Purpose of MD/PHD?

[efc123]

Hey guys, so I'm going to be applying this cycle, and I've kind of always figured that I'd be applying MD/PhD. I've loved my research experiences so far and would pursue such a career in a vacuum without a doubt. I've also really enjoyed my shadowing experiences (clinical volunteering is not so much), and think the 80/20 model in translational research is the ideal career for me. However, this past week I've been reading a few threads regarding this pathway and I'm starting to have second thoughts.

It seems as if the 80/20 model doesn't exist anymore(at least for new graduates), in which case MD/PhDs wanting a research career would be at a disadvantage to straight PhDs, having wasted all those years spent in medical training. Plus, getting into top PhD programs and working with that big name PI might even be slightly easier via grad school admissions vs MSTP admissions. Likewise, a career spent primarily in the clinic/OR does not require the scientist training of a PhD. It just seems like one's desired career can be achieved more effectively with simply a PhD or an MD.

So what exactly is the purpose of doing an MSTP or MD/PhD program? Is it for those hardcore gunners aspiring to be department chairs? Or maybe it is, as someone here put it, an opportunity for the "devious" among us to establish connections and publish in their desired competitive specialty field of choice. Or is it for those like my friend, who I must admit is quite talented (perhaps even brilliant?) as a researcher but lacks the standard laundry list of humanitarian and/or leadership experiences to complete for spots at top MD programs?

But what about the rest of us mortals who have an interest in both in medicine and research? Should we just apply now and hope things get better by the time our careers begin? Because right now, other than having a backup (although a pretty good one) for a failed research career, I'm having a hard time justifying my decision to apply MD/PhD. Are there any other benefits to going down this path?

I'm sorry if I come off as whiny, I guess I was just really excited about the idea of pursuing this program and now it just doesn't seem what it was all cracked up to be

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[dl2dp2]

It seems as if the 80/20 model doesn't exist anymore(at least for new graduates), in which case MD/PhDs wanting a research career would be at a disadvantage to straight PhDs, having wasted all those years spent in medical training. Plus, getting into top PhD programs and working with that big name PI might even be slightly easier via grad school admissions vs MSTP admissions. Likewise, a career spent primarily in the clinic/OR does not require the scientist training of a PhD. It just seems like one's desired career can be achieved more effectively with simply a PhD or an MD.

MD/PhD is the best for the kind of thing that it's designed to do--i.e. "translational" research. Everything else from 100% basic research to 100% pure clinical, it can do, but as you observed, not very efficiently. However, not efficiently does not mean that the pathway doesn't have other advantages. At the moment, even if you do a PhD at a top program with a big name PI, your chance of success in a career in research (eventually getting an R01) is very low (~10-20% at best). Your chance of getting an R01 eventually from an MD/PhD program is slightly higher, ironically, but not by much.

PhD programs even at top places are not very competitive right now, in contrast to MD/PhD programs which are getting more and more competitive. The trend seems to be the best students who would have originally done a PhD program have been streaming into MD/PhD programs, primarily because the exit from even top PhD programs are so abysmal. You are doing the right thing.

 

[dl2dp2]

This post prompted me to look at the alumni list of my year from my PhD program, which is one of THE the best programs in this field--definitely a "top 5" program. Out of the 14 people who defended in my year, 6 years later, exactly 0 is now in a tenure track position. Adding now another 8 from the year before, only 1 "PhD-only" is now in a genuine tenure track position in a research institute. Ironically (or not), the two other from the year before who are now assistant professors are both MD/PhDs and fully clinically trained, who are on K-awards, which is not exactly "tenure" track but at least en route to an R01. In a few years perhaps 1-2 additional "PhD-only" postdocs will end up in a tenure track position.

Do you feel lucky?

 

[Lucca]

This post prompted me to look at the alumni list of my year from my PhD program, which is one of THE the best programs in this field--definitely a "top 5" program. Out of the 14 people who defended in my year, 6 years later, exactly 0 is now in a tenure track position. Adding now another 8 from the year before, only 1 "PhD-only" is now in a genuine tenure track position in a research institute. Ironically (or not), the two other from the year before who are now assistant professors are both MD/PhDs and fully clinically trained, who are on K-awards, which is not exactly "tenure" track but at least en route to an R01. In a few years perhaps 1-2 additional "PhD-only" postdocs will end up in a tenure track position.

Do you feel lucky?

