MD to MD/PhD?!?

[RunMimi]

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[Mitro]

There is nothing wrong with accepting an MD seat and applying MD/PhD later. People do it - I've met a few people at MD/PhD interviews who were internal applicants. So there's no reason why you can't go somewhere with the intention of entering the MD/PhD program later. The real problem maybe getting into a program once at the school. It's unlikely that you'll add more research experience between now and when you'll apply internally. Thus, your application maybe as strong as it will ever get for an MD/PhD program NOW rather than once you arrive at whatever school you decide to matriculate.

Since there is no guarantee that you will get into the program once you go to a school, and if you're really committed to MD/PhD, you might want to consider contacting the MD/PhD programs at the schools where you've been accepted to ASAP. You never know if deadlines haven't passed for the application, or if they'll consider your application for this cycle regardless. Generally the MD/PhD people are much friendlier than the MD admissions people - so I would definitely give them a call.

Good luck with whatever you decide.

 

[ImmunoANT]

ummmm... you actually don't really need a PhD to do research. there are tons of opportunities once you get into med school for basic science research (in addition to clinical research). lots of people take a year off for scholarly pursuit (bench work type) or do a HHMI fellowship. but again, wouldn't hurt to apply internally after MS1

 

[Gut Shot]

ummmm... you actually don't really need a PhD to do research.

True dat! IMHO, if you have an MD acceptance in hand, there are much saner ways to pursue a research career than the multi-year torture of a PhD. With some exceptions, myself and the other PhD candidates I have known all pondered taking a warm bath with a toaster before it was all over.

You can acquire all the scientific acumen you need during residency/fellowship, and it will be much more brief (and better paid) than the PhD route. Granted, you will have med school debt, but it's small price compared to years of your life.

 

[solid snake]

I'm in the application cycle right now for MD-only programs. I've done a good bit of research in college (I'm a senior) but not for like eight years or anything. The point is the more I do the more excited I get about it. I considered MD-PhD programs before but decided I wasn't ready to make the commitment. I'm thinking more and more that I want to do the PhD part also. What should I do?!? I don't want to give up my acceptances. Is it devious to accept my position with the intention for applying for entry in the MD-PhD program after one year of MD school?

How do schools look at PhD to a MD/PhD? Is that even possible?

 

[b&ierstiefel]

How do schools look at PhD to a MD/PhD? Is that even possible?

possible but quite rare. i think md to md/phd is better received than phd to md/phd.

 

[Neuronix]

How do schools look at PhD to a MD/PhD? Is that even possible?

Do a search for this one. It's been discussed ad nauseum at this point I think.

 

[b&ierstiefel]

Do a search for this one. It's been discussed ad nauseum at this point I think.

awesome avatar there Neuronix.

...you can be my secretary or something...

 

[sharpnerd00]

True dat! IMHO, if you have an MD acceptance in hand, there are much saner ways to pursue a research career than the multi-year torture of a PhD. With some exceptions, myself and the other PhD candidates I have known all pondered taking a warm bath with a toaster before it was all over.

You can acquire all the scientific acumen you need during residency/fellowship, and it will be much more brief (and better paid) than the PhD route. Granted, you will have med school debt, but it's small price compared to years of your life.

Do you think if you could do it again... then you would just go and due the MD route rather than spending years of your life doing MD/PhD?

I'm completely undecided and applying for 2006 entrance... but one must admit that the lack of school debt makes MD/PhD look very appealing...

 

[BDavis]

Do you think if you could do it again... then you would just go and due the MD route rather than spending years of your life doing MD/PhD?

I'm completely undecided and applying for 2006 entrance... but one must admit that the lack of school debt makes MD/PhD look very appealing...

I wanted to do MD/PhD so that I could get protected time to do research. At the time I applied for medical schools, most of the research committment was 1 year, but I felt I needed at least 2-3 years to get comfortable with doing research. I chose a research field that was completely different from anything I had worked on before. At the time I applied, many programs were advertising "7 years" for the total length. In retrospect "7 years" was more like 8-10 years in reality. Sure there are students that get out in 7 years, but there are many that don't make it out that fast. I didn't get as much as I wanted to out of my grad school classes and I would of much rather jumped straight into lab to work.

I don't regret doing MD/PhD, but I think I should of factored the graduate school in making my decision (i.e. a program where the graduate school class requirements are kept to a minimum would be a better fit for me). For most programs, the PhD is the rate limiting step and you will spend most of your time in graduate school (vs. 3 years for medical school).

