Harvard (MD only) vs. WashU (MSTP) vs. Colorado (MSTP)

[cerevisiae2026]

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Hi everyone,

April 30th is approaching fast and I'm feeling a bit stuck. Hoping for some outside perspective from people who've been through similar decisions.

Background: No gap year, state school but 4 years of basic science research + a few nationally recognized scholarships. Most of my clinical exposure has been orthopedic surgery + oncology, so those are the specialties I've been mainly interested in. At this point I am interested in matching into a competitive specialty (ortho maybe??) but I know things change over time. My ultimate goal is to be a physician-scientist, I love research, but I don't know if I can deal with the pressure of grant applications/running my own lab in the future, especially with funding being so scary rn.

Here are the options I am considering:

Harvard MD only

Pros:

• Great for matching ortho
• Great research opportunities
• Get out in 4 years (but honestly the timeline isn't a huge deal for me, I'm prepared to take several extra years for a PhD)
• Could apply to their MDPHD program internally but would still have to pay 2 yrs tuition, and that's if I even got accepted to their graduate school
• Could do a few research years even if the PhD wasn't an option

Cons:

• I'm originally from CA, so being in the east is a huge change
• Giant financial burden --> this is a pretty big deal breaker for me
• Research may be peak and incredible, but I might feel like I'm not going to get the protected research time I want

WashU MSTP

Pros:

• Incredible program
• Great ortho residency
• Tons of research I would be interested in
• Large program
• Low cost of living

Cons:

• LOCATION. Very scared abt St. Louis and am concerned about safety, weather, etc. Since I'd be living there for 8+ years, this is a pretty huge deal
• Maybe less individualized attention bc the program is so large?
• Very supportive of creating physician-scientists who will run an academic lab (but most MSTPs are identical to this anyway), but idk if that's actually what I want to do.

Colorado MSTP

Pros:

• LOCATION. Closer to home, more aligned with my outdoorsy lifestyle
• People seem happy there
• Could do PhD at Boulder in a program I really like
• Awesome research faculty who I could see myself working with (but the same is likely the case at WashU)

Cons:

• Smaller cohort
• Not as well-established as WashU
• Denver isn't exactly the mountains even if it's adjacent to them, and I worry I romanticized the location.
• Program is strong but not at the WashU/top-5 tier.

Would love anybody's insight on:

Is the PhD worth it if I don't want a traditional academic research career? I'm not anti-research... I truly love science and it fulfills me in a way nothing else really does, but I am really discouraged by the PI lifestyle/lack of fair compensation relative to fully clinical work/grant rat race.

For those who matched into ortho/competitive specialties from an MSTP: how much did the PhD help vs. complicate things? Did you feel behind clinically?

Is $400k+ debt at Harvard a dealbreaker if ortho is the goal? I'd have to take out max federal loans + private loans and it would immediately start accruing interest which is not ideal...

How much does city/QOL actually matter?

 

[riv_jordan]

Hmm, I can't say I feel qualified to comment on your questions about whether a PhD is worth it, but assuming that you do want this PhD, I think you should rule out Harvard (*gasp* I know but in my head it's impossible to justify choosing Harvard given the fact that you'd need to take out private loans to go to a school that doesn't offer the PhD you want and you already have an MSTP offer from WashU which will not hold you back in anyway when it comes to matching competitively and forging a successful career in academic medicine).

Between WashU and Colorado, I think you really need to think about quality of life and your specific career goals. You seem to prefer Colorado for quality of life reasons and have serious concerns about St. Louis, and considering how long an MD-PhD is, it makes total sense to weigh quality of life heavily. But as you noted, most people would consider WashU's MSTP the superior program. How significant this edge in prestige/certain resources is for you will depend on your specific career goals. Saying that your "goal is to be a physician-scientist" but you "don't want a traditional academic research career" is pretty ambiguous and so you'll need to clarify exactly what you'd want out of that PhD and whether WashU would give you something that Colorado could not.

