Xuguang Chen wanted to improve the human condition. When he graduated from Beijing's Peking University in 2004, he chose to go to graduate school to study biology, believing that studying fundamental biological mechanisms would allow him to have the greatest possible impact on human health.

But soon he learned that basic science wasn't enough by itself. "To answer more fundamental questions in diseases, I had to have more background in medical science and had to have more insight into how the human body works," says Chen, who currently is a research fellow at Dana-Farber Cancer Institute—and has been admitted to the medical school at Case Western Reserve University in Cleveland, Ohio.

Attending medical school after a Ph.D. is not a common path, but it's not unheard of, either: According to the Association of American Medical Colleges, each year between 0.6% and 0.8% of medical school matriculants have Ph.D. degrees when they enter medical school. The statistics aren't definitive, but there seems to be an upward trend.

After college, Chen became interested in biomedicine and was accepted into a graduate biochemistry program at Case Western Reserve. Chen's thesis project focused on treatments for cystic fibrosis (CF). His graduate advisor, Pamela Davis, was a physician as well as a geneticist, and Chen was exposed to medicine when Davis opened group meetings with stories from her recent rounds.

"Oftentimes she would come to the lab meeting and share stories about her patients and how they were improving and how she was trying to manage their cystic fibrosis disease," Chen says. "I got more and more interested in the fact that she was in a position that she could directly improve people's lives."

 Then one day, at a conference, Chen had an experience that changed his career direction. "I saw a teenage girl with CF, looking completely normal, give a guitar performance, and towards the end she said she had completed a half marathon and was training for a full marathon. This completely blew my mind, because from all the papers I read, CF patients were slim, malnourished, and had lung function half of normal people. That was about the time when I decided that I should become someone who can make that kind of miracle happen," he recalls.

Big switch

The transition from lab to clinic can be challenging. First you have to get into medical school.  "Medical school is probably one of the most competitive admission processes in existence," says Suzanne Miller, who is founder and CEO of MDadmit, a medical school application consultancy. Miller attended Harvard Medical School and served on the admissions board there. Every year, about 40,000 people apply for medical school, Miller says, and about 17,000 get in. "It's not a profession you enter lightly. It needs to be your vocation, something you have a calling for," she adds.

A Ph.D. in a scientific field is definitely an advantage. "It's not a traditional path, but getting into medical school in some ways is about showing you're unique and different. A Ph.D. is an incredibly impressive achievement," she says.

In fact, says Daniel Albert, F.A. Davis Professor at the University of Wisconsin School of Medicine and Public Health, in Madison, medical schools are increasingly interested in applicants who don't come straight from their senior year in college. (Albert is also a frequent contributor to Science Careers.) "There's an increasingly favorable bias toward 'nontraditional' medical school applicants: students who are more mature and have experience and achievement beyond their premed studies are generally a better bet to be successful in medical school and beyond," Albert says. "In my experience, successful grad school experience is a definite advantage for a medical school applicant."

Patient powered

A Ph.D. may be an advantage, but after you've spent half a decade or more in a lab, the admissions committee will want to know why you're switching to a clinical career. "You have to explore the clinical side, and understand what you're getting into, and prove that to the admissions committee," Miller says.

An excellent way of doing that is to shadow a physician or volunteer at a hospital or in some other health context, Miller says. Shadowing also helps the potential applicant be sure. Chen agrees that it's a good idea. "I hope everyone who thinks about this would do some shadowing or volunteering," he says. "It will really open their eyes to what doctors really do in everyday life, and to see whether they could see themselves doing the same thing in 5 to 10 years. And if they decide that this is the path they want to take, they should do it."

In fact, the desire to work with patients is precisely what inspires many Ph.D. scientists to go on to medical school. "They want the people aspect of it. It's very hard for a Ph.D. to have the clinical component and contact with patients that makes medicine so fulfilling."

