MD/Phd vs. MD (not the usual questions)

[sailin]

Hey all,

Up until recently, I was mostly set on on doing an MD/PhD after college, but I've started having second thoughts. I think my profile makes me competitive for MSTP programs. I'm a rising junior with a 3.9 science and cumulative GPA at a top private and 37 MCAT. I've done research since high school, for a total of 3 years and have worked in 4 labs thus far. I enjoy research and hope to continue doing biomedical research as part of my career. In addition to this, I want to see patients and practice medicine, and the 80/20 research/clinical split seems like an attractive career for me. Because of this, the MD/PhD route seemed like the way I wanted to go.

However, I've done some thinking lately and am not sure that it's the best way for me to go for my situation. I have been dating my girlfriend for about four years now, with the last two long distance. She's premed, and we don't want to do the whole long distance thing in medical school. The more I think about the logistics, I feel like I might want to apply MD for the following reasons:

1) I gathered from threads on the forum that MD/PhD programs are more competitive than MD programs in general– even for very competitive applicants. I currently plan on applying to MD/PhD programs in big cities to maximize the chances that we end up in the same place,but is it likely for even for competitive applicants to get into most of the schools they apply to? I was under the impression that since all MSTP programs are looked upon as so desirable, even ones attached to lower ranked medical schools are still very competitive. So to maximize my chances of getting into particular geographic locations would it be to my advantage to apply to MD schools?

2) I'm not 100% certain that I want a career that where I mostly do basic science research. While right now that seems like the most attractive option to me, I don't know if I will change my mind once I start doing clinical rotations in medical school. Though I don't think I just want to go into private practice or anything like that, I could also see myself working in an academic setting and maybe doing clinical research. While the financial support of the MD/PhD is a big attracting factor, I've heard that the three+ years of lost physician income mitigates this. If I just get an MD does that close the door for a research career or if I decide that I really want to go that route later can I do a research residency/fellowship and still be fine? Given the circumstances would it make sense for me to forgo the financial/career benefits of the MD/PhD for the practical benefits and added career flexibility of just doing an MD?

3) We are both in-state for the same med school, which is a top 15 school. However since MD/PhD programs don't give residents preference and the school is so highly ranked, I don't think I can't rely on the fact that I would probably get in if I apply MD/PhD, whereas I think I will have a better chance with the straight MD admissions? Also I was told this med school offers full ride merit scholarships.

As an added consideration, I think my application's strength is my science/research background because I feel that letters from my PIs will be quite good based on their feedback to me. I have a varied number of EC's, but I don't have a ton of leadership to display. I also don't have that much volunteering/shadowing/clinical experience. I've heard from a student from my school who is at a Top 10 MSTP that he only did ~10 hours of clinical work, and he gave me the impression that it wasn't as important for MD/Phd programs. If I choose to apply to MD programs will I need to up my non research areas of my application like leadership and clinical experience? I know that MD/PhD's are more competitive than MDs but given that research is my main strength might applying to MD schools actually not make things that much easier for me?

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[solitude]

Hey all,

Up until recently, I was mostly set on on doing an MD/PhD after college, but I've started having second thoughts. I think my profile makes me competitive for MSTP programs. I'm a rising junior with a 3.9 science and cumulative GPA at a top private and 37 MCAT. I've done research since high school, for a total of 3 years and have worked in 4 labs thus far. I enjoy research and hope to continue doing biomedical research as part of my career. In addition to this, I want to see patients and practice medicine, and the 80/20 research/clinical split seems like an attractive career for me. Because of this, the MD/PhD route seemed like the way I wanted to go.

However, I've done some thinking lately and am not sure that it's the best way for me to go for my situation. I have been dating my girlfriend for about four years now, with the last two long distance. She's premed, and we don't want to do the whole long distance thing in medical school. The more I think about the logistics, I feel like I might want to apply MD for the following reasons:

1) I gathered from threads on the forum that MD/PhD programs are more competitive than MD programs in general– even for very competitive applicants. I currently plan on applying to MD/PhD programs in big cities to maximize the chances that we end up in the same place,but is it likely for even for competitive applicants to get into most of the schools they apply to? I was under the impression that since all MSTP programs are looked upon as so desirable, even ones attached to lower ranked medical schools are still very competitive. So to maximize my chances of getting into particular geographic locations would it be to my advantage to apply to MD schools?

