MD/PhD or MD?

[odddodo]

This is a somewhat rambling thread asking for advice, so if you're not in the mood to read through, then sorry!

First off, let me start out that I'm currently a junior in college.

I didn't decide on any career paths up to the summer before my junior year, when I joined a bioengineering lab and started research.

Fast forward to now: For some reason, the professor of the lab seems to have very high expectations/hopes for me, and whenever he emails me, he mentions that I will make a very strong MD/PhD candidate and that he will help me.

I myself would like to do MD/PhD; however, I am not 100% sure! There are many days when I feel that I just want to apply for an MD program and become a surgeon, and that an MD/PhD would be too long for me (8 years!). Normally, I wouldn't mind, but I am REALLY putting a priority on staying in California near my family (personal reasons). That puts another additional chore on me: California MD/PhDs are notoriously difficult to get into, let alone any MD/PhD in the US.

Here's the catch: With all the constant support that my professor provides, I feel that I would be doing something akin to betraying him if I chose not to go for the PhD. I know all the usual about this being my life and that I'd have to choose my own path, but in the end, I feel that if I really did choose the MD path, I'd lose opportunities that I want in the future.

And finally, here's another factor: I'm doing research this coming summer in another lab, and from what I hear, MD/PhD apps require at least two different letters of recs from two PIs. Since it would be unreasonable to ask the new PI for a rec when I've just started working there, I'd probably have to wait another year before applying. This is something that I do not want to do.

What are your experiences with professors who have high hopes/expectations for grad/professional school of you that you aren't quite sure you want to meet?

What I would especially like to know is, is it feasible to get the MD and PhD separately? Doing them separately makes it more likely that I'd stay in California for at least one of them, so I'm seriously considering that option.

Sorry if parts of this sound like rambling; I've been stressing over this ever since junior year started. If I've missed anything, I'll come back and add more information.

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[mtlove]

odddodo,

You are definately not alone in having a PI that is sat on you doing a certain career path. My PI is an MD/PhD, who views his MD/residency years as a complete waste of time and money (he paid for it since it was before the time of NIH funding). He constantly tries to pursuade me from doing an MD. It is difficult to work with people like this, but you need to make the decision for yourself.

If you do not love basic science research, do not do an MD/PhD. If you are not sure about the PhD, just do the MD. You can pick up a PhD later or just do research at another point of your career to get the training. If you want to just be a surgeon (private practice), you would be wasting many years of your life, future salary, and government money. If you want to do research in academia, it may want to do the combined program or get research at another time.

Good luck with the decision.

 

[ThatOne]

but in the end, I feel that if I really did choose the MD path, I'd lose opportunities that I want in the future

What opportunities do you think you want in the future? Think about this carefully, including personal goals as well as professional goals. When you think you have a good idea of what you want to do, it will help you decide what path to take to get there.

If you have a hard time figuring it out, well, MD-PhDs are notorious for being indecisive -- so you would fit right in! If you have a good idea of what you want to do, however, there's no reason to burden yourself with overly protracted training.

 

[Circumflex]

You DO NOT need a PhD to do research later in your career. If you are having such serious doubts, I would say to apply for MD only. Your life and career will take many unpredicted twists and turns. If you did MD only and residency, you are still 8-10 years aways from being done. At that time, you may still want to do research and you may not.

Whether you do the PhD or not, if you want to do basic science research as part of your career, you will need extra training in the form of a post-doc experience. This can be done as part of a residency or fellowship. So, if you decide that you want to do basic science in the future, you can get the training in a variety of ways and there are many incentives to attract MDs to basic science. I have enjoyed my training, but this path is not necessary for an academic career. Also, you may decide that you want to do more clinical research as a surgeon, or whatever specialty you choose.

 

[odddodo]

Hi all! Thanks for replying.

My motivation isn't a problem; in a career, I would like to do everything: research, teach, and practice.

