MD/PhD Questions

[brandonite]

I know there are a bunch of people hanging around here that know a lot about MSTP and MD/PhD programs, so I thought I would pick your collective brains.

Basically, barring some sort of minor miracle at Stanford, I will be going to the University of Manitoba this fall. I don't have an acceptance in hand yet, but I have been assured by various people that it is coming... My choice now is whether to do an MD or and MD/PhD.

I am aware that it's difficult to do both clinical medicine and basic science research. But I'd like to give it a shot. To be honest, clinical research doesn't really apply to me. But I do really enjoy basic science research.

Manitoba has a couple really interesting opportuities for research. First of all, the major Canadian government research lab for biophysics is located in Winnipeg (where the University of Manitoba is). I was there yesterday, and I was very impressed. I talked to the director and he seems really interested in having me there as an MD/PhD student. Also, the only Canadian lab with biocontainment level 4 regions is located in Winnipeg - I think there are only like 3 in North America.
Anyway, at least on paper, things look really great. But the med school doesn't have an amazing reputation in and of itself. Maybe it would be top 50 in the US, or something like that. And, they don't really have an established MD/PhD program. It just started up a year or two ago, and I think I would be the second student to go through it. Oh, and I think I would be a fully funded MD/PhD. About a $20,000/yr stipend.

So, after this lengthy preamble, here are my questions:

1. How concerned should I be about the reputation of the med school?? Will that hurt me later on if I want to get into academic medicine? The reputation of the research facilities is really strong, both within Canada and internationally.

2. Should I be worried that the MD/PhD program is not all that established?

3. After graduating MD/PhD and doing a residency, would I have to do a post doc or a fellowship before I could expect to land an academic position? Another 3 years for the MD/PhD isn't too much, but if I have to do five years as a post doc before I can hope to do my own research...

4. What would be my chances at getting a top residency in the US? I know ppl from Manitoba have gone to Harvard/Duke in the past, so I don't think there's discrimination against Canadians. But, in general, would a person from a top 50 med school with an MD/PhD be able to go to a top 10 hospital??

Thanks! And sorry for the long post...

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[Rumit]

Hey,

I can give my take on some of the questions. Obviously, nobody knows answers to many of the questions you raised because everyone is different. I think the reputation of the med school as a clinical training ground is not as important for MD/PhD as its reputation in the research community. I won't say that reputation doesn't matter, because it does, but if you do good work with someone who is well respected in the field, it doesn't matter where you came from...that's all people are going to look at.

Regarding the age of the program, it really depends on how dedicated the people in the administration are. If you are going to have to find your own way and cut through tons of red tape, then that's not too great. But, if they're really dedicated to making a new program then it should be ok, and being in a small program has its advantages as well. You can get a lot more personal contact and you can really help shape the future of the program.

After graduation many people go on to do a residency or postdoc or both. So, if you want to go into academia you will probably have to do more beyond school. There combined research residencies in some specialties, such as oncology where you combine a postdoc and residency and it takes 5-6 years. So, if you really want to practice and do basic research that's the kind of commitment you have to want to make.

Like I said before, if you do good work in a good lab then you'll have no problem getting into excellent programs all over the place. MD/PhD's from many schools do very well in the match, so I think you shouldn't worry too much about that.

I hope that helps. That's just my take on your questions. I hope I'm not too off on that

Good luck,

Adam

 

[Original]

Brando,

I think you should go for muddphudd. I think you'll really enjoy it and do very well. As for residency matching, I know that MD/PhD matches are ridiculously awesome. Chef posted University of Maryland's a while back. Here it is:

Pediatrics Boston Combined Pediatrics
Pediatrics University of Michigan Hospitals
Psychiatry Massachusetts General Hospital
Anesthesiology University of California, San Francisco
Pediatrics Boston Combined Pediatrics
Internal Medicine Barnes-Jewish Hospital, MO
Diagnostic Radiology B.I. Deaconess Medical Center, MA
Radiation Oncology Stanford Health Services
Radiation Oncology University of Michigan Hospitals
Pathology University of California, San Francisco
Emergency Medicine Washington University
Radiation Oncology Sloan Kettering, New York
Neurology University of California, San Francisco

I don't know how UMaryland is ranked, but despite the fact it's very good, I don't think it's a top-20 school; yet their MD/PhD matchlist is crazy. I saw Penn State's as well, and it had lots of UCSFs and MGHs.

