MD/PhD Competitiveness/School List

[hello888]

Hello,

I have been working in research full-time after graduating and am wondering if MDPhD would be an option for me. I know I would not be competitive enough for T10 schools but that’s okay with me.

Date of Submission: Spring 2023
cGPA: 3.78
sGPA: 3.72
MCAT: 514 (no retakes)

Residence: Currently a Washington resident but went to school in Dallas and am living in Dallas so might switch residency
Major: Biology, minor in Neuroscience
Not a minority, low SES, or disadvantaged

Non-research experience: I have a good amount of shadowing plus I am an EMT, so as far as the clinical experience for MDPhD I’m not really worried about that since I know it’s not the focus anyway.

Research experience:
100 hours on short research project on the informatics side after freshman year of college -
Sophomore/Junior year - Covid labs were closed at my school
Senior year - 300 hours working as a research technician in a bench lab (very low-level work + things were again slow moving in the lab because of Covid)
100 hours working on my own research project related to the academic/social/curriculum side, gave a poster presentation recently at a conference for medical school faculty
Currently working in a neuroscience/biomedical informatics/engineering lab at a top research institution with a pretty prominent PI. At the time of submission I should have about 2000 hours. No publications yet because my role has been mainly focused on working with patients/collecting the data/writing IRBs/etc but am hoping to dive more into the data analysis and get my name on a couple things. By time of matriculation I would definitely have publications and over 4000 hours of research in this role.

I know my research experience isn’t as high as some of these top applicants, but Covid really did put a damper on things and I feel very strongly I could convey that I just love research.

Interests: I have been really loving working on the more CS/informatics side and could see myself wanting to do something along those lines, but honestly I am not completely sure and care more about the PI/mentorship/etc.

I haven’t done a huge amount of research, but the schools I am currently looking at are:

UC Denver
University of Illinois at Chicago
University of Maryland
University of Massachusetts
University of Minnesota
Albert Einstein
Stony Brook
University of Rochester
Oregon Health and Science University (where I am most interested, close to family, graduate programs I’m really interested in)
Indiana University
Ohio State
University of Cincinatti

Some that I just am not sure of their competitiveness:
Emory
University of Chicago
Tufts

Would happily take other suggestions or advice if any are just way out of reach! It can be hard to tell online which ones are more competitive. But please be nice, I’m not going to take people’s opinions on here as the be-all-end-all, I’m just looking for a little guidance + hopefully gather a list of non top-tier MDPhD programs for other applicants out there

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[thr1932359]

I am just a current applicant, but here's what I think:

I think you'd be okay putting Emory on your list as they don't seem to emphasize GPA and MCAT too heavily (based on their matriculating profile). UChicago could be a bit tough as they seem to have high-stat entering classes, but you can always apply if you have time and see where it goes.

If you're interested in computational work, I think you should pay particular attention to Indiana. I recently interviewed and they seem to be very keen on recruiting students from quantitative backgrounds -- there's a lot of push on both Purdue and IU's end to strengthen the MD-PhD's collaboration with the BME department and get students involved in translational engineering work. My impression is that you'd get a lot of interest from them if you were to apply and it helps that your stats are within the range they consider competitive; my DMs are open if you have any questions.

Since you're in Texas, another physican-engineery school I'd look at is Texas A&M, although I'm slightly less clear on the specific research fields they excel at as I didn't apply there.

Some other schools that you can think about adding in no particular order: University of Washington potentially for MD-only (since you have residency there), Penn State, Thomas Jefferson, UT Houston, Kaiser, USC (strong computational work going on at Caltech), UC Irvine, Drexel

2000 hours of research also sounds like enough time for you to get deeply involved with a project and build your research experience + CV. This might be a controversial take, but I wouldn't worry too much about the raw hour count (someone who is involved with admissions should chime in, however). I had far less than 2000 when I submitted my primary and my cycle has been going quite well. As long as you are contributing intellectually, can convey this through your writing come application time and have a reference letter from your PI detailing your research acumen, I imagine you'll present a strong track record and get several interviews. Regardless, both 2000 hours (and 4000 hours) sound like they'd clear whatever cutoff number a program uses to do initial screenings before moving on to what you've accomplished in your experiences, so I think you don't need to worry much.