Good luck...

 

[Gut Shot]

Do you think if you could do it again... then you would just go and due the MD route rather than spending years of your life doing MD/PhD?

I'm completely undecided and applying for 2006 entrance... but one must admit that the lack of school debt makes MD/PhD look very appealing...

If I could go back in time and slap 1993 self around, I would totally go straight for the MD. Granted, being a slightly older and wiser student has had its perks, but I still would have done thing differently. Ideally I would have liked to have worked for about 2 years before starting the MD. Alas.

The debt question depends on what type of practice you want to have. I admit, it's appealing for academic types to have no debt. However, when you take an extra few years before starting your career, the time you're really losing is on the other end of your career (unless you want to push back your retirement date). And those are the highest earning years you will ever have.

 

[sharpnerd00]

If I could go back in time and slap 1993 self around, I would totally go straight for the MD. Granted, being a slightly older and wiser student has had its perks, but I still would have done thing differently. Ideally I would have liked to have worked for about 2 years before starting the MD. Alas.

The debt question depends on what type of practice you want to have. I admit, it's appealing for academic types to have no debt. However, when you take an extra few years before starting your career, the time you're really losing is on the other end of your career (unless you want to push back your retirement date). And those are the highest earning years you will ever have.

could you enlighten me/us on why you would have gone straight to being an md student? do you/ppl think that being an mdphd student is only useful to those who want to pursue academic medicine?

at least i have half of your ideal going... i am planning on working two years before embarking on the md/phd route

 

[the citizen]

do you/ppl think that being an mdphd student is only useful to those who want to pursue academic medicine?

No, the PhD training will help you no matter what type of medicine you plan to practice. Substitute "worth it" for "useful" and the answer is yes.

 

[Gut Shot]

No, the PhD training will help you no matter what type of medicine you plan to practice. Substitute "worth it" for "useful" and the answer is yes.

I will echo your sentiment here. A PhD is invariably useful. The question is what is it worth to an individual? Going through the PhD has helped me. It honed my critical thinking skills, taught me the nuts and bolts of science, and greatly increased my pain tolerance. But were the years and frustration and poverty worth it to me? The jury is still out on this, but I'm inclined to say no.

Every person will be different, however, so you have to establish what you really want before you can decide if combined training is appropriate. I do believe that my PhD has helped me get some residency interviews, and during one of them I was having a discussion with the head of the chem lab at a large west coast medical center (a PhD). Since I did my PhD separately he wanted to know what I thought of combined training in general. I gave him my opinion (which he agreed with) that a subset of MD/PhD students really, really thrive in their programs, but that most of them do not. These unfortunates usually manage to suffer through or sometimes drop the PhD, and for what? To get five letters after your name with no debt?

I don't know how to determine who will thrive and who will end up just surviving, but whenever I hear someone say "I can get both degrees and not pay anything!" it sends a shiver up my spine. Sure you can, and it will only cost you your youth and your soul. Getting either is a labor of love, but it's difficult to convey that to the uninitiated.

I wish I had just pursued an MD because I have determined that my drive is towards clinical cases more so than research. Not that MD's can't do research. In fact, MD's have better success than PhD's at obtaining grants, can work on human subjects, and possess clinical training/experience that no PhD can touch. Department Chairs at medical centers are predominantly MD's. There are MD's swimming in grant money in every field, from the most basic science research to the most clinical. I still enjoy research and want to keep my hands in it, but I could have done that with an MD alone. Heck, I'd be an attending right now if I'd gone straight through. As it is I'm still eating Progresso and drinking Natural Light, waiting to start residency.

 

[BDavis]

I gave him my opinion (which he agreed with) that a subset of MD/PhD students really, really thrive in their programs, but that most of them do not. These unfortunates usually manage to suffer through or sometimes drop the PhD, and for what? To get five letters after your name with no debt?

