MD/PhD: will I be stuck?

[aamna0601]

Hey I was wondering, I am kind of interested in a MD/PhD program, since Id really like to go into Neuroscience, but at the same time I dont want to get stuck in one if I dont like it. I know that most operate on the, first two years of med school, then 3 yrs PhD then 2 yrs Med school clinicals....I was wondering, if after the first 2 yrs of med school you decide you dont want to do a PhD anymore would you be able to continue? Or would you be 'stuck'?

Thanks in advance all

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[Gut Shot]

Hey I was wondering, I am kind of interested in a MD/PhD program, since Id really like to go into Neuroscience, but at the same time I dont want to get stuck in one if I dont like it. I know that most operate on the, first two years of med school, then 3 yrs PhD then 2 yrs Med school clinicals....I was wondering, if after the first 2 yrs of med school you decide you dont want to do a PhD anymore would you be able to continue? Or would you be 'stuck'?

Thanks in advance all

No, you're never stuck. People drop the PhD all the time. Depending on the type of program, however, you may nor may not be liable for "back tuition."

Also, 3 years for a PhD may happen, or it may not.

 

[Mr Cookie Pants]

You need to ask yourself if you want to go into clinical neuroscience or lab research.

If you wanna stay clinical, just stick to the MD route, you'll have plenty of opportunities to get into the lab. The MD holds significant value with regards to funding and I still dont understand fully the point of the MD/PhD...


Now beyond that, I dont konw if you're stuck. I know that you get grants and funding (and maybe even your preclinical years paid for as well as obviously your reserach time), so I would imagine you are.

 

[Lukkie]

for my department (hematology-oncology) the division chief is md/phd and everyone else is either a phd or an md. i think if u want to get all the way to the top it might help but even 'regular' MDs still can do tons of research

 

[JHopRevisit]

About 50% of a typical MD/PhD interview is devoted to finding out if you're committed to an MD-PhD. If you're waffling, I suggest you not apply, one of the reasons being that your indecision will likely shine through in your interview and you will be passed over (and in my opinion, rightly so) for candidates who are more likely to stick through the program. Then again, you might be a good actor, and it might not matter, but ADCOMs have a lot of experience figuring these things out.

If you are an MSTP (the NIH's "official" MD-PhD program), you are not liable for MD-PhD tuition should you quit, although it still is a bit of a gray area and schools have threatened quitters in the past. If your school has a separate funding source, policies vary. Unfortunately, it's not a question I'd ask at an interview.

Whatever the case, you will not make friends unless you have a very good reason for dropping the MD-PhD. It is considered something to do for only serious and undpredictable reasons, like illness in your family or your PI moving to China. The MD-PhD people at your school probably won't make your life miserable, and you will match somewhere, but pissing off a number of faculty becuase you lied to them (told them you were passionate about MD-PhD at the interview, then quit for trivial reasons) is not a good way to start a medical career.

Thus, I suggest you take more time to think about what it is you want from your career before you apply, or apply as an MD-only and then to an MD-PhD program at that school after your first or second year, which can be difficult at some institutions (ask about it at interviews, it's definitely an acceptable question to ask at an MD interview, as in "I'm not ready to commit to MD-PhD, but I'm interested, what's your policy on that, how many internal applicants do you accept per year?")

 

[Neuronix]

I know that most operate on the, first two years of med school, then 3 yrs PhD then 2 yrs Med school clinicals....

The most common path nowadays is

2 years of med school
4.5 years of PhD
1.5 years of med school

Some people do their PhD in 3.5, but nationally and at most programs the total time to graduation is closest to 8 years on average (at least). The 5.5 years of PhD is not at all unheard of and there are programs whose averages are up past 8.5 years. I just wanted to point out that if you're planning on it being a 7 year program, you can try, but it's difficult.

I think JHop got the rest. I only want to know when I will become dedicated to this whole MD/PhD thing

 

[ecoli]

Here's a related question, and hypothetical, because I'm not planning on doing anything like this.

What if you get through the first two years of med school, get your PhD and decide you've had enough, and can't possibly deal with another 2 years of school. You already have your PhD, but don't want to finish your MD.

