MD/PhD vs MD only...decision time

[mstp]

I realize this question and many like it have been answered. Ive read them but I still feel a little uneasy. I have been admitted to a few MD/PhD programs and cleveland clinic this year. I am unsure of what to choose and decision time is looming...

The MD/PhD programs Im considering are fully funded MSTPs ~25k stipend per year = no debt. The cleveland clinic is a 5 year program that pays full tuition plus a stipend (~25k I think) for the research year, but you have to pay living expenses for the 4 medical school years ~ 100k debt.

My ultimate goal is to have a career that is research heavy 70/30ish. I want to do immuno/pathology infectious disease. So Im thinking regardless of the program I choose now Ill either do a pathology or IM/Infectious Disease residency afterwards.

Ive always intended to do the MD/PhD but Im 24 now and the thought of 8 years plus residency/fellowship sounds so much more daunting than 5 years plus residency/fellowship + 100k debt.

If I want the career of an MD/PhD (academic medicine, faculty position, yadda yadda) do you think the Cleveland Clinic program could get me there faster, or would the lack of PhD hold me back later?

I figure if I have to compensate through a longer post-doc or fellowship later in life then Id rather do the PhD now to get that training formally and integrated. But, if I can go MD alone and still be considered equally competitive for the same faculty position fresh out of fellowship as an MD/PhD, then Ill save my 3 years and dish out the 100k.

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[1day]

The age is irrelevant, especially if you want to do research. Research will take all your life anyways. You'll need the titles to work and having no debt will help you a lot. Go for the MD/PhD, do NOT worry about how old you are, instead, look at people born with no opportunities whatsoever. You'll be fine. Congratulations.

 

[alacast]

Wait...seriously?

The username "mstp" hadn't been taken yet?

 

[gbwillner]

Wait...seriously?

The username "mstp" hadn't been taken yet?

 

[gbwillner]

My ultimate goal is to have a career that is research heavy 70/30ish. I want to do immuno/pathology infectious disease. So Im thinking regardless of the program I choose now Ill either do a pathology or IM/Infectious Disease residency afterwards.

Ive always intended to do the MD/PhD but Im 24 now and the thought of 8 years plus residency/fellowship sounds so much more daunting than 5 years plus residency/fellowship + 100k debt.


I figure if I have to compensate through a longer post-doc or fellowship later in life then Id rather do the PhD now to get that training formally and integrated. But, if I can go MD alone and still be considered equally competitive for the same faculty position fresh out of fellowship as an MD/PhD, then Ill save my 3 years and dish out the 100k.

Do the MD/PhD. I would say to skip the PhD if your goal was to dabble with science or do clinical research, but honestly I doubt you could ever be "considered equally" with MD/PhDs as an MD only (at least in this day and age) in basic science or good applied research. You would certainly need to compensate with a longer post-doc/fellowship to even get close, and it will be harder for people to take you seriously from the get-go. You may be competitive out of training for a faculty position, but it will not include sufficient research time for your interest (they will hire you to see patients/read slides while the MD/PhDs get to play on their bench).

 

[solitude]

yeah, just do the MSTP. The age is not really a factor here--I would say at least 30% of people start the MSTP after taking one or two years off and being about 24. And as has been noted elsewhere, it won't save you much time, if any, to do the MD route. Having no debt is nice.

 

[mittymark]

I'm starting an MSTP this fall at the age of 26. Do not worry about your age. Go for the MD/PhD. No joke. 70/30 though might be a little hard to swing.

 

[nomogram3]

Not a doubt in my mind...do the MSTP. If you want to have a research career (say 20% clinical, 80% research) the MD/PhD will be more valuable. In addition, if you do the Cleveland Clinic program you will need additional research training in addition to the fellowship of your choice, so don't think that you will be cutting off that much time (but, admittedly, more than with an MD/PhD). Besides, ID doesn't pay that well, and the pressure to get grants on top of the $100K hole doesn't sound fun.

 

[RxnMan]

In many respects, I'd say it's six of one, half-dozen of the other. I agree that age shouldn't be an issue here. The factors I'd consider are:

1) There's many ways to get research experience as an MD
2) Overall PhDs don't significantly assist in residency placement
3) 4-5 years of wages lost as a PhD is pretty balanced by extra fellowship years with higher income
4) Changes in your priorities through the training period
5) Past the trainee level, there's no differences in the quality of science between degree holders. Only differences in perspective.

It really depends on if and when you want to do the PhD. Have you considered the ABIM research pathway or the CSTAs? You can get your PhD as a resident and fellow, you'll have a better idea of what type of career and field you want then, and your research will be better focused at that point.