I agree with your statement and sometimes I hear it often from potential MSTP candidates. The debt factor is always raised as a bonus for doing MSTP, but I try to encourage potential MSTP students to not even factor money into the choice between MD vs MD/PhD. I use the following as an example: My wife and I were both in the same MD/PhD class and she quit the program and ended up paying more for her tuition because it was out of state. At the end of medical school she owed ~110K in loans (I think the average medical student owes ~120K depending on where they go to school?). Even if she never started the MSTP and dove right into medical school debt, this example is still somewhat relevant. By the time I finish my MD/PhD program, she will be an attending (her offers for jobs are at least 150K starting). Even though she has more debt, assuming I would do the same residency as her and retire at the same age as her, I would "lose out" on the 5 years I spent in graduate school when I could of spent that 5 years making an attending salary which would more then negate the debt incurred in medical school (one can factor in academics vs private practice, those who go onto residency vs postdoc and other confounding variables, but for the sake of simplicity, I just try to make broad assumptions). Thus, from a practical standpoint I think that when entering a MD/PhD program, one should not focus much on the lack of debt as a huge point to sway you from MD to MD/PhD programs.

 

[Gut Shot]

Thus, from a practical standpoint I think that when entering a MD/PhD program, one should not focus much on the lack of debt as a huge point to sway you from MD to MD/PhD programs.

I could not agree more.

 

[OldPsychDoc]

I don't know how to determine who will thrive and who will end up just surviving, but whenever I hear someone say "I can get both degrees and not pay anything!" it sends a shiver up my spine. Sure you can, and it will only cost you your youth and your soul.

Words to live by.

 

[marglinw]

I assure you that if you are admitted into any MD program, you can easily (without question) receive stipend to complete the phD part at that respective school. I am considering this. The downside is that you still have to pay for medical school. There are many plusses to this and you should look into it if you like research but perhaps are not interested in being part of an MSTP spotlight!

 

[tr]

Not that MD's can't do research. In fact, MD's have better success than PhD's at obtaining grants, can work on human subjects, and possess clinical training/experience that no PhD can touch. Department Chairs at medical centers are predominantly MD's. There are MD's swimming in grant money in every field, from the most basic science research to the most clinical. I still enjoy research and want to keep my hands in it, but I could have done that with an MD alone.

I hear this a lot, but I think there are a couple of caveats to it.

First, the pace of biomedical research is accelerating at an astounding rate. Sure, there are MDs who do good basic research, but I think it is becoming ever more difficult to pick up 'on the fly' the extensive and rigorous training required to do it well. I wonder how many straight MDs will be doing top-quality basic research thirty or forty years from now.

Havarti666, it's easy to downplay your training now that you've gotten it; but try to remember yourself as a first-year graduate student. Could you have jumped straight into a postdoc or research fellowship with that level of experience? Because that's how much basic science training you get in an MD program: zero. I shudder to think of myself trying to start up a lab without having had the experience of PhD training. Shudder, I tell you!

Second, it's true that debt-free is not worth it for those who plan to enter clinical practice. But those who actually do want to do research will spend many more years in low-paying positions. The earning power they will have after graduation or residency (as a postdoc, research fellow, or assistant prof) is far lower than that of an attending physician. It's much more difficult to carry $120K of loans on $60K/year as an asst prof than on $150K/year as an attending.

So, is the MD-PhD worth it as an alternative to a straight MD for someone who only wants to practice? Of course not, duh. But is it worth it as an alternative for someone who would otherwise go from residency to undertrained, underpaid postdoc? Or as an alternative to a straight PhD for someone who is interested in biomedical problems? Absolutely for both.

 

[qqq]

I assure you that if you are admitted into any MD program, you can easily (without question) receive stipend to complete the phD part at that respective school. I am considering this. The downside is that you still have to pay for medical school. There are many plusses to this and you should look into it if you like research but perhaps are not interested in being part of an MSTP spotlight!

i've heard it's not that easy (being accepted into the school's PhD program). Your school may have that arrangement in place, but I doubt all schools have that.

 

[Neuronix]

i've heard it's not that easy (being accepted into the school's PhD program). Your school may have that arrangement in place, but I doubt all schools have that.

This is actually untrue for most graduate programs. Medical students already have high GPAs and LORs. In some cases they might need to take GREs, but in most cases not even then. If you're not even looking for medical school funding, the acceptance rates for MD/PhD from the MD program are very high. The only difficulty would come if you didn't have any research experience when you applied. But, if this was the case, why would you be applying?

PS: to marginlw, the MSTP spotlight is a GOOD THING! The NIGMS coordinators are very pro-student, so it really behooves you to be in a MSTP.

 

[BDavis]

PS: to marginlw, the MSTP spotlight is a GOOD THING! The NIGMS coordinators are very pro-student, so it really behooves you to be in a MSTP.