Is this looked down upon at all? Would it be hard to get a post-doc under such a scenario?

 

[Neuronix]

Is this looked down upon at all?

Of course it is. The problem with commenting is... It almost never happens. I have no idea what percentage of MD/PhDs do this, but it has to be really really small. I wonder if it's happening even less nowadays with the funding crunch?

Would it be hard to get a post-doc under such a scenario?

I doubt it. To paraphrase from a recent article, if you're an American with one publication that will probably be enough to get the post-doc of your dreams. Everyone is hurting badly for post-docs and so competition is very low.

 

[echod]

The most common path nowadays is

2 years of med school
4.5 years of PhD
1.5 years of med school

Some people do their PhD in 3.5, but nationally and at most programs the total time to graduation is closest to 8 years on average (at least). The 5.5 years of PhD is not at all unheard of and there are programs whose averages are up past 8.5 years. I just wanted to point out that if you're planning on it being a 7 year program, you can try, but it's difficult.

I think JHop got the rest. I only want to know when I will become dedicated to this whole MD/PhD thing

About the 1.5 years of med school, do people usually postpone reentering clerkship until winter or do they delay defending the thesis until starting clinical rotations?

 

[Neuronix]

The exact timeline is program dependent. What I most commonly see and have heard from other programs is that students return on the order of November to January. Rotations are typically flexible enough that you don't have to start third year with the other medical students. At my program though you must defend before returning. They've been burned too many times by the students who didn't defend before returning.

 

[DulyNoted]

About 50% of a typical MD/PhD interview is devoted to finding out if you're committed to an MD-PhD. If you're waffling, I suggest you not apply, one of the reasons being that your indecision will likely shine through in your interview and you will be passed over (and in my opinion, rightly so) for candidates who are more likely to stick through the program. Then again, you might be a good actor, and it might not matter, but ADCOMs have a lot of experience figuring these things out.

If you are an MSTP (the NIH's "official" MD-PhD program), you are not liable for MD-PhD tuition should you quit, although it still is a bit of a gray area and schools have threatened quitters in the past. If your school has a separate funding source, policies vary. Unfortunately, it's not a question I'd ask at an interview.

Whatever the case, you will not make friends unless you have a very good reason for dropping the MD-PhD. It is considered something to do for only serious and undpredictable reasons, like illness in your family or your PI moving to China. The MD-PhD people at your school probably won't make your life miserable, and you will match somewhere, but pissing off a number of faculty becuase you lied to them (told them you were passionate about MD-PhD at the interview, then quit for trivial reasons) is not a good way to start a medical career.

Thus, I suggest you take more time to think about what it is you want from your career before you apply, or apply as an MD-only and then to an MD-PhD program at that school after your first or second year, which can be difficult at some institutions (ask about it at interviews, it's definitely an acceptable question to ask at an MD interview, as in "I'm not ready to commit to MD-PhD, but I'm interested, what's your policy on that, how many internal applicants do you accept per year?")

Great post. I believe, but am not 100%, that the NIH actually labels you a persona non grata if you fail to complete the Ph.D. portion and you're barred from applying for grants for X years. Anyone heard something similar?

 

[MiniFreud]

About 50% of a typical MD/PhD interview is devoted to finding out if you're committed to an MD-PhD. If you're waffling, I suggest you not apply, one of the reasons being that your indecision will likely shine through in your interview and you will be passed over (and in my opinion, rightly so) for candidates who are more likely to stick through the program. Then again, you might be a good actor, and it might not matter, but ADCOMs have a lot of experience figuring these things out.

This brings up a good point. Since you seem to know what you're talking about, I want to ask you to elaborate: What are some good reasons to be committed to an MD-PhD instead of simply an MD?

I am toying with the MD-PhD idea, but I'm beginning to wonder what the point really is other than a fancy title, some respect and a tuition waver.

Somebody already pointed out earlier that an MD often has more access to research funding than an MD-PhD, so it seems like being a physician scientist doesn't really grant you a research advantage.

Why should we aspire to be physician scientists then, other than to avoid medical school bills?

How about personal interest in the field?
What about research aspirations?
What about desire to contribute to your field of medicine as well as practice it?