2) I'm not 100% certain that I want a career that where I mostly do basic science research. While right now that seems like the most attractive option to me, I don't know if I will change my mind once I start doing clinical rotations in medical school. Though I don't think I just want to go into private practice or anything like that, I could also see myself working in an academic setting and maybe doing clinical research. While the financial support of the MD/PhD is a big attracting factor, I've heard that the three+ years of lost physician income mitigates this. If I just get an MD does that close the door for a research career or if I decide that I really want to go that route later can I do a research residency/fellowship and still be fine? Given the circumstances would it make sense for me to forgo the financial/career benefits of the MD/PhD for the practical benefits and added career flexibility of just doing an MD?

3) We are both in-state for the same med school, which is a top 15 school. However since MD/PhD programs don't give residents preference and the school is so highly ranked, I don't think I can't rely on the fact that I would probably get in if I apply MD/PhD, whereas I think I will have a better chance with the straight MD admissions? Also I was told this med school offers full ride merit scholarships.

As an added consideration, I think my application's strength is my science/research background because I feel that letters from my PIs will be quite good based on their feedback to me. I have a varied number of EC's, but I don't have a ton of leadership to display. I also don't have that much volunteering/shadowing/clinical experience. I've heard from a student from my school who is at a Top 10 MSTP that he only did ~10 hours of clinical work, and he gave me the impression that it wasn't as important for MD/Phd programs. If I choose to apply to MD programs will I need to up my non research areas of my application like leadership and clinical experience? I know that MD/PhD's are more competitive than MDs but given that research is my main strength might applying to MD schools actually not make things that much easier for me?

1) no, it is very unusual for even the most competitive applicants to get into most of the programs they apply to. I would characterize your application as very competitive, but not outstanding. It is possible you are an all-star and wiould get into most of the programs you apply to, but I doubt it, and certainly wouldn't bet on it. Even the lower ranked MSTPs. No offense.

2) there are no financial benefits of MSTP. The 3-5 years that you trade in debt for medical school are more than offset by the 3-5 years of peak earning power that you lose by extending your graduate training. Now, there is a psychological benefit to carrying no debt, let me be clear. And most MSTPs would be lying to you if they told you that having no debt was not an attractive component of the MSTP. That being said, you sound a bit wishy-washy on the whole physician-scientist thing. Not incredibly wishy-washy, but somewhat. If you are not dead set on the idea at the beginning of MSTP, you will almost certainly be fully clinically-oriented well before you finish. Your PhD will be miserable. Therefore, I discourage you from pursuing MSTP.

yes, MD is quite flexible for a later research career. In practice, few people do, but it is definitely doable, and especially clinical research which it sounds like may be more of your thing.

3) in state MSTPs can't technically offer you preference as an in-stater, but you will be seen as more likely to matriculate, and they will often favor you for that reason alone. It's a soft factor, but it's a factor. If you could get a full ride merit scholarship for a straight MD, that would certainly be nice.

4) yes, in general, you should get a lot more leadership/ECs if you are applying straight MD. If you are mostly science oriented, you may have a bit more trouble, although your scores are good so perhaps not. You will do better at certain programs that favor hard metrics like grades and MCAT. Other schools that like the soft stuff may give you more trouble. Hard to predict, hard to plan, just apply broadly and come what may.

Lastly, some advice you didn't ask for. Don't do long distance. Just don't. Also, don't base life decisions on a college romance. Too many people have gotten burned on this one. Also, don't marry another doctor. Many of my classmates have done or are doing just this. Looks miserable.

good luck.

 

[URHere]

A few points to consider in your situation:

A) Try to assess how competitive you really are for MD/PhD programs. Your stats look fine, but the fact that you have worked with 4 separate labs in 3 years worries me a bit. MD/PhD programs tend to favor longer term commitments that advance into significant, independent projects. Has any single lab experience spanned the full 3 years for you? How independent is your work? Have you applied for grants, given talks, attended conferences, published papers, etc? From this point on, focus on quality over quantity.

