2009 MD/PhD Match

Discussion in 'Physician Scientists' started by Doctor&Geek, Mar 16, 2009.

  1. solitude

    solitude Senior Member
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    haha it's the only time of the year when I have time to spend worrying :)
     
  2. Spacedman

    Spacedman amateur vibeologist
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    are you seriously concerned about not getting interviews after finishing a phd? think about it from a residency selection point of view. 95% of applicants to most specialties are indistinguishable suits in their mid 20s. having a second advanced degree sets you apart. unless you've bombed step 1 and you're horrible with people in the hospital, your app will at least get a good look, and you will more likely than not get an interview. especially for IM. things get dicey if you're applying to derm/plastics/rad-onc. even so, i know a md/phd who failed step 1 on the first pass and still matched into one of those specialties. anyway, bottom line, getting a phd helps but doesn't save you from having to work your a ss off as a med student.
     
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  3. Orange Man

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    Tufts (source: correlate)
    Radiation Oncology - MDAnderson
    Unknown
    Unknown

    Colorado (source: correlate)
    Internal Medicine - Colorado
    Anesthesiology - Colorado
    Dermatology - OHSU
    Internal Medicine - Michigan
    Pediatrics - U of Washington

    Minnesota (source: correlate)
    Neurosurgery - Stanford
    Internal Medicine - Vermont

    SUNY Upstate
    Internal Medicine - Weill Cornell
    Emergency Medicine - Case MetroHealth
    Radiology - Rochester
    Deferred

    Rochester (source: correlate)
    OB/GYN - Johns Hopkins
    Neurology - UCDavis
    Ophthalmology - UCSD
    Anesthesiology - Rochester

    Michigan (source: correlate)
    Pediatrics - Michigan
    Ophthalmology - Michigan
    Internal Medicine - Cornell
    Radiology - Johns Hopkins
    Pathology - Michigan

    UCLA (source: PM)
    Dermatology - UCLA
    Radiation Oncology - UCLA
    Psychiatry - UCSD
     
  4. solitude

    solitude Senior Member
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    I agree with you about the importance of having it, and how that doesn't absolve you from the responsibility of doing well as a med student, but I am still curious to see the data.
     
  5. strangeglove

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    I can say that in psychiatry, a relatively non-competitive specialty, some MD-PhDs were not offered interviews at at least one of the "top" programs in the country, despite reasonably good M1-2 grades, high board scores and publications during the PhD. There is no guarantee.

    I would add, however, that certain "top" residencies value research accomplishments above all else. Sometimes they are not so interested in clinical rotation grades, and will accommodate anyone with an MD-PhD. I would argue that on average these residencies turn out less well-trained clinicians who end up being 100% research in the end.

    There is a perception out there among PD's that MD-PhDs are not so committed to clinical medicine, and we end up spending a lot of effort trying to overcome this.
     
    #105 strangeglove, Mar 29, 2009
    Last edited: Mar 29, 2009
  6. InNotOf

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    Stanford (source: correlate)

    Dermatology - Emory
    Internal Medicine - Brigham & Women's
    Internal Medicine - Penn
    Neurosurgery - UCSF
    Ophthamology - UCLA
    Pathology - Stanford
    Radiology/Research - Barnes-Jewish
     
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  7. axlf1997

    axlf1997 Member
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    UChicago

    Anesthesia - UChicago
    IM - UTSW (research track)
    IM - UTSW (research track)
    IM - Wash U (research track)
    IM - Stanford
    IM - MGH
    IM PC - Brigham & Women's
    Path - URochester
    Peds - Stanford
    Peds - Advocate Christ
    Psych - UChicago
    Rad - Duke
    Rad-Onc - Vanderbilt
     
  8. Enkidu

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    Ohio State University

    Neurology - Ohio State
    Neurology - WashU
    Neurosurgery - Emory
    Pathology - Brigham and Women's
    Orthopaedic Surgery - Duke
     
  9. Chemdocx

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    why do you think more MD/PhDs don't go a surgical route? time?
     
  10. BozoSparky

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    I can only tell you what I thought...