 

[hello888]

I am just a current applicant, but here's what I think:

I think you'd be okay putting Emory on your list as they don't seem to emphasize GPA and MCAT too heavily (based on their matriculating profile). UChicago could be a bit tough as they seem to have high-stat entering classes, but you can always apply if you have time and see where it goes.

If you're interested in computational work, I think you should pay particular attention to Indiana. I recently interviewed and they seem to be very keen on recruiting students from quantitative backgrounds -- there's a lot of push on both Purdue and IU's end to strengthen the MD-PhD's collaboration with the BME department and get students involved in translational engineering work. My impression is that you'd get a lot of interest from them if you were to apply and it helps that your stats are within the range they consider competitive; my DMs are open if you have any questions.

Since you're in Texas, another physican-engineery school I'd look at is Texas A&M, although I'm slightly less clear on the specific research fields they excel at as I didn't apply there.

Some other schools that you can think about adding in no particular order: University of Washington potentially for MD-only (since you have residency there), Penn State, Thomas Jefferson, UT Houston, Kaiser, USC (strong computational work going on at Caltech), UC Irvine, Drexel

2000 hours of research also sounds like enough time for you to get deeply involved with a project and build your research experience + CV. This might be a controversial take, but I wouldn't worry too much about the raw hour count (someone who is involved with admissions should chime in, however). I had far less than 2000 when I submitted my primary and my cycle has been going quite well. As long as you are contributing intellectually, can convey this through your writing come application time and have a reference letter from your PI detailing your research acumen, I imagine you'll present a strong track record and get several interviews. Regardless, both 2000 hours (and 4000 hours) sound like they'd clear whatever cutoff number a program uses to do initial screenings before moving on to what you've accomplished in your experiences, so I think you don't need to worry much.

thank you, this is so helpful!

 

[moggat]

UW MDPhD is super competitive since they have no in-state preference, but UW MD-only exclusively accepts WWAMI residents so you'd have that.

Since you're in Texas I'd highly recommend adding UT San Antonio as well! They just got their MSTP a few years ago I think, but they've had a fully funded MD/PhD program for a while, and (anecdotally) everyone I met in the MDPhD program there was really passionate about the training and super kind!

Frankly all biomedical fields are dying for more computational folks to handle the insane boom in techniques, especially if they have any ability to integrate bench work, so I strongly support your inclination to seek out mentors who will support you in your goals/growth as a scientist rather than any one particular research niche/project!

 

[ChordaEpiphany]

I'm going to offer an alternative perspective here. Most people take it at face value that you want MD/PhD no matter the tier of program. When you consider other options available to you, I'm not sure how worthwhile the MD/PhD is if you are outside of the top ~20 programs. Right now you aren't particularly competitive for T20 programs given your stats and lack of pubs, but you might be competitive for much more worthwhile careers depending on your goals.

To continue and enroll in a non-name brand MSTP program, you need to be okay with the following reality

1) The pathway is not nearly as streamlined as it used to be. 5-6 year PhDs are increasingly common, and our PD recently told us the average for MSTP programs is now ~9 years. You will work 4-6 extra years at very low pay, enter your residency at 31-34 years old, and probably even get shoehorned into more work as a post-doc or low-level instructor. Unfortunately, unless you are a superstar, academia has become a game of attrition. It benefits PIs and deans to have skilled workers in the labs, post-docs are in short supply these days, and the baby boomer generation seems intent on keeping their tenured positions well into their 70s and 80s.

2) Even with the sacrifices outlined above, your success is not guaranteed. Conversion rates for K and R grants are low. It's about 40% at each step, and there is a small chance of taking alternative pathways (e.g., private grants, surviving on R21s or R29s, etc...). It all compounds to a ~25% chance of being an independently-funded investigator, and coming from an average MSTP program won't help your chances. Even if you do everything right, so much is out of your control. You'll quickly realize how political and random it is to achieve success at a high enough level.

3) Even if you are successful, you'll probably have a low impact. MD/PhD feels exciting when you're working with someone larger than life. When your PI is at a top tier institution and has an H-index of 80+, spins off companies from the lab, and publishes in top journals, it's easy to say, "yes I want that life." What about oscillating between periods of funding and drought at a mid-tier academic center publishing infrequently in mid tier journals? What about hiring only foreign post-docs who only see your lab as a temporary means of staying in the US, and trying to mentor a hodgepodge of inexperienced undergrads, gap year students, and med students taking research years? How do you feel about that life in exchange for you primary earning/investing years, making half of your MD-only colleagues?