Do you feel that the climate for science funding will change in the future? From what I've seen and heard, most tenured physician scientists (over 50%) are over 55 and the number of graduating PhysScis has been stagnant if not dropping and government money for research has basically not moved. 10-15 years from now (the relevant timeline for people entering training today or next year) hopefully this means somethin has to budge? Either more vacancies due to retirement or even a small increase in research funding. But I'm just speculating out of optimism. What do current faculty think?

 

[dl2dp2]

Do you feel that the climate for science funding will change in the future? From what I've seen and heard, most tenured physician scientists (over 50%) are over 55 and the number of graduating PhysScis has been stagnant if not dropping and government money for research has basically not moved. 10-15 years from now (the relevant timeline for people entering training today or next year) hopefully this means somethin has to budge? Either more vacancies due to retirement or even a small increase in research funding. But I'm just speculating out of optimism. What do current faculty think?

No. The climate for science funding will not improve in the next 10-15 years. There is a good chance that it will further worsen. Currently, for those who have had an R01, only 50% will have subsequently have a second R01. It's likely that this number will drop.

This has more to do with the poorly regulated pipeline (i.e. excess supply) than the total size of the funding bucket, which is fixed. Correcting the excess supply is difficult, because there is a competing priority of lowering labor cost. It's unlikely that PhD production and academic job market around the world would become more regulated in the next 10-15 years.

In contrast, while the total size of the bucket in healthcare is also flattening, because the supply is also fixed (i.e. the total number of Medicare funded ACGME training slots), this problem is not an issue for MDs in most specialties, at least for right now.

Please plan your career development with that in mind.

 

[Lucca]

No. The climate for science funding will not improve in the next 10-15 years. There is a good chance that it will further worsen. Currently, for those who have had an R01, only 50% will have subsequently have a second R01. It's likely that this number will drop.

This has much more to do with the poorly regulated pipeline (i.e. excess supply) than the total size of the funding bucket, which is fixed. Correcting the excess supply is extremely difficult, because there is actually a competing priority of lowering production cost. It's highly unlikely that PhD production and academic job market around the world would become highly regulated in the next 10-15 years.

In contrast, while the total size of the bucket in healthcare is also somewhat flattening, because the supply is also fixed (i.e. the total number of Medicare funded ACGME training slots), this problem is not an issue for MDs in most specialties, at least for right now.

Please plan your career development with that in mind.

In your last paragraph you are referring to clinical employment, correct? Since they compete for the same "science bucket" as PhDs and MD PhDs. Also what do you mean by a "competing priority to lower production cost"? Do you mean reducing the training length and cost for PhDs / other scientists?

Also do you think the current model of academic science prohibits academia regulation? That is, if there were significantly less grad students a lot, lot less would get done in academe and they would need to be replaced by more expensive, already trained scientists.

 

[dl2dp2]

Also do you think the current model of academic science prohibits academia regulation? That is, if there were significantly less grad students a lot, lot less would get done in academe and they would need to be replaced by more expensive, already trained scientists.

Exactly. This is what I mean by "lowering labor cost". Postdocs are being paid such a low salary for such a long period of time, with such a lower probability of a good exit, it's unconscionable.

 

[tr]

Do you feel that the climate for science funding will change in the future? From what I've seen and heard, most tenured physician scientists (over 50%) are over 55 and the number of graduating PhysScis has been stagnant if not dropping and government money for research has basically not moved. 10-15 years from now (the relevant timeline for people entering training today or next year) hopefully this means somethin has to budge? Either more vacancies due to retirement or even a small increase in research funding. But I'm just speculating out of optimism. What do current faculty think?

I sort of think it has to budge, although it will probably remain very highly competitive.
Right now there is this huge bulge of people who entered training in the late 1990s and early 2000s, when there was an unusual increase in NIH funding, which was parceled out by way of R01s to hire low-wage labor (i.e., graduate students and postdocs). Those people are now all in what should be the young-faculty phase. I believe current numbers of trainees are much lower, both because there is not as much money to fund their presence and because it is not too difficult for today's prospective academics to inform themselves about the bleak career prospects (through sites like this one).

So even if funding does not increase, I do think there will be some lessening of the intense competition 10-15 years down the road, when the population of those seeking careers in research is smaller.

It will probably still be the case that you have to be the right combination of smart, lucky, and driven to grab the brass ring. But maybe the relative contribution of the luck factor will be smaller with respect to the other two than it is at present.