2009 MD/PhD Match

RxnMan said:

you incur tuition, a cost, as a grad student.

Click to expand...

*sigh* yes, i'm NOT saying that it doesn't cost money to have grad students.

The question is over the COST of an MD/PhD program to a school and to the government. A given school needs to have X number of people working in its labs to get research done. Grad students are the cheapest labor (trust me, as a tech I cost way more than any grad student including the cost of tuition). This money is usually covered by grant funding (direct or indirect).

Now, you have X number of people that need to work at the graduate student level. They can be either in an MD/PhD program or in a PhD program. During the graduate school years of the MD/PhD program, the University is incurring the same cost for its MD/PhDs as it does for it's PhDs and getting the same benefit in terms of being one of X workers. Therefore, when examining the marginal cost of having an MD/PhD program to a university, you should exclude the fixed cost of labor during the PhD years because it will be incurred regardless of whether the students doing the work are MD/PhD or PhD only.

Finally, in order for a university to survive, the average lab HAS to be bringing in more money in grant money than it is spending on personnel (tuition and salaries) to survive (through indirects that don't kick back to the labs). That means that your average grad student must be part of a team that is bringing in more money than it costs (aka a profit). Therefore, the cost to have grad students at a university that is successful is, in fact, negative.

So, in conclusion, when looking at the cost of an MD/PhD program, you need only to look at the cost of the medical school years. As to cost to the gov't, it's likely only a small fraction of the cost to universities.

itsallthesame said:

I think the reason that this data isn't published or tracked widely is that it would be bad data.

Remember we are scientists? The question is: given an input (person X) what do you get as output when you shift funding from program I to II?

But we can't really quantify input or output. How can you ascertain what educational path a person would have chosen if a given option was taken away? If you take away the MD/PhD option, would people end up in med school, grad school or law school? Would they do MD then research fellowship or would more people just practice medicine? No way of knowing without taking it away. Is it worth that risk?

Secondly, how would you quantify output? It's easy to look at the "number of people who end up in research." But really, that's meaningless. The important question is "what is the benefit to research?" To answer that we'd need to evaluate the quality of research.

If the MD/PhD program is increasing the quality of research and/or medicine and/or health/science policy in this country over alternatives, it is worth the price; however, everyone knows that that would be such a subjective assessment that it's not really worth keeping track of.

Basically tracking outcome by career path is 100% worthless (and for the same reason using grant data since you don't really know the input and what these people would have done with their lives if not for the md/phd program.)

Click to expand...

Career outcomes are quite important if one is interested in finding out whether the program is effective in churning out biomedical researchers vis a vis the stated MSTP program goal. For instance, I would say that a program that an MD/PhD program that produces 10% researchers is significantly less effective than one that produces 70% researchers, wouldn't you?

You are correct, however, that it is more difficult to compare the efficacy of MSTP programs to other training pathways, although this could be done to some extent comparing MSTP to non-MSTP MD/PhD programs or other medical research training pathways (i.e. MD with thesis programs, PhD-only programs, etc).

You are also correct that the issue of what constitutes an appropriate outcome measure is a difficult one. I think it would be important to look at percentage of biomedical researchers produced by the program, success in obtaining NIH funding, and publication number/impact factor. It is also important to look at the debt incurred, years of productivity, career satisfaction and other measures that quantify the potential benefits of the program. For example, even if there is no difference compared to other biomedical training pathways in terms of quality of researcher produced, the fact that MSTP students graduate debt-free could be seen as a major advantage that justifies the program.

I think it is the variability in possible career paths of MD/PhDs that is a major factor that makes quantification and comparison of efficacy difficult. There is also program-to-program variability in terms of the percentage of biomedical researchers that are produced, making an overall comparison between MD/PhD vs. other pathways difficult. Finally, there is no way to reasonably do a randomized controlled trial to truly assess the effect of MSTP pathway vs. other pathway on career outcome. Thus, we are limited to cohort and case-control setups to address these questions.

I'd like to make a correction.


Rochester (source: correlate)
OB/GYN - Johns Hopkins
Neurology - UCDavis
Ophthalmology - UCSD
Orthopaedic Surgery - Cleveland Clinic

There were 5 OHSU MD/PhDs graduating this year. I have data for 4 of them (I'll add the 5th when I can)

OHSU
Pathology - U. Washington
Peds - OHSU
Internal Medicine (Cardiology fast track) - OHSU
Internal Medicine - Utah

I know at least 3 of these students ended up with the first choice spot, not sure about the other.

One that really bothered me was hearing that a MSTP director was selling to applicants an average time to graduation of 7.5 years when I knew it was well above 8, when considering the previous 4 years or so.

Doctor&Geek said:

Mayo (source: director)
Plastic Surgery - South Florida

Click to expand...

Nice. Is he/she taking over the old McNamara/Troy center?

