Hello mushy, hope all is well.
We're all newbies. Don't worry about it.
This is always a difficult question that gets much debate on all levels. Which is the best way to train somebody to be a physician-scientist? Should we invest in them on the front end by giving them a PhD or should we train them on the back end by extensive research training after medical work.
The truth is, there's no good answer. I always give three general reasons why it's good to do a combined program.
1) It's good to get a MD/PhD or DO/PhD because the training you get in both supplement whichever you end up doing. In other words, if you do clinical research or academics, your ability to appreciate and apply research to clinical practice is enhanced. Meanwhile, if you do research, your ability to understand disease to ask the right questions is enhanced.
That part doesn't really apply to you so much, but it's the general answer to the interview question
😉
2) By starting out on a physician-scientist training program (MSTP, MD/PhD, DO/PhD, etc), you get training more appropriate to that pathway in theory, rather than just doing a PhD and a MD alone. Good combined degree programs have this in mind and integrate in various ways the MD and the PhD so you begin thinking early about how they contribute to one another and produce new niches.
3) $$$. We won't delude ourselves and pretend this isn't important. The fellowship pathway will contribute at most $70,000 towards your debt (2 years x $35,000/year) in NIH grant money. That's not welcome news for someone who has greater than $200,000 in medical school debt. MD/PhD programs are usually (though not always!) fully-funded, which means you are paid a stipend throughout the entire program. That being said, I am yet to hear of a fully-funded DO/PhD program. I hear anecdotes where people have been offered a full package or have found their own funding, but no DO/PhD gives full funding to their students (and most don't give ANY medical school funding).
To me this means, you have to be darn sure you want to do the physician-scientist job somewhere down the line if you aren't even getting the money to help you with debt relief. In fact, your debt is going to increase as your loans accrue interest! In essence, (Emphasis here: this is all my opinion!!!) I would only enter a fully funded program for this reason. These not fully-funded programs tend not to be well integrated, so you get a MD and a PhD but without integration there goes reason #2 as well.
That being said, it is rare that fellows enter primarily research positions. The hurdles to doing so are growing. Besides the increasing debt load, the number of MD/PhDs is increasing. Many are beginning to look at it as if "The MD is a clinician only", and it will take some work to overcome that. That being said, you can always pick up the PhD as a fellow if you really want one. For basic science research, whether you want a PhD or not you're looking at on the order of 5 years of training. For clinical research, the training time, hurdles, and competition tends not to be so bad. At least for now. The funding for basic science research is extremely tight and you have alot of competition from PhDs.
There is a practical aspect as well to the fellow v. MD/PhD pathway that the pre-med should consider. Being a pre-med, medical student, and resident all suck. You put in long hours, get lots of abuse, and you are full of uncertainty about your future. You spend all your time doing someone else's bidding, having no idea where are you going to end up for your next stage, but constantly fighting to get there. When you finally become an attending yourself, you get a certain amount of autonomy and pay that whether you've been looking for it or not, is going to feel good when you're 30+ years old and probably have a family. Are you really going to want to go back and spend 5 years in a fellowship getting training on barebones pay only to fight to find a new job that will take more hours and pay you less than the job could have right then? This seduces alot of MD/PhDs out of the research pathway. It's worse for MDs, because their hurdles to getting a research job are even higher.
One thing I haven't really mentioned yet is that these programs are usually geared towards producing basic scientists only. The common argument is that you don't need a PhD to do clinical research. You might find a program that will let you do an epidemiology or social science PhD, but this is rare.
In summary, the problem looking up at this whole process as a pre-med is that you really don't know how your future is going to pan out. Some of us are very committed to a basic science pathway, and that's why we do the MD/PhD. That being said, a great number of us (more than half IMO, but you can't get stats on this) will fall off the path for the reasons I mentioned before. So, I always recommend that if you're not at least at this point in your life committed to doing basic science, just go to med school and figure it out later. The PhD is never a waste, but if your destiny is truly to become a clinician it will keep you from that for another 4 or so years--time that you could be working towards your early retirement.
Hope that's helpful. Feel free to IM me. That goes for any of you. I used to get a lot more random IMs and I enjoy those conversations
Good luck,
Eric
