What makes a good MD/PhD Program?

[bioobgyn]

I've been fortunate enough to get into a few MD/PhD programs but I'm finding it difficult to compare between the programs. I was wondering if I could get some general ideas as to how I can determine what program is a good program. So far these are the things I've been looking into:

1) Research: I've been told that I should look for faculty that I'm interested in and to only go to schools that have multiple faculty in that particular subject. However, how will I know if these faculty members will accept graduate students 2 years later? Or if their personality would make a good research mentor? I understand some programs have a "internal list" of approved faculty that are receptive towards MD/PhD students. Would it be appropriate to ask the MD/PhD director for that list? Other than looking at the faculty's training record, publication record, amount of grants, how else can I narrow my potential thesis adviser list?

2) Clinical Experience: I'm interested in going into oncology. Alot of the schools I've applied to have strong cancer biology programs with NCI comprehensive cancer center designation. How is a NCI labeled cancer center different from a non-NCI cancer center? Will a NCI cancer center have any additional benefits towards my clinical or science training vs a non-NCI designated cancer center?

3) Program Integration: What makes a MD/PhD program integrated other than waved PhD courses? It seems like almost all MD/PhD programs would allow MD courses to substitute for PhD courses so what makes that so special? Also, some programs have clinical preceptor programs during the PhD years. Is this helpful at all or is it a gimmick?

4) Funding: I've also applied to non-MSTP programs. Other than a potential repayment clause, what difference between a MSTP program and a non-MSTP program? Does having a MSTP designation inherently make that program a better choice?

5) Program Support: Some schools seem to have a very supportive MD/PhD staff that is willing to "go up to bat for their students". How significant is this?

6) Classmates: How should I go about seeing how happy other MD/PhD students are? All the students were bubbly at every program I've interviewed at. Is there anyway I can see if the majority of the MD/PhD students are happy or just North Korean fake happy?


Are there any factors I should potentially look at? Any feedback would be greatly appreciated.

Thanks!

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[mTORC]

Location!!! You're going to spend such a long time there, make sure you're going to be happy with the city, the weather and the people

 

[catalyst25]

Success of the program's alumni.

 

[Shifty B]

I'm going to go out on a limb and say that #5 may be one of the most important things. You need strong administration that interfaces well with the medical school, because they are going to need to help with your schedule, make sure you get paid on time, etc. You need a program director who can interface well with your department should a problem arise.

A lot of the things that you mentioned are merely markers of successful programs. As in, you don't need to be an NIH MSTP program to be a good MD/PhD program with solid funding, but most of the better programs are. Same for NCI cancer centers. There are quite a few requirements which must be in place to get those designations, which offers you a bit more of a guarantee that a program will meet some minimum standards. Several non-designated places may do the same.

I would definitely look at the track record of alumni. What kind of residencies did they do and what kind of careers do they have now? If you don't see someone like yourself, then that is a problem. You don't want to be the first person to ever do biomedical engineering at your program, if you get my drift.

 

[gbwillner]

I think the 2 most important things are 1: the strength of the GRADUATE PROGRAM you are interested in (not sure "oncology" is a a department most places, but I could be wrong), and two- the institutional support and history of the program. There is a direct correlation with both of these and the academic "rank" of many institutions, but it is not always the case.

Once you pick a training program you need OPTIONS for PIs. It's not just about who's accepting students- as an MD/PhD you are likely to get your lab of choice- but PIs leave the institution and run out of funding. You don't want to put yourself in a tough situation if you can help it. The more established programs have more students and thus are more accustomed to providing you assistance when you need it.

Other factors can be important but are really personal preference. For example location. You will be studying and working hard- not sitting on the beach every day. And there is an inverse relationship between the desirability of a city and lifestyle based on your income- and let me tell you there is no easy answer as to which is more important (I would argue the latter).

 

[uniqenam]

And there is an inverse relationship between the desirability of a city and lifestyle based on your income- and let me tell you there is no easy answer as to which is more important (I would argue the latter).

This is something not many consider, and is really unfortunate for a lot of people after they have been at med school for a few years. Cost of living is extremely important, and something that a lot of institutions in big cities won't really mention (ever). There are some exceptions though, as I can think of at least one "big city" off the top of my head that is unbelievably cheap to live in and a really awesome environment.

 

[mTORC]

This is something not many consider, and is really unfortunate for a lot of people after they have been at med school for a few years. Cost of living is extremely important, and something that a lot of institutions in big cities won't really mention (ever). There are some exceptions though, as I can think of at least one "big city" off the top of my head that is unbelievably cheap to live in and a really awesome environment.

Which city is that?

