Top-choice PhD vs very good MSTP

[MSTPhD]

I've been following these threads for a while and thought I might post my dilemma.

I am very fortunate to have been accepted to several good programs: my top choices of PhD program (e.g. Stanford/MIT), as well as some very good MSTP programs (I’ve withdrawn from all but one of WashU/Hopkins/Penn). The alumni from all these programs seem to be doing really great things.

Reaching out to my mentors and colleagues, the advice I've heard seems to fall under two categories:

1. If you have any doubt about whether you want to see patients, don't do the MD/PhD, since the ~7-10 years away from research during medical school/residency/fellowship is too large a commitment
2. If you have any feeling that you may wish to see patients in the future, do the MD/PhD, since a clinical career can be very fulfilling and biomedical researchers commonly regret not doing the MD

In reality, I'm somewhere in the middle. I primarily want to make an impact in our understanding of human disease, and seeing patients with ~20% of my time may be very rewarding to me (although who can predict that far in the future?). It seems unwise to take the MD/PhD plunge without being totally certain that it is worth the extra ~7-10 years, yet also unwise to close that door since I may find the clinical component to be fulfilling in the decades after my training.

Does anyone have any thoughts on this matter, or can anyone else relate to this situation? Any advice here would be appreciated!

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[chutzpah]

The following is my opinion, and is probably a bit too pragmatic/pessimistic.

I would say do the MD/PhD.

The funding climate sucks and is unlikely to improve. Frankly, the vast majority of PhD students will not become tenured faculty, let alone stay in academia (even those that studied at top institutions). K awards are hard to get and R01 paylines are terrible across the board.

MD/PhDs, while admittedly do have to undergo a few extra years of training, on average do get their first R01 at roughly the same time if successful (late 30's-early 40's). In addition, R01 funding rates are purportedly higher for MD/PhDs because theoretically their clinical significance grant portions hold more weight. The bottom line is that even if you don't make it in research as a MD/PhD, you have a pretty good plan B, whereas with PhD alternatives aren't great.

Also the 7-10 year number is kind of high. There are plenty of research track residency programs that fast track you into becoming tenured faculty with protected research time.

MD/PhD 7-8 years + (PTSP 2+2 program) + 2-3 year postdoc / (IM with research subspecialty fellowship (usually guaranteed) 3+~2) = 12-13 years until possible faculty position?

PhD 5-7 years + 2-4 postdoc + (possible second postdoc)= 7-11

So it's more like 1-6 years more depending, also you have more job security.


Also: 20-80 is hard to get.

 

[eteshoe]

I was in a similar position to you few yes ago and ultimately went with option 2. This path is a weird one since length of training can really affect your views on the system and the MD/PhD is one of the most ridiculously long ones (especially for those that do surgery afterwards). Unfortunately such a long term training path means one cannot truly evaluate the 'wisdom' of the path until many yes down the line IMO.

You have a couple options (others may chime in w/ better ones):

1. Attend the MD/PhD and if you find you don't enjoy the patient side of things, forgo residency and do a Postdoc (I know quite a few people who did this)

2. Do the MD/PhD and go to do a residency in something that would allow you to utilize your research skills (e.g. some of the IM sub specialties)

3. Attend the PhD and if you still have the desire to see patients, attend med school afterwards. Not the most efficient path, but I know a couple of people who did this.

4. Forgo being a physician and just be a top notch scientist

This is quite a decision but good luck.

 

[Neuronix]

R01 funding rates are purportedly higher for MD/PhDs because theoretically their clinical significance grant portions hold more weight.

"Purportedly" ? There is data. Funding rates for R01s are the same for MDs, MD/PhDs, and PhDs. https://report.nih.gov/workforce/psw/award_rates.aspx

 

[dl2dp2]

Common question. The difference between the MSTP and phd programs you are looking at (i.e. Penn vs Stanford) is very minimal. In this case, going mdphd is a no brainer.

Do not listen to senior scientists, especially those who only have a phd, who tell you to do a phd only. Their experience and current crop of PhDs are vastly different. Your chance of getting a quality TT position is below 10-20% coming out of Stanford/MIT.

There are very specific reasons to ditch MDPHD and do Phd only, mostly having to do with PhDs that are not biomedical and other very specific research oriented reasons or if there is a huge difference in tiers of institutional quality. However, I would argue in general anyone who wants to do biomedical research of any kind in the US should generally aim for MDphd instead of only phd. Unfortunately, due to a variety of reasons, doing phd only does not shorten your time to independence...(i.e. At most one year based on most NIH data). However, the life time salary differential and job security difference are not even comparably in the same league for those two tracks.

