2009 MD/PhD Match

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

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  1. itsallthesame

    itsallthesame 2+ Year Member

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    *sigh* yes, i'm NOT saying that it doesn't cost money to have grad students.

    The question is over the COST of an MD/PhD program to a school and to the government. A given school needs to have X number of people working in its labs to get research done. Grad students are the cheapest labor (trust me, as a tech I cost way more than any grad student including the cost of tuition). This money is usually covered by grant funding (direct or indirect).

    Now, you have X number of people that need to work at the graduate student level. They can be either in an MD/PhD program or in a PhD program. During the graduate school years of the MD/PhD program, the University is incurring the same cost for its MD/PhDs as it does for it's PhDs and getting the same benefit in terms of being one of X workers. Therefore, when examining the marginal cost of having an MD/PhD program to a university, you should exclude the fixed cost of labor during the PhD years because it will be incurred regardless of whether the students doing the work are MD/PhD or PhD only.

    Finally, in order for a university to survive, the average lab HAS to be bringing in more money in grant money than it is spending on personnel (tuition and salaries) to survive (through indirects that don't kick back to the labs). That means that your average grad student must be part of a team that is bringing in more money than it costs (aka a profit). Therefore, the cost to have grad students at a university that is successful is, in fact, negative.

    So, in conclusion, when looking at the cost of an MD/PhD program, you need only to look at the cost of the medical school years. As to cost to the gov't, it's likely only a small fraction of the cost to universities.
     
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  3. Vader

    Vader Dark Lord of the Sith Moderator Emeritus 10+ Year Member

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    Career outcomes are quite important if one is interested in finding out whether the program is effective in churning out biomedical researchers vis a vis the stated MSTP program goal. For instance, I would say that a program that an MD/PhD program that produces 10% researchers is significantly less effective than one that produces 70% researchers, wouldn't you?

    You are correct, however, that it is more difficult to compare the efficacy of MSTP programs to other training pathways, although this could be done to some extent comparing MSTP to non-MSTP MD/PhD programs or other medical research training pathways (i.e. MD with thesis programs, PhD-only programs, etc).

    You are also correct that the issue of what constitutes an appropriate outcome measure is a difficult one. I think it would be important to look at percentage of biomedical researchers produced by the program, success in obtaining NIH funding, and publication number/impact factor. It is also important to look at the debt incurred, years of productivity, career satisfaction and other measures that quantify the potential benefits of the program. For example, even if there is no difference compared to other biomedical training pathways in terms of quality of researcher produced, the fact that MSTP students graduate debt-free could be seen as a major advantage that justifies the program.

    I think it is the variability in possible career paths of MD/PhDs that is a major factor that makes quantification and comparison of efficacy difficult. There is also program-to-program variability in terms of the percentage of biomedical researchers that are produced, making an overall comparison between MD/PhD vs. other pathways difficult. Finally, there is no way to reasonably do a randomized controlled trial to truly assess the effect of MSTP pathway vs. other pathway on career outcome. Thus, we are limited to cohort and case-control setups to address these questions.
     
  4. Armess

    Armess Junior Member

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    I'd like to make a correction.


    Rochester (source: correlate)
    OB/GYN - Johns Hopkins
    Neurology - UCDavis
    Ophthalmology - UCSD
    Orthopaedic Surgery - Cleveland Clinic
     
  5. Doctor&Geek

    Doctor&Geek 25 > 5 / 15 < 8 Lifetime Donor 10+ Year Member

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    Physician
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    Emory (source: correlate)
    Neurology - Emory
    Neurosurgery - UCSF
    OB/GYN - Pitt
    Pathology - Brigham
    Psychiatry - Emory
    Psychiatry - Penn
    Postdoc
     
  6. Doctor&Geek

    Doctor&Geek 25 > 5 / 15 < 8 Lifetime Donor 10+ Year Member

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    Physician
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    UTMB (source: correlate)
    Internal Medicine - UTMB
    Pathology - UAB
    Pathology - UTMB
    Radiation Oncology - Utah
    Surgery - SUNY Buffalo

