PhD after MD logistics?

[wholeheartedly]

Obviously the desired path here is to do the combined degree program if possible, either getting admitted directly or through an internal application once already in med school. If that's not feasibl, then it's often suggested on here that if you're still deadset on both degrees, do the MD first then PhD.

So I guess my questions are

1) if you're sure you want to do both, why MD first? True, you'll finish as something more marketable and can pursue research in something that is more relevent to your field. OTOH you'll be accruing med school loan interest while working on the PhD.

2) logistically, how does this work. I know of a few progrms that will let you do a PhD in reisdency or fellowhip, but seems pretty uncommon. So then if you're done with training, do you do grad school with some moonlighting or something?

3) If you have an interest in something very niche for research with few places doing it or with the capabilities to do it (think BSL 4 lab or something) would it perhaps be worth it to try for the opportunity to do that first? (and if you can't get in then, try again later on the path)

4) Mainly for someone like @Fencer, any idea how MSTP s feel about the GPP track where you can get your PhD and during your final year apply for NIH /MSTP funding for med school? ie track three http://mdphd.gpp.nih.gov/prospectiveStudents/prospectiveStudents.asp

I'm not sure how the med schools view that given the PhD was not at their institution and they're using an MSTP spot for someone already done with a PhD...

(plz excuse any ridiculousness or lack of coherence as I'm falling asleep writing this... )

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[dl2dp2]

I'm not sure one should be "deadset" on both degrees. As I'm getting farther along this academic medicine track, it's becoming increasingly apparent to me that PhD is practically useless...

The main reasons to do a PhD under any "logistical" circumstances: 1) as part of an MSTP such that tuition for MD can be remitted. 2) the PhD itself is in a field that has a very high potential for transferrable skills (i.e. computer science, engineering, economics, etc.) If you have interest in something "very niche", be prepared to have your grants repeatedly not funded. NIH is now managed in a very top-down driven way, and investigator initiated grants, even well scored, are constantly rejected because they don't fit the "initiatives" and "Congressional mandates", and whether your grant fits into their puzzles is completely based on the whims of division chiefs at ICs--so funding is becoming even more unpredictable to an already unpredictable process of scoring. It's becoming much more like lobbying than doing science. The professors are constantly calling various figureheads at NIH to develop "relationships", is how this game is played these days etc.

This all leads to a very practical set of considerations, which is if you really want to do niche research, MOST likely you'll be "self-funded", meaning for large swaths of your effort will be not immediately and continuously funded by extramural support. This means either 1) you do postdoc/staff scientist/"research assistant prof" for a long time 2) you practice medicine 3) you are independently wealthy. Practically EVERYONE is now having funding gaps. Having a PhD literally does not add anything for you when you have a funding gap...having an MD, however, protects you from having to starve...or live on 45k in San Francisco...for 10 years...which is now the default...on the PhD job market I'm seeing people with MULTIPLE Cell/Nature/Science papers not getting a tenure track jobs in the first year or getting rejected for career development grants. 2nd tier tenure track jobs are awful and there's been flat salary for years.

Just to give you a sense of how ridiculous this has become. The cohort of people on SDN that's around the time of my application, which is now about 10-15 years after getting into MD/PhD programs, I maybe one of the ONLY people who's still making pitches for the NIH for grants...and I may drop out very soon...and the only reason I'm not dropping out is because my CLINICAL career is going better than I thought it would. Previously very promising candidates like the authors of the well known "On the Path to Physician Scientist guidebook", various posters on this board, etc. have all at least temporarily ceased pursuing this... Medicine remains an excellent job, but unless you have supportive wealthy parents (or have made a lot of money early in life some other way--and, believe it or not, this is increasingly not rare at top PhD programs, a lot of what in the end become successful trainees are wealthy...) I don't recommend going into biomedical research as a career. Unless you can get MD tuition remission...

If you don't get into MSTP, I'd just do the MD and residency, play around with research in med school (i.e. do a year of Doris Duke or something if you want) and see where the chips fall, to be honest.

 

[Naruhodo]

I agree with the poster above. There are more research opportunities as an MD than I think I realized when I was nearing the end of undergrad and contemplating MD/PhD. Tons of MD programs have an optional "free" 5th research year (I think usually between the pre-clinical and clinical years), and I've seen some folks do that and get pretty sweet publications from it.