    I found the hierarchy/military-style training to be too much for me...curiosity didn't seem to be valued much. I did appreciate the lack of passive-aggressiveness, though. They are straight shooters and that was great for a change. I really enjoyed my surgery rotation and respect what surgeons do.
     
  11. Enkidu

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    I kind of think that most MD/PhD students are interested in research that's not very applicable to surgery.

    I also think that there is a generally bias in the MD/PhD world against going into surgery, whether it is justified or not, I don't know.

    The time commitment might also be a problem, at least for the surgical specialties.

    Personally, I just don't think that surgery is that interesting. Maybe because I'm a nerd...
     
  12. Jorje286

    Jorje286 Member
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    There are actually quite a few who matched in neurosurgery which I find quite surprising. It's the surgical specialty with the toughest training, but seems to attract most MD/PhDs (out of surgery specialities). I'm really interested to know if these individuals plan on continuing research.
     
  13. RapplixGmed

    RapplixGmed Looking for the Ether
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    A chair of surgery at a top 20 school told me that in his experience, most MD/PhDs who go into surgery do not end up doing research at the end of training. The major issue for those people, he said, was that the MD/PhD training was so long plus the surgical training time, that the trainees ended up being far removed from the research field they originally trained in, behind on the literature, and life tends to change people over time so he said they generally just went into clinical practice so they can earn a comfortable living for their families. He told me that the best research surgeons from his experience all started their research in residency or fellowship.

    Ironically, this was at an interview for an MSTP program... I did not get in...:laugh:
     
  14. Neuronix

    Neuronix Total nerd
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    Do most MD/PhDs who go into any field end up doing research at the end of training?

    I don't see how this is different for surgery versus other specialties.
     
  15. pseudoknot

    Physician PhD Faculty Lifetime Donor Verified Account 10+ Year Member

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    I have to say, this is an incredibly good point, and in retrospect it seems obvious, but it never occurred to me. Indeed, not only do most straight PhDs not stay in academic science, they couldn't if they wanted to because it's a pyramid scheme. This makes the whole argument about individual MSTP trainees staying in science seem quite pointless.
     
  16. gstrub

    gstrub Member
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    I suppose the argument can be made that for surgery, (unlike any non-procedural specialty) more hands on time is required to remain proficient.

    But I am with Neuro on this one...plus I am heavily considering a surgical subspecialty. Also I can't stand when people say "there's no research in that field so why would a MD/PhD do that." First off, there is PLENTY of research in surgical subspecialties, particularly surgical oncology, neurosurgery, ENT, hell even plastics.

    That being said, if you want to cut that chain tying you to the research bench, there is no better tool than a surgical saw...
     
  17. britishmafia

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    Something I've noticed in general about MSTP programs regarding how they view post-graduation success is not necessarily where they match. Instead, it's the classifications of where they end up. Breakdowns years out of those going into academic medicine, private practice, pure research, consulting, etc. are what they focus on.

    To them, they seem to consider it more of a success to see an MSTP graduate go into a postdoc and full-time research than to go into residency and then private practice. Directors really try to push the research side of things, and you'll notice a lot of top research-heavy MSTPs having match days with a few going straight postdoc as opposed to residency.

    I also believe it is a horrible practice to base the success of programs solely off of these lists. You should also consider intangibles, like whether it was their first choice, whether they were pulled more to research than medicine, or other personal reasons. Just throwing that out there. It's alright to think about motivations or options for residency/postdoc, but my perspective is that it is a poor gauge of program quality.

    Just had to get that off my chest after reading some of the comments being thrown around in this thread.
     
  18. gstrub

    gstrub Member
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    One guy who didn't match earlier nabbed a Rad Onc spot at U. Pitt. Awesome.

    PITT Research Fast Track IM
    DUKE Path
    Penn RADS
    PITT Rad Onc
     
  19. OP
    OP
    Doctor&Geek

    Doctor&Geek 25 > 5 / 15 < 8
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    Lucked out. Pitt didn't rank enough this year.
     
