Taking the Plunge

To begin I should note that I am privileged to have befriended some incredible people in my relatively short time on this earth -- people who are brilliant and talented in every way possible.  It is this group of people that keeps me grounded and confident that I am on the right path, because no matter what my decisions may be, I never seem to be alone. 

Last month I received an e-mail from a friend in medical school who had encountered a scientist (MD) who claimed that a life which straddles both science and clinical medicine in some sort of balance is impossible.  In closing, she asked: 

"This got me pretty depressed because I had thought that maybe I could pursue an MPH or Masters in Epi at some time later in the future and be a clinician-scientist doing epi research.

I was wondering what your thoughts were on the possibility of research AND clinical medicine. It seems like you had a lot of thought on this and chose a different path [than] I."

It was an impeccably timed letter -- one which echoed some of my own struggles with deciding on a career path.  I was able to reply with some thoughts that had recently come to light:

"The age-old question: is it truly possible to be a physician scientist? You're right, I have struggled with this myself, as I realize more and more that my true passions, although still diverse, still share a single commonality: activities which make advances in biomedical research relevant to the world, rather than at the laboratory bench itself. So this reply will be biased: I want a career which translates scientific achievements into health care improvements and involves some patient interaction. This means I will most likely end up going to medical school once I finish this degree (yikes). I'm not sure if the career I envision will involve bench-top research, but it will certainly include clinical research at very least in a collaborative effort. I must confess, I cannot provide an authoritarian answer, but I can tell you what I do know (which includes a little bit of hope, too).

Obviously, I can really only speak for myself and my own preferences. Ultimately, perhaps the most difficult decision we face is answering the question, "What do you want?" If an answer to this, for you, involves a career which emphasizes both patient-care and epidemiological (or any other) research, I think it is more than possible to make that happen for yourself. That said, I also have heard from people who have both encouraged and discourages a dual degree (MD/PhD) that a perfect 50/50 balance is impossible -- at some point you will need to decide to research and have a practice on the side or practice and do research on the side. "On the side" tends to mean different things for different people. I've met people who break their work-weeks up four days in the clinic, one day in the lab (or visa versa) and others who set aside a couple of hours every day for research. The type of research you choose to do may be more or less amenable to a career as a successful physician. Clinical research (I think epidemiology could easily fall into this category), especially that which relies on a particular patient cohort which you cater to in your practice, makes research a bit easier, while true "basic" research (i.e. biochemistry, cell biology, and even physiology to a certain extent) which takes place in a laboratory (often not within the hospital itself) can be more difficult. Outcomes research can be more easily fit into downtime, while managing an NIH-[funded] laboratory is much more involved.

As the NIH shifts its funding priorities towards more clinically-valuable projects, I think that people with dual skill sets will become (and are already becoming) valuable assets to research teams, especially those at institutions which rely on outside funding to support things like medical education. The result of this is the development of more and more options in medical education which allow physicians time to do the thinking necessary to be successful in research. Personally, I've looked into medical schools which include options for research experience during training (a research rotation, for example). I would be shocked if this weren't an option at Michigan State. I know that there exist dual "post-doc/residency" programs which allow physician-scientists to further develop their research and clinical skill sets, somewhat simultaneously. Some of those [programs and opportunities] are listed here, http://www.physicianscientists.org/careers/training/residency, and that site also provides some good information on a career as a physician-scientist in general. Year-out programs are also an option (those are described on that site as well) which might compliment an MPH/Epi Masters nicely. These opportunities may have not been available to physician-scientists of previous generations, so perhaps we could more successfully balance such a career? This remains to be seen. "

So sometime in the last few months, I have decided to make these dreams a reality -- and the first step in this was accomplished two weeks ago when I registered for the March 27th administration of the MCAT. 

In all honesty, I am terrified. 

It's an odd regression, going back to studying subjects (organic chemistry, physics) which I am confident I need not remember much of for medical school success because I've already taken graduate level bio-medical coursework.  It is a humbling experience to try to relearn what surely comes easily to my fellow test-takers, most of whom are high-achieving undergraduates with plenty of time on their hands to devote to studying.  Electron fields?  Angular acceleration? 

I think about finishing school at thirty, and what my life will be like.  How does one finally "settle down" (i.e. buy a house, hell, buy a car, get married and have babies, or maybe just more cats) when faced with $200K in student loans and a demanding residency/fellowship/work schedule?  How will it feel to watch my friends blossom in their chosen careers as I start mine at the bottom of the medical totem pole?  How will I find time and energy to nurture my other priorities? 

But then I take a look around me (from) at the Milwaukee Regional Medical Center:



At the faculty and physicians doing tremendous work in the clinics, in the classrooms, and at the bench.  At an impressive and state-of-the-art medical infrastructure.  I am reminded that this is my journey, that it is incredible and exciting, and that I am surrounded by the kinds of people and opportunities which can help make my dreams possible.  This is my future...

...So, I'm taking the plunge.