Oops.

Neuronix said:

Charting outcomes 2007:
# of US Seniors who did not match: 1,157
% with a PhD degree: 2.8
% of matched applicants with PhD: 4.0%
Total # of unmatched MD/PhD students: 32

Charting outcomes 2009:
# of US Seniors who did not match: 1,961
% with a PhD degree: 3.7
% of matched applicants with PhD: 4.2%
Total # of unmatched MD/PhD students: 73

This very much seems like a growing problem to me. The 2007 data includes two clear notes that PhD assists students in matching to competitive specialties. The 2009 data includes no such notes. In the specialty I plan to apply to, 24% of applicants with PhDs did not match. This is identical to the percentage of those without PhDs who did not match.

Click to expand...

I doubt the PhD is a "bad" thing. Even if a residency program cares not a bit for a PhD, I doubt they'd look on it as a negative. The problem seems to be that many MD/PhD's don't do their research properly and explore how highly research is valued by the residency programs they're interested in. They slack off, don't excel as much (or can't) in the med school years as their MD-only competition, and then they're shocked when it turns out that that's all the residency programs really care about.

How many unmatched MD/PhD seniors did not enter the match? Any? What percentage were FMGs? It says n/a for some of that data.

I saw for ENT for example that out of 8 MD/PhD applicants, 7 matched...same trend for other smaller fields, so I am not concerned. It looks like 2009 was more competitive across the board from my initial cursory glance...

Neuronix said:

Word of mouth from a student one year my senior is that 4 (!) students from last year's batch at our school failed to match.

Click to expand...

4 MD/PhD's from UPenn not matching in one year! What were they applying to - derm, plastics, and rad/onc?

Neuronix said:

Derm, Rads, OB/GYN (scrambled into rare OB/GYN prelim spot), and wasn't sure.

Click to expand...

...hmm, if that's true, do you know how selective the applicants were when making their match list. (i.e. did they only rank the top 3 programs in the country?)

Neuronix said:

Word of mouth from a student one year my senior is that 4 (!) students from last year's batch at our school failed to match.

Click to expand...

Dude. They must have done something horribly, horribly wrong (i.e. ranked 3 programs, interviewed without having completed major core rotations, complete dorks with no interpersonal skills, <200 step I, etc.). Also I would be concerned with whatever entity advises students when it comes to matching...either the students weren't listening, or that office is terrible.

gstrub said:

Dude. They must have done something horribly, horribly wrong (i.e. ranked 3 programs, interviewed without having completed major core rotations, complete dorks with no interpersonal skills, <200 step I, etc.). Also I would be concerned with whatever entity advises students when it comes to matching...either the students weren't listening, or that office is terrible.

Click to expand...

Don't you find it peculiar that there would be so many people like that in one class at a top 3-5 rank school? I mean, that would indicate a complete lack of critical self-reflection and common sense.

What would be very useful is for residency programs to release the average stats of MD/PhD matchees. That way applicants could see exactly how much, if at all, the PhD really compensates for deficiencies. People may be going in thinking they'll be matching at UCSF Ob/Gyn for sure because they have a PhD but are not realizing that they won't even get a sniff with that 205.

The residency application process is not so simple as a checklist with grades, USMLE scores, and PhD/non-PhD. There is no doubt in my mind that the PhD only helps your application (with rare exceptions), but it doesn't mean EVERYTHING, nor should it. It has been well discussed in this forum that how much weight is given to the PhD depends on the field you are entering and the institution to which you are applying. Your performance during the interview can be just as important. Making the proper contacts, and keeping communications open with program directors is also key. Then there are also the field-specific weird factors that may or may not break your application... like:

Derm: how nice is your skin/how hot are you (female)
Rads: how nice is your tan/how much you work out
OB/GYN: hormonal factors...

On a serious note, given the above scenarios, I also feel these students were poorly advised. If they knew they were marginal candidates they should have applied for "back-up" specialties, or applied to lower-tiered programs. I can't explain GYN any other way since it is not really competitive.

gbwillner said:

The residency application process is not so simple as a checklist with grades, USMLE scores, and PhD/non-PhD. There is no doubt in my mind that the PhD only helps your application (with rare exceptions), but it doesn't mean EVERYTHING, nor should it. It has been well discussed in this forum that how much weight is given to the PhD depends on the field you are entering and the institution to which you are applying. Your performance during the interview can be just as important. Making the proper contacts, and keeping communications open with program directors is also key. Then there are also the field-specific weird factors that may or may not break your application... like:

On a serious note, given the above scenarios, I also feel these students were poorly advised. If they knew they were marginal candidates they should have applied for "back-up" specialties, or applied to lower-tiered programs. I can't explain GYN any other way since it is not really competitive.

Click to expand...

I agree with this. Except that ob/gyn is actually a very competitive specialty, particularly at UCSF.