PhD then MD

[starscollidehi]

I was accepted to an MD/PhD program, and also to my top choice PhD program (different school), and am considering (due to quality of life and quality of study) to go the PhD route first.

I'd like to know what you guys think some of the drawbacks and benefits would be of doing a PhD and then MD rather than the 2-4-2 setup that many MD/PhDs have.

Thanks!

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[ShinySephiroth]

You already got accepted to what you're intending. Unless you're not going to have your MD tuition waived, financially and time wise MD/PhD is the best case scenario. Congrats.

 

[Lucca]

PhD to MD is a bad deal compared to MD/PhD from the get go if ur initial intent is to get both degrees. Debt, time to degree, integration of training, educational community, network, etc. Congrats on the acceptance!

 

[StIGMA]

PhD to MD would have a huge gap between PhD and research fellowship (most likely 6-9 years, meaning when you transition back your “shiny top PhD” is stale/rusted) and would also essentially guarantee you a 9-10 year PhD-MD phase as its uncommon the finish a PhD earlier than 5 years. It’s also “less prestigious” and could be less competitive during K phase if all other things equal.

 

[SurfingDoctor]

Just don't.

 

[GrosslyUnremarkable]

n=1 but my first PI did that, PhD then MD. He turned out just fine, highly successful in both cancer bio and hem-onc. That said, consider carefully how many years each option would take you, and how much money would be going in or out for how long.

 

[starscollidehi]

Just don't.

why? is money all that matters, passion/meaning doesn't count when doing PhD?

 

[SurfingDoctor]

why? is money all that matters, passion/meaning doesn't count when doing PhD?

No, but if your goal is to have an MD, then you should take the most straightforward path that gets there. Additional, it is no drop in the bucket to have no student loans on graduating as opposed to going PhD first, then going through traditional MD programs only to incur the cost, but end up at the same spot. It's also incredibly hard to predict how useful the techniques you learned during your PhD will be relevant after you've completed the MD and residency +/- fellowship. I have seen a good number of MD/PhDs (not PhD-->MD, as that is quite rare), completely change focus of their research after all is said and done (or they just got out completely).

If you're goal is only to get a PhD and study things relevant to that, then do it. If your goal is however to be a physician scientist, I wouldn't recommended taking the road less travelled.

 

[starscollidehi]

No, but if your goal is to have an MD, then you should take the most straightforward path that gets there. Additional, it is no drop in the bucket to have no student loans on graduating as opposed to going PhD first, then going through traditional MD programs only to incur the cost, but end up at the same spot. It's also incredibly hard to predict how useful the techniques you learned during your PhD will be relevant after you've completed the MD and residency +/- fellowship. I have seen a good number of MD/PhDs (not PhD-->MD, as that is quite rare), completely change focus of their research after all is said and done (or they just got out completely).

If you're goal is only to get a PhD and study things relevant to that, then do it. If your goal is however to be a physician scientist, I wouldn't recommended taking the road less travelled.

I see what you mean, but what if the difference is in doing a biomedical (neuroscience) vs behavioral (psychology) PhD? And I have ethical problems with the current methods in neuroscience? It's a lot of money at stake, but are you really in the same place after? Especially if you did PhD->MD at a better institute, PhD more in line with your interests (leaning towards vet/behavioral). Doesn't it mean you'll have to do postdoc after the MD/PhD program anyway? And does having loans really inhibit one's ability to spend more time doing research later on vs clinical when you can pay them off anyway?

 

[SurfingDoctor]

I see what you mean, but what if the difference is in doing a biomedical (neuroscience) vs behavioral (psychology) PhD? And I have ethical problems with the current methods in neuroscience? It's a lot of money at stake, but are you really in the same place after? Especially if you did PhD->MD at a better institute, PhD more in line with your interests (leaning towards vet/behavioral). Doesn't it mean you'll have to do postdoc after the MD/PhD program anyway? And does having loans really inhibit one's ability to spend more time doing research later on vs clinical when you can pay them off anyway?

