MD/PhD or PT/PhD

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ScarletK1901

Scarlet Knight
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Hi all,

I am currently completing a post-bac and have been prepping for my MCATs for a little while now in preparation for a fall 2010 md/phd application. Recently, a friend of mine recommended I check out Physical Therapy schools with strong neuromuscular curriculums that also offer a PhD tract, knowing my interest in research geared towards neuro rehabilitation.

Is anyone here familiar with pt/phd programs? I have done some research, and there seems to be a few with some interesting PhDs ranging from Engineering or Biomechanics to just Physiology. These programs range from 5 - 6 years, and they seem like a shorter and rather more efficient route to getting both the clinical and scientific education to do the type of research I am interested in.

I guess my main question is: does a MD/PhD have an advantage over a PT/PhD in the rehabilitation academia/industry? If so, does that advantage really outweigh the extra schooling years spent being trained in things that will not really lend much advantage to producing excellent science relevant to rehab - specifically stroke if it makes a difference?
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On the research front, it probably doesn't make a difference, although there are special grants for MD/PhDs. Not sure if that is the case for PT/PhD

Clinically there is a big difference. Being a PT is much different than being an MD in PM&R, or Neurology, or any field related to rehab.

Financially there is also a big difference. First, it is possible to have your MD/PhD paid for via the NIH, but then you have residency to complete. Most clincian scientists earn some mix between what they would make between a full time researcher and clinician. MDs can make significantly more than PTs. Therefore, depending how much time you want to devote to being a clinician and your specialty, you could make alot more with an MD than a PT.

Also, ask yourself, how much clinical work do you want to really do? It sounds like you are more focused on the research, you could just do a PhD.
 
I have considered going just the PhD route, but I believe that clinical training gives such a very necessary, "inside" look into the realities of the needs currently out there, that I have pretty much ruled out that option. A few extra years of clinical training will go a long way I believe...but 4 yrs + residency does seem like overkill for what I believe will be a soley academic/research career. This is why 3 years of clinical rehabilitation training with the DPT seems so attractive. Any other thoughts guys?
 
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Are you talking about programs where you get a single doctorate in physical therapy?

Or are you talking about some sort of combined degree program where you get a master's/doctorate in physical therapy and do a basic science PhD?

I could imagine that you could probably do some doctorate in PT and get into research, either clinical or translational, and that might be useful. However, there is no scenario that I can think of where having a PT degree in addition to a basic science/engineering PhD is going to boost your career. I can see where you are going with the clinical experience, but I just don't think that the clinical experience you're going to get from going to PT school is going to be that practical or useful, or justify the expenditure in time.

You need to sit down and make the hard choice about whether your career:
1) is going to involve working with people and helping them overcome injuries and illness
2) is going to be research oriented in a field which has applications to PT

If #1, then go to PT school. If #2, then get a masters/doctorate degree in your field of choice, get involved in research, and work at a PT clinic in your spare time. PT degree + PhD in basic science = no added value
 
ScarletK1901 said:
I believe that clinical training gives such a very necessary, "inside" look into the realities of the needs currently out there, that I have pretty much ruled out that option.
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You do not need 3+ years of training to get an "inside" look. Just go talk to some clinicians. Communication is the key, not more education.

The only reason to get a clinical degree is if you want to treat patients.
 
wordswordswords said:
you don't have to do residency--every MSTP seems to have at least 1 student go on straight to a postdoc a year.
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From my own experience (and others at my MSTP program), "Post-doc" is code for "did not match" in most cases.
 
calvinNhobbes said:
From my own experience (and others at my MSTP program), "Post-doc" is code for "did not match" in most cases.
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Yep, this has been true here in the past as well. I also remember our one "post-doc" on the match list who went straight into industry from the program.

Also be suspicious of any preliminary year only matches. This can be due to a few reasons (deciding on a specialty too late or changing their mind), but typically the prelim only person didn't get a spot in a categorical residency. Extremely few MD/PhDs are going to apply to prelims only. For those of you who don't know, generally when applying to competitive non-medicine/non-surgical specialties, applicants will want to do their 1 required prelim/transitional year at a relatively no-name place as these programs often require less work/stress. This is a seperate match from the subspecialty match.

