Why MD/PhD instead of MD/Postdoc?

structurelab said:

I understand that MST programs are fully funded, plus living expenses. However, I've never seen a doctor begging for money on the side of the road. But, what is the advantage of spending four years doing a PhD instead of spending that four years as a postdoc in a top lab? I've talked to several professors where I reside and they have different opinions. Some say the PhD really isnt necassary for a biomedical research career and others say it is necassary. I understand that it's very competitive getting that coveted post-doc position. But, if your research background is good enough to get into an MSTP and you spend some time doing research in med-school, I would assume you would be fairly competitive. Am I wrong? I should also mention the funding opportunities available for a postdoc with MD after their name. This makes the decision a little easier for the PI if the postdoc can supply his/her own funding. I see top notch researchers such as Robert Leftowich (Duke) and Art Horwich (Yale) who are "only" MD's and have excellent basic science labs and it leaves me confused. Bottom line, is the PhD really necassary? Does it help that much securing an RO1? Thanks for the opinions.

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It's probably not all that necessary if you can find the resources to do research and get your training in other ways. But it just sucks to have to pay back all those loans with a post-doc salary.

for problems paying off med school while postdoc-ing, check out the NIH loan repayment program:

"In exchange for a two-year commitment to your clinical research career, NIH will repay up to $35,000 per year of your qualified educational debt, pay an additional 39% of the repayments to cover your Federal taxes, and may reimburse state taxes that result from these payments."
http://lrp.info.nih.gov/about/lrp-clinical.htm

structurelab said:

Bottom line, is the PhD really necassary? Does it help that much securing an RO1? Thanks for the opinions.

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As a MSTP student close to finishing with the Ph.D. I feel like the Ph.D. probably was not necessary to get where I am now. I didn't get much from my classes and my qualifier was based on a topic I did not learn about in school (our qualifiers have to written on topics outside our lab rotations or potential research interests). However I did need the protected research time that the Ph.D. provides (no grant writing; the only writing I had to do were papers, editor cover letters, reviews and abstracts). I was chemistry major as an undergraduate and it took me about 6 months to get up to speed with all the molecular biology techniques (I don't know if PI's would be happy their post-doc was just learning to micropipette for the first time).

As post-doc I would be expected to spend the first couple of months writing for grant to fund myself (although MSTP students often apply for NIH NRSA grants if they can get their grants sent to the right institute). Supposedly the Ph.D. helps you get grants (or this is what I am told by others), but I suspect for R01 grants, I am not sure how more degrees factor into it. Instead from the pink sheets that I have seen for R01 grants, the critiques focus on the quality of the grant and past productivity.

In the end, I am getting my Ph.D. from an advisor who has a M.D. (which is a little ironic) with several R01 grants. He did however do a post-doc for ~6 or 7 years after medical school.

I completely agree with BDavis. We actually are in almost exactly the same situation - finishing up our Ph.D., in labs with M.D. PIs. The OP is correct that there are many outstanding researchers who don't have the Ph.D. I think my mentor is a brilliant researcher and he is very well funded and well respected. He did do several years of basic research post-doc after his clinical training.

I think that is the key thing - at some point you will have to get the protected research time. Sometimes I wish I had gone the MD/postdoc route instead of MSTP because graduate school can feel like such a waste at times - classes, comprehensive exams, being a TA, writing the thesis, etc. As a postdoc, my impression is that you get to focus more exclusively on the research (but you do have the funding worries that we don't have as MSTP students). Of course, I am feeling pretty jaded right now as I am struggling to do all this thesis formatting nonsense and am starting to worry about going back to clinics and not knowing a single thing. On the other hand, I am happy that at this point in my career I already have some background in research and hope to be able to jump right into a productive post-doc after residency. I also have heard some folks say that you need to "prove yourself" in two different labs - in this case, your graduate lab and your post-doc lab. I don't know how much this is true, especially for folks in a clinical department, but it is something that I keep in mind.

I'm just posting to give an alternative viewpoint. I'm an MSTP student currently deep in my research years.

BDavis said:

As a MSTP student close to finishing with the Ph.D. I feel like the Ph.D. probably was not necessary to get where I am now.

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My experience has been very different. I feel like I have learned an enormous amount in my laboratory years. I am much more familiar with the research world, with what is expected and what is reasonable to accomplish, what makes a good scientific question and how to go about getting an answer. Also I have a much larger fund of knowledge on which to draw, so as not to look like an idiot when interviewing for postgrad positions.

Also, I have learned a great deal about my own interests. My interests were fairly broad and unformed when I started my PhD; now they are much more clear (and somewhat different from what I'm doing in my PhD). Your postgraduate research pretty much determines what types of questions you will ask in your first faculty appointment; I'm happy I got the chance to clear this up for myself now rather than in a high-stakes postgrad research position.

(I don't know if PI's would be happy their post-doc was just learning to micropipette for the first time).

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Absolutely - but it isn't just about techniques, which can be picked up quickly. It is about learning how to think and write like a researcher. When a new postdoc comes to our lab, he typically picks up a project, works efficiently and intelligently, and turns it to good account in half a year or so. When a graduate student comes, he typically flounders around for at least a year before getting any solid results. You have to pay your dues at some point; but graduate students are expected to screw up for a bit. There's a lot less leeway for postdocs, and also far less protection. If you produce nothing in two years as a grad student, well, that's not unexpected. If you do that in a postgraduate research position of two years' duration *total*, you'll have a hard time recovering. An untrained person in a postdoc is a bad, bad scene.