 

[Fencer]

It must be in Texas

http://www.city-data.com/top1.html
Three in the top 10 in size and 5 in the top 20. People don't realize a big they are and how cheap relatively to the rest of the US.

 

[Jimsy]

This is something not many consider, and is really unfortunate for a lot of people after they have been at med school for a few years. Cost of living is extremely important, and something that a lot of institutions in big cities won't really mention (ever). There are some exceptions though, as I can think of at least one "big city" off the top of my head that is unbelievably cheap to live in and a really awesome environment.

Portland?

 

[cpi89]

Portland is no San Francisco or New York, but still not particularly cheap to live in.

 

[gbwillner]

Lots of "big cities" fit this criteria- they just tend to be away from the coasts. Texas certainly does have at least 3 (Houston, Dallas, San Antonio) that I know well and have low costs of living. But this is also true in the Midwest and South. Your dollar will go far in St. Louis, Kansas City, Nashville, Atlanta, Cincinnatti, Cleveland, Minneapolis, Denver, Pittsburgh, Salt Lake City... I could go on.

 

[gutonc]

Portland is neither big nor cheap. My bet is on Dallas.

 

[StilgarMD]

I think Philly is a pretty great and affordable place to live, both for the culture present and how close it is to other places. Then again, I'm from the area, so I'm biased.

 

[gbwillner]

I think Philly is a pretty great and affordable place to live, both for the culture present and how close it is to other places. Then again, I'm from the area, so I'm biased.

Philly is affordable only relative to the other east coast cities. Compared to the South, Southwest, Midwest, and Texas it is fairly expensive. But I also agree that it is a pretty nice city with a lot to offer and your dollar will certainly take you further than in NY, Boston, or Washington. On a similar note, Chicago is also affordable relative to those other cities.

 

[uniqenam]

Yes, I was speaking of Dallas, but really any of the "Big 3" in Texas are pretty great places to live on a student stipend. A lot of people assume they'll be fine on a student stipend for 8 years in a place like NYC, which is certainly plausible, but I think the ability to have a little more financial security (especially if you're considering marriage/children) is a nice stress-reliever.

 

[bioobgyn]

I'm going to go out on a limb and say that #5 may be one of the most important things. You need strong administration that interfaces well with the medical school, because they are going to need to help with your schedule, make sure you get paid on time, etc. You need a program director who can interface well with your department should a problem arise.

A lot of the things that you mentioned are merely markers of successful programs. As in, you don't need to be an NIH MSTP program to be a good MD/PhD program with solid funding, but most of the better programs are. Same for NCI cancer centers. There are quite a few requirements which must be in place to get those designations, which offers you a bit more of a guarantee that a program will meet some minimum standards. Several non-designated places may do the same.

I would definitely look at the track record of alumni. What kind of residencies did they do and what kind of careers do they have now? If you don't see someone like yourself, then that is a problem. You don't want to be the first person to ever do biomedical engineering at your program, if you get my drift.

I've looked into where the alumni are but with a small sample size of 8 graduates per year, should I focus more on what specialty they're at or the school? For example, the alumni list shows that graduates do go into internal medicine (what I'm hoping to go into), but only a select few at top residency programs for cancer (Sloan Kettering, MD Anderson, Dana Farber...). What does that say about the program?

 

[gutonc]

I've looked into where the alumni are but with a small sample size of 8 graduates per year, should I focus more on what specialty they're at or the school? For example, the alumni list shows that graduates do go into internal medicine (what I'm hoping to go into), but only a select few at top residency programs for cancer (Sloan Kettering, MD Anderson, Dana Farber...). What does that say about the program?

That it's graduates may not have wanted to go someplace like MSK or MDACC. I got interviews at those places...I didn't want to go there. "The Best" program isn't always best for everyone.

The fact that this particularly program has matched people in programs you're interested in is good enough.

 

[gbwillner]

I've looked into where the alumni are but with a small sample size of 8 graduates per year, should I focus more on what specialty they're at or the school? For example, the alumni list shows that graduates do go into internal medicine (what I'm hoping to go into), but only a select few at top residency programs for cancer (Sloan Kettering, MD Anderson, Dana Farber...). What does that say about the program?

Be careful about this kind of search... many specialized cancer centers don't have a full repertoire of residency programs. Does Dana Farber even have a residency program? Or is it staffed by BWH? For example, I did a residency in pathology- which is cancer-centric. None of these institutions have a path training program, but SK and MD Anderson have fellowship programs.

 

[ValentinNarcisse]

That it's graduates may not have wanted to go someplace like MSK or MDACC. I got interviews at those places...I didn't want to go there. "The Best" program isn't always best for everyone.

The fact that this particularly program has matched people in programs you're interested in is good enough.

Umm....none of those institutions have IM residency programs.