B) Your stats would make you very competitive for MD programs, but you need more clinical experience (both shadowing and volunteering) if you want to go that route. For volunteering, I'd say that 150 hours is a good target minimum. For shadowing, pick a couple of specialties and go a couple of times - just often enough that you have something to talk about in your essays/interviews.

C) There are several cities that have multiple MD and MD/PhD programs in a small area. Look at Chicago, New York, Boston, and Philadelphia. It's not a guarantee that you would end up in the same place as your girlfriend, but it might increase your chances.

D) You can make it work regardless of the path you pick. Many MD/PhD graduates decide that they only want a clinical career and, of those I've talked to, very few truly regret the PhD. Alternately, there are several successful MD-only researchers who picked up research experience during fellowship. The caveat is that it's going to be harder to gain research experience as a fellow - to be considered for grants, you need papers, so you are essentially trying to be as productive as a standard postdoc without the experience (and hard-earned lessons on failure) that come from a PhD. On top of that, fellows will be juggling variable amounts of clinical responsibilities, and (depending on the program) will be facing pressure from their colleagues and superiors to be in clinic more often. If you are confident that research will be a dominant part of your career, I think the MD/PhD path is the more reasonable one to pursue.

 

[dl2dp2]

Also, don't marry another doctor. Many of my classmates have done or are doing just this. Looks miserable.

good luck.

This seems like a blanket statement. I married a doctor and it's kind of awesome... For one thing, you double your household income.

To OP, I don't see why you wouldn't even APPLY to MD/PhD. You can always drop the PhD later, and to be honest I don't think that your application would get easier if you applied MD only. Just apply to lots of places and make the decision once you have acceptances in your hand with your girlfriend. The other issues (i.e. basic vs. clinical, etc.) are kind of irrelevant right now.

 

[sailin]

Thanks for the responses everyone.
URHere, thanks for the tip regarding what I should aim for in my research. I wasn't very detailed in my description, but I have worked in 4 labs over three years because I worked in a lab in high school, have worked in a lab at my college during the term-time since freshmen spring, and wrote research proposals to receive fellowships to perform summer research away from my institution for the past two summers. I am planning on writing a thesis with the lab I am currently working in at my college, so I think I am not sacrificing too much quality for quantity.

Sluox, I was wondering if you could explain your reasoning as to why you think that my chances of getting into programs are not too different for MD/PhD programs and MD programs. My decision on which way to go hinges in large part on how much harder it would be to get into MD/PhD programs in cities with many medical schools versus MD programs. I know for some schools you can ask to get your app considered for their MD program if you don't make the cut for MD/PhD but I was under the impression that your chances are significantly worse because they have to consider you later in the cycle. Given that it seems that just going for the MD doesn't preclude me from doing a research career later if I choose to, and there isn't a large overall difference in the financial aspect, my main consideration right now is just to get into as many schools as I can so that there is a better chance I can get into a school in all the cities with a density of med schools. This is a factor pushing me to apply to MD programs.

An additional thought, though this one falls much further down the line: It looks like it would be a headache when it comes to residency if your timing doesn't match up with your partner's because you can't do the couples match? Is this a valid problem when it comes to trying to stay in the same city as your SO? The only solution that I can see would be if the person applying for residency only applies for programs in the same geographic area that they are currently in, but that seems much less than ideal. I suppose this is another factor that is pushing me to just do the MD.

 

[dl2dp2]

Sluox, I was wondering if you could explain your reasoning as to why you think that my chances of getting into programs are not too different for MD/PhD programs and MD programs.

Just a matter of statistics. While there are more spots for MDs, there are also more applications. I think the overall numerical acceptance rates for the two are not wildly different--I'm willing to be convinced otherwise, but that has been my impression. They look for different types of people, and your application is a much better fit for MD/PhD spots.

An additional thought, though this one falls much further down the line...I suppose this is another factor that is pushing me to just do the MD.

There is a degree of commitment you do need in order to succeed as a physician scientist. If the risk of having to spend a couple of years apart is an intolerable risk for you, I'm not sure if you are not just coming up with reasons to not go into this line of work in the first place. Remember if you are a physician scientist your SALARY isn't even guaranteed.

