Questions to consider for deciding between MD and MD/PhD?

[CCC342]

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Hey everyone, this is my first (re)post on SDN.

I'm a current junior and I'd like to apply for medical school next cycle. After shadowing many different doctors, I'm very set on becoming a surgeon (love transplant and neuro). I've also researched since the beginning of my Freshman year, and I recently started my own project studying neuromuscular disease this summer, which will most likely lead to a 1st person publication this year (in addition to 3 4th or 5th person pubs I have). I won't dive into the details, but I've also been very involved in community service for low-income populations and I'm founding two community service programs this year as a member of our university's pre-med honor society. Finally, I'm also an NCAA XC/Track athlete. I really do love research a lot and I love spending hours and hours in lab performing experiments or thinking up the next phase of my projects.

I was wondering what you all thought about applying to MD programs versus MD/PhD programs. I know they're both rigorous, and I'm really not that concerned about the extra years the PhD tacks on since I figure it's another few years of something I enjoy. I'm also a bit worried about the PhD being too one-track-minded for me, since I don't know if I'll have time to serve the community or run in semi-pro races during this time. I've talked with surgeons with MDs and MD/PhDs and the advice they've given goes both ways, but I know that in the future, my dream is to work in a big, renown research hospital performing surgical duties 3-4 days a week and researching 2 days a week (I don't want to be a PI, just make contributions to translational research projects). What do you guys think suits me, and why. Also, what are some questions I should be asking myself to decide between both paths? Thanks in advance.

If having my application statistics would help, just let me know, but I don't think my grades would be a limiting factor

 

[Mr Avante]

Hey everyone, this is my first (re)post on SDN.

I'm a current junior and I'd like to apply for medical school next cycle. After shadowing many different doctors, I'm very set on becoming a surgeon (love transplant and neuro). I've also researched since the beginning of my Freshman year, and I recently started my own project studying neuromuscular disease this summer, which will most likely lead to a 1st person publication this year (in addition to 3 4th or 5th person pubs I have). I won't dive into the details, but I've also been very involved in community service for low-income populations and I'm founding two community service programs this year as a member of our university's pre-med honor society. Finally, I'm also an NCAA XC/Track athlete. I really do love research a lot and I love spending hours and hours in lab performing experiments or thinking up the next phase of my projects.

I was wondering what you all thought about applying to MD programs versus MD/PhD programs. I know they're both rigorous, and I'm really not that concerned about the extra years the PhD tacks on since I figure it's another few years of something I enjoy. I'm also a bit worried about the PhD being too one-track-minded for me, since I don't know if I'll have time to serve the community or run in semi-pro races during this time. I've talked with surgeons with MDs and MD/PhDs and the advice they've given goes both ways, but I know that in the future, my dream is to work in a big, renown research hospital performing surgical duties 3-4 days a week and researching 2 days a week (I don't want to be a PI, just make contributions to translational research projects). What do you guys think suits me, and why. Also, what are some questions I should be asking myself to decide between both paths? Thanks in advance.

If having my application statistics would help, just let me know, but I don't think my grades would be a limiting factor

Stats?

Very strong post.
I'd like to see what Winged might say

 

[DrEnderW]

my dream is to work in a big, renown research hospital performing surgical duties 3-4 days a week and researching 2 days a week (I don't want to be a PI, just make contributions to translational research projects).

Of course this is just my opinion, but I would not do MD/PhD route if you want to be doing primarily surgical procedures.

Any physician can do translational research on the side without a PhD background, especially after doing academic fellowships which will be a pre-req anyways for a big academic institution. It sounds like you would be more than fine with going the MD route. I would only go dual if you want to be a basic/translational science researcher and run my own lab. Furthermore, if you want to do general surgery or a surgical subspecialty, you're looking at a 5-7 year residency (most likely not 5 for academic) and a couple fellowships (tack on 1-3 years). Adding 17 years of academic training after undergrad doesn't sound appealing to me personally, but if that's what you want, go for it! It seems a lot more reasonable if you go the peds or IM route first, IMO.

I think it comes down to... do you want to primarily be hands on operating with a couple side projects or do you want to be a major player in a lab or a PI and constantly strive for grants and papers? A PhD is by no means a requisite for the latter but the training and pedigree can obviously help.

 

[Ismet]

Hey everyone, this is my first (re)post on SDN.

I'm a current junior and I'd like to apply for medical school next cycle. After shadowing many different doctors, I'm very set on becoming a surgeon (love transplant and neuro). I've also researched since the beginning of my Freshman year, and I recently started my own project studying neuromuscular disease this summer, which will most likely lead to a 1st person publication this year (in addition to 3 4th or 5th person pubs I have). I won't dive into the details, but I've also been very involved in community service for low-income populations and I'm founding two community service programs this year as a member of our university's pre-med honor society. Finally, I'm also an NCAA XC/Track athlete. I really do love research a lot and I love spending hours and hours in lab performing experiments or thinking up the next phase of my projects.

