Advice/Recommendations?

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kuro_62389

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I'm trying to figure out which med schools I should be applying to for Fall 2028 cycle. I want to become a psychiatric geneticist, which in essence, is a psychiatrist that can treat patients and research the genetic underpinnings of mental health disorders to advance precision medicine/individualized psychiatric treatments. This career path requires an MD, psychiatry residency, and a postdoctoral fellowship in an AMBGG-certified genetics program.

Here are the current options I'm looking into:
  1. 3-Year MD program with guaranteed track into psychiatry residency (some have an additional research track)
  2. 5-Year MD-Master's programs (MS in Clinical Research or Biomedical Informatics)
  3. 4-Year MD program with Distinction in Research or Thesis
The factors that I'm considering:
  1. Time Requirement: I will be turning 26 by Fall 2028 (non-trad student), and it'll take around 12 years before I can really start in my career. Is a year (give for 5-year MD/MS or take for 3-year MD) going to make that much of a difference?
  2. Finances: Med school is expensive, as are MS degrees. The 3-Year MD program will save me money and time, but would the MD-MS program be more worthwhile in the long run? Or, is a 4-Year MD with Distinction going to give me equivalent value to an MD-MS?
  3. Plausability: 3-Year MD programs are exceptionally difficult to get into (about 1-2 students accepted per residency), and even though it states there's a guaranteed track, it's based on the NRMP Match program. 5-Year MD-MS programs or a 4-Year MD with Distinction might help me secure a residency by making me more competitive, but there's still no guaranteed track.
  4. Flexibility: I don't plan to switch tracks, but there's a lot that can change during med school. For 3-Year MD programs, you are required to know which specialty you want to track into, meaning there's little to no flexibility if I end up changing my mind or wanting to switch tracks. An MD-MS program will give me flexibility to change tracks, as I can decide to apply during med school. If I go through with it, an MS will also expand my career options. A 4-Year MD with Distinction gives flexibility since I can decide to apply during med school. It'll help me be competitive for residencies and potentially secure early-career research grants.
Additional Questions:
  1. Is an MD-MS or MD with Distinction better than just going into a psychiatry residency with a research track?
  2. How do "guaranteed" residencies work for generic 3-Year MD Programs? Am I guaranteed the residency at the school even if someone else in the program also wants the same residency? For example, NYU has a 3-Year MD program with a guaranteed residency if you rank into their program. Their psychiatry clinical research training track residency only accepts 2 people per year. If I want to go into that residency, am I still guaranteed that residency if 2 other students also want that same residency?
I know this is a lot of information and sorry if it's confusing. I just want to evaluate what options are going to be best for what I want to do while taking those factors into consideration. I would greatly appreciate any advice or recommendations for which path I should take.