Here are my two biggest concerns:
1. Seeing as the MD/PhD is extremely difficult to get into, chances are that I'd have to go out of the state somewhere I would rather not live for 8 years! If I could get into an MD/PhD in California, this would not be an issue (I'd go for the MD/PhD), but I have to accept that this is not a too likely situation. As such, I'd prefer to take MD and PhD separately to increase my chances of staying in California for at least one of them.

Seeing this, I'm wondering how feasible it would be to take the MD and PhD separately as opposed to doing a combined program. I know about the basics such as the cost, but what difficulties are there in doing them separately?

2. Following the MD/PhD combined versus separate path, so far I've only worked in one lab. From what I've seen, MSTPs all seem to require letters of recs from at least two PIs. I am working in a new lab this coming summer, but I really doubt that I'll have worked there long enough to ask the PI for a rec for this year's applications. Either I'd have to wait a year to apply Md/PhD, or I could apply this year as an MD only and work for the PhD later after med school.

There is a third concern, but it's one I'll have to deal with myself: What am I going to tell my PI if I decide to go MD only for now and ask him for a rec??! I am afraid of the possible consequences.

And yes, if indecisiveness is a common factor in MD/PhD candidates, then I am definitely qualified!

 

[ThatOne]

There are some people who do / have done the degrees separately. Other than monetary concerns, one issue with doing the degrees separately is that the programs won't be integrated, of course, which would cost you extra time. There are some other posters here who are doing the degrees separately and would be able to give more input (QofQuimica for example).

You are right, CA schools tend to be some of the most competitive, but as an in-state student my understanding is that you would have some advantage. Also, if location is really important to you and prestige is less so, there might be some lower-tier places you could apply to as well.

If your current professor is supportive of you, you might as well at least take a shot at applying. I don't think it should be too impossible to get an LOR from the prof you are starting with this summer -- you'll submit the primaries in the summer, but you won't be getting secondaries until later in the summer / early fall, I think. LORs will be requested when you get the secondaries, so you'll have time. Aim to have the secondaries in by the end of September. I would work hard this summer and let the prof know my plans a month or so into my term there, if I were you.

Taking a year off is not a bad thing, lots of people do it. If you're not in a rush, I'd say go for it, and I'd suggest working in a science/medicine related field during that time. Such experience would give you the time to focus on your research and really learn how to talk about what's going on in your field of interest convincingly. Plus you would time for applications and the interview trail without worrying as much about missing tests (although missing work can become a hassle too), and you'd even be able to pay for all those secondary application fees! Furthermore, if you can arranged to be a lab technician for someone supportive of your goals (like your current PI), it can really help reduce the stress of the whole process.

I just re-read the part where you stated that you don't want to take a year off... well, you would probably "lose" at least a year (maybe even two or more) if you do the degrees separately, in terms of how old you are when everything is all said and done.

 

[gbwillner]

I myself would like to do MD/PhD; however, I am not 100% sure! There are many days when I feel that I just want to apply for an MD program and become a surgeon, and that an MD/PhD would be too long for me (8 years!). Normally, I wouldn't mind, but I am REALLY putting a priority on staying in California near my family (personal reasons). That puts another additional chore on me: California MD/PhDs are notoriously difficult to get into, let alone any MD/PhD in the US.

Its ok to question yourself now, but don't go through with it if you're not 100%. I have been very unsure about many things (where to go, what to do a residency/PhD in), but this is a HUGE commitment. For most people, getting into an MD/PhD program and your career takes precedence over all other factors. This is as it should be when you are still young. Any less devotion than this and chances are you won't make it all the way through anyway.

Here's the catch: With all the constant support that my professor provides, I feel that I would be doing something akin to betraying him if I chose not to go for the PhD. I know all the usual about this being my life and that I'd have to choose my own path, but in the end, I feel that if I really did choose the MD path, I'd lose opportunities that I want in the future....What are your experiences with professors who have high hopes/expectations for grad/professional school of you that you aren't quite sure you want to meet?