I was wondering what you all thought about applying to MD programs versus MD/PhD programs. I know they're both rigorous, and I'm really not that concerned about the extra years the PhD tacks on since I figure it's another few years of something I enjoy. I'm also a bit worried about the PhD being too one-track-minded for me, since I don't know if I'll have time to serve the community or run in semi-pro races during this time. I've talked with surgeons with MDs and MD/PhDs and the advice they've given goes both ways, but I know that in the future, my dream is to work in a big, renown research hospital performing surgical duties 3-4 days a week and researching 2 days a week (I don't want to be a PI, just make contributions to translational research projects). What do you guys think suits me, and why. Also, what are some questions I should be asking myself to decide between both paths? Thanks in advance.

If having my application statistics would help, just let me know, but I don't think my grades would be a limiting factor

If med students can find the time to volunteer and/or train for and run half/full marathons, so can phd students. I'm not md/phd so I really don't know what the phd portion entails, but I'd imagine that your schedule will be considerably more flexible in the phd years. It will obviously depend on the school and the specific program, so do your research on what the different programs offer. Also, have you considered doing a 5 year program? In addition to our MSTP, my school also has a PSTP program which involves a year of research between 2nd and 3rd year. It sounds like you want to focus more on the clinical side of medicine while still contributing to research, so I think a 5 year program might be something to consider as a happy medium between 4 years of MD and 8+ years of MD/PhD.

 

[Chir0nex]

My biggest concern would be the time commitment. 7 years of med school+7 years of residency (for either neuro or transplant) is a long time to be training, not including a possible fellowship. To me this is too much time, especially because a PhD is not required for doing research anyway. That being said, if you really love research, and are willing to wait a decade and a half for an attending pay check it is reasonable to go for it.

 

[joonage]

I don't really think a PhD is necessary. I work in the dept. of neurosurgery and many of the doctors only have MDs but all of them do significant research. Might be the fact that nsurg is geared towards research/academics so a lot of them have their own projects. There are docs with MD/PhDs as well. I would say though that neurosurg is getting very competitive and a lot of residency applicants have MD/PhDs. However, that will not exclude you from a top school. MD/PhDs just have it easier as they are able to get more pubs (extra years), which is pretty significant in a surgical specialty such as nsurg.

Also, with your goal of mostly practicing and just few days of research (particularly transitional), I don't feel as if a PhD is necessary. Many of the MD/PhDs I know (in nsurg and neurology) spend significant time in their lab 4+ days with minimal clinic/OR (1 or 2 days).

I would say go for MD and push yourself during medical school. Get into research early and get some good pubs. Kill Step 1 and do well in your surgical rotations. Which school you go to won't matter too much, although try to look for schools with academic teaching hospitals that have your specialties of interest. Continue to push yourself in residency (do lots of research/take a research fellowship/pubs/you see the trend?), which should set yourself up for a academic position in the future.

 

[CCC342]

Thanks everyone, I didn't consider a lot of the arguments you have made. I'll definitely look into that PTSP program. I was leaning towards the MD to begin with, and I really think I can accomplish my career goals without a phd. And I hate bringing money into the picture (I really don't like considering the importance of money), but the mstp scholarship money is very enticing. If it helps at all, I've got a 3.88 at a top 15 US university, yet to take the mcat but expecting 34-36 range based on practice tests. I'm originally from India, but am now a us citizen (Massachusetts resident to be specific). Go Pats!

 

[DrEnderW]

And I hate bringing money into the picture (I really don't like considering the importance of money), but the mstp scholarship money is very enticing.

As for the money portion, if you want to be in surgery (and I assume specialize because of the research/niche focus), it can be possible to make that money back in not too long anyways. In other words, you can pay off that med school loan in first few years as an attending and come out a wash at the same point in time because you would have been spending those salary years still as a student not earning money. I'm not at this stage yet, so I'm sure other's could speak about this in more detail. It would be worth running the numbers for your situation.

 

[kyamh]

I battled with this question for upwards of two years, going back and forth.

I think the issue comes down to the following points. If you are critically worried about paying for medical school and have good stats, then go for the MD/PhD.

If, however, you want to see patients and do research, there isn't a real reason to get that PhD (from what I have come to as my own conclusions). These days, an MD can do the same caliber of research that a PhD could. Many researchers (even a full time huge-name PI at Harvard Medical Neuro) does research with an MD only. You can still get grants, you can still make time for the lab (if you cut down on clinical) and you can still make great progress in science. The perk of just doing an MD is that you don't spend an extra few years in school.

