The MD-PhD partnership: Unleashing synergy in research

0:00 Welcome to the Clinician Researcher podcast, where academic clinicians learn the skills to build their own research program, whether or not they have a mentor. As clinicians, we spend a decade or more as trainees learning to take care of patients. When we finally start our careers, we want to build research programs, but then we find that our years of clinical training did not adequately prepare us to lead our research program. Through no fault of our own, we struggle to find mentors, and when we can't, we quit. However, clinicians hold the keys to the greatest research breakthroughs.

0:40 For this reason, the Clinician Researcher podcast exists to give academic clinicians the tools to build their own research program, whether or not they have a mentor. Now introducing your host, Toyosi Onwuemene. Welcome to the Clinician Researcher podcast. I'm your host, Toyosi Onwuemene, and it is an absolute pleasure to be talking with you today. Thank you so much for tuning in. Today I am talking about the MD and PhD partnership. The MD and PhD partnership. I think that this may be one of the most overlooked and underutilized partnerships in all of clinical research.

1:26 I say that because of my perspective as a newbie clinical researcher, always looking around at the clinicians around me. That was my environment. I was surrounded by clinicians in my division. Most people are clinicians. We do have a few PhD scientists that are within our division, but we're mostly clinical people. So when we gather, we're talking about the last patient. We're talking about the schedule. We're talking about call. We're always talking about things that are clinical. And then when we think about collaboration, well, we just look to each other and we say, hey, let's collaborate on this project. But the challenge is that we all kind of think the same way. If we didn't think the same way before we came to our faculty positions, when we've spent enough time together taking a call, talking about patients, attending conferences together, we really start to think the same way.

2:17 And not many new things can come out of thinking exactly the same way. And so one of the beauties, one of the privileges of connecting with a PhD researcher is you suddenly are thrust into a place of new ideas or a person who has different ideas. They don't spend all the time with patients. They don't spend all that time talking about clinical stuff. They have different ideas and it can absolutely energize and enhance your research. So I want to talk about the MD and PhD partnership. And I hope that at the end of this, you'll think about who are the PhDs in my life. And I'm assuming you're MD only, you're not a PhD researcher. And even if you are an MD PhD, I want to let you know that you spend a lot of time thinking about clinical care, assuming that you have a significant clinical component.

3:06 Even if it's just 25%, you spend a lot of time in your brain thinking about your patients. And so the more partnerships you have with people who don't think like you, the more beneficial. I'm going to tell you seven reasons why. Number one is that when you come together with a PhD scientist who is not in the clinical space, you have access to more resources, the two of you combined. What do I mean by that? Clinical departments are geared to support clinical things. What does that mean? Well, when we're looking to hire, we're looking to hire medical assistants, we're looking to hire nurses. And honestly, the way things go in medicine, there's always a need.

3:47 And so there is a lot of heavy focus spent in building the clinical infrastructure. Most clinical departments are funded by clinical dollars and therefore the priority will always go to the thing that funds it the most. And so if clinical dollars fund the priorities of the department, guess where the money's going to go? To building clinical resources. So you as an MD, when you come to the MD and PhD partnership, you end up having a lot of clinical resources. Yeah, your MA is probably not involved in research, but she lets you know when the patient is coming in who is eligible for your trial. Everybody in the clinic knows that the trial is open or accruing.

4:29 And so you are able to support anything that has to do with the clinical domain when it comes to samples. Of course you can get samples. The patients will give you their blood. They give you their blood all the time. Of course with consent. But what I'm saying is that as the MD, you bring a wealth of clinical resources to the project that your PhD researcher likely doesn't have access to. Okay. How about the PhD? Okay. So they don't have all the patient access, but you know what? Their departments are largely funded by education dollars and research dollars. And so they have access to the postdocs who will work with you on the project.