On a side note, my uncle was at UManitoba Winnipeg Neonatology till 3 yrs ago. He moved to GrandPrarie Alberta with his family. Anyhoo, I think you'll really love academic medicine.

 

[brandonite]

Thanks. Again, the research is very cool, and the lab that I want to do my PhD with has a very strong international reputation. They've got a program now where they're working with NMR and MRI of infectious diseases using the virology lab next door (the one with the level 4 containment area). And they have lots and lots and lots of money. They've spun off companies worth $60 million over the past ten years, and their share is sitting in a big bank account...

I'm meeting with the director of the MD/PhD program next week to talk about funding, and hopefully then I get can get a better feel for the program. Like you said, Rumit, I don't want to be some sort of guinea pig and have to fight my way through the red tape of a new program...

I know people in academic medicine tend to make less money than doctors in hospitals. Does anybody know what kind of a financial hit you end up taking?? I know that PhD's don't make a lot of money, especially in universities. Does the MD after your name cause the pay to jump up? I suppose if you did clinical work half the time, you could make your money doing that...

And thanks for the match list, Original. Nice to know you're keeping track of things all the way from Africa. :wink: I would think that Maryland is a comparable school to Manitoba. It's a decent school. I think it ranked fourth, behind McGill, Toronto, and the University of British Columbia in the last Gourman rankings.

And you're uncle's a brave man for moving to rural Alberta...

 

[Original]

•••quote:•••Originally posted by brandonite:
• And you're uncle's a brave man for moving to rural Alberta... •••••Yeah but they like it. I think he said only a couple of thousand people live in the town. On a side note, my mom now knows about my SDN addiction. I hope she doesn't login and start posting stuff under my name <img border="0" alt="[Laughy]" title="" src="graemlins/laughy.gif" />

 

[brandonite]

•••quote:•••Originally posted by Original:
• •••quote:•••Originally posted by brandonite:
• And you're uncle's a brave man for moving to rural Alberta... •••••Yeah but they like it. I think he said only a couple of thousand people live in the town. On a side note, my mom now knows about my SDN addiction. I hope she doesn't login and start posting stuff under my name <img border="0" alt="[Laughy]" title="" src="graemlins/laughy.gif" /> •••••People from Alberta scare me... It's Canada's own little bible belt. But I guess if you're from Alabama, you might have a bit of an idea what that's like. Anyway, before I dig myself in too deep here...

How do I know I'm not talking to your mom right now??

 

[RNAgirl]

Hi brandonite,

If you know now that you want to have a career in academic medicine AND research, I would say go for the MD-PhD vs. the MD.

In such a new program, the medical and graduate phases would probably not be as highly integrated as some more established programs. Also, with so few people, you can't have special seminars, retreats, etc. On the other hand, there are a lot of potential advantages, such as having a great deal of personal attention from the director and having the flexibility to individualize your training. If you have ideas about how you would like to structure your training (i.e. if you want to do a longitudinal clerkship during your graduate training), bring them up in your conversation with the director and see how receptive he is. Also discuss these issues with potential research mentors.

Is the director of the program an MD-PhD? It's probably be a good idea to meet with several other MD-PhD faculty members as well since it would be really helpful to have several people at the school who can advise you on your progress in the program, residency selection, and career options. When you meet with the director, ask him what visions he has for the program in the near future, and what steps they are taking to further develop it.

Overall, this sounds like a great opportunity, especially considering the unique research prospects you described (I love virology, so I get excited about BSL-4 labs). Best of luck!!!

 

[brandonite]

Thanks RNAgirl.

I think I've decided now on the MD/PhD program. I can't call it MSTP, because it has a different name up here, but it's the same idea.