If you want to see patients, why put that off by yet another few years? If you want to be sure that you get the same level of training that a PhD would, go to a program that focuses on training clinician scientists (any program with a mandatory research requirement or something even more intensive like the Harvard/MIT HST program) and be sure the dedicate time to research during medical school.

Ultimately, having a PhD no longer affects a career as much as it used to - at least that's what every MD/PhD doing research in Boston has told me...

This is all especially true if you want to be a surgeon. One: you will make plenty of money so paying back loans shouldn't be awful. Two: your training will last a long time so do you really want to spend extra years away?

 

[LuciusVorenus]

I battled with this question for upwards of two years, going back and forth.

I think the issue comes down to the following points. If you are critically worried about paying for medical school and have good stats, then go for the MD/PhD.

I never really understood this part. Taking into account the 200k in loans, 200k in interest (over a 30 year period) and the 240k in stipends given during the eight years, you only come out 600k ahead taking the md/phd path. But seeing as how you lose out on 4 years of your career, you only really need to be making 150k/year during those 4 years to offset all the financial benefits of an mh/phd.

I know it's a crude calculation, and you may actually come out a bit ahead financially, but it seems to me like all the financial benefits of md/phd programs are simply in place to repay you for lost career time, not to incentivize you with money.

Am I missing something?

Also...

Did the forum design change for everyone else too?! I can't tell if it's just my browser and it's driving me INSANE.

 

[Microglia]

I think the issue comes down to the following points. If you are critically worried about paying for medical school and have good stats, then go for the MD/PhD.

This advice couldn't be more wrong. Makes no sense financially due to the opportunity cost.

OP, I highly recommend pursuing an MD/MS, which will allow you to participate in translational bench research without being a PI. There's really no need to do a PhD if you don't want to be a PI and you want most of your time to go to surgery, it would be a huge waste of time IMO.

 

[kyamh]

This advice couldn't be more wrong. Makes no sense financially due to the opportunity cost..

To defend my advice, I want to point out that you aren't considering some possibilities that OP may face. What if OP has a hard time getting loans because of past credit history? What if OP - who clearly loves research - decides to not go through with residency after all?

I have a colleague who started an MD/PhD program only to realize during residency that he didn't want to be a clinician after all and wanted to do research full time. If he had crazy debt by that point, he may not have been able to make that decision - he would have been financially forced to stay through residency and get to the big paycheck to pay off the loans before he could go into a low paying post-doc position.

You never know what can happen. If you are in a position where you know you want research in your life, it's a real concern that you may not go through with being a physician. It happened to my PI (who dropped out of med school to go to grad school two years in) and another PI across the hall (who had a scholarship to go to med school so she didn't blink twice at switching to a PhD...but how many of us are going to be that lucky?)

 

[OCDOCDOCD]

To defend my advice, I want to point out that you aren't considering some possibilities that OP may face. What if OP has a hard time getting loans because of past credit history? What if OP - who clearly loves research - decides to not go through with residency after all?

I have a colleague who started an MD/PhD program only to realize during residency that he didn't want to be a clinician after all and wanted to do research full time. If he had crazy debt by that point, he may not have been able to make that decision - he would have been financially forced to stay through residency and get to the big paycheck to pay off the loans before he could go into a low paying post-doc position.

You never know what can happen. If you are in a position where you know you want research in your life, it's a real concern that you may not go through with being a physician. It happened to my PI (who dropped out of med school to go to grad school two years in) and another PI across the hall (who had a scholarship to go to med school so she didn't blink twice at switching to a PhD...but how many of us are going to be that lucky?)

Being MD/PhD and deciding to go full time research is different than being MD/PhD with the intent to go full time clinical. In fact, the whole reason that MD/PhD programs pay stipends and waive tuition is because everyone knows that academia wouldn't be a feasible career path if you had to pay for the MD. It's the same reason why PhD programs also waive tuition and pay stipends. No one in their right mind would go into research if they had to pay for the degree first.

Being a clinician is different. Your future salary is so high that the loans don't mean much in the long run. Doing an MD/PhD for the free education is stupid because you lose out on 4+ years of physician income. If you go into a specialty like rads, derm, or neurosurgery, you're trading $1.6 million to $3.2 million in lost income for $300k to $600k of waived tuition/loans.

Another thing to consider is that if you're competitive for MSTPs, you're also competitive for MD scholarships, so the financial incentives are further weakened.

So what if you have no/bad credit and can't get a loan? You take time off to improve your credit. Considering credit also affects everything else in your life (insurance premiums, car payments, credit card eligibility which is important if you ever want to book a hotel room or rent a car, ability to rent an apartment/buy a house, and more) it'll be important to get your credit under control before you embark on med school, be it for an MD or MD/PhD. The time off from school will also be a nice respite from academics, and it will increase your chances in admissions (at my last interview one of my interviewers gushed for a few minutes about the fact that I took a couple years off because "it means you've lived an adult life" and even mentioned that "we don't even like to take kids right out of school because they lack maturity and perspective on what it means to be an adult").