If possible, I think you'd really benefit from attending a visit weekend. Maybe you'll find St. Louis isn't as bad as you think? Maybe you can ask students at Colorado how often they actually get to the outdoors and how accessible the mountains are in practice. Some things and dealbreakers become very apparent after a second look.

 

[kidcat]

i’m not a med student at washu but i spend most of my time there doing research. i will say that the dangers of st. louis are extremely over blown. at the med campus, it doesn’t feel like st. louis at all. the med school is in a cute neighborhood called central west end and there are tons of good restaurants. if this puts it into perspective, there is a whole foods right next to the med school so the area is pretty gentrified. i’m never felt any issue or fear walking home at night. the public transportation is getting major security upgrades too so it definitely feels safer. regarding whether, it is the midwest so seasons change quickly (and sometimes it feels like you get multiple seasons in a week). winters are cold and summers are hot, but it’s never too unbearable. we do sometimes get tornados, but it’s extremely rare for them to touch down in central west end/med school area (maybe 3 in all of st. louis history and there was no major destruction). tornados are more west. if you have other questions about stl feel free to message me

 

[Mr.Smile12]

It's sad that if you can't afford Harvard now, you are probably good enough to get to Harvard later (residency/fellowship/professional), especially if you have MD/PhD credentials. I can't answer your question about whether the Ph.D. is worth it*, but consider your other two options if you were to drop out of MSTP because you became too disillusioned about the funding rates squeezing out new investigators for the next 5 years or so. No guarantees this current political admin will die suddenly... and I also include governors and the state government.

For MSTP, you must be confident and comfortable with your school and university admins, their career services teams (because you would need specialized help as MD/PhDs), and your department's resources. All MSTP's generally know each other (hope you ask the Research Scientists subforum where they hang out), so you are entering an academic fraternity for life. So then, where do you want to live for 10 years? Which community will "have your back" as you move forward with research, clinic, personal/family life, and wellness to position you for the postdoc or residency that works for you? You'll "always" have the MD/PhD community should you choose it.

You will travel to many great places as an MD/PhD, including the annual retreat in Breckenridge (not too far from UColorado, and you'll get your mountain vibe every year).

* Actually, I do have my own opinions on this. 🙂

 

[YellowSalamander]

Disclosure: WashU MD student so obviously biased

Congratulations on a fantastic application cycle! I would encourage you to first decide if you want MD versus MSTP...

• The MD would be a more streamlined path to clinical practice. You would be making an attending salary sooner, which can be important for some. However, with your only option being HMS at full-cost, you are looking at 400-500k in loans at 9% interest, which will be closer to 600-800k once you are done with residency. That is a lot of debt, especially now that PSLF is essentially nerfed.
  
  
• The MSTP journey is a long and arduous path, but also one that is incredibly rewarding! Many who pursue MSTP do not become basic science researchers, but rather department heads, medical school professors, medical school deans, and consultants for large clinical trials. It also opens up the possibility to pivot into pharma, biotech, and innovation should you want to leave clinical medicine behind at some point. You will have a rather substantial advantage when it comes to matching competitive specialties with a PhD. I don't think fear of grants and research bureaucracy should be a major concern at this point in your career, because there is simply so much you can do with your MD/PhD that barely involves these headaches. I would pick WashU over Colorado for MSTP, simply because the program is larger, has much better funding and thus will be more resilient should the current funding cuts become long-term concerns.

WashU

• I come from the East Coast and was initially hesitant about moving to St. Louis. When I first visited the city during the second-look weekend, I had mixed feelings about it. I had offers from peer programs at both coasts, but decided to come here because it would allow me to graduate debt-free, live like a king for $1100/month rent, and I really enjoyed the community during the second look weekend. Now having lived here for a while I absolutely adore this city! It's a city of neighborhoods so you wont get to explore and appreciate it much during second look, but once you live here you will start to appreciate the different neighborhood subcultures, the hidden gems, all the cool events taking place around the city, and just the ease of living here. It's very affordable, people are welcoming and kind, and life is a lot slower in the Midwest than it is on the East Coast. There have genuinely been weekends where I've gone to MLB on Thursday, the theater on Friday and MLS/NHL on Saturday, and it cost me less than $70 bucks. You don't get that sort of lifestyle as a student on the coasts.
  
