat different fashions.

And so I am an MD-PhD student or candidate, which means that I'm afraid of anything that isn't school. So I'll be here forever. I've done two years of med school and I'm finishing up my PhD in the next year. Anticipated graduation of my nine-year double-doctorate degree program in 2028. I have to believe that year will come someday, and it gets closer every day. Hope sometimes dwindles, but that's fine.

I am, one might say, greedy and trying to have both the MD side and the PhD side of things. And so I brought on friends who can maybe speak to a more decisive mind perhaps.

There's the idea of what you enjoy and then there's the on-the-ground reality of what that looks like day-to-day. And I think it can be really challenging to disentangle "I care about people and I appreciate interactions with people. Do I want to talk to patients all day every day?" and "I enjoy research and I love the scientific process. Do I want to submit grants and go to conferences and participate in what it actually looks like to have that be your career?"

For me, as the one who can't decide historically, which I've brought up before non-binary bisexual MD-PhD is its own joke, right? Because I just refuse to pick a side in pretty much anything. But for me, it really was in going through clinical experiences and research experiences. I had, I suppose, the realizations y'all had separately of, "This is something I really enjoy and want to do," and had to reconcile the feeling of something will be missing from my life if I am not participating in both of these.

And so a piece of advice that I give fairly frequently to individuals who ask me whether or not . . . I mean, it's funny, especially when you're young, right? You're 20 and you're looking for advice. It can feel a little bit like someone who I don't know is asking me should they do an MD-PhD, and I'm like, "Well, how could I possibly know that better than you?"

But what I end up saying is, "If you can see yourself doing literally anything else, you should do that. And then if you cannot see yourself doing anything else, then you can sign up for your decades-long degree program where you have to wear multiple hats and think in completely different ways and sort of constantly oscillate between two pretty different worlds."

And for me, it was the realization that I don't think that I would be genuinely fulfilled and, to use maybe a trite word, happy choosing between, and so I decided I wouldn't.

Which made me wonder, and this is perhaps a loaded question, if y'all think that you would be happy had you picked the other fork in the road. Is there a universe in which you turned left instead of right? And how is that version of you doing?

Hạ: Honestly, I guess I am a person . . . I'm trying to think of the words. Instant gratification. That's the thing. I realized I'm an instant gratification sort of person, and research is not instant gratification.

I like to believe in the fact that a lot of us can be very flexible and we can be very resilient, not in the way that the wellness industry has co-opted the word resilient, but resilient in the paths that we pursue.

But I do think I am happy that I went for medicine, medical school versus the research side of things, because even in med school, the research that I fell in love with was more medical education-type research.

And then even now, as a resident, I barely think about scholarly pursuits and research. It's not the thing that really brings me that much joy. The things that bring me a lot of joy is getting that one-on-one clinical interaction with patients and walking in that room and having a really fun convo and being able to engage with the community. Those are the things that ultimately make me a lot happier and keep me going through the day.

I do feel like even in these moments where sometimes I'm working on a quick research thing outside of when I finally get the product done and feel happy about it, a la instant gratification, I feel it doesn't fill my cup as much.

So based off of that, I feel like, ultimately, I chose the right decision for me. But I also would like to believe that with all of our capabilities and our flexibilities and our ability to find love and happiness, regardless of what we choose, I could still be pretty happy as a researcher too.

Hannah: I feel similarly in that when I look back at my last 15 years or so, I have been able to, I think, find ways of being from a range of okay to great in the choices that I've been able to make. And I'm fortunate to have been surrounded by people who support me in my various decision-making.

But I have two ways of thinking about this. One is throughout the last 15 or so years, as I've made more choices that take me down a very particular path, especially after deciding to go to grad school, being in the PhD process, when it feels a little less like you can then pivot, I've had moments of thinking, "Should I have gone to med school? Should I have done the MD-PhD?"

And those largely come from loving the interactions that I have with or that I've been able to have with clinical collaborators and patients and patient groups and stuff like that. I've loved those interactions. And those are the ones that make me think, "Should I have done this?" However, I think I always come back to, "Nope. I'm okay and I do like the path that I've chosen."

The medicine path is very long and hard, and that is not to take away from the challenges of the PhD, but there's a lot more flexibility baked into that.

And I think partly I've chosen to be . . . I don't know. Not content, but I've chosen to accept the path that I've been on, partly because I can make choices within the decision to go the PhD route that bring me those little bits of joy that I've gotten from the clinical collaboration and working with clinicians and patients into my career as a scientist. I love that, and that works for me.

I know you can make a change at any point. People do. At this point in my life, I don't want to go to med school. I'm 33 and I am . . . Yeah, I'm not going to do that at this point. Not to say that one couldn't, and I fully support somebody making that decision if that's what's going to work for them, but I'm not going to do that.

Laurel: I like the idea of the world where someone comes in and they're like, "No, you will be going to med school. Many people are trying very hard to get into med school, but you don't get the luxury of choice here. You're going to go."