All this said, there are financial incentives for the MD/PhD that make sense, but only if your original plan was PhD.

 

[SN12357]

I never really understood this part. Taking into account the 200k in loans, 200k in interest (over a 30 year period) and the 240k in stipends given during the eight years, you only come out 600k ahead taking the md/phd path. But seeing as how you lose out on 4 years of your career, you only really need to be making 150k/year during those 4 years to offset all the financial benefits of an mh/phd.

I know it's a crude calculation, and you may actually come out a bit ahead financially, but it seems to me like all the financial benefits of md/phd programs are simply in place to repay you for lost career time, not to incentivize you with money.

Am I missing something?

Also...

Did the forum design change for everyone else too?! I can't tell if it's just my browser and it's driving me INSANE.

I asked a friend in finance to run the numbers for me when I was considering MD/PhD and his conclusion was that from a financial standpoint the equivalence point for MD/PhD vs MD is roughly around 200k of loans. Which is to say below that, MD/PhD is more likely to be overall worse from a lifelong financial perspective and with more than 200k of loans it starts to be better. This was from the perspective of someone strongly considering internal med, so MD/PhD makes less and less sense for higher paying specialties (speaking strictly of financials).

This obviously varies from person to person depending on what loans you can get and your specialty of choice, but that's the rough outline of things under the current loan system. My takeaway from my convo with him was that finances weren't a driving factor in deciding MD vs. MD/PhD. I ended up deciding to apply only to MD programs.

 

[CarlosDanger]

I considered this question as well, and it came down to a couple of points. I had to eventually ask myself if I wanted to be primarily a bench scientist or primarily a clinician. As a physician doing bench research, your not going to have time to also be a clinician for any significant amount of time. I work at a major academic research center, and all the physicians I work with are in the lab at least 80%. If you want to be a productive scientist, you really can't split time evenly. In the end, you're competing with other scientists who are in the lab full time writing grants and publishing papers full time, and if you want to stay ahead of the funding game, you've gotta be there putting in the time. Its not like every week you can do some stuff on Monday, go to the clinic Tuesday and Wednesday, and then come back to the lab Thursday and pick up where you left off. Just doesn't work like that.

There are some people who get MD/PhD and do more patient focused clinical studies, but from my perspective a PhD is not that helpful for that type of research. What a PhD will really help with is the basic science - learning about new technologies and model systems. If you wanted to see patients and do comparative effectiveness studies you really don't need a PhD, and like the other posters said, its not going to put you ahead financially as tempting as it sounds.

As far as time constraints go, as a PhD student, your time will be much, much more flexible than as a med student or as a resident. Grad students get to basically set their own schedules. They can come in to lab at noon, come in to lab at 8am, leave at 3pm, leave at 10pm, it doesn't really matter as long as they get experiments done. Its actually pretty nice. As a med student or an MD, your time is NOT your own.

Anyways, the MD/PhD is awesome, but just make sure it really aligns with your goals before you commit to it. Good luck!

 

[LuciusVorenus]

I think it comes down to...

Someone's post broke this spam bot.

 

[gumdrops]

Hey everyone, this is my first (re)post on SDN.

I'm a current junior and I'd like to apply for medical school next cycle. After shadowing many different doctors, I'm very set on becoming a surgeon (love transplant and neuro). I've also researched since the beginning of my Freshman year, and I recently started my own project studying neuromuscular disease this summer, which will most likely lead to a 1st person publication this year (in addition to 3 4th or 5th person pubs I have). I won't dive into the details, but I've also been very involved in community service for low-income populations and I'm founding two community service programs this year as a member of our university's pre-med honor society. Finally, I'm also an NCAA XC/Track athlete. I really do love research a lot and I love spending hours and hours in lab performing experiments or thinking up the next phase of my projects.

I was wondering what you all thought about applying to MD programs versus MD/PhD programs. I know they're both rigorous, and I'm really not that concerned about the extra years the PhD tacks on since I figure it's another few years of something I enjoy. I'm also a bit worried about the PhD being too one-track-minded for me, since I don't know if I'll have time to serve the community or run in semi-pro races during this time. I've talked with surgeons with MDs and MD/PhDs and the advice they've given goes both ways, but I know that in the future, my dream is to work in a big, renown research hospital performing surgical duties 3-4 days a week and researching 2 days a week (I don't want to be a PI, just make contributions to translational research projects). What do you guys think suits me, and why. Also, what are some questions I should be asking myself to decide between both paths? Thanks in advance.