In the same vein, be highly suspicious of medicine or surgery matches to no-name community places. It might be a prelim match, but some programs don't want to admit their student didn't match to a catagorical program, so they just list the med/surg match to make it look like a catagorical spot. Other programs when a catagorical match was not achieved will simply list their prelim match as a full match with a *prelim* denotation.

For example:
I apply in Radiology, which requires a standalone seperate year in Surg or Med or Transitional (essentially a year of various rotations as an intern). So I apply seperately for transitional years. BTW, transitional years are as competitive as competitive clinical specialties. Surgical years are not competitive at all. Medicine years can be very competitive at easier places to not competitive at stressful but not big name places.

Now what might happen to me:

I may ONLY get the Transitional internship but not Radiology. How will a program list me on the match list? Transitional Year. Maybe with a "planning to apply in Radiology" caveat.

I may ONLY get Radiology but not the internship. In this case I would likely scramble into a nightmarish surgical prelim (high hours, mostly scut). The prelim may not even be listed.

I may get NEITHER. In this case, I scramble into a nightmarish surgical prelim and reapply. This will likely be on the match list as surgery or surgery (prelim). Or perhaps I take a year off and decide to reevaluate life. This might be listed as post-doc. Or I might be left off the match list for that year entirely.

Separate example:
I apply in Radiation Oncology which typically requires a standalone Medicine year.

Let's say I get the medicine year only. Again, most of your students with required internship years will apply to less stressful internships, so I'm listed as medicine at some community medicine program you've never heard of. Some programs would list me on the match list as: Medicine. Others would list me as Medicine (prelim) with nothing else specified.

You guys getting the picture here? Unfortunately you wouldn't know if a student had to take a less competitive specialty choice, go way down their rank list, not get interviews where they wanted to be, or just outright scramble.

All of these issues are all far more common than I was led to believe when I was applying. It's been quite a surprise for me. The standard excuses were always:

1) "That student WANTED that residency at lower-tier academic program". Reality: usually far down rank list. Also possible: strong location preference if the location is not a big city.

2) "That student couldn't decide on a specialty." Reality: Didn't match catagorical. Other possibilities: couldn't decide because they realized too late there's no way they'd get the competitive specialty they wanted, couldn't decide because their cirriculum gave them no time for fourth year electives.

3) "That student had personality issues." As much as I hear this one you'd think we're all demented freaks. Reality: Under 220 step I score and not AOA.

Overall point:

MD/PhD! Your ticket into top residencies anywhere!***

***Offer valid only in certain residency specialties. Offer not valid at community programs. Offer may only be used in conjunction with good to excellent medical school performance. May not apply to residencies in competitive locations.

Anyone who tells you otherwise is lying to you either for recruiting purposes or just because they're too junior to know the reality.
 
This thread has been basically diverted to a different topic, but I think PT/PhD is a total waste. End of story. Choose one or the other.

I'll briefly bite on the MD/PhD match business, but this is a different thread for a different time. The vast majority of MD/PhD students match. Not only do they match, they match into more competitive specialties at more competitive institutions than their MD only counterparts. Unless you f-ed up or something, a PhD is always an asset. It may mean more or less depending on the situation, but it is always an asset. Some MD/PhDs will not will not match (like many MD counterparts). There will be a variety of explanations, some of them true, some of them excuses.

A couple of the very small specialties, particularly plastics, neurosurgery, ortho, and rad onc are old boys clubs where you have to know the right people and kiss the right asses. A PhD is not an instant in, but it is still an asset.

People need to quit whining. I'm sorry you didn't match ortho, but the explanation is likely above. Do the best you can on your USMLE exams, your research, your clinical rotations, and your application. That's all you can do.

Sometimes people don't do residencies because they choose not to. If you think that you might not redirect your career from goals you set 8-12 years ago, you are sadly mistaken. If you fail to reconsider your goals from time to time and just blindly follow the course you set for yourself that long ago, that's a problem. If you get to the end of your MD/PhD and decide you want to do only research: redirect to a postdoc. If you get to the end and don't think you'll ever want to do a day of basic science research again: focus on clinical training. Sometimes people fail to match and change their plans. So what. This happens to MD graduates too.

