MD/PhD for academic medicine but not basic science research

definitely_chondria

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I have had the great fortune of being accepted to a few incredible MD/PhD programs, but this application process has made me seriously reconsider my career aspirations. I am still 100% committed to academic medicine, in that I fully envision myself participating in teaching and administrative duties (admissions, curriculum committees, diversity recruitments, etc.) alongside clinical practice. However, I am fairly confident that I don't want to run my own lab as a PI. I'd prefer to conduct clinical research or public health research (20-30% of my time) rather than wet lab/basic science work. All this considered, should I still go forward with the MD/PhD or do MD-only? Finances are an important consideration, since I don't qualify for need-based aid and my parents will only help with my COL expenses, so I would likely graduate $300k of debt. I feel that the financial benefit of MD/PhD would reduce a lot of stress and improve my quality of life for the next decade, even though the financial benefits are null in the end. Additionally, timing isn't a huge issue for me because I love being in school, I look forward to the intensity of graduate training, and I am excited about living in a new city for 8 years. I think doing the PhD would give me important experience in designing and conducting sound research, and this experience may help me secure a position in academic medicine in the future. That being said, would I be expected/constrained into doing basic science research in the future if I get a PhD? I would appreciate any other perspectives on this dilemma.
 
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No one will force you do to basic science research after you graduate. You can do whatever you want after an MD/PhD. Many, if not most MD/PhDs do not run their own labs. I say go for it if you don't mind 3-5 years of low paid hard work.
 
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I have had the great fortune of being accepted to a few incredible MD/PhD programs, but this application process has made me seriously reconsider my career aspirations. I am still 100% committed to academic medicine, in that I fully envision myself participating in teaching and administrative duties (admissions, curriculum committees, diversity recruitments, etc.) alongside clinical practice. However, I am fairly confident that I don't want to run my own lab as a PI. I'd prefer to conduct clinical research or public health research (20-30% of my time) rather than wet lab/basic science work. All this considered, should I still go forward with the MD/PhD or do MD-only? Finances are an important consideration, since I don't qualify for need-based aid and my parents will only help with my COL expenses, so I would likely graduate $300k of debt. I feel that the financial benefit of MD/PhD would reduce a lot of stress and improve my quality of life for the next decade, even though the financial benefits are null in the end. Additionally, timing isn't a huge issue for me because I love being in school, I look forward to the intensity of graduate training, and I am excited about living in a new city for 8 years. I think doing the PhD would give me important experience in designing and conducting sound research, and this experience may help me secure a position in academic medicine in the future. That being said, would I be expected/constrained into doing basic science research in the future if I get a PhD? I would appreciate any other perspectives on this dilemma.
MD-only, you will likely struggle and not enjoy grad school if your heart is not in your work. You will recover the cost of tuition by being an attending that much sooner. Also, grad school does not prepare you well for clinical research or public health, unless this work is in Epidemiology or Statistics.
 
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EyeOweYou

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Hard to think of a worse reason to do an MD/PhD than for a perceived financial benefit. If you really want to do it, go for it but it sounds like you don't need it. Grad school is no joke and it's hard to truly grasp until you're already in
 
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eteshoe

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If you have a high pain tolerance, then maybe pursue this path. But when your cohort starts to graduate and make real money while you're still chugging away in lab, it can be a tough pill to swallow. Unless you have that fire burning in your stomach to keep pushing through.

Based on your career aspirations, I'd just say take the time and figure out if a PhD is what you really need. The nebulous nature of it and the loneliness of the path are variables to consider amongst others. At the end of the day you'll be a professional with a decent renumeration package and the means to pay back loans in a reasonable amount of time.
 
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pBar

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Curious if the programs you've been accepted to are friendly to "non-trad" PhD fields such as public health, epidemiology, implementation science, etc.? And if so, how willing they might be for you to transition into a non-basic science area of research for your PhD if you had originally applied in with the intent of doing basic science research. As someone who is currently attending an MSTP for a graduate degree in one of these more "non-trad" fields, I never have and probably never will step foot in a wet-lab and I am 100% okay with that, since I don't see that as a part of my career path as a physician social scientist. However, at programs that support this route, non-trad students need to have pretty strong justification and reasoning for why an MD-PhD is necessary for their career goals and worth being funded.

Of course all this only really applies if (a) you feel like a PhD in the social sciences would better fit your career goals and (b) your MSTP program supports such courses of study.
 