In the end, I am getting my Ph.D. from an advisor who has a M.D. (which is a little ironic) with several R01 grants. He did however do a post-doc for ~6 or 7 years after medical school.

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Okay, so this guy did 4 med school + 4 residency + 6-7 postdoc = 14-15 years. There are a few profs at my school like that as well.

To me, it seems far preferable to do 7-8 years of med/grad school and explore your interests without severe consequences, then to do a 4-6 year 'research residency,' in which you can expect to be highly productive, having been previously well trained, for 11-14 years total. You work in two labs, so acquire breadth of knowledge and variety of expertise, and you're debt-free. The time is comparable, but the risk is lower (both financial and career) and the education is better.

Also bear in mind that you have to *get* the postdoc position in the first place, and there are a lot of PIs who are not interested in taking on clinicians untrained in basic research. Sure there is grant support available - know why? Because PIs are not interested in risking their funds on somebody unproven in research. Postdocs are normally selected on the basis of the quality of their graduate research and their ability to discuss it knowledgeably. Someone who *has no* graduate thesis to discuss is going to be at a distinct disadvantage in a basic research lab.

structurelab said:

I understand that it's very competitive getting that coveted post-doc position. But, if your research background is good enough to get into an MSTP and you spend some time doing research in med-school, I would assume you would be fairly competitive. Am I wrong?

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I wouldn't say postdocs are competitive positions per se - demand is generally greater than supply (mostly because the position is so demanding and the salary so pathetic).

But I definitely would not say that one's *undergrad* research experiences would have much bearing at all on his postdoc application. By the time you applied for a postdoc after med school and residency, that research would be 8 years behind you. It probably shouldn't even be on your CV unless you had a first-author pub out of it. And research in med school is usually pretty lame: it typically lasts 1 year, which is not enough to get much of anything done unless you are already very well trained, which a medical student is not. You might get lucky and get a paper out of it; but more likely you wouldn't.

Or you could spend more time on it (I know one guy who took 2 years off to do research, which he sort-of continued during 4th year, and he'll be competitive for good research residencies); but then your time commitment is inching up on that of the dual degree (6 years vs. 7-8), and you may find yourself asking whether you wouldn't have given that extra year or two in exchange for $100,000 of debt that you'll be paying off on your measly resident/postdoc/clinical fellow's salary.

AndyMilonakis said:

Again, the MD-only PIs are prodigies in this regard because somehow (whether it be by serendipity, brilliance, and hard work) they were able to get to where they are today without PhD training. Unfortunately, many people do not know that they were cut out for science until they have already become successful. Hindsight is 20/20. And personally, in my case, even having completed a PhD, I am still not completely certain whether I possess the skills and sheer smarts to be a successful investigator.

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Totally, dude.

I think MD-->postdoc is sort of a quick-fix route for people who only realized they were interested in research after having started med school. It can work, but only if you're naturally very very talented (not just clever), and there's no way you can know this about yourself at this point. So it's a bit of a nasty risk at an age when risk is becoming less acceptable (early-mid 30s vs. mid-late 20s).

AndyMilonakis said:

Like BDavis and beary, I too completed my PhD thesis under an "only" MD PI. I do appreciate that there are some fantastic non-PhD holding MD PI's out there who do great research. However, my impression is that in the whole research community, these MD-only PI's represent a significant minority.

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Interesting that there are many MD/PhD students receiving PhD's from MDs. When I told people I was joining a MD lab, graduate students looked at me like I was crazy. While I was on the interview trail (many years ago), I learned an interesting fact-some MDs told me that they intentionally did NIH postdoctoral fellowships so that they could become a government employee and effectively remove themselves from the draft.

With respect to the Ph.D., for me the most important thing I will get out of it will be protected research time. My mentor was more passive and sort of let me dig holes for myself while providing a seemingly bottomless pit of money so that I could blow lots of money on kits (I have good relationships with the Qiagen and Dharmacon). I got lucky and hammered out a project that was different from the lab's interests and should graduate in under 4.5 years; however I could of been unlucky and have nothing and if I were a post-doc I would of really been in trouble.

Nowadays, there are medical school with funded research years (1-3) that I think are potential alternatives to MD/PhD programs and MD/postdoc routes. Some MD/PhD programs are getting longer (8-11 years total) and I think for most people (MD/PhD and PhD students), a PhD longer than 6 years is too long. However, I think the NIH is actively trying to reduce the length of training for MD/PhD programs that high proportions of students going for more than 9 years or "lifers". Students that take six or more years for their PhD sometimes are bitter about graduate school. The combined MD/research programs would give you protected time without the "hassles" of being a graduate student (teaching requirements, taking 1-2 years of core graduate school classes, publishing requirements for graduation). What remains to be resolved is whether these programs confer some advantage like the MD/PhD programs during the residency matching process (for ex. our MSTP students applying to pathology residencies seem to be aggresively recruited for programs such as UCSF, MGH, Johns Hopkins with promises for protected time to do research during residency).