 

[mstp]

thanks for the replies guys, haha I made this account today...I couldnt believe "mstp" wasnt taken either

I think I concur with a lot of what has been said so Im leaning MSTP for sure. I havent been concerned with my age that much in the past. Ive always considered the MSTP to be the equivalent of a low paying job where I get to do what I love. BUT, after a while it gets to you when people keep saying, youre gonna be in school for HOW long??

Also appreciate your input rxnman - Ive heard of research heavy condensed residency fellowship programs but I had never heard of PhD during residency or fellowship.

 

[Shifty B]

So, I'll agree with the others and say you should probably do the MSTP. I don't think it's that clear cut, because I think you can probably achieve what you want either way. However, given that you already anticipate that you would be willing to spend 2-3 years post MD getting research experience I think you might as well suck it up now and get the PhD credential and the financial benefits.

I am going to disagree with the others on one fact though. Age does make a difference in this decision. For most people, there is some age at which is starts to make less sense to consider MD-PhD programs; you're just not there yet. Me personally: I would put that cutoff at 26 years old.

Why 26? Well, if you start at 26 there is a chance you'll have a real job by the time you're 40. You'd start residency at 34, and then start making your first decent salary. You'd first start having a more manageable work load at 37 when you became a fellow (if you did IM). You'd be looking for your first faculty job at 40. At some point, that 4 years becomes too much to tolerate.

 

[Build]

Just to add in a point for consideration, if you're in a hurry, you can certainly look at strategies for a speedier PhD. At my program, Path has the least additional coursework, so if you put a lot of effort into working with current students and faculty to find the right lab early, you could aim to shave some time off of the 4 year average. While many people will readily point out the uncertainties of research that slow things down and the merits of trying different labs, I know a few people in my program who stuck with the same lab for three summers during MS1-MS2 and wrapped up productive PhDs in 2.5-3 years. There are some obvious trade offs and no guarantees, but if you spend significant time talking with the current students you can make smart choices early. Look for faculty with speedy, productive track records and put the research topics into the perspective of importance of specific topic vs importance of general skills as a scientist. Good Luck!

 

[RxnMan]

...Also appreciate your input rxnman - Ive heard of research heavy condensed residency fellowship programs but I had never heard of PhD during residency or fellowship.

I think there's many paths to becoming a clinician-scientist - the MD is incredibly flexible in this regard - and one should explore all of them. From what you've written, you've only got good choices and good choices.

...However, given that you already anticipate that you would be willing to spend 2-3 years post MD getting research experience I think you might as well suck it up now and get the PhD credential and the financial benefits.

I am going to disagree with the others on one fact though. Age does make a difference in this decision. For most people, there is some age at which is starts to make less sense to consider MD-PhD programs; you're just not there yet. Me personally: I would put that cutoff at 26 years old.

Why 26? Well, if you start at 26 there is a chance you'll have a real job by the time you're 40. You'd start residency at 34, and then start making your first decent salary. You'd first start having a more manageable work load at 37 when you became a fellow (if you did IM). You'd be looking for your first faculty job at 40. At some point, that 4 years becomes too much to tolerate.

Huh. I started med school at 26 y/o, I've taken a year off to go to the NIH, and I've got a MS. By your post, if anyone on this forum should be "on the fence" about getting a PhD, it's me.

I seriously considered just extending my stay here and doing a GPP. As-is, I'll start residency a little before turning 31. The plan is to graduate residency at 35 and transition into a CSTA/research fellowship/etc. at the junior faculty level supported by a K, T, or society grant, +/- NIH-LRP. That would go for a few years, and then I'd be in position to go for a R01. I'll have to pay off my loans, but I'd spend more at fellow-level salary and status (which is important later) which will relate to my field. I can still get the PhD if I want, I'd just do it as a fellow.

If I went MD/PhD, I'd be here for another 3-4 years before going through residency, but I'm not going to be able to build enough intellectual capital (ideas + prelim data) to have a convincing seed for an R01 right out of the gate. Nobody has the time to do that during residency, and I'd need to get re-acclimated to the lab anyways. So I'd still do a fellowship before going for an R01. Here, the benefit is probably a shorter period as a fellow, with no tuition bills, but at the expense of doing a PhD as a student, which may or may not line up with my fellowship, and wages lost at the attending level. My age at the end is the same either way.

But why did I bring up status? I had a bad graduate mentor that poisoned my grad school experience. Neuronix is another poster who's had trouble during his PhD. This is not uncommon in grad school, and it's most frequently due to poor choice of mentors/thesis committee. As a new grad student you usually don't have enough info to make a smart choice of mentors, so there's a large element of luck involved. On top of that, grad students have very little say in what goes on in their thesis or the lab in general. I simply didn't want to be that powerless again. As a fellow, if I do a PhD, I will control the situation, and that increases my chances of success and satisfaction.