  
• Don't sleep on the cost of living... Are you prepared to live with roommates for 8 years in Denver or 4-years in Boston? In St. Louis you can easily afford a rather cushy apartment within a 5-minute walk of the school with all the amenities you would need. It also helps that so many amenities (botanical garden and zoo (both world-class), art museum, history museum, MUNY, science museum, Forest Park etc.) are all free. You can live a very interesting life here without spending a lot of money.
  
  
• If orthopedics is your passion, I can not recommend this hospital enough. It's a T3 program in ortho and the department is so welcoming and supportive. It will be easy to find excellent mentors, fascinating research projects and early clinical experiences in orthopedics. I know people in my class who got to do a 3-week orthopedic surgery rotation and another 3-week PM&R orthopedic rotation during MS1, which is almost unheard of at other programs with later clinical exposure.
  
  
• Your concerns
  • Safety: As with most cities there are good and bad areas of St. Louis. The crime in the city is highly concentrated to certain neighborhoods that you won't really venture to as a medical student and that are easy to avoid. I explore the city both during the day and at night (bars, concerts, sporting events) and I do not feel more unsafe here than I did in Boston or NYC. The areas surrounding the undergraduate campus (Clayton, University City, Demun, Brentwood) are very safe and affluent. The area around the medical school is trendy and rather gentrified at this point. The average resident here is a medical student, law student, graduate student, doctor or young professional. Lots of bars, restaurants, and other events going on. It's also frequently patrolled by WashU police, STL police, BJC security and neighborhood watch patrols, so it's rather safe. In summary, I would not be more concerned about safety here than you would in LA, SF or NYC. If you have a family and want something that is even safer than your average city, move to the county and commute to the medical campus.
    
    
  • Weather: The weather here is unpredictable. The summers are predictably hot and humid, but the winters are all over the place. We had 70F in the last week of December, and a snowstorm the following week. As someone who is used to the predictable four-season weather of the Northeast, it hasn't been that difficult to adjust to the weather. Severe storm events do occur, but are rare in the city.
    
    
  • Individualized attention: Not even remotely a concern here! As an MD student who occasionally dabbles in research, I get a lot of individualized attention from faculty members, administrative staff members and mentors. In fact, I often feel overwhelmed at times because there are so many opportunities and research projects coming our way that I would love to join, but simply do not have the time to take on.

 

[jvquarterback]

Wash U grad many years ago.

Go to Harvard. You want ortho. You don’t want grant writing. It’s that easy. You’ll come out way ahead financially. 600-800k is only 1.5 years of work after taxes for an ortho.

One of my partners is an MD phd and he lies through his teeth every time some one asks him if the PHD was worth it. No one likes to admit they wasted 3-5 years.

One exception to this is I remember a couple people in the MD PhD program dropped out at washU after two years and joined us on the MD only tract and never had to pay tuition for the first two years. Not sure what the policy is these days and I would feel bad about pulling that but might be worth checking into. Maybe ask what the PhD washout rate is.

Also I’m from LA and was worried about St. Louis but it’s a great town. I did residency there too , nine years total, and I would have been happy staying.

 

[Mr.Smile12]

I also encourage you to post in the Research Scientists subforum where the MSTP folks hang out.

 

[cerevisiae2026]

Disclosure: WashU MD student so obviously biased

Congratulations on a fantastic application cycle! I would encourage you to first decide if you want MD versus MSTP...

• The MD would be a more streamlined path to clinical practice. You would be making an attending salary sooner, which can be important for some. However, with your only option being HMS at full-cost, you are looking at 400-500k in loans at 9% interest, which will be closer to 600-800k once you are done with residency. That is a lot of debt, especially now that PSLF is essentially nerfed.
  