This is always an interesting topic. I think in the end both paths lead you to the smae place. Like it has been said above it is nice to have the protected time as a PhD student to learn how to think and design experiments. However, in reality the post doc is where you really make a name for yourself with either an MD or MD/PhD. Now if money for med school is taken out of the equation also makes the decision even more difficult.

structurelab said:

Thanks for the different opinions everyone.

I've also wondered how well a PI could actually train a grad student if the PI has never been a grad student his/herself. I've been told by some that they may not be very good, while others say you would learn how to mentor grad students as a postdoc.
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As an undergraduate I trained for 3 years with a Ph.D. advisor and as a graduate student I trained for 3 years with a M.D. To be successful in academics, both PI's had to publish and get external grants. For me I do notice a difference in how they approach experiments. I think the Ph.D. advisor was very comfortable about diving into the dreaded word "mechanism". The papers tend to be more biochemical. However the Ph.D. advisor was less comfortable with human data (in other words, you can have all the tissue culture and mouse data you want, but often the human data is much more complex to interpret). His grants proposed looking at diseases, but I felt it was more bait for the NIH reviewers to show the relevance of the work (he also used it to get into institutes with better paylines).

On the other hand, my MD advisor is comfortable with the complexity of human data, but I feel from a mechanism point of view, he addresses mechanism more in the discussion than results. The experiments to address mechanism are not as tight. He is however very good at making the critical link of his experiments to a disease.

Although they have different approaches, in the end both succeed in academics and have R01 grants. I am glad I trained with both because I was able to learn from their strengths and weaknesses.

BDavis said:

As an undergraduate I trained for 3 years with a Ph.D. advisor and as a graduate student I trained for 3 years with a M.D. To be successful in academics, both PI's had to publish and get external grants. For me I do notice a difference in how they approach experiments. I think the Ph.D. advisor was very comfortable about diving into the dreaded word "mechanism". The papers tend to be more biochemical. However the Ph.D. advisor was less comfortable with human data (in other words, you can have all the tissue culture and mouse data you want, but often the human data is much more complex to interpret). His grants proposed looking at diseases, but I felt it was more bait for the NIH reviewers to show the relevance of the work (he also used it to get into institutes with better paylines).

On the other hand, my MD advisor is comfortable with the complexity of human data, but I feel from a mechanism point of view, he addresses mechanism more in the discussion than results. The experiments to address mechanism are not as tight. He is however very good at making the critical link of his experiments to a disease.

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And therein lies the value of doing an MD/PhD--you get trained to act as a bridge between the two very different fields of medicine and science. It is critical for physician-scientists to ask mechanistic questions about human disease and to develop that way of thinking early in their careers.

MD+ postdoc does not equal MD/PhD. There are many advantages to going through graduate school, as mentioned by others.

Although many MD/PhD students on this board seem to feel that the lab research was the most significant aspect of their time, the other parts of graduate education should not be overlooked or minimized. For example, I greatly enjoyed the grad classes I have taken--I feel they have increased my awareness of broad areas in the field of neuroscience and enhanced my ability to read papers.

I also feel that teaching experience is valuable, as for many who will stay in academia, teaching will be part of their career.

Preparing for the oral exam is also another aspect of graduate school that has value. I feel that it gave me an opportunity to really sit down and read all the papers that had stacked up on my lab desk, to understand my project better, and to formulate new questions and avenues of investigation.

Finally, the thesis is a very important part of graduate school and represents the body of work and data you have accumulated about a topic. Thesis committees are designed to move you along, focus your work, and generally provide support in your training. Postdocs have nothing equivalent--you are on your own.

In essence, graduate school provides a supportive environment for students to train, whereas postdoctoral fellows are simply expected to produce data and papers and generally have a much more independent role.

I think a lot of MD/PhD students end up under MD-only PIs because the MD PIs do more clinically relevant research. But that's just a guess

Vader said:

Although many MD/PhD students on this board seem to feel that the lab research was the most significant aspect of their time, the other parts of graduate education should not be overlooked or minimized. For example, I greatly enjoyed the grad classes I have taken--I feel they have increased my awareness of broad areas in the field of neuroscience and enhanced my ability to read papers.

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I guess if the classes are on subjects of interest to you, taking grad classes can be very helpful. But it can be a waste of time if you're forced to take a course on a subject you have already taken in undergrad or you have little or no interest in. True, the grad course may be more advanced, but unless it's in your field of research, you're not likely to ever use the information.

Vader said:

I also feel that teaching experience is valuable, as for many who will stay in academia, teaching will be part of their career.

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I have hardly every heard anyone tell me that they really enjoyed being a TA. At most universities, being a TA is in essence being a slave grader (well, maybe not exactly like being a slave since you are getting paid). I probably would agree more with this statement if PhD programs would actually train grad students how to lecture and give them opportunities to lecture rather than just use them as graders and office hours replacements.

Vader said:

Preparing for the oral exam is also another aspect of graduate school that has value. I feel that it gave me an opportunity to really sit down and read all the papers that had stacked up on my lab desk, to understand my project better, and to formulate new questions and avenues of investigation.

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I guess this is true if your oral exam is based solely on your thesis research. I think many PhD programs make you study many other unrelated topics that many grad students take off months from their research to study for but will forget a few months after the exam.

Another grad school requirement that I think has very little value for MSTP students is rotations. If you are really happy with your initial lab choice, shouldn't it be a waste of time to rotate in other labs. Diversification of one's research training is no longer a good reason to do rotations since most MSTP students have a lot of prior research experiences already. The only benefit you may gain is to learn new techniques, but I'm not really sure how much more understanding you would gain about technique in one rotation reading beyond the textbook.

