As an MD in psychiatry residency, is it better to conduct research with an MD or a PhD, or does it not make a difference?

[Psychferlyfe3000]

Hi all,
I just matched to a psych residency and am very excited to do some research during residency. If my goal is academic psychiatry, how much of an advantage is it to work with an MD vs. PhD? Thoughts? Thank you!!!

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[Psychferlyfe3000]

Also, to clarify, I am just an MD (I have no PhD).

 

[SourceOfDenial]

First you have to define research. Do you mean write some papers? Do you mean participate in some capacity in ongoing studies? Do you mean design and run something that falls under the guise of research?
Then consider if you want this to be something you do on the side, or do you want a big part of your medical career set aside to do it? That means grant writing and all that accompanies it in many instances.

And finally, is it research you want to do? Or clinical innovation...or QI.

I think it’s always helpful to first start with why you want to do it and figure out what your goal is first.

Also, most ‘academic medicine’ positions are not research positions. Most academic psychiatrists do not conduct research.

 

[Psychferlyfe3000]

Hi! Thank you for your response!

I would like to design and run studies and write some papers. The dream for me would to have research be 40-50% of what I spend my time doing as an attending. So, yes, I would expect to do some grant writing as well. I am not looking to do QI.

First you have to define research. Do you mean write some papers? Do you mean participate in some capacity in ongoing studies? Do you mean design and run something that falls under the guise of research?
Then consider if you want this to be something you do on the side, or do you want a big part of your medical career set aside to do it? That means grant writing and all that accompanies it in many instances.

And finally, is it research you want to do? Or clinical innovation...or QI.

I think it’s always helpful to first start with why you want to do it and figure out what your goal is first.

Also, most ‘academic medicine’ positions are not research positions. Most academic psychiatrists do not conduct research.

 

[dl2dp2]

It's tough. You need to talk to lots of people and carve out a niche. The alternative is very attractive in psych and it's hard to push through the nonsense.

This might sound like trolling but it's not: it's helpful to have 1) family money; 2) stay at home spouse or childfree lifestyle.

 

[fenders567]

Hi all,
I just matched to a psych residency and am very excited to do some research during residency. If my goal is academic psychiatry, how much of an advantage is it to work with an MD vs. PhD? Thoughts? Thank you!!!

Congrats on matching! I would suggest working with PhD, work with people someone who is productive and publishing and who seems like they would treat you well. In general, PhDs will take their research more seriously then MDs who are more focused on clinical work.

 

[SourceOfDenial]

Hi! Thank you for your response!

I would like to design and run studies and write some papers. The dream for me would to have research be 40-50% of what I spend my time doing as an attending. So, yes, I would expect to do some grant writing as well. I am not looking to do QI.

So, most importantly you should start to seek out research mentors.
What you describe sounds like ‘Big R’ Research—which for the majority of clinicians, means NIH, VA or foundation funding. It means at the minimum 75% of your time will be spent on research. Academic centers won’t just pay your salary to make up projects, so you need to get the money yourself, show you can be productive and bring money in. This means aiming towards career development awards for the majority of folks starting out after residency/fellowship/research fellowship.

While some folks can pull off the shangri-la half clinical half research model, it largely doesn’t exist. Or it exists but you are significantly overextended. Most positions are 80/20 split or close to it.

There are some clear advantages to being an MD versus a PhD. MD researchers are harder to come by and are desirable by many study sections. You can also easily make money for the institution on your clinical time. You can also build a really compelling narrative about why you want to do research that feels more connected to patient care. “as a Clinician I was troubled by X, so I decided to do Y and make it my life to better understand how A and B can improve the lives of people who live with X. In my clinical capacity I continue to be shaped and learn from patients with X”

Get a research mentor, find out if you like to write, and learn from those who have taken this path.

 

[tr]

Sounds like the OP is asking about the degree of a potential research mentor.
This is pretty much irrelevant.
You should try to work with someone who has lots of research funding, who has a good record of training people who go on to faculty positions and to conduct independent research, and who has a reputation for being a reasonable human being. Priorities in that order if all 3 cannot be satisfied.

 

[WisNeuro]

Depends on your goals, really. Do you want to learn the ins and outs of research? In general, probably a PhD. We do spend 5+ years with this as a pretty integral part of our training. Most PhDs are required to carry out original data collection from start to finish at least once (dissertation), some twice (masters and diss.). We've also taken a multitude of coursework on research collection, methodology, years of different statistics courses, etc. Not to say that you can't do good research without this, but in general, those extra years of training help. Will also make you a better clinician, for example, why a good deal of pharma research is junk due to using incorrect data analyses (e.g., LOCF, certain prediction models, etc, among othr clinically useful reasons to have a good handle on stats.

