BACK TO THE FEATURE INDEX

MD/PhD programs give students two markedly different perspectives on human biology, and then launch them on two separate, simultaneous careers. Most people agree that the professional advantages of dual training are considerable. But how do those disparate elements add up to a single life? And can they allow room for the crucial things beyond work: family, home, marriage, and children?

Yes, absolutely, say four MD/PhD faculty members who talked about their lives with Next Wave. Each of the four runs a basic science research lab, regularly sees patients, and teaches medical residents. All are married, have children, and "place a very high priority" on family life, in the words of Chester Brown, assistant professor of molecular and human genetics and pediatrics at Baylor College of Medicine in Houston.

Doing so much, they agree, takes discipline, focus, realism, and humility--not to mention high energy and a willingness to compromise. Within those constraints, they find satisfaction and a surprising degree of flexibility.

The central challenge, most agree, is managing time effectively while making personal time a high priority at every stage. In the early years, the training program's great length can tempt people to defer life's other aspects until it is over. And once a faculty career begins, the demands of keeping up in two challenging fields can tempt people to do nothing but work.

The solution? Physician-scientists must "really learn to prioritize, focus, and, then triage because you can't do everything," says Hal Yee Jr., assistant professor of medicine and physiology at the University of California, Los Angeles. Yee warns that people on the physician-scientist track must "make sure not to be a martyr and to enjoy the training." The program "puts you almost into middle age before you're actually doing" the work you trained for. "You do have to enjoy your nonacademic parts of your life" along the way because "otherwise at the end of it you will have no nonacademic life."

"You have to have the discipline to focus" on a narrow set of research and clinical objectives, adds Sumayah Jamal, assistant professor of dermatology at New York University. From the beginning, she says, "I knew that I wanted to do research primarily. ... I chose my clinical specialty keeping in mind that I wanted to have a big chunk of my schedule available for research." Like the others interviewed for this article, she "chose a clinical field that is primarily outpatient [so that] I can schedule. If you're an obstetrician, having a research career is going to be much more difficult because you don't have that much control." And, also like her fellow interviewees, she strictly limits her clinical work to a small minority of her time, in her case 10% for seeing patients and 10% for teaching residents.

Inability to do everything--and resisting the temptation to try--presents a difficult challenge for the high achievers attracted to the demanding MD/PhD track. "At some point along the way [you] realize that ... you're probably not going to be the best scientist and clinician that you could be" if you were only doing one or the other, says Michael Miles, associate professor of pharmacology/toxicology, neurology, and human genetics at Virginia Commonwealth University in Richmond. "Obviously you try and be the best that you can at both" but "you have to come to grips with [this reality] eventually because it will be frustrating."

For all its demands, however, the MD/PhD lifestyle offers an important personal advantage over a clinical career. Balancing family and careers is "not easy [in] any profession, [but] if I were in private practice it would be just as bad or worse," says Miles. Academic research gives "more control over my time ... than being a straight clinician. I have to work as many or more hours, but I sort of get to dictate which [ones] they are."

"When it comes to family life and raising children," agrees Yee, "the flexibility that academic medicine permits is a benefit. If a child needs to be picked up because he has a fever, I can go pick him up. If he needs to be brought or picked up from school, I can be involved in that. If I were in private practice, I couldn't ... because I'd have patients."

The dual career can afford another important protection. "There are a lot pressures in our country to generate income," says Brown. "You've got to generate income [for your department] in some way, either writing grants bringing in extramural support or generating clinical income. That's the financial reality of our academic world today and it's gotten much worse over the last decade. So being in the clinician-scientist mode will protect you ... from ... overwhelming clinical responsibilities. But it carries with it the need to remain productive." Dual degrees is also an advantage in seeking grants, he notes, because the data show that MD/PhDs as a group tend to do better than straight PhDs in getting research funding.

But running that productive lab is the career's greatest challenge, the interviewees agreed. It requires lessons not included in medical and scientific training. "One of the hardest," Yee says, is learning "how to delegate responsibility, learning that, OK, there are other people who can do the things that I know I can do. I try to focus now on things that only I can do. This is something that everyone learns when they're managing a new laboratory. It becomes even more important when you have clinical responsibilities that are interrupting you."

What's more, "you have to become accustomed to asking for help," says Jamal. "I was banging my head against the wall writing grants, not really being that experienced and not getting funded. Then I just talked to my chairman about it, and he said, 'OK, let's get some people together and help you out.' ... And after they did this, I started getting the grants. You have to be humble enough to say, 'I need a little help here.' "

But is this complicated life worth the effort? "It's almost a calling," says Brown, with the potential to make an "impact on medicine as a whole." The dual perspective puts "a human face" on the science of disease, notes Jamal. "People like myself, who basically can't make up their mind [between science and medicine], get a lot of enjoyment out of both," adds Miles. "I get so excited about the basic science" and "feel [I've] made a contribution to the care of a patient." Yee puts it more simply: "I wake up every day happy I'm doing it."

Beryl Lieff Benderly writes from Washington, D.C.