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creode

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I agree with the above sentiment. I personally knew two MD/PhD students (matriculated many years apart) with similar feelings coming into their MD/PhD program. They each decided to stick it out hoping the dual degree would still be a benefit to their career plans or that perhaps they would change their mind during the program. Both ended up leaving the program during their PhD and were suddenly stuck with replanning many aspects of their career. Both wish they had listened to their gut and saved themselves the time. Switching their plans would have been much easier before entering the MD/PhD program. Seriously think about it, but if academic medicine is what you want and not to be a physician-scientist running a basic research lab, MD-only will be a better, cheaper, and more direct route.
 
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BRTC200

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It was only upon a re-read of your post that I noticed your username...was not expecting you to be the author of this! I have watched your cycle with admiration this past year and congratulations on your incredible results. I imagine with your application having been received as well as it had, you must have had an exceptional record of production thusfar, so at the very least if you can see yourself continuing to work in the capacity that you already have, you *could* make it through the PhD years and finish with an MD/PhD debt free.

However, I've went through this consideration process many times of whether I truly want the MD/PhD or not, and at least for me, it really came down specifically to training in basic biology research that made it the compelling and right choice for me. I have most definitely not accomplished as much as you have in the lab, but even when I conferred with my own basic biology PI in whether to pursue an MD/PhD or an MD-only education, they (a PhD) leaned more on the side of pursuing an MD-only degree with the rationale that running a basic biology research lab is possible with MD-only, and thus the PhD, for the sake of pursuing basic biology research, is not required.

In your shoes, I would see at least these aspects to consider:
- do you WANT to do basic biology research for 4 years? (will it be tolerable at least, perhaps even enjoyable?) I would hate to see you in a position in 4 years, as you're deep in GS2, finding yourself unhappy about where you are as you watch MD-only peers finish school and match to residency.
- do you really feel passionate about having that second degree? I always see the argument against as one of financial basis, where you lose out on at least 2-4 years of attending-level salary (I say 2-4 in case you end up pursing some specific training in public health, say a MPH). With some big assumptions in future attending salary, your financial break-even point between pursuing a fully funded MD/PhD versus paying for MD-only out of pocket will likely be within 2-3 years, which may seem like a near wash considering the additional salary we had just discussed, but consider that that will also be 2-3 years of additional experience which will empower future career movement as well.

Congratulations on all the amazing As you've received and best of luck as you make this tough decision here. I am sure that there will be a great institution in the end that can accommodate for what you truly decide you want to do in your life!
 
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SurfingDoctor

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I mean, you don’t have to do biology wet lab stuff in your PhD (ie there’s biomedical engineers, computation science, etc.)

Also, no one is gonna pay you anything special for teaching resident and students and being on a committee. Everyone is obligated to do that in academic medicine. It’s not some elective career choice. I guess, maybe you mean something different, but so often I ask trainees “What do you want to do in your career?” and everyone who says “Teach students”... I think “Oh really?”

All that being said, you shouldn’t consider the impact of debt of school (or the lack there of) in your training because it in the, ie retirement, it won’t really matter BUT you should consider the impact of spending 5% of your life on doing something you have no interest in doing.
 
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I have had the great fortune of being accepted to a few incredible MD/PhD programs, but this application process has made me seriously reconsider my career aspirations. I am still 100% committed to academic medicine, in that I fully envision myself participating in teaching and administrative duties (admissions, curriculum committees, diversity recruitments, etc.) alongside clinical practice. However, I am fairly confident that I don't want to run my own lab as a PI. I'd prefer to conduct clinical research or public health research (20-30% of my time) rather than wet lab/basic science work. All this considered, should I still go forward with the MD/PhD or do MD-only? Finances are an important consideration, since I don't qualify for need-based aid and my parents will only help with my COL expenses, so I would likely graduate $300k of debt. I feel that the financial benefit of MD/PhD would reduce a lot of stress and improve my quality of life for the next decade, even though the financial benefits are null in the end. Additionally, timing isn't a huge issue for me because I love being in school, I look forward to the intensity of graduate training, and I am excited about living in a new city for 8 years. I think doing the PhD would give me important experience in designing and conducting sound research, and this experience may help me secure a position in academic medicine in the future. That being said, would I be expected/constrained into doing basic science research in the future if I get a PhD? I would appreciate any other perspectives on this dilemma.

I kind of don't even get this question. You're admitted to a program that you're excited about in an area where you will enjoy living, to study something you want to learn and to gain valuable experience in research design and the scientific method that will undoubtedly serve you well in almost any area of medicine or biomedical research.

I really don't understand all the naysaying around here. Congrats on your acceptance, sounds like it was hard won and undoubtedly well deserved. If you are pretty clear you don't like the wet lab then use M1/M2 to see what possibilities for computational, epidemiological, biobehavioral, or public health research might be available and interesting to you.
 