This notion of failure because a combined degree graduate goes into clinical practice only is dated and foolish. Same for the notion of failure if someone goes to a postdoc only. MD/PhD graduates are going to have a variety of career paths. I would actually encourage people to go to a program where graduates pursue a variety of specialties, and maybe even more diverse paths like industry or post-docs. A program where everyone goes into internal medicine/pathology and plans on an 80/20 time split doesn't sound like a success to me; it sounds like a place where all graduates are funneled into the same career regardless of opportunity.

I'm out.
 
Shifty B said:
This thread has been basically diverted to a different topic, but I think PT/PhD is a total waste. End of story. Choose one or the other.
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No offense, this is a very uninformed answer. Take a look at some of the research coming out of these Pt/PhD programs:

http://physicaltherapy.wustl.edu/pt...b3dda79dc03da9b386256fd50064e32e?OpenDocument

http://www.udel.edu/PT/Research/research.html

http://dpt.duhs.duke.edu/modules/cfmdpt_rsrch/index.php?id=2

http://pt.usc.edu/SubLayout.aspx?id=1554

Lack of familiarity with something does not translate into: "a total waste."

I am currently in the DPT phase of a PT/PhD program. In the PhD program, there are about 40-50 total students, of which 15 are Physical Therapists, half are Engineers (mechanical, electrical, or computer), and the rest having some kind of physiology background.

I will tell you from personal experience, in terms of academic and industry employment post-graduation, those graduating with PT backgrounds have a great deal more flexibility and "muscle" than those not.

PTs play an important role within the healthcare team...but as so eloquently portrayed in the NYT both recently and in the past, there is what's perceived as "voodoo" practiced within the profession. All biases aside, I will argue that those currently pursuing the dual degree will play critical roles in the advancement of rehabilitation science.
 
Although you did not quote me, so I am not sure your comment was directed at my earlier recommendations, I just want to clarify that I think a PT/PhD sounds like a wonderful combination, assuming you want to do both clinical work and research.

If you know you don't want to do clinical work then it is hard to justify the clinical degree. I personally do not think a clinical degree will give enough advantage in the research arena to justify the extra time and money.
 
calvinNhobbes said:
Although you did not quote me, so I am not sure your comment was directed at my earlier recommendations, I just want to clarify that I think a PT/PhD sounds like a wonderful combination, assuming you want to do both clinical work and research.

If you know you don't want to do clinical work then it is hard to justify the clinical degree. I personally do not think a clinical degree will give enough advantage in the research arena to justify the extra time and money.
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I agree, or at the very least a desire to work in a clinical setting.

For the OP's sake, let me also add that as different as Physical Therapy and Medicine are, so to is the type of research that a PT/PhD and MD/PhD would do.

On a side note: many of the dual PT/PhD programs offer various ways to pay for the entire education (grants, scholarships, GA/TAships).
 
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MotionDoc said:
No offense, this is a very uninformed answer. Take a look at some of the research coming out of these Pt/PhD programs:
Click to expand...

You're right, at least to a degree, about me not understanding. If research is part of a doctoral program in Physical Therapy, then I think it makes more sense. This is more similar to the clinical style PhDs which are often granted in Europe. These degrees are not frequently conveyed in the US.

What I was referring to as a waste is getting a clinical degree in physical therapy while pursuing a basic science or engineering PhD in the traditional sense of the word. Sorry as I appear to have misunderstood.
 
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Shifty B said:
You're right, at least to a degree, about me not understanding. If research is part of a doctoral program in Physical Therapy, then I think it makes more sense. This is more similar to the clinical style PhDs which are often granted in Europe. These degrees are not frequently conveyed in the US.

What I was referring to as a waste is getting a clinical degree in physical therapy while pursuing a basic science or engineering PhD in the traditional sense of the word. Sorry as I appear to have misunderstood.
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I am not familiar with the clinical PhD in Europe, is it similar to the DSc here in the states?