I've written about this because the OP is in essentially the same place I was, so hopefully my thought process will be informative. Basically, I think doing the PhD earlier is too much of a committment too early, and for me at least, doing it later would be better.

OP, if you do decide to go MD/PhD, then pick your mentor wisely. F--- the flashy project: choose the best mentor you can find. Never let anyone convince you that the PhD will make up for poor performance as a med student.

 

[Shifty B]

...I know a few people in my program who stuck with the same lab for three summers during MS1-MS2 and wrapped up productive PhDs in 2.5-3 years. There are some obvious trade offs and no guarantees, but if you spend significant time talking with the current students you can make smart choices early. Look for faculty with speedy, productive track records and put the research topics into the perspective of importance of specific topic vs importance of general skills as a scientist. Good Luck!

I would not by any means advise someone to enter an MD/PhD program expecting a 2.5-3 yr PhD. It may happen occasionally, but you need to realistically anticipate 4 years or even 5. It is possible to finish in 3, but it is not likely to be in your control. If you end up in that circumstance, take it, but don't expect it.

Huh. I started med school at 26 y/o, I've taken a year off to go to the NIH, and I've got a MS. By your post, if anyone on this forum should be "on the fence" about getting a PhD, it's me.

Well, it sounds like you are on the fence about getting a PhD!

Just a word about PhDs obtained during residencies, fellowships, etc. It is an interesting option, but I'm not sure it is viewed as being as valuable a degree as the old-fashioned basic science degree. Most PhD-only investigators may be dubious that you completed as rigorous a degree course as they did.

 

[sanktank7]

I've written about this because the OP is in essentially the same place I was, so hopefully my thought process will be informative. Basically, I think doing the PhD earlier is too much of a committment too early, and for me at least, doing it later would be better.

OP, if you do decide to go MD/PhD, then pick your mentor wisely. F--- the flashy project: choose the best mentor you can find. Never let anyone convince you that the PhD will make up for poor performance as a med student.

I agree 100% and your thought process is definitely helpful, thanks for sharing. The reason Im starting MD/PhD at 24 is because I spent 3 years doing research full time. I feel really confident going into a PhD now but if you asked me straight out of undergrad the answer would have been NO.

As for the choosing the mentor part - I think this is the biggest challenge and its this part of the equation Im trying to get a handle of at second visits.

 

[RxnMan]

...Just a word about PhDs obtained during residencies, fellowships, etc. It is an interesting option, but I'm not sure it is viewed as being as valuable a degree as the old-fashioned basic science degree. Most PhD-only investigators may be dubious that you completed as rigorous a degree course as they did.

Regardless of how you get your PhD as a MD, you will always face this criticism from PhD-only researchers. Evidently the only way to get a "worthwhile" or "real PhD" is to spend 6-7 years in grad student hell.

Also, the focus on basic science as being somehow more noble or better than clinical science is a product of a cultural shift in medical science, and is not based in reality. My PhD colleagues constantly give me new ideas of how to proceed in testing one idea or another, but it is by my medical experience that those ideas are refined into something useful for patients. Both views are needed, and neither should be elevated at the expense of the other.

 

[calvinNhobbes]

There is a huge difference between being given a project that has been successful, taking a few months learning the techniques, doing the next logical group of experiments for a couple years and then writing it up (ie. what I have seen residents and fellows do). And being told to come up with your own project, spend years failing, feeling like you just want to quit, some how gutting it out, and in the process defending every decisions you've made against experts in the field (ie. a PhD).

Having done extensive basic science and clinical research, I would have to say both are very important. However, clinical research is boring, requiring minimal creativity or effort to design or interpret.

 

[RxnMan]

There is a huge difference between being given a project that has been successful, taking a few months learning the techniques, doing the next logical group of experiments for a couple years and then writing it up (ie. what I have seen residents and fellows do). And being told to come up with your own project, spend years failing, feeling like you just want to quit, some how gutting it out, and in the process defending every decisions you've made against experts in the field (ie. a PhD)...

This is what I've done as a med student - had projects I came up with fail, started over, and so on. Also, remember that folks who have done a MD->residency->fellowship haven't had the time in the lab that a PhD has. Of course they will not have the research experience a PhD has. You're comparing apples and oranges. If they stay in research, the fellow will eventually develop their own ideas and diverge from their PI. This is the natural progression of any researcher.