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All that being said, you shouldn’t consider the impact of debt of school (or the lack there of) in your training because it in the, ie retirement, it won’t really matter
I find this argument bizarre. The real QOL difference does not come in retirement, it comes on the front end. The financially tight period is residency and fellowship, a time when lots of people want to buy houses and start families, and a big debt burden can force unwanted delays and generate a lot of stress during this critical time. Additionally for early career physicians with an interest in science, a debt burden can prevent them from being able to sink several years into a low-paid research fellowship, instead directing them into a more remunerative attending job, and effectively closing them off from a research career.

Having to downsize in retirement seems like a relatively minimal consideration in one's overall life trajectory. Financial choices that determine where you can live, how many children you have, and whether you can pursue a research career seem like a much more relevant consideration with life-long and life-altering consequences.
 
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SurfingDoctor

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I find this argument bizarre. The real QOL difference does not come in retirement, it comes on the front end. The financially tight period is residency and fellowship, a time when lots of people want to buy houses and start families, and a big debt burden can force unwanted delays and generate a lot of stress during this critical time. Additionally for early career physicians with an interest in science, a debt burden can prevent them from being able to sink several years into a low-paid research fellowship, instead directing them into a more remunerative attending job, and effectively closing them off from a research career.

Having to downsize in retirement seems like a relatively minimal consideration in one's overall life trajectory. Financial choices that determine where you can live, how many children you have, and whether you can pursue a research career seem like a much more relevant consideration with life-long and life-altering consequences.
I don’t think it equates to as big of a deal as people make it out to be. If you learn to save and live with your means, the 200k debt of MD training after 4 years and the 0 debt training after 8 years probably work out pretty close in academia. I would love to see some actual numbers that would prove some life changing disparity.

They do these salary comparisons in Pediatrics every couple years and the lifetime difference in earnings isn’t as remarkable as one would think. I mean, if you’re comparing a Pediatric ID person at Ivory Tower U to a private practice Neurosurgeon, sure, but all things being equal and having the exact same career track after school, I’m not convinced that MD only versus MD/PhD really makes a financial difference in the long run.
 
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I agree with people that if you're dead set on not wanting to be a PI, then MD only is the better track. MD/PhD makes no sense whatsoever for financial purposes. 4 years in PhD = 4 years attending level where you pay off your debt AND arguably have a higher QOL than a PhD. If you're still unsure then, yes, debating this makes sense. Bare in mind that QOL is not just money. In those 4 years of being a lowly student at the whims of your PI whose motivation is already questionable for working extra hard in the lab, you would be an attending.
 
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The PhD provides research training. That's it. You can do whatever you want with that. Do not try to squint in between the lines and make up some grand purpose - do not listen to people who do the same.
 
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Based on your post, I would say try to sit down and seriously consider sticking with the PhD but pursuing dry lab / computational work and trying to use M1/2 to identify a specific clinical interest so that you can target your PhD to that work. It sounds like you are the right "kind" of person for an MD/PhD. Being a PI is just one possible outcome of an MSTP. If you want to be an academic focused on clinical research, you can still do a PhD that would be more relevant to that end goal than a hardcore basic science PhD.

If you really just dont wanna do research at all, skip the PhD. But use M1/2 to explore I'd say.
 

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PhD is a waste of time if your only goal is to go into academic medicine and practice clinical medicine. The vast majority of academics is clinical MDs who do little or no research. This does not require a PhD, and a PhD is a waste of four (?) years of your life for such a goal.

The last thing I want as a PI is an unmotivated graduate student who is just looking for some "experience", doesn't plan to use the degree when they finish, and either quits the program or does the bare minimum because they wanted a free MD and/or think the PhD title alone is going to do something for them someday.

Either you have the fire to compete and be the best to become a PI or you don't. If you don't, don't bother with a PhD.
 
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I disagree to some extent. It is not black or white, but a lot of shades of gray. PhD gives you a better understanding of the process of inserting a scientific fact or explanation within a textbook. It gives you greater credibility among your other clinical MD colleagues. The process of clinical research fundamentally is the same scientific process, but just as with another discipline, many subtle differences and new techniques and statistical analysis. Indeed, it might be an inefficient use of your time for that goal, and as indicated previously, completing the PhD may become a grind and unpleasant process for an unmotivated student.
 
