Top 25 MD vs State School MD/PhD

[cinnaroast]

I'm currently choosing between a top 25 MD program and an MD/PhD program that is out of the top 50. For quite some time I wanted to do the MD/PhD because I love medicine and research, but after a lot of discussion with faculty I've realized it's hard to do both... and since research is more competitive, I would eventually spend most of my time in the lab. If I had to choose between the two, I would choose seeing patients over research.

It also doesn't help that I am not enjoying my gap year as a research assistant. The lab is very high pressure and result-oriented... the PI actually gets angry when your experiments don't work or you don't get amazing results. There is no room for learning and experimentation. I hate coming into lab every day. But I do remember a time when I absolutely could not wait to come into lab and see my results/crunch some data.

So it's very difficult for me to choose. It helps that the MD/PhD program provides free tuition + stipend, but I'm not sure if I can make that commitment to a PhD especially since I'm having doubts about research. I know the PhD provides a solid training, but maybe a research fellowship would be better for my career trajectory (e.g. residency placement).

---

Members don't see this ad.

 

[nordr]

You know what specialty you want to go into? If Yes, do you know you can work in a lab that in related to that specialty? I think would think that if you don't see yourself in the lab in some form for a good portion of your career then it may not be worth it. On the other hand, free tuition is no joke.

 

[ImagineThis]

and since research is more competitive, I would eventually spend most of my time in the lab. If I had to choose between the two, I would choose seeing patients over research... I'm having doubts about research. I know the PhD provides a solid training, but maybe a research fellowship would be better for my career trajectory (e.g. residency placement).

I mean, maybe I perceived this wrong, but it seems to me even in the way that you are writing about this that you want to do the MD only.

Granted, you could always start out MD/PhD and then drop the PhD but
a) It's really not fair to program admins or to other applicants who will be shut out of the program.
b) If you drop the PhD you lose the advantage of the top 25 medical school. While if you are just going to practice medicine, the advantage is debatable, but if you do end up pursuing academic medicine it could make a difference.

Also, you could always to the MD and then get back to research, even apply for the MD/PhD program at that school (is internal application an option?). However, there, you run into some funding issues.

Best of luck with your decision. I'm sure that you cant go wrong.

 

[obscurehero]

If you like research, choosing an MD-only program does NOT close that door for you. Especially the top 25 MD schools will encourage you to try doing research in a summer, or to take a gap-year in your program to do research, or to apply for grants specifically for MD's who want to do research. Granted, that is also a path to doing more research than actual clinical medicine as research really requires the majority of your time...its selfish like that.

If you have doubts about doing research, honestly, then you should just dump the PhD. I don't think money should be a primary reason for your decision, but it's definitely a helpful deciding factor.

As for medical school prestige, I've heard most allopathic schools will give you exactly the same education. I don't really know, but I think it might also matter in matching to a 'better' residency program.

Based on your doubt, and if money isn't an issue, go to the top-25 MD program and keep an open mind toward research.

 

[eighty-twenty]

If you truly enjoy the intellectual aspect of coming up with hypotheses and designing experiments, I would do the MD/PhD, provided that the institution you're considering has the labs that you would considering working in. Doing the PhD is hard work, but it's also fun. Remember that when you're in an MSTP, you get to choose your PI/lab, so you can screen any potential personality issues you have with a future boss. Don't let your experience with one PI discourage you.

The key is if you think you have the innate curiosity to ask questions and willingness to persevere through failures and multiple repeated experiments. Handling failure on a daily basis with only a nebulous carrot (in the form of publication) hanging in the distant future is not for everyone.

It's true that you can just go straight MD and then do a fellowship after residency. (In-depth research during medical school and residency is difficult but not impossible--just a matter how much contiguous research time you're allowed.) Many successful researchers have gone the MD/fellowship route, but most I have met did a dedicated research-oriented fellowship or extended their clinical fellowship to shore up their training/publications. In essence, they still put in their time elsewhere. Many fellowships now have in-fellowship MS/MPH/PhD options, but these are geared more toward clinical/translation research rather than basic science. Of note, however, if you did a PhD and then also did your fellowship (such as my case), you could hit the ground running when it comes time to figure out your projects since you had all of that experience provided that you stay relatively close to the field in which you did your PhD thesis.

