Considering internal transfer from MD --> MD/PhD

[mocha-teas32]

Hi SDN,

I am an MD student and have the opportunity to transfer into the MD/PhD program at my school.
I have always felt a strong passion for basic science research. I love being in the lab. I've always hoped that I could incorporate basic/translational research into my medical career in a significant way. Initially, I didn't apply MD/PhD because I was scared by the length of the training program, and I knew MD researchers could also do basic science research. But now that the opportunity is presenting itself to me, I feel like I should strongly consider it. I know the PhD program content would help me in eventually conducting my own independent research and grant writing, experiments, running a lab, etc.

But it's so hard to envision leaving my med school class and embarking on a 4+ year PhD program. Four years definitely feels like a significant amount of time. These are the pros/cons of switching:

Pros:
- Training in basic/translational research (what I love and want to incorporate into my career)
- Potentially an easier time being a physician scientist with the PhD, both in terms of skillset and grants
- Potentially more eligible for research tracked residency programs
- Tuition free + living stipend

Cons:
- Leave my med school class and watch them all go on to graduate
- Social circle dwindling and potential loneliness
- Another 4 years of school, which also means an extra 4 years living far away from my family

The cons of not taking the MD/PhD would basically just be missing out on this potential opportunity to develop this type of career and get this advanced training, and maybe regretting it when I'm 40 and wishing I had taken this opportunity. By far it feels like the path of least resistance would just be to continue in the MD track and see how things go with research, but I'm wondering if I'm making a mistake and letting that "4 years" part really freak me out.

Does anyone have any advice? Thanks 🙂

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[Dral]

- Another 4 years of school, which also means an extra 4 years living far away from my family

And another four years of lost income. That doesn't matter to everyone, but it's something to consider.

 

[FalconSlice]

- Another 4 years of school, which also means an extra 4 years living far away from my family

And another four years of lost income. That doesn't matter to everyone, but it's something to consider.

Lol might I also add to the OP that this number can only become larger and has a very strong tendency to...

You can also be trained at PSTP and other residency programs (i.e. that have other mentors and grants that you can win). Albeit, you won't get the actual PhD, but who cares as long as you're trained?--Also this will take extra time away from clinical training, but won't feel like a black hole like it sure can (especially during the 2nd or 3rd year of the PhD).

Can I also say that the "80/20 gun-ho and die-hard physician scientist" hard-on has a very interesting way of dying down for a LOT of people when you're in residency. Obviously, I'm not saying you're going to be that person---but perhaps graduate from med school and be involved in real research on the way--and then revisit this when you're applying to residencies (or even when you're in residency?).

I'm sure other wiser members can help you, but just my $0.02

FS

 

[ACSurgeon]

Hi SDN,

I am an MD student and have the opportunity to transfer into the MD/PhD program at my school.
I have always felt a strong passion for basic science research. I love being in the lab. I've always hoped that I could incorporate basic/translational research into my medical career in a significant way. Initially, I didn't apply MD/PhD because I was scared by the length of the training program, and I knew MD researchers could also do basic science research. But now that the opportunity is presenting itself to me, I feel like I should strongly consider it. I know the PhD program content would help me in eventually conducting my own independent research and grant writing, experiments, running a lab, etc.

But it's so hard to envision leaving my med school class and embarking on a 4+ year PhD program. Four years definitely feels like a significant amount of time. These are the pros/cons of switching:

Pros:
- Training in basic/translational research (what I love and want to incorporate into my career)
- Potentially an easier time being a physician scientist with the PhD, both in terms of skillset and grants
- Potentially more eligible for research tracked residency programs
- Tuition free + living stipend

Cons:
- Leave my med school class and watch them all go on to graduate
- Social circle dwindling and potential loneliness
- Another 4 years of school, which also means an extra 4 years living far away from my family

The cons of not taking the MD/PhD would basically just be missing out on this potential opportunity to develop this type of career and get this advanced training, and maybe regretting it when I'm 40 and wishing I had taken this opportunity. By far it feels like the path of least resistance would just be to continue in the MD track and see how things go with research, but I'm wondering if I'm making a mistake and letting that "4 years" part really freak me out.