    Duke (source: website)
    Anesthesiology - Duke
    Internal Medicine - Brigham
    Internal Medicine - MGH
    Internal Medicine - St. Mary's (?)
    Internal Medicine - UCSF
    Pediatrics - Penn
    Unknown

    Arkansas (source: correlate)
    Neurosurgery - Arkansas
    Surgery - Arkansas
     
    Last edited: May 26, 2009
  7. URHere

    URHere 7+ Year Member

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    There were 5 OHSU MD/PhDs graduating this year. I have data for 4 of them (I'll add the 5th when I can)

    OHSU
    Pathology - U. Washington
    Peds - OHSU
    Internal Medicine (Cardiology fast track) - OHSU
    Internal Medicine - Utah

    I know at least 3 of these students ended up with the first choice spot, not sure about the other.
     
  8. Doctor&Geek

    Doctor&Geek 25 > 5 / 15 < 8 Lifetime Donor 10+ Year Member

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    The fifth student deferred (source: director).

    MUSC (source: website)

    Internal Medicine - UAB
    Pediatrics - UTSW
    Radiology - U of Washington
    Radiation Oncology - Fox Chase
    Radiation Oncology - Stanford

    Mt. Sinai (source: newsletter on website)

    Internal Medicine/Medical Genetics - Mt. Sinai
    Internal Medicine - BID
    Pathology - Penn
    Pathology - UCLA
    Pediatrics - U of Washington
    Radiation Oncology - Mt. Sinai
    Venture Capital

    U of Washington (source: me bothering them to get their website updated)

    Emergency Medicine - Yale
    Family Medicine - UCSF
    Internal Medicine - MGH
    Neurosurgery - U of Washington
    Pathology - Yale
    Psychiatry -UCLA
    Deferred
     
    Last edited: Jul 1, 2009
  9. Doctor&Geek

    Doctor&Geek 25 > 5 / 15 < 8 Lifetime Donor 10+ Year Member

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    Add Also:

    "Postpone radiology residency for 1 year
    Fine Art Photography Intern
    Schatz/Ornstein Studios
    New York, NY"

    Awesome.
     
  10. Doctor&Geek

    Doctor&Geek 25 > 5 / 15 < 8 Lifetime Donor 10+ Year Member

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    Discrepancies:

    More and more now, I'm beginning to see that my data collection method is not absolutely faultless. In more than a few cases, I am beginning to see one cannot trust the information found on websites when compared to student reports.

    ====

    Examples:

    A student reports that his or her program had a prelim matcher in internal medicine at residency program "X".

    His or her program later reports a match in internal medicine at residency program "X" leaving out the "prelim" part!

    OR

    I find a school-wide match list, and compare it to a program's roster. A graduate's name is missing.

    That graduate's program later reports on their website a match in internal medicine at a low-ranked residency program "X" not found on the school-wide match list.

    Suspicious, I google that graduate's name and residency program, and find that that student is a preliminary only match!

    OR

    Based on a program's roster on their website, I know that there are say for example ten students that are MS-4.

    That program later reports nine students graduating on their website.

    I google the missing graduate's name and find that that person is out of medicine entirely!

    ====

    These are all true examples just from this year. Of course, I should not have been so naive to believe everything a website says to be gospel; however, I did not believe that some programs would withhold certain information - behavior I might consider to be deceptive.
     
  11. Neuronix

    Neuronix Total nerd SDN Advisor SDN Administrator 10+ Year Member

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    Might? It's very deceptive. Add to it the case I've seen from my program of someone a few years ago who wasn't doing a post doc or residency but came up on the match list as "post doc". I think it's absolutely lying. These match lists are recruiting and funding acquisition tools, and nobody wants blemishes on their's, even though it happens in real life.

    I remember when I was an applicant I was told the PhD would basically get me any residency I wanted. Now that I'm here it is simply untrue. Those students I know who matched very well were all AOA. Those who didn't match or didn't match at big name places all of a sudden were "problem" students, just like the ones who took 9+ years to graduate, yet when you meet those students you hear a very different picture.