From my experience (I went through MSTP/residency and am now a clinical fellow), grad school was the only time that you had completely free to read what you want, come up with ideas and run those experiments without having other academic/clinical obligations that you will have as a clinical fellow. It was great to have fun while learning through your mistakes. Having the PhD (even without significant publications) also would make you a very attractive candidate for academic residency programs provided you have above average grades/test scores (vs superb scores for a MD applicant). It might be able to let you jump tiers in terms of prestige if the MSTP you're considering is not as well-known.

Not having loans after MSTP is also nice but shouldn't be the main reason. Of course, there would be no pressure to choose a residency/career path that will reimburse well because you do not have $200K hanging over you. But even if you did the MD route and graduated with $200K in loans, there is a competitive NIH-funded repayment program that will repay your school loans provided you commit to x number of research years at certain institutions (http://www.lrp.nih.gov/).

I figured it would be helpful to hear your options from someone who had to make similar decisions a decade ago. Good luck!

 

[gbwillner]

... I would eventually spend most of my time in the lab. If I had to choose between the two, I would choose seeing patients over research.

It also doesn't help that I am not enjoying my gap year as a research assistant. The lab is very high pressure and result-oriented... the PI actually gets angry when your experiments don't work or you don't get amazing results. There is no room for learning and experimentation. I hate coming into lab every day. But I do remember a time when I absolutely could not wait to come into lab and see my results/crunch some data.

Dude, those are your own words. Doing an MD/PhD is a waste of your (and everyone else's) time. It's true that a bad lab experience may hide your interest in a research career, but that is what you will be trained to do. If you don't love research, you WILL drop out- it's only a matter of time.

 

[cinnaroast]

Thank you for the helpful responses. If I had to be honest with myself, I don't think I could make the commitment to a PhD at this stage in my career; perhaps I would pursue research during a fellowship after med school. But I'm still torn because I feel that the MD/PhD program is such an exciting opportunity that not many people get to do, so I'm trying to find ways to justify going this route. Fortunately money is not a big factor so I can make a decision based on fit.

Ultimately I want to go into academic medicine, and I feel that graduate program training combined with an MD would be great preparation for this. Also, the program that accepted me is strong in the research I would like to do. However, I don't want to commit to MD/PhD if I am not 100% confident I want to do it. Ahh tough decisions!

 

[gbwillner]

However, I don't want to commit to MD/PhD if I am not 100% confident I want to do it. Ahh tough decisions!

This is wise. It may seem like you are giving up an opportunity now, but in 4 years you will be thinking you just shed 4-5 years' worth of dead weight. Trust me.

 

[obscurehero]

Don't pick a training program simply based on exclusivity, by declining it you're doing two things: One, you're giving someone else who wants to do research the opportunity to do an MD/PhD; and, Two, you're able to say that you could have done it had you wanted to.

As for research, you don't have to be 100% confident to choose it. I've met more than few MD/PhD students who were forced to by their parents (weird), chose it because of the money, or decided they didn't like research and still made it through. I don't think it's likely you'll drop out, because you did make it into a program. Chances are that you convinced the adcom you're capable of being a scientist, which means you probably are. Also, remember you will be almost a regular med student for two years...the bad taste of your current boss may have worn off by then.

 

[gbwillner]

I don't think it's likely you'll drop out, because you did make it into a program. Chances are that you convinced the adcom you're capable of being a scientist, which means you probably are. Also, remember you will be almost a regular med student for two years...the bad taste of your current boss may have worn off by then.

...except experience tells me this is wrong. If you don't like research, grad school is torture. The OP's experience on research is "I hate going to lab every day." MAYBE in another lab things would be better. MAYBE. maybe not. His N of 1 isn't looking to good for his outlook on lab life. Maybe the OP would "survive" grad school. What for? What is the purpose of doing an MD/PhD if you don't want to do research and can only "survive it"? The answer: none.
I have a lot of friends who when into the PhD without being sure. Those that loved research continue to do it. Those who "survived it" abandoned it after graduation. Those that didn't much care for it all dropped out and wasted time. You don't get those years of life back. And don't even bring money into it- there is absolutely NO advantage (see 1000 other threads devoted to that topic).