Does anyone have any advice? Thanks 🙂

Whatever you chose you should try really hard to be at peace with it and accept that you make decisions now based on what you know now. In 10+ years you’ll know other things but there’s no way you could have known that now.

I can’t relate much to the passion about research. I’ll echo what others have said about doing training afterwards during residency or as an attending.

 

[voxveritatisetlucis]

Why not do something like physician scientist training program or Howard Hughes and then focus on a getting a research-intensive residency to leverage into a tenure track position somewhere?

I don’t know the specifics of R0 grants and what not but many research focused professors at top schools are MD only

 

[Mr.Smile12]

It's up to you, and you have a slight advantage if you know which PI you want to work with who (hopefully) has experience mentoring MD/PhD students. I agree there are other options to do research without having to do the dual-degree track, including taking time off to do research as an NIH medical research scholar, HHMI grants for med students, or other opportunities that NIH supports.

 

[GoSpursGo]

Here is my usual advice that I give for students considering MSTP and a career as a physician scientist, as an MD-only 80/20 tenure-track faculty member: at some point, you will need protected research time. You can do it now, or you can do it later, but one way or another you will not be competitive for grants without some credibility which can only be gained though dedicated research time.

MSTP is more or less the least economical version of gaining this research experience, both in terms of your compensation while doing research and in terms of years of attending salary lost where you spend 3-5 years on an MSTP living stipend. However, the negative in terms of the time it takes is also an advantage in that it is noncompetitive to attain, and that you have so much protected time. For some perspective, I did my fellowship at a very strong institution which allowed us 2 years of protected research time. As an MD only, you are basically not going to get a grant unless either you come with a track record of basic science publication (such as from MSTP) or your PI gifts you a project that already has a ton of preliminary data. I very nearly got pushed out of academia due to not having a publishable product until the 3.5 year mark, and was very lucky to be able to string together some stop-gap funding honestly completely through generosity of my mentors. Several of my co-fellows were not as fortunate and either had to accept full clinical jobs (which they didn't really want) or leave clinical medicine. The fellows who came in with publications from their PhD just had a level of credibility that the rest of us MD-onlys did not have entering fellowship.

That said... obviously it has worked out more or less for me 🙂 You can get the research experience later for sure. But there is something to be said for getting your protected time early, as if you are truly set on becoming a physician scientist that PhD will pay dividends down the road.

 

[ChordaEpiphany]

I agree with @GoSpursGo, and I'll add my two cents as a current MSTP student.

The MD/PhD increases your odds of becoming an R01-funded scientist. However, the odds are still bad, the pathway is longer, and the opportunity cost falls entirely on the trainee. While the pathway to physician-scientist as an MD is less clear and probably somewhat less likely, the risk is mitigated. Consider the two pathways below. I'm a little verbose, but this is what I wish someone had spelled out for me when I was considering this:

To make it as an MD-only, you need an MD degree, a great academic residency, a top fellowship, an elite post-doc, preferably with a fellowship that has some loan-forgiveness attached to it (I'm hazy on the details, but a few exist through NIH and other organizations), and great performance during that post-doc. Let's say you're an MD at a T40 NIH university. You match IM at a low-tier academic residency. You've lost nothing, go be a doctor. If instead you match at a T20 IM program, you can vie for an elite fellowship. If you miss out and wind up at a lower tier fellowship, you've lost nothing, go be a doctor. If you manage to match at a top fellowship, you find a lab there and get your research career started. If it falls completely flat and you hate bench research, you've lost nothing, go be a doctor. If it's promising and you've got a shot at some major publications that could become a K-award, secure your elite post-doc and shoot your shot. If your elite post-doc doesn't work out, you've lost a few years, go be a doctor. In most cases you'll "fail upwards" financially. In the worst case you'll do 3 years of post-doc, come up short, and you'll be about 36-37 when entering the workforce as a specialist (vs. 33-34 for a typical MD).

