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From "Book Rat" to Neurologist: An Interview with José Cavazos, MD-PhD

As a child, José Cavazos, MD-PhD, was a self-proclaimed “book rat”. So, it makes sense that his career path was clear after reading a book.
“I stumbled into the literary work—meaning the autobiography—of Don Santiago Ramón y Cajal. He’s a Nobel laureate, the discoverer of the neuron, from Spain,” said Cavazos, speaking to SDN at the 2016 UC Davis Pre-Health Conference. “And, you know, [his work was] the beginning of what excited me to become a neuroscientist, and eventually, a neurologist and a clinician scientist.”
While Cavazos, the Assistant Dean of the MD-PhD Program and Neurology professor at the University of Texas Health Center Graduate School of Biomedical Sciences, knew what he wanted his future to look like from a very young age, he acknowledges that most people make these decisions much later in life. When it comes to those debating the MD-PhD path, he knows that it takes a specific sort of vision to understand why this track might be the right one – or at least a good explanation of why it might be.
Cavazos begins his explanation by stating that there are advantages to all three of the typical health-related degree paths, MD, PhD, and MD-PhD. For example, MDs can see the impact of their work immediately. “If somebody comes with appendicitis, you fix, you take it out, you sew them back, and they are happy and back to normal,” he says. For PhDs, the payoff can take much longer, but might eventually be seen on a larger scale. A scientist studying ways to prevent, cure or diagnose appendicitis could eventually improve the health of many millions of people who end up with condition.
But there’s another option – the one Cavazos himself chose. “As a clinician scientist, or MD-PhD, you can combine both fields by trying to pursue better understanding (of a disease), and also trying to work exclusively with that group of individuals (who have the disease), so you become a super specialist of that particular condition.”
While most MD-PhD programs support students financially, paying tuition, stipends, fees and even providing health insurance, Cavazos admits that the 7-9 years of training necessary to earn this prestigious title can be arduous. There’s also some pushback from what he calls “100 percenters” – MDs who think clinician researchers aren’t serious doctors, and scientists who think the MD-PhDs are dilettantes who aren’t serious about research. But Cavazos stresses that the advantages far outweigh the drawbacks.
“It can be exhilarating…the process of discovery and finding the ‘this looks funny’ or the eureka moments. The ‘looks funny’ means that you’re finding that something is not consistent with the known theory. That’s the first step to realizing that the current understanding is faulty, and that’s a very exhilarating moment,” he says. And to ensure that these moments are an inherent part of your career, Cavazos can see no better option than the MD-PhD.
“The statistics and the outcome studies have shown that only 23% of PhDs are in academic medicine ten, twenty years after their training—and only 80% of them are doing research. If you want to become a practicing physician, doing research is not going to be a significant part of what you do on a daily basis,” he explains. “But if you ask the same question from MD–PhD, about 75% of them are in academic medicine, and more than half of those individuals in academic medicine as MD–PhDs are doing research.”
If you do decide to pursue the dual degree, Cavazos suggests evaluating potential MD-PhD programs not on their prestige, but rather “how the program can provide mentoring for the students and how those students can learn, publish, obtain grants, graduate, and move on.” He also stresses the importance of learning to communicate science. “Truly speaking, we’re in the business of selling ideas. We sell ideas to the NIH, to the public so that they can support our research, to our peers so that our papers get accepted into a particular journal. So, the skills of being concise, of being clear in terms of communications, are critical skills, and are not often taught in MD–PhD programs.”
Cavazos’s program does this very well, and the proof is in the high percentage of his students who have received NIH grants. And once that has happened, says Cavazos, you are truly on your way to success as an MD-PhD. “Nobody can take that away from your CV. You got it. You got a grant, and that’s the beginning of your career. That’s the life of the clinical scientist.”