I can't answer your first question. And the ethics of methods? I don't know what that means, but it sounds like an uphill battle. And, yes whether you get an PhD, then MD separately, or together, at the end of post-graduate training (residency +/-) you are still a MD/PhD who is subjected to the whims of job availability and funding, both of which are well beyond your control. And no, almost no MD/PhD do a post-doc. I mean, I bet there are anecdotes, but they would be the exception and not the rule.

What isn't beyond your control is whether you approach that uncertain next phase with $200K in student loans or not. Does that debt impact your research first hand? Probably not, but it may impact your ability to practice and provide a certain lifestyle for your family (if that matters to you) as well as all future earnings. The money you save early is vastly worth more than the money you save at the end. And of course, this is all beyond the fact that your particular topic of interest, 10+ years after all is said and done, may be a thing of the past.

 

[tr]

I see what you mean, but what if the difference is in doing a biomedical (neuroscience) vs behavioral (psychology) PhD? And I have ethical problems with the current methods in neuroscience? It's a lot of money at stake, but are you really in the same place after? Especially if you did PhD->MD at a better institute, PhD more in line with your interests (leaning towards vet/behavioral). Doesn't it mean you'll have to do postdoc after the MD/PhD program anyway? And does having loans really inhibit one's ability to spend more time doing research later on vs clinical when you can pay them off anyway?

Postdoc: Yes you will have to do postgraduate research training after finishing residency pretty much regardless. They call them 'research fellowships' when you're an MD and they pay slightly better than PhD postdoctoral positions. It's still pretty much a postdoc. You can do it after 7+(3-5) years of MSTP+residency or after 6+4+(3-5) years of PhD, then MD, then residency.

Loans: Yes there is a very significant salary differential between research jobs and clinical jobs, and new docs who are carrying lots of debt can therefore find it difficult to take a research position vs clinical.

Admission: Another thing to consider is whether you will even be admitted to an MD program after your PhD. The MD applications ask whether you have ever previously applied to medical school, and if so whether you were accepted. Having turned down an MSTP for a PhD and then applying 6 y later for MD again is going to raise a lot of eyebrows on the admissions committee.

 

[starscollidehi]

I can't answer your first question. And the ethics of methods? I don't know what that means, but it sounds like an uphill battle. And, yes whether you get an PhD, then MD separately, or together, at the end of post-graduate training (residency +/-) you are still a MD/PhD who is subjected to the whims of job availability and funding, both of which are well beyond your control. And no, almost no MD/PhD do a post-doc. I mean, I bet there are anecdotes, but they would be the exception and not the rule.

What isn't beyond your control is whether you approach that uncertain next phase with $200K in student loans or not. Does that debt impact your research first hand? Probably not, but it may impact your ability to practice and provide a certain lifestyle for your family (if that matters to you) as well as all future earnings. The money you save early is vastly worth more than the money you save at the end. And of course, this is all beyond the fact that your particular topic of interest, 10+ years after all is said and done, may be a thing of the past.

The thing is what I really want to do is a DVM/PhD, but I didn't get into any. By doing the PhD first, I have a chance to reapply to a DVM/PhD and see if I get in. If not, then I could try applying for med school (I will not pay full price for vet school). I already have a master's, so I don't anticipate my PhD taking longer than 4 (at most 5) years, so the timeline is only extended by max 1 year, if at all.

I am passionate about evolutionary psychiatry, animal behavior, and psychobiology research, which is not necessarily the closest relative to human medicine. So pursuing a biomedical PhD in neuroscience, related only to human health (and using invasive animal models), is quite a stretch for me, hence the difficulty. It's really difficult to turn down the MD/PhD scholarship, however, as if I don't get into the DVM/PhD the second time around, I'll have to pay in full for med school (granted I get in again!)

