Nontrad - considering MD/MPH or MD/Phd

[member42892]

Hi all,

A few years ago I was considering applying PhD in the Public Health field. I've grown a lot since then and decided I want to pursue an MD/MPH or MD/PhD so I can treat patients and research. I'm working through my post-bacc right now (will finish next year in May) and am trying to figure out what to focus on, as well as a timeline for applications.

I'm hoping to apply with just one semsester of orgo and one semester of biochem, and take the mcat in march or april while I'm finishing biochem. Doable with studying on my own, or would it make more sense to wait and risk applying a bit later? If I continue to do well in my post-bacc and science courses, will that be weighted more heavily than my undergrad GPA? For recs, would it make sense to use most of my employers, or should a lot of them be professors who've had me as a student? What would be realistic schools to look at, and would there be any advantage to applying MD/MPH at once school as opposed to applying MD there and then applying for an MPH between med school and residency?

Thanks so much! I know that's a mouthful, so I really appreciate your help!

About me:
cGPA: 3.78, sGPA 3.9, liberal arts major with public health minor (from top-50 school with full ride). Working through post-bacc at Harvard Extension.

MCAT: Not taken yet

Research: Worked through undergrad - 4 years part-time research experience (10-25~ hours per week), now working full-time as RA. Almost exclusively public health research, including a lot of research with clinics in low-income neighborhoods in Boston and summer research in various low and middle-income countries in public health (some of which I designed). Have a few posters and abstracts, 1-2 publications on the way, mix of global and domestic work.

Other work experience: Worked on international aid projects for USAID, WHO, etc as paid intern for 1 yr (~15-20 hr/wk) with large global health consulting organization. Resident assistant for 2 years at my university.

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[ridethecliche]

These aren't even the same considerations.

Mph can be done in a gap year in med school or integrated in some programs.

MD/PhD requires a completely separate MSTP application. Your GPA is okay, but your MCAT score has to be a 36ish+ to have a reasonable shot at MSTP along with research experience up the wazoo.

You also don't need either of those degrees to do research, depending on what you're interested in.

 

[TheTao]

Just checking in as another nontrad interested in the MD/PhD or DO/PhD.

 

[dorothyntoto]

You don't need a PhD to do research... just an FYI... I have plenty of friends who do onc research with just their MD...

 

[arachnidette]

I can't comment on the MD/PhD other than to say that I recently met someone who had just finished residency and had a PhD in microbiology and they told me that if they could do it again they would just skip the PhD. Everybody is different.
Most Public Health programs would love to have you with that experience and GPA. I don't know much about applying concurrently, but most of the people who did an MD/MPH in my 2-year Master's program were only around for the first year and I would consider what they got to be an MPH-lite. They are now MD/MPHs and nobody really cares if they did or didn't take that one really miserable statistics course because they had to dissect something instead, so there is that.
If you are not sure about the MPH I would postpone it for residency or after. I have met quite a few docs doing career MPH programs, usually a few intensive weeks and some long weekends spread out throughout the year and a lot of online courses. Or they did an intensive 1 year or extended 3 year program. I have met lots of docs who had been practicing for years and got MPHs when they were in their 50's or 60's. Everyone I met doing the MD/MPH concurrently seemed pretty unhappy and stressed. When I met people who had finished their MD and went back for an MPH they seemed about as stressed as your average student, or less so.
You really don't need to have an MPH if you have an MD to work in public health or to do research, you just have to be willing to let a biostatistician or epidemiologist or policy person step in when you get in too deep. I have met a lot of MDs and DVMs with and without an MPH working at federal agencies, state health departments, and community health agencies.

 

[member42892]

Thanks for the help, everyone!

 

[deleted648172]

I am also deciding between MD-PhD or MD-alone. I have my MS already.

I know 5 people who are in various stages of MD-PhD. Most of my MD friends also have a masters of some kind. In general, clinical work pays better, and is more stable than research work (where you need to write/get grants, and your salary is capped by NIH, and you need to be the best of the best to be funded). Depending on the nature of your research and clinical concentration, I have heard that they are a bit at odds, ie: the more research you do, the less time you have to improving your practice.