Thanks for the advice. I'd never actually considered before the problems associated with being (probably) the only MD/PhD student in my year... I suppose life might get a bit lonely, but I guess you'd always have MD classmates during your MD years, and PhD classmates during your graduate work, so there would be people around... Just nobody doing the same program as you.

The director is a PhD. Strange, I guess. But there are a few MD/PhD's on staff, so I should try and talk to them. There's actually one working in the lab that I'll do my PhD at, so I'm going to try to get ahold of him, to see what he says.

Seeing as how I'll be the second MD/PhD candidate at the school, how much negotiating can I do with regard to the cirriculum? The current MD program only has two electives in the clerkship - one seven weeks long, and the other three. Is that normal? Do you think that I might be able to negotiate another elective? Also, the whole first third of the first year is dedicated to things like community medicine. It's not that I don't think that stuff is valuable, but I think that I'd rather do research then...

Oh, and does anybody know how long a post doc you would have to do to get a good position in academics or research? By the time I've done the 7 year MD/PhD and a 5 year (for example) residency, I might be a bit anxious to get started...

Thanks again!

Kris.

 

[RNAgirl]

Hi brandonite,

I think MD-PhD grads generally do a residency OR a post-doc. At that point, you're ready to seek out an assistant professorship. Yeah, it's a little unnerving to think about 7-8 years as an MD-PhD student, followed by a residency, followed by a fellowship, and then finally trying to start a lab. But there is hope, when I interviewed at Michigan, I talked with an assistant professor who had graduated from their program, finished a residency in clinical pathology, and already had MD-PhD students rotating through his lab. All this, and I met a two other fellows who were just finishing the program, and all three of them were in the same first year class! While this is pretty uncommon, the point is that some residency programs are shorter than others (and more conducive to doing research at the same time), and there are also some that specifically include research. It is possible to get hired as an assistant professor while you are finishing your residency.

 

[brandonite]

Great! Thanks!

Ideally, I'd like to say, do three days of research and two days of clinical medicine each week. So, most MD/PhD's would get hired by a University out of their residency program, and would be able to do both research/teaching and practicing right then?

Do most residency programs offer opportunities to do research? I think I would like to get into a top 10 residency program, so I would assume that those programs would probably offer more opportunities for research.

 

[RNAgirl]

•••quote:•••Originally posted by brandonite:
•Great! Thanks!

Ideally, I'd like to say, do three days of research and two days of clinical medicine each week. So, most MD/PhD's would get hired by a University out of their residency program, and would be able to do both research/teaching and practicing right then?

Do most residency programs offer opportunities to do research? I think I would like to get into a top 10 residency program, so I would assume that those programs would probably offer more opportunities for research.•••••This is something that I know very little about, but it's on my high priority list to ask about when I start the program this summer. Here's an anecdote: someone told me that as an internal medicine resident at Mass Gen, you spend a significant amount of time in journal club, discussing relevant basic science research. So, there are research-oriented residency programs. I'm not convinced, however, that it's such a good idea to physically do much research during the residency.

For me, I think my clinical practice will be fairly limited in the beginning when I'm trying to establish a research group and run a new lab; however, later on, I think I would have more time available for clinical care.

Vader? Others? Any thoughts?

 

[brandonite]

Well, I suppose you couldn't expect to do a lot of lab work when you're doing you're residency! I suppose I could live with journal club, provided it was only for a little while. I wouldn't want all my PhD training to flow out of my brain during residency, though. :wink:

Anyway, I'd like to do both research and practice right from the start... I would be afraid that if I just did one or the other, then it would be hard to get back to the other. I don't know how practical that is, though. Given the choice, I suppose I would prefer to start off with research. , get a lab established, and then get back into clinical medicine, like you said. If you did just clinical medicine right from the start, it might be hard to get used to the pay cut that going back into research would mean...

 

[gizzdogg]

Brandonite,
Just wanted to say i appreciated your post. I've been struggling with the MD vs MD/PhD issue myself, and your post articulated my concerns in a way i never could. Thanks for all those who posted too!