If having my application statistics would help, just let me know, but I don't think my grades would be a limiting factor

You sound like someone who would really enjoy and get a lot out of the MD/Ph.D experience. You seem pretty involved outside of classroom and lab. Graduate school would give you the flexibility to pursue those interests-and a breather from the intensity of medical school training. It's much harder work intellectually but it's also nice to be able to set your own hours and not have to dress up every day. Also, you sound as if you truly enjoy solving problems and learning things below the surface level. A Ph.D would satisfy those needs much better than an MD, honestly.

You'll be 30-31 when you apply to residency, which isn't old at all. You'll also have no loans, be much more competitive for virtually every opportunity in medicine and will likely be far less jaded and burned out when you reach residency than the average 27-29 year old entering residency. If it seems appealing now, go for it. Don't think so much about money gained or lost. Happiness is more important.

 

[Gut Shot]

and I'm really not that concerned about the extra years the PhD tacks on since I figure it's another few years of something I enjoy.

Yeah, this right here tells me that you don't have the first idea what you are asking for. You enjoy it because your ass isn't really riding on it, as an undergraduate it's just fun and games. 99.8% of doctoral students find getting a PhD to be a truly awful, soul crushing experience. If you want your primary activity to be practicing medicine then get an MD. It's really that simple.

Even if you do spend 14-18 of your best years pursuing this arbitrary goal (while living on Ramen and dog meat), research funding in the country has already been metaphorically stabbed in the throat and buried in a shallow grave. Good luck!

 

[Mr Avante]

Yeah, this right here tells me that you don't have the first idea what you are asking for. You enjoy it because your ass isn't really riding on it, as an undergraduate it's just fun and games. 99.8% of doctoral students find getting a PhD to be a truly awful, soul crushing experience. If you want your primary activity to be practicing medicine then get an MD. It's really that simple.

Even if you do spend 14-18 of your best years pursuing this arbitrary goal (while living on Ramen and dog meat), research funding in the country has already been metaphorically stabbed in the throat and buried in a shallow grave. Good luck!

Thanks for the words of wisdom, Master.
🙂

 

[CCC342]

You sound like someone who would really enjoy and get a lot out of the MD/Ph.D experience. You seem pretty involved outside of classroom and lab. Graduate school would give you the flexibility to pursue those interests-and a breather from the intensity of medical school training. It's much harder work intellectually but it's also nice to be able to set your own hours and not have to dress up every day. Also, you sound as if you truly enjoy solving problems and learning things below the surface level. A Ph.D would satisfy those needs much better than an MD, honestly.

You'll be 30-31 when you apply to residency, which isn't old at all. You'll also have no loans, be much more competitive for virtually every opportunity in medicine and will likely be far less jaded and burned out when you reach residency than the average 27-29 year old entering residency. If it seems appealing now, go for it. Don't think so much about money gained or lost. Happiness is more important.

Yeah, this right here tells me that you don't have the first idea what you are asking for. You enjoy it because your ass isn't really riding on it, as an undergraduate it's just fun and games. 99.8% of doctoral students find getting a PhD to be a truly awful, soul crushing experience. If you want your primary activity to be practicing medicine then get an MD. It's really that simple.

Even if you do spend 14-18 of your best years pursuing this arbitrary goal (while living on Ramen and dog meat), research funding in the country has already been metaphorically stabbed in the throat and buried in a shallow grave. Good luck!

Interesting to get two such starkly contrasting views. Tough love from Gut Shot, but I certaibly appreciate advice from an attending. And point taken - both paths are essentially equal money-wise (i should've searched that question myself, my bad). Well thanks for the input everyone, I'll certainly try to contribute more to these forums than I have been.

 

[OCDOCDOCD]

Interesting to get two such starkly contrasting views. Tough love from Gut Shot, but I certaibly appreciate advice from an attending. And point taken - both paths are essentially equal money-wise (i should've searched that question myself, my bad). Well thanks for the input everyone, I'll certainly try to contribute more to these forums than I have been.

You haven't gotten two starkly contrasting views. With this thread and the other one you've made that got moved to the MD/PhD forum, the consensus has strongly been that you should not do the MD/PhD. Only one person has suggested you do the MD/PhD, and that person was a pre-med, as opposed to all the pre-MD/PhDs, current MD/PhD students, and MD/PhD graduates telling you not to do it. I'm curious why you still seem to want to do the MD/PhD so badly. Why do you think it would be better for you than the MD?

Before you answer:
- "It will let me do research" is not a good reason
- "I like research" is not a good reason
- "It will make me more competitive for residencies" is not a good reason
- "Free med school" is not a good reason
- "My title will be 'Dr. Dr.' for a double dose of my medicine" is not a good reason
- All of the above put together is still not a good reason

I don't mean to attack you here, rather I'm just trying to get you to seriously think about why you're even considering MD/PhD, and also to evaluate whether or not your reasons are actually good. You said yourself you can accomplish your career goals without the PhD; why, then, would you even consider taking twice as long to finish medical school, watch your best friends move on to their careers while you're still stuck in school, and potentially harm your chances of getting into residency? (yes, the MD/PhD can actually be detrimental to matching in a number of ways) What does the combined degree offer you that you can't get with just one degree or the other?