I think what really matters in the end is still just your research and publications. No one is going to care whether you have taken certain classes, done rotations, been a TA, or taken an oral exam when you're applying for grants and trying to start a lab. All these aspects of grad training are meant to help you as stepping stones to do good research. But I'm quite sure that there are some highly prepared students out there who can certainly do without them.

Vader said:

For example, I greatly enjoyed the grad classes I have taken--I feel they have increased my awareness of broad areas in the field of neuroscience and enhanced my ability to read papers.

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I agree that classes are valuable as long as you have some choice of what to take. However for me, when I wanted to explore a topic, I would try to do a lab or reading rotation with a faculty member in that field.

Vader said:

Preparing for the oral exam is also another aspect of graduate school that has value. I feel that it gave me an opportunity to really sit down and read all the papers that had stacked up on my lab desk, to understand my project better, and to formulate new questions and avenues of investigation.

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Our qualifying exams were intended to not encompass any of our own thesis research; instead we had to propose three unrelated, different topics from which faculty chose and then we had to defend that topic.

Vader said:

In essence, graduate school provides a supportive environment for students to train, whereas postdoctoral fellows are simply expected to produce data and papers and generally have a much more independent role.

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I agree that graduate school provides a protective bubble for uninterrupted bench work and learning; however I think there is a point of diminishing returns when your Ph.D. starts to last longer than 6 years.

structurelab said:

However, I've never seen a doctor begging for money on the side of the road. But, what is the advantage of spending four years doing a PhD instead of spending that four years as a postdoc in a top lab?... Bottom line, is the PhD really necassary? Does it help that much securing an RO1? Thanks for the opinions.

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Some information on this issue can be found in the NIGMS study:
http://www.nigms.nih.gov/news/reports/mstpstudy/mstp-print.html

Thanks for all the great posts here everyone.

I am an MD doing an IM residency and am considering doing a research fellowship vs. a postdoc. How do I find out about postdoctoral options after an IM residency? I have heard of general Internal Medicine fellowships but have not come across any info on postdocs. How does one usually obtain research experience in advance of a postdoc, if is is necessary, and how do applications work? Thanks!

way to rescue a very very old thread some of the posters above have already graduated etc...

fellowship and postdocs are essentially equivalent. Since this is different depending on resources of your department, you need to go directly to your department head and see if there are grants ear-marked. There are training grants available from the NIH, as well as HHMI. If you are a superstar, there are also private money, such as ones from the Burroughs Wellcome Trust. Intramural NIH fellowship is also available. You may then gradually transition into a more independent role.

But if I were you I would start with my own department chairman.

This is the age old question and now having gone through it and having seen clinical fellows walk into lab on day #1 without *any* lab experience--i.e. never picked up a pipetman before--and two years later had become research superstars, I'm not so sure what the answer is. If you can find the right mentor who will bring you up and support you, then I'm not convinced that you need the PhD to succeed. However, I think the benefit of the PhD comes from the training. The postdoc experience is just not the same as graduate school. Plus, the PhD training--while not necessary--will give you better odds at making it. In my opinion at least...

themudphud said:

This is the age old question and now having gone through it and having seen clinical fellows walk into lab on day #1 without *any* lab experience--i.e. never picked up a pipetman before--and two years later had become research superstars, I'm not so sure what the answer is. If you can find the right mentor who will bring you up and support you, then I'm not convinced that you need the PhD to succeed. However, I think the benefit of the PhD comes from the training. The postdoc experience is just not the same as graduate school. Plus, the PhD training--while not necessary--will give you better odds at making it. In my opinion at least...

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After having finished the Ph.D. and now applying for residency, I am even more convinced that for people like us, this is the way to go. I am planning to get up and running very quickly during residency so that I can apply for (and hopefully get) funding before I finish residency. The advantage I have is that I already know the research direction I would like to take, so it a matter of getting this started and progressing sufficiently to be fundable. If I had not done it this way, I would be taking a big risk in starting a line of research as a postdoc that may or may not be ultimately fundable as an independent investigator.

If one wants a research career, how crucial is it to do a clinical fellowship? Necessary? Or can one be successful in a research career starting out with a research fellowship post-residency and going from there?

Neuronix said:

Similarly, one can see in this thread (http://forums.studentdoctor.net/showthread.php?t=585855) that the PhD really does not gain one much versus other top medical students when it comes time to apply for strong residencies.

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Did you mean to quote another thread? That's just a guy saying he thinks grades matter. Obviously, they do, but just looking at the matchlists D&G compiles suggests that MD-PhDs do help.

I agree with Neuronix. I say this as someone who finished their MDPhD over 20 years ago. You dont need a PhD to do research. You will be taken seriously as a researcher with an MD degree. But you do need a residency to be taken seriously as a doctor.
I found that by the time I had finished my residency, I was married and had two kids. I had run up debt not on education but on my family. So I ended up going into clinical medicine and never regretted it. There is lots of room for creative expression and research in clinical practice.

JHopRevisit said:

Did you mean to quote another thread? That's just a guy saying he thinks grades matter. Obviously, they do, but just looking at the matchlists D&G compiles suggests that MD-PhDs do help.