As a MSTP student, you are sort of a "bastard child" between the medical and graduate school. Since most start in medical school, then switch to graduate school and finish in medical school, many requirements can change over the course of your training. The medical school can add extra requirements (for ex. additional standardized tests to practice for the Step II clinical skills exam) while you are in graduate school. Being a MSTP student, you have additional advantages such as specific committees and faculty to fight for your personal interests.

However, there are caveats, in that MSTP students have addtional requirements that no medical student or graduate student have. For example, graduate students don't have to devote time to clinical responsibilities or medical students don't have to devote their summers to work in lab rotations. Personally I had to take ethics classes in medical school, graduate school, as well as MD/PhD specific ethics.

In the end, I guess it comes down to a personal decision which route is a better fit for yourself.

 

[Neuronix]

In the end, I guess it comes down to a personal decision which route is a better fit for yourself.

My apologies, I meant my response to mean non-MSTP MD/PhD programs. What I said still stands for the most part for MD and PhD separately as well, and I still think it's preferable to do them together than separately if you know from the beginning. Ah well, that's an argument for a different thread I think

 

[Gut Shot]

Sure, there are MDs who do good basic research, but I think it is becoming ever more difficult to pick up 'on the fly' the extensive and rigorous training required to do it well. I wonder how many straight MDs will be doing top-quality basic research thirty or forty years from now.

Well, I was speaking more about my own preferences and options than someone who is hellbent on doing basic science research. If a person's goal is to get down and do the nitties, grittiest basic science then that individual should probably be pursuing a straight PhD. My opinions about people doing MD-only vs. MD/PhD are predicated on them being interested in medicine enough to consider the four years of clinical training. And in thirty or forty years from now we will be ruled by a race of Super Apes, so who cares?

Havarti666, it's easy to downplay your training now that you've gotten it; but try to remember yourself as a first-year graduate student. Could you have jumped straight into a postdoc or research fellowship with that level of experience?

What I did do was go from a chemistry degree with almost no biology background into a lab that was doing genetics and microbiology, with no postdocs or other graduate students to guide me. It sucked, but I got up to speed, and had learned almost everything I was going to in about 3-4 years. The only problem was that it dragged on for close to 6 years.

It's much more difficult to carry $120K of loans on $60K/year as an asst prof than on $150K/year as an attending.

Hmmm, when I was in grad school in the late 90's, the only folks making 60-70K/year were the PhD assistant profs. Unless they went administrative, they topped out at full professor around 120K. That 120K was also about the entry salary for the MD assistant profs. Those were base salaries, by the way.

But is it worth it as an alternative for someone who would otherwise go from residency to undertrained, underpaid postdoc? Or as an alternative to a straight PhD for someone who is interested in biomedical problems? Absolutely for both.

Eh, it MIGHT be worth it for those people. I guess that's my main point; it's a helluva commitment, so choose wisely. Successful researchers have such incredibly rich and varied backgrounds, so there are obviously many ways to skin these cats. As with so many things, one's drive to do science with carry him/her much further than spending 4 years MD/PhD in Lab X vs. 3 years post-MD fellowship in Lab Y. Top tier research is often both a lifestyle and an obsession.

 

[GiantGiantsFan]

i have the same dilemma as the OP: i am currently an MD applicant but I am being lured into pursuing an MD/PhD. many people have brought up trivial reasons for pursuing md/phd, namely that of debt reduction.

personally, my own interest in MD/PhD is because I am genuinely interested in advancing knowledge and technology within the realm of medicine. I think that science and medicine go hand in hand, and I would like to have access to both tools in my career as I quest to improve health care for everyone.

i think my reasons are genuine for pursuing an MD/PhD. I wonder, to those MD/PhD's who have discouraged others from following their footsteps, what would you say in my case, as someone who is genuinely interested? Did you have similar, seemingly genuine reasons when you opted for the dual degree, that turned sour somewhere in the midst of the program?

 

[GiantGiantsFan]

also, i should mention that although im applying for an md, i am skilled as a research, having spent 2+ years in labs and successfully completing projects for publication. so, i believe i have the ability and mindset to complete the program.

