Having doubts about entering MD/PhD

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.

potatoplease

Full Member
10+ Year Member
15+ Year Member
Joined
Mar 10, 2008
Messages
84
Reaction score
0
Is anybody having doubts about entering an MD/PhD program versus just straight MD? I'm sure not everyone here applied strictly MD/PhD. What to do? This is a hard decision.

Members don't see this ad.
 
i am not having doubts but I vaguely remember this topic coming up last year. I think it's probably somewhat common to have those feelings. The MD/PhD route might initially seem awesome and then the closer you get to the start the more you realize just how long the program is going to be...maybe??

I think that the "coldfeet" so to speak will subside, there is obviously a reason why you decided to apply MD/PhD.
 
You're not alone. I'm a bit freaked out, just because of the length of the program, but I know this is what I want to do. I guess we just need to accept the fact that we'll be in school for a loooong time and keep a good, upbeat attitude. Not idealistic, but positive. That's how I reassure myself.
 
Members don't see this ad :)
If you are having cold feet, then withdraw and give me your spot

lol :D:D:D
 
Yes. I'm also having cold feet...I keep thinking:

1. What the hell was I thinking
2. I don't want to be in school for 8 yrs...I didn't even last 4 years of college.
3. What if I'm the clown that breaks everything...I know squat
4. Why did they let me in
5. What if I go and really hate it

A current MD/PhD student assured me these are normal feelings.
 
Yeah, I think its normal to be freaked. Just think of it this way: you're getting paid, so its a job not more school. It just happens that your job is to learn for the next 10-15 years before you change professions to being a research doctor!
 
I'm definitely having doubts but I'm choosing between MD/PhD and PhD...grrrr decisions
 
Yea time is the biggest factor for me. Like if I can get done in 6 years, epic! in 7 years, great!, in 8 years, cool! but if it goes longer than that, i'd rather just go with the straight MD. Like you look on the school's website and you see people in their G6+ years and it just makes me want to cry thinking that I might become one of them and looking at how many there are, the chances are nontrivial. Its just impossible to know ahead of time if you're going to be in the good batch or stuck in tar.

Another thing I've noticed is that the average number of people on some schools match lists is significantly lower than the average number of people who matriculate. What happened to the rest? I've asked some directors about their attrition rate and they consistently say its less than 5% but that seems inconsistent with these numbers. Why the discrepancy?
 
Maybe some people do post docs first? (no idea)
 
i think it's about people varying in lengths of time to graduate, so people graduate in clumps. plus the people graduating now are the people who matriculated however many years ago, and schools may have accepted fewer students back then.
 
Cold feet is normal. Take the above advice and figure it as a job. You will have job security for 6-8 years, and when you are done you will have 2 degrees and an inexhaustible job market and will likely emerge during better economic times. You will also not be saddled with a 6 digit loan, which is of course a nice bonus.

Remember though, it is an interest in research that needs to be your primary motivating factor. The truth is, if you love research before MD/PhD, you can survive. You may emerge hating basic science research, but that's OK, you don't HAVE to do research as a career later. It's the folks that are lukewarm on research to start and just see the financial/prestige benefits that have the most serious problems, IMO.
 
I think all the factors mentioned here are legit. However, the cold feet factors (ie, long time, 80%+ research career, etc) aren't just "thoughts that will go away." I think they are actually serious concerns that shouldn't be brushed aside. I'm not sure if I now want to pursue MD/PhD over just a straight MD for these reasons and more.
 
First, congrats to all who have been accepted!

Hate to say it, but you have to get used to having these sorts of doubts in professional life. There will always be reasons for self-doubt, worry, and critique. Think of it as your built-in safety mechanism for checking to see whether you are still committed to the path you have undertaken.

I am about to graduate from an MD/PhD program (8 years), and still have these moments of doubts and reflection. However, I realize that I am still doing what I love and that even on the worst days, I would rather be doing this than sitting in a cubicle in some office or waiting tables (not that jobs that involve those things are bad--they just are not my cup of tea).

There are several specific points along the MD/PhD path that are particular moments for self-doubt and reflection:
1) acceptance to the programs (what many of you are experiencing right now)
2) when your friends go off to 3rd year clinical rotations, and you go off on a different path to grad school and the lab.
3) during grad school when you hit the valleys and start to think "is this all worth it? I could be almost finished with med school right now like my friends!"
4) when your former classmates graduate from medical school. "It could have been me..."
5) when you re-start medical school & 3rd year clerkships. "I went from the pinnacle of knowledge in my field to be the guy who gets the attending and residents coffee!"
6) when you apply for residency and realize that many programs or individual faculty could care less about the PhD after your name, or ask you to summarize 3-5 years of research in 2 sentences.
7) when you are about to graduate from the program and you realize that you will not finish residency and have any hope of getting a reasonable paying job until your mid-thirties.