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  20. gstrub

    gstrub Member
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    Remember, this applicant interviewed for Rad Onc but didn't rank any Rad Onc programs. Likely he was highly ranked by Pitt in the first place as he was an extremely competitive applicant for that field.
     
  21. OP
    OP
    Doctor&Geek

    Doctor&Geek 25 > 5 / 15 < 8
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    If they ranked him, and he didn't rank them, I would think they would have had an interesting conversation during scramble.

    PD: "We ranked you. Why didn't you rank us?"
     
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  22. solitude

    solitude Senior Member
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    Wait why didn't he rank a single problem??
     
  23. OP
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    Doctor&Geek

    Doctor&Geek 25 > 5 / 15 < 8
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    UCI (source: e-mail from student)

    Neurology - Partners/Harvard
    Neurology - UCLA
    Pathology/CP - WashU
     
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  24. OP
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    Doctor&Geek

    Doctor&Geek 25 > 5 / 15 < 8
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    This fortunate soul applied for more than one specialty, ranked only one specialty, failed to match into that specialty, and then scrambled into a specialty in which the person did not rank.
     
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  25. solitude

    solitude Senior Member
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    I see. I didn't even know that that was an option.
     
  26. RxnMan

    RxnMan Who, me? A doctor?
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    These are the reasons why I wonder if integrated MD/PhD programs may not be the best use of money if their intent is to create clinician-scientists.

    Do MD/PhD graduates get grants more frequently? Sure, the published grant success rates seem to indicate a small benefit over MDs and PhDs (PhDs still get more grants). But would the NIH and schools get more bang for their buck (i.e., more academic physician-scientists per dollar spent) if they stressed post-MD, research residencies a-la the ABIM research pathway? You'd weed out the "did it for the CV," direct-to-PP-ROAD crowd and the material of the PhD would likely be more relavant to the trainee's career.

    Note I'm not debating whether MD/PhD programs can train some good physican-scientists. But is there a different order of operations that will net us better results?

    /thread hijack
     
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  27. Spacedman

    Spacedman amateur vibeologist
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    so, instead of "did it for the CV" (which is a slim minority as it is) you'll get people "doing it to get out of that massive debt i accrued as a med student". if you've got a 22 year old interested in research and medicine, i tend to doubt that 6+ years of all-clinical education is the best way for the NIH to cultivate a potential researcher. anyway, doesn't the NIH already give financial incentives for straight MDs to do research after med school?

    as others have posted before (?Vader?), what we're missing is real outcome data for the MSTP.
     
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  28. Neuronix

    Neuronix Total nerd
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    Everyone is pointing this out. Keep in mind a few things in this game.

    MD/PhD directors are trying to increase the size of their program. They believe in what they're doing. Their success is measured by how much money they can get into the program and how much it grows. Of course outcomes are important. But, directors are only going to say and do those things that benefit their programs and MSTP as a whole.

    If you read the literature there are plenty of competing loan repayment and 5-year programs. These programs constantly try to boost their own programs (i.e. find money) and part of that is in comparison to MSTPs. They will constantly say they wish they had data on things like MSTP outcomes so they could make their own objective comparisons to try to spin things their way to get a slice of that MSTP pie.

    Hence, everyone knows MSTP is missing real outcome data. The question in my mind is why. Is it just poor record keeping, poor cooperation among directors, are is something being hid. It doesn't matter to me really, I just like to get people to think about these things. The more we all collectively sit around and spin MSTP as being a good thing that is worth a tremendous investment to produce scientists, the more money MSTP gets. Should this be the way it is? Who knows... It depends on your perspective. Do you run a LRP or 5 year program? Do you run a MSTP? ;) NIH money is competitive... You don't want to shoot yourself in your own foot do you? What happens if your program is cut while you're in it?
     
  29. RxnMan

    RxnMan Who, me? A doctor?
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    The "slim minority" is not my experience. But fair enough: I hadn't thought of the bolded point, and it's a good one.