Are these good reasons at all, or am I on the wrong track?

The goal of a physician is to administer medicine, while the goal of the researcher is to contribute to basic science. How is a physician scientist more than the sum of his parts?

 

[gbwillner]

I am toying with the MD-PhD idea, but I'm beginning to wonder what the point really is other than a fancy title, some respect and a tuition waver.

Somebody already pointed out earlier that an MD often has more access to research funding than an MD-PhD, so it seems like being a physician scientist doesn't really grant you a research advantage.

The goal of a physician is to administer medicine, while the goal of the researcher is to contribute to basic science. How is a physician scientist more than the sum of his parts?

The point is to get a PhD in a basic science field. That's not just a bunch of letters. Graduate school is difficult and in the end you are a scientist and truly think like one and are prepared to act like one. Why go to med school to be a doctor when you can just read Cecil's and buy Epocrates?

MD's don't often have more access to research funding. Maybe "rarely" is a more accurate term. Many MDs that are basic scientists now come from an older generation when the program was not available. We will see in time if the MD alone will become more of a detriment to funding opportunities.

A physician-scientist is more than the sum of his parts- he/she looks at research with the insight of a physician and looks at clinical practice with the insight of a biochemist/geneticist/biologist/engineer. We are betting that that insight will lead to novel ideas and breakthroughs in treatment.

 

[StIGMA]

You pursue the combined degree if you foremost want to pursue career in research and secondly have a legitimate reason that the MD would benefit your research endeavors/career.

A common reason cited for the combined degree over an MD for basic research is that MD's are not trained to be researchers through such an intensive program. You must learn research at some point to do basic science. MD's can do this through a post-doc, etc, but the training may not be up to par as would be gleaned from a formal graduate program. On the flipside, an MD alone may be better suited for clinical research, but to be competitive in hard science a PhD (or similar training) is highly useful.

 

[mdphdstudent1]

I think many medical students do not understand the rigors of a PhD program, and vice versa. The PhD program is intended as more than just to generate a bunch of publications for you, but rather to initiate you into the realm of science, where all is not perfect, and good intentions don't always get you results or grant money. For example, proactive medical students will typically infer research projects or suggest things that are interesting to pursue scientifically (e.g. find a particular mutation in a group of patients), but unless you understand the rigors of undertaking a research project, you won't be poised to efficiently pursue that project. In a similar respect, PhD students sometimes suggest clinically-related projects that would be quite difficult to undertake (e.g. draw blood from a patient every day), and would not be feasible without clinical experience. My firm belief is that motivation and persistence will drive one more towards his/her goal than just having degree(s) after your name, but you can't deny that training helps prepare one for the future, and moreover will open doors that would not be possible without having those credentials. I think if you want to pursue a research career with only an MD, you should be prepared to do a post-doc or research-intensive fellowship. And for a PhD to do clinical research, I think you should be prepared to make good relationships with your clinical piers during and after your post-doc training. In either situation though, you have to be highly motivation and interested. Ideally you do not want MDs in the lab who couldn't care less about the lab's goals, or PhDs who see patients as larger lab specimens. As an MD/PhD you learn to work in both these worlds, but sometimes neither side will understand your motivations.

 

[dl2dp2]

so for the original poster who asked the question of why PhD, there are several implicit answers that i figured out.

(1) PhD is valuable in itself (this is very dubious, and i can barely convince myself of it.)

(2) Over-credentialism is beneficial for various reasons. For one thing, there's a clear tendency nowadays for dept heads/center directors to be hired from the MDPhD pool. Secondly, there's a very clear tendency for the most competitive residency programs to take MDPhDs. Do you want to be a neurosurgeon? Or a radiation oncologist? Or a dermatologist? These days if you don't have a really high score, your best shot to get into your dream program is a MDPhD.

(3) The tuition waiver is more important than you think. I don't think you'll be thinking very clearly about science and its trivial and non-profitable problems with a $1500 a month loan payment over your head. Many med students have told me that the loan pushed them toward "lifestyle" specialty. If you are really interested in a research oriented career, you'd have to think very carefully about how much financial cushion you are willing to give up.

Nothing is free. You either pay $ or you pay by time.