I'm sure it only continues during residency... perhaps the current residents can comment on that. :D
 
Last edited:
Members don't see this ad :)
Thanks for your thoughts. So right, after all the things you listed out, is it still worth it, especially for someone entering now?
 
I would say that if you worry that it will take too long, and don't want to go more than 8 years.... get out now. Seriously. 1/2 of all MD/PhDs who FINISH will take longer than that. If you know this is what you want to do, stick with it. There will be good times and bad times. But if you're already telling yourself that you'll leave if it looks like it will take more than 8 years, then you're already not allowing yourself to be immersed in this program and prepared to see your classmates graduate from med school in your second year of graduate school. I am not kidding, you should probably bail
 
Cold feet is normal. Take the above advice and figure it as a job. You will have job security for 6-8 years, and when you are done you will have 2 degrees and an inexhaustible job market and will likely emerge during better economic times. You will also not be saddled with a 6 digit loan, which is of course a nice bonus.

Remember though, it is an interest in research that needs to be your primary motivating factor. The truth is, if you love research before MD/PhD, you can survive. You may emerge hating basic science research, but that's OK, you don't HAVE to do research as a career later. It's the folks that are lukewarm on research to start and just see the financial/prestige benefits that have the most serious problems, IMO.

THIS.
IF you have a strong research backgound and love it, this is a great career path for you. You will truly have a unique perspective that will allow you to thrive.
If you are just lukewarm to it or are doing this for financial reasons or because it's hard to matriculate into these programs, do yourself a favor and withdraw now. Seriously. I can't tell you how many of my friends went though this and were never really convinced that this was what they wanted to do. It cost them all several years of extreme pain (ala Neuronix) that they are very bitter over or glad that they bailed when they did.
 
I was nervous when I started. Pretty normal from what I experienced.
 
gbwillner said:
It cost them all several years of extreme pain (ala Neuronix) that they are very bitter over or glad that they bailed when they did.

You make it sound like the people who weren't convinced they wanted to do MD/PhD come out bitter. Many who were convinced at one point still come out bitter. There was a guy in my class who was so into cell and molecular biology and loooovveedddd disecting out little pathways that the rest of us found kind of boring and not relevant enough to medicine. He ended up having a huge falling out with his PI and more or less left with his PhD before he was kicked out. Fortunately he had lucked into a paper on his rotation and left with that. He says he's never doing research again in private.

My point is that you have no idea as an undergrad if MD/PhD is right for you. You have no idea what it's like to be a doctor or a PI as an undergrad, no matter how many you talk to. You simply have no idea what the career pathways entail. Everyone who is an undergrad is as unsure about this as they are unsure about residency specialty. To think otherwise (as I did actually) is just self-delusion in the hopes that you are making the right decision so you don't question it.

I don't consider myself very bitter though. The bitter people just don't post on SDN, and you see how few senior MD/PhD students actually do. Grad school wasn't all pain, just half of it ;).

If you think you're making the right decision--you are. You were accepted because you're the best and the brightest medical students around. Be proud of yourself. A little self-doubt is good. Everyone has it. But you have the credentials or you wouldn't have been accepted. Thus you are the most qualified of anyone.

The finances sure aren't bad. I got to travel a lot of the world, take a year off, pick up a few hobbies, work on some others... All things I would never have been able to do with the meager cost of living loans I would have gotten from the medical school and with the huge financial debt burden. I mean my loans from undergrad go into repayment at $200 and my loans from med school are another $200. That's a joke compared to all my MD counterparts.

Over 40 days of skiing so far this winter. 10" overnight. Weeeeeeeeeee!
 
Last edited:
OP:

My personal view on this is that you cannot know what either medicine or "science" is like before you actually experience it in the MD program/residency or full time research. It's hard to know what's right for you. Only you know your own abilities and interests.

I can say that my experience as an MD/PhD has been bad. I have almost a visceral revulsion to most of what is characterized today as science. :laugh: Yeah, I know. The impression that a naive student may have in high school and undergrad is that going into science they will be adding to the record of human knowledge, helping humanity, etc. That's a joke. Most scientific careers end up producing no more than a paragraph or two (or is it sentence?) in a textbook, if you're lucky! The work of science is tedious, the rewards usually rather minimal. Forget about those dazzling idols of science - the Nobels and Laskers, polio vaccine and penicillin. In biology, those things are not so much the product of genius as the result of hard work on a topic that turns out to be very important or something that's completely unknown and uncharacterized and then you go ahead and characterize and describe it. For the vast majority of things there's no way of knowing if what you're studying is very important until you get the results. Frequently it's the unexpected results that don't fit within your agenda that are truly important. Also, the work that has the greatest impact on the lives of others usually is more mundane - clinical research (biomarkers), public health, infection control. You will notice that many basic science researchers gradually shift into clinical/translational research, and then into public health or administration. At some point there comes a realization that you've been slamming your head on the wall for a decade or two and that damn malaria continues to evade your vaccine attempts, so you'll take charge of a medical school and beguile other naive individuals to go down the same path you did.