4) If you are qualified for any MD/PhD, you are qualified for some very competitive and exciting career paths. What about science and medicine excites you? If you love biotechnology and translation, you could do top tier PhD --> VC or consulting and then exit to C-suite roles in small pharma/biotech, or you could do a PhD and run a team at a large company. If you love medicine and patients, but want to continue using your scientific background, you could do an MD and take an 80% clinical position and collaborate with up-and-coming PhDs. You can also make a smarter bet on yourself and go for a post-MD NIH fellowship, which doesn't ask for the commitment upfront. If you love CS/tech you could join the tech world and work in bioinformatics or even start a company. Think about how you want to invest your time (and money). There's a lot you can do and learn with the massive allocation of time you're giving to this pathway.

From your post, it seems like you haven't ventured outside of academia. Ironically, the competitive recruiting advantage of academia is ignorance. No other industry gets away with demanding perfect grades and test scores from top-tier universities for a pipeline of 11-17 years paid at $30K-80K for 60-80 hours/week and no guarantee of success. That's just a function of extraordinarily lopsided supply/demand that comes from university's unrivaled access to talent from ages 18-22. It can make a lot of sense if you are coming out of it with an MD/PhD from Harvard/Stanford and can make a legitimate run at being a big name PI and world expert (or exit to any number of very highly paid positions in finance, tech, biotech, etc...). However, I have a hard time recommending someone with these sorts of credentials go for an MD/PhD at almost any institution on your list.

I say all of this as someone who didn't make it into a T20 MSTP (despite 3.95+ GPA, 99th percentile MCAT, and publications pending) and went for it anyway. In hindsight, I had so many opportunities, but this "set path" seemed so attractive. Make sure you understand the investment and aren't overlooking better opportunities.

 

[Fencer]

I'm going to offer an alternative perspective here. Most people take it at face value that you want MD/PhD no matter the tier of program. When you consider other options available to you, I'm not sure how worthwhile the MD/PhD is if you are outside of the top ~20 programs. Right now you aren't particularly competitive for T20 programs given your stats and lack of pubs, but you might be competitive for much more worthwhile careers depending on your goals.

To continue and enroll in a non-name brand MSTP program, you need to be okay with the following reality
......
I say all of this as someone who didn't make it into a T20 MSTP (despite 3.95+ GPA, 99th percentile MCAT, and publications pending) and went for it anyway. In hindsight, I had so many opportunities, but this "set path" seemed so attractive. Make sure you understand the investment and aren't overlooking better opportunities.

Your post is very thoughtful and I agree with most of the issues/barriers listed in 1-4. However, you begin with the "prestige" assumption... From the standpoint of a MSTP Director from a non-top 20 MSTP... Out of my 18 MD/PhD graduates (< or = 2017) who trained in a plain MD/PhD program (MSTP received after their graduation), I have 2 serving as faculty at Harvard, 3 at UTSW, 1 at WUSTL, 2 at U Penn, and several at other institutions. It is more critical to train in a supportive MD/PhD program with a terrific PhD mentor and collaborators, and to produce scientifically rigorous and solid research publications and to earn fellowship grants THAN to train in a swim-or-drown top 20 MSTP environment. This is why I got a better impact score from my peers directors (i.e.: study section) on my MSTP renewal than some of those "prestige" MSTP programs. Some programs reach a state of complacency and entitlement associated to their USNWR rankings. The prestige of your institution will not carry you too far, your publications, track record, and the skill-sets that you learn while training do. Out of hundredths of letters of support that I have written for faculty promotion, the only one that I refused to write was for an entitled graduate from one of those top 20 programs (Nobel PhD mentor) who wasted all his training despite becoming academic faculty...
Just food for thought.