Now consider the MD/PhD route. You start off losing about 4-5 years, and when you commit you barely even know yourself, the industry you're entering, or your clinical interests. If you happen to love path, peds, or IM, good for you. Try for an elite PSTP. Better hope you get a position and startup funding afterwards though, because you'll be less hirable in the community than someone who did a purely clinical residency. A lot of people at this stage refuse to cut their loses and wind up in academia in a clinical role doing things they find unfulfilling. If you fail for the elite PSTP, now you are on the outside looking in, and you have to gauge if you can still get an elite fellowship. Do you continue doing work that would establish you as a basic scientist, or do you bail and start prepping for a more clinical/translational career? If you love something else, say a surgical sub, anesthesia, rads, etc... you may find yourself finishing residency without any additional research training. So even though you are now 37-39 and have likely dedicated upwards of 7 years of your life to fulltime research and have 2x the basic science publications of your MD-only colleagues doing a post-doc, the committee that reviews your grant is going to "tsk-tsk" you for having been out of the lab for 7+ years. It's back to the lab for you.

The MD/PhD opens up that golden path to salvation. The MSTP -> PSTP -> K-grant -> R01. The problem is that the risk is frontloaded, there are few if any pathways outside of academia that favor the MD/PhD over an MD or PhD only, and most people, even at elite MSTP programs, never get to the end of that path.

FWIW, if you pass on the opportunity you won't regret it when you're 40. At 40 you'll be thanking God that you aren't just starting out as an attending. You might regret it at 60, but I really think that will only happen if you don't explore the MD career to its fullest as an attending.

 

[wondervisions]

Current G2 MD-PhD student. I would focus on whether or not you simply want to do a PhD for the pure intellectual fulfillment and let the career stuff factor in secondarily.

 

[SurfingDoctor]

Initially, I didn't apply MD/PhD because I was scared by the length of the training program, and I knew MD researchers could also do basic science research.

To answer this specific point, the answer is "yes but no". Certainly you can do basic/translational research as an MD only, but in order to get there you have to have additional training through some mechanism that usually extends your overall training time. For non-PhD, this means finding programs with R38s/T32s/F32s, doing research instructor years or a combination of all of the above. The PhD gives a more formalized version of research development, where the T/F mechanisms require a little more self-guidance (unless the PI in the lab you join sucks... then it's all self-guidance).

But either way, if you want to do research MD-only or MD/PhD, you have to put in extra time. The financial and opportunity costs associated with either are real though.

 

[GoSpursGo]

I agree with @GoSpursGo, and I'll add my two cents as a current MSTP student.

The MD/PhD increases your odds of becoming an R01-funded scientist. However, the odds are still bad, the pathway is longer, and the opportunity cost falls entirely on the trainee. While the pathway to physician-scientist as an MD is less clear and probably somewhat less likely, the risk is mitigated. Consider the two pathways below. I'm a little verbose, but this is what I wish someone had spelled out for me when I was considering this:

To make it as an MD-only, you need an MD degree, a great academic residency, a top fellowship, an elite post-doc, preferably with a fellowship that has some loan-forgiveness attached to it (I'm hazy on the details, but a few exist through NIH and other organizations), and great performance during that post-doc. Let's say you're an MD at a T40 NIH university. You match IM at a low-tier academic residency. You've lost nothing, go be a doctor. If instead you match at a T20 IM program, you can vie for an elite fellowship. If you miss out and wind up at a lower tier fellowship, you've lost nothing, go be a doctor. If you manage to match at a top fellowship, you find a lab there and get your research career started. If it falls completely flat and you hate bench research, you've lost nothing, go be a doctor. If it's promising and you've got a shot at some major publications that could become a K-award, secure your elite post-doc and shoot your shot. If your elite post-doc doesn't work out, you've lost a few years, go be a doctor. In most cases you'll "fail upwards" financially. In the worst case you'll do 3 years of post-doc, come up short, and you'll be about 36-37 when entering the workforce as a specialist (vs. 33-34 for a typical MD).