I have met many MD-alone (or MD-MPH) who do research. They may not be as competitive as MD-PhD when it comes time to writing R01 or other grants, but they are still being published and funded.

In my situation, I believe I will be applying to MD-alone. The PhD is additional years, it interrupts my training, and although there is a stipend, and tuition is free, you are trading off years as a practicing attending. So... I could be an MD-PhD student for 8 years with a stipend of $20-$30K per year... or those 4 additional years as a PhD student could have been spent practicing (after all my training), with a salary ranging from $150 - $600K...

"but I won't get the research training" you say? well, that's not true, because fellowship is heavily based on research - if you do one. Or an MPH is a nice year off to learn what you need.

So... I'm not entirely convinced that the MD-PhD combined degrees make any sense.

MD-MPH however, I think is a slick deal. I'd go for that if you don't have any research experience, and want research to be at least part of your career.

 

[wholeheartedly]

I say md/mph or m.s. focussing on epidemiology or clinical research, unless you're basic science oriented.

I think my Epi training is going to be valuable for the type of research I want to do and I'm glad I'm doing it.

 

[TheTao]

Having spent a significant amount of time at the NIH and MD Anderson, I can tell you that the MD/PhD gives you a TON of research "credibility" at places with research "superstars".

Can you do research without it? Of course, but just like a Honda will get me where I need to go, I prefer a BMW.

 

[chooks]

The other advantage of MD/Phd is that usually (from my understanding) MD tuition is waived and you get a stipend during the course of your training. In-state residency requirements may be a little looser as well (e.g. you can live in a neighboring state and still get "in-state" tuition, since you are not paying for it).

Coming out of training with no debt would be nice -- although it will cost you 3+years of your life.

 

[wholeheartedly]

The other advantage of MD/Phd is that usually (from my understanding) MD tuition is waived and you get a stipend during the course of your training. In-state residency requirements may be a little looser as well (e.g. you can live in a neighboring state and still get "in-state" tuition, since you are not paying for it).

Coming out of training with no debt would be nice -- although it will cost you 3+years of your life.

If you cruise on over to the physician scientist forums, you'll find several calculations that will show that while you might not leave school with the debt you would for just MD, you actually wind up behind in the long run because you'll have 4+ fewer years of practice as a physician. That's especially the case if you stay in academics where pay is less than private practice.

The consensus of pretty much everyone around here who has done MD/PhD is that you should absolutely not do it for the tuition waiver, etc. You should only do it if you truly want to have a career doing research for the bulk of your time.

It's also worth noting that most MD/PhD programs are geared towards basic science, so if you'd rather do clinical type research then there are probably better options out there .

 

[QofQuimica]

OP, a PhD is only necessary if you want to do basic science research in a lab. For public health research, either an MPH or an MS in clinical research would be appropriate. You could do a combined program or do the research degree later, but financially, you're probably better off doing it later when you're getting paid as a doc.

One other consideration: you didn't say how old you are, but age discrimination is a much more significant consideration for MD/PhD applicants. While people in their 30s and 40s can and do get into straight MD programs, that becomes extremely unlikely for MD/PhD programs, because their goal is to train future PIs who will run basic science labs. If you're in your 20s still, it won't be an issue. But if you're in your 30s, you should definitely have a backup plan in case MD/PhD doesn't pan out.

 

[chooks]

If you cruise on over to the physician scientist forums, you'll find several calculations that will show that while you might not leave school with the debt you would for just MD, you actually wind up behind in the long run because you'll have 4+ fewer years of practice as a physician. That's especially the case if you stay in academics where pay is less than private practice.

The consensus of pretty much everyone around here who has done MD/PhD is that you should absolutely not do it for the tuition waiver, etc. You should only do it if you truly want to have a career doing research for the bulk of your time.

It's also worth noting that most MD/PhD programs are geared towards basic science, so if you'd rather do clinical type research then there are probably better options out there .