 

[gutonc]

Umm....none of those institutions have IM residency programs.

And your point is?

 

[gbwillner]

And your point is?

I don't think he meant to respond to you directly... the OP's point about wanting to do a residency in "Oncology" and looking for training program's whose alumni do residencies in that field... he was looking specifically for places who produce oncologists at those cancer centers, yet those institutions don't have IM residencies, meaning he'd never find such a program. The OP probably doesn't realize that Oncology is a fellowship after IM, or through another pathway (like Pathology, which also is not a residency program at those institutions). Other fields like Rad Onc are residency programs at some of these institutions.

 

[miz]

Congrats on your multiple acceptances (in October?!)! This is a fantastic question.
1: You don't know if they will accept grad students in two years and you don't know if any one of those individuals share your future goals in terms of your training, so the best bet is to find a program with a strong department/grad program and multiple faculty doing things you find cool in your areas of interest. I suspect more programs have an internal list that goes the other direction- PIs who they prefer their students not work with. Nobody is going to give you that list, it's not professional. But if such a list exists they will generally warn you away from individuals on that list.
1b. Thesis advisors- those things that you list are plenty to start. The only thing I'd add is talk to MD/PhDs in the lab if there are any, grad students in the lab, recent graduates/students who are graduating soon, people who rotated but didn't join, and get a diversity of opinions, which you should take with a grain of salt. You just want to look for patterns, not take any individual's opinion for gospel.
3. Not all programs allow MD courses to substitute for PhD courses, much to my chagrin. It depends on what you are planning to pursue and is graduate department and school-specific. You can just ask.
Clinical preceptorships might be a gimmick because shadowing isn't super difficult to set up, but it's still nice. Integration means a lot of things, like if there are graduate classes on certain days they might avoid scheduling med school classes during those times for the entire class just so that you can attend. Or they might let you do a pre-PhD clinical rotation. They might have a special training program/review before you return to the wards. Etc.
4. MSTP designation generally suggests funding stability and NIH support. There are quality non-MSTP MD/PhD training programs as well.
5. Pretty important, but it also depends on your individual situation. If everything goes well for you, administrative support might not be as important as if there is some kind of catastrophe. The problem is that you can't foresee these situations very well. I didn't rank this as particularly important when I made my decision, but it has affected me periodically.
6. 1st year students will generally be happy and bubbly. Try talking to older students. I did see a program where the 1st years were stressed, and I noted that.

I've been fortunate enough to get into a few MD/PhD programs but I'm finding it difficult to compare between the programs. I was wondering if I could get some general ideas as to how I can determine what program is a good program. So far these are the things I've been looking into:

1) Research: I've been told that I should look for faculty that I'm interested in and to only go to schools that have multiple faculty in that particular subject. However, how will I know if these faculty members will accept graduate students 2 years later? Or if their personality would make a good research mentor? I understand some programs have a "internal list" of approved faculty that are receptive towards MD/PhD students. Would it be appropriate to ask the MD/PhD director for that list? Other than looking at the faculty's training record, publication record, amount of grants, how else can I narrow my potential thesis adviser list?

2) Clinical Experience: I'm interested in going into oncology. Alot of the schools I've applied to have strong cancer biology programs with NCI comprehensive cancer center designation. How is a NCI labeled cancer center different from a non-NCI cancer center? Will a NCI cancer center have any additional benefits towards my clinical or science training vs a non-NCI designated cancer center?

3) Program Integration: What makes a MD/PhD program integrated other than waved PhD courses? It seems like almost all MD/PhD programs would allow MD courses to substitute for PhD courses so what makes that so special? Also, some programs have clinical preceptor programs during the PhD years. Is this helpful at all or is it a gimmick?

4) Funding: I've also applied to non-MSTP programs. Other than a potential repayment clause, what difference between a MSTP program and a non-MSTP program? Does having a MSTP designation inherently make that program a better choice?

5) Program Support: Some schools seem to have a very supportive MD/PhD staff that is willing to "go up to bat for their students". How significant is this?

6) Classmates: How should I go about seeing how happy other MD/PhD students are? All the students were bubbly at every program I've interviewed at. Is there anyway I can see if the majority of the MD/PhD students are happy or just North Korean fake happy?


Are there any factors I should potentially look at? Any feedback would be greatly appreciated.

Thanks!

 

[ValentinNarcisse]

1. Med School Reputation
2. Match List for MSTPs
3. Avg Time to degree for PhD
4. Program Size (MD/PhDs need to be a significant (>10%) proportion of the med school class to get appropriate attention/resources).

Always decide on medical school first, at the end of the day you are applying for residency positions, not postdoc positions. You can find a high quality mentor at any institution that is an NIH-sponsored MSTP.