 

[Ismet]

Interesting to get two such starkly contrasting views.

The first one is from a pre-med. You can pretty much disregard that advice, some of the things he said are even the complete opposite of being true.

 

[LuciusVorenus]

I don't mean to attack you here, rather I'm just trying to get you to seriously think about why you're even considering MD/PhD, and also to evaluate whether or not your reasons are actually good. You said yourself you can accomplish your career goals without the PhD; why, then, would you even consider taking twice as long to finish medical school, watch your best friends move on to their careers while you're still stuck in school, and potentially harm your chances of getting into residency? (yes, the MD/PhD can actually be detrimental to matching in a number of ways) What does the combined degree offer you that you can't get with just one degree or the other?

You know, I wondered about this when considering MSTP. Don't they take their step exam end of second year, then spend another 6 years in their program before actually matching? What effect does a step score that old have on matching? None? For example, I know med schools don't accept MCAT scores older than 3 years, does the same thing apply to step scores?

 

[Gut Shot]

You know, I wondered about this when considering MSTP. Don't they take their step exam end of second year, then spend another 6 years in their program before actually matching? What effect does a step score that old have on matching? None? For example, I know med schools don't accept MCAT scores older than 3 years, does the same thing apply to step scores?

Step scores do not expire. Once you pass you are stuck for life with whatever you get.

 

[Gut Shot]

Before you answer:
- "It will let me do research" is not a good reason
- "I like research" is not a good reason
- "It will make me more competitive for residencies" is not a good reason
- "Free med school" is not a good reason
- "My title will be 'Dr. Dr.' for a double dose of my medicine" is not a good reason
- All of the above put together is still not a good reason

I have been trying to imagine the type of person for whom the MD/PhD route is still a good idea, and it's difficult. Academic physicians were once expected to do research, practice, and teach. Nowadays you can't do research casually as a PI (too competitive), you may have a hard time practicing part time (too difficult to stay on top of your field with research demands), and nobody cares about teaching. You essentially have to decide whether you are going to practice and (maybe) diddle around in research or whether you are going to be a researcher who happens to have an MD. You don't need all those letters after your name to do either.

I'm sure there are prospective MD/PhD students out there who have eaten, breathed, and slept biomedical research since they came out of the womb. Superstars who are able and willing to compete for dwindling NIH dollars, work for industry, hit up foundations, or move to another country where resources are still available. Perhaps for them the thought of a dual doctoral program hasn't yet evolved into a completely terrible idea.

tl;dr If you're on SDN asking about whether to apply MD/PhD the answer is automatically "no."

 

[gumdrops]

The first one is from a pre-med. You can pretty much disregard that advice, some of the things he said are even the complete opposite of being true.

What did I say that wasn't true? I've been in research for years and worked for two MD/Ph.D's, both of whom outlined those reasons? I'd be interested to know what I said that was the "complete opposite of being true," as substantiation would help everyone here.

 

[OCDOCDOCD]

You know, I wondered about this when considering MSTP. Don't they take their step exam end of second year, then spend another 6 years in their program before actually matching? What effect does a step score that old have on matching? None? For example, I know med schools don't accept MCAT scores older than 3 years, does the same thing apply to step scores?

There is a rule about needing to match in something like 6-8 years after getting your STEP 1 score, however from what the MD/PhD forum says that rule is often waived for MD/PhD students when applying to residencies.

The bigger issues with the MD/PhD and residency are:
- You're 4 years removed from your pre-clinical classes when you start your 3rd year of med school, so good luck on clinicals
- Having that PhD pretty much precludes you from qualifying for community residencies. The programs most likely to give you a shot are the academically-oriented ones which, just like med school, tend to also be the top programs.
- That may sound like a good thing until you're trying to shoot for specialty that isn't a traditional field for MD/PhDs. So if, for example, you want to do surgery you shouldn't expect that PhD to do much for you in matching (except narrowing the residencies you can choose from as stated earlier). So if you want to do, say, neurosurgery or radiology, you need to be a top med student on top of all the extra work MD/PhDs are thrown in their programs. It's worth noting that the most popular and traditional MD/PhD specialties are also among the least competitive (eg: psych, peds, path, neuro).

It's a shame this thread isn't in the MD/PhD forum or I'm sure Neuronix would chime in.

 

[LuciusVorenus]

There is a rule about needing to match in something like 6-8 years after getting your STEP 1 score, however from what the MD/PhD forum says that rule is often waived for MD/PhD students when applying to residencies.