This has to be the single worst reason I have ever heard for someone doing a MD/PhD. It is a long and sometimes painful process. to do it because you think someone else thinks you should is dumb.

And finally, here's another factor: I'm doing research this coming summer in another lab, and from what I hear, MD/PhD apps require at least two different letters of recs from two PIs. Since it would be unreasonable to ask the new PI for a rec when I've just started working there, I'd probably have to wait another year before applying. This is something that I do not want to do.

Not true at all.

 

[tc970106]

Personally, I would not do the PhD because I think it's a waste of time. You can go into basic research with just an MD plus a couple years of research postdoc/fellowship. Why go through another 4+ years for a PhD when a postdoctoral fellowship is all you need, if you want to go into research. On the other hand, if you are still undecided, you can apply to both MD and MD/PhD programs at the same time. My friend did that and ended up only getting into an MD program (at a pretty good UC school though). I think things worked out for him in the end because he didn't like research that much anyway. So you can definitely apply for both and in the end you can always opt for only the MD.

 

[odddodo]

Hmm...I really want to do both. I've constantly heard and read that PhD's don't tend to be worth the time invested in them, but after my extensive involvement in the lab, I realize that the training that a PhD provides is invaluable and necessary in order to become a competent scientist.

I actually just talked to my professor over an instant messenger, and I mentioned to him my indecision between an integrated program and doing the degrees separately. It seems that he is willing to support me either way. Well, that's a bit of a load off my back. For now.

 

[Circumflex]

Hmm...I really want to do both. I've constantly heard and read that PhD's don't tend to be worth the time invested in them, but after my extensive involvement in the lab, I realize that the training that a PhD provides is invaluable and necessary in order to become a competent scientist.

Having a PhD is not necessary to becoming a competent scientist - good training is. Plus, after the PhD, you still have 2 years of med school + 2-4 years of residency before returning to research. A lot can change in 4-6 years after the PhD, so you still require further research training after residency.

If you want a PhD, then go for it. You just have to make priorities regarding living in CA vs. wanting to do the MSTP. If you don't get into a MSTP, then any medical school will allow you to take a leave of absence after your 2nd year of med school to do the PhD. And, most any grad school will accept you if you do this. A friend of mine did this and they just accepted hic MCAT - no GRE required. He got credits from medical classes to transfer to graduate school, so his curriculum was like a MD/PhD student. The biggest problem is the debt accumulated.

 

[greg12345]

This is going to sound harsh but unless you can grow a backbone maybe you should stay out of academic medicine in the first place. If you are stressing so much now about possibly disappointing your PI because you might choose something that he/she disapproves of, well then you will probably be eaten alive by the stresses and demands and politics of the training track and career that you are looking to pursue.

 

[odddodo]

This is going to sound harsh but unless you can grow a backbone maybe you should stay out of academic medicine in the first place. If you are stressing so much now about possibly disappointing your PI because you might choose something that he/she disapproves of, well then you will probably be eaten alive by the stresses and demands and politics of the training track and career that you are looking to pursue.

Oh, I may have mistakenly exaggerated my main sources of stress. That's just a minor factor; my major point is that I want to do both, but I don't want to leave California to do so. I am not so stupid as to consider a path only because my mentor wants me to



Here's what I'm thinking of doing; I'd appreciate any advice: I'll apply for the MD/PhD path to the California schools and MD only to the out-of-state schools. I don't know if it would be viewed negatively that I want to stay in California; perhaps the schools will think that I am not dedicated enough to my dream.

 

[Vader]

Here's what I'm thinking of doing; I'd appreciate any advice: I'll apply for the MD/PhD path to the California schools and MD only to the out-of-state schools. I don't know if it would be viewed negatively that I want to stay in California; perhaps the schools will think that I am not dedicated enough to my dream.