 

[ChordaEpiphany]

Your post is very thoughtful and I agree with most of the issues/barriers listed in 1-4. However, you begin with the "prestige" assumption... From the standpoint of a MSTP Director from a non-top 20 MSTP... Out of my 18 MD/PhD graduates (< or = 2017) who trained in a plain MD/PhD program (MSTP received after their graduation), I have 2 serving as faculty at Harvard, 3 at UTSW, 1 at WUSTL, 2 at U Penn, and several at other institutions. It is more critical to train in a supportive MD/PhD program with a terrific PhD mentor and collaborators, and to produce scientifically rigorous and solid research publications and to earn fellowship grants THAN to train in a swim-or-drown top 20 MSTP environment. This is why I got a better impact score from my peers directors (i.e.: study section) on my MSTP renewal than some of those "prestige" MSTP programs. Some programs reach a state of complacency and entitlement associated to their USNWR rankings. The prestige of your institution will not carry you too far, your publications, track record, and the skill-sets that you learn while training do. Out of hundredths of letter of support that I have written for faculty promotion, the only one that I refused to write was for an entitled graduate from one of those top 20 programs (Nobel PhD mentor) who wasted all his training despite becoming academic faculty...
Just food for thought.

This is a fair criticism, and I should have been more clear. My hesitation on T20 vs. mid-tier is not about opportunities in academic medicine. You can make it from anywhere (though it will be harder coming from mid-tier). However, the exit opportunities from the physician scientist path are so, so much better from the T20 schools, and when success rates are relatively low (~30% of grads running labs, far fewer running very successful ones), exit opportunities matter. Most paths look like decent opportunities when you look at the more successful half of people doing it.

At a T20 MSTP, there are opportunities at every junction. If your PhD bombs (which is less likely with a big name PI and highly capable lab mates), you can easily pursue top-tier residencies and be in line for any number of MD-only prestige roles or biotech/pharma positions. You can also exit to life sciences-oriented VC, consulting, or finance roles since those institutions recognize and value the smartest people from the highest tier institutions. A mid-tier MSTP grad faces much more uncertainty in research success and residency match success, and the opportunities at the next critical junction are poor in comparison. A mid-tier MSTP grad isn't going to complete a very average PhD and then waltz into a top tier residency OR a finance-adjacent role at MBB or NEA/Third Rock to revive their career in the biotech/pharma business world. They're looking at much more average opportunities, pretty much equivalent to someone with a mid-tier MD with a slight boost.

So at a T20 you are vying for a decent shot at running an R01-funded lab with a fallback option of MD prestige role/admin track or a high-level business or tech role. At a T100 it's more like vying for a medium-low shot at running an R01-funded lab with a high chance of being strung along for years in low-level roles with a fallback option of being a standard community doctor. In both cases you have to sacrifice 4-6 extra years, but at the T20 you are less committed. You can basically hit the "undo" button and either leave medicine entirely or unlock a whole new level of upside in the academic world. At the T100 it's just a 4-6 year side quest. Then you have to start asking, "is this really what I want?" and "Are there better opportunities available if I can make up my mind now and pursue a more targeted MD, PhD, or business track?"

 

[hello888]

I'm going to offer an alternative perspective here. Most people take it at face value that you want MD/PhD no matter the tier of program. When you consider other options available to you, I'm not sure how worthwhile the MD/PhD is if you are outside of the top ~20 programs. Right now you aren't particularly competitive for T20 programs given your stats and lack of pubs, but you might be competitive for much more worthwhile careers depending on your goals.

To continue and enroll in a non-name brand MSTP program, you need to be okay with the following reality

1) The pathway is not nearly as streamlined as it used to be. 5-6 year PhDs are increasingly common, and our PD recently told us the average for MSTP programs is now ~9 years. You will work 4-6 extra years at very low pay, enter your residency at 31-34 years old, and probably even get shoehorned into more work as a post-doc or low-level instructor. Unfortunately, unless you are a superstar, academia has become a game of attrition. It benefits PIs and deans to have skilled workers in the labs, post-docs are in short supply these days, and the baby boomer generation seems intent on keeping their tenured positions well into their 70s and 80s.

2) Even with the sacrifices outlined above, your success is not guaranteed. Conversion rates for K and R grants are low. It's about 40% at each step, and there is a small chance of taking alternative pathways (e.g., private grants, surviving on R21s or R29s, etc...). It all compounds to a ~25% chance of being an independently-funded investigator, and coming from an average MSTP program won't help your chances. Even if you do everything right, so much is out of your control. You'll quickly realize how political and random it is to achieve success at a high enough level.

