Considering MD/PhD--Need Guidance

[JAK2-STAT3]

Hi everyone! I am a confused premed in need of guidance. Since graduating in 2018, I've worked as a research assistant in a Neuroscience lab at a major academic hospital. I have since decided to pursue medicine, so I am currently wrapping up prereqs via DIY postbac (I was a science major but not a premed in undergrad) and am planning on taking the MCAT in late 2021. Up until recently figured I could still do research as an MD only. I am posting this because last past week I have had 2 PhDs (including my PI) tell me that they regret not pursuing an MD/PhD for reasons relating to access to funding and pay, and now I'm questioning my decision to go MD only. I already have a very research heavy application and am starting to wonder if I'm in that class of people who would have a better MD/PhD app than an MD-only app. I get the sense that if I applied MD-only with 5,000+ hours of research I'd have some explaining to do, whereas if I applied MD/PhD that would be a plus, not something to try and minimize. I enjoy research (particularly Neuroscience research) but don't want to the spend the rest of my life working on a very narrow bit of physiology without being able to apply it to patients and patient care. While I would be open to multiple specialties, I am currently most interested in Neurology (adult or pediatric).

Here are the highlights of my app so far:

GPA: c3.86, s3.79 (4.0 for my junior and senior year of undergrad), DIY postbac GPA 3.89 so far (12 credits). I have all A's with 1 A- in my most recent 78 credits including DIY postbac

No MCAT yet

Clinical: ~100 hours as hospital volunteer pre-covid, no shadowing yet (was going to start when Covid hit--I know this is a problem)

Non-clinical: ~300 hours volunteering with an organization serving people with disabilities

Research:

• ~650 hours in undergrad with 3 different professors, published senior thesis in an undergrad journal
• Nearly 3 years (~4800 hours) of full time work as a technician in a Neuroscience lab. I do the typical technician stuff but have my own project.
  • Have presented posters at 3 conferences and given oral presentations at 2 others (different aspects of same project)
  • 1 mid-author pub accepted with revisions, 1 first author (but listed second) pub in the pipeline

Because I'm lacking good clinical experience, my current plan is to quit my lab job and get a clinical job starting in the fall, take the MCAT, and apply in 2022.

Here are my questions as I wrestle through possibly turning an MD app into an MD/PhD app:

1. I have heard all of the downsides of going MD/PhD, so I would welcome hearing about its advantages or anecdotes on how you knew it was the right path for you. Alternatively, if you think my app so far is not good enough for MD/PhD I would appreciate the feedback.

2. What are MSTP programs known for strong Neuroscience research? I know that without an MCAT score a school list is impossible, but having an idea of what to target would be helpful.

3. If I fully commit to MD/PhD, would it be a bad idea to exchange my research job for a clinical one?

4. I have heard that state of residence is not important for MSTP programs--can someone please confirm/deny this?

EDIT: 5. I realize that not everything that technicians typically do (e.g. ordering supplies, animal colony maintenance) counts as research--will MSTP programs count all of my hours as a tech as research, or will I need to calculate how much time I spend running experiments/analyzing data vs. the mundane stuff?

Thank you all very much for reading this stream of consciousness!

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[Lampstrike]

1. From what you wrote, you seem pretty set on the MD side of things in terms of being interested in patient care. As for whether or not to get a PhD, I think the question has two parts. The first part is how involved do you see yourself being in research in your career. Do you see yourself as a PI that designs and asks your own independent research questions or would you prefer to collaborate with others and help assist another PI on their projects. In the case of the latter, the full PhD is not as essential since you will likely always have support from someone who does have a PhD and knows how to write grants and secure funding. In the case of having your own independent projects, then the next question you have to ask yourself has to do with how clinical do you want your research to be. Most MDs are really only trained to do basic chart reviews and clinical outcome follow-up type studies with very basic statistics (T-tests, linear regression, etc.). If you see your research career involving model systems of any kind (mice, cell culture, etc.), translational aspects, or advanced statistical analysis, then a PhD can be really helpful. These are just some guide rules that may help you better contextualize what MD and MD/PhD research looks like and how they differ generally. Only you can decide which category seems to fit you better.

P.S. your app seems fine for MD/PhD. Just get something resembling shadowing and maybe another 100-200 hours of clinical experiences.

2. Disclaimer: These opinions are only my own based on my interests in Neuroscience. Others may disagree vehemently.

In a perfect world where MCAT score was not a barrier, I would say the top neuroscience programs (in no particular order) are UCSF, Harvard, JHU, Columbia, and Stanford. Some slightly less competitive programs with just as strong neuroscience departments as those 5 include UW, UCSD, and UTSW.

3. Others may disagree, but I think you may get some probing questions about why you quit your research job. The goal for most programs is to produce physician-scientists (with an emphasis on the scientist part). You have to prove that you really really love research. Quitting research to pursue a full-time clinic role harms that narrative and could make it more challenging for you to convince schools of your passion.

