How much does a MD/PhD help

[Choboy]

So I am really interested in RadOnc, its one of the few places I can see myself really enjoy working for 40+ years and I would love to match. Unfortunately, reality slapped me super hard during my MS1 and I haven't done very good in my classes (mid-high 70s for most classes). I know this isn't good enough and I am going to try harder but I need to start being realistic about how my Step 1 scores will be. I am confident that I can do decent but I don't think I'll get the 240+ that seems to be the average in RadOnc. My question is if switching to an MD/PhD program would really help me in my application? I want to do research when I actually practice medicine so the PhD isn't problem but I would hate to waste 3-4 years on something that is a super long shot.

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[Gfunk6]

Unless you envision yourself as a career physician scientist it is a really, really bad idea to enroll in an MD/PhD program.

 

[Neuronix]

Rad onc programs don't really care about your pre-clinical grades as long as you don't fail things.
Step 1 score has little correlation to pre-clinical grades. Study hard for it.
A PhD won't compensate for a lousy step 1 score. An MD/PhD applying with a 210 still runs a good chance of not matching.
The value of a PhD is grossly overrated by SDN. A year out for dedicated rad onc research can be just as effective.
If your goal is to get a PhD just for a residency, you will never finish the PhD. PhDs are grueling and self-motivated. You won't last for the four years.

 

[ramsesthenice]

Look at the charting the match outcomes data. MD/PhDs have the same match rate as anyone else. A good PhD may help you match into a competitive research program (after a ton of hard work) but unless you have a complete application the evidence suggests it won't help you match to the field. What you suggest makes no sense and I wouldn't do it.

 

[MegaVoltagePhoton]

Rad onc programs don't really care about your pre-clinical grades as long as you don't fail things.
Step 1 score has little correlation to pre-clinical grades. Study hard for it.
A PhD won't compensate for a lousy step 1 score. An MD/PhD applying with a 210 still runs a good chance of not matching.
The value of a PhD is grossly overrated by SDN. A year out for dedicated rad onc research can be just as effective.
If your goal is to get a PhD just for a residency, you will never finish the PhD. PhDs are grueling and self-motivated. You won't last for the four years.

I got to say, I feel like rad onc as a specialty grossly overappreciates MD/PhDs. Obviously it is a very bad move to become an MD/PhD to match in rad onc (particularly if you appear to have difficulties in the preclinical years). But I have seen MD/PhDs compensate for bad grades and scores (within reason). This is particularly true in the low and mid-tier programs.

It's totally nonsensical since most, if not all, of these programs do not have the infrastructure to support basic science research, and an MD/PhD is not needed for the types of clinical projects that people do in rad onc. Anyway most rad oncs are clinically oriented and I think it's a big mistake for the field to value research as much as it does.

</soapbox>

 

[prometheus1]

Doing an MD/PhD program primarily to increase chances of matching into a competitive residency program is a mistake.

However, if you are serious about doing basic or translation research then it is a reasonable option. The other option is to complete residency and then do research afterwards. The later has the advantage of giving you the option to not to the research should you choose not to, without wasting time. The later option is also not clearly worse than the former.

I will say, though, that if you do an MD/PhD, publish well, do well in clinical rotations, and score high on Step 1 (Step 2 important as well but less so) , then yes, you will be a top residency applicant for any field. But this is a little like saying, "if you do everything and are good at all of it then yes, you will do well," so that's not helpful.

My opinion, do the MD/PhD if you like research, see yourself doing it in the future, are not in a hurry, and are not averse to risk (spending 3-5 years in a PhD risks wasted time, but it is also could be a potential huge win). The funding environment 10-15 years out from now, which is the timeline most relevant to you, is unpredictable.

 

[punkedoutriffs]

What are some options for research training after residency w/o a PhD? Like a postdoc? Fellowship?

 

[ReOxygenation]

I think it's a big mistake for the field to value research as much as it does.

</soapbox>

This is unadulterated idiocy. Lest you seek irrelevance.

To date, Rad onc has ridden a wave of physics advances. "We" should be proud of this, but not complacent. Now is the time to seize the opportunity to push the field into the molecular/targeted era which will be requisite for future viability.

Should this not happen, I am comforted by MVP's chart review(s), because those are great.

 

[MegaVoltagePhoton]

This is unadulterated idiocy. Lest you seek irrelevance.

To date, Rad onc has ridden a wave of physics advances. "We" should be proud of this, but not complacent. Now is the time to seize the opportunity to push the field into the molecular/targeted era which will be requisite for future viability.

Should this not happen, I am comforted by MVP's chart review(s), because those are great.

I take it reading comprehension is not a strong point?

