Before I begin, I just want to say that what you will read is a first-hand account, and I believe it will be helpful to paint a picture of my own experiences for those trying to determine what kind of career to pursue – especially in the sciences and/or healthcare. I go into more detail about my research experiences, but I do have a medical background as well – I’ve worked in hospitals and worked and talked along-side doctors in and out of the clinic, so I don’t want people to think that some of the comments I make are based on assumptions. However, I do make some general assumptions throughout this paper about medicine and research without going into detail simply because I have to abide by a word limit, and I’m critical about both professions because I don’t want to give people false impressions or give either profession a nice sugarcoating. I don’t like to sugarcoat things, but retrospectively thinking, I believe that’s how a lot of information was presented to me. I want to provide people with information, and you can choose to do with it what you wish.
I’ll start by talking about my initial motivations for pursuing medicine then move into my reasons for pursuing graduate research studies despite having been a pre-medical student. I’ll continue by explaining how my graduate studies influenced my decision to pursue medicine versus research and then conclude with some remarks about medicine and research as a whole. In the time it takes for you to read this post I will have hopefully portrayed to you an accurate enough description as to why I have chosen to pursue medicine over research and give you more information about either career. Now with that out of the way, grab a coffee or drink of choice and read along – it’s a long one.If you’re an individual who purports “I like everything, and I don’t know what to do” then you and I have something in common. The only difference is that I’ve figured out what I want to do now, and you may be struggling with that particular facet of your life. If you name an extracurricular activity, I’ve probably done it because I enjoy it and because I see the value in learning about new things and taking advantage of opportunity. I played sports, and I acted in high school. In college I played intramurals, and I took up a music minor along with my biochemistry major. I ride my bike, I’ve been rock climbing since I was eight, and I participate in competitive diving. I like reading fiction and non-fiction alike, and I peruse medical journals like The Lancet and the New England Journal of Medicine regularly. I like everything, especially learning, so how is it possible to stay focused and realize what it is you’re truly passionate about when you’re inherently a multifarious individual? Fortunately, my diverse personality has generally never gotten in the way of pursuing the things I am passionate about. Unfortunately, when it does, my life seems to take a bizarre tangent that leaves people to equally question my rationale or encourage me to take advantage of the opportunity. The most recent of these spontaneous manifestations resulted in my discovery for why I truly want to pursue medicine over research.I knew I was destined for a career in something science because I enjoyed learning the empirical, qualitative facts about the world, but I found most of my interests were concentrated on disease pathology and pathway medicine. I was fascinated with the complexity of the underlying biological pathways of the human body and the simultaneous resilience and fragility. When I first studied biology, I begin to realize the sheer complexity of the underlying physiology behind cells, tissues, and organs, and I begin to ask myself “all of that is happening in me at this very moment?!” When even one little thing goes wrong – say a frameshift mutation from a single DNA nucleotide – the effects can be detrimental ranging from a reduced quality of life to even death. Studying biology even helped me change my lifestyle. As I became more educated, I began to eat healthier and exercise regularly because I began to understand the implications of doing otherwise.
The causal nexus of gaining knowledge and translating it into lifestyle changes was one of my principle reasons for choosing to become a premedical student, but I drooled at the opportunity for scientific discovery. It was this acquisition of knowledge that drove me to pursue research projects in my first year of college. Unfortunately, I was involved in research that I soon discovered I was never fully passionate about, so I ended up discouraged and frustrated that my research did not live up to my initial expectations. I eventually succumbed to my premedical studies – putting in hours of studying to make sure my grades never faltered – and I “resigned” to a career as a physician. If I had to assign a numerical component to it, I’d say I was 80% certain I’d become a doctor one day. But what about the other 20%? It was only during the last semester of my final year of university when I had the luxury of “extra time,” and my interests rekindled themselves as I began reading and exploring more.