Now consider the MD/PhD route. You start off losing about 4-5 years, and when you commit you barely even know yourself, the industry you're entering, or your clinical interests. If you happen to love path, peds, or IM, good for you. Try for an elite PSTP. Better hope you get a position and startup funding afterwards though, because you'll be less hirable in the community than someone who did a purely clinical residency. A lot of people at this stage refuse to cut their loses and wind up in academia in a clinical role doing things they find unfulfilling. If you fail for the elite PSTP, now you are on the outside looking in, and you have to gauge if you can still get an elite fellowship. Do you continue doing work that would establish you as a basic scientist, or do you bail and start prepping for a more clinical/translational career? If you love something else, say a surgical sub, anesthesia, rads, etc... you may find yourself finishing residency without any additional research training. So even though you are now 37-39 and have likely dedicated upwards of 7 years of your life to fulltime research and have 2x the basic science publications of your MD-only colleagues doing a post-doc, the committee that reviews your grant is going to "tsk-tsk" you for having been out of the lab for 7+ years. It's back to the lab for you.

The MD/PhD opens up that golden path to salvation. The MSTP -> PSTP -> K-grant -> R01. The problem is that the risk is frontloaded, there are few if any pathways outside of academia that favor the MD/PhD over an MD or PhD only, and most people, even at elite MSTP programs, never get to the end of that path.

FWIW, if you pass on the opportunity you won't regret it when you're 40. At 40 you'll be thanking God that you aren't just starting out as an attending. You might regret it at 60, but I really think that will only happen if you don't explore the MD career to its fullest as an attending.

I agree with some of what you say, but I would highlight a couple of pieces:

1) The amount of protected time in any of the MD-only paths is shorter than it is in the MD/PhD. Whether that is a plus or a minus depends on how you frame it.
2) I don't really buy that you get "tsk-tsk"'d for being out of the lab for that long. Sure your app isn't as strong as if you'd done a PSTP, but you did a PhD, you published (presumably a reasonably impactful paper), and now you're applying for a grant--you're not applying for a K right out of the gate, but nobody is, and you're still going to be a stronger applicant for those $50-100k fellow-level grants than the majority of the applicants out there. I would argue you're going to get a lot more benefit of the doubt and the level of preliminary data you'll need to generate is going to be lower bar than if you were an MD-only with absolutely no research track record at all.

Of course, your point that the PhD-->K-->R pathway is still fraught with difficulties is valid. But if your goal is to wind up as a physician scientist, then you should just go for it. If you fail at any step along the way, then while maybe you wasted a couple of years I really don't think you're ever going to really hurt your hiring prospects just because you have a PhD. In fact you probably are more marketable in non-clinical positions like pharma.

 

[mlfpprf]

Just my 2c as a lowly M2. I think the MD/PhD program is almost fundamentally flawed:
You do 2 years preclinical, do your PhD, and then 2 years clinical. Think about a class you took 4 years ago. What do you remember? Most likely close to zero.
Now imagine being on rotations during which you're expected to function at the same level as someone who just took Step 1 (and maybe has had a few weeks to vacation). You must be able to recall and execute interview skills, physical exam skills, differential, assessment and plan, every single day. On top of getting pimped and dragged in all sorts of different directions.
What happens a lot with MD/PhD students is that they do 6-6 during clinic days, and then have to review a lot of preclinical material on top of M3 studying. I know I can't handle this level of stress during M3-M4. Can you? Only you can answer this for yourself.