    Possibly. Right now we have a range of training programs, some of which integrate clincial and research experience:

    - MSTP and MD/PhD programs
    - the ABIM research residencies, CSTA programs, and similar
    - year-off programs HHMI, DDCRF
    - combined research/medical training (e.g. CCLM)
    - post residency MS/PhD training (e.g. fellowship +/- NIH loan repayment)

    They do, but my question is how to best spend limited dollars.

    I agree. The MSTP cohort has improved grant success rates. But it also costs a lot of time and money, and there's significant hurdles with when to do the PhD, going back to the wards, timing of Steps, PhD burnout, applicability of PhD to medical practice, and where program participants go after graduation.

    I think this measure of success - obtaining funding - is entirely reasonable and is what every program director, be it a residency, department, or MSTP, will point to as proof. And no director will talk down their program for obvious reasons.

    But they need to show the results of where everyone goes. That means long-term f/u on all people who start the program, not just graduates, preferably compared to failed applicants and/or MD students. This data should also be compared to the results of the programs I listed above.
     
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  30. solumanculver

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    I kind of think that this "resume padding" group might be almost purely imaginary. I think that what you're seeing is MD/PhD students who are disenchanted with research and want to go into private practice, and to look on the bright side they reinterpret their PhD as something to pad the resume with. This is quite a bit different from people going into MD/PhD programs purely to improve their resumes and not planning on doing research from the beginning.

    I'm not sure that grant success rates are the best indicator of the success of MSTP programs. To be honest, I'm surprised that MD/PhDs have a higher grant success rate than straight PhDs at all. After all, the idea behind MD/PhDs is not that they're suppposed to be better scientists than straight PhDs, which is what a higher grant success rate might indicate. I think that the idea is that MD/PhDs will have different kinds of ideas that are informed by their clinical experience, and that they may have more success in translational projects.

    I don't think that these problems are really all that problematic, and I think that comparable 'problems' could be found for any of the alternatives that you mentioned.
     
  31. JHopRevisit

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    They definitely track a lot of this data for their grants, it's available. We release a lot of our outcome data, including exactly what % is in academics, private practice, etc. based on a survey we do. I think there was some problem you had with the data, something you thought was misleading, but I forget what it was (separate from the graduation times increasing issue, although based on the just matched class graduation rates are holding steady in the last 5-6 years I think, though they definitely have ticked up about .5 years for us since the 90's).

    I mentioned a while back that I thought someone could cross-reference old graduating classes and the CRISP database to see what percentage have R01s, but I think for whatever reason we decided that was too complicated (maiden names is the only issue I remember off the top of my head).
     
  32. JHopRevisit

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    I mentioned a while back that I thought someone could cross-reference old graduating classes and the CRISP database to see what percentage have R01s, but I think for whatever reason we decided that was too complicated (maiden names is the only issue I remember off the top of my head).
     
  33. itsallthesame

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    I think the reason that this data isn't published or tracked widely is that it would be bad data.

    Remember we are scientists? The question is: given an input (person X) what do you get as output when you shift funding from program I to II?

    But we can't really quantify input or output. How can you ascertain what educational path a person would have chosen if a given option was taken away? If you take away the MD/PhD option, would people end up in med school, grad school or law school? Would they do MD then research fellowship or would more people just practice medicine? No way of knowing without taking it away. Is it worth that risk?

    Secondly, how would you quantify output? It's easy to look at the "number of people who end up in research." But really, that's meaningless. The important question is "what is the benefit to research?" To answer that we'd need to evaluate the quality of research.

    If the MD/PhD program is increasing the quality of research and/or medicine and/or health/science policy in this country over alternatives, it is worth the price; however, everyone knows that that would be such a subjective assessment that it's not really worth keeping track of.

    Basically tracking outcome by career path is 100% worthless (and for the same reason using grant data since you don't really know the input and what these people would have done with their lives if not for the md/phd program.)
     
    #133 itsallthesame, Apr 13, 2009
    Last edited: Apr 13, 2009
  34. itsallthesame

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    it's like trying to ask what the single best way to approach long term treatment of cancer as a disease in america is.

    the problem is that you need to find very bright, highly motivated people. they have to be interested in working long hours, training extremely long and hard, and giving up the ability to make a ton of money. no matter how you look at it, the people who make serious contributions to medical science work long hours and devote their lives to it. there won't be a single good program because either it will cost too much money, won't have enough training or will see too many of its grads go on to give up science in exchange for making money.
     