I realized that the only way to discover whether or not research was truly the path I had always expected it to be – that other 20% – was to pursue it full time. The four years at university that people proclaimed to me were the hallmark years of freedom and self-discovery was simply not enough time to discover my other interests. Increasingly, I had attended a small, private institution that wasn’t a hugely funded research institution, so I felt like I wasn’t in the correct environment to accurately judge my interests. I researched graduate programs, but I didn’t like most of the structures of the programs in the United States. The programs were structured with classes, TAing, and lab time. This wasn’t appealing to me because I wanted to work on a research project full-time. Plus, I’m a very motivated individual who enjoys self-directed learning, so I didn’t want to “waste” my time in a lecture hall taking required classes and grading undergraduate multiple-choice exams (maybe I’m a bit too critical) when I could be reading the information and performing the research that interested me. After all, I’d already learned about cellular biology three other times in my past, so I didn’t see the point of learning basic science again when I could be learning about advanced topics in biology. This is basically what I saw as a problem with most of the programs I looked at – the goals of the programs simply didn’t meet my goals as an individual. I do not seek to denigrate the scientific education in the United States. I just want to reaffirm that the programs in the U.S. did not meet my extremely specific goals. We do have some of the best schools in the world – Stanford, Duke, Johns Hopkins, Harvard, and the University of Chicago to name a few.
It was then that I turned to look for programs abroad. This was actually hugely advantageous for me because the programs that I looked at did not require entrance exams like the GRE whereas most graduate programs in the United States require applications with the GRE to be submitted before the end of the previous year. On the plus side, the programs were still accepting applications in the spring for entrance in the fall. Increasingly, the programs are a full year with greater emphasis on developing the skills required of a researcher without taking structured courses. I was accepted to the University of Edinburgh in Edinburgh, Scotland for a Master’s by research in the biomedical sciences. I quickly accepted, and I soon found myself in a lab researching away.
Research at the graduate level, in the UK especially, can be a challenge for some because the curriculum is different, and it is more self-directed. If an individual is not motivated to learn, then these types of programs can produce more harm than benefit. For the past few years I had been training myself to pursue a medical career and not a career in research. The transition was much more difficult than I thought – especially in the writing process, as I had been equipped with skills to write one way whereas now I was being taught to conform to scientific standards. I thought with all the previous research experience I had had that I would be provided with the knowledge to carry out a full research project at the level of a graduate Master’s student. I was convinced my undergraduate studies had prepared me. They had – but less than I realized. I worked incredibly hard to ameliorate the deficiencies in my writing, and I would rewrite papers completely half a dozen times at the minimum.
Now it just so happened that the lab I was working in had a trained pediatric surgeon who was studying to obtain his PhD. I had opportunities to talk to him regularly, and he proved to be an excellent source of information when it came to discovering interests. One of the more enlightening pieces of information that I received from him is summarized as such – “as you begin your career, those that have a passion for learning begin to realize that they have other interests, and you learn to incorporate other aspects of your education into your true passions.” As a pediatric surgeon, he is expected to be an expert in pediatric surgery (obvious yes?). Thus, who best to carry out pediatric surgery research than a pediatric surgeon himself? In the spirit of education, he chose to pursue a PhD because he wanted to become a physician-scientist to help better the profession of pediatric surgery.
This is the direction of medicine. To become the best physician you can possibly be, you must have research experience. You don’t need to have a Master’s or a PhD – you need exposure. Physicians of the past, present, and future are tasked with life-long learning, and they are required to read scientific literature and learn to question others’ logic and spot flaws. As a clinician – regardless of where you practice – you may be approached by researchers who need your patients for research studies.1,2 Physicians are involved in research one way or another, and it is only through research that clinical practice will get better. How is it that practice is improved by new knowledge? Simple – by learning to question. Research exposes you to how science is performed, and an educated person will be able to spot flaws or even identify falsified data! You don’t have to have a PhD to call yourself a researcher; You can have a medical degree and perform research. However, as far as I see it, research is learning how to question in order to improve the quality of care. Being a physician versus being a researcher are two different paths for advancing the quality of healthcare not only in the United States, but also internationally.