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"just a guy"... I find your lack of faith disturbing...

You are absolutely right--the PhD does affect how programs look at you (more often positive than negative) and will certainly help for the more research-oriented residency programs. However, my point was that the PhD should NOT generally be regarded as a "golden ticket" that will substitute for poor/mediocre clinical ability or lack of clinical interest. This is especially true at more clinically-oriented programs and preliminary programs. Even for many residencies at research-oriented programs, it is important to show strong clinical interest and ability.

Neuronix said:

I'll play devil's advocate for a minute...

If you're really not sure whether you want to do research or clinical work for your career, why not do your MD and part or all of your residency training first. This way, once you're a resident or fellow, you can you can decide on a career based on your interests at that time. That is, once you are finished or nearly finished with your clinical training, you will have a better sense of whether you want a majority clinical or research based career. At that point you understand the clinical world, and and can decide whether you want to go off and be an attending with the money, flexibility, and status that provides. Or, you can decide to go back and be a student, losing all of the money, flexibility, and status, but gaining intellectual stimulation and academic rewards.

Similarly, you can tailor your research to your clinical background and interests after or during residency. This is as opposed to an MD/PhD student who very often will completely switch their focus from their PhD to their residency and fellowship research. Thus, the MD-only research pathway often represents a more efficient training pathway for the motivated student. The student going into the lab, having typically not done any clinical rotations (and very rarely all), has little clue what medical specialty they will enjoy. Thus that student can either not worry about their future career research (a bad thing with the subspecialization of research), do something so broad that it really applies directly to nothing, or take a gamble that the research they do fits with future clinical interests.

Meanwhile, the pre-med really has little sense of what the clinical or research worlds are really about. How can a starting MD/PhD make a good decision about their career 12+ years from when they they finish undergrad? Consider that it's 8 years for MD/PhD then 5 years for residency and fellowship. This probably contributes to the unpublished data (will this ever be published?) I've seen that well over half of all MD/PhDs don't make research a majority of their career. So why spend 4 years of your life training for something you are more likely than not to ever substantially use? Similarly, why should we train so many PhDs who will never use those PhDs?

With medical school payback for research, you shouldn't have to worry about the medical school loans as much, so finances are not so much of an issue. Similarly, one can see in this thread (http://forums.studentdoctor.net/showthread.php?t=585855) that the PhD really does not gain one much versus other top medical students when it comes time to apply for strong residencies. These top academic residencies are the ones that set you up for faculty positions and future research. Thus, if you are strong clinically (which you must be anyway), research opportunities will present themselves to you in good time if you wish to seek them out. So in the end it's easy to make the conclusion that MD followed by research fellowship is an excellent pathway for research training.

Ok, done playing devil's advocate, flame away

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Ah, always the devil's advocate Neuronix--certainly makes for lively discussion.

I agree that the MD -> research fellowship pathway is certainly a good route for some folks, particularly ones who are not initially sure about a research career. There are several potential difficulties with this pathway, however, that deter folks from it.

1. One of the most significant is honestly debt--even with loan repayment programs, with medical school tuition as high as it is (and increasing), the payback will not cover the loans in total.

2. Another is the opportunity cost; one could go into practice, make much more money and live a much better lifestyle, versus if one were to go into research, continue to have debt and get paid much less. I think this unfortunately deters many brilliant people from entering research.

3. A third difficulty is breaking into research at a high level; the clinical world is obviously very different from the bench research world and it takes some time to get up to speed. There is less time and much more pressure to do this successfully as a postdoc compared to as a grad student. The research fellowship route allows for less "margin of error" in my opinion.

4. If you know you want to do research from the onset, would you really want to put off getting your hands wet for 4 years of medical school + a number of years of residency? It is easy to imagine that even if someone is very interested in research initially, it would be easy for this interest to wan after so many years. At that point, for many it may be more attractive to stick with clinical medicine.


I'm not saying the MD/PhD route is perfect by any means, and there are certainly several areas that need improvement. Most significantly, the post-graduate portion is simply too long. People with the motivation we have and kind of training we have acquired should be able to start a lab reasonably soon after finishing residency. Moreover, this should be strongly supported and encouraged (and actually is at many institutions). It is obviously more difficult if you end up in a field totally different from the one in which you did your PhD work. However, I would argue that the experience and thinking ability gained from the PhD years gives you a cognitive and skill set that is invaluable for getting quickly up to speed no matter what particular areas you worked in. I think the idea of doing a 4-6 year postdoc (which I have seen many examples of) in preparation for one's first academic appointment is unreasonable for MD/PhDs. Instead, MD/PhDs should be given time and support during residency to conduct significant research in preparation for a K-award, leading toward becoming an independent investigator.

At any rate, I think both pathways are reasonable and essential for different people who develop interests at different points along their career.

It is superficial but unfortuanetly true. When you have MD PhD, the wow factor is better than MD IMHO

hi,

Do MD/PhD programs expect you to enter with knowledge of what research you want to pursue? I'm hoping rotations will do the trick.

Thanks

To go back to the original question, I think the right answer for MD/PhD vs. MD+postdoc depends heavily on the individual. If you are young, have very good organizational skills, don't have unrealistic expectations of research, and willing to push for a fast PhD (these three yield to a PhD in 3.5 yrs), then MD/PhD is a very good deal. For instance, I started MD/PhD @ 21 (there are a couple more people in my program who did so as well), and will finish in 7 years. Most MDs at my school start around 23-24, and take a year off in between 3rd and 4th to do research/MPH/etc. At the end of the day you are as old as most of your MD-only colleagues. If this is the case, I think MD/PhD is a good choice.