But, if you want to learn the ins and outs of the politics of conducting research as an MD, an MD mentor will probably help you out more.

 

[Chimed]

The degree doesn't matter. What's important is that you work with someone who can mentor you and has an established research career. The stuff I was interested in as a resident was fMRI. The best researchers at my institution were MDs. They tended to do more clinical work as well. But in the end, find what you're interested in and seek those people out.

 

[NickNaylor]

With sufficient opportunities, you can be a prolific researcher without a PhD. One of our faculty runs a very large research-based center and is well-known in his area of research. He "only" has a MD. I second what's written above: the key is to get experience and have good mentors.

 

[Psychferlyfe3000]

Thank you all for your responses!!! They're very informative. The general consensus seems to be that it is not an important distinguishing factor for the most part.

 

[Psychferlyfe3000]

Part of the reason that I asked the question was because I did research with a PhD in medical school who I felt did not fully realize how intense clinical duties were for medical students and did not fully understand that I had limited time to do research (a few hours a week). It created a little bit of tension at times.

 

[WisNeuro]

Part of the reason that I asked the question was because I did research with a PhD in medical school who I felt did not fully realize how intense clinical duties were for medical students and did not fully understand that I had limited time to do research (a few hours a week). It created a little bit of tension at times.

That seems to be more of a problem with a discussion up front. Honestly, I can't imagine a researcher of any degree only taking on someone a few hours a week. It's honestly a waste of training and mentorship time for so little of a contribution. Also, that's really not enough time to be able to engage and take on duties enough to really learn anything of value. It's fine to get a very rough taste of research, but you're learning at less than the average undergraduate level at that point.

 

[psyguru]

If you are looking to make income on the side (to free up more time for research), focus your research in litigated areas such as PTSD. You could potentially do expert witness work in that niche. There was a psychology expert opposing me on a case. She was known to be a PTSD research and does little clinical or forensic work. Her hourly rate as an expert witness was very high. If you did a few cases a year, you could possibly do one less day a week in clinic.

 

[Psychferlyfe3000]

It's funny that you mention ptsd be ause that's exactly where my interests lie. Why would this be a more "litigated" area than other areas in psychiatry?

If you are looking to make income on the side (to free up more time for research), focus your research in litigated areas such as PTSD. You could potentially do expert witness work in that niche. There was a psychology expert opposing me on a case. She was known to be a PTSD research and does little clinical or forensic work. Her hourly rate as an expert witness was very high. If you did a few cases a year, you could possibly do one less day a week in clinic.

 

[psyguru]

It's funny that you mention ptsd be ause that's exactly where my interests lie. Why would this be a more "litigated" area than other areas in psychiatry?

PTSD requires trauma and is the only disorder that requires it. Adjustment disorder requires a stressor (and generally causes long-lasting damages unless it leads to chronic depression). Trauma could be assault, MVA or rape. So it could form the basis for a personal injury case. Often you will have MDD and GAD with PTSD. However, when you have PTSD with nightmares or other symptoms specifically linked to the trauma, it clearly indicates specific causation. You don't really have that same quality representation of causation for MDD and GAD that would impress a jury. As I am specialized in BIM, I run into a lot of cases that involve PTSD and TBI (the above logic is relevant to TBI as well).

In criminal cases, PTSD could be a mitigating factor or even lead to NGRI (not guilty by reason of insanity) due to dissociation in extreme cases. Generally,, successful NGRI pleas are usually due to extreme psychosis, IDD or NCD and not for PTSD. In Texas, you have to be board-certified in forensic psychiatry for Insanity cases or have some type of CME in such work to do Insanity cases.

I see PTSD in immigration cases such as Human Trafficking, Asylum, and Violence Against Woman cases. My fellowship attending did an article about its relevance as an expert at the UN War Crimes Tribunal in the Balkans. PTSD can also be relevant to the ability of one not to recall aspects of a crime as a witness.

The issue with this researcher as an expert was that she hardly ever does clinical or expert work. She used self-report scales which may be ok in research and clinical practice that would not be acceptable in forensic work (unable to rule out malingering). You could tell that even though she knew a lot about PTSD, she did not have the skillset, expertise or experience to perform a good Independent Medical Examination.



I can see the utility in having a PTSD researcher testifying about certain issues with PTSD and having another expert do the IME (examination). If you do decide to be the examining expert, you may want to self-learn how to do one well. It would also help to treat patients and do regular IMEs.

When you become a researcher, feel free to reach out. We could co-author a paper on PTSD and Forensics.