Considering a Career in Medicine - SCIENCE!

We focus a lot on how students can prove they're good enough for medicine. These posts are for students wondering if medicine is good enough for them.

Short Version: Medicine absolutely requires a solid understanding of scientific principles and facts, as well as an ability to critically analyze new scientific studies or discoveries. The common undergraduate precursors to a career in medicine are based in scientific study, for good reason. Scientific research is intimately connected to medicine, and involvement in research can be beneficial to a prospective physicians' career goals before, during, and after medical school. An interest in science is therefore a common reason why students choose to pursue medicine.

Medicine is an inherently applied field, however - when it comes to the nuts and bolts of scientific discovery, the basic or fundamental research that underlies much of humanity's technological progress, physicians rarely get involved. Rather, physicians involved in research tend to spend most of their time on clinical research, which investigates potential applications of discoveries others have made. This can be an advantage or a disadvantage, depending on individual preferences. Science-loving potential medical students should give some thought to how they want to incorporate scientific knowledge into their careers and ensure that being a physician will satisfy that objective.

Long Version: Modern medicine could not exist without the development of the scientific method and its continual application to new realms of human knowledge. To the extent physicians' interventions are effective in preventing death or improving life, it is thanks to the works of physicians and scientists in the past and present. As such, it is impossible for a capable physician to exist without a solid understanding of both prior scientific discoveries as well as the process that leads to new scientific discoveries.

Furthermore, the pathway to become a physician, with some uncommon exceptions, requires a solid scientific background. Medical school admissions has moved away from requiring certain degrees or pre-requisite courses, but most still require the science-heavy MCAT and the vast majority of medical students do their undergraduate education in science, math, social sciences, or engineering. Put simply, the pathway to medicine runs through science and therefore medicine attracts those with a proclivity towards scientific study.

Part of the path to medicine for many students includes becoming actively involved in scientific research. Research is by no means required for admissions to any medical school in Canada, but it can certainly help with the admissions process at the majority of schools. Even at schools that do not consider research in their admissions process, or do not weigh it heavily, many matriculants will have significant research experience. There continues to be some value to engaging in research after admissions. Many residency programs will take research experience into account. This is usually as a secondary consideration to clinical performance, however, and research is really only required for a few highly-competitive fields. Once in residency, most programs will have required research projects, and research productivity can be important for landing positions after residency, depending on specialty and desired location of employment.

Yet, despite its close ties to the study and advancement of scientific knowledge, medicine is far more concerned with application of new discoveries than in their production. Physicians are largely involved with what is termed "clinical research" as opposed to foundational research or basic sciences research. To oversimplify somewhat, clinical research involves study on humans. For ethical reasons, we tend not to allow such research without having some expectation as to what will happen, so clinical research generally involves relying heavily on knowledge derived from basic sciences research, typically performed by non-physicians. This is not to diminish the difficulty or importance of clinical research, which is fraught with challenges and is critical to developing truly evidence-based medical practice. However, it does speak to the place of physicians within the process of developing new approaches to medicine - if a useful new intervention in medicine takes 100 steps to become discovered, developed, optimized, and proven effective, physicians involved in research are usually responsible for the last couple steps only, with an emphasis on optimization and proving efficacy rather than on discovery or development.

To many, this limited role of physicians in the scientific process is not a drawback. Many physicians have no desire to be involved in research at all, even those enthralled by the miracles of science. Medicine is vast and learning how properly apply the ocean of scientific information relevant to one's practice can be plenty of mental stimulation for science-minded individuals. Similarly, for those interested in advancing medical knowledge but are uninterested in the basic sciences research students typically encounter in their undergraduate studies, clinical research can be an ideal way to satisfy that objective.

At this point, the growing demographic of clinician-scientists deserves recognition. Clinician-scientists are physicians who have additional training towards becoming capable researchers, usually through intensive graduate work. In some cases, the focus remains on clinical research, with clinician-scientists doing much the same research that an academic physician without additional training would undertake, but with perhaps a bit more expertise and often with a greater proportion of time spent on research activities rather than on clinical duties. Other clinician-scientists, however, will try to straddle the divide between clinical and basic sciences research. Translational research, with its emphasis on taking or making new scientific discoveries and bringing them into clinical practice, is receiving substantial attention in academic circles. Clinician-scientists, with focused training in basic sciences research, are considered ideally placed to take advantage of these opportunities.

The number of these clinician-scientists is fairly small, however, and not without reason. Becoming established as both a clinician and basic sciences researcher requires a substantial amount of time. A physician typically does not enter independent practice until their early 30's, and the same can be said for most basic sciences researchers. To manage a career in both areas can easily require a person to train into their late 30's or early 40's before independence in medical practice and research are achieved. That additional time spent training means losing significant financial opportunities, that extended training delays entry into employment. Additionally, research tends to pay less than clinical work, meaning clinician-scientists often earn less than their clinician-only counterparts.

Additionally, not all who pursue clinician-scientist training take advantage of both their intended roles. Many individuals who obtain both an MD and a PhD, whether that PhD was obtained before, during, or after medical school, do no research or research that could easily be accomplished with an MD alone. Likewise, there is a small group of clinician-scientists who no longer work with patients in a clinical setting, or who have minimal clinical duties, effectively working off their PhD alone. Obtaining both an MD and PhD can be an attractive prospect for highly ambitious students, but should be approached with caution and with as full an understanding of the clinician-scientist role as possible.

To summarize, medicine absolute involves scientific knowledge and benefits from those interested in science. Being interested in science is a good reason to consider medicine! Yet, potential medical students must keep in mind that an MD prepares students to be clinicians first and researchers second, with a focus on clinical research only. A physician's use of scientific knowledge is usually confined to direct applications for patients. For those who would strongly prefer to do research outside of a clinical setting, or those who have minimal interest in working with patients, an MD may not be the best fit, and those students would likely be better served in a PhD-only program. For those who truly want to do both, the clinician-scientist route, which usually involves completion of both an MD and a PhD, may be worthwhile. Science-lovers should take the time to check out all their options before diving into a career in medicine that may or may not be tailored to their specific interests.