 

[obscurehero]

...except experience tells me this is wrong. If you don't like research, grad school is torture. The OP's experience on research is "I hate going to lab every day." MAYBE in another lab things would be better. MAYBE. maybe not. His N of 1 isn't looking to good for his outlook on lab life. Maybe the OP would "survive" grad school. What for? What is the purpose of doing an MD/PhD if you don't want to do research and can only "survive it"? The answer: none.
I have a lot of friends who when into the PhD without being sure. Those that loved research continue to do it. Those who "survived it" abandoned it after graduation. Those that didn't much care for it all dropped out and wasted time. You don't get those years of life back. And don't even bring money into it- there is absolutely NO advantage (see 1000 other threads devoted to that topic).

I don't think the OP should do an MD/PhD from what I've read.

I'm simply stating that it's not ALL negative, and there is a chance that the OP finds a nice adviser that really helps him/her rediscover his/her passion for research.

Although, I would tend to agree with you.

 

[echod]

But I do remember a time when I absolutely could not wait to come into lab and see my results/crunch some data.

Similar to you, I've had both benign and malignant PIs. The good PI was the reason that I'm doing an MD/PhD now, and the malignant PI is what's making my days now as a grad student hard. Things were really hard when I first started in this lab, but it has gotten to be more tolerable. For me, the difference between the bad PI and good PI was how much support and whether expectations were reasonable. I haven't been a very successful grad student, and I think I would probably have done better if my PI had at least talked to me for 15 minutes a week instead of 15 minutes every 6 months. Even though I'm not doing that well in research as a grad student, I don't see myself quitting the MD/PhD program. I still haven't given up the idea of being a physician scientist, but if I continue to perform as bad as I am now, I probably would never get funding.

It's extremely hard to know whether you would be a successful scientist without really trying. I've heard of Nobel Lauretes say that they wouldn't be a scientist again if they could live life over. If you are okay with spending the extra years, why not try it? But if you want to have $ as early as possible, MD/PhD is not a good idea.

 

[achamess]

I might be misreading the OPs post, but it sounds like he dislikes his current research situation rather than disliking research in general. Working for tyrants or hard-asses isn't for everybody. Perhaps the OP's issue is more that he needs to work for someone with whom his interests and personality meshes better? Don't we talk all the time on this forum about picking a good mentor? I'd dare say many people here who are completely committed to MD-PhD might lament their situation if they worked for PI who blasted them for not getting the 'right' results. OP, is this the case for you, or do you just not like doing science at all anymore? Have you ever had a research experience that was pleasant and excited if you?

 

[random cell]

Hello OP, I think you should take a look at your situation and carefully distinguish the source of dissatisfaction. Is it coming from your lab environment and people/PI, or is it a general feeling of loath toward the hardships inherent to research?

If it is the former, then you should stick with research because once upon a time in a friendlier lab environment you probably actually enjoyed research. But if it is the latter, then perhaps you should seriously reconsider the MD/PhD route. Good luck with whatever you decide.

 

[cinnaroast]

I took a gap year after undergrad to work in a lab as a research assistant. The main reason I did this is because I found that I truly enjoyed research as an undergrad, and I wasn't ready to choose between an MD and PhD. Then I learned that there was such thing as an MD/PhD, so I figured a gap year would be great for me to focus on research as well as apply to MD and MD/PhD programs.

I decided to stay in the same lab I had worked in for 3 years of my undergraduate career. There were reasons not to do this: 1) My peers were telling me that I needed to broaden my experience and work in another lab/field, and 2) I felt somewhat betrayed because the lab published a paper on the project that I had worked on for those 3 years, but since "none of my figures made the paper," my name was left off. Ultimately I decided to stay because I wanted to contribute to a lab that had introduced me to the field of science, and I felt that the lab still provided a great opportunity to learn.

As an undergrad, my PI had complete control over my projects, and dictated what steps I should take. I thought this was a great thing because I was relatively new to science and didn't know what to do. But once I started my gap year as a research assistant, I quickly learned why the lab had so much turnover and why it was unproductive in terms of publishing. The post-docs are treated with no respect, and are only used for their cheap labor. The PI also has complete control over their projects, and does not give them the opportunity to experiment and be independent. When experiments don't work, they are heavily criticized, and their work is never appreciated. The PI never takes responsibility for anything. For the amount of money the lab receives, it is publishing much less than it should. And the post-docs get paid the bare minimum salary for post-docs at the institution.