If you are really sort of wishy-washy about applying MD/PhD, I think the main consideration right now is financial. If you absolutely positively cannot handle the student loans, then go with MD/PhD. Otherwise go with MD-only.

 

[sailin]

Just a matter of statistics. While there are more spots for MDs, there are also more applications. I think the overall numerical acceptance rates for the two are not wildly different--I'm willing to be convinced otherwise, but that has been my impression. They look for different types of people, and your application is a much better fit for MD/PhD spots.

Could anyone else comment on the competitiveness of MD programs vs. MD/PhD programs? I had the impression that it was usually harder for applicants to get into an MD/PhD program and that MD admission was more of a given than MD/PhD admission for applicants with good stats (even with a research focused application). Also even if the numerical acceptance rates are similar, doesn't the average MD/PhD applicant have higher stats than the average MD applicant?

A follow up on the timing issue, couldn't the time apart theoretically be 6+ years? Assuming the MD would begin a 3-4 year residency somewhere, the MD/PhD would probably begin residency as the MD finished residency. I suppose the MD could just get a job in the location where the MD/PhD is doing residency? I'm not sure how easy it is to find a physician job in a specific geographic location, don't really know much about that. Regardless, 3-4 years more of doing long distance while in a position as stressful as residency doesn't seem like an insignificant challenge. I'm not sure how considering this as a downside really could be held as being too risk averse for someone considering the path of a physician scientist.

Remember if you are a physician scientist your SALARY isn't even guaranteed.

Well you do have an advantage over your PhD colleagues that if you lose funding you can just take up clinical duties and still make a good living in academic medicine. The 6th year postdocs that I've met who are still stuck in the holding pattern have quite a different opinion on the riskiness of the physician scientist career path.

 

[StIGMA]

Well you do have an advantage over your PhD colleagues that if you lose funding you can just take up clinical duties and still make a good living in academic medicine. The 6th year postdocs that I've met who are still stuck in the holding pattern have quite a different opinion on the riskiness of the physician scientist career path.

The comparison is MD vs MD/PhD, not MD/PhD vs PhD (or any other job in the world). A physician scientist is taking significantly more financial risk to pursue science over a purely medical career.

Could anyone else comment on the competitiveness of MD programs vs. MD/PhD programs?

The average student accepted to >1 MSTP has a significantly higher average MCAT (~36) and GPA (~3.8) than the average M.D. medical student (31.3 / 3.63). Those stats- 31.3/3.63 in fact are below the average for MSTP applicants with 0 acceptances (32.7/3.68). [Data from Garrison handout in WAMC, a few years old, for MSTP's and 2013 for MD]. There is significant selection bias.

Keep in mind though that at most MSTPs, which correlate with the top 40 most competitive medical schools, the GPA/MCAT between the MD class and the MD/PhD class tends to be very similar.

 

[bd4727]

A few points to consider in your situation:
The caveat is that it's going to be harder to gain research experience as a fellow - to be considered for grants, you need papers, so you are essentially trying to be as productive as a standard postdoc without the experience (and hard-earned lessons on failure) that come from a PhD. On top of that, fellows will be juggling variable amounts of clinical responsibilities, and (depending on the program) will be facing pressure from their colleagues and superiors to be in clinic more often. If you are confident that research will be a dominant part of your career, I think the MD/PhD path is the more reasonable one to pursue.

This is just flat out false. Most major academic programs in IM/Peds/Neuro/Path and especially lab PIs in these departments are desperate for MD fellows who actually want to do basic science research. Also there are plenty of fellow-level training grants that have high funding rates compare to all NIH grants. The problem is not that it will be hard to find research experiences (this will be incredibly easy) or even to find protected time (built into good programs) or money (also built into most good programs, at least one year anyway), the problem is that at this point will you really want to work for 60k on some mouse project as a 'trainee' instead of just going out and being an adult to practice. This dilemma is discussed ad nauseum on other threads so its not worth going into here, but I just want to point out to the OP and other readers that if for whatever reason the research bug doesn't get you until fellowship, there will be plenty of opportunities.