I think one of the biggest – but general – differences between a career in research and a career in medicine is summarized as such: research teaches you how to ask the right questions whereas medicine teaches you the answers to the questions. Think about it – a patient comes in with certain symptoms and you, as the physician, are equipped with knowledge about the signs and symptoms of diseases. You recognize that patient A has ailment XYZ, and you diagnose the patient based on the signs and symptoms. Also, many medical specialties are highly repetitive, and some physicians even complain that their careers are boring. In research, you are equipped with a hypothesis, and you carry out experiments to prove or attempt to disprove the hypothesis. Somewhere along the lines, something you didn’t expect happens, and now you are tasked with investigating the cause behind something else. Research is also an incredibly serendipitous discipline, and that’s how many major scientific discoveries have revolutionized the world – penicillin for example. You also get to work on different projects in your discipline, so there’s always variety. People claim research is a social atmosphere, but it is extremely isolating at times. The majority of the work is done in a lab concentrating on data analysis, and each person is busy working on his/her own experiments.
I imagine someone somewhere is reading this thinking, “so all physicians are just dumb then?” – no, but I will say that most doctor’s aren’t as smart as the public is led to believe. Doctors are glorified and assumed to be the know-it-alls when it comes to health, but that’s not the case at all. Doctors do not know everything but neither do researchers. Don’t get me wrong, I think you need a certain amount of smarts when it comes to medicine, but the thinking abilities required by each profession are different. However, if you do variable Google searches for “smartest people in the world” I guarantee there’s not one physician on the list. The majority are scientists and mathematicians, and when I think of scientists I think of Albert Einstein, Louis Pasteur, Michiu Kaku, and Brian Cox. From personal experience, some of the best conversations and lectures I’ve had are with people who have at least a PhD – just saying.
I acknowledge that the paths people take in life are different and that some ways are better for others to discover themselves. I had a chance to study at what is considered to be one of the best universities in the world, and I was surrounded by some of the brightest and most intelligent individuals I’d ever met. It was intimidating, but this was my catalyst because I was influenced by those who encouraged me to seek out the opportunities available in both professions. I went to a university to learn how to become a researcher, but I was introduced to more opportunities that encouraged me to study medicine or integrate the lifestyles of both a researcher and a medical professional. I’m not studying to become a researcher; I’m still studying to become a physician – a better physician nonetheless.
Medicine has had an alluring effect on me. The more I think about the last few years of my life the more I come to compare it to the event horizon of a black hole – there’s a point of no return. I can’t get out no matter what opportunities come my way. It’s impossible. Despite what other interests I have, I’ve been influenced too heavily throughout my life to pursue anything but medicine. I live a great life in research – I make my own schedule, I have an excellent social life, and the money in research is great (should I decide to pursue it as a full-time career, which is unlikely). Amidst the articles that I read about the deteriorating state of the American healthcare system, the stress and anxiety of malpractice lawsuits, the time, money, and effort required for a medical education, the insufferable erosion of the doctor-patient relationship, the venal relationship between some pharma companies and physicians, the controversy of DTC drug marketing, the increasing bureaucracy – you get the idea – I still want to pursue medicine amidst doctors encouraging me against this lifestyle choice. Hardly anything about healthcare seems positive! Why do it? — because someone has to do it. There’s someone out there crazy enough to give people back their lifestyle under the constant stress of this face-paced and ever-changing profession.
That person is myself and possibly the one reading this. The job description of a physician – not the sugarcoated one on the HR website but the one told to you directly by an actual physician – is very attractive to me. I personally like working long hours, and I take pride in my work – I always have. It’s who I’ve always been, and it’s who I was raised to be. Thirty years from now when I look back on my life, I can say that I have no regrets about exploring opportunity and discovering my interests. I can say that I explored the other 20% and better yet, synthesized what I have learned and incorporated it all into my dream profession. Sure, medicine is an immense challenge and a long haul, but I don’t think I could be happier with my decision to pursue it, especially if I’m pursuing it for the right reasons.
REFERENCES: 1. Bloomrosen M, Detmer DE. Informatics, evidence-based care, and research; implications for national policy: a report of an American Medical Informatics Association health policy conference. Journal of the American Medical Informatics Association : JAMIA. 17(2):115-23. 2. Manca D, Maher P, Gallant R. Ethical concerns in community practice research. Canadian Family Physician. 2006;52(3):288-289.
About the Author:
Anonymous is a Master’s student at the University of Edinburgh in Edinburgh, Scotland performing research in developmental biology and viral infectious disease. He intends to go to medical school within the next couple of years.