As an undergrad I was not subjected to this treatment, but now I get it full force. But I remember when I used to be so excited to come to lab. During boring classes, I would look over my data from lab. I would go to seminars whenever I had free time. I stayed at the institution every summer to do research. I knew it was something I enjoyed.

But the experience I have now makes it hard to know how much I truly love the research. As I talk to more PhD's and research faculty, I learn that it is very difficult to do well in research. It's stressful to continually apply for funding and publish. There is a lot of delayed gratification in terms of faculty positions, and for many that gratification never comes. Mainly I have been introduced to many PhDs who feel broken down by the research track and wish they had never done it. They say they would have gotten an MD, because more respect and money come with it. Even with a dual degree, I wonder if I should go down the research track. People tell me that you should do it only if you really, really enjoy it.

Sorry for the novel. Hope this explains it a bit better.

 

[tortuga87]

I took a gap year after undergrad to work in a lab as a research assistant. The main reason I did this is because I found that I truly enjoyed research as an undergrad, and I wasn't ready to choose between an MD and PhD. Then I learned that there was such thing as an MD/PhD, so I figured a gap year would be great for me to focus on research as well as apply to MD and MD/PhD programs.

I decided to stay in the same lab I had worked in for 3 years of my undergraduate career. There were reasons not to do this: 1) My peers were telling me that I needed to broaden my experience and work in another lab/field, and 2) I felt somewhat betrayed because the lab published a paper on the project that I had worked on for those 3 years, but since "none of my figures made the paper," my name was left off. Ultimately I decided to stay because I wanted to contribute to a lab that had introduced me to the field of science, and I felt that the lab still provided a great opportunity to learn.

As an undergrad, my PI had complete control over my projects, and dictated what steps I should take. I thought this was a great thing because I was relatively new to science and didn't know what to do. But once I started my gap year as a research assistant, I quickly learned why the lab had so much turnover and why it was unproductive in terms of publishing. The post-docs are treated with no respect, and are only used for their cheap labor. The PI also has complete control over their projects, and does not give them the opportunity to experiment and be independent. When experiments don't work, they are heavily criticized, and their work is never appreciated. The PI never takes responsibility for anything. For the amount of money the lab receives, it is publishing much less than it should. And the post-docs get paid the bare minimum salary for post-docs at the institution.

As an undergrad I was not subjected to this treatment, but now I get it full force. But I remember when I used to be so excited to come to lab. During boring classes, I would look over my data from lab. I would go to seminars whenever I had free time. I stayed at the institution every summer to do research. I knew it was something I enjoyed.

But the experience I have now makes it hard to know how much I truly love the research. As I talk to more PhD's and research faculty, I learn that it is very difficult to do well in research. It's stressful to continually apply for funding and publish. There is a lot of delayed gratification in terms of faculty positions, and for many that gratification never comes. Mainly I have been introduced to many PhDs who feel broken down by the research track and wish they had never done it. They say they would have gotten an MD, because more respect and money come with it. Even with a dual degree, I wonder if I should go down the research track. People tell me that you should do it only if you really, really enjoy it.

Sorry for the novel. Hope this explains it a bit better.

Bottom line: you don't like research because your PI sucks.

There are much better PIs. Go do an MD/PhD with such a better mentor. Your board scores and grades matter much more than the US News rank.

 

[random cell]

I have heard the same warnings and regrets from many PIs as well. Yet on the other hand I have also heard the opposite. Research is not easy, and there is also luck involved. But I am someone that would rather take the shot and fail than not take it at all and wonder "what if?" In my weaker moments I admit I share your thoughts and doubts about a future in research, but I remind myself their life is not mine, and my life is not theirs. Just because they are miserable does not mean I will be. And there are numerous examples of professors that are the antithesis of their misery. It sounds like you really enjoy science and have a passion for it. Too bad this experience had to sour it for you. My research experience was littered with conflict and abuse as well, but if I let that keep me down 10 years from now I will look back and regret it so much that I let a few jokes (read tools) hinder me from pursuing my dreams. I say go MD/PhD.

 

[h9i9j9]

Take home message (for anyone reading this in 2061): try to get experience in more than one have lab...even if you're doing good research in one. It'll help you get a broader scope of knowledge.

For OP, I think with the info you have, its pretty hard to decide.... but with MD you can decide to do research later and MD/PHD can always drop research, so I think you'll be fine either way chill out...relax.