Most of these PhDs are focused on translational, interdisciplinary research that combines faculty and resources across medical, engineering, health and exercise, and physical therapy specialties. Sure, it is clinical in nature, but certainly not a requirement.
 
I think he/she is referring to something like the clinical PhDs in psychology. They are combination clinical/research degrees. From my understanding the DPT is not like this. A PhD in clinical psychology takes 6+ as far as I now. The DPT is 3 years I think with a majority of the time devoted to clinical work.
 
I was referring to clinical doctorates frequently obtained by physicians in a variety of countries in Europe and also China, I believe. From what I understand, in many countries medical school gives you a bachelor's/master's level degree and after completing a residency you can then practice medicine. This is largely due to the fact that medical students in many countries do not obtain undergraduate degrees. However, additional effort can be spent to obtain a sort of "Doctor of Medicine" by completing a thesis. I think this can usually consist of anywhere from no additional time to 1 year or so of research.

In contrast, most basic science/engineering PhDs in the US take anywhere from 3-8 years and involve courses, grant writing, and then years of independent, mentored research. By most standards, these degrees are considerably more rigorous in terms of time and effort.

Which goes back to why I originally said PT/PhD would be a waste. It wasn't an attempt to dismiss it offhand, but rather an assessment of your time and its value after spending say 6 years doing a PhD. If you're going to spend that amount of time devoting a career to research, I would argue that your effort is subsequently too valuable to spend working in a PT clinic and the clinical credential is not necessary. It might be better to spend your time doing a PhD in biomechanics or something.

If a PT PhD is simply a more advanced credential that you need to have an academic career and or do research in PT, then I guess that's something else and you have to make your individual choice.

In fact, some people feel the same way about people who get MD/PhDs in medicine. That is, they feel like devoting your effort to only seeing patients would be a waste after spending so much time getting a PhD. At the very least, MD/PhDs usually end up in academic practice involving teaching and mentoring residents.
 
ScarletK1901 said:
I have considered going just the PhD route, but I believe that clinical training gives such a very necessary, "inside" look into the realities of the needs currently out there, that I have pretty much ruled out that option. A few extra years of clinical training will go a long way I believe...but 4 yrs + residency does seem like overkill for what I believe will be a soley academic/research career. This is why 3 years of clinical rehabilitation training with the DPT seems so attractive. Any other thoughts guys?
Click to expand...

Part of the reason I went back to medical school, after PhD and Postdoc research, was to gain this "inside look", to become a better scientist when it comes to answering questions about the human body and the pathological processes that are at war with it.

If you want a global look inside then I would go for medical school (MD or DO). When there, you may be surprised at what you find. If you had told me that Dermatology was the best match for me went I entered medical school I would probably have laughed a little. This is because I had no clue about this field and that this was in fact the best match for me given my research background, e.g. physics, crystallography, more materials science training than anyone without the degree should have, and structural biology. Who would have thought? o_O

Give yourself the opportunity to explore it all! Given your interests, just watch, you may end up becoming an Anesthesiologist, who does a fellowship in pain management, to then go on and design even better implantable gizmos to help those who suffer from chronic pain. :)

What PhD field are you aiming for?
 
Oh, I just wanted to put in a shout out for one of the other options mentioned above: doing MD only and going into PM&R.

It depends on your willingness to go to medical school for 4 years and then PM&R residency for 4 years (internship + 3 years), for a total of 8 years. At the end, you'll be an MD, you can see your own patients and prescribe PT treatments. Plus, many people don't realize it but with an MD you have the credentials to do clinical research already and with 1+ years of extra training, you can get into most of the same basic science research that someone with an PhD can. I think an MD with training in PMR can do anything that you could do with a PT and PhD degree, plus more clinical stuff. Compared to doing a PhD and PT degree:

Positives: more freedom of clinical practice, better salary, many more career opportunities, you have the MD credential to do whatever career you want, you can actually prescribe PT treatments for your patients

Negatives: more time in training, greater cost of training, greater stress of training (medical school is stressful)
 
And be your own PI?

