MD Vs. MD/PhD. Pros, cons?

soulsight5000 · Dec 14, 2006

Hello everyone!

I would like to conduct biomedical research in my career (that will most likely be a combination of basic and clinical research), and was wondering what the best career path would be. I think that an MD is generally a good idea in order to perform clinical research, and I'm debating the use of a PhD. It doesn't seem to give you the ability to any additional things than an MD can; many PIs are "only" MDs.

Advantages to MSTP programs over MD programs
- Fully funded with a stipend
- Get both MD and PhD degrees
- Develop insight into scientific methodology

Disadvantages of MSTP progams over MD programs
- MD only is shorter
- The PhD is after the first year of medical school. Once you finish your medical school and residency and come back to research... it's been 6 or so years and the field has completely changed (?)
- Long. Is the PhD necessary?

I'm graduating this year and I'm taking a year off, probably doing some clinical research. Any advice and opinions would be appreciated.
I'd love to go to Harvard HST but I haven't taken calculus up to differential equations, and I don't know if my stats are good enough anyways...

Here are my stats:
36M (13 PS 10 VR 13 BS)
~3.8 GPA
1 year + 1 summer basic science research
1 year clinical research (after graduation)
2 years volunteering at a hospital
1 Poster presentation
Various smaller extracurriculars

Thanks for your advice, and good luck! :luck:

SpeakLittleB · Dec 14, 2006

I think if clinical research is the goal, then you don't need the PhD to do it. I believe most people (at least me) who pursue MSTP are interested in basic science for the research component.

There are a fair number of "MD-only" PIs, but this does not mean it is trivial to become a PI in basic science with an MD degree. Grant-writing, running a lab, and even basic science, were issues they probably had to struggle with without having been trained formally in these areas. I believe many of them took time for rigorous basic science training if that is what they're doing (and that time could be almost equivalent to the extra time to do an MSTP program). But also, as one MD in basic science told me, the field of medicine is changing, and the medical school curriculum is not what it was like years ago. There is less emphasis on the basic sciences and more a rush to learn the ever-expanding catalogue of disease.

I also thought hard about perhaps getting only the MD and then doing research... but finally decided that I wanted the training that the PhD offers and the time differential is not so different (than if I were to do research fellowship anyway after med school). Again, if you would be happy with clinical research, I think the PhD is not necessary. So perhaps in the end it comes out to, what do u want to get out of your schooling and what are your goals in the future.

solitude · Dec 14, 2006

Another thing to keep in mind is that most of the "MD-only" PIs that actually run their own labs are pretty old, at least in my experience. These days you don't see a lot of assistant professors hired to run their own labs (and perhaps conduct clinical duties as well) that "just have an MD". So the number of "MD-only" PIs does not actually reflect the reality that it is becoming harder and harder in contemporary academic medicine to obtain a position that allows one to run their own lab, without a PhD. That's not to say it can't happen, only that a better metric than the current number of "MD-only" PI's would be: how many assistant professors starting their own labs today have "just an MD" (and not an MD-PhD, or PhD)? I think the answer to that question is, very few.

SpeakLittleB said:
I think if clinical research is the goal, then you don't need the PhD to do it. I believe most people (at least me) who pursue MSTP are interested in basic science for the research component.

There are a fair number of "MD-only" PIs, but this does not mean it is trivial to become a PI in basic science with an MD degree. Grant-writing, running a lab, and even basic science, were issues they probably had to struggle with without having been trained formally in these areas. I believe many of them took time for rigorous basic science training if that is what they're doing (and that time could be almost equivalent to the extra time to do an MSTP program). But also, as one MD in basic science told me, the field of medicine is changing, and the medical school curriculum is not what it was like years ago. There is less emphasis on the basic sciences and more a rush to learn the ever-expanding catalogue of disease.

I also thought hard about perhaps getting only the MD and then doing research... but finally decided that I wanted the training that the PhD offers and the time differential is not so different (than if I were to do research fellowship anyway after med school). Again, if you would be happy with clinical research, I think the PhD is not necessary. So perhaps in the end it comes out to, what do u want to get out of your schooling and what are your goals in the future.

chirurgino · Dec 14, 2006

I'm finishing my MD-PhD this year and am in the middle of applying for an ENT residency position.

I would agree with most of what has been said on this thread, and I'll add that it's critical to think very very carefully about what you want to do with your career before committing to an MD-PhD. It's hard (at least, it was for me) to do that when you're coming out of college, but you have to think about what the PhD is going to do for you, because it's a LOT of time. If you want to pursue clinical research, a MPH with a strong emphasis on biostatistics is probably more useful than a basic science PhD. (I suppose you could also do a PhD in statistics for clinical research, but I've personally never seen this) Also remember that you can take a year off during medical school to do research full-time, which meets the needs of many people who want to get some research experience. Beyond med school, many residencies offer research experience as well (e.g., 7 year research track for ENT at some residencies), and PIs typically will jump up and down for joy if a motivated resident (and with funding, usually!!!) wants to spend some time in the lab.

The MD-PhD program is not an easy program. Attrition rates are high (less so at my institution). You will return to medical school and I guarantee you will have attendings, fellows, and senior residents from your original med school class with a lot of power over you (and likely not as bright as you are)--you have to think hard if all that is OK for you.

All that being said, I'm convinced that the MD-PhD program sets you up to do things that very few people are trained to do. You will see things in both science and medicine from a totally different perspective than average scientists and clinicians. It will open a lot of doors (as it should) no matter what residency you apply for.