3) Even if you are successful, you'll probably have a low impact. MD/PhD feels exciting when you're working with someone larger than life. When your PI is at a top tier institution and has an H-index of 80+, spins off companies from the lab, and publishes in top journals, it's easy to say, "yes I want that life." What about oscillating between periods of funding and drought at a mid-tier academic center publishing infrequently in mid tier journals? What about hiring only foreign post-docs who only see your lab as a temporary means of staying in the US, and trying to mentor a hodgepodge of inexperienced undergrads, gap year students, and med students taking research years? How do you feel about that life in exchange for you primary earning/investing years, making half of your MD-only colleagues?

4) If you are qualified for any MD/PhD, you are qualified for some very competitive and exciting career paths. What about science and medicine excites you? If you love biotechnology and translation, you could do top tier PhD --> VC or consulting and then exit to C-suite roles in small pharma/biotech, or you could do a PhD and run a team at a large company. If you love medicine and patients, but want to continue using your scientific background, you could do an MD and take an 80% clinical position and collaborate with up-and-coming PhDs. You can also make a smarter bet on yourself and go for a post-MD NIH fellowship, which doesn't ask for the commitment upfront. If you love CS/tech you could join the tech world and work in bioinformatics or even start a company. Think about how you want to invest your time (and money). There's a lot you can do and learn with the massive allocation of time you're giving to this pathway.

From your post, it seems like you haven't ventured outside of academia. Ironically, the competitive recruiting advantage of academia is ignorance. No other industry gets away with demanding perfect grades and test scores from top-tier universities for a pipeline of 11-17 years paid at $30K-80K for 60-80 hours/week and no guarantee of success. That's just a function of extraordinarily lopsided supply/demand that comes from university's unrivaled access to talent from ages 18-22. It can make a lot of sense if you are coming out of it with an MD/PhD from Harvard/Stanford and can make a legitimate run at being a big name PI and world expert (or exit to any number of very highly paid positions in finance, tech, biotech, etc...). However, I have a hard time recommending someone with these sorts of credentials go for an MD/PhD at almost any institution on your list.

I say all of this as someone who didn't make it into a T20 MSTP (despite 3.95+ GPA, 99th percentile MCAT, and publications pending) and went for it anyway. In hindsight, I had so many opportunities, but this "set path" seemed so attractive. Make sure you understand the investment and aren't overlooking better opportunities.

This makes a lot of sense, I guess here is some of my thinking...

First off, I'm gonna be honest I really want to do exciting things but unlike a lot of the premed personality types, I really don't feel any need to have this huge prestige attached to my name. I just want to have a job that I really enjoy and that helps people. I'll outline a little bit about what I was thinking with MDPhD

1. I have just been really loving my current job, working in research is really fun and I think there's a huge difference that comes when you are able to really focus and dedicate yourself fulltime to it for a period. If I don't do MDPhD I'll probably take a year at some point to do research because I just like having that dedicated time. I am curious if people have any thoughts on MD vs MD + year of research vs MDPhD in terms of residency competitiveness.
2. I think the MDPhD part sounds fun! I think I'm one of the few people who is looking forward to medical school and not just seeing it as a stepping stone to becoming a doctor. The idea of more years of school doesn't deter me.
3. I feel pretty confident that I want to go into a surgical specialty like otolaryngology, and I know being an MDPhD would help (I know it's also not necessary but it would make me feel a lot more secure about my chances, it would suck to go through all of medical school and then not get a residency in the specialty I want).
4. I actually don't think I would become a PI. I know that sounds like I should just immediately take MDPhD off the list because of that, but I would really love to work in an administrator role at some point at a hospital or medical school, which MDPhD is very valuable for. I know people in those roles who have told me MDPhD is very smart for that.

I really appreciate everyone's advice! I know a lot of it is based on opinion/different goals, but it's nice to have some more insight!

 

[deleted819639]

This makes a lot of sense, I guess here is some of my thinking...