  
• The MSTP journey is a long and arduous path, but also one that is incredibly rewarding! Many who pursue MSTP do not become basic science researchers, but rather department heads, medical school professors, medical school deans, and consultants for large clinical trials. It also opens up the possibility to pivot into pharma, biotech, and innovation should you want to leave clinical medicine behind at some point. You will have a rather substantial advantage when it comes to matching competitive specialties with a PhD. I don't think fear of grants and research bureaucracy should be a major concern at this point in your career, because there is simply so much you can do with your MD/PhD that barely involves these headaches. I would pick WashU over Colorado for MSTP, simply because the program is larger, has much better funding and thus will be more resilient should the current funding cuts become long-term concerns.

WashU

• I come from the East Coast and was initially hesitant about moving to St. Louis. When I first visited the city during the second-look weekend, I had mixed feelings about it. I had offers from peer programs at both coasts, but decided to come here because it would allow me to graduate debt-free, live like a king for $1100/month rent, and I really enjoyed the community during the second look weekend. Now having lived here for a while I absolutely adore this city! It's a city of neighborhoods so you wont get to explore and appreciate it much during second look, but once you live here you will start to appreciate the different neighborhood subcultures, the hidden gems, all the cool events taking place around the city, and just the ease of living here. It's very affordable, people are welcoming and kind, and life is a lot slower in the Midwest than it is on the East Coast. There have genuinely been weekends where I've gone to MLB on Thursday, the theater on Friday and MLS/NHL on Saturday, and it cost me less than $70 bucks. You don't get that sort of lifestyle as a student on the coasts.
  
  
• Don't sleep on the cost of living... Are you prepared to live with roommates for 8 years in Denver or 4-years in Boston? In St. Louis you can easily afford a rather cushy apartment within a 5-minute walk of the school with all the amenities you would need. It also helps that so many amenities (botanical garden and zoo (both world-class), art museum, history museum, MUNY, science museum, Forest Park etc.) are all free. You can live a very interesting life here without spending a lot of money.
  
  
• If orthopedics is your passion, I can not recommend this hospital enough. It's a T3 program in ortho and the department is so welcoming and supportive. It will be easy to find excellent mentors, fascinating research projects and early clinical experiences in orthopedics. I know people in my class who got to do a 3-week orthopedic surgery rotation and another 3-week PM&R orthopedic rotation during MS1, which is almost unheard of at other programs with later clinical exposure.
  
  
• Your concerns
  • Safety: As with most cities there are good and bad areas of St. Louis. The crime in the city is highly concentrated to certain neighborhoods that you won't really venture to as a medical student and that are easy to avoid. I explore the city both during the day and at night (bars, concerts, sporting events) and I do not feel more unsafe here than I did in Boston or NYC. The areas surrounding the undergraduate campus (Clayton, University City, Demun, Brentwood) are very safe and affluent. The area around the medical school is trendy and rather gentrified at this point. The average resident here is a medical student, law student, graduate student, doctor or young professional. Lots of bars, restaurants, and other events going on. It's also frequently patrolled by WashU police, STL police, BJC security and neighborhood watch patrols, so it's rather safe. In summary, I would not be more concerned about safety here than you would in LA, SF or NYC. If you have a family and want something that is even safer than your average city, move to the county and commute to the medical campus.
    
    
  • Weather: The weather here is unpredictable. The summers are predictably hot and humid, but the winters are all over the place. We had 70F in the last week of December, and a snowstorm the following week. As someone who is used to the predictable four-season weather of the Northeast, it hasn't been that difficult to adjust to the weather. Severe storm events do occur, but are rare in the city.
    
    
  • Individualized attention: Not even remotely a concern here! As an MD student who occasionally dabbles in research, I get a lot of individualized attention from faculty members, administrative staff members and mentors. In fact, I often feel overwhelmed at times because there are so many opportunities and research projects coming our way that I would love to join, but simply do not have the time to take on.

This is so incredibly helpful, thank you so much!!