To MD/PhD or Not...that is the question?

I think doing well in either pathway will set you up for doing well in the match; by doing well I mostly mean clinical grades, boards scores, and strong letters. Research is important, yes, but I don't think it's wise to do a PhD only for the sake of bolstering a residency application.

In fact, having the PhD may prevent you from getting interviews at some lower-tier programs that don't offer significant research. If you're a superstar or close to it clinically, this is not an issue. If your clinical grades/scores are weaker, this may be a significant problem.

If you love doing basic science research and are really focused on a physician-scientist career at this point in your life, do the PhD. If you think you can live your life happily without bench research, skip it. The time commitment, mental exhaustion and uncertainty with respect to graduation will not be worth it. Med school puts you on a firm timeline to graduation. Grad school can take any amount of years, and this is not entirely dependent on your effort (though definitely requires an infinite supply of the latter). You can always do a mentored basic research experience as a one year out of med school then some more during rad onc residency, etc.

Don't get me wrong that a strong research performance is not important in applying - it is. But the difference between a very productive year out (especially one spent doing basic research) and a PhD in getting interviews and matching at top academic programs does not seem to be significant in my view.

With this stance, I am gathering that the PhD would indeed pass the "cost/benefit" analysis. Is that correct?

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Most likely, yes. The other crucial elements to this equation are full funding (including through med school) and an ethical, supportive PhD lab advisor that protects trainees (this can sometimes be difficult to ascertain in advance, so do your homework extensively).

Asklepian said:

I do have a very strong interest in not only clinical research, but also lab (which I am trying to reaffirm in my current position). I would hope to continue doing this type of research throughout my career. I don't think I could bear 4 extra years just for a resume boost.

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As you go through your training your research will stop/start/stop/restart. This may make your skills outdated when you get back to the lab, hence less competitive for grants. Try to focus on skills during the research part that will stand the test of time, translational work that straddles clinic & lab has worked for me. In an MD/PhD program up to 50% may drop the PhD, even MSTP programs with full funding. After residency (even Rad Onc at MDACC) most MD/PhD residents don't go into research academic careers, many into private practice or academic clinical tracks. It doesn't get better once you're an attending. In the MDACC Physician Scientist program (80% funded research time x 5 yrs), only 33% go on to get their first NIH R01 grant.

One of the current MDACC residents is a UNMC graduate (MD only).
Good luck!

Neuronix said:

... The data I have seen for combined students dropping the PhD is around 10%. 50% is a gross overstatement.

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Assuming the NIH/NIGM 1998 study is a random sample, (http://publications.nigms.nih.gov/reports/mstpstudy/), then for MSTP graduate before 1990 the percentage of MSTP-MD-only graduates is 28%.

The other number, .. most rad onc MD/PhD residents don't go into academics is only an observation. The Physician-Scientist (junior faculty 80-20 awards) numbers are unpublished data from a single institution.

On a similar note, what are the pros/cons of doing an MD in 4 years as opposed to taking just one year off for research?

In regards to taking a year off to do research during your MD training, the obvious benefit is improving your CV/increasing your research so that you are a more competitive applicant. I am surprised by the number of abstracts and publications that current applicants have on their CV

That said, I conceptually dislike the trend I see of more med students spending 5 yrs to finish med school b/c of a research year. I fear that if this becomes more widespread it will be like fellowships in other fields (you have to do them to stay competitive and get a job...not to say all fellowships are this way, but some are). Training is long enough IMO. When I evaluate residency applications I try to account for this "extra" year of research. Efficiency is an important component of being a successful resident and the person with the same amount of research in 4yrs as someone else has in 5 yrs is more impressive IMO. However I imagine I'm in the minority of people who take this into account.

IF you're going to take a year off, make sure you have good research projects with well defined goals and timelines, so that you have something to show for your time and effort.

I was in your exact situation a year ago: recently accepted, interested in rad onc, and aware of the benefit of a PhD in matching. I opted to forgo the PhD because I would be using it primarily as something to boost my application and not because I was really passionate about the PhD (I had some interest in it but I was wavering back and forth because of the time commitment vs benefit, etc. etc.). Based on what you've said in your previous posts I would recommend the same. I'm almost done with my first year and I feel it was the right decision for me.

Efficiency is an important component of being a successful resident and the person with the same amount of research in 4yrs as someone else has in 5 yrs is more impressive IMO. However I imagine I'm in the minority of people who take this into account.

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I agree with this in principle but find that efficiency is a necessary but not sufficient component to have a productive looking year out - at least in the lab, where so much depends on luck, mentoring, and protection of authorship slots. Have you come across a lot of applicants who do solid basic science work without taking extra time off? - (that would be impressive to me)

For retrospective chart reviews and more clinically oriented research work, this may hold true if the project(s) are well chosen - but I have less familiarity with the overall success rate of these. The five year folks in this boat with no basic science pubs/abstracts may have also been working on a lab project but not been as lucky there, and are applying with clinical research pubs/abstracts from their "backup" work. Just my two cents.

Overall, would it be fair to say that most current MD-only radonc residents/attendings finished med school in 4 years without any extra research time, or are they in the minority?

I got the sense that most people interviewing at mid to top tier programs this year had a year+ extra research/extra degree experience. This is completely subjective and I have no hard data though.