I would advise you that, financial considerations entirely ignored, if you wouldn't do a lone PhD or a lone MD to not do this program. I was actually asked at an interview by an MD/PhD, if I had to make a choice between MD OR PhD, which would I choose. The "correct" answer is PhD. I said MD, because in science you have no guarantees whereas in medicine, routine although it may become, you have some guarantee of having helped someone. Needless to say, I did not get accepted to that program, although I did get into more highly ranked ones. The PhD is the bottleneck, the rate-limiting step. If you find the idea of a PhD on its own revolting, it isn't going to get any better when you slap on an MD.

Some people do this program because they want to secure a great residency in an ultracompetitive field. I advise against that entirely. The reality of the matter is that you can work *less* in total, albeit compressed in four years rather than 7-10, to get a stellar residency. If you're smart enough to get into an MD/PhD, you could likely ace all your med school coursework and board exams and get that coveted residency without any Ph.D. Furthermore, some residencies don't care for a PhD, or it's just a nice extra credential. Clinical rotations and the board score can actually count for (a lot) more than the PhD for some residencies.

Regarding money, I must confess that, in retrospect, this was a factor. I come from parents that have been in serious financial hardship all my life, and my sister has followed suit. You see, they're educated (physicist father, lawyer sister), but the finances have just been very bad all around for reasons I needn't go into: to illustrate, my parents don't own a home and my sister works in the public defender's office and her salary is 1/4 of her law school debt! She'll never crawl out of that hole on her own.

My advice is that finances shouldn't be a consideration whatsoever. I don't know of any unemployed or starving doctors. All seem to do well in the end. All of them pay off their debt eventually, own nice homes, go on vacations, finance their child's private school education, etc.

Doing the MD/PhD with money as any consideration at all, except as having the MD as a backup for primarily a research focus, is a big mistake. Doing it for a residency is a mistake. Doing it for prestige is a mistake. Doing it if you're peripherally interested in research but have lots of other interests is a mistake. You really have to be a somewhat obsessive person who can spend most of your life focusing on details and mechanisms that have little impact on the world. If you want to do research that will have a major impact on human health, just do an MD - trust me on that.
 
Doing the MD/PhD with money as any consideration at all, except as having the MD as a backup for primarily a research focus, is a big mistake.

So you would recommend an MD/PhD to have an "MD backup plan" for someone considering a career in research?

I can definitely see myself getting a PhD (I don't necessarily need to be helping people, I'm interested in science for science's sake), I'd be hardpressed to get just an MD, but it's something that I think I would find interesting and satisfying.
 
So you would recommend an MD/PhD to have an "MD backup plan" for someone considering a career in research?

I can definitely see myself getting a PhD (I don't necessarily need to be helping people, I'm interested in science for science's sake), I'd be hardpressed to get just an MD, but it's something that I think I would find interesting and satisfying.

Let's just put it this way. There are a lot of PhD's who end up having not very great careers. The best they can do is teach at a small college or become a "research associate" (translation: glorified post-doc) in someone else's lab or make the shift to industry, where money has an even bigger role to play than in academia. The US is saturated with both US and foreign biomedical scientists and competition is fierce.

An MD means that you can supplement your income with clinical money, and if the research fails altogether or you hate academia or hate academic politics, you can always go into private practice. Clinical work pays a lot more money and is substantially more versatile.

You may think you don't care about money now, but in 20 years, especially if you have a wife/husband, children, and aging parents, money will matter a lot more to you.

I would not recommend an MD without doing a residency. That's the most pointless thing ever.
 
There are no guarantees in life, OP. All that any of us can do at any point is to make the best decision possible using the available information at our disposal. You will never have perfect information, and throughout your life, you will still have to make hard decisions in spite of that.

What I suggest is that you make a list of pros and cons for MD/PhD. List everything you can think of, no matter how far-fetched or frivolous it may seem. Show your list to several other people whose opinions you trust and get their input. Heck, post it in this thread if you want, and let the forum gang here have at it. Look at your list and think about which things (both pros and cons) matter most to you. At some point (by May 15 in your case), it's time to stop thinking, make the decision you think suits you best, and move on with your life.

