MD/PhD with PhD during fellowship/residency

[pathdr2b]

Originally posted by Lactic Folly

It's just that I've been considering graduate studies during residency/fellowship, as there are Clinician Investigator and Surgeon Scientist programs out there.

Not sure what the difference between those programs and an integrated MD/PhD would be, in practical terms.

Hello Everyone:

I thought Lactic Folly introduced an interesting topic on a previous thread.

At 36, I've certainily considered doing the Phd as a part of a residency/fellowship and at the NIH, I see plenty of examples of doctors doing this type of thing. I guess the major disadvantage would be no stipend for the medical school years but from what I've seen at NIH, MD's that get there PhD's receive incomes above what "normal" residents do. Also, MD's can apply for NIH supplements (similar to applying for a grant) to support their resident income.

So if I'm not admitted to MD/PhD and/or get a full ride as an MD only applicant, I would certainily consider getting the PhD in a residency/fellowship program.

Any one have a differing view?

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[Gradient Echo]

How long is a residency that includes a PhD?

 

[Neuronix]

What happened to that thread? Ya know, a bunch of my posts since the site has come up have dissapeared.

Anyways, I think those kinds of programs are cool. In agreement with pathdr, the money is an issue there. Also, it's going to be alot easier to match into really good residencies if you're coming out of med school with a MD/PhD than if you're coming out with just an MD. Of course this doesn't apply if you're coming from Hopkins/Harvard MD, but for everyone else, it may be difficult to get better residencies.

I think these kinds of residencies end up taking an extra 2 - 3 years. I've met some people doing at the U of Chicago (for neurosurgery), but I didn't ask how long it would take them.

 

[pathdr2b]

Originally posted by Neuronix
I think these kinds of residencies end up taking an extra 2 - 3 years. I've met some people doing at the U of Chicago (for neurosurgery), but I didn't ask how long it would take them.

I think it may depend on the residency you choose, how much research experience you have, type of project, ect. In some pathology programs, research is already integrated into the residency/fellowship requirement. I guess the thought is that you might as well get the PhD while you're at it although I can't imagine it taking any loner than an additional 2 years(due to coursework requirements and the general "time frame" of PhD programs.

Also from what I've seen, MD's that get PhD's have a much easier time at it in terms of getting in and out of the program. I've personally observed them getting better personal "treatment" in terms of respect and other interpersonal issues.

 

[Lactic Folly]

The problem for me with applying MD-PhD from the outset is that I'm not ready to commit to a particular area/supervisor yet. If the goal is to apply research clinically, I would feel more comfortable settling on an avenue of research when I've had more exposure to the breadth of what is out there in medicine, as well have a clearer idea of what residency to pursue (presumably related to my graduate work). Would it be correct to think that most MD-PhD applicants have done a lot of research in a defined biomedical area in undergrad and wish to continue in a related vein?

Financially speaking, I'm in Canada, and am not aware of MSTP-like programs here. However, there are MD-PhD students which offer a stipend for six years. For people who enter graduate studies with an MD, there are fellowships. But aside from this (debt load will be substantial regardless), would there be any significant difference in length time?

I guess the PhD would make one more competitive for residencies. It's also true though that I've read about many residency programs that include one year of research in their program (sometimes leading to a master's in themselves, with possibility of continuation).

 

[surge]

Originally posted by Lactic Folly
The problem for me with applying MD-PhD from the outset is that I'm not ready to commit to a particular area/supervisor yet. If the goal is to apply research clinically, I would feel more comfortable settling on an avenue of research when I've had more exposure to the breadth of what is out there in medicine, as well have a clearer idea of what residency to pursue (presumably related to my graduate work). Would it be correct to think that most MD-PhD applicants have done a lot of research in a defined biomedical area in undergrad and wish to continue in a related vein?

Not really. I would almost argue that most of the time, the opposite is true. Many people I talked to at interviews don't really know exactly what they want to pursue. Some are not even sure about the general area. That's definitely where lab rotations come in. Even in my case, and I consider myself very certain of exactly what research I want to do, it is not what I did in undergrad at all.

Having said that, I certainly see your point. Have you considered schools like Baylor or Yale, which let you do about 6-7 months of clinical rotations (2-3 rotations, typically) before entering a lab? I think it's a good idea, even if you know exactly what area you want to go into. It may give you a very valuable new perspective.

 

[Neuronix]

Less than 50% of people who come into a MD/PhD program know what field of research they want to do their PhD in. So during year one and two of medical school you will be exposed in the classroom to all kinds of fields. Further, you will be able to get significant clinical experience, and even rotations (in addition to what surge said, Penn, Duke, etc...) in before going to the PhD phase and picking your area.