First off, I'm gonna be honest I really want to do exciting things but unlike a lot of the premed personality types, I really don't feel any need to have this huge prestige attached to my name. I just want to have a job that I really enjoy and that helps people. I'll outline a little bit about what I was thinking with MDPhD

1. I have just been really loving my current job, working in research is really fun and I think there's a huge difference that comes when you are able to really focus and dedicate yourself fulltime to it for a period. If I don't do MDPhD I'll probably take a year at some point to do research because I just like having that dedicated time. I am curious if people have any thoughts on MD vs MD + year of research vs MDPhD in terms of residency competitiveness.
2. I think the MDPhD part sounds fun! I think I'm one of the few people who is looking forward to medical school and not just seeing it as a stepping stone to becoming a doctor. The idea of more years of school doesn't deter me.
3. I feel pretty confident that I want to go into a surgical specialty like otolaryngology, and I know being an MDPhD would help (I know it's also not necessary but it would make me feel a lot more secure about my chances, it would suck to go through all of medical school and then not get a residency in the specialty I want).
4. I actually don't think I would become a PI. I know that sounds like I should just immediately take MDPhD off the list because of that, but I would really love to work in an administrator role at some point at a hospital or medical school, which MDPhD is very valuable for. I know people in those roles who have told me MDPhD is very smart for that.

I really appreciate everyone's advice! I know a lot of it is based on opinion/different goals, but it's nice to have some more insight!

Your points 3 and 4 make me think that a MD-PhD might not be fully compatible with your goals.

For 3, being a surgeon-scientist is a monumentally difficult task, and surgical departments and residency programs will not necessarily value you more for having the PhD. The kind of academic productivity will make you competitive for surgical specialties (# of publications) can be obtained outside of your PhD with significantly less work and heartache. The surgical specialties also tend to have longer training period, and you may easily find yourself in residency until late 30s. If you are truly thinking of doing a MD-PhD for the career benefit of being a surgeon, I would reconsider the stated benefit carefully.

For 4, I cannot see how a PhD would benefit you in an administrative/educational role within a hospital or a medical school. The PhD is a degree designed to foster independent researchers (and eventual PIs); although there would indubitably be tangential benefits of learning how to be organized, navigating academia, etc. that may translate to being an hospital admin, you are better off learning those skills as a practicing physician in the four years you would save by not doing a PhD.

This being said, I can tell from your post that you currently seem passionate about your research, and if you think that obtaining a PhD would be a personally meaningful and fun thing to achieve I think that may be sufficient reason to do so.

 

[Fencer]

In biomedical research, there are statistically significant differences that are NOT clinically significant. In my view, this is similar for the effect that you are ascribing to Top 20 vs Top 100 MSTP. I beg to differ... Publications and grants will carry you farther than institutional prestige. Some big shoots only want to get a Nature/Science/Cell/Neuron manuscript, and their productivity dips, which ends up prolonging the time to dual-degree. Whereas in other more collaborative institutions, trainees end up with more publications in same or lesser amount of time to dual-degree. Now, in the 35+ years that I have observed first-hand the careers of many clinician-scientists

 

[ChordaEpiphany]

This makes a lot of sense, I guess here is some of my thinking...

First off, I'm gonna be honest I really want to do exciting things but unlike a lot of the premed personality types, I really don't feel any need to have this huge prestige attached to my name. I just want to have a job that I really enjoy and that helps people. I'll outline a little bit about what I was thinking with MDPhD

1. I have just been really loving my current job, working in research is really fun and I think there's a huge difference that comes when you are able to really focus and dedicate yourself fulltime to it for a period. If I don't do MDPhD I'll probably take a year at some point to do research because I just like having that dedicated time. I am curious if people have any thoughts on MD vs MD + year of research vs MDPhD in terms of residency competitiveness.
2. I think the MDPhD part sounds fun! I think I'm one of the few people who is looking forward to medical school and not just seeing it as a stepping stone to becoming a doctor. The idea of more years of school doesn't deter me.
3. I feel pretty confident that I want to go into a surgical specialty like otolaryngology, and I know being an MDPhD would help (I know it's also not necessary but it would make me feel a lot more secure about my chances, it would suck to go through all of medical school and then not get a residency in the specialty I want).
4. I actually don't think I would become a PI. I know that sounds like I should just immediately take MDPhD off the list because of that, but I would really love to work in an administrator role at some point at a hospital or medical school, which MDPhD is very valuable for. I know people in those roles who have told me MDPhD is very smart for that.