The bigger issues with the MD/PhD and residency are:
- You're 4 years removed from your pre-clinical classes when you start your 3rd year of med school, so good luck on clinicals
- Having that PhD pretty much precludes you from qualifying for community residencies. The programs most likely to give you a shot are the academically-oriented ones which, just like med school, tend to also be the top programs.
- That may sound like a good thing until you're trying to shoot for specialty that isn't a traditional field for MD/PhDs. So if, for example, you want to do surgery you shouldn't expect that PhD to do much for you in matching (except narrowing the residencies you can choose from as stated earlier). So if you want to do, say, neurosurgery or radiology, you need to be a top med student on top of all the extra work MD/PhDs are thrown in their programs. It's worth noting that the most popular and traditional MD/PhD specialties are also among the least competitive (eg: psych, peds, path, neuro).

It's a shame this thread isn't in the MD/PhD forum or I'm sure Neuronix would chime in.

I think this part is definitely true, although I never really knew WHY - but I think what you're saying makes sense. From what I've seen it looks like very few MSTP kids match into surgery.

I mean, look at the UCLA-CalTech match list for example: http://mstp.healthsciences.ucla.edu/pages/match-lists

 

[OCDOCDOCD]

I think this part is definitely true, although I never really knew WHY - but I think what you're saying makes sense. From what I've seen it looks like very few MSTP kids match into surgery.

I mean, look at the UCLA-CalTech match list for example: http://mstp.healthsciences.ucla.edu/pages/match-lists

Several reasons come to mind (I'm making a lot of lists today it seems):
- It's harder to be competitive as an MD/PhD, so the less competitive specialties are going to be overrepresented in the MD/PhD pool
- MD/PhDs aren't very concerned with earning potential and lifestyle since no matter what specialty they pick, they're still going to be earning a researcher's salary and living a researcher's life. Go peds or go derm, it doesn't matter, your income is the same.
- MD/PhDs, having taken 4+ years longer to start residency than MD students and more likely to take a gap year or two, are going to be more averse to specialties with long training, and much more attracted to specialties with short training. Put another way: How much more would you like to start your career in your 30s instead of your 40s?
- The popular MD/PhD specialties also tend to lend themselves well to sporadic, occasional practice (eg: as a psychiatrist you can see patients in your lab office if you so wish; I had a PI who did this. Try doing that as a surgeon). This makes them attractive for MD/PhDs who, in an ideal world, practice medicine only 20% of the time.
- Perhaps most importantly, they also offer a lot of basic science and translational research opportunities, as compared to other specialties. Neuro and psych are very closely intertwined with neuroscience, for example, and as a result depend heavily on basic and translational findings. Contrast this to surgery where the vast majority of possible and relevant research is strictly clinical in nature. Not only does this make some specialties more attractive than others for would-be translational researchers, but it also makes some specialties more open or closed to physician-scientists.

 

[LuciusVorenus]

Several reasons come to mind (I'm making a lot of lists today it seems):
- It's harder to be competitive as an MD/PhD, so the less competitive specialties are going to be overrepresented in the MD/PhD pool
- MD/PhDs aren't very concerned with earning potential and lifestyle since no matter what specialty they pick, they're still going to be earning a researcher's salary and living a researcher's life. Go peds or go derm, it doesn't matter, your income is the same.
- MD/PhDs, having taken 4+ years longer to start residency than MD students and more likely to take a gap year or two, are going to be more averse to specialties with long training, and much more attracted to specialties with short training. Put another way: How much more would you like to start your career in your 30s instead of your 40s?
- The popular MD/PhD specialties also tend to lend themselves well to sporadic, occasional practice (eg: as a psychiatrist you can see patients in your lab office if you so wish; I had a PI who did this. Try doing that as a surgeon). This makes them attractive for MD/PhDs who, in an ideal world, practice medicine only 20% of the time.
- Perhaps most importantly, they also offer a lot of basic science and translational research opportunities, as compared to other specialties. Neuro and psych are very closely intertwined with neuroscience, for example, and as a result depend heavily on basic and translational findings. Contrast this to surgery where the vast majority of possible and relevant research is strictly clinical in nature. Not only does this make some specialties more attractive than others for would-be translational researchers, but it also makes some specialties more open or closed to physician-scientists.

I appreciate your lists! They're informative 🙂

 

[Reckoner]

You know, I wondered about this when considering MSTP. Don't they take their step exam end of second year, then spend another 6 years in their program before actually matching? What effect does a step score that old have on matching? None? For example, I know med schools don't accept MCAT scores older than 3 years, does the same thing apply to step scores?