    For me there's no might about it. It's all a part of very deceptive marketing. Thanks for this interesting perspective. You're in the best position to know how much this is going on. I imagine you've known about odd cases over the years, but I wonder if you have a sense of what percentage of students are discrepancies and if this trend is increasing (though be careful for bias that you're able to pick them up more now). Interestingly, this would probaly inflate the number of MD/PhDs in Internal Medicine on your list, but by how much it seems unclear.
     
  12. Doctor&Geek

    Doctor&Geek 25 > 5 / 15 < 8 Lifetime Donor 10+ Year Member

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    I'm the one who will get up in July to present this stuff - do you really think I'm going to ask the people in charge why they're not being completely truthful to their faces?

    The huge red flag is a graduate entering low-ranked "categorical" internal medicine/pediatrics/OB/GYN residency. Unless the student is a horrible human being, an MD/PhD is almost guaranteed to land an IM spot at a good research institution. There are not too many incongruent matches in previous years, but it seems like this year we have a problem.
     
  13. Doctor&Geek

    Doctor&Geek 25 > 5 / 15 < 8 Lifetime Donor 10+ Year Member

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    Mar 25, 2002
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    This is the last NIH-funded MSTP:

    Mayo (source: director)
    Plastic Surgery - South Florida

    and I'm spent :p
     
  14. malchik

    malchik New Member 7+ Year Member

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    Jul 19, 2006
    One that really bothered me was hearing that a MSTP director was selling to applicants an average time to graduation of 7.5 years when I knew it was well above 8, when considering the previous 4 years or so.
     
  15. Gfunk6

    Gfunk6 And to think . . . I hesitated Lifetime Donor SDN Moderator 10+ Year Member

    Nice. Is he/she taking over the old McNamara/Troy center?
     
  16. Doctor&Geek

    Doctor&Geek 25 > 5 / 15 < 8 Lifetime Donor 10+ Year Member

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    USF is in Tampa, not Miami :p (though of course she might be opening up a new branch!)
     
  17. JHopRevisit

    JHopRevisit 7+ Year Member

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    Oops.
     
    Last edited: Jul 2, 2009
  18. Neuronix

    Neuronix Total nerd SDN Advisor SDN Administrator 10+ Year Member

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    Charting outcomes 2007:
    # of US Seniors who did not match: 1,157
    % with a PhD degree: 2.8
    % of matched applicants with PhD: 4.0%
    Total # of unmatched MD/PhD students: 32

    Charting outcomes 2009:
    # of US Seniors who did not match: 1,961
    % with a PhD degree: 3.7
    % of matched applicants with PhD: 4.2%
    Total # of unmatched MD/PhD students: 73

    This very much seems like a growing problem to me. The 2007 data includes two clear notes that PhD assists students in matching to competitive specialties. The 2009 data includes no such notes. In the specialty I plan to apply to, 24% of applicants with PhDs did not match. This is identical to the percentage of those without PhDs who did not match.
     
    Last edited: Aug 16, 2009
  19. mercaptovizadeh

    mercaptovizadeh ἀλώπηξ 10+ Year Member

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    I doubt the PhD is a "bad" thing. Even if a residency program cares not a bit for a PhD, I doubt they'd look on it as a negative. The problem seems to be that many MD/PhD's don't do their research properly and explore how highly research is valued by the residency programs they're interested in. They slack off, don't excel as much (or can't) in the med school years as their MD-only competition, and then they're shocked when it turns out that that's all the residency programs really care about.
     
  20. gstrub

    gstrub Member 10+ Year Member

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    How many unmatched MD/PhD seniors did not enter the match? Any? What percentage were FMGs? It says n/a for some of that data.

    I saw for ENT for example that out of 8 MD/PhD applicants, 7 matched...same trend for other smaller fields, so I am not concerned. It looks like 2009 was more competitive across the board from my initial cursory glance...
     