I really appreciate everyone's advice! I know a lot of it is based on opinion/different goals, but it's nice to have some more insight!

1) You are correct that the extra time allows focus and more meaningful contribution to a project. I've never seen someone contribute meaningfully to a project in 1 year unless they are simply assigned grunt work to reduce the workload of others on the project. Authorships obtained in a single year are usually a function of generosity. Most graduate students in my department create almost nothing of value in years 1-3 and then produce all of their data in years 4-5. For ENT, I don't think MD vs. MD/PhD is that big of a boon. Much more important is your clinical performance, step 2 score, MD school ranking, and access to ENT faculty who can write strong letters.

2) I've met some MD/PhDs who come in saying they're okay with failure and simply want the PhD because they'll have fun doing it. I think about 50% retain this view and are simply happy for the experience. Another 50% are a little bitter they wasted their time and that now their training is colliding with things that are more fun/important than research, like spending time with family or their young children.

3) Just consider that you'll feel even worse if you dedicate 8-9 years of your life to MD/PhD and still don't match the specialty you want. MD/PhD is not a guarantee for any specialty.

4) I can't see how an MD/PhD would help for admin roles. Granted I have no interest in this path, but unless those roles are Chief/Chair of a department, which is often (but definitely not always) decided by funding, I don't see the connection. All of our pure admins are MD-only. If anything I think you'd have an advantage by establishing yourself early and spending the extra years learning what elevates someone to a dean.

I truly believe MD/PhD is only appropriate if you're trying to become an NIH-funded physician-scientist. There is a better pathway to nearly every other career.

 

[Sure25]

I'm going to offer an alternative perspective here. Most people take it at face value that you want MD/PhD no matter the tier of program. When you consider other options available to you, I'm not sure how worthwhile the MD/PhD is if you are outside of the top ~20 programs. Right now you aren't particularly competitive for T20 programs given your stats and lack of pubs, but you might be competitive for much more worthwhile careers depending on your goals.

To continue and enroll in a non-name brand MSTP program, you need to be okay with the following reality

1) The pathway is not nearly as streamlined as it used to be. 5-6 year PhDs are increasingly common, and our PD recently told us the average for MSTP programs is now ~9 years. You will work 4-6 extra years at very low pay, enter your residency at 31-34 years old, and probably even get shoehorned into more work as a post-doc or low-level instructor. Unfortunately, unless you are a superstar, academia has become a game of attrition. It benefits PIs and deans to have skilled workers in the labs, post-docs are in short supply these days, and the baby boomer generation seems intent on keeping their tenured positions well into their 70s and 80s.

2) Even with the sacrifices outlined above, your success is not guaranteed. Conversion rates for K and R grants are low. It's about 40% at each step, and there is a small chance of taking alternative pathways (e.g., private grants, surviving on R21s or R29s, etc...). It all compounds to a ~25% chance of being an independently-funded investigator, and coming from an average MSTP program won't help your chances. Even if you do everything right, so much is out of your control. You'll quickly realize how political and random it is to achieve success at a high enough level.

3) Even if you are successful, you'll probably have a low impact. MD/PhD feels exciting when you're working with someone larger than life. When your PI is at a top tier institution and has an H-index of 80+, spins off companies from the lab, and publishes in top journals, it's easy to say, "yes I want that life." What about oscillating between periods of funding and drought at a mid-tier academic center publishing infrequently in mid tier journals? What about hiring only foreign post-docs who only see your lab as a temporary means of staying in the US, and trying to mentor a hodgepodge of inexperienced undergrads, gap year students, and med students taking research years? How do you feel about that life in exchange for you primary earning/investing years, making half of your MD-only colleagues?

4) If you are qualified for any MD/PhD, you are qualified for some very competitive and exciting career paths. What about science and medicine excites you? If you love biotechnology and translation, you could do top tier PhD --> VC or consulting and then exit to C-suite roles in small pharma/biotech, or you could do a PhD and run a team at a large company. If you love medicine and patients, but want to continue using your scientific background, you could do an MD and take an 80% clinical position and collaborate with up-and-coming PhDs. You can also make a smarter bet on yourself and go for a post-MD NIH fellowship, which doesn't ask for the commitment upfront. If you love CS/tech you could join the tech world and work in bioinformatics or even start a company. Think about how you want to invest your time (and money). There's a lot you can do and learn with the massive allocation of time you're giving to this pathway.