As a PhD-to-MD who is basically going through a career change, I would also remind you that whatever you decide is not carved in stone. Medical school (whether for MD or for MD/PhD) is not a prison sentence, and you are free to drop one or the other program (or drop out altogether) if you wish. Ideally, it won't come to that, because too many dead ends on your path through life can end up with you not ever getting anywhere. But you always have the option to make a change, should the need arise. :)
 
I was actually asked at an interview by an MD/PhD, if I had to make a choice between MD OR PhD, which would I choose. The "correct" answer is PhD. I said MD, because in science you have no guarantees whereas in medicine, routine although it may become, you have some guarantee of having helped someone. Needless to say, I did not get accepted to that program...

To the same question, I said MD to a committee member/dept head/MD-PhD at Columbia and was accepted. I prefaced my statement with the pros and cons of research with each degree, and it was acceptable. To future applicants... know each pathway and the combined degrees to the best of your ability, and do not feel forced to answer the 'correct' way. Maybe you were not meant for that school.

Otherwise, I appreciate everyone's perspective! Very helpful.
 
OP:

I can say that my experience as an MD/PhD has been bad. I have almost a visceral revulsion to most of what is characterized today as science. :laugh: Yeah, I know. The impression that a naive student may have in high school and undergrad is that going into science they will be adding to the record of human knowledge, helping humanity, etc. That's a joke. Most scientific careers end up producing no more than a paragraph or two (or is it sentence?) in a textbook, if you're lucky! The work of science is tedious, the rewards usually rather minimal.
Doing the MD/PhD with money as any consideration at all, except as having the MD as a backup for primarily a research focus, is a big mistake. Doing it for a residency is a mistake. Doing it for prestige is a mistake. Doing it if you're peripherally interested in research but have lots of other interests is a mistake. You really have to be a somewhat obsessive person who can spend most of your life focusing on details and mechanisms that have little impact on the world. If you want to do research that will have a major impact on human health, just do an MD - trust me on that.

Dude, this is seriously depressing. Your post should come with some Lexapro.

From my experience it's not all that bad. By the end of your PhD, if all goes well, you WILL be the world's expert on whatever you've been working on and will receive appropriate attention and recognition. Your papers will be cited, and you will see how your small, perhaps seemingly minuscule contribution leads to a better understanding of the way things work, and how you piece of the puzzle was critical in that process.
I would also argue with the notion that you don't really help anyone with research and that an MD helps more. This is only a matter of perspective. Another way to look at it is that all your patients will die and in the end you may actually do very little to help any of them in any real sense. If you go into IM, you'll likely spend you days figuring out the quickest way to discharge your patients so they can go die somewhere else. In any oncology related field you will be luck to prolong someone's painful demise by 3 months. In rads and path you will only help diagnosing the thing that will ultimately kill most of your patients. On the other hand, adding that little paragraph to our knowledge in science can change the way we treat patients, making therapies more effective. To me it's more like the "teaching a man to fish" analogy. I'm sure you all know it.
 
To the same question, I said MD to a committee member/dept head/MD-PhD at Columbia and was accepted. I prefaced my statement with the pros and cons of research with each degree, and it was acceptable. To future applicants... know each pathway and the combined degrees to the best of your ability, and do not feel forced to answer the 'correct' way. Maybe you were not meant for that school.

Otherwise, I appreciate everyone's perspective! Very helpful.

Guess it must have been my sucky GPA, then. :laugh:
 
From my experience it's not all that bad. By the end of your PhD, if all goes well, you WILL be the world's expert on whatever you've been working on and will receive appropriate attention and recognition. Your papers will be cited, and you will see how your small, perhaps seemingly minuscule contribution leads to a better understanding of the way things work, and how you piece of the puzzle was critical in that process.
I would also argue with the notion that you don't really help anyone with research and that an MD helps more. This is only a matter of perspective. Another way to look at it is that all your patients will die and in the end you may actually do very little to help any of them in any real sense. If you go into IM, you'll likely spend you days figuring out the quickest way to discharge your patients so they can go die somewhere else. In any oncology related field you will be luck to prolong someone's painful demise by 3 months. In rads and path you will only help diagnosing the thing that will ultimately kill most of your patients. On the other hand, adding that little paragraph to our knowledge in science can change the way we treat patients, making therapies more effective. To me it's more like the "teaching a man to fish" analogy. I'm sure you all know it.

Awesome, that's how I look at it! :D:D:D

...and sometimes, we prolong life to the misery of both the patient and the family. What's the point of living another three years if your body no longer functions and you can't recognize your family or friends. We need to reevaluate our approach to the end of life and treat it as carefully as the beginning. These are the really interesting questions that make me want to do the MD portion.
 