Just having an "MD/PhD" doesn't make someone the next big thing in research, nor does it make up for poor clinical skills. For every bogus "chart review" a clinician researcher does, there is at least one bogus gene expression/IHC paper basic science paper that contributes even less. There are superstars MD/PhDs out there, and then there are duds. My point was merely that many programs have a weird fetish with "research" without an accompanying understanding, and will recruit MD/PhDs because it sounds good to do so. Particularly with people like you harping about the next wave of radiobiology/oncology breakthroughs.

How many MD/PhDs in general, let alone in rad onc, actually pursue basic science research careers? Further, what % of MD/PhDs at low-mid tier rad onc residency programs get protected research time that would allow for meaningful basic science research?

Not to mention, your derision of "chart reviews" speaks even more to your ignorance. Particularly given the fact that most MD/PhDs will end up doing that type of research in our field anyway, if they even do research at all.

But I'm glad you bought into your own hype as a "scientist".

 

[ramsesthenice]

We have gotten way off topic. As is always the case no one knows what advances will bring us into the future. Might be physics, might be immunology based research. I think it will be good for us to have more rad oncs in basic science to make sure radiation gets incorporated into multiD paradigms with emerging technology. We also need chart reviews and retrospective research to monitor how we are doing and where to improve.

I personally think the degree is less important. Plenty of non-PhDs do post-docs or fellowships and get into lab based careers. And yes, a lot of PhDs don't go into that kind of career and there is nothing wrong with that. Science is a ton of fun but it's pretty understandable that people get a taste of translational/clinical medicine (which you can't really experience until your a clinician) and really like it.

What is bad for the field is when people overvalue their own work and miss out on important advances going on around them.

 

[thecarbonionangle]

doing an MD PHD is a million dollar mistake.

I can think of a few top programs that have a hard on for MD PHDs and the majority of their graduates go into PP without any desire for research.

 

[medgator]

doing an MD PHD is a million dollar mistake.

I can think of a few top programs that have a hard on for MD PHDs and the majority of their graduates go into PP without any desire for research.

Considering the starting salary in rad onc (and considering it does go up incrementally each year regardless of pp vs academics vs hospital), you aren't too far off target with quantifying the amount of the mistake.

It's at least 3-4 years of potentially lost income by going the md/phd route. Plenty of MDs match straight out of med school or with a year of research at most

 

[thecarbonionangle]

My school had an average of 4.5 years-5 for completion of PhD. I knew of an MSTP that was in an almost 7 year PhD in my lab. The 3-4 year thing was rare. You're also talking about working slave hour wages at the mercy of a "Committee" who decides when you're done. Not to mention the occasional PI who finds you too valuable for the lab and wants to keep you another year so you can teach the grad-students all you know.

Do a year of research at most if you want, but don't sell your soul for a PhD.

 

[ReOxygenation]

doing an MD PHD is a million dollar mistake.

I can think of a few top programs that have a hard on for MD PHDs and the majority of their graduates go into PP without any desire for research.

Overall agree with this. It's a bit more complex when you factor in graduating debt-free and the value of (usually) being able to match better with the degree than without on the whole. Certainly it is not wise to peruse MD/PhD training from an economic standpoint.

And as has been pointed out, the MD/PhDs still go into private practice in large #s. I think I heard stats somewhere on the order of 60ish%. And actually a similar %age of Holman end up in PP as well.

Unfortunately, I think a huge misperception by med students and residents in the field is that if one ends up in PP, this is somehow a failure or disappointment. This mentality is simply a product of the environment in which we are raised but couldn't be further from reality. MD/PhDs are not immune to burnout and likely suffer from it in larger proportions than MD-"only" counterparts and choose to exit the rat race. That, coupled with the fact MD/PhDs are older and more often subject to family pressures/obligations, it's easy to see how PP is often their destination.

Ultimately, all that matters is you get a job that you want and fulfills you, no matter the setting. MD/PhD or not, PP or academia. We are in the best field in medicine by far. Enjoy it in any and all ways possible.

 

[Neuronix]

MD/PhDs are not immune to burnout and likely suffer from it in larger proportions than MD-"only" counterparts and choose to exit the rat race. That, coupled with the fact MD/PhDs are older and more often subject to family pressures/obligations, it's easy to see how PP is often their destination.

I don't like the phrase "burn out" because I don't feel like it reflects reality. There simply aren't enough positions out there for all the MD/PhDs in radiation oncology to continue in research that would require PhD-level training. The ones who are getting those positions nowadays are a combination of lucky, persistent, and flexible.