 

[FalconSlice]

Just my 2c as a lowly M2. I think the MD/PhD program is almost fundamentally flawed:
You do 2 years preclinical, do your PhD, and then 2 years clinical. Think about a class you took 4 years ago. What do you remember? Most likely close to zero.
Now imagine being on rotations during which you're expected to function at the same level as someone who just took Step 1 (and maybe has had a few weeks to vacation). You must be able to recall and execute interview skills, physical exam skills, differential, assessment and plan, every single day. On top of getting pimped and dragged in all sorts of different directions.
What happens a lot with MD/PhD students is that they do 6-6 during clinic days, and then have to review a lot of preclinical material on top of M3 studying. I know I can't handle this level of stress during M3-M4. Can you? Only you can answer this for yourself.

Re the above bolded portion: This is so overstated by MD/PhD students that haven't went through the program. I can tell you the majority of what you said actually is not that much of an issue. When I was a lowly MD/PhD student, I was 4 years out and on rotations with people who had just taken Step I and I felt no more disadvantaged/advantaged than they did. This has been largely the anecdotes I have heard from my classmates at that time too-- third year of medical school is equally (or sometimes more) of how you work with people than "what you know" when it comes to clinical evaluations. The shelf exams also weren't that bad. I don't think this should be a consideration... but there are, however, other reasons I think the MD/PhD programs are flawed... but that is a much different topic that I have too many thoughts on for the time I have to type...

Come over to the Physician Scientist forum and we'll party

FS

 

[ChordaEpiphany]

Just my 2c as a lowly M2. I think the MD/PhD program is almost fundamentally flawed:
You do 2 years preclinical, do your PhD, and then 2 years clinical. Think about a class you took 4 years ago. What do you remember? Most likely close to zero.
Now imagine being on rotations during which you're expected to function at the same level as someone who just took Step 1 (and maybe has had a few weeks to vacation). You must be able to recall and execute interview skills, physical exam skills, differential, assessment and plan, every single day. On top of getting pimped and dragged in all sorts of different directions.
What happens a lot with MD/PhD students is that they do 6-6 during clinic days, and then have to review a lot of preclinical material on top of M3 studying. I know I can't handle this level of stress during M3-M4. Can you? Only you can answer this for yourself.

The objective data from our school says this interpretation is wrong. We outperform the general class in induction into AOA by about 50%.

Every once in a while you get a grumpy MD who likes to harp on this and say, "MD/PhDs are worse/overrated/useless and they perform worse clinically." I even recently found an article claiming that MD/PhDs aren't a great choice for residency programs because "by the time these residents apply to your program, they have already had three or four years of PhD work without even seeing a patient." So that's the level of ignorance we're talking about here.

Objectively, MD/PhDs do much better clinically because they vibe with the residents, multi-task better, and aren't eager beaver 25 year olds.

 

[GoSpursGo]

I will +1 that the idea that you’re going to forget all of your preclinical medicine is a bit overblown. As an MSTP your research probably has some clinical relevance so it’s not like you’re completely detached from medicine. And even if there’s a tiny bit of rust it’s not like any of the other new clinical rotation students are master clinicians either. You will get caught up quickly. The cost really is the years of your life

 

[mocha-teas32]

Thank you so much everyone 🙂
Just wanted to update the thread for future people to say I decided to apply for the MD/PhD. I think the deciding factor for me was a certainty that I love basic science research and want to pursue it, regardless of the difficulties of the path, and having support from mentors/parents. Another way of deciding was when I realized I was checking this thread hoping for someone to tell me to do it, which told me I think where my heart was at the end of the day.

 

[SurfingDoctor]

Thank you so much everyone 🙂
Just wanted to update the thread for future people to say I decided to apply for the MD/PhD. I think the deciding factor for me was a certainty that I love basic science research and want to pursue it, regardless of the difficulties of the path, and having support from mentors/parents. Another way of deciding was when I realized I was checking this thread hoping for someone to tell me to do it, which told me I think where my heart was at the end of the day.

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