Pursue MD/PhD in same lab after 4 years of undergrad/gap year research?

[sboardclark]

Hi all!

I'm in a pickle and was wondering if my reasons to do MD/PhD is strong enough?

I've been in charge of my personal project since four years ago when I started in my current lab (medically related bench research) as an undergrad. Fast forward four years, I got accepted into the MD program in the same school and will be matriculating this fall. I've always known that I will continue my research project in the same lab when I attend my medical school, but now I'm wondering if it is worth pursuing an MD/PhD.

Even though I personally don't have an inclination to become a PI in the future, I really enjoy doing experiments that my personal project entails (surgeries on animals) and my critical thinking process has developed so much better throughout my time in research that I want to keep developing that aspect of myself.

My PI estimated that I already have results equivalent of a master's thesis. If I continue my research in her lab for MD/PhD, it would take an additional 2-2.5 years to finish the PhD portion of my dual degree.

Pros:
- I think my project is just fun to do. I'm always pretty excited to finally get to see results for the surgeries I do and how to interpret it.
- Get extra years to dedicate myself to research project. I'm really dedicated to my project and I want to see it through all the way
- I'll probably want to teach in the future and do some sort of research, this could help alot with this aspect
- Develop a critical thinking mindset that I might not get as a pure MD
- Additional degree for if I want to be more competitive for a research residency
- Tuition is covered and stipend is always nice financially


Cons:
- Longer time (2-3 years additional)
- Little inclination to become a PI in the future, this PhD degree might not be used to its full potential (Although futures always change)
- Takes time away from studying purely for my MD classes. The MD/PhD curriculum seems like it has a few extra classes to take during the first year.
- I've been interested in surgery. MD/PhD limits my door if I want to pursue a surgical specialty (not sure how true this is, but seems like a common notion?)
- Lower potential earnings in the long run

Please let me know if you think my reasoning for wanting to pursue an MD/PhD is valid or if I'm too ahead of myself?

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[mdphdNYC]

I assume you are talking about applying to the MD-PhD from medical school via your school's internal process, and not dropping out of your current MD acceptance(!) to re-apply to MD-PhD programs, which would be a disastrous decision.

I would advise you to think hard about why you want the PhD. If your final goal is not research faculty (+some clinical work), that's an almost immediate indication that MD-PhD isn't the right path. From what you've said so far, it sounds like you have some misconceptions about the program and unfortunately I don't think the MD-PhD will give you what you're looking for

Pros:
- I think my project is just fun to do. I'm always pretty excited to finally get to see results for the surgeries I do and how to interpret it.
- Get extra years to dedicate myself to research project. I'm really dedicated to my project and I want to see it through all the way
- I'll probably want to teach in the future and do some sort of research, this could help alot with this aspect
- Develop a critical thinking mindset that I might not get as a pure MD

You can do research as a medical student and later as an MD. In fact at my school and at many schools I interviewed at it's become very common for MD-only students to do lab work during the preclinical years, and to take a year or two off to focus on research leading to a publication and possibly an MS degree. I can't speak for your school, but many have a "scholarly project" elective or requirement for MD students that you should look into as an outlet for your research interests. Likewise, many MDs teach.

- Additional degree for if I want to be more competitive for a research residency
- Tuition is covered and stipend is always nice financially

While true, these are not good reasons to do an MD-PhD. It is not worth the additional time and hassle if all you want is to get a bump up in the residency review process, and the tuition/stipend coverage is much less than you would make as an attending over an equivalent period of time. Furthermore, if you're applying internally, that means you will already have paid 2 years of med school tuition before qualifying for support from the program (assuming they guarantee it to internal applicants), so you have if anything the worst of both worlds - medical school debt and more time before you can start paying it off.

Cons:
- Longer time (2-3 years additional)
- Takes time away from studying purely for my MD classes. The MD/PhD curriculum seems like it has a few extra classes to take during the first year.

The extra years may be a consideration, though I'd argue it is worthwhile to take 2-3 years while you're young that will permanently shape the direction of your career over decades and the fulfillment you derive from it. By the time you're 70 (and there are plenty of active physicians and researchers at that age) 2-3 years will feel like no time at all. This may take the form of a research project or Master's and doesn't necessarily need to be a PhD.

The time for studying shouldn't be a consideration. You don't need 24/7 to study for MD classes (especially in a pass-fail system), and I found taking grad school classes and thinking about pure science to be a welcome distraction from thinking about medicine.

- Little inclination to become a PI in the future, this PhD degree might not be used to its full potential (Although futures always change)
- I've been interested in surgery. MD/PhD limits my door if I want to pursue a surgical specialty (not sure how true this is, but seems like a common notion?)
- Lower potential earnings in the long run

These are the big ones. The fact of having an MD-PhD doesn't inherently limit your eventual salary or your chances of matching into surgery. The main reason MD-PhDs are rare in surgery and have lower average salaries is that the people who do an MD-PhD don't do it for the money. It's not harder to match into surgery from an MD-PhD, but most MD-PhDs choose specialties that will allow them to run a lab as PI eventually (to the tune of 70-80% research, 20-30% clinical practice), which is extremely difficult to do as, say, an attending surgeon making $500,000 per year. It's worth at least taking a pause to think about whether this program is the right fit for you given that most of your colleagues probably have a very different set of goals.

Sorry for the TL;DR and I'm happy to answer any more detailed questions by PM.