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NIHNewInnovator

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Congratulations on your MSTP acceptance!
I got my PhD in medical physics along with my MD from an incredible MSTP program. 15 years ago I invented a new imaging method. We just completed a phase II study with positive results, in review at JCO. The PhD allowed me to lead that research and keep my own group funded for 15 years. The PhD has also allowed me to be the dissertation advisor for 10 PhD students, though not one was an MSTP student. Finally the MD PhD has allowed me to receive a physician salary while doing research-clinical 80-20% for those 15 years. I really enjoyed the research, teaching graduate students in research, and making the physician salary. The physician part is pretty cool too, especially when you can say you saved someone's life or restored someone's ability to walk. However, there are MD's who go one to win Nobel Prizes (e.g. Harold Varmus MD). Those few typically have found a post-doc experience with a very good mentor (J Michael Bishop MD, who research training was from the NIAID).
 
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NIHNewInnovator is exactly the kind of career MD/PhD is meant for, and the kind of career I've been fighting like hell to have for the past decade. I wish I could say that I've had the opportunity to be an 80/20 physician-scientist my whole career or that I will have the opportunity to continue as a majority researcher after my K grant.

Nobody is going to hand a research career to you though, and if you know from the outset you don't want to fight for it, I don't think that you should waste your time. That's just my opinion.
 
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sluox

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You should do a search. There's a long post where I did the math on the financial aspect of the PhD in the MD/PhD. I think you will make the right decision after reading it. The short answer is that the financial benefit is *hardly* null. The PhD portion of the MD/PhD is worth approximately 150k per year at the time of completion of residency, assuming 3 year PhD length, and 1-1.5M at the time of retirement.

Very purely on a financial level, the PhD in the MD/PhD is one of the most lucrative gig you can get out of college. It compares relatively well with say, investment banking or a job in tech, neither of which one would ask the question of "whether you'll plan 15 years down the line that you'll still want to do this." For this reason, MD/PhD at a prestige school with high tuition is by far the most competitive graduate program today. If you go to NYU or have a big financial aid package, that's a different story.

I don’t think it equates to as big of a deal as people make it out to be. If you learn to save and live with your means, the 200k debt of MD training after 4 years and the 0 debt training after 8 years probably work out pretty close in academia. I would love to see some actual numbers that would prove some life changing disparity.

They do these salary comparisons in Pediatrics every couple years and the lifetime difference in earnings isn’t as remarkable as one would think. I mean, if you’re comparing a Pediatric ID person at Ivory Tower U to a private practice Neurosurgeon, sure, but all things being equal and having the exact same career track after school, I’m not convinced that MD only versus MD/PhD really makes a financial difference in the long run.

Total lifetime earning is not that different. But lifetime investment income is hugely different. I hope this point is clear to everyone here.
 

SurfingDoctor

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You should do a search. There's a long post where I did the math on the financial aspect of the PhD in the MD/PhD. I think you will make the right decision after reading it. The short answer is that the financial benefit is *hardly* null. The PhD portion of the MD/PhD is worth approximately 150k per year at the time of completion of residency, assuming 3 year PhD length, and 1-1.5M at the time of retirement.

Very purely on a financial level, the PhD in the MD/PhD is one of the most lucrative gig you can get out of college. It compares relatively well with say, investment banking or a job in tech, neither of which one would ask the question of "whether you'll plan 15 years down the line that you'll still want to do this." For this reason, MD/PhD at a prestige school with high tuition is by far the most competitive graduate program today. If you go to NYU or have a big financial aid package, that's a different story.



Total lifetime earning is not that different. But lifetime investment income is hugely different. I hope this point is clear to everyone here.
I’d like to see some actual evidence though, not anecdotes. Is there some published data?
 

sluox

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I’d like to see some actual evidence though, not anecdotes. Is there some published data?

What's even better than data is deductive reasoning. You don't need data when you do math. And that's exactly what I did in that post.

Here, saves you the trouble to search it. That thread needs to be stickied

 
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SurfingDoctor

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What's even better than data is deductive reasoning. You don't need data when you do math. And that's exactly what I did in that post.

Here, saves you the trouble to search it. That thread needs to be stickied

So in your examples, the MD-PhD track yields an additional million dollars in net worth?

Within my own department of pediatrics, I guarantee that is probably not close to true.

There’s too many iterations and variables to make some one size fits all statement. If you’re talking some hypothetical ideal... maybe, but life rarely works out as that. Thanks for the link and the academic exercise though.
 

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So in your examples, the MD-PhD track yields an additional million dollars in net worth?

Within my own department of pediatrics, I guarantee that is probably not close to true.

There’s too many iterations and variables to make some one size fits all statement. If you’re talking some hypothetical ideal... maybe, but life rarely works out as that. Thanks for the link and the academic exercise though.