From your post, it seems like you haven't ventured outside of academia. Ironically, the competitive recruiting advantage of academia is ignorance. No other industry gets away with demanding perfect grades and test scores from top-tier universities for a pipeline of 11-17 years paid at $30K-80K for 60-80 hours/week and no guarantee of success. That's just a function of extraordinarily lopsided supply/demand that comes from university's unrivaled access to talent from ages 18-22. It can make a lot of sense if you are coming out of it with an MD/PhD from Harvard/Stanford and can make a legitimate run at being a big name PI and world expert (or exit to any number of very highly paid positions in finance, tech, biotech, etc...). However, I have a hard time recommending someone with these sorts of credentials go for an MD/PhD at almost any institution on your list.

I say all of this as someone who didn't make it into a T20 MSTP (despite 3.95+ GPA, 99th percentile MCAT, and publications pending) and went for it anyway. In hindsight, I had so many opportunities, but this "set path" seemed so attractive. Make sure you understand the investment and aren't overlooking better opportunities.

I am just a lowly applicant (probably MD only, after learning about the uncertinty that is MD-PhD careers). I do not want to spend 80% of my time writing 3 R01 grants a year to sustain a lab or become PI.

I disagree with the statment "trying to mentor a hodgepodge of inexperienced undergrads, gap year students, and med students taking research years? How do you feel about that life in exchange for you primary earning/investing years, making half of your MD-only colleagues?" That is part of your job as academic faculty (tenure track or clinician) and meeting your progression track it should not be looked as an inconvniance. It should be rewarding to mentor students and guide their careers.

 

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This is a fair criticism, and I should have been more clear. My hesitation on T20 vs. mid-tier is not about opportunities in academic medicine. You can make it from anywhere (though it will be harder coming from mid-tier). However, the exit opportunities from the physician scientist path are so, so much better from the T20 schools, and when success rates are relatively low (~30% of grads running labs, far fewer running very successful ones), exit opportunities matter. Most paths look like decent opportunities when you look at the more successful half of people doing it.

At a T20 MSTP, there are opportunities at every junction. If your PhD bombs (which is less likely with a big name PI and highly capable lab mates), you can easily pursue top-tier residencies and be in line for any number of MD-only prestige roles or biotech/pharma positions. You can also exit to life sciences-oriented VC, consulting, or finance roles since those institutions recognize and value the smartest people from the highest tier institutions. A mid-tier MSTP grad faces much more uncertainty in research success and residency match success, and the opportunities at the next critical junction are poor in comparison. A mid-tier MSTP grad isn't going to complete a very average PhD and then waltz into a top tier residency OR a finance-adjacent role at MBB or NEA/Third Rock to revive their career in the biotech/pharma business world. They're looking at much more average opportunities, pretty much equivalent to someone with a mid-tier MD with a slight boost.

So at a T20 you are vying for a decent shot at running an R01-funded lab with a fallback option of MD prestige role/admin track or a high-level business or tech role. At a T100 it's more like vying for a medium-low shot at running an R01-funded lab with a high chance of being strung along for years in low-level roles with a fallback option of being a standard community doctor. In both cases you have to sacrifice 4-6 extra years, but at the T20 you are less committed. You can basically hit the "undo" button and either leave medicine entirely or unlock a whole new level of upside in the academic world. At the T100 it's just a 4-6 year side quest. Then you have to start asking, "is this really what I want?" and "Are there better opportunities available if I can make up my mind now and pursue a more targeted MD, PhD, or business track?"

I'm late to this discussion but really take issue with the idea that a 'mid-tier MSTP' is equivalent to a 'very average PhD'.

The quality of the PhD is a function of the skills of the mentor, the skills of the student, the supportiveness of the institutional environment, and a huge swollop of luck. Institutional prestige is nowhere on that list. Many students at brand-name universities complete 'very average PhDs' while many others at 'mid-tier' universities by USNWR criteria produce groundbreaking work.

The farther along the path you go, the more 'prestige' accrues to your individual accomplishments, not to the halo effect of the institutions where you trained. Institutional halo effect is relevant to undergrads who aren't old enough to have accomplished much on their own yet. After that it loses relevance very rapidly.