In general I think if you can finish your MD/PhD before 30, it's worth it. The average age for the first R01 is now 42, and most PhD-only PIs spend most of their 30s in postdoc, and only get tenure track positions in their late 30s. (Is it fair to compare MD/PhDs to PhDs?) I think MD/PhD is contraindicated for people starting after 25, and the older you start, the less worthwhile it is.

If you are young and interested in translational/disease oriented research, I would say go for the MD/PhD. I have this weird feeling that in 30 years, due to the increasing number of MD/PhDs out there, this degree may be de facto required credential to get funded for certain types of research. Anyone with an MD will block PhD-onlys from access funding ear-marked to translational projects, either explicitly (as in Burroughs Wellcome Fund), or implicitly (by rejecting based on the grantee's lack of clinical intuition. I have been told this is a common objection in R01 reviews.)

The number of MDs willing to do bench research is dropping, and will continue to drop as long as career in research entails a substantial loss of lifestyle. Again, going back to the posts previously, for any of those MD/PhDs (or MDs with interests in research) ended up mostly clinical, if they can be sure (say 50-80% funding rate) that they can have an R01 to support a small/moderate sized lab, and have a reasonable (say 70% of their clinical) salary and not have to move around the country where the job is, I BET you a HUGE number would stay in research. The pipeline is leaking because an overwhelming majority of PhDs cannot make it as an independent investigator, and even for those who can, their lifestyle sucks. The odds are somewhat better for MD/PhDs (i.e. 40% success rate for K08 rather than 10% for K99) but the opportunity cost is still high.

In my particular field, a substantial number of well-known PIs in the 50-60 y o range have only an MD. There is NO younger MD+postdoc only PIs who is well-known that I can THINK of off the top of my head (believe me I do quite a bit of star-gazing, and I know all the celebrities in my field. Granted this field is relatively basic). But I can name A NUMBER younger generation MD/PhDs (<40) who are in this field and getting to be pretty successful and well-known. You really do see this effect. I think since the onset of the MSTP (in the late 70s?), the absolute best people with a disease-oriented bent DID go into this program (rather than MD+postdoc), and their influence is beginning to show. I think the biggest disadvantage of MD+postdoc as a pathway is that you won't want to do research by the time you get out of residency.

BDavis said:

As a MSTP student close to finishing with the Ph.D. I feel like the Ph.D. probably was not necessary to get where I am now. I didn't get much from my classes and my qualifier was based on a topic I did not learn about in school (our qualifiers have to written on topics outside our lab rotations or potential research interests). However I did need the protected research time that the Ph.D. provides (no grant writing; the only writing I had to do were papers, editor cover letters, reviews and abstracts). I was chemistry major as an undergraduate and it took me about 6 months to get up to speed with all the molecular biology techniques (I don't know if PI's would be happy their post-doc was just learning to micropipette for the first time).

As post-doc I would be expected to spend the first couple of months writing for grant to fund myself (although MSTP students often apply for NIH NRSA grants if they can get their grants sent to the right institute). Supposedly the Ph.D. helps you get grants (or this is what I am told by others), but I suspect for R01 grants, I am not sure how more degrees factor into it. Instead from the pink sheets that I have seen for R01 grants, the critiques focus on the quality of the grant and past productivity.

In the end, I am getting my Ph.D. from an advisor who has a M.D. (which is a little ironic) with several R01 grants. He did however do a post-doc for ~6 or 7 years after medical school.

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I couldn't agree with you more. However one advantage for MDPHD is , early on in your career, it's easier for you to get grant from NIH compared to fresh MDs. Though older,and well established MDs can get grant as easily as MDPHDs do.

so this guy did 4 med school + 4 residency + 6-7 postdoc = 14-15 years. There are a few profs at my school like that as well.

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If you're going to spend 6-7 years doing a postdoc, why not get a PhD at the end of it all?

TundraT100 said:

If you're going to spend 6-7 years doing a postdoc, why not get a PhD at the end of it all?

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That's what i'm wondering too. . .is that possible to do?

chicamedica said:

That's what i'm wondering too. . .is that possible to do?

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Yes, there are programs designed for MDs to do postdoctoral research and earn a PhD (i.e. UCSD's physician-scientist training program, UCLA's STAR program, etc).

chicamedica said:

That's what i'm wondering too. . .is that possible to do?

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Beyond the STAR program, there are many - U of CO has one. I think Pitt has one too...