Of course, everyone's different-- if you were born rich and had 1M net worth at 35, you'll have a higher net worth at 65, even if you did an MD instead of an MD/PhD.

I find this argument not very compelling though. Do you?

If you tell me that having a higher net worth at 35 influences people's behavior such that they are more likely to be less willing to save as much, that might be. But this is actually a separate point--and in fact it makes an argument on my side rather than on yours. If you did a PhD, you don't have to save as much. That's kind of the point. My math exercise simply illustrates how big of a difference it makes because of simple rules of compound interest.

I find it very interesting that the idea that the PhD programs are extremely lucrative is very dissonant with most MDPhD graduates, in that they went into this program with a certain sacrificial intent, as PhD programs (and a career in science) *in general* are very poor investments financially. However, the PhD part of the MDPhD is so extremely different in terms of process (if not in terms of content), that these things are actually not comparable at all, even though they are both called "PhD".
 
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SurfingDoctor

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Of course, everyone's different-- if you were born rich and had 1M net worth at 35, you'll have a higher net worth at 65, even if you did an MD instead of an MD/PhD.

I find this argument not very compelling though. Do you?

If you tell me that having a higher net worth at 35 influences people's behavior such that they are more likely to be less willing to save as much, that might be. But this is actually a separate point--and in fact it makes an argument on my side rather than on yours. If you did a PhD, you don't have to save as much. That's kind of the point. My math exercise simply illustrates how big of a difference it makes because of simple rules of compound interest.
I’m not convinced that the MD-PhD should be a consideration as a decision branch point to achieving wealth based on my own observations. But I also don’t think it’s the path to poverty as I have seen suggested. But people are gonna believe what they want.

I would like to see some actual data, but I suppose that won’t happen.
 

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I’m not convinced that the MD-PhD should be a consideration as a decision branch point to achieving wealth based on my own observations. But I also don’t think it’s the path to poverty as I have seen suggested. But people are gonna believe what they want.

I would like to see some actual data, but I suppose that won’t happen.

You want data that proves that MD PhDs have a higher net worth at the end of residency? That's so trivial a hypotheses that it would not be logical to try to get data to prove it. It would seem silly to attribute what happens after residency to MDPhD as the proximate cause, given that the residency itself would be much more proximate.
 

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You want data that proves that MD PhDs have a higher net worth at the end of residency? That's so trivial a hypotheses that it would not be logical to try to get data to prove it. It would seem silly to attribute what happens after residency to MDPhD as the proximate cause, given that the residency itself would be much more proximate.
I thought we were talking all MDs versus all MD-PhDs with net worth at some point 30 years out of training (or whatever point)? Then people could break it down by field, location, age of retirement, etc. My hypothesis is that collectively it would be a wash, with some specific paths that favor either group depending on the circumstances.

Actually, the highest net worth physicians I know are all MD-MHSA, but that’s probably a different discussion.
 

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I thought we were talking all MDs versus all MD-PhDs with net worth at some point 30 years out of training (or whatever point)? Then people could break it down by field, location, age of retirement, etc. My hypothesis is that collectively it would be a wash, with some specific paths that favor either group depending on the circumstances.

Actually, the highest net worth physicians I know are all MD-MHSA, but that’s probably a different discussion.
This makes no sense. You are making a collective argument for a particular decision. It's like saying collectively we are all going to die so it doesn't make a difference what you do in your life. The whole point of the discussion is the implication of a PARTICULAR decision holding everything else equal. You are making an argument that MD PhD is either worse off financially or at best equivalent to doing an MD. That argument is just factually false, and people who don't do the math aren't aware how false it is. It's like saying that taking on a high-interest credit card loan "doesn't matter" because most Americans have less than $300 in savings anyway. I also don't need empirical data to tell me that if I had $1000 loan at 25% interest for a year my end of the year loan amount will be $1250. I don't think this is a valid counterargument.
 

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Take the MD/PhD and do your PhD in public health or epidemiology.

1) It's becoming increasingly common for MD-only students to take a research year to be competitive for many specialties. With Step 1 going P/F, I think research years will become even more common. At my program at least, almost everyone finish their public health/epidemiology PhD within 3 years with a ton of publications.

2) The debt from medical school will greatly restrict your choice of specialty to the higher paying ones, for the practical reason of you having to pay the bills. Yes, it's not difficult to eventually pay off the debt with an attending's salary, but the psychological pressure of accruing interest on their loans is always there on the back of their mind for my former classmates who are now residents.

3) I think having the extra PhD title and experience can help you if you want to take on leadership roles in academic medicine.
 
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