5:09 They have access to research infrastructure because you know what? When they're not teaching, they're able to do research. They have a lot more time and a lot more training dedicated to research than you do. And so a lot of the research resources, the people who know how to do qualitative interviews, the people who know exactly how to schedule patients, those kinds of things. They're all available. For example, we had a recent team meeting with one of our research projects and my collaborator is a measurement scientist. And that's what they do. They interview patients qualitatively. And so they have a team that'll be available to interview patients during the daytime. And they have a team member who's available to do the evening interviews.

5:50 And so here we are in medicine saying, oh, I'm too busy. I'm not going to be able to do this time. And they have a team that's structured to facilitate qualitative interviews of people who have real life. Wow. I mean, that just feels actually, it's still a little bit overwhelming to me. I'm like, what? You have a team member who works the evening shift? Okay. My point is that there are resources that are different and they're different because we have different perspectives and we have different priorities. We have different things that we think are more important than others, right? And so we are optimized to have clinical care kind of be the driver of a lot of the resources we have. And they are optimized to have research and education be the driver of a lot of the resources they have.

6:34 And when you bring that together in partnership, that's synergy because you can bring together a lot of clinical resources and they can bring together a lot of research resources. So it's really awesome. Okay. Access to a broader research pool. That's number one. Number two is complementary expertise. What I said at the beginning, your MD brain is thinking about patients a lot. You're thinking about that case that you can't crack. And then you gather together with your colleagues and you start talking about the case and somebody else has another case. Similarly, you get to conferences, you're mostly talking about clinical cases. You're always in the clinical perspective, which is excellent because hey, everything we do in research is with the end goal of serving patients.

7:17 And the people who are focused on flies, who are focused on worms, at the end of all of these discoveries is to serve patient care, is to serve patients. And so your very largely patient focused perspective is so important and it's not enough. And so the PhD researcher comes with deep methodologic expertise. I don't care how much time you spent doing research in your fellowship, or maybe you even went and got a PhD. You have not spent nearly as much time as a PhD researcher has spent thinking about and conducting research. I will meet a lot of MD PhDs who said, well, I spent the same amount of time. And it's like, no, it's not the same.

7:58 It's not the same when you were in your clinical space for a couple of years and then you came out and you went back to your PhD and you came out and went back. It's different. It is different. And it's not saying that you're any less qualified because I also get that too, where some of my MD PhDs would be like, I'm not less qualified. And I get that. But it's a pain point where sometimes you feel like you're inferior because as the MD, you come to the clinical space and people are like, oh, you've been in the lab for the last three years. What do you know? And then you go to the PhD space and then they're like, eh, you're always in the clinic. What do you know? And so there's this feeling of where do I belong? And I get that from my MD PhDs and I just want to honor that. And I also want to say that you have a different perspective that a PhD scientist doesn't have and an MD scientist doesn't have.

8:41 You have a unique perspective. So celebrate that. You're not like everybody else. You're unique. But the reality is, and when we look at PhD researchers, they've had more time, more focused time over time invested in research in a way that MDs have not had the luxury of having. And so when you bring down, bring together your expertise in mostly clinical care, even if you have an MD PhD and you have research experience, a PhD scientist is bringing a totally different perspective. They don't have the clinical perspective, but their expertise is deep in a certain area of research. Their methodologic expertise is big. And they have a team that has complementary expertise as well.

9:24 They're working with a postdoc who also has expertise in this area. You bring your team together and their team together and it's a powerful synergy. So the second benefit is complementary expertise. The third benefit is that you're bringing diverse perspectives. And I don't have to go into this for too long because that kind of speaks to the things I've talked about earlier. You are very clear on how the patient can be helped. You're very clear on the definition of the disease. You're very clear on who's an affected individual, who's not. You know all these things. You take them for granted. You have no idea that nobody else is thinking like you. For example, one of my great colleagues and friends, we write together and we have a project that we're doing together and we are focused on a disease called TTP, thrombotic thrombocytopenic perfora, for those of you who remember.