  21. Neuronix

    Neuronix Total nerd SDN Advisor SDN Administrator 10+ Year Member

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    Word of mouth from a student one year my senior is that 4 (!) students from last year's batch at our school failed to match.
     
  22. mercaptovizadeh

    mercaptovizadeh ἀλώπηξ 10+ Year Member

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    :eek:

    4 MD/PhD's from UPenn not matching in one year! What were they applying to - derm, plastics, and rad/onc?
     
  23. Neuronix

    Neuronix Total nerd SDN Advisor SDN Administrator 10+ Year Member

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    Derm, Rads, OB/GYN (scrambled into rare OB/GYN prelim spot), and wasn't sure.
     
  24. BozoSparky

    BozoSparky 10+ Year Member

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    ...hmm, if that's true, do you know how selective the applicants were when making their match list. (i.e. did they only rank the top 3 programs in the country?)
     
  25. gstrub

    gstrub Member 10+ Year Member

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    Dude. They must have done something horribly, horribly wrong (i.e. ranked 3 programs, interviewed without having completed major core rotations, complete dorks with no interpersonal skills, <200 step I, etc.). Also I would be concerned with whatever entity advises students when it comes to matching...either the students weren't listening, or that office is terrible.
     
  26. mercaptovizadeh

    mercaptovizadeh ἀλώπηξ 10+ Year Member

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    Don't you find it peculiar that there would be so many people like that in one class at a top 3-5 rank school? I mean, that would indicate a complete lack of critical self-reflection and common sense.

    What would be very useful is for residency programs to release the average stats of MD/PhD matchees. That way applicants could see exactly how much, if at all, the PhD really compensates for deficiencies. People may be going in thinking they'll be matching at UCSF Ob/Gyn for sure because they have a PhD but are not realizing that they won't even get a sniff with that 205.
     
  27. Neuronix

    Neuronix Total nerd SDN Advisor SDN Administrator 10+ Year Member

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    I don't know the situation for all of them, but I can say for two out of the four that they applied broadly but received few interviews. This is presumably due to not high enough Step I and clinical clerkship grades. However, the Step I scores were certainly not <200. Things are definitely not as clear cut as exaggerated by mercapto and gstrub. I won't comment further because I don't want to invade anyone's privacy. But to me it seems their medical school performance was acceptable, but not stellar, and to me it seems that an excellent med school performance is required for competitive specialties regardless of MD/PhD.

    I do think advising has been somewhat poor for those students. But I think that's because this is a somewhat new situation and growing problem (see post #167 in this thread) for MD/PhDs as MD/PhDs become more numerous, research funding remains very tight, and competitive residencies get more competitive. Even the advisors are surprised at how things are going, and are modifying their current advice.
     
    Last edited: Nov 29, 2009
  28. gbwillner

    gbwillner Pastafarian Moderator Emeritus 10+ Year Member

    The residency application process is not so simple as a checklist with grades, USMLE scores, and PhD/non-PhD. There is no doubt in my mind that the PhD only helps your application (with rare exceptions), but it doesn't mean EVERYTHING, nor should it. It has been well discussed in this forum that how much weight is given to the PhD depends on the field you are entering and the institution to which you are applying. Your performance during the interview can be just as important. Making the proper contacts, and keeping communications open with program directors is also key. Then there are also the field-specific weird factors that may or may not break your application... like:

    Derm: how nice is your skin/how hot are you (female)
    Rads: how nice is your tan/how much you work out
    OB/GYN: hormonal factors...

    On a serious note, given the above scenarios, I also feel these students were poorly advised. If they knew they were marginal candidates they should have applied for "back-up" specialties, or applied to lower-tiered programs. I can't explain GYN any other way since it is not really competitive.
     
  29. Vader

    Vader Dark Lord of the Sith Moderator Emeritus 10+ Year Member

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    I agree with this. Except that ob/gyn is actually a very competitive specialty, particularly at UCSF.
     

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