If staying in California is your priority, then you should apply mostly to California schools (perhaps also some programs in nearby states). However, I don't really understand your rationale for applying out-of-state MD-only. Why not apply MD/PhD all the way if you are truly committed?

Interviewers will often ask what other programs you are applying to--if interviewer at a non-California program hears a California-heavy list, then they might be suspect that you lack the desire to go elsewhere.

 

[odddodo]

If staying in California is your priority, then you should apply mostly to California schools (perhaps also some programs in nearby states). However, I don't really understand your rationale for applying out-of-state MD-only. Why not apply MD/PhD all the way if you are truly committed?

Interviewers will often ask what other programs you are applying to--if interviewer at a non-California program hears a California-heavy list, then they might be suspect that you lack the desire to go elsewhere.

Yes, I am somewhat worried about how other programs will view the California-heavy list...hmm...

My rationale for applying out-of-state MD-only: I may be truly committed to going into academic research, but my family is my priority too. I hate to go into personal stuff, but I have a filial responsibility, and I don't know how bad I'd feel if I couldn't be there for my family (including my aging dog). Simply put, I don't see the definite need to give up this part of my life just to follow another part of my dreams, especially since there are ways to compromise. Can't a guy combine both his career aspirations and his family? By doing MD-only out-of-state, I'd at least be able to go home during the summer breaks (I think MD-only has summer breaks?).

Of course, with all this emphasis put on "following the MD/PhD path no matter what if you're committed," I don't know if the programs will look favorably upon this. Stupid decisions.

 

[Circumflex]

Of course, with all this emphasis put on "following the MD/PhD path no matter what if you're committed," I don't know if the programs will look favorably upon this. Stupid decisions.

Everything is a compromise and everyone has different personal situations and, therefore, different priorities. You have to do what feels right for you in your situation. The advice you are getting in this forum is based on the experience of people who have gone through the process and have a different perspective. The PhD years can be very physically and emotionally taxing. I personally know of 2 MSTP students who quit mid-way through their PhDs to return to medical school. Both of these people were gung-ho about basic science and wanted a career in academic medicine. But, it's different when you are going through the process.

In medical school, you form strong bonds with your classmates, then you leave them to do the PhD. You work your a$$ off day in and day out, sometimes weeks or months without good results. Some of my cell culture experiments would take 3-4 weeks to do and when I would get a contamination in the 4th week and have to start over, losing a month, I would seriously think about quitting. On top of the experiments, you have classes, seminars, qualifying exams, papers to write, etc.

My point is that we, as people with some hindsight, just want to let you know that it is a difficult process even for people who really love research. I grew and learned so much, that I would not trade my experience for anything. Just know that it is not the only path to becoming a physician-scientist or academic clinician. Just follow your instincts and everything will work out for you.

 

[gbwillner]

My rationale for applying out-of-state MD-only: I may be truly committed to going into academic research, but my family is my priority too. I hate to go into personal stuff, but I have a filial responsibility, and I don't know how bad I'd feel if I couldn't be there for my family (including my aging dog). Simply put, I don't see the definite need to give up this part of my life just to follow another part of my dreams, especially since there are ways to compromise....
Of course, with all this emphasis put on "following the MD/PhD path no matter what if you're committed," I don't know if the programs will look favorably upon this. Stupid decisions.

This is why programs (especially MSTP) are biased against older applicants. During the Med school years, you will often be up all night either studying for tests or on call. During the PhD you might be in lab all night long for timepoints and be completely engrossed with writing. It's hard to imagine now, from the outside looking in, but it can be very taxing on any relationship. I can't tell you how many relationships were ended because of med school. If you have responsibilities outside of school (and trust me, school is enough responsibility by itself) you may be forced to make a decision- family or MD/PhD.

 

[odddodo]

All right, thanks for the responses. They were very helpful.

