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[StayChillin]

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[Lucca]

Two things.

First of all, nobody is that sure. We are all betting on ourselves. Some of us will turn out to be right, others wrong, others still might be surprised by a new set of opportunities which may present themselves. MD/PhD training is a fairly insane thing to sign up for, so doubting whether it is the one true path for you is only evidence of your sanity in my opinion.

As for me, I, like you, love science and for the moment want to keep doing it as long as I am able to in a satisfying way. I also like the clinical setting, think people and biology are fascinating, and am excited to learn the skills to have a more direct impact on others with the help of modern science. But do I have some rock solid plan? No. A glimpse maybe a dream, but not a prophecy.

Second. I think you would be absolutely insane to turn down an mstp offer just to reapply into it the next year. Take the money and run. Ask questions later. From your post, I get the sense this is the right path for youe

 

[pubh12]

You're not the only one getting some success this cycle and then thinking "what the hell am I doing?" lol. I've been getting that too.

@Lucca had some really good points, and I had two thoughts to add on.

First, my main experience of other MSTP applicants is at interviews...when we're all kinda pressured to look/feel gung-ho. I don't know if this is true for you, but if so you might be getting a biased sample of people's attitudes.

Second, I'd argue for choosing a program where the administration cares about you as a person, and not just how good or bad they make your program look on paper. If you find a MSTP director wants the best for their students (as I imagine most of them do), then that will be a much better environment to explore these feelings you're having. They do want their programs to look good, but they also don't want to force people into careers they don't want (I'm hoping).

Having these doubts is normal (at least I hope so lol). I'm planning to mark mine down to understandable anxiety about the future and the committment that these programs require, and I'm going to matriculate MSTP rather than moving to a cabin in the woods and growing a wide selection of root vegetables (as nice as that sounds sometimes).

 

[raysearch]

Some details about me (semi-anonymized):

• Have done research for 4 years full-time
• 11+ publications and first-authors in high impact journals (30+ impact factors)
• Sad leaving lab now as I am stepping away from a productive time

I have been accepted into a number of top-tier MSTPs (narrowed down to 4 now), but I am freezing up because I feel like I am being forced to make an uninformed decision. I have had a stellar time within my lab. I have forged amazing friendships and find it so enjoyable. I am also very much a people person and can see myself loving clinical medicine, but I can only determine this after some clinical rotations (thankful for 1-1.5 year curriculums). Yes, I have done clinical volunteering. Yes, I really enjoyed it. Yet, obviously “clinical volunteering” will be nothing compared to actually being in it. I have read numerous threads on students dropping their PhD and @Neuronix 's perspective on the journey as well. People state that if you don’t want to run a lab, then don’t do the PhD. How does any MD/PhD know this? Are people banking on the fact they won’t enjoy clinical rotations as much as lab? How can anyone forecast their life that far into the future? Currently, I don’t see myself wanting to run a lab, but this is because I think seeing patients daily full-time could be so fun, but it may ultimately be “repetitive and boring” as my MD-PhD mentors have mentioned. Furthermore, (maybe this is weird) I rather be a post-doc than a PI because it feels less lonely. Doing lab work in bays alongside everyone else seems way more appealing than being stuffed in an office, but then again, maybe when I get older, to have people doing work for me and having peace of mind could be appealing. I truly feel like I don’t have enough information to make this choice right now. How the heck does anyone know? I am only 23 years old.

I brought up applying internally because I feel dishonest not displaying the extreme commitment to an MD/PhD as everyone else seems to have (or maybe I am just one to express my concerns more so…). I am very low-income so I am pretty sure I am eligible for full tuition scholarships at all my MSTPs. I feel that it's somewhat better to take this day by day and during my research year (which I will most definitely take), after having done some clinical rotations, decide then to apply internally. Does this seem backwards? I just worry about dropping out of an MSTP midway as it hurts the program’s stats, it may affect my Dean’s letter, and my shot at academic residencies.


Thoughts?

Edit: People have also mentioned the mental toll of friends starting their clinical pathway or them making actual salary. I don't know how this will affect me. Many of my friends are software engineers making 300k+ and the only way that has affected me is that I get them to cover drinks. Other than that, I am happy with my tech salary!

How have you done 4 years of research full-time when you are 23?