10:17 And TTP is not ITP. So there's some confusion in the literature where people want to say immune TTP is ITTP, which is so confusing because immune thrombocytopenia is ITP. I mean, whose idea is this? Okay, I'm going to get off that box right now. But it's confusing to the best of us. And so if we're paying attention as clinicians, we're like, of course, ITTP is not ITP. My colleague has no idea. She has no idea that we're confused enough to use the same kind of three letters to describe two different diseases that are very similar. Why would I think a thrombocytopenic disease that's ITTP is different from a thrombocytopenic disease that's ITP?

10:58 Why wouldn't we just call it a different name? Okay, I'm going to come back down because that does irk me. This is really confusing. I know as a hematologist, I will never be confused. I know ITP is ITTP, but you know, if it was just hematologists reading the literature, then yes, call it whatever you want. But anyway, I digress. But when my PhD scientist goes looking in the literature, she comes back with papers who have that and they're all talking about ITP. And she's like, oh my gosh, this is so exciting. In fact, I've seen published papers where people are talking about ITTP and they're actually they have a cohort of patients who have ITP. So they're like, oh my gosh, bleeding is increasing this population.

11:39 I'm like, but this is the wrong population. Who was your partner? So we come with diverse perspectives. So in clinical things, as an MD, you know, you know the deal. You would never be confused that ITTP is ITP. You would never be confused. The PhD scientist doesn't think about anything clinical. In fact, they know methodology inside and out. And they would never be confused about certain assays or certain experimental methods. For example, yesterday I was in a meeting with two biostatisticians and they were speaking and I literally was doing this. Like, OK, if you're listening to me, I was like my head would turn to the left and then I would turn to the right and then I would look at the person on the left and I would look at the person on the right and I would be like, holy cow, I don't understand what you're saying because when they get together, they speak a different language.

12:26 And they have totally different perspective from me and it's so beautiful because when they start flying off into biostatistical heaven, I pull them back down and I say, hey, the problem we're solving is here on Earth. It is so beautiful. But they have diverse perspectives that really come together and give us like a brand new view of the problem. And so here, it's kind of like two eyes coming together to see in a way that one eye can't see alone. It's like you have the peripheral vision and it just comes together and it gives you compound vision in a way that one eye, which is doing great by itself, can't do except when two eyes come together and then they're really able to give you a really great perspective.

13:14 You can see all sides, all sorts of things. And so diverse perspectives are so important and you don't get more diverse than the MD-PhD partnership. Now, you think you're diverse when you jump from hematology, you'll meet a pathologist at some diversity, but it's still a very deep clinical orientation. So diversify your clinical team, yes, but especially diversify your research team with deep PhD methodologic expertise. Okay. Oh, one of the things, one of the ones I'm most excited about is number four. Can you tell I'm so excited? It's about peer mentoring.

13:54 It is about peer mentoring. It's about the fact that the two of you come together, you start finding out that you think differently about things, you know different things, and now you can educate each other. For example, when my PhD scientist collaborator comes to me with an ITP document and she's so excited about what she's learned, I can educate her about the difference between ITP and ITTP. I can do that very easily and not in a judgmental way because we're colleagues. And when I say, oh, this is not, this instrument is not valid, she can gently correct me and say, well, what we say is that there is no validity evidence.

14:35 You know, that just doesn't feel as powerful. It's not valid. It feels more powerful than there's no validity evidence. So I'm always, it took me a long time to move away from this. These instruments are not now, but it's great. It's great peer mentoring because I'm learning. I'm learning. I have never taken a qualitative research methods course and perhaps I should, but I haven't. I'm working with somebody who's an expert in qualitative methods. This person teaches qualitative methods and I learned so much just by being around her. I don't even have to audit her class. I can just be around her and learn so much. And she can be around me and learn so much about clinical things. And so it's a beautiful peer mentoring that happens as well.