Both of you have brought up, I think, the importance of maybe perspective, choosing to accept the path you're on, the flexibility we have as people. My partner used the phrase in the last couple of weeks, which is a folksy phrase that I had heard before, but wasn't really in my lexicon, of "you have to dance with the one that brought you," which I love a lot. It was used in a very different context, but I think about it with regards to wherever you are, finding joy in that and making that the thing that you're passionate about.

I've created a very funny, I guess, binary, again, as the MD-PhD person, of, "Ah, there is medicine and there is research." But there is the role of a pathologist in medicine who is a physician who does a very, very research-adjacent, minimal patient interaction role. And there are researchers who work frequently with patients in a regard that looks different from the stereotype of lonely person in white coat.

So I think that even within these different realms, there's room for nuance and to find the thing that fits you personally.

And I think about a clinical mentor I had when we were talking . . . Basically, I didn't get into the MD-PhD program at the institution this mentor was at, but I did get into the medical school and my mentor very wonderfully was trying to encourage me to still consider going to that institution and was like, "Well, there are a lot of physicians who are phenomenal researchers like me." And I was like, "Well, yeah, you're right."

And so it was one of those things where within these kind of large existential questions of "What degree is going to be on my resume?" it's thinking about what does my day-to-day look like and how can I find the highlights there.

I'm really lucky that the research I'm interested in is very compatible with an MD-PhD clinical practice. I'm personally interested in pediatric rare disease and medical genetics. And so there's a lot of opportunity for patient interaction and research there.

There's a built-in balance that I think could be more difficult to find in certain specialties, although, certainly, anything is possible. But I feel like it is a real joy, as an MD-PhD, to find the highs and lows in both.

The way that I think about it is, in medicine, I feel like there are a lot of good days and bad days, and in research, there are good years and bad years. And the fun of doing both is that at any given time, I'm able to think, "Well, this is a bad year, but it's a good day," and vice versa.

And so I think that there's a lot of randomness in what we encounter in choice and how we respond to it, and I think that that plays out a lot in these big cosmic choices.

Hạ: Honestly, I really loved what you were saying, Laurel, about how there are so many nuances to careers than what we anticipate. As a person who does also often think in the binary, like black and white and all of that, one of the things that I've grown to realize as I've continued through this journey and continually needing to reassess in med school . . .

You then reassess what specialty you want to go to. And then you're interviewing for residencies and you're like, "What type of residency do I want to go to?" Then now you're thinking about career jobs after residency or even fellowship and more training.

And what I've come to realize is that there's just so much more degree of flexibility and nuance to build the career or the life that you want than what people make it out to be.

Of course, there are sometimes logistical limitations and things like that, but you can create a fulfilling life and integrate stuff. And sometimes it doesn't even just need to be from your career. It can be from other aspects of your life too.

So I would advise in trying to choose what path to take, first giving yourself a lot of grace and a lot of understanding that things can be flexible and that things can change. And the decision that you make when you are in your early 20s and your brain is still developing can be very different and not set you for life for the decisions that you want to make in your 30s and beyond.

I wish people would have told me about that grace and about recognizing that nuance and that potential a lot more, because I think that would take away a lot of the struggle with the decision-making, feeling like, "Oh, I've made this decision. I have chosen this for life and there is no way that I can get out of this very straight and narrow path." But actually, it isn't very straight and narrow. It can be basically a blob, honestly, the path that you go on.

Hannah: So I'm thinking about two things. One is the piece of advice that I give to anybody considering a path in research and/or medicine, and that's particularly because I've worked in research labs and interacted with many and worked with many people considering the path of either medicine or research, or both.

But I also want to take a moment . . . and I feel like I've kind of danced around what my research path has been. Take a moment to plug the research world a little more, I think, especially for people who haven't considered it.

The picture I had in my mind of research before my junior year of college was sterile, white coats, cold, not interacting with people. And I was like, "That's not a career for me. I like talking with people." My experience in research has not been what I had in my mind. There's a whole variety of the types of labs that you can work in. What I have found is so many great people working in research.

And although I'd like to say that it's the scientific process that drives me, no, the scientific process takes a really, really long time. Certainly, it does drive me. If I went through that process and still derived no fulfillment from that, this would not work. But since it does take a long time, the day-to-day that keeps me going is little things of an experiment working. Although more often than not, the experiment doesn't work until it does. The day-to-day stuff that fills me up is my interaction with people.

This is not going to work for everybody. But if you are even on the fence of taking some time between undergrad and grad school or med school, and grad school being a PhD or genetic counseling or another sort of master's but not specifically med school, I think that people considering those routes have generally enjoyed or at least not minded school and academia, and most likely thrive in academia. That's kind of what you know.

I think that it can be both a little scary and the transition to, say, working not in . . . It still could be in academia, but you're not actively in school. That transition is uncomfortable for a little while.

But it also gives you the space to be a person in the world outside of school, get a sense of the potential options, to really talk to people and see what their paths have been outside the context of school, without the momentum of, "Here's just what I do next."

Like, you're at the end of high school and you apply to college. You're in college, and you apply for your internships, and then you do your internships and you try to make decisions about what's going to come next. There's that momentum there, but giving yourself some space to make that decision without the momentum, I can't emphasize how valuable that can be.