Anecdotally, I know of three people from grad school who went the PhD first, MD later route. One was a hard-working and generally nice person that everyone liked who finished the PhD in 4 years and returned home to attend state medical school. I heard this person express once that they'd had a more generous scholarship offer from the MD program when they applied straight out of college with good numbers, but they also didn't seem to regret the PhD. Another was similar and on track for the 4-year PhD when they had some major mental health issues and were asked to leave. This person was actually arrested for acting out over social media and I was worried for a while that one of the smartest scientists I know wouldn't be able to recover from a terrible half year. However, this person got their life together and received a full scholarship to a top 20 medical school plus stipend. They really didn't need the PhD (though the publications from grad school probably helped). The third person was pretty much a gunner who had their sights on the most prestigious programs and found it easier to get into name brand school's PhD program and then stick around for the MD.

I know of one physician who did their MD first and then later PhD. They went to a pretty small medical school without much research, and I think in this case the PhD was a chance to get to an academic medical center and make a name for themselves. This person is now an attending at another major academic medical center and doing well (jumped around fields a bit, but doing well where they landed with cross appointments in two departments). I'm pretty sure this person didn't "need" the PhD but so long as they enjoyed it what does it matter? With changing fields (different residencies before and after the PhD), it probably gave them time to figure out what they really wanted to do. This person is fantastic with patients by the way.

Good luck with your application/decisions!

 

[SurfingDoctor]

Sorry if this has been covered as I didn't read all the posts, but in pursuing a PhD after MD, if you do the PhD after residency, the NIH time clock of new investigator status is ticking while you are pursuing a PhD because you are already post graduate. It's 10 years post-terminal research degree (ie PhD) or 10 years post residency, whichever happened first. For today's funding market, when you go for your first R01, you want the leverage afforded by the new investigator status. Just something else to consider.

 

[Fencer]

There are multiple ways to become a clinician scientist. The circumstances of every individual are different. It might be that PhD --> MD is the track for some people with UG GPAs below 3.1 or so. There is also the late bloomer track, PhD after residency. Despite all the real and/or perceived shortcomings, the traditional MD/PhD program (i.e.: 2+4+2) is the most economical and functional mechanism for most people at the present time, perhaps followed by a PSTP residency. I don't know about the statistics for GPP track 3. Perhaps, a student within GPP can shed light. I suspect that most of the funds go into the more traditional tracks 1 and 2.

 

[wholeheartedly]

Thanks folks. I know what I want to do, but I'm just not sure how my very weird/very mixed academic and work background will be received. So I'm just trying to look at other possibilities and some outside the box solutions.

Fortunately, as noted, there are many paths to get there. Obviously a lot of great options out there like CCLCM's program, away research years, opps during fellowship, etc. I've spent a lot of time looking into those.

I also have been fortunate to have spent time surrounded by sucessful people from a variety of paths. So I know you can be succesful regardless of path. Unfortunately, life threw a bit of a monkey wrench in my plan of attack on this and I also wound up moving away from some of those good contacts/resources.

I just feel strongly about wanting the depth of training provided by the PhD, especially given the type of career path I'm envisioning. We'll see how the MCAT goes and how my master's degree ties up, I guess.

 

[drstatinatorva]

Which would be the best route for a non US IMG done with medical school (MBBS) to be a lab scientist; A residency followed by research fellowship or a PhD and post doc ? Particularly considering that residency IMG tend to get are community programs with little focus on research? Thanks.

 

[Fencer]

PhD to residency. The problem is the number of years away from patients must be limited to 4 or 5. It would be best to have some clinical experiences along the process. The USMLE scores should be competitive for PSTPs too.

 

[QofQuimica]

I think the main reason why MD-first is suggested is because the MD is a more versatile degree. You can do research as an MD, but you cannot do clinical work as a PhD. Even as a trainee, you have options to do research during medical training (say, to take a LOA to do an MS or PhD), while you do not have the option to do clinical work during graduate training. It is also much easier to get into grad school than it is to get into medical school.

For efficiency reasons, I agree that the combined program is the best option for those who know they want both degrees. That being said, for some people (say, a nontrad over age 30 who does not have stellar stats), going the formal MSTP route simply may not be realistic. I especially like the research MD pathway option for this kind of situation. A formal program like CCLCM is one possible option, but it's not necessary; pretty much any MD program will give you the option of taking a fifth year for research/MS work. Though the nice thing about a program like CCLCM is that your med school tuition would be paid for, which would obviously be a huge benefit for someone who wants to have a research career. However, that program and others like it (say, Pitt's PSTP) are also very competitive, so you still need to have a backup plan.

 

[SurfingDoctor]

I will also add that one can apply for the NIH LRP. They are competitive, but they are another way you can pay down debt and do research. My two years on a LRP paid down about half my debt. The only caveat to the LRP is that you can't double-dip in service time, meaning that if you are a T32 (or a KL2 or some other NIH-based funding source) and LRP at the same time, you can only apply 1 year of research to either the T32 or LRP, not both, thus for me, I had to "pay back" LRP time during my first faculty year. That was fine for me because I was doing research anyway, but just something to consider.