I'm a MDPhD who's back in the clinic, and I think I'm one of the few (along with Vadar) who hasn't yet regretted the decision of doing this program.

My PhD wasn't too painful, but it wasn't too phenomenal either. It was kind of a lukewarm PhD with no drama--and received average evals. My advisers loved me cause i'm very efficient, a habit learned during med school. Right now back in the clinic, my attending likes me (i think) because i'm independent and can speak in front of an audience really well, skills learned in PhD. You'd be surprised how experiences in life contribute and add on to each other in the end.

My PhD wasn't nearly as painful though...my experience isn't necessarily generalizable. Furthermore, I think you do need to have a special place in your heart to be able to continue in academia. I enjoy teaching people about my work. I enjoy going to conferences, giving seminars. I enjoy reading papers. I enjoy being a scholar. On the other hand, I enjoy being a physician, treating patients, explaining their medications, feeling appreciated, etc. For someone like me, I just don't see any other way to do what I wanted to do. So at the end of the day I didn't make a mistake by doing the MD/PhD. Now, just because you want to be a good academic physician scientist doesn't mean your abilities/diligence is sufficient to achieve that. But being on this track optimizes my ability to do what I want to do later on.

As far as the argument of basic science not being able to save any lives...that's not necessarily true. My PhD has more of a statistics/quantitative bent to it, and what I learned can be conceivably used in very clinical scenarios--and the straight MDs won't know a thing about these techniques. My point is, you never know...never say never.
 
Although there has much adversity along the way and many, many hoops to jump through, I am still feeling the love for the physician-scientist pathway. There is no better way to both help people in the short term and make long term contributions to medicine and society. Sometimes we lose sight of this when dealing with all the B.S. Despite all the hoops and adversity, it is the best pathway for those who love the excitement of discovery and who desire to make a difference in their patient's lives. :thumbup:
 
Vader, would you mind sharing your research interests? I know you're somwhere between neurology/psychiatry, and as someone interested in going in that domain, I'd like to hear specific interests by people already there.
 
The MD-PhD is a PITA - only do it if you MUST do it. If you really have doubts, do the straight MD.
 
I'm a peon aka undergrad and I know MD-PhD is for me. FAILURE IS NOT AN OPTION
 
Love that attitude! :thumbup:

But you should know that you will fail, and very likely, more than once, if you take the MD/PhD path. That's sort of the definition of being a researcher. You have to be able to deal with failure... and find ways to get out of being stuck. But if you keep hacking away, you can finish.
 
It seems like a majority of the professor didn't care if their PhD took them four or seven years... They just loved what they were doing.

You can think of it as a 4 yr scholarship and debt free if you get the funding?
 
Not to sound like a jerk, but I'm actually not having any second thoughts at all. I am so freaking excited!!! :soexcited: The government is going to pay for my med school. I'm never ever going to complain about paying taxes again, because at this point, I'm going to be getting it all back and more! Not only that, but I'll be getting paid. This freaking rocks! With the average human life expectancy going up, I have no problem spending an extra 4 years in school. In the long run, I will be extremely employable for the rest of my life and won't ever have to worry about being out of a job.

I didn't apply to any programs MD only. It took me the first 2 years of my college career to be able to admit to myself that MD/PhD was what I actually wanted. I didn't dare to dream that I could get into a program that only takes a tiny percent of the applicants. I kept making excuses and being afraid, but once I let go of my fear of being rejected from everywhere I applied and just went for it, I knew I was doing the right thing. (I was traumatized by almost not getting into any undergrad programs. I didn't know that it is customary to visit colleges, interview, and actually write full essays on the application instead of just a sentence or one word answer per question. I was so upset when I found out that I had totally screwed up after working so hard to get a good GPA and a good SAT score. Thank goodness Rochester saw through my lack of a visit or interview, and even lack of a secondary application and took me anyway. But I did it! Hence my eternal gratitude to these forums for helping me find the information I needed to succeed this time around. It was good to know that MD/PhD interviews are not optional... :D)

Also, if I had to choose between the two degrees, I'd go for the PhD over the MD hands down. It really surprises me that so many people would choose the MD. I guess I'm just a weirdo. My grandma is thrilled that she can finally tell all of her friends that she has a grandchild in medical school AND a grandchild who will one day cure her Parkinson's all rolled into one super awesome granddaughter! And that's my REAL motivation for getting the MD as well. :p
 
I'm having doubts about whether or not i'll get in anywhere....
 
You still have a couple of places left to hear back from, correct? Don't lose hope!
 