You need to be lucky enough to have any opportunity to pursue the research you believe in.
You need to be persistent to get through high levels of uncertainty, rejection, and often the requirement for a temporary, low paying position such as in a fellowship in the *hope* that you will someday get a real research position.
You need to be flexible, because these positions are uncommon, and that may mean moving *anywhere*. Can your family relocate *anywhere* ? How long do you feel comfortable not only going *anywhere* but also living on resident level salaries? There aren't many people who meet that kind of threshold.

There aren't even unlimited fellowship opportunities out there for future physician-scientists, even if every MD/PhD was required to do a fellowship to pursue significant research careers. I constantly hear that you need to do a fellowship to go out and get funding. A lot of departments will tell you "we don't hire physician-scientists without funding". Yeah, except my buddy applied for a K grant and the study section SRO told him, off the record of course, that they aren't even considering grants from fellows given that the funding rates are so low. The sentiment is: why should they give grants to fellows when they have assistant professors with real permanent positions and real institutional support (many of whom are in med onc...) applying for those grants? What a catch-22.

Where's the burn out here? You can't be burnt out doing a job that you can't even get.


At the end of the day, research is the basis of our specialty. I believe that it's important. I believe that my particular area of interest based on a skillset earned from years of obtaining a closely related PhD could transform how we do radiation oncology in the next 10 years. I believe that there are a lot of opportunities out there. But, everyone's heard that before. The money isn't there. Grant funding continues to decline. Clinical reimbursements are not increasing. Departments, and particularly research programs, are in survival mode. So in an ideal world, we should have lots of research that utilize all these MD/PhDs towards the goal of improving cancer cure. But in the real world, the money just isn't there to support us.

So what percentage of residents should have PhDs? I don't know, it depends who you ask. When I applied to residency, my experience was certainly that, subjectively and objectively, my PhD was not valued. I felt like the sentiments from MegaVoltagePhoton were overwhelmingly more common than the sentiments from ReOxygenation, even at the big name academic programs. At least MD/PhDs typically have no fear of pushing a few buttons in SPSS to generate the stats for their retrospective chart reviews. Hooray.

 

[MegaVoltagePhoton]

So what percentage of residents should have PhDs? I don't know, it depends who you ask. When I applied to residency, my experience was certainly that, subjectively and objectively, my PhD was not valued. I felt like the sentiments from MegaVoltagePhoton were overwhelmingly more common than the sentiments from ReOxygenation, even at the big name academic programs. At least MD/PhDs typically have no fear of pushing a few buttons in SPSS to generate the stats for their retrospective chart reviews. Hooray.

I feel like you have misinterpreted my position.

(1) "Research experience" and in particular having a PhD are overvalued in this field, relative to some indicators of clinical competence (flawed as those may be). Let's face it, how many times have we seen on here that people should take a year off to make up for those clinical grades or step 1 scores? That having a PhD can outbalance a low(er) Step 1 score or grades?

(2) In my opinion, this overvaluing of research at the residency level is foolish. As you enumerated in your post in detail, the support is simply not there for basic research even at the attending level, let alone for trainees. Sure, some huge, top name programs can pull it off -- but in general those programs are going to be taking the "best of the best", who have globally strong applications. The low and mid-tier programs that talk a big game about training physician-scientists don't even have attendings with enough protected time to do research, an no support infrastructure for residents.

The harsh reality is thus that without globally changing our field's support of science, one must consider that the majority of MD/PhDs who are recruited will never become physician-scientists. And an even harsher reality is that the majority of people getting PhDs may not even want to, or may not even have the complete skillset required to, run a lab in the first place. Thus if they are not clinically up to snuff it is a mistake to overvalue their research. And if someone does have off-the-charts research, then their research is not being "overvalued", but is being valued appropriately...but again, they would need to go somewhere that can support it, not some random program that can't or won't actually support it.

 

[Neuronix]

I feel like you have misinterpreted my position.

I apologize for any comments that you feel misrepresent your position. I appreciate that you have restated your thoughts, and I think those sentiments and variations thereof are very common within academics. I didn't mean to imply that you or academic programs in general have *no* value for PhDs, but rather that the high perceived value of a PhD on SDN and often by residency applicants is not reflected in the real world. Your comments are a very good argument to that effect, and they reflect my own anecdotal experience with what I continue to feel was a very strong PhD by almost any basic science research benchmark.

 

[MegaVoltagePhoton]

I apologize for any comments that you feel misrepresent your position. I appreciate that you have restated your thoughts, and I think those sentiments and variations thereof are very common within academics. I didn't mean to imply that you or academic programs in general have *no* value for PhDs, but rather that the high perceived value of a PhD on SDN and often by residency applicants is not reflected in the real world. Your comments are a very good argument to that effect, and they reflect my own anecdotal experience with what I continue to feel was a very strong PhD by almost any basic science research benchmark.

I apologize as well for not being clearer in my first post.