The "gutting it out" is something I disagree with. Beyond the basic skills of problem-solving and trouble-shooting your techniques, there's no utility in suffering in a lab for years. Anyone who does research for any length of time will have earned these skills from the trail of failed projects behind them, regardless of their degree. "Gutting it out" as graduate student does not make one special in this regard, only miserable. Anyone who brags about it is analogous to the attending who brags about how hard they had it before the 80-hour limit.

Any way you cut it, you have to put the time in at the lab, it's just a question of when - which is what I put in my first post. Having an extensive research experience or doing a PhD after residency, is in my opinion, better for the reasons I stated above.

...Having done extensive basic science and clinical research, I would have to say both are very important. However, clinical research is boring, requiring minimal creativity or effort to design or interpret.

I have extensive basic and clinical research experience too, and the fact that you don't recognize the amount of thought and effort that goes into designing a good clinical trial shows that you probably weren't involved as much as you thought.

 

[Freak]

The only thing I have to add is that there are certain "critical" windows in which to learn certain skills. I am not sure if the PhD falls into such a critical window, where your brain has more plasticity. I have seen my fair share of quality MD-only researchers.

On the PhD side, I think that there should be a "med school lite" sort of curriculum for people who want to do translational or biomedical research. I have seen many cases where this curriculum would have lead to insights / changes in methodology.

I agree that pain for the sake of pain is not normally a wise course of action. On the flip side though, the advent of calculators (ie. tedium easing devices) has created (myself included) a bunch of people who cannot do simple math in their heads. I remember in HS Calc I had to wean myself off of a calculator to regain multiplication skills.

Another issue with PhD's is the fuzziness of the end-point. It seems to be a hybrid of work and time spent at most institutions I know of.

 

[calvinNhobbes]

This is what I've done as a med student - had projects I came up with fail, started over, and so on.

It's different as a PhD student. I'm not talking about a summer project, I'm talking about a thesis, ie. potentially years of work.

Also, remember that folks who have done a MD->residency->fellowship haven't had the time in the lab that a PhD has. Of course they will not have the research experience a PhD has. You're comparing apples and oranges. If they stay in research, the fellow will eventually develop their own ideas and diverge from their PI. This is the natural progression of any researcher.

You were the one making the comparison, I was simply stating that it is not the same, which apparently you agree with.

The "gutting it out" is something I disagree with. Beyond the basic skills of problem-solving and trouble-shooting your techniques, there's no utility in suffering in a lab for years. Anyone who does research for any length of time will have earned these skills from the trail of failed projects behind them, regardless of their degree. "Gutting it out" as graduate student does not make one special in this regard, only miserable. Anyone who brags about it is analogous to the attending who brags about how hard they had it before the 80-hour limit.

And you would be wrong. Unless you've done it, you just don't understand. It's like trying to explain to an RN or PA that they in fact don't have the same education as an MD. A PhD is not like any other degree. There is no finite set of requirements equally applied to everyone with a set time for graduation. You're there until you prove you're ready to go. You make it work or you don't get the degree.

I have extensive basic and clinical research experience too, and the fact that you don't recognize the amount of thought and effort that goes into designing a good clinical trial shows that you probably weren't involved as much as you thought.

I have first author clinical and basic science papers. I've spent an entire year doing it. Clinical research is elementary compared to even the most mundane basic science research. The fact you even suggest otherwise makes your claim of "extensive" basic science research suspect.

 

[RxnMan]

It's different as a PhD student. I'm not talking about a summer project, I'm talking about a thesis, ie. potentially years of work...

Neither was I, but way to assume. I've written two theses, both based on my ideas, both based on years of work.

...I've spent an entire year doing it...

But didn't you just say that...

...doing the next logical group of experiments for a couple years and then writing it up...

...didn't mean anything? How's that double standard working for ya?

...Clinical research is elementary compared to even the most mundane basic science research...

Sounds like you're trying to pass off opinion as fact. How about you show some proof to back up your claims?

The fact of the matter is, the big studies that change clinical practice take years of effort and our brightest thinking about the best ways to answer relevant questions in rigorous, believable ways. Sure, extracting data from a bunch of charts is boring, but so is running gels. Don't try to pass of basic science as some sort of higher work. Much of basic science goes nowhere. Just like 99% of case reports.

...And you would be wrong. Unless you've done it, you just don't understand. It's like trying to explain to an RN or PA that they in fact don't have the same education as an MD. A PhD is not like any other degree. There is no finite set of requirements equally applied to everyone with a set time for graduation. You're there until you prove you're ready to go. You make it work or you don't get the degree...

Let me guess, getting to the lab was uphill both ways?

But thanks for proving my point. The OP is asking for advice about choosing to MD/PhD, and I caution that there's a good deal of grad student abuse out there. Then you come in saying the only way to be a real scientist is by suffering for your project.