As OCD mentioned, Neuronix has given some really valuable insight:

http://www.neuronix.org/2012/06/effects-of-score-creep-trends-in.html
http://www.neuronix.org/2011/07/nrmp-puts-out-charting-outcomes-in.html

His blog is worth reading for anyone interested in MD/PhD programs.

 

[Jimsy]

This is a very insightful thread 👍

This advice couldn't be more wrong. Makes no sense financially due to the opportunity cost.

OP, I highly recommend pursuing an MD/MS, which will allow you to participate in translational bench research without being a PI. There's really no need to do a PhD if you don't want to be a PI and you want most of your time to go to surgery, it would be a huge waste of time IMO.

How beneficial would having an MS be? Wouldn't just going into a research fellowship following residency be more advantageous?

 

[LuciusVorenus]

This is a very insightful thread 👍



How beneficial would having an MS be? Wouldn't just going into a research fellowship following residency be more advantageous?

I'm guessing in some fields an MS can give you a background a fellowship cannot. For example, an MS in tissue or bioengineering would give you a technical background a fellowship in surgery couldn't give you on its own, but could easily build on.

 

[SN12357]

This is a very insightful thread 👍



How beneficial would having an MS be? Wouldn't just going into a research fellowship following residency be more advantageous?

I have noticed a certain amount of degree arms-racing among the successful researchers I work with. I'm not sure what is cause and what is effect, but most of the MD researchers I know acquire another degree (either MS or MPH) somewhere along the line.

It may be the way a bachelor's degree is the new requirement for entry level jobs, even if degree isn't directly relevant you have to have the diploma anyway. That in the tightening competition for funding, having a second degree is another marker of (supposed) success/competence.

I'm in clinical/epidemiological research, so not as familiar with the basic science side of things.

 

[xijowxw]

I think there are prospective MD/PhD students out there who have eaten, breathed, and slept biomedical research since they came out of the womb. Superstars who are able and willing to compete for dwindling NIH dollars, work for industry, hit up foundations, or move to another country where resources are still available.

 

[tiedyeddog]

I am a third year medical student who applied MSTP, got in, and then went MD-only.

I too am 99% sure I want to go into surgery and the extra years really was what stopped me from going MD/PhD. I love research, I worked in two labs in undergrad for 3.5 years, I have worked in one lab during medical school for 2.5 years now, and still want research to be a significant part of my career eventually.

Seeing tons of previous MD/PhDs go into private practice or purely clinical roles really turned me off from the PhD, too. It's really unfair we have to decide if we are going to get the PhD before we finish residency, once our life goals are more in tune and we really know if research CAN be done while still being a decent clinician. In surgery, this is almost impossible to do.

So, I think a better path for anyone interested in basic/translational research and surgery is to probably try to do a research fellowship after residency. Most people getting funding after residency need to get a fellowship to get data for grants, anway, regardless if they have an MD or MD/PhD. So, I plan on skipping the PhD and just doing a research fellowship after/during residency. At least I will know at that time if research is even feasible at that time as a surgeon. It's really hard to make that choice as a pre-med or even as a medical student.

 

[CCC342]

I am a third year medical student who applied MSTP, got in, and then went MD-only.

I too am 99% sure I want to go into surgery and the extra years really was what stopped me from going MD/PhD. I love research, I worked in two labs in undergrad for 3.5 years, I have worked in one lab during medical school for 2.5 years now, and still want research to be a significant part of my career eventually.

Seeing tons of previous MD/PhDs go into private practice or purely clinical roles really turned me off from the PhD, too. It's really unfair we have to decide if we are going to get the PhD before we finish residency, once our life goals are more in tune and we really know if research CAN be done while still being a decent clinician. In surgery, this is almost impossible to do.

So, I think a better path for anyone interested in basic/translational research and surgery is to probably try to do a research fellowship after residency. Most people getting funding after residency need to get a fellowship to get data for grants, anway, regardless if they have an MD or MD/PhD. So, I plan on skipping the PhD and just doing a research fellowship after/during residency. At least I will know at that time if research is even feasible at that time as a surgeon. It's really hard to make that choice as a pre-med or even as a medical student.

Thanks, this an extremely reasonable answer. I agree, it's a tough decision to make this young in our education and careers. A lot of us want to do research and practice medicine, but at least for me, it's tough to pick how you'll split your time between them before you've even really had a chance to immerse yourself in either (not counting working in the lab during the summer).

 

[Instatewaiter]

The PhD does make you more competitive for competitive surgical subspecialties... everyone thinks they're gonna be top 1/3 of the class but most can't cut it. That PhD may come in handy.

 

[Microglia]

This is a very insightful thread 👍



How beneficial would having an MS be? Wouldn't just going into a research fellowship following residency be more advantageous?

Marginally, but it will open a few doors. I believe, though I'm not positive, that it can help to get the research fellowship residency.