Forget the PhD or the MSTP. The #1 most important factor in whether you will be a successful investigator is not whether you have tons of years in the lab (doesn't hurt, sure), it is who your mentor is who will help you get that K award and make the K to R transition as you finish up your fellowship and in the first few years that you are junior faculty. The mentor really is everything. Just to reiterate what was said before, plenty of fellows have rolled into the lab with zero basic science experience and have emerged as solid junior faculty with great potential...as long as they had a superb mentor. The PhD was a huge asset to me and it helps, but by no means does it have the importance that a lot of people attribute to it. By the time I pick up a pipette again I will have been out of basic science for 6 years, an eternity. The mentor is the key. Save yourself 3 (if you're lucky) or 5+ (if you're unlucky) years of time.

greg12345 said:

Forget the PhD or the MSTP. The #1 most important factor in whether you will be a successful investigator is not whether you have tons of years in the lab (doesn't hurt, sure), it is who your mentor is who will help you get that K award and make the K to R transition as you finish up your fellowship and in the first few years that you are junior faculty. The mentor really is everything. Just to reiterate what was said before, plenty of fellows have rolled into the lab with zero basic science experience and have emerged as solid junior faculty with great potential...as long as they had a superb mentor. The PhD was a huge asset to me and it helps, but by no means does it have the importance that a lot of people attribute to it. By the time I pick up a pipette again I will have been out of basic science for 6 years, an eternity. The mentor is the key. Save yourself 3 (if you're lucky) or 5+ (if you're unlucky) years of time.

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Any advice on how to judge who a good mentor might be when searching for a post-doc position?

WorkaholicsAnon said:

Any advice on how to judge who a good mentor might be when searching for a post-doc position?

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A "mentor" is actually not someone you work for, but someone who can give you real career advice without having a conflict of interest. Such people don't really exist in today's biomedical research environment. You may get lucky and bump into one, and develop a relationship, but most of the time you have to figure things out yourself.

As to how to pick a boss, there are different schools of thought on this. Picking a famous boss has lots of advantages. I think the fundamental issue is if you like the research topic. I think at the end of the day you should pick a boss because you are interested in his work.

WorkaholicsAnon said:

Any advice on how to judge who a good mentor might be when searching for a post-doc position?

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There are of course many characteristics that define a "good" research mentor when searching for a postdoc. Among them:

1) Funding: will the mentor be able to support you financially? Do they have Howard Hughes or other prestigious funding sources? Do they regularly obtain and renew their R01's?

2) Fame: Is the mentor well known in the field? Outside the field? Will the mentor's name help you when it comes to getting grants (i.e. K award), when trying to publish, and when applying for faculty positions?

3) Track record: Has the mentor trained postdocs previously? Have these folks gone on to big time careers in academia?

4) Interest/support: Does the research mentor take a special interest in making sure his/her postdocs are successful? Does he/she have a lot at stake in your particular area of interest? Will the mentor be willing to send you to national meetings/conferences to present your work and network? Will the mentor be someone who will "go to bat" for you when needed? Will the mentor make technical support (technician, core facility access, etc) available when you need it? Does the mentor invest in equipment and supplies appropriate for the lab members to succeed?

5) Willingness to collaborate: Does the mentor regularly collaborate with other labs/encourage collaboration?

6) Encouraging independence: Is the mentor someone who encourages their postdocs to be independent, plan their own experiments, analyze and interpret data, and present their own work?

7) Exit strategy: Will the mentor let you take a piece of the lab with you when you leave?

8) Collegiality: Is this someone who is well-liked by others? Treats others with respect?

When looking for a postdoc position, it is very important to visit the lab and talk with lab members to get the "low down" on what the environment is like. Folks in the lab will generally be very honest about these things and give you great insight into the above characteristics.

Hope this helps!

If you know you can commit a minimum of several years to an intense research subject and you are seriously considering academia, the MD/PhD route is the way to go.

1. Though there are financial options for MD/Postdocs, they are not guaranteed and in the interim, you're accruing well over $100,000 in debt. For the financial reason alone, it's smarter to have things paid for along the way without having to go through an application process that may or may not pan out 4-5 years down the road.

2. It's not just about publications: Writing and defending a thesis and prior to that, qualifying and presenting your data to your committee are IMHO a major part of obtaining a PhD. If you only do a postdoctoral fellowship, you haven't lived and breathed some of the most essential parts of the PhD candidate process. It irks me when MD/fellows say, "Well, I practically have a PhD" simply because they have research experience and some publications. To me, that's akin to saying someone has basically gone to medical school without rotating through the clinicals.

3. Being on both sides of the fence, with your medical student colleagues and then with your graduate student colleagues, and rejoining a separate medical student class upon returning to clinical training, is such a unique experience and I think, very helpful in understanding the translational mentality. As an MD/Postdoc, few are truly able to commisurate with the PhD mentality.

4. You learn a lot about academia. The politics, the strategies, the ups and the downs. It's helpful to have some of this under you belt before fellowship.

5. There are certainly examples of outstanding MD's involved in basic science research, but for the most part, MD research consists of epidemiological studies which do not address mechanism. This, to me, is not as attractive.

All that being said, yes... even with a PhD, it is smartest to follow up with a fellowship, as the majority of MD/PhD's will need protected research time after residency to get a project going. This is true especially for those pursuing different research areas. So I don't think getting a PhD necessarily waves the need to do a fellowship.

In sum, if you're unsure about whether you can stick it out with the whole MD/PhD route, I'd consider the straight MD route. If you think/know you can do it, go for it!

I'm going to have to respectfully disagree with the above post.

1. Financial reasons are the absolutely worst possible reason to consider doing a PhD, it should play absolutely NO part in your decision to pursue a PhD. It is nice to be debt free right now, but IMHO do not even let that influence your decision the slightest bit.

2. The PhD does give you a (small) leg up, but I feel that many of the hoops I jumped through as a graduate student will have a minimal impact on my ability to be a successful investigator. Just my opinion.