 

[ClimbsRox]

There is value both in a research-trained physician and a medically-trained basic researcher. Maybe you'll be a top-notch clinical trialist. Maybe you'll run a research lab. Maybe you will facilitate the use of new treatments in your rural practice. The path of the MD-PhD isn't straight into PI-ship.

 

[Neuronix]

I have read numerous threads on students dropping their PhD and @Neuronix 's perspective on the journey as well. People state that if you don’t want to run a lab, then don’t do the PhD. How does any MD/PhD know this? Are people banking on the fact they won’t enjoy clinical rotations as much as lab? How can anyone forecast their life that far into the future? Currently, I don’t see myself wanting to run a lab, but this is because I think seeing patients daily full-time could be so fun, but it may ultimately be “repetitive and boring” as my MD-PhD mentors have mentioned. Furthermore, (maybe this is weird) I rather be a post-doc than a PI because it feels less lonely. Doing lab work in bays alongside everyone else seems way more appealing than being stuffed in an office, but then again, maybe when I get older, to have people doing work for me and having peace of mind could be appealing. I truly feel like I don’t have enough information to make this choice right now. How the heck does anyone know? I am only 23 years old.

This is a reasonable perspective. The best mindset in my opinion is to think you want to run a lab. Nobody can know at your point in life.

The post-doc instead of PI thing just reflects your position in the world. PIs have their own community and interactions. You can't be in the lab forever--that's the job of a lab tech. You have to reach the point where you generate the ideas, write the grants, and oversee those doing the work. Otherwise you are a lifetime lab tech, which is not the long-term career for an MD/PhD.

I am very low-income so I am pretty sure I am eligible for full tuition scholarships at all my MSTPs. I feel that it's somewhat better to take this day by day and during my research year (which I will most definitely take), after having done some clinical rotations, decide then to apply internally. Does this seem backwards? I just worry about dropping out of an MSTP midway as it hurts the program’s stats, it may affect my Dean’s letter, and my shot at academic residencies.

I was very low income as well. I'm not sure if you mean for MD-only, but the best I could do there was half tuition. That plus living expenses was still a lot of money in loans.

 

[EvoMed]

You seem like a super dynamic, engaged, creative, and collaborative researcher. I think you are the type of person that the MD-PhD is meant to empower. Even if you end up becoming a physician that spends most of your time seeing patients, your education as a researcher will empower you to think about challenging questions, pull out data and insights from places that many physicians would let slip away, and write up and publish observations. Also, regardless of the finish line, I would bet that even during your PhD time you will be able to complete a meaningful project(s)-- this whole matter is about the journey as much as the destination. I think you can forge your own future, and define your roles as you see fit for the most fulfilling career.

 

[dl2dp2]

I would stay in MSTP and just forget about your qualms for a while. This pathway has really appreciated in my mind looking in hindsight and became much more flexible and versatile, especially as tuition increased dramatically and NIH funding dropping in real dollars.

MSTP (esp. subspecialty training) != a linear combination of MD + PhD. It's actually a fairly unique pathway that makes you more accessible for certain jobs that are not about running labs. For example, your prospect in industry in a translational (such as regulatory affair, or business development etc) role is much better with MSTP than with either MD or a PhD. This pathway also opens up significant opportunities in careers outside of medicine/biopharma broadly defined (i.e. specialized financial services and consulting). These types of jobs MAY be accessible through strict MD or PhD at top end institutions, but they are usually accessible also through MSTP at a lower end institution.

Institutional leaders who are effective can smell value when they look at a CV. People who complete a MSTP with a significant piece of writing or two have a very different "feel" compared to a straight MD from even a top school, because in order to groom that person for a significant leadership role, you'd have to give them additional training. Let me be more explicit: there are significant soft skills for leadership roles in almost every organization, mainly relating to things like effectively writing on prompt, explain complex scientific/domain material, and smooth synthesis and presentation of complex ideas. PhD trains you for that, but they don't provide you with valuable subject matter knowledge (except in say econ or CS). The knowledge-base from PhD is for the most part devoid of economic value. MSTP (even though the PhD is usually in basic bio) is sort of a PhD for medicine, so its value is similar to a PhD in another practical discipline like econ/CS.

If PhD is not a good fit, you'll know fairly quickly. It's like eating garbage or hitting your head with a brick. It's very obvious.

 

[lovebiochem]

How did you get 30+ Impact factor first author paper when you are 23 out of undergrad?! That is Cell or Nature Medicine...