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Bottom line: Don't sign up for an MSTP unless you are 100% certain that you want to have (at least in part) a lab-based career. 'Nuff said.
I'm not sure this is sound advice. I personally think that if you are "devious" enough, you can totally use MD/PhD as a stepping stone to a highly lucrative career in a high-paying specialty. This is esp. true for radiology, rad onc, optho and possibly derm. Subspecialty surgery i hear don't care about the PhD as much.
Suppose I'm a regular med student but have an eye for derm/rad onc, but don't have the confidence that I'll do phenomenonal on boards/third year, doing a PhD is NOT a bad idea at all. Considering that everyone who matches into Derm does a Doris Duke/research year ANYWAY, you are just spending 2.5 more yrs earning for a much increased chance at a really competitive specialty. Just be sure that...
(1) Your story is credible.
(2) Your research is derm related.
Finally, I just want to point out that roughly 40% of MSTP graduates from the largest program in the country eventually do MOSTLY medical practice. Over 20% end up in 100% private practice positions. You most CERTAINLY do not need to be 100% committed to a research career to go for MSTP. Such expectation does not exist and isn't necessarily healthy.