But it's not the only reason to consider medical school. Let's face it: The job market for doctoral graduates can be dicey at times, depending on the economy and grant availability. On the other hand, "Clinical work can almost always be come by, both in the United States and abroad. [Also], the cachet of [an] M.D. often translates into higher pay when a doctor moves to other fields, such as business, consulting, technology, or policy," Miller says.

The transition

As a Ph.D. student at Weill Cornell Medical College, studying immunology, Julia Foldi found research invigorating—at first. But then she had some bad experiences with graduate advisors and became disillusioned with pure science. "I found the questions I was asking and trying to answer very narrow-minded and sometimes insignificant—as in, having a project just for the sake of having a project and being able to graduate instead of thinking that my project was exciting and had some potential to contribute to some greater understanding," she recalls.


CREDIT: Utthara Nayar, Ph.D.
Julia Foldi

During her 5th year in the program, she started studying for the MCATs, and later she applied to medical school. In the fall she will begin her second year at the New York University School of Medicine in New York City.

Foldi noticed important differences between Ph.D. and M.D. cultures, even before she was admitted to medical school. The med-school approach, she says, is more regimented. "It's almost like a game and you have to play the game by the rules. As scientists, we tend to feel like we have a lot of freedom in what we do, because that's how lab work is. But when it comes to medical school applications, it's a strict procedure, and you have to play by the rules," Foldi says. "I had one friend who didn't take some of the required classes as an undergrad, but he said, 'I have a Ph.D. and they'll overlook things I didn't do.' That's not the case. Having a Ph.D. is a huge advantage, but you have to play by the rules. I ended up taking a summer class before I started applying to medical schools because I was missing [a requirement]. That's annoying, but it has to be done."

Once you're in, the differences are even bigger. "Medical school is incredibly broad," Miller says. "You have to learn the broad, general understanding (of medicine) so that when you step on the floor as an intern in a hospital, you don't kill anybody. A Ph.D. is the ultimate expertise. You have the luxury of 3 to 5 years to become an expert on one subject."

Complementary science

Before he started a Ph.D., Rameshwar Rao applied to medical school. He didn't get in, so he went to graduate school instead, studying biomedical engineering at the University of Michigan in Ann Arbor. It was there that Rao joined with several other doctoral students to form a company, STIgma Free, which aimed to develop and market a self-administered home test for sexually transmitted diseases. They built a prototype, then abandoned the project when they realized that the company would require intense commitment—and that something was missing from the team.


CREDIT: Surbhi Gupta
Rameshwar Rao

"A company like STIgma needs a pathologist or some kind of M.D. to champion it," Rao says. "As a researcher, I talked to clinicians about [the technology], and there always needed to be one cowboy, one champion to take that work and try it in a few patients. I'm always going to be dependent on a clinician to get this into a patient, so I personally just decided it would be more effective for me to become that clinician and try to do it myself," he says.

So he applied again to medical school, and this time he got in. He benefitted, he says, not only from his experience but also from his connections at the University of Michigan. His added maturity also made him more confident as he worked his way through the admissions process. "I hammered people with questions, and I didn't really do that the first time. I met with the director of admissions here at Michigan, probably a year before I applied. I talked to tons of medical students. [At] every school I was legitimately interested in, I sent messages to physicians and faculty members. The majority of them ignored me, but there were some that did reach out. I think it was just about being very proactive and making it seem like I was very interested, whereas the first time around I was too lax about it."

Rao has an interest in entrepreneurship that grew out of his Ph.D. research, but Foldi doesn't expect her doctorate in immunology to directly affect her medical career. Her shadowing experience led to an interest in oncology and hematology. "My project was very narrow, focusing on one cell type and one pathway, one molecule. I'll probably never see that again in my life. But in terms of the kind of thinking, and the ability to reason, knowing where to look for things in the literature, it's very useful no matter where someone ends up. Especially in a field like oncology, it's so important to be able to keep up with the current research, not just clinical but also the basic research," she says.

Jim Kling is a freelance science and medical writer based in Bellingham, Washington.
10.1126/science.caredit.a1300155