 

[abeanatrice]

i have the same dilemma as the OP: i am currently an MD applicant but I am being lured into pursuing an MD/PhD. many people have brought up trivial reasons for pursuing md/phd, namely that of debt reduction.

personally, my own interest in MD/PhD is because I am genuinely interested in advancing knowledge and technology within the realm of medicine. I think that science and medicine go hand in hand, and I would like to have access to both tools in my career as I quest to improve health care for everyone.

i think my reasons are genuine for pursuing an MD/PhD. I wonder, to those MD/PhD's who have discouraged others from following their footsteps, what would you say in my case, as someone who is genuinely interested? Did you have similar, seemingly genuine reasons when you opted for the dual degree, that turned sour somewhere in the midst of the program?

If you do the math, you lose more money in the long run doing the MD/PhD...not only do you lose money in those 4 years you get behind, but in the long run when you're doing research and all of your peers are in private practice, you're losing the big bucks. So, any MSTP that goes in thinking that they just want to get out of med school with little to no debt, clearly isn't thinking too straight. My impression from my time on this board is that no one is just in it for the "free ride" through med school.

 

[BDavis]

I wonder, to those MD/PhD's who have discouraged others from following their footsteps, what would you say in my case, as someone who is genuinely interested? Did you have similar, seemingly genuine reasons when you opted for the dual degree, that turned sour somewhere in the midst of the program?

First I think you are right in not factoring in the lack of debt as a motivating point. For some programs, you may need to ask yourself the question, "I am comfortable with spending up to 10-11 years for a MD/PhD?". If you come in with the attitude that you will get out in 7 years, then you might be in for a nasty surprise (although I believe the average really is 7 years at some programs). Many of the MSTP students have had substantial research experience so most have some taste of the successes and pitfalls that research will bring.

From my own perspective, I felt some of the administrators were really advertising the 7 year average and I believed it. Take for example my specific MSTP class: We started out with 12 students, 6 quit, and the remaining six are all still in graduate school. I will finish the whole program in 8 years; however my other 5 classmates are looking at 9+ years total. Maybe this an isolated example, let's examine the class above me: I know of 3 that got out in 7 years, 2 will get out in 9, and 2 will get out in 10+. Now here is what our website says "The MSTP at Baylor College of Medicine requires a minimum of six years to fulfill the requirements for completion. Typically, you can finish MSTP training in seven or eight years." The word "typically" seems a little misleading to me. Maybe 1 or 2 years is not that much time to some, but when you are trying to coordinate your graduation with a spouse it can be pretty tricky.

My other point of contention is the lack of continuity between the graduate school and medical school (I had to fill out a piece of paper to transfer medical school classes to graduate school and vice versa even though I go to the same school). Since we are stuck between both worlds, neither side likes to make major concessions to reduce our graduating requirements. Thus we truly get a full PhD and an abbreviated MD (I think they are adding medicine/surgery sub-I requirements, but that doesn't bother me because I would do sub-I's anyways). I do admit however, the medical school is pretty accomodating when it comes to relaxing elective courses.

More frustrating to other students is that the medical school is upping its fees and these fees are not covered by the MD/PhD program; our salary is 23K, but these fees run between $1800 and $2800 a year (+ a 1 time fee of $1000 for a practice Step II clinical skills exam). I think some students feel that this should be lumped into tuition so that the MD/PhD program should pay for it (otherwise decrease the stipend by these fees so that you are paying with pre-tax money). The fees don't bother me so much because I am almost done and they could charge me $23,000 and I will pay it just to graduate, but for those students below me, I have sympathy for them.

I try not to discourage people from pursuing MD/PhD programs, but I encourage people to truly scrutinize the program that they want to go to. I don't think there is anything intrinsically wrong with the MD/PhD concept, but each program has a certain philosophy about how to train MD/PhD students. Some are MD/PhD programs and others are PhD/MD programs. Even once you decide to go MD/PhD, you have to pick a program that is compatible with your own philosophy of training. Make sure you get multiple perspectives and make sure you talk to students at different phases of their training.

P.S. US News and World Report doesn't list average graduation times or all the little things that piss you off.

P.S.S. White coats turn yellow after 7 years of being stuck in a closet.

 

[b&ierstiefel]

P.S.S. White coats turn yellow after 7 years of being stuck in a closet.

They also get tighter after 7 years too. I used my roommate's med school white coat by the time I re-entered med school (he's about a few inches taller than me).

 

[BDavis]

They also get tighter after 7 years too. I used my roommate's med school white coat by the time I re-entered med school (he's about a few inches taller than me).