 

[greg12345]

Your rationale for applying MD-only to out of state schools is a little flawed. At most you would have one full summer in which you could come home and visit (the summer between 1st and 2nd year). If you are serious about pursuing a career in research or a competitive specialty it would be wise to not "waste" this summer and rather use it to get some quick research experience or buff your residency app. Once second year is done you must study for and take Step 1, which (unfortunately) carries a lot of weight in residency applications and is no laughing matter in terms of the subject material. Theoretically you could study at home for this, but keep in mind that clinical rotations for 3rd year start at the end of June/early July. There is no extended "summer break" between 3rd and 4th year.

I do not know the particulars of your family situation, maybe if your parents are terminally ill and you want to be there for them as they die, etc. I could see the necessity of staying. But an aging dog?? If you choose to pursue a career as a physician scientist you will have to make many sacrifices at many junctions (leaving your med school friends behind, suffering the rigors of grad school, delaying residency training for 4-6 years, potentially fast-tracking through residency and losing cush outpt clinical months, putting in long hours to get a lab up and running as junior faculty, taking a huge pay cut in comparison to your peers, not to mention putting your wife/kids through what could potentially be a 13-16 year training program which is not exactly a walk in the park as far as rigors/hours, etc.)... might as well start getting used to not having your cake and eating it too. With a traditional MSTP you will be able to take more time to visit your family because you will have flexibility to take vacations whenever and however long you want while in grad school (whether it is advisable to do so is another story).

And I hope I don't sound like I would throw my family under a car for my career; my career has always been way lower on my priority list than my family. But sometimes you gotta make tough decisions...if you are really committed to the career you should apply MSTP everywhere and hope you get into a CA school.

 

[tc970106]

If you are serious about staying in California, you should apply to MD-only programs in California too. Apply broadly to as many California schools as you can. If you have any doubt about doing the PhD, you should just get the MD. Besides, most people will agree that you don't need a PhD to do biomedical research. The PhD is a long haul and you will be miserable if you end up with the wrong PI or the wrong project, not to mention it might take more than 4 years (7 year PhD's is not uncommon). I would highly recommend against getting a PhD.

 

[AtmaWeapon]

this is out of topic but:

This is why programs (especially MSTP) are biased against older applicants.

How old does the bias begin? I'm a late born (late november) so I could have been among the oldest crowd or the youngest crowd of my classes in school. My parents decided to stick me in the young crowd in preschool. I'm thinking about taking 2 or 3 years off after college (research, as well as trying out different things) before applying to MSTP...I figured even 3 years would be okay because age-wise I would be the same age as a person taking 1 or 2 years off in the older crowd.

I'd graduate at 20, turn 21 later that year of graduation. If I took 3 years off I'd be 23 when I apply and 23/24 the school year I'd matriculate. If applying at 23 is considered late, I can probably cut things shorter and apply at 22.

Maybe it'll help if I put I can be very nocturnal due to my computer science background

 

[Ultra7]

this is out of topic but:



How old does the bias begin? I'm a late born (late november) so I could have been among the oldest crowd or the youngest crowd of my classes in school. My parents decided to stick me in the young crowd in preschool. I'm thinking about taking 2 or 3 years off after college (research, as well as trying out different things) before applying to MSTP...I figured even 3 years would be okay because age-wise I would be the same age as a person taking 1 or 2 years off in the older crowd.

I'd graduate at 20, turn 21 later that year of graduation. If I took 3 years off I'd be 23 when I apply and 23/24 the school year I'd matriculate. If applying at 23 is considered late, I can probably cut things shorter and apply at 22.

Maybe it'll help if I put I can be very nocturnal due to my computer science background

I am pretty sure he meant "older" as in 33 or 43, not 23. Substantially older individuals tend to have more family responsibilities (older parents, young children, a spouse), which might be hard to balance with the demands of physician-scientist training.
One or two or three or even five years is probably irrelevant. Especially if you are a single male.