3. Agree that MD only cannot even begin to understand the ordeal that graduate school is....just like PhD's can not even begin to understand what being an intern is like. But is this relevant? As a clinician, whether you are straight MD or MD/PhD, you will likely have a translational focus. That is much more relevant than being able to commiserate with "the PhD mentality".

4. Agree that the earlier you realize all the BS and politics that goes into science/funding/promotion, etc. is helpful. Helps you better to prepare for all the crap you will deal with.

5. Totally disagree with this statement..., at least in my field (IM), there are countless MDs that do excellent bench research. Maybe it is different in other fields.

I really think the mentor is everything. Ask any successful academic MD or MD/PhD investigator what is the single most important factor in determining whether a fellow will become a successful investigator and I bet 99% would say "finding the right mentor" or something to that effect, it will not be whether the person in question has a PhD. It certainly never hurts (well, it hurts in terms of psyche and 4 years of your life) but I think we all put too much stock in the importance of the PhD.

Well, the above are some valid points, with an extra pinch of cynicism.... My take:

1) I agree that money should not drive the decision on whether to pursue a PhD. However, as I stated, once a student can commit to several years of intensive research and is strongly considering academia, it would be naïve not to consider financial factors. My MD-only colleagues have started receiving notices that they will need to pay over $600/month toward their student loans upon graduation from residency. Some have scrambled to get loan repayment grants (which they won't find out about until it's really too late to change jobs), but a lot of them have said "the heck with that!" and are going into private practice. Since academia is about delayed gratification, plan ahead, including the financial options.

2) Okay, I see your point that not understanding the PhD mentality may be irrelevant when it comes to becoming an independent PI. It can, however, be relevant in other career paths, e.g. administration. It's not generally something MD/PhD's shoot for, but we are probably among the best-trained physicians to take on some of these leadership roles. They also pay significantly better than traditional faculty positions in academia.

3) Small point, but an MD/postdoc who claims to "practically have a PhD" is more akin to a medical student claiming to "practically have an MD" without rotating on clinicals in years 3 and 4 or without passing Step I/II. Likewise, I think if one does not defend a PhD thesis, that's like not having completed a PhD. ABD = Masters. Internship is another ball game. Having the extra research training with a PhD makes the initial stages of fellowship a much smoother transition.

4) Yes, by definition, graduate students at one point or another become hopeless, cynical and we all have our war stories that lay people just don't get unless they've spent a lot of time with us. It's as brutal as intern year, though in a different way. And longer. The most difficult time is often the last half of the PhD candidate years. Some of that cynicism continues, and can be a healthy dose of realism. For example, my straight MD colleagues were blindly enthusiastic about research as 4th year residents, tried it out, decided they disliked research, got their student loan repayment notifications , then opted to go into private practice. As an MD/PhD, you're much more well-informed. I'm not exactly sure why you sound like it was all such a terrible experience. Do you carry even a scintilla of honor with the MD/PhD badge? Even if it's an internal sense of accomplishment?? Or do you feel like you lost time that could've been spent doing something more meaningful? Maybe you're an intern now, and too tired to appreciate much of anything? Then again, IM residency is hectic throughout&#8230; Maybe I have lower standards than you... Yes, quite likely&#8230; Well, I guess it's not my business, and these could be rhetorical questions. But traditionally, the jaded phase for the MD/PhD ends when you obtain the PhD. Then we're realists. Until we are unable to get RO1s, which leads to the second major episode of jadedness. Anyhow, in my opinion, I think the fact that you were able to complete the MD/PhD says something good about you.

5) I'm in psychiatry &#8211; Yes, maybe the relative lack of basic research by straight-MD's is specialty specific. Because despite being at a research powerhouse, I don't see many straight MD role models for research. MD/PhD's, absolutely.

6) Yes, by all means, the mentor is the most important factor.

The PhD and MD degrees are inherently distinct level degrees with very different training and completion requirements. A PhD is not necessary if an MD wants to perform clinical research or just be a clinician. However, the PhD is critical for Biochemistry/Molecular Biology research. Medical school does not provide the necessary training to perform basic science techniques, lacks a dissertation, does not teach scientific writing and presentation. Med school is concerned with memorization and test taking and does not train one to think as a scientist. I have seen many MDs that join a basic research lab as a postdoc and do not know how to perform basic research and PhD students or technicians have to train them. However, they are making a postdoc level salary Often times, they rely on technicians to get the data for them or pay a company to perform a technique that anyone with the proper tools or the understanding of basic science could perform without the need of a company. Under these conditions even a high school student could be a postdoc

Most often MDs have to do 2-3 postdocs to be well trained in basic research so they have their own labs. The standards for an MD wanting to become a PI or to get tenured in terms of publication are lower than that required for a PhD. It is true that without doing a PhD, it is possible to be well versed in basic science, but this is as true as anything else. It is also possible (in theory because as we know, the medical system prohibits PhDs from doing this) that if a PhD works very hard studying, he/she could get all the knowledge that medical school provides and I bet that if they studied with the proper materials they could pass the USMLE I and II. Just as a PhD could possess the medical knowledge of an MD, an MD can possess the scientific knowledge of a PhD, but it is going to be difficult and time consuming to do so. Therefore, I believe that if either a PhD or an MD wants to do a cross over into the other field they should go through the proper channel and complete an MD, a PhD, or do both.