  35. Neuronix

    Neuronix Total nerd
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    1) The data on the Hopkins website seems to pools current residents/fellows in the percentages for current outcomes. Not a serious issue.

    2) Just because someone is in academics does not mean they participate in research. I want to know what percentage of MD/PhDs graduate from programs and go on to lead majority research careers. Or perhaps, how many go on to obtain an R01 grant.

    It is a good suggestion cross-match old class lists with the CRISP database. The question is, how do you get the class lists?
     
  36. JHopRevisit

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    Well, there's an "in training" category, and an "academic" category. But you're right, just cause someones in academics doesn't mean they're researching, and I would guess a good percentage of our medical school class is in academics as well, so I can't prove we're better than our "control."
    (Oh, and sorry, your post seems out of whack now cause I deleted that part right after I wrote it cause yet again I thought better of having that discussion ;-), This happens all the time, you're always on and quick with the trigger).

    As far as getting the class rosters, maybe just email the programs? D&G does that type of thing, maybe (s)he could do it, since it comes up so often.
     
  37. BNSN

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    Has anyone ever come up with a reasonable number estimating how much is spent on training MD/PhDs by the NIH and individual university funds?

    An example calculation that could or could not be accurate:

    Penn takes 24 students at a rate of 45000 tuition + 28000 stipend + 2000 health insurance = 75000/year/student * 24 students = 1.8 million for one year worth of students. Mulltiply that by 8 years worth of students, you get an incredible $14.4 million per year to train 192 students at only one program. This doesn't include any funds dedicated towards the actual upkeep of the program, the program director salary, administration, etc. Let's be conservative and say that is all $600,000. That means Penn spends $15 million dollars on its MSTP per year.
     
  38. itsallthesame

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    I highly doubt that the mstp program is giving support to penn's students for 8 years. Probably more like 3. Also, I highly doubt that all 24 students are on MSTP training grants.
     
  39. StIGMA

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    Not to mention, much of that money would be spent anyway either as scholarship money to attract top medical students or as tuition/stipend to train PhDs. The question is then how much extra does it cost for training in the other field and if that additional training is worthwhile. I can't find the data, but at an interview one of the directors said that each year the MSTP grants pay on the order of $300,000 to around two mil each to the top ~20 programs.
     
    #139 StIGMA, Apr 14, 2009
    Last edited: Apr 14, 2009
  40. fairalexfield

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    You have to remember, the graduate program usually takes care of the students once they're done with M1/M2 so you can cut that number in half immediately. Next, just because we get free tuition doesn't mean they're actually paying it. It could be an agreement with the med school to kind of just shove us in there (it doesn't cost that much to grade an extra few exams every year).
     
  41. JHopRevisit

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    I think the NIH has to give the total number it uses on the MSTP training grants, in fact as I remember those numbers were floating around on this forum a while back. I could probably find them on the website if I had time, but I'm in a hurry. Maybe someone else can hunt them down, probably much more accurate than trying to calculate it.
     
  42. itsallthesame

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    One program that interviewed me had 3 of 7 spots MSTP funded for three years (M1-2, G1). Using 40K/year tuition (only two of those years since go G1 tuition paid) and 30K/year stipend + health, you'd see that the average yearly cost would be ~510K for the fed. Considering grad school cost is same as would be a PhD student, the grad school years aren't really a cost to the school per se. The school is then putting in payment for 8 M1/2 and 14 M3/4 in any given year for a total of $1.54 mil/year.

    That means that, at that one MSTP program, the Fed is only footing the cost of 25% of that MSTP. Now, if one of those seven kids stays in research (what everyone seems to think of as an MSTP success) then you've got a cost of $510k on the part of the gov't to produce an extremely well trained scientist. Two of seven (<30%) and you're down to a mere $205k. And that's right about the cost of a medical education (and you get 5 docs with no debt at no cost to you as a bonus, not bad).
     