In terms of hiring, I would like to do animal behavior focused research and practice psychiatry (stretch, but not so much) unless I can do veterinary. So is doing a PhD at a med school that's more far removed from my research interests (they are quite stable, it's not just a topic of interest) going to harm my chances at focusing on the research direction I want in the future? That's the difficulty. If not, then I'd just go with MD/PhD, and toss my slim chances at the successful DVM/PhD application.

Thank you for all the replies by the way! I am just using this as a place to express my ideas and get some unsolicited opinions. By no means will I base my decision on what others say, however, but I do appreciate the insight.

 

[SurfingDoctor]

The thing is what I really want to do is a DVM/PhD, but I didn't get into any. By doing the PhD first, I have a chance to reapply to a DVM/PhD and see if I get in. If not, then I could try applying for med school (I will not pay full price for vet school). I already have a master's, so I don't anticipate my PhD taking longer than 4 (at most 5) years, so the timeline is only extended by max 1 year, if at all.

I am passionate about evolutionary psychiatry, animal behavior, and psychobiology research, which is not necessarily the closest relative to human medicine. So pursuing a biomedical PhD in neuroscience, related only to human health (and using invasive animal models), is quite a stretch for me, hence the difficulty. It's really difficult to turn down the MD/PhD scholarship, however, as if I don't get into the DVM/PhD the second time around, I'll have to pay in full for med school (granted I get in again!)

In terms of hiring, I would like to do animal behavior focused research and practice psychiatry (stretch, but not so much) unless I can do veterinary. So is doing a PhD at a med school that's more far removed from my research interests (they are quite stable, it's not just a topic of interest) going to harm my chances at focusing on the research direction I want in the future? That's the difficulty. If not, then I'd just go with MD/PhD, and toss my slim chances at the successful DVM/PhD application.

Thank you for all the replies by the way! I am just using this as a place to express my ideas and get some unsolicited opinions. By no means will I base my decision on what others say, however, but I do appreciate the insight.

Well, if you’re really passionate about DVM/PhD, then I wouldn’t pursue MD as a backup. I mean, who can say, but the chance of your becoming dissatisfied with a degree that isn’t something you really want to do is very high.

 

[starscollidehi]

Well, if you’re really passionate about DVM/PhD, then I wouldn’t pursue MD as a backup. I mean, who can say, but the chance of your becoming dissatisfied with a degree that isn’t something you really want to do is very high.

Very true, but I love the clinical environment as much as research. And if I can't afford to get a degree in vetmed unless it's funded, human medicine is nice as well (just one species though). It just doesn't quite make sense, to do animal behavior research, and clinical psychiatry does it? I suppose it's doable, but a stretch. And the med school loans can make it hard to do my research! (shouldn't have applied to the particular MD/PhD program I did back then, but I thought they'd allow me to do research at vet school...far from true)

 

[SurfingDoctor]

Very true, but I love the clinical environment as much as research. And if I can't afford to get a degree in vetmed unless it's funded, human medicine is nice as well (just one species though). It just doesn't quite make sense, to do animal behavior research, and clinical psychiatry does it? I suppose it's doable, but a stretch. And the med school loans can make it hard to do my research! (shouldn't have applied to the particular MD/PhD program I did back then, but I thought they'd allow me to do research at vet school...far from true)

I mean, people do animal behavior and try to extrapolate it to humans… eg. Fear conditioning. But if your goal is to learn why animals behave a way with no interest in extrapolating to the humans you treat… seems a bit misguided and kinda a waste of your time. But that’s just my opinion.