Not to sound like a jerk, but I'm actually not having any second thoughts at all. I am so freaking excited!!! :soexcited: The government is going to pay for my med school. I'm never ever going to complain about paying taxes again, because at this point, I'm going to be getting it all back and more! Not only that, but I'll be getting paid. This freaking rocks! With the average human life expectancy going up, I have no problem spending an extra 4 years in school. In the long run, I will be extremely employable for the rest of my life and won't ever have to worry about being out of a job.

I didn't apply to any programs MD only. It took me the first 2 years of my college career to be able to admit to myself that MD/PhD was what I actually wanted. I didn't dare to dream that I could get into a program that only takes a tiny percent of the applicants. I kept making excuses and being afraid, but once I let go of my fear of being rejected from everywhere I applied and just went for it, I knew I was doing the right thing. (I was traumatized by almost not getting into any undergrad programs. I didn't know that it is customary to visit colleges, interview, and actually write full essays on the application instead of just a sentence or one word answer per question. I was so upset when I found out that I had totally screwed up after working so hard to get a good GPA and a good SAT score. Thank goodness Rochester saw through my lack of a visit or interview, and even lack of a secondary application and took me anyway. But I did it! Hence my eternal gratitude to these forums for helping me find the information I needed to succeed this time around. It was good to know that MD/PhD interviews are not optional... :D)

Also, if I had to choose between the two degrees, I'd go for the PhD over the MD hands down. It really surprises me that so many people would choose the MD. I guess I'm just a weirdo. My grandma is thrilled that she can finally tell all of her friends that she has a grandchild in medical school AND a grandchild who will one day cure her Parkinson's all rolled into one super awesome granddaughter! And that's my REAL motivation for getting the MD as well. :p

Agreed with the outlook. Call me "naive", "idealistic" or whatever, but I truly believe that grad school will be fun. As long as I enjoy thinking deeply about a topic, coming up with experiments and getting all excited for results, it should be fine. On top of it, everything will be paid, and you'd be extremely marketable for the rest of your career, and always have job security. Not thinking twice about the choices atm.

But first, I have to get in. (*crossing figners at hearing good news from two places I interviewed at that didn't respond back*).

dmargul, don't lose hope yet. And I assume you're young and you're in your early 20s, so there's always hope for next year.
 
Northwestern and UIC for mdphd. I would definitely like to go to NW. I think i am going to write them a letter of intent tonight. Does anyone have tips for them? Paper/email?

I guess doing research this summer and getting a masters next year while i reapply isn't the end of the world.
 
Don't do the MD/PhD if you have any doubts at all, you'll regret it more than anything else in your life.

Also, I would disagree with whoever said that residencies don't care about the PhD. In many fields the PhD is a HUGE card, as long as it is a quality one with publications in good journals. It is not unusual for places to try to recruit you as junior faculty while you are interviewing for residency because they realize that it takes a sort of person who loves misery to pursue hard core research in academic medicine, and those types of people with your skill set AND a willingness to accept punishment are few and far between. It is a tremendous buyers market, except possibly in specialties saturated w/MD/PhDs like rad-onc, etc.
 
Don't do the MD/PhD if you have any doubts at all, you'll regret it more than anything else in your life.

Also, I would disagree with whoever said that residencies don't care about the PhD. In many fields the PhD is a HUGE card, as long as it is a quality one with publications in good journals. It is not unusual for places to try to recruit you as junior faculty while you are interviewing for residency because they realize that it takes a sort of person who loves misery to pursue hard core research in academic medicine, and those types of people with your skill set AND a willingness to accept punishment are few and far between. It is a tremendous buyers market, except possibly in specialties saturated w/MD/PhDs like rad-onc, etc.

totally agree re: the PhD and residency apps - i just got through residency interviews for a field relatively underpopulated by md/phds (anesth). still waiting to hear about the match, but there are extremely generous offers on the table - several programs (mostly "top tier") are offering 1) junior faculty positions or the equivalent right out of residency with ~2 years of 80/20 protected research time, no clinical fellowship required, and 2) stipends during residency ranging from 5K to 20K above resident salary. they all expect to retain who they train as faculty.

i don't feel quite as strongly about not doing the md/phd if you have any doubts at all-- at worst, you waste a couple years of your life and will never have to wonder "what if". it's not as if choosing a "straight MD" guarantees that you know what you're getting into- clinical medicine is not at all what i expected, and it's no coincidence that radiology applications have gone through the roof in the past few years.
 