  43. StIGMA

    StIGMA Doctor Professor
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    That is nice and all, but the money the school pays apart from MSTP funding is not entirely private donations or endowment. Part of the extra funding is coming from other sources, for example as distributed from pooled collections of all grants from a university that are taken as overhead from each awarded grant. I am curious how much non-MSTP federal funding also pays for MSTPs.
     
  44. RxnMan

    RxnMan Who, me? A doctor?
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    If you guys get tuition and stipend, you're getting money. Period. Remember opportunity cost - if they simply "don't charge tuition," then they are losing money by not filling that seat with someone who would pay. It's still a cost to the school.

    Again, opportunity cost. But if the funding is so different, then you could separate folks based on MSTP and non-MSTP MD/PhD.

    Sub-dividing the population would improve your survey's results because it would take a relatively unproductive (research-wise) group out of the analysis and allow you to focus on the productive academicians.
     
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  45. itsallthesame

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    I was talking about cost to the gov't, not med school (eg penn) themselves.

    I believe the thrust of the question is whether the mstp program is a good use of gov't $. It's almost certainly a good deal for med schools, as it tended to attract better grad students to schools and serves as a scholarship type thing to pull in good kids. Not to mention that (I'm pretty sure) that F30s are funded at a higher rate than the PhD equivilent, so these people are more likely to bring in individual federal $ to cover their grad stipend (plus m3/4).
     
  46. RxnMan

    RxnMan Who, me? A doctor?
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    If you're excluding MSTPs, then you're talking about school-supported MD/PhD, which have been shown to have the same effect on research careers as students in year-off programs. In that case, the school's money would be better spent funding 7-8 kids to do research for one year instead of one MD/PhD.
     
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    #146 RxnMan, Apr 15, 2009
    Last edited: Apr 15, 2009
  47. RxnMan

    RxnMan Who, me? A doctor?
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    If you have 7 spots/year, with the average length of stay for a MD/PhD of 8 years, you'll have 56 kids at one point or another in their training, in the program at any time. Each kid has 40K of tuition and gets 30K of stipend per year. That costs 3.9M/year total.

    You said that 3 of these spots were MTSP-funded for 3 years (I assumed that MSTP + gov't pays for all of MD + PhD training, but OK). So then that becomes (7 x 8) - (3 x 3) = 45 (i.e., at any one time, 56 kids will be in the program, but 9 of them will be in a year that's MSTP funded).

    We get a cost per year for the school: $3.1M
    Cost per year for NIH: $630K

    Very different numbers than what you presented.

    We can talk about subdividing these populations. But if it takes 8 x 40K to train a MD/PhD, then that money has to come from somewhere. We can't talk about one component of the money and act as if the rest just took care of itself.
     
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  48. itsallthesame

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    Regardless of who is paying, graduate school is free and comes with a stipend. My (and I think others') point is that you don't consider the cost of the PhD years (tuition which is way lower than med school + stipend) as a factor because A) labor is provided in exchange and B) these are graduate school slots where, if students weren't coming from the MD/PhD program, they'd be coming from a straight PhD program.

    Basically, you should only consider the 4 years of medical school a true cost of an MD/PhD program to the school itself. When considering the cost to the gov't, you can factor in a paid stipend for any PhD years (and if there is a payment to cover tuition, that as well).
     
  49. RxnMan

    RxnMan Who, me? A doctor?
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    :laugh: You realize that this is a non-sensical statement, right? You also know money doesn't come from trees, right?

    It doesn't matter if you think if PhD time is worth worth less, or if because you trade labor for tuition it doesn't cost anything (again, *value*), or if you believe anyone agrees with you: you incur tuition, a cost, as a grad student. A student proposing that graduate school does not cost anything would be laughed out of any basic econ class.
     
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  50. JHopRevisit

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    Hmm, what do you mean? We just collect survey responses from people that say "I'm still training" or "I'm a junior faculty at XYZ university," and we just take whatever responses we get and publish them. What do you mean sub-divide?
     

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