 

[Original]

Kris,

Andrea and Adam bring up some very important points about the uniqueness of your situation. It would definitely be a good idea to bring up all those points with the director. As far as retreats go, MSTPs usually have only 1 each year in the fall. All the other retreats are usually departmental. So you'll lose almost nothing on that front.

•••quote:•••Originally posted by brandonite:
• People from Alberta scare me... It's Canada's own little bible belt. But I guess if you're from Alabama, you might have a bit of an idea what that's like. Anyway, before I dig myself in too deep here...
How do I know I'm not talking to your mom right now?? •••••Actually, my Alabama experience was very insulated. I'm in school alot and most of my friends I hung-out and clubbed with and stuff on the weekends were from my school as well. Actually, about 95% of the professors at UAB are not from Alabama, and about 35% of them are not even from the U.S. Students from rural Alabama (cullman, willacoochi, wollolumba <img border="0" alt="[Laughy]" title="" src="graemlins/laughy.gif" /> ... county) usually admit to experiencing culture shock when they come down to UAB. Most of them would have never seen so many chinese, indian, and black people till then. I can't say for sure, but I think Alabama gets an undeserved bad rap.
But then again, the other day, I saw a UAB medical student wearing a T-shirt with a huge confederate flag with the words "the confederate cotton company".

But in general, most people are pleasantly surprised (even shocked) when they come down to UAB. The biomedical research is top of the line; it's a top-5 AIDS research center; top-5 cardio-thoracic surgery center; and the cost of living is unbeatable.

 

[RNAgirl]

•••quote:•••Originally posted by brandonite:
•
Seeing as how I'll be the second MD/PhD candidate at the school, how much negotiating can I do with regard to the cirriculum? The current MD program only has two electives in the clerkship - one seven weeks long, and the other three. Is that normal? Do you think that I might be able to negotiate another elective? Also, the whole first third of the first year is dedicated to things like community medicine. It's not that I don't think that stuff is valuable, but I think that I'd rather do research then...

•••••Hi Kris,

There probably won't be much room to negotiate the MD curriculum. However, depending on the intensity of the first and second year classes, and the amount of time spent in class, you may be able to take some graduate school courses. Some programs do substitute a few graduate school courses for their med school counterparts. It might help you to look at the webpages for a few of the MSTPs and see what features about their training programs interest you. Then you could bring up some of these ideas in your discussion with the director, if it seems appropriate. It could be that he already has a very specific course of training in mind, but my guess is it will be fairly flexible.

Good luck!

 

[brandonite]

Gizzdog - thanks for the support. I think after wrestling with this decision for the better part of a year, I'm finally ready to commit to MD/PhD. I think that seeing the lab where I'll do my PhD and talking to the director really convinced me. I'm still a bit concerned about the length of the program, but I think it's worth it...

Original - Rural Alberta is the kind of place where evolution is a dirty word, and they campaign to teach creationism in schools. <img border="0" title="" alt="[Eek!]" src="eek.gif" /> I mean, I'm sure all the people there aren't like that. And like you said, the cities have a completely different dynamic. Edmonton and Calgary are the two big cities in Alberta, and both of them are great cities. So, I suppose I shouldn't be slamming the whole province, or all of Alabama/Miss etc... And again, I should stop before I dig myself in too deep... :wink:

RNAGirl - I'd like to see what I can do about taking some grad school courses during the first two years. I mean, it would be nice to get some research done over that period, especially over the summer. And without any background in just biophysics, it might be hard to do decent research. So, a course or two here or there would be great. I'll try and convince them of this when I talk to the guy on Thursday. I think it's a completely new program, so there might be a lot of flexibility. And maybe a few modifications can be made to the clerkship... Like only 4 weeks of FP instead of 8, or maybe I could do some of my core clerkships away (which usually isn't allowed...). Like I said, I do want to go to a top residency program, and usually one of the best ways to do that is to do a clerkship at the school. It's kinda hard to do a lot of that when you only have two electives...

I do think that I have a bit of a pull here, because they are really pushing the MD/PhD program, and it's be nice for them to 'steal' me away from somewhere else. I might conveniently forget to mention that I was rejected by Duke, and just mention that I interviewed there recently... Is that unethical??