 

[tr]

Very true, but I love the clinical environment as much as research. And if I can't afford to get a degree in vetmed unless it's funded, human medicine is nice as well (just one species though). It just doesn't quite make sense, to do animal behavior research, and clinical psychiatry does it? I suppose it's doable, but a stretch. And the med school loans can make it hard to do my research! (shouldn't have applied to the particular MD/PhD program I did back then, but I thought they'd allow me to do research at vet school...far from true)

It's really common for MD/PhDs in psychiatry to study animal behavior. However they are overwhelmingly interested in the animals as a model for human behavior, and the research almost invariably involves less than ideal treatment of the animal models in question. Best case scenario is cognitively and socially deprived cage housing and a rapid demise. Worst case is repeated/extended painful procedures, sensory/motor impairments, models of fear/pain/abuse, etc. This seems like it might be a sticking point for the OP. It's really hard to avoid nasty treatment of animals in neuroscience research. This is a major reason why I decided to study people instead.

 

[starscollidehi]

It's really common for MD/PhDs in psychiatry to study animal behavior. However they are overwhelmingly interested in the animals as a model for human behavior, and the research almost invariably involves less than ideal treatment of the animal models in question. Best case scenario is cognitively and socially deprived cage housing and a rapid demise. Worst case is repeated/extended painful procedures, sensory/motor impairments, models of fear/pain/abuse, etc. This seems like it might be a sticking point for the OP. It's really hard to avoid nasty treatment of animals in neuroscience research. This is a major reason why I decided to study people instead.

Yes, this is exactly right. I would study animal behavior as a psychiatrist, but in the context of using spontaneous disease models, and with translational benefits not only for humans, but also animals. I would focus on farm animals, for example, which are a nice translational model in many ways but the research can also work for animal welfare purposes. I have ethical reservations with straight neuroscience research...

The thing is, if I "sacrifice" my morals for a 4 year PhD, I can save over 200k and can still do the research I want after. The question biting me is whether it's worth it. A degree from one of the best vet schools, doing animal behavior, may help get me further with my research, even if I have loans....very tough. But thanks for all the insight everyone!

 

[SurfingDoctor]

Yes, this is exactly right. I would study animal behavior as a psychiatrist, but in the context of using spontaneous disease models, and with translational benefits not only for humans, but also animals. I would focus on farm animals, for example, which are a nice translational model in many ways but the research can also work for animal welfare purposes. I have ethical reservations with straight neuroscience research...

The thing is, if I "sacrifice" my morals for a 4 year PhD, I can save over 200k and can still do the research I want after. The question biting me is whether it's worth it. A degree from one of the best vet schools, doing animal behavior, may help get me further with my research, even if I have loans....very tough. But thanks for all the insight everyone!

Just as a caveat... that can be very expensive and would probably be impractical to manage from a physician-scientist standpoint. I mean, certainly large academic centers have sheep and pigs, but they are, generally speaking, caged and used for strict physiology models. I would assume that for behavioral research on large animals, you would need a lot of space, which probably isn't realistic. I mean, do you know any medical school that has this setup where it would be close to where you see patients in practice?

 

[starscollidehi]

Just as a caveat... that can be very expensive and would probably be impractical to manage from a physician-scientist standpoint. I mean, certainly large academic centers have sheep and pigs, but they are, generally speaking, caged and used for strict physiology models. I would assume that for behavioral research on large animals, you would need a lot of space, which probably isn't realistic. I mean, do you know any medical school that has this setup where it would be close to where you see patients in practice?

Usually medical schools that have an affiliated veterinary school have those resources, where you can sort of manage working at the intersection (or so I hope to develop something like this). The school I was accepted to for PhD has this exact setup in place, which is why it's pretty hard to turn down...

Expensive is for sure. That's the root of all my hesitation and why I'm sort of expressing my thoughts on this thread!

 

[Lucca]

Perhaps one could put it another way:

You can take the md/Phd and at the end of all this training you will at least definitely have an MD that can earn you a living and the possibility of doing the science you want to do (or. As is even more likely, the science you end up being interested in at the end of training); OR you can turn it down and have no guarantee of either doing the science you want to do in the long run outside of your PhD, and more general have less solid job prospects and no guarantee of getting into an MD program, and if you do having to pay for it in full.