Asklepian said:

If an extra year+ of research is indeed becoming requisite, I think this would solidify my current lean toward the MD/PhD. I do genuinely love the lab science side of things (yet I still reserve the right to revise this after my next several months of experience). My only real reservations I suppose are A) being behind a few years where I could have been making attending $ which would benefit if I have kids/wife in the next few years, and B) I have heard many negative things from MD/PhDs on SDN regarding their choice of path.

I realize that neither of these should be a deterrent if I truly love what I'm doing, but I don't want to waste some of my prime years going through hell if it is needless, either.

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The best, most distilled version, of the advice I got when I was making this decision 2.5 years ago was simply this:

If you love research and want a PhD, then get one. If in ANY way you are doing it for application purposes, then don't do it.

Sounds simple, but so far seems to be true. That three (potentially more) years it will take may not seem massive now, but now that I am just about to finish my first two years of medical school I can't imagine having to step out for three+ years. All I can think about is how excited I am to be done with school and (hopefully!!!) practicing medicine as a radiation oncologist.

This got long. I'd vote: No to the PhD since it sounds like you are doing it because you think it may help with getting into a residency. "Liking" the research isn't enough to justify the extra work towards a PhD in my opinion, as a MD will allow you do a ton of research as well.

Good luck in making the first of many difficult decisions!!

haha not to beat this topic to death, but can one get the necessary research experience to be competitive at the top programs in 4 years if they get started early?

it was said a few posts back that the most competitive md-only applicants had taken extra time off for research. but let's say hypothetically that i get involved with rad onc projects as an M1 this fall, could i get the research experience i need without taking extra time off of school to be competitive at the top programs?

Asklepian said:

I do genuinely love the lab science side of things (yet I still reserve the right to revise this after my next several months of experience). My only real reservations I suppose are A) being behind a few years where I could have been making attending $ which would benefit if I have kids/wife in the next few years, and B) I have heard many negative things from MD/PhDs on SDN regarding their choice of path.

I realize that neither of these should be a deterrent if I truly love what I'm doing, but I don't want to waste some of my prime years going through hell if it is needless, either.

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I guess you can tell from my screen-name where my loyalties lie on this. I loved my MD/PhD, but I didn't do it for the application purposes (didn't even know about Rad Onc when I started med school). I knew that I loved science, but I wasn't so sure about the clinical side, so the MD/PhD was an obvious fit. I have a brother who is an incredibly successful MD-only bench researcher, and he recommended the combined program for me because he said it was the one time in life when I could study the skills to be a good researcher, without having other commitments. He has always had to balance learning research skills with clinical work, and feels that the gaps in his knowledge have been harder to fill as a result.

I spent my PhD years focusing on gaining statistical skills, study design, writing as many papers and giving as many presentations as I could, and writing a grant. Although all of those activities look good on a CV, the best thing about my training is that I really feel ready to be an academic researcher. I don't need someone to do the analyses for me, or write the papers for me, or write the grant application. I've got the experience, and could step into a K grant now. I may need to spend five years in residency training, but all of those skills will serve me well even after that.

Oh, and about the $$... for most people, the opportunity-cost of missing attending money for the few extra years balances out with not having loans to pay for med school. I don't know if Rad Onc is an exception, since we have higher attending salaries, but I do know that my life is a lot more sane right now compared to my cohort who are wholly overloaded with debt. They all talk about moonlighting to make up as much cash as possible.... I know that Rad Onc has fairly good hours, but I'd like to spend my off time studying, doing research, and enjoying myself. Not working a second job.

mdphdgirl said:

I guess you can tell from my screen-name where my loyalties lie on this. I loved my MD/PhD, but I didn't do it for the application purposes (didn't even know about Rad Onc when I started med school). I knew that I loved science, but I wasn't so sure about the clinical side, so the MD/PhD was an obvious fit. I have a brother who is an incredibly successful MD-only bench researcher, and he recommended the combined program for me because he said it was the one time in life when I could study the skills to be a good researcher, without having other commitments. He has always had to balance learning research skills with clinical work, and feels that the gaps in his knowledge have been harder to fill as a result.

I spent my PhD years focusing on gaining statistical skills, study design, writing as many papers and giving as many presentations as I could, and writing a grant. Although all of those activities look good on a CV, the best thing about my training is that I really feel ready to be an academic researcher. I don't need someone to do the analyses for me, or write the papers for me, or write the grant application. I've got the experience, and could step into a K grant now. I may need to spend five years in residency training, but all of those skills will serve me well even after that.

Oh, and about the $$... for most people, the opportunity-cost of missing attending money for the few extra years balances out with not having loans to pay for med school. I don't know if Rad Onc is an exception, since we have higher attending salaries, but I do know that my life is a lot more sane right now compared to my cohort who are wholly overloaded with debt. They all talk about moonlighting to make up as much cash as possible.... I know that Rad Onc has fairly good hours, but I'd like to spend my off time studying, doing research, and enjoying myself. Not working a second job.

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What did you get your PhD in?

Maforce said:

What did you get your PhD in?

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Epidemiology. Apparently, it's the true love of my life.

Although physics is a close second.

I just finished my MBBS program and I'm still thinking about doing a PhD program in oncology related field .

we need md PhDs no question. But we really need good PhDs. Your reason for doing the MD which is an extra 4 years has to be overwhelmingly a good reason otherwise you're not going to be happy spending all that extra time to see patients 1 day a week or less.

Sorry repeat post. See below.

Can't be worse than my experience with a patient that was treated at CTCA.

Poor lady got months of treatment to multiple sites to eventually die while on treatment for a non symptomatic met. It was awful.