 

[odddodo]

I have an off-topic question, too. Why is there an impression in some people that the MD/PhD does not involve a "complete PhD"? What elements of a PhD are missing in an MD/PhD?

 

[Vader]

I have an off-topic question, too. Why is there an impression in some people that the MD/PhD does not involve a "complete PhD"? What elements of a PhD are missing in an MD/PhD?

The grueling agony of taking another 1-2 years for no reason whatsoever.

 

[tacojohn]

I have an off-topic question, too. Why is there an impression in some people that the MD/PhD does not involve a "complete PhD"? What elements of a PhD are missing in an MD/PhD?

Because there's a time limit for taking step 1, step 2, and step 3 of the USMLE exams in most states. This means that there is a lot of pressure from medical schools on basic science departments to get the MD/PHD students out within 4 years whether or not they've done the equivalent amount of work that is expected of a "real PhD". Unlike an MD/PHD student, a straight PhD student has absolutely no time limit to finishing and professors generally expect them to stay around longer and get more done before they leave.

 

[Circumflex]

I have an off-topic question, too. Why is there an impression in some people that the MD/PhD does not involve a "complete PhD"? What elements of a PhD are missing in an MD/PhD?

Also, MD/PhD students don't have to take as many classes in the PhD portion as graduate students. Classes can really cut into lab time, so not having to take as many classes is an advantage. Lab rotations are often done differently for MD/PhD students in that either you don't have to rotate through as many labs as PhD students or you do smaller rotations in the summer between first and second year of med school. Some schools don't require MD/PhD students to serve as TAs (some do). That can also eat up lab time. And, many schools have time limits for MD/PhD students.

MD/PhD programs are usually set up to make for more efficient lab time. Between classes, TAing, seminars, and not picking a lab until the end of their first year, PhD students aren't able to be as productive as early as MD/PhD students in the lab. So, there is the perception of differential treatment in some cases. At my school, most PhD students take 5 years and the MD/PhD students spend an average of 4 years in the lab.

 

[greg12345]

Tacojohn brings up a good point that all MSTP'ers need to be aware of. Some states have MD/PhD exceptions for their board taking policies and add on extra years if you have a combined degrees (10 years is what i've seen). But usually if there is a limit to the amount of time between when you take Step 1 and Step 3, the shortest interval will be 7 years. So if you take Step 1 after MS2, do a 4 year PhD (average), and then do 2 years of med school (MS3-MS4) you must take Step 3 during your intern year. If you are dead set on a certain residency program, look up that state's policies on board taking timelines so you don't get caught by surprise having to retake Step 1 (ugh).

 

[tacojohn]

Also, MD/PhD students don't have to take as many classes in the PhD portion as graduate students. Classes can really cut into lab time, so not having to take as many classes is an advantage. Lab rotations are often done differently for MD/PhD students in that either you don't have to rotate through as many labs as PhD students or you do smaller rotations in the summer between first and second year of med school. Some schools don't require MD/PhD students to serve as TAs (some do). That can also eat up lab time. And, many schools have time limits for MD/PhD students.

MD/PhD programs are usually set up to make for more efficient lab time. Between classes, TAing, seminars, and not picking a lab until the end of their first year, PhD students aren't able to be as productive as early as MD/PhD students in the lab. So, there is the perception of differential treatment in some cases. At my school, most PhD students take 5 years and the MD/PhD students spend an average of 4 years in the lab.

Everybody took the same classes, rotations, and TA'd where I was but I can't speak for anybody else. In general, advisors were well aware of the four-year limit on MD/PhDs and usually projects were taylored so as to make sure that time frame didn't become an issue. I had a classmate a year behind me who ran in to rouble, however, when his project just failed miserably. At the end of his third year, his advisor switched projects on him and gave him what was basically technician work - cloning a few genes out and characterizing them - and he was allowed to leave after that. That kind of thing never would have happened with one of the regular PhD students. They would have been expected to tough it out and finish the original project.

 

[Dr.Watson]

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