Even then, if you still can't make up your mind, you could do something in molecular/cellular biology that you could take into almost any type of residency.

That is true what you say about doing research during residency. I think it's an even better use of your time to go into a residency research oppertunity with significant research experience, so that you can really hit the ground running and either get a faculty position after residency or do a short post-doc. If you're learning the basics of research in your residency, you will most likely have to do a longer post-doc to get where you wanna go in an academic setting.

The only good argument other than money for doing the MD/PhD in one program is the integration. Both are done from the outset in well-integrated programs, so you learn from the outset how to become a clinician-scientist. Even that is not the greatest of arguments as there are tons of great physician-scientists who are MD-only or who did their PhD after MD. So it's fine if you want to do it any of those ways.

 

[Lactic Folly]

Definitely some food for thought there..

Well, the clinical rotations option sounds like a good idea, but I'm not sure if any universities around here offer it.. will have to do some digging I suppose. School-specific MD-PhD program info on the web can be scarce.. low enrollment and all

It's good to hear that not everything needs to be set at the time you enter the program. Would you therefore in your applications/interviews etc. propose a plausible path of study that is understood not to be binding? Getting into the dual degree seems trickier as you have to meet two committees' standards for admissions.

So.. what do you think of MD-MSc as a background for the same type of career?

 

[Neuronix]

Originally posted by Lactic Folly
Would you therefore in your applications/interviews etc. propose a plausible path of study that is understood not to be binding? Getting into the dual degree seems trickier as you have to meet two committees' standards for admissions.

So.. what do you think of MD-MSc as a background for the same type of career?

At this point I know exactly what I want to do. I want to do research relevant to neurosurgery that I can take into a neurosurgery residency. If I decide that it really is too long/difficult down the road, I can do a neurology residency. It is subject to change and at the interviews nothing you say about your future is binding. At Duke for example, the director does not care what you say about what you wanna do in your future. He says that more than 50% of his students will change their minds. If interviewers ask you "why MD/PhD?" or "where do you see yourself in 15 years?", it is really to get to know that you really know why the MD/PhD is useful and that you know what you are getting yourself into.

As for admissions, the way MD/PhD admissions works varies from school to school. At most schools you only have to please the MD/PhD committee and you are in. At some schools the admissions processes are disconnected, so you can get in for one and not the other or both (I did at Baylor and the MD-only program is still trying to recruit me). Only at a few schools do you have to be accepted by a separate MD committee before the MD/PhD committee.

As for a MD/MSc, I would recommend it for clinical research, such as epidemiology/trials, etc... But not basic science research. Basic science researchers at Universities almost always have PhDs, and so the MSc will limit your career choices in that regard.

 

[pathdr2b]

Originally posted by Neuronix
At this point I know exactly what I want to do. I want to do
As for a MD/MSc, I would recommend it for clinical research, such as epidemiology/trials, etc... But not basic science research. Basic science researchers at Universities almost always have PhDs, and so the MSc will limit your career choices in that regard.

Great advice! I can tell you that at the NIH/NCI you really need the PhD ( as opposed to the MSc) to be considered an "expert" in any field, including epidemiology

 

[Lactic Folly]

Then do MD-only researchers focus mainly on clinical trials.. or what do they commonly work in? Thanks for the replies so far.

 

[surge]

No, I would say that the number of basic science researchers who are MDs only still surpasses the number of those that are MD/PhDs.
As any mudphuder who had to defend their desire to do an MD/PhD at an interview will tell you, you CAN do the exact same thing with an MD only. Most people actually do. Which is why we are making the argument that we're the select few (I can feel the flaming already )

 

[Neuronix]

Originally posted by Lactic Folly
Then do MD-only researchers focus mainly on clinical trials.. or what do they commonly work in? Thanks for the replies so far.

I say that the it's the MSc that is limiting, but it's kind of complicated. I don't think I've ever met a MD/MSc doing basic science, and yet there are TONS of MD-only people doing research. Some of the biggest names in science are MDs. The way for MDs to become basic science researchers is to post-doc. These days a MD reseacher would have to do one long post-doc (5 years) or two post-docs.

I think that over time there will be more MD/PhDs replacing the aging MD-onlys. I think the reason why is because there's more MD/PhD programs, it takes longer to get established in research (hence, a 3 year post-doc after MD will no longer do), and that MD/PhDs may have an increasing edge when it comes to getting grant money. There's also the factor of money. The most prestigous medical schools are also some of the most expensive, and so coming out of one MD-only and choosing research would be very difficult (if not impossibly) because of the debt load being carried.