is this normal for many MD/PhD's looking for a residency or is it because you're applying to anesthesiology? I've heard another story of a woman who graduated MD/PhD from not a prestigious program, but was offered faculty track positions in her residency at some great universities. Does this kind of path normally lead to a research faculty position or is there pressure to commit more of your time to clinical work? Do you start out doing a sort of mini-post-doc before getting your own lab?
 
it really depends on the specialty-- anesthesiology departments get a far lower share of NIH grants than their counterparts in medicine and surgery. at large academic centers, there is a strong incentive for a department to be innovative (or at least look that way). anesthesiology departments can typically afford to subsidize research out of their clinical revenue more than other departments. that said, the "crunch" seems to happen between 2 and 5 years after residency, when the department is less willing to pay your bills, and you have to secure your own funding (e.g. K08, R01 etc). if you can't, your department will likely lean on you to do more clinical work to make up the difference. i believe this is true in most specialties.

i don't know what kind of deals are "normal" in other specialties, since i only applied to one. my overall impression is that any department will want to keep you as faculty if you can get a grant - but some specialties are so md/phd heavy, as noted above, in specialties like rad/onc, heme/onc, neuro, that they can't just offer faculty track residency spots to everyone who is interested.

and btw, if you're looking to go into research-track residency, it usually matters more who your phd advisor is and what you publish than the prestige of your program.
 
...but there are extremely generous offers on the table - several programs (mostly "top tier") are offering 1) junior faculty positions or the equivalent right out of residency with ~2 years of 80/20 protected research time, no clinical fellowship required, and 2) stipends during residency ranging from 5K to 20K above resident salary. they all expect to retain who they train as faculty.

#1 is insinuated with several top MD/PhD applicants to "top tier" psychiatry residency programs. Certainly, chairmen simultaneously interview residency applicants as possible faculty applicants. However, since there are no signed contracts (this is the match process, after all, where that would be illegal), I'd take some of these offers with a grain of salt. Once you're a 4th year resident, the bargaining process can be drawn out until May or June of the year you graduate, by which time most MD/PhD's (who are often used to being planners) will want to know what the h*ll they're doing. Also, "junior faculty positions or their equivalent" is a vague phrase which implies assistant professor, but can include anything from an elevated postdoc to instructor to assistant professor to sometimes, clinical associate, and the chairperson *may* attempt to bargain between these depending on how much time you will spend doing clinical work.

#2 is awesome. I never got that offer. But again, unless it's in writing (or at least confirmed by current residents receiving such an offer at that institution) I'd be skeptical about that panning through.

Lastly, if you are a resident/young attending who procures these offers, it will be difficult to leave for another academic institution, as you will receive immense pressure to stay. So, I'd consider whether *you* could see yourself staying there long term.
 
Last edited:
And one more thing, in considering the appointments of (elevated) postdoc v instructor v asst prof v clinical associate, your salary can range from $mid-50's K to mid - $160K depending on where you work. My point is that offering a "junior faculty position that is protected for research time" can be a very vague promise in terms of your title, your duties and your salary. If they lay out 80/20 for you, that does say something about duties, I suppose. But then there's the specific title and the salary. And not all specific titles get the same salary, even at the same institution.

Though you can't (and probably don't want to) make a contract prior to starting internship, I'd be aware of all the options. You might be getting a great deal. Or you might be taken advantage of. So shop around. Chairmen will respond to counteroffers if presented in a friendly (passive aggressive ? :laugh: ) way. If you want to stay where you're at, obviously, you want to play nice. Besides, as they as say, never make enemies in academia.
 
(not to totally hijack the thread)... tradewind, most of those very issues came up during my interviews- i agree with you that anyone looking into a long term gig (residency->faculty) should really pay attention to these details early. as i wrote above, i can only really speak for anesthesiology programs. this thread (starting at post #13) has links to a number of them. in most cases, there are written contracts obligating a resident to stay on for 1-2 years and guaranteeing the resident stipend. they've found a couple ways to deal with the match - ucsf has a separate NRMP code for its program; others send out letters pre match saying, more or less, "you are accepted for the scholarship if you come here for residency, but the acceptance in no way guarantees a successful match".

i really haven't heard of anything like this (other than "fast track" IM residencies) for other specialties. from what i've heard in neuro & psych, it's more or less what you describe - sunshine and promises, usually in good faith. the fact is that md/phds interested in continuing research careers gravitate to these fields, so there's no need to lock 'em in to the same extent.
 
The young applicants and MD/PhD students should be highly encouraged by the insights of Spacedman and Tradewind. I share some of these same experiences in interviewing for residency. I applied in neurology and found that at several of the programs, particularly ones interested in encouraging physician-scientist careers, interviewers were very encouraging and did hint at or explicitly mentioned future opportunities like faculty positions, etc. I can say that I wasn't really expecting this--but was a pleasant surprise. Of course, there was nothing written in stone, but nice to know that the opportunities exist and that people are very interested in having MD/PhDs as future colleagues.

