General Considering turning down MD/PhD for a PhD -> MD route

[lord999]

I was accepted very early in this cycle to both an MD/PhD and a PhD in my current city with the lab I've been working in full-time for the past two years. My PI has made the PhD offer very tempting, and I have some reservations about the MD/PhD program. Second look weekend is coming soon, and I'd like advice on what things to look out for.

The PhD offer is from the institution I currently work at (city is also a major Sci/Tech hub). I have a guarantee from my PI to graduate in <4 years. My PI considers me as a graduate student (complete project autonomy, multiple projects, papers in prep, etc...). I enjoy my projects, my labmates are fantastic, and my PI is a good mentor. The PhD program director has been very supportive as well, and the particular training (computational/quantitative biology) is very much the style of thinking I enjoy. Both PI and PD know I want to be a physician scientist, and will help me with securing clinical collaborations/projects/connections in our affiliated med school. I also have volunteer leadership positions at an affiliated hospital + personal vested interest in growing our program. The major downsides are financials and having to report during re-application that I turned down an MD/PhD offer. The major upside is that I know I'll be happy here, and splitting the degrees gives me a bit of flexibility to move and take care of aging parent (a v. high personal priority) should something happen.

The MD/PhD offer is in my hometown, so there are larger familial and local support networks in place. The MD-only portion is very appealing as well. The MD cohorts seem very happy and close-knit, as do the MD/PhDs. Their PD mentioned in my interview they have never had a computational MD/PhD, although I'm not sure what sort of trailblazing this will translate into. I also don't like my hometown, but at least it's much closer to some good fishing spots should I need to take some personal time. The major downsides here are that I'm not sure if I'll be happy spending 8 years of my life here. I don't think there are as many research opportunities in the particular computationally-heavy field I want to pursue. The advantage over the PhD-only offer is that it's free med school, and a guaranteed acceptance to an MD.

I'm not sure if there are factors that I'm leaving out in my decision process, and would appreciate any criticisms or insights offered. Additionally, I know a few things I'll be looking out for during second look, but what sorts of things would you advise I pay more attention to? Are there career opportunities that I'd be giving up if I chose a PhD->MD path over an MD/PhD?


Thank you for your advice! I'm happy to provide more information if needed.

PhD Institution:
Although I can only know what you tell us, I honestly have some real misgivings about how your home institution does things. Speaking from a PI standpoint myself, if you want to be a physician scientist, you might as well take the MD/PhD now with a big caveat that I hope you actually figured out which laboratories you are intending to work for in the PhD portion of the program. By the way, NO PI can "guarantee" dissertation completion in X time, that really would be considered coercive in a negative way when looking at this from NIH T-grant standards, and would easily be a post-tenure review committee hearing if a faculty member made that kind of a blatant offer. Since you are going to do computational biology, the usual funding IC in the US is NLM. Would you be put under the predoctoral T if you were accepted?


MSTP
So, I take it that your MSTP is not a mainline NLM BIDSR or NIGMS program, because I can say that all of them routinely graduate MSTPs in Computational Biology (anywhere between 1 - 4 a year considering how hot the topic is):
NLM's University-based Biomedical Informatics and Data Science Research Training Programs

That's ok, but do you have options for a Computational Biology laboratory within the MSTP institution? I'm curious, why did you apply to the MSTP program in a place where you knew your major beforehand but applied to an institution without a background in training an MSTP in the field?

As far as advice, computational biology tend to not be as resource dependent or as specialized as a standard wet lab. That said, it's almost always in an interdisciplinary department with cross-affiliated faculty, and that causes some grief in terms of figuring out faculty considerations for a PhD committee. You've already figured out your home institution, but when it comes to it, would the topics be comparable at both institutions?

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[Mr.Smile12]

TL;tried to read.

Taking a little larger view, you need to know what is your endgame. What opportunities do you see yourself doing with an MD/PhD in a computational biology/medicine area? Do you want to do clinically relevant research with a Ph.D. outside computational biology? Do you really believe this is your only opportunity to get an MD due to your concerns about being a "pity case" (which for MD/PhD I doubt really exists... you have to be qualified).

It would bug me that if this were really important that you have an MD/PhD spot in your hometown med school knowing that they don't have the research infrastructure or experience to support someone going in that direction (noting as before, it can be done at other NIH/NIGMS-funded MSTP programs). [I suspect from your .sig that you're Canadian, so this could be a Canadian program.] I also would be wary though not completely shocked if your background could make it feasible to be done with a Ph.D. in a short period of time, though I also agree one can never guarantee your degree attainment timeline in a Ph.D. program (or MD/PhD for that matter).

You mentioned you want to maintain some degree of flexibility to care for a family member, and that's why you are considering the Ph.D. option. While I would hope that your MD faculty would allow you to be flexible if something should come up, there's no guarantee that your Ph.D. route will offer you that flexibility either. You also ultimately choose the PI you wish to work with in your MD/PhD situation so you can always avoid working for your close family friend if you are at all uncomfortable.

In the end you need to know your own value because apparently others see something that you are bringing to the table that you are somehow blinded to. So the choice is yours to decide which road to take and which destination is more meaningful to you, additional personal circumstances taken into consideration.