4. MSTP programs cannot discriminate by residence since they receive federal funding. This is the law. Any deviations you may see in class residence demographics are due purely to locals being highly interested in staying in the area (California applicants are likely to stay in California because they like it there, regardless of their competitiveness at other out-of-state "better" programs)

5. Nobody gives two ****s what hour count you put on the AMCAS. They only care about your ability to describe your research project and answer questions about the process and the underlying science. Across 10+ interviews, I didn't get asked a single time how many hours I spent in lab running "real" experiments.

 

[Fencer]

You are competitive in experiences, but unfortunately, your MCAT scores will determine which tiers of MD/PhD programs you will be successful. Once you have a score, PM me to provide you advise.
Good luck!

 

[JAK2-STAT3]

1. From what you wrote, you seem pretty set on the MD side of things in terms of being interested in patient care. As for whether or not to get a PhD, I think the question has two parts. The first part is how involved do you see yourself being in research in your career. Do you see yourself as a PI that designs and asks your own independent research questions or would you prefer to collaborate with others and help assist another PI on their projects. In the case of the latter, the full PhD is not as essential since you will likely always have support from someone who does have a PhD and knows how to write grants and secure funding. In the case of having your own independent projects, then the next question you have to ask yourself has to do with how clinical do you want your research to be. Most MDs are really only trained to do basic chart reviews and clinical outcome follow-up type studies with very basic statistics (T-tests, linear regression, etc.). If you see your research career involving model systems of any kind (mice, cell culture, etc.), translational aspects, or advanced statistical analysis, then a PhD can be really helpful. These are just some guide rules that may help you better contextualize what MD and MD/PhD research looks like and how they differ generally. Only you can decide which category seems to fit you better.

Thank you very much for this detailed reply and for meticulously breaking down research as an MD vs. MD/PhD. This is the most helpful reply on this question that I've every gotten. I still have several months before taking the MCAT (which I understand will be a major component of whether MD/PhD is even an option) and will continue soul-searching during this time.

In a perfect world where MCAT score was not a barrier, I would say the top neuroscience programs (in no particular order) are UCSF, Harvard, JHU, Columbia, and Stanford. Some slightly less competitive programs with just as strong neuroscience departments as those 5 include UW, UCSD, and UTSW.

Thank you for the list! I am actually currently at one of these institutions.

3. Others may disagree, but I think you may get some probing questions about why you quit your research job. The goal for most programs is to produce physician-scientists (with an emphasis on the scientist part). You have to prove that you really really love research. Quitting research to pursue a full-time clinic role harms that narrative and could make it more challenging for you to convince schools of your passion.

I am mainly considering leaving my research job for personal reasons, mainly due to location. This would likely be before I take the MCAT. It sounds like I'll either be in the position of having a great MCAT score and needing to explain to MSTP adcoms why I left, or having a mediocre score with no point of applying MD/PhD in the first place, in which case a clinical job would be a plus for MD adcoms. I guess I'll just have to let the chips fall where they may.

 

[JAK2-STAT3]

You are competitive in experiences, but unfortunately, your MCAT scores will determine which tiers of MD/PhD programs you will be successful. Once you have a score, PM me to provide you advise.
Good luck!

Thank you for the response! I will come back with a more definitive plan/set of questions when I have a score.

 

[moggat]

I think with a good MCAT score, your app will be competitive for either MD or MD/PhD, but you should be able to convincingly answer "why do you want to be a physician-scientist?" and its not clear from your first post that you really do...? Instead trying to get a new job (tech-ing is fine--if you like it, keep doing it) I would recommend shadowing both physicians AND physician-scientists to get a feel for what it's actually like and make sure it's something you want to do.

 

[JAK2-STAT3]

Thanks to everyone for their advice--I figured I'd update this thread after some reflection. I have some rather strong location preferences (no large east coast or CA cities, and ideally no large cities at all), and have learned the hard way that location truly does matter. I realize that I'll likely have little/no choice in where I attend medical school, but I can live somewhere I'm not thrilled about for 4 years. However, I am not willing to tie myself down for 8 years in a huge city I'll know I'll hate. I would rather not be an MD/PhD than do that. Moreover, I understand that many MD/PhDs end up in major academic medical centers (read: big cities), which is not in line with my long-term goal of practicing medicine in a rural/semi-rural area.

If I get a good MCAT score I would hypothetically be open to an MD/PhD if I could do it somewhere like Mayo, UVA, UMN, IU, etc., but I realize that that is not the right attitude to have while pursuing this path.

Anyways, thanks again for everyone's advice. Hopefully in 30 years I'll be a physician in the middle of nowhere and involved in research on a lesser scale.