15:16 When we write grants, the way we write, I write and then she's like, well, you know, you couldn't, you wouldn't really say it this way because they speak a whole different language than I do. And similarly when she writes it, I say, oh, clinically we would not do this. When we say, oh, these are the end points we're going to measure, I would say, clinically these are not meaningful. And so we're mentoring each other and it's so powerful, so powerful because on the one hand when you're thinking about your mentor mentoring you, it's a hierarchical relationship. And there are some things you're afraid to ask about because you feel like you should already know them. And sometimes you ask and your mentor looks at you saying like, you don't know that? And even when they're trying to be, they try to be nonjudgmental, you feel the hierarchy of their position.

16:00 You feel it because medicine is so hierarchical. And so when you work with a collaborator, a PhD scientist who's maybe at your level, and even if they're not, you're learning from each other. It's a beautiful peer mentoring relationship. That's powerful. You're both learning. It's nonjudgmental. You're advancing. It makes your experience fun. So yes, number four is my favorite one is that peer mentoring happens because you're coming from different disciplines. And if you're going to be able to work together, you have to speak the same language and you both can come together to do that. Number five is that you also get access to interdisciplinary grant opportunities.

16:41 So when me and my collaborator came together, I'm going to shout her out because sometimes she listens to this podcast. Hey, Theresa. When we come together, we have different grant opportunities. So my collaborator will say, hey, I have a lot of experience writing grants and being successful with FDA. I don't have as much experience in writing grants and being successful with NIH. And at the time, I actually didn't have experience being successful with grants with NIH, but we came together and we wrote a grant for NIH and we were successful. And we're going to come together, we're going to write a grant for FDA, and we're going to be successful. You know, we both have different opportunities and interdisciplinary opportunities come together when we come together to write grants.

17:24 And so it's a really beautiful opportunity to now expand the bucket where you literally have the three grants in your society that everyone applies for. You can now really expand the pie and now you can apply for grants that only PhDs apply to, but you are collaborators together. So there's the part for you as the MD and there's the part for you as the PhD. And so you have access to more funding opportunities than you do if you're going it alone with just you and your clinical team. It is a beautiful thing. Your wealth is involved in this partnership. If I haven't sold you on this partnership by now, I feel like I will get you.

18:05 I have two more things to talk about. Number six is that when you write grants together, there is powerful synergy. There is powerful synergy. So I will tell you that one of the most fun experiences, oh my goodness, that I've ever had writing grants was writing a grant with my PhD collaborator. It was so fun because one, we both owned the grant and we both really came at it with diverse perspectives and complementary expertise. Now when it comes to background and significance, I own the grant. And I say that not bragging, with humility, but just saying that I understand where this applies to patients because I think about patients a lot.

18:51 I certainly think about patients a lot more compared to my PhD scientist collaborator. And she knows how it can help people, but not to the extent to which I know because I've been thinking about clinical medicine for over 20 years. So yeah, I can write the background and significance and really relate it to patients really well. And it doesn't mean she can't do that. It just means that it's easier for me to do. So I will take the background significance first and I'll write it. And she, oh my goodness, she's king when it comes to methodology. I mean, I have an idea and sometimes I've put together some nice paragraphs with methodology. But to be honest, she's so much better than me. She's faster. She's just, wow, she's good. She's really good.

19:32 And so we divide and conquer the grant. I say, I'm going to write the background significance first. You focus on the approach and then we're going to switch. Because now when I go back to like revising the approach, I revise from my clinical perspective. And when she goes to revise the background significance, she's revising from her PhD methodology expertise. And so it is powerful synergy. I mean, we write great grants together. And so I remember the first time we wrote a grant together. And I mean, it was just such a powerful experience. And I knew, I'm like, this is a good grant. We both felt that way. Like, this is a great grant. And I have to tell you, I got on a plane and there was the worst kind of turbulence. I mean, there was someone screaming on the plane.

20:12 That's how bad the turbulence was. It was turbulent. And I remember thinking, I was like, this plane is not going to go down because we just wrote a great grant. That's how much confidence I had in the grant. I mean, the confidence is not in the grant. But just I was like, I had such a sense of purpose about the grant. Like the work we were going to do felt so powerful. I knew there was no way I was going to die before doing that work. I was like, nope, I'm not crashing in this plane. I know that for a fact. And it came from the powerful synergy we had of writing the grant. I would tell you, even if I got on the plane that day, I was the last person on the plane because I was putting some finishing touches to like one of the pages of the grant.