Of course, I don't know how you negotiate without coming off arrogant... I don't have the acceptance in hand yet, so I maybe should wait until then before I do all this??

Thanks again!

Kris.

 

[brandonite]

Sorry to post twice in a row... But, I need more advice. What should I be looking for in the program? Both of you have interviewed at some of the top schools in the country. What's really impressed you?? What might I want to talk to the director about this Thursday?

Something I'd like (like I said above) is flexibility within the MD program to take grad school courses.

What else??

 

[Sonya]

Hey original,and brandonite! (and everyone else).

I talked to several profs about doing MD PhD vs. MD. To be doing academic research after MD, you need several (3 to 6) years of research training. This can come with MD PhD program, or with doing an MD and then doing fellowship or postdoc (i will use the words interchangably, because everyones definition seems to be different). But, basically, you need a few years of solid research training.

That's just a quick summary of what i learned. I just talked to several profs.
okay, i'm going back to resurrecting this semesters preformance... any more questions, i'll try to help.

sonya

 

[Rumit]

Brando:

I think you've definitely made a good decision, and it's also good that it took you a long time to make it. It's definitely a huge commitment and shouldn't be taken lightly. I think a lot of people make the decision without fully understanding that. I personally took a year off because I wasn't sure what I wanted to do. Anyhow, I wish you the best of luck and hopefully we'll end up meeting up some time as colleagues or something in the future

Later,

Adam

 

[brandonite]

Sonya - I've decided on the MD/PhD as opposed to some sort of fellowship because of a couple pretty simple reasons. Firstly, there is a lot of monetary support out there for the dual degree. Secondly, I think that having both degrees makes it easier to secure an academic position when you're done with everything...

And, thanks Adam. It is something that I've been wrestling with seriously for the past year, and considering even before that... At any rate, I'm looking forward to it. And it's nice to finally have that decision off my back... Now I just have to make the final decision as to where I'll be next year, and as to whether I should reapply...

 

[JJ4]

I second Adam's commending your thought-out decision. In regards to flexibility, the MD/PhD programs at most schools are much more amenable to flexibility than the MD programs. I'm sure you can tailor your curriculum immensely provided it doesn't contradict the basic approach to finishing medicine and grad school. If you are set on mudphudding with the rest of us, you should seriously consider the different labs and departments at your schools and what they have to offer in terms of projects and training (although some just like to take it in stride and play the field when they get there). There are some people that may really trigger your interest but the kind of project they have in mind for an incoming grad student may be completely out of your interest range. Talk with several PI's and get a good feel for it all. Also, don't shove off departments just yet -- you may be pleasantly surprised.

Best of luck with the options.

 

[brandonite]

Thanks for all the opinions. I know generally what department I'd like to work in. My general area of interest is biophysics, and the major Canadian lab in that area is in Winnipeg. There are about 100 researchers working there, so I don't think it would be too hard to find one group that I'm interested in! At any rate, there are a number of departments at Manitoba who do a lot of research, so I'm hoping that as one of the few MD/PhD students, I should get a pretty good choice.

I've had this asked to me a couple of times today, and it's not something I've ever thought about. Do researchers look down on MD/PhD's because of their supposed lack of research background? I've heard a few people warn me now that my PhD won't be respected because of time constraints. I completely disagree with that, but is that a common perception? I would hate to do the MD/PhD and then be forced into purely clinical medicine because my PhD is called into disrepute... What do you guys know about this??!?!

 

[MacGyver]

brandonite,

At all the interviews I've been at, I have specifically asked all of the PhD-only (about 20-30 people) interviewers that specific question.

NONE of them responded that it was a watered down PhD, and all of them had worked with MD/PhDs both as students and as collaborators on research.

So, the opinion you got that its not a real PhD is very rare.

 

[brandonite]

Great. Thanks MacGyver. It's not even something that I'd really considered until all of four people asked me about it today. They were all either med students or physics profs, so it's not like they are experts in the area of MD/PhD's, but it was a bit unnerving.