And when you're in college, the order of months means a lot. And so the idea of taking one, two, three years or more of more schooling, more training can be really intimidating. But one, two, three years in the grand scheme of a career ends up being quite negligible, and I think should be considered.

Hạ: Highly retweet that. I needed my gap years to make decisions. But I think if you're able to do it, logistical and other things notwithstanding, sometimes just getting away from the grind of academia and the expectation to keep churning along can be so helpful in figuring out what fills your cup. So retweet.

Laurel: Yeah, I agree. I think it's actually pretty consistent with my perspective on the MD-PhD when inevitably people bring up that it's a very long program, is that I would rather take the time and end up exactly where I want to be than end up somewhere I don't want to be potentially more quickly.

And so I think having the time to really be able to choose intentionally your next step is time well spent. And I think it resonates very well with what I was thinking I would tell someone, besides don't do MD-PhD unless you have to, which is to actually pay attention to how you feel.

I think some of the best career advice I ever got was not career advice. It was, at the time, a med student, now resident friend of mine, actually sort of complaining. She was talking about one clerkship versus another and was saying that the days where she was working 12 hours on one clerkship felt much shorter than the days she was working four hours on another clerkship.

And I thought that was just such a concise way of thinking about . . . or again, not thinking, but really just how she felt. What she said was she felt more exhausted after the shorter day because she didn't love it. And that really meant something to me.

I think, as science-minded individuals, we can get excited about a lot of things, and a lot of those excitement pieces are very cognitive and intellectual. But how do we actually feel when we're doing the thing, I feel like, is really important.

And especially as high-achieving people, do we enjoy the thing or do we just enjoy that we are good at the thing? Because there is a very salient difference there.

And so I think however you can give yourself the space to really process and figure out at an individual level what you want, visceral want, over what you could potentially do, I think, is very worthwhile.

In closing, before we end this episode, which can be found anywhere podcasts stream, I thought maybe we could close by saying one nice thing about the professional group we are not a part of.

As an MD-PhD, I feel called upon to end the beef. We're all good noodles. And even though we occasionally end up in very different silos and spheres, I think that healthcare and health is better for both communities and groups of people.

And so I can start. I really love that everyone . . . I guess not everyone, but almost everyone I've interacted with in the PhD space is almost frustratingly curious. There is no stopping at, "This is in your Step 1 book. Therefore it is true." Everything is always going deeper and deeper, and I like that that pushes my mind further.

On the medical side of things, I really love I guess the groundedness of, "Okay, but what does this mean for a patient?" And I think sometimes in research, we can get so excited with discovery and biology that I really appreciate the reminder of physicians who are like, "Well, I'm talking to someone with this condition tomorrow. What does this mean for them?"

So I really love getting to wear both hats, even though I also love getting to complain about both.

Hannah: Certainly, this isn't what drives all scientists, but the realm of science that I've always been in has been biomedical research where the first and last part of every grant application we ever write is, "Eventually, we will be able to translate this into therapies for patients." But the day-to-day gets often very far away from that.

I think that the best science is collaborative science, and a big part of that collaboration when you're doing biomedical research includes the clinical side of things.

And I'm more biased than I think some straight pure researchers that you're going to interact with, but I have been driven my entire scientific career by the collaborations and interactions that I've had with clinicians and patients, and I am so grateful for those.

It is, from a personal perspective, a way of connecting my day-to-day grind with an outcome that ultimately motivates me. And this is where another researcher is going to have another perspective of what personally motivates them.

But I love medicine. I am beyond fascinated by it and I like being able to connect that, and the way I do that is via clinical collaborations.

I'm so grateful for the clinicians that want to work with researchers and that let us ask our gazillions of questions, and ultimately do say, "Well, here is my perspective."

And also, I think it comes back to the best science is done when there's collaboration, and that includes between clinicians and researchers. Not to say clinicians can't also be researchers, but, yeah, I think you know what I mean.

Hạ: I mean, if you didn't know and you're interested in medical history, some of the things that we used to do in medicine were kind of wild, but then researchers came along and helped right all of our wrongs that we're still working on. But it's because of researchers that we are able to practice evidence-based medicine, that we are able to get really cool cures and things out.

And it is really cool how even looking at a cell line, the signals that that cell line sends out to each other, the ways that that cell line responds to stress, and all of that can have meaning for the clinical medicine that we practice with patients and all of our cures and everything that we provide for patients.

Or even as we're looking into new things like CAR-T therapy and genetics, engineering, and all of that, or even people are looking into designing/building 3D-printed organs. There are so many cool things that can really make a big impact for patients, and that's all thanks to researchers and the people who sit there and really do think about the little things instead of the big picture.

For us, I am thinking more about the big picture of the side effects on the patients and what does that mean for cures and all of that, but ultimately, to get to that safety point where I can start thinking about that, it's in part to all the work that researchers have done to get there.

So I love researchers. We need more researchers. Otherwise, we will go back to the dark ages of medicine.

Laurel: We've talked about a lot of things and all of these things have been our personal perspectives and viewpoints and not reflective of the University of Utah in any capacity. Thanks, y'all. I'm glad we could find world peace today.