20:54 And I was like, I'm going to finish this page before I get on the plane. It was such a synergistic grant writing experience. It absolutely was. And I do want to pause and say that you have to find the right person. This is not like, oh, every PhD scientist I write with is going to be a powerful, you know, powerful experience. I've written with other PhD scientists where they literally were like, you're on your own. Good luck. Show me the grant and I'll help you edit it. This was really two of us coming together to really write something that was synergistic. And so it has to be mutual commitment. You don't just find someone off the street and say, well, write with me.

21:34 There's relationship building. There's chemistry. That is important. But it really is a powerful synergy when two people who are like-minded, but from different perspectives come together to create something. It's really a powerful synergy. Finally, increased productivity. Increased productivity. You know, this one probably doesn't need too much explanation. You both have different perspectives. You can submit to different journals. For example, we have manuscript and we're like, should we submit to a qualitative research focused journal, health services focused journal? Or should we submit to a hematology focused journal? We have options. And so, yeah, we can do that.

22:16 And for example, we're thinking about a project that we're working on together and we're like, okay, well, why don't we lay out what the landscape should look like? How about we just write a paper that describes why it's important for us to do the work we're doing? Let's lay the foundation for why our work is important. I mean, we did that in the grant anyway, so why not just write the paper out of it? And then as we're starting to work, we're like, wait a minute, why don't we publish our protocol? Wow, there's another manuscript, right? And I'm working on some manuscripts, she's working on other manuscripts. It really allows us to be super productive. And then we have different avenues that we can send our work to. And so it's a really powerful, powerful, powerful experience. Okay, so I shared seven things.

22:56 I shared seven things. I want to summarize them. Access to border resource pool. You get access to a broader resource pool. You have complementary expertise, diverse perspectives. You can mentor each other, so peer mentoring. You have interdisciplinary grant writing opportunities. You have synergistic grant writing, and you have increased productivity. So if you are an MD researcher, even if you're MD PhD, and you're like, oh, I don't really have any PhD scientists in my collaboration pool. I want you to think about who is like you, similarly looking for opportunities.

23:36 Many times we're looking for the senior mentors just to give us the light of day. And in reality, they're so full, they don't care about us, right? They're not hungry. But there are people who are on the same level as you. They are early career, and they are hungry for collaborators. And you are an expert person that they can partner with. Yes, you don't have all the resources. Yes, you don't have all the opportunities. But wow, when two of you come together, you can really create something amazing. So who might you partner with? I want to invite you to think about your PhD friends, or at least somebody who can link you to a PhD colleague who has complementary expertise. And see if you reach out to them and set up a meeting, just this week.

24:20 Set up a meeting and talk, see what's possible. And I'd love to hear about how the conversation went. And it may be that it goes well, and you start thinking about a collaboration, or it may be that it doesn't go well. But at least you are working to expand your networks and to create the kind of synergy that allows you to really go far. All right. It's been a pleasure talking with you today. As always, if you're looking for a coach, I'm happy to support you in that process. And I want you to succeed, because we need more clinicians winning in research. And it's so hard, because we're not set up to do it. Our clinical departments, even though they tell us they want to do research, they don't really support us to do it.

25:02 And so it takes time, it takes effort, it takes energy. And I would love to see you win. All right. Until next time, I look forward to talking with you again on the Clinician Researcher podcast. Have a great day. Thanks for listening to this episode of the Clinician Researcher podcast. Where academic clinicians learn the skills to build their own research program, whether or not they have a mentor. If you found the information in this episode to be helpful, don't keep it all to yourself. Someone else needs to hear it. So take a minute right now and share it.

25:46 As you share this episode, you become part of our mission to help launch a new generation of clinician researchers who make transformative discoveries that change the way we do healthcare.