Thanks again! And it's too bad that your name has been dragged through the mud here on SDN.

 

[RNAgirl]

Hey Kris!

I definitely agree with MacGyver...I have never heard anything negative about the quality of the PhD training for MD-PhDs.

I did think of one important issue when I was reading back over a few of your previous posts. Be sure to ask about the time window for entering into 3rd year clerkships. A lot of programs make it easier for MD-PhD fellows to re-enter the clinical phase by being flexible about this. For example, at Michigan, you can start anytime from the normal July date, up through the following January. If you don't have this option, you could run into problems if you happen to finish your PhD after that July date.

Okay, that's all for now.
Andrea

 

[brandonite]

Merci beaucoup, Andrea! :wink:

I'll mention that. The whole program seems kinda thrown together, at least from what i can see. They have no webpage, just some site that says that the program exists, and the webpage will be updated soon (and the page is dated August 1998!). So, I generally don't get a good vibe from them. But I don't really want to kill a whole year doing nothing, so I'm not sure...

 

[RNAgirl]

Mon ami,

I personally took a year off (it ended up being one and a half since I graduated a semester early), and I don't regret it. In the fall of 2000, I had filled out my AMCAS and was all set to send it in, but I decided at the last moment to wait a year. As long as you do something useful during your year off, I think it can only help your application. I have been working at the NCI in a fellowship specifically for students taking a year off before medical or graduate school. Unfortunately, I just checked the website for the program, and they only take U.S. students. Anyway, I hope your meeting goes well on Thursday. Maybe the outdated website is just a fluke! :wink:

 

[RNAgirl]

Brandonite,

One type of research you could do during the first two years is computer-based modeling studies, or something like that which you could work on at your own pace. This might be an option for you in biophysics.

 

[brandonite]

Noooo! I'm fleeing computers and computer modelling. That's all that astronomy is, as far as I can tell... And I hate it!! That's why I want to get into something more practical and hands on, but I still would like to use my physics background. So, I know that biophysics is heavily based on computers (NMR, MRI, etc...), but at least there is a chance to do something that doesn't involve a keyboard and a mouse...

If I don't like things on Thursday, I'll probably just start (and hopefully finish) my Masters next year, and apply to more established programs in Canada and the US. I'm still not sure what kind of a shot I would have in the US - I didn't do all that well this year, and that was when I was applying just plain MD, not MSTP! So, who knows... Ugh. Life is so confusing... :wink:

Mais, merci beacoup pour penser de moi...

 

[Ponyboy]

While not an MD/PhD student myself (decided against it), several of my friends/classmates are Mud/Phudders.

One thing that you should also consider when thinking about MD/PhD is the possibility of doing your PhD after your MD. This can be done after or during your residency/fellowship. The Royal College has a program called the Clinician Investigator Program which entails doing your PhD during your residency and fellowship. The advantages to doing this are: 1) you already know which specialty you'll be in and can pick your project based on your specialty 2) you will have a larger clinical knowledge base and will be able to decide which problems are worth looking at 3) by doing your PhD at a date closer to when you can become an attending (ie. 1-2 years before you finish your residency) you will be more up-to-date on current research and will not have been out of the lab for 6-8 years.

In terms of U Manitoba not having a very established program, there always has to be someone to break new ground. MD/PhD programs are very new to Canada (except for maybe McGill and Toronto), and there are only a handful of these students around. By not having a program established, there are more open doors for you and less restrictions on your program. In terms of elective time, many schools in Canada have around 10-12 weeks of elective time. What matters most is when you have your elective time (ie. at the beginning of your rotations or closer to the end).

Also, forget about reputation and top schools/programs. What really matters is quality and interests. You want to go to a program that will give you quality training and has interests that are similar to yours. Some of them may be at top 10 programs, some of them may not.

Finally, think very hard about turning down med school for grad studies. If you really want to be a doctor, go to med school. The research can always come later. Also, you may decide that you like clinical medicine and clinical research a lot more than basic science. There are quite a few people that I know who thought that they loved basic science research but found out that they liked clinical research and work much more.