There are actually relatively few MD/PhDs (around 15-20 per year lately) that have been going into neurology, which is itself a small field compared to internal medicine and pathology. Neurologists are very interested in having MD/PhDs interested in neuroscience pursue clinical careers in neurology because the field has a strong academic/research tradition, tends to meld well with the goals of a physician-scientist, and there is great need for understanding the basic mechanisms of neurologic diseases to advance therapy. That is why neurology-related organizations like the NINDS and AUPN sponsor programs that encourage physician-scientists to pursue neurology.

Fields that have even fewer physician-scientists tend to be even hungrier--so I'm not surprised to hear about anesthesiology and additional perks. I think this should be highly encouraging for those applying to or just starting MD/PhD programs!
 
Spacedman, I'm really glad to hear that things went so well for you. I remember that thread you linked; it does seem pretty uncommon for MD/PhDs to go into anesthesiology. You and I are the only ones I'm aware of on SDN who were even interested. Assuming I go for anesthesiology, would you mind if I PM you to get some feedback and advice when I apply?
 
Thank you all for posting about these opportunities. Given the current research environment (which hopefully will only improve...), it's really heartening to hear that there are faculty jobs on the horizon even starting in residency.

I know IM is more popular among MD/PhDs and might therefore have fewer residency programs hinting at or offering longer-term positions, but do you know about any? Or any associated with IM fellowships, particularly ID or GI?

Thanks!
 
Thank you all for posting about these opportunities. Given the current research environment (which hopefully will only improve...), it's really heartening to hear that there are faculty jobs on the horizon even starting in residency.

It's easy to get a faculty job out of residency. You might make next to nothing, work a bazillion hours a week, and have no job security, but it's still a faculty position. In my chosen specialty they can't find anyone to become academic faculty. Top posts go vacant for many years. They are extremely attending short-staffed, to the point where hospitals can't even find physicians to do the job and contract it all out to private practice physicians. Why? PP pays a lot better, works a lot less, etc etc etc... The MD/PhD faculty I knew didn't even get to go to the big conference in the field every year--he had to cover the clinical service while all the 90% clinical but older attendings went to the conference.

So sure, residency programs are happy to sign you on. They're happy to force you into fellowship when you start residency. The fellowship positions often don't fill. They'd love to have you be their assistant faculty, when you could go off into PP and easily triple your salary (gas, Rads, others). It's likely you're just going to be paid as you would as a fellow ($60k) unless you can bring in big grants in what... 2 years?! hahaha! Bringing in enough grants to cover your salary in 2 years! That's rich! Good luck getting a startup package.... Errr umm... What's that? Tenure track? What's a... tenure? Ohhhhh that old antiquated thing. Yeah right, you lose your funding, do clinical work or gtfo. Or maybe you can go back to being our clinical bitch AND trying to find funding all for your fellowship salary. You don't mind doing that forever right?

When I was a pre-med the idea of being medical school faculty sounded very appealing. There's a reason they're trying like heck to get MD/PhDs to sign on to their fellowships. There's a reason they try to recruit you early into their residency/fellowship/faculty positions... If they paid well or had some other amazing benefits, they wouldn't be trying to recruit you. Everyone would be banging down the door for those spots. If research was a great gig, every guy with an MD would be trying to grab a spot in a lab. But... Oh yeah... Instead, the section chief spot for a particular subspecialty in a particular very big name hospital goes unfilled for 3 years and is finally filled by an foreign doc who can't even technically practice for a few years. Wonder if he'll bail out as soon as he gets licensed and board certified too?
 
Last edited:
When I was a pre-med the idea of being medical school faculty sounded very appealing. There's a reason they're trying like heck to get MD/PhDs to sign on to their fellowships. There's a reason they try to recruit you early into their residency/fellowship/faculty positions... If they paid well or had some other amazing benefits, they wouldn't be trying to recruit you. Everyone would be banging down the door for those spots. If research was a great gig, every guy with an MD would be trying to grab a spot in a lab. But... Oh yeah... Instead, the section chief spot for a particular subspecialty in a particular very big name hospital goes unfilled for 3 years and is finally filled by an foreign doc who can't even technically practice for a few years. Wonder if he'll bail out as soon as he gets licensed and board certified too?

And yet, you'll have a position. Compare this to most PhDs, who spend three or more years trying to get a junior faculty spot after a few years as a postdoc. If we wanted to make as much as we might in private practice, why the hell would we apply for MD/PhD programs in the first place?
 
Top