Clinical research, probably true. I would think this would be at least in part a collaboration in effort.

Basic science research, probably not so much. I wouldn't know the first thing to running my own lab, writing grants, designing my own experiments, and mentoring students in my basic science field if it weren't for my PhD training. It isn't something one just picks up along the way.
 
N-Surge said:
And be your own PI?

Clinical research, probably true. I would think this would be at least in part a collaboration in effort.

Basic science research, probably not so much. I wouldn't know the first thing to running my own lab, writing grants, designing my own experiments, and mentoring students in my basic science field if it weren't for my PhD training. It isn't something one just picks up along the way.
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Yes, you can be your own PI. More first time R01 grants are given to MD only investigators than MD/PhDs. According to a JAMA from a few years ago (http://jama.ama-assn.org/cgi/content/full/297/22/2496), the distribution of first time R01 applicants was:

MD - 689 (with a 28% success rate)
MD/PhD- 511 (with a 34% success rate)
PhD - ~2800 (with 31% success rate)

I think that's fairly reasonable rates of success, giving you a good chance of doing research. Now, you're right that more of them are doing clinical stuff (67% for MD only vs 43% for MD/PhDs), that still leaves 33% of those MDs doing basic science. I'd be remiss if I didn't mention that this paper also points out some drawbacks of being an MD only investigator.

You're also right that there are skills that don't just come naturally, like grant writing, mentoring, and so forth. But you're wrong that you can't pick them up as you go along. It just takes effort and time. Many people spend time doing intramural research at NIH, doing basic science research during fellowship, etc. You and I (I completed an MD/PhD) learned those things during a PhD program, but that doesn't mean it's the only way to learn those skills. I could make an argument that <50% of the time I spent in graduate school was learning useful skills, and that the rest was just jumping through hoop after hoop of degree requirements, irrelevant courses, etc. During and shortly after your fellowship is a great time to learn those skills and you won't have the rigid requirements of a PhD program. There are also a number of medical schools incorporating extensive research into their curricula (see Cleveland clinic and Yale for examples) to make that easier.

Plus, after your 8 years of medical school + derm residency you'll have to spend some time getting back into research anyway. It's not like your skills (or mine!) will be fresh. You'll just be starting with a more extensive background than your MD only colleagues interested in research, and it should take you less time/effort.
 
An MD can go on and do a research fellowship. I will give you that.

You bring up another point, the percentages of R01 victories is dismal, for anyone...

We PhDs got the MD to increase our R01 victory chance by 3%. :)
 
N-Surge said:
An MD can go on and do a research fellowship. I will give you that.

You bring up another point, the percentages of R01 victories is dismal, for anyone...

We PhDs got the MD to increase our R01 victory chance by 3%. :)
Click to expand...

Are you sure that is not because they are thinking ... we need to give these guys at least one grant before they retire in a few years (MD+PhD+residency+fellowship+postdoc => OLD) :laugh:

On topic, the MD is not an easy degree esp. when you consider the residency component (not sure about the PT requirements). If your heart is not in the training, it will be brutal. The plus side is that with the MD your end-pay will probably be higher. The other plus on the MD side is that if your research interest were to change from rehab to something else, your clinical degree could still be relevant. The negatives of the MD are you will have to learn a lot of things that you may not see as relevant. MD/PhD's generally do more basic science rather than clinical translational research.
 
Freak said:
Are you sure that is not because they are thinking ... we need to give these guys at least one grant before they retire in a few years (MD+PhD+residency+fellowship+postdoc => OLD) :laugh:

On topic, the MD is not an easy degree esp. when you consider the residency component (not sure about the PT requirements). If your heart is not in the training, it will be brutal. The plus side is that with the MD your end-pay will probably be higher. The other plus on the MD side is that if your research interest were to change from rehab to something else, your clinical degree could still be relevant. The negatives of the MD are you will have to learn a lot of things that you may not see as relevant. MD/PhD's generally do more basic science rather than clinical translational research.
Click to expand...

according to official NIH stats, mstp graduates age @ first r01 and PhD grads age @ first r01 are now nearly equal (mstp is usually 1-2 yrs older).
 
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