 

[chutzpah]

"Purportedly" ? There is data. Funding rates for R01s are the same for MDs, MD/PhDs, and PhDs. https://report.nih.gov/workforce/psw/award_rates.aspx

Isn't it like 1-2% higher across the board for MD/PhDs at different stages according to the link?

At the top it states:

• In 2012, MD/PhDs overall had higher award rates for RPGs (24.6 percent) than MDs (21.7 percent, p<0.01) or PhDs (21.4 percent, p<0.01) (Figures 3.21 to 3.23).

 

[GadRads]

Do the MD/PhD. But realize medical school involves a lot of memorization, some of which can be uninspiring, however the breadth of knowledge is quite cool.

 

[gbwillner]

Do the MD/PhD if you really want to study disease. Also, if that is your intent, all the MSTP programs you listed are much better than the PhD ones you listed.

 

[Neuronix]

Isn't it like 1-2% higher across the board for MD/PhDs at different stages according to the link?

At the top it states:

• In 2012, MD/PhDs overall had higher award rates for RPGs (24.6 percent) than MDs (21.7 percent, p<0.01) or PhDs (21.4 percent, p<0.01) (Figures 3.21 to 3.23).

Look at the graphs.

Do you really believe that a difference of 3% in funding rates across ALL grant types is meaningful to choosing a career?

Also, you wrote R01 in your initial post. The numbers for R01s are virtually identical between the degree types in the post I linked.

 

[tr]

Those graphs are not informative for the OP because the denominators represent a highly selected population. The vast majority of all MD, PhD, and probably MD/PhD never get to the point of submitting an NIH grant as PI.

They get siphoned off to clinical practice (for the MDs), or to industry, teaching, or policy (for the PhDs).

The relevant statistic for the OP would be NIH grant attainers over all degree holders. We don't have these data but they are for sure not encouraging. Certainly under 10% no matter which degree you are talking about. I saw an article that followed 14 graduating PhDs in biochemistry/micro from Yale who all had a stated interest in running academic labs. Only one ended up in such a position. It can only be lower for MD/PhDs because the alternatives for them are more attractive than those for straight PhDs.

If the OP is dead set on running a basic science lab, meaning s/he is aiming for a tenure-line position where salary and start up funds for the lab are provided by the university ('hard money'), the odds are not good and the MD provides no advantage. It may be a slight disadvantage because this path requires consistent publication of high-impact papers and the years spent on clinical training impair one's ability to achieve that.

The advantage of the MD is that it offers more attractive alternative pathways if the hard money is not forthcoming. ('More attractive' assuming you have at least some interest in clinical work.). You can bail out of academics altogether, with a lucrative parachute to soften the blow. But there is also a parallel pathway in clinical academic medicine, which is much less competitive than the tenure-line pathway. On this pathway you don't get protected research time ( you have to fund your own research time out of grants - 'soft money') but the opportunity to do research in some capacity is preserved (depending on how good you can get at the funding game), without the pressures to produce and beat the tenure clock. The money and job security are better too. Unlike the tenure-line positions, clinical faculty positions are pretty much available to any qualified individual who wants one.

So if the OP has any interest in clinical work and/or clinically focused research, the dual degree is the better choice. If s/he is hell bent on running a basic science lab despite the dismal odds, and would not be interested in more clinically focused alternatives, s/he might as well do the straight PhD. In this case it is best to join a bigwig laboratory (Nobel winner or similar), publish multiple high- impact papers, and repeat this performance in a postdoc.

 

[chalamilasidney]

can you apply and receive multiple NIH grants (Ks/Rs) during residency or fellowship? do you know anyone who did this?

can MDs enter PSTP?

 

[Fencer]

Rs during residency - no
Ks during residency - no (require a faculty position)
Ks late during fellowship - yes/maybe (if instructor hybrid position)
MDs into PSTP - yes, but less competitive... The product of the PSTP with typically a total of only 2 years of research needs to compete for faculty positions with heavy research emphasis. PSTPs are also measured by their outcomes.

 

[mega_]

Do you have specific labs that you are so attracted at Stanford/MIT? Otherwise, I don't think there is any difference for even just a PhD student to chose between those schools.