Our VA hospital got real computers (not those workstations where the screen is a monochrome green or orange) while I was tucked away in graduate school. I am also glad I didn't memorize all the drugs because 10% of them have been taken off the market (Vioxx, troglitazone, cervastatin-Baycol, cisapride). The other day I asked about troglitazone and how the mechanism was supposed to be the end all to diabetic meds and the attending burst out laughing (I didn't think it was funny at all).

 

[b&ierstiefel]

Our VA hospital got real computers (not those workstations where the screen is a monochrome green or orange) while I was tucked away in graduate school. I am also glad I didn't memorize all the drugs because 10% of them have been taken off the market (Vioxx, troglitazone, cervastatin-Baycol, cisapride). The other day I asked about troglitazone and how the mechanism was supposed to be the end all to diabetic meds and the attending burst out laughing (I didn't think it was funny at all).

oh and i remember learning that vancomycin was the big wonder antibiotic when all other antibiotics fail. the lecturers would say, "use vancomycin as a last resort, we must not use this frivolously." then 4 years later, i hit the wards and half the patients on the floor are on IV vanco.

scenarios like this make me think that it may be a decent idea to do the PhD between the 1st and 2nd years of med school.

 

[beary]

They also get tighter after 7 years too.

I have gotten so fat in grad school that I am sure my white coat will not even remotely fit on me anymore.

 

[Gut Shot]

I try not to discourage people from pursuing MD/PhD programs, but I encourage people to truly scrutinize the program that they want to go to.

I agree. Since no one has a crystal ball, it is impossible to say who will thrive in combined programs and who will have all hope and goodness crushed out of them. If someone is going to take the plunge, I would advise that person to have considered their exit strategy from the PhD segment, should it ever become necessary.

 

[mdphd1]

While research training in some particular Ph.D. program may be unusually valuable - the plain truth of the matter is that most Ph.D. programs require far too much coursework that is required in order to support faculty who aren't making the grade in bringing in research dollars.

Given your preparation in a broad range of classes as students in an MD program - there is little need for additional coursework - instead what is really needed is time in the lab - which you can best secure via work as postdoctoral research fellow - supported by an NIH Kxx series training or fellowship grant.

You will gain mopre practical experience specifically targeted to your own specific interests as a postdoctoral fellow - instead of as a PhD student.

It is far more efficient to earn an MD then work as a postdoc for research.

 

[Hard24Get]

Hmmm, when I was in grad school in the late 90's, the only folks making 60-70K/year were the PhD assistant profs. Unless they went administrative, they topped out at full professor around 120K. That 120K was also about the entry salary for the MD assistant profs. Those were base salaries, by the way.

The key is whether these new MD assitant profs had KO8 grants. Generally, it is difficult to grab one of these grants straight out of residency, so people end up doing an extended fellowship with 2-3 yrs tacked on while generating the preliminary data to win a new faculty grant. During this time, they are often granted the title of assistant professor or instructor for the purposes of demonstrating institutional support, and also are attendings at the hospital, but are paid according to their PGY level, which puts them at 60K. Two such persons were members of my lab, and both eventually got frustrated and left for private practice feeling ery disillusioned. They agreed that they would have been spared this had they gone MD-PhD, and it is part because of them that I know I made the right decision. Like tr, I shudder!

 

[durfen]

i have the same dilemma as the OP: i am currently an MD applicant but I am being lured into pursuing an MD/PhD. many people have brought up trivial reasons for pursuing md/phd, namely that of debt reduction.

personally, my own interest in MD/PhD is because I am genuinely interested in advancing knowledge and technology within the realm of medicine. I think that science and medicine go hand in hand, and I would like to have access to both tools in my career as I quest to improve health care for everyone.

i think my reasons are genuine for pursuing an MD/PhD. I wonder, to those MD/PhD's who have discouraged others from following their footsteps, what would you say in my case, as someone who is genuinely interested? Did you have similar, seemingly genuine reasons when you opted for the dual degree, that turned sour somewhere in the midst of the program?

Starting MD/PhD with a genuine interest may lead you to question that interest in the future. Debt reduction is actually a reason that will never be questioned, whereas idealism always leads to disillusionment. The idea is to keep both reasons, and if one is questioned, fall on the other. Mid-PhD you will think....Tera-Star Inc. has already done what I'm doing! NO, their patent is different...I'm useless....then you think 'debt-reduction' and you keep going.

Anyway, this is a cynical view, not one I hold strongly.