Yes - most of my MD/Phd colleagues are fairly ambivalent about having done it. I wouldn't recommend it for tuition waiver by itself unless you really had an interest in an area of basic science research.

 

[wholeheartedly]

OP, here's how the math would hypothetically work out for me.

Say I start the MD/PhD program next year at 33. Then 8 years for the md/PhD puts me at 41 starting residency. I'm interested in infectious disease, so that's 3 years internal medicine and 3 years ID fellowship. Although since I'm planning on a research career, I'd likely extend the fellowship for an additional year of research. That puts me at 47-48 starting my medical research career. It often takes researchers 10 years to really get their work off the ground and get their first major grant. at which time I'd be nearing retirement age.

Now I don't plan on retiring to a golf course when I turned 65, but you can see why even though I want to be a physician who does research, it doesn't make a whole lot of sense for me to go the MD/PhD route.

 

[TheTao]

That puts me at 47-48 starting my medical research career.

Why do people continue to perpetuate this silly idea that a career starts when training ends? I'd argue that a career starts FROM THE MOMENT YOU RECEIVE A PAYCHECK!!! How many people get PAID to learn? Or are you just blithely unaware of the fact that the money MD/PhD students receive during training EXCEEDS the incomes of quite a few Americans. Or is the "quarter milli" income the ONLY income worth mentioning? GEEZ!!!!

BTW, grad students OFTEN publish during grad school, so in addition to "gettin' paid", they're establishing themselves in their careers!!!

It often takes researchers 10 years to really get their work off the ground and get their first major grant. at which time I'd be nearing retirement age.

Research careers aren't slugs. Publish in grad school = the START of establishing your career. PERIOD.

Life usually works best when people play to their strengths or stay in their "imma' doctor for money and prestige" lanes. Leave the grunt work of physician/scientist careers for those in the "game" for far less self serving reasons. Or go Pharma.

 

[wholeheartedly]

Why do people continue to perpetuate this silly idea that a career starts when training ends? I'd argue that a career starts FROM THE MOMENT YOU RECEIVE A PAYCHECK!!! How many people get PAID to learn? Or are you just blithely unaware of the fact that the money MD/PhD students receive during training EXCEEDS the incomes of quite a few Americans. Or is the "quarter milli" income the ONLY income worth mentioning? GEEZ!!!!

BTW, grad students OFTEN publish during grad school, so in addition to "gettin' paid", they're establishing themselves in their careers!!!

You know what I meant.

While I probably could have worded it a bit better, the fact is that would be the age where I would be starting as a fully independent investigator outside of the training pipeline.

If you want to be that technical about it, I have a career right now and one that I'm well-compensated for by my standards. I don't need more than what currently make. What I'm talking about is being fully out of training.

Research careers aren't slugs. Publish in grad school = the START of establishing your career. PERIOD.

Life usually works best when people play to their strengths or stay in their "imma' doctor for money and prestige" lanes. Leave the grunt work of physician/scientist careers for those in the "game" for far less self serving reasons. Or go Pharma.

No they are't slugs, and yes they are publishing to establish their careers. Your nit-picky arguments aside, however, the point remains that the average researcher, even those productive in graduate school, takes 10 years to get their first major grant.

The average age of an MD/PhD to first R01 is 43 years old. Recalculate that for someone who starts as a nontrad, and you can clearly see why starting as nontrad is problematic.

Given that you need grants to be successful and sustain a career as a researcher, I'm not sure where exactly your statement to "leave the grunt work of physician/scientist careers for those in the "game" for less self-serving reasons" comes from?

You need grants to fund the science. There's nothing self serving about that.

 

[TheTao]

You know what I meant.

You were crystal clear that "success" beings when training is done. I simply corrected that erroneous way of thinking least US born folks take a pass on research careers and the entire research "industry" becomes an "overseas" adventure.

The average age of an MD/PhD to first R01 is 43 years old. Recalculate that for someone who starts as a nontrad, and you can clearly see why starting as nontrad is problematic.

Is an RO1 the ONLY measure of a successful research career? Tell that to the thousands of researchers in Industry and with the Government making things happen everyday. Without RO1s.