But these are not necessarily good reasons to spend 3-6 years of your life in the lab (esp help on residency apps). In my mind, the only reason to do a PhD during your MD training is if you are absolutely, totally committed to pursuing a career with SERIOUS basic science as a component. You should envision a career that is around 50% clinical practice and 50% basic research. Do NOT embark on this training if you are unsure about this. It's just too many years of your life.

solitude · Dec 14, 2006

👍

chirurgino said:
I'm finishing my MD-PhD this year and am in the middle of applying for an ENT residency position.

I would agree with most of what has been said on this thread, and I'll add that it's critical to think very very carefully about what you want to do with your career before committing to an MD-PhD. It's hard (at least, it was for me) to do that when you're coming out of college, but you have to think about what the PhD is going to do for you, because it's a LOT of time. If you want to pursue clinical research, a MPH with a strong emphasis on biostatistics is probably more useful than a basic science PhD. (I suppose you could also do a PhD in statistics for clinical research, but I've personally never seen this) Also remember that you can take a year off during medical school to do research full-time, which meets the needs of many people who want to get some research experience. Beyond med school, many residencies offer research experience as well (e.g., 7 year research track for ENT at some residencies), and PIs typically will jump up and down for joy if a motivated resident (and with funding, usually!!!) wants to spend some time in the lab.

The MD-PhD program is not an easy program. Attrition rates are high (less so at my institution). You will return to medical school and I guarantee you will have attendings, fellows, and senior residents from your original med school class with a lot of power over you (and likely not as bright as you are)--you have to think hard if all that is OK for you.

All that being said, I'm convinced that the MD-PhD program sets you up to do things that very few people are trained to do. You will see things in both science and medicine from a totally different perspective than average scientists and clinicians. It will open a lot of doors (as it should) no matter what residency you apply for.

But these are not necessarily good reasons to spend 3-6 years of your life in the lab (esp help on residency apps). In my mind, the only reason to do a PhD during your MD training is if you are absolutely, totally committed to pursuing a career with SERIOUS basic science as a component. You should envision a career that is around 50% clinical practice and 50% basic research. Do NOT embark on this training if you are unsure about this. It's just too many years of your life.

CCLCMer · Dec 14, 2006

I just wanted to add to this excellent discussion that you can also look into getting an MD/MS if you're not sure about doing a PhD. My program is a five-year program that is set up for all students to do a year of research, and there are some others out there as well. But pretty much any medical school will allow you to take a fifth year of research to do an MS if you want to do that. Just thought I'd throw that out as another option to consider.

totalcommand · Dec 14, 2006

I'd like to highlight that a PhD is not entirely necessary for doing basic research either - and basic research and clinical research do not have to be mutually exclusive.

I think the biggest reason for doing the MD/PhD is it's a much easier path for getting your foot in the door on basic or translational research.

My reasons for MD/PhD:

1) If you go for the research fellowship after MD, you're basically forced to sink or swim during that time. If you don't accomplish things quickly, the PI will most likely not give you the same treatment he would give a grad student who has problems. If you fail to learn and perform quickly, you'll find it even harder to get into research in the future.

2) You simply get a more sustained research experience doing a PhD than a research fellowship. Even if things like grant writing and running a lab will be learned later during your post-doc, you'll learn a lot during your grad years on how to develop a problem from start to completion, and learn to frame your questions and results to fit the current issues in your field over the long term.

strangeglove · Dec 14, 2006

I would add that, with a PhD, you have the opportunity to explore a subject in a way that you cannot in a fellowship, or anywhere else, for than matter. Straight MDs going into research will tend to have a narrower focus than MD-PhDs, who are usually required to learn about an entire field (e.g. neuroscience, immunology) before they begin their specialized dissertation project. There is also something to be said for a place where you are encouraged to make mistakes as part of your education. As an MD research fellow, you are obliged to publish as many papers in as little time as possible and therefore cannot spend too much time futzing around the lab, learning how to think creatively. For this reason, you are more likely to be given projects by your mentor that are low on creativity and high on routine. Sure, you'll spend fewer years in school. However, remember that as a researcher your whole life will be spent "in school" (teaching, working in the lab, seeing patients in an academic setting). The only thing that changes is how much responsibility you have over your work and how much you are getting paid. By the way, the lower salary that you'll receive as a researcher (vs. private practice) will be the same whether you are an MD or an MD-PhD.

Circumflex · Dec 15, 2006

All good ideas. I agree that the PhD portion of the MD/PhD is probably the best "protected" time of pure research you will have if you want to do basic science.

Something else to consider is that if you go through residency and want to do basic science research and have clinical duties in a related area, you will have to do a clinical fellowship. Doing 7-8 years in the MD/PhD program, followed by 3 years of IM or Peds + 3 years of fellowship + 2 years of post-doc experience is a looooooooooooooong time. There are fast-track residencies that combine residency, fellowship, and post-doc experiences that make the training a little shorter, but not much. It's just something to consider.

I am applying for Pathology residency and do not regret going the MD/PhD route, but a lot of people do it with grandiose ideas, not thinking it through all the way.

MD Vs. MD/PhD. Pros, cons?

soulsight5000

New Member

SpeakLittleB

Member

solitude

Senior Member

chirurgino

A pound of flesh

solitude

Senior Member

CCLCMer

CCLCM Alum c/o 2011

totalcommand

Senior Member

strangeglove

Full Member

Circumflex

Junior Member

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