 

[bd4727]

Always decide on medical school first, at the end of the day you are applying for residency positions, not postdoc positions. You can find a high quality mentor at any institution that is an NIH-sponsored MSTP.

I feel like this is a great point that the majority of MD/PhD applicants don't consider strongly enough.

 

[Patros]

I feel like this is a great point that the majority of MD/PhD applicants don't consider strongly enough.

Um hold on. I thought a med school's "reputation" is just how extensive their research facilities are and the strength of their faculty. How can this be separated from the quality of mentors and productivity of research done at the school (ie the PhD part)?

Besides, I thought everyone considered the preclinical med school curricula to be basically equivalent in terms of what you learn. And as far as clinical rotations are concerned, I haven't found a reliable way to compare them between institutions. So what should I be looking for, as an MD/PhD applicant?

 

[gbwillner]

I strongly disagree with the notion that the med school portion should come first when selecting a program. Quite the opposite, actually. I would say that the #1 overall consideration should be the strength of the graduate department you are going to join. This is by far the most variable component to your training, and your choice of mentor will have FAR more importance than where you did your training, for many reasons I have previously outlined.

 

[Fencer]

I strongly disagree with the notion that the med school portion should come first when selecting a program. Quite the opposite, actually. I would say that the #1 overall consideration should be the strength of the graduate department you are going to join. This is by far the most variable component to your training, and your choice of mentor will have FAR more importance than where you did your training, for many reasons I have previously outlined.

I'm going to go out on a limb and say that #5 may be one of the most important things. You need strong administration that interfaces well with the medical school, because they are going to need to help with your schedule, make sure you get paid on time, etc. You need a program director who can interface well with your department should a problem arise.
A lot of the things that you mentioned are merely markers of successful programs. As in, you don't need to be an NIH MSTP program to be a good MD/PhD program with solid funding, but most of the better programs are. ....

I strongly agree with these two statements:

• Graduate program - look for a T32 training grant in that discipline, it is another marker that good training in that discipline happens there.
• Strong MD/PhD administration - a strong PD is able to protect, mentor, and solve problems for you

 

[ValentinNarcisse]

Most residency directors outside of research pathways in medicine, pathology, and pediatrics know little about impact factors or graduate program rankings. I have directly heard from multiple program directors they just care if you have a PhD (yes/no), the total number of publications, and will take special note for anything in Cell/Science/Nature. The reputation of your medical school, usmle scores, and third year grades are way more important. If you want to do anything competitive, PhD will not make your residency application the way most MD/PhD programs would have your believe.

 

[mercaptovizadeh]

Most residency directors outside of research pathways in medicine, pathology, and pediatrics know little about impact factors or graduate program rankings. I have directly heard from multiple program directors they just care if you have a PhD (yes/no), the total number of publications, and will take special note for anything in Cell/Science/Nature. The reputation of your medical school, usmle scores, and third year grades are way more important. If you want to do anything competitive, PhD will not make your residency application the way most MD/PhD programs would have your believe.

Completely agree. In the midst of the process right now, I can attest to the fact that they look at the PhD as almost an extracurricular, rather than a real qualification/body of work preparing one (partially) for a parallel career in research. Many PDs, associate PDs, other faculty, and chief residents who interviewed me didn't ask me about my research at all. If they did, I could tell they would get bored if I went on for more than, say, 4 sentences. No one probed much deeper, probably because they weren't too interested. They counted my publications, and couldn't tell apart what really counted from what didn't. I wouldn't be surprised if many of them found a paper in NEJM/JAMA to be a big deal (not saying it isn't) while not having a clue about Cell/JCI/PNAS.

MD/PhD is not a golden ticket to residency.

 

[solitude]

Completely agree. In the midst of the process right now, I can attest to the fact that they look at the PhD as almost an extracurricular, rather than a real qualification/body of work preparing one (partially) for a parallel career in research. Many PDs, associate PDs, other faculty, and chief residents who interviewed me didn't ask me about my research at all. If they did, I could tell they would get bored if I went on for more than, say, 4 sentences. No one probed much deeper, probably because they weren't too interested. They counted my publications, and couldn't tell apart what really counted from what didn't. I wouldn't be surprised if many of them found a paper in NEJM/JAMA to be a big deal (not saying it isn't) while not having a clue about Cell/JCI/PNAS.

MD/PhD is not a golden ticket to residency.

I'm curious--which specialty?

 

[Fencer]

As a former residency associate program director, I disagree... Step I scores are as important, but any high powered residency wants at least 1 and up to 50% of the class to be MD/PhD students. You are not giving them enough credit to know scientific quality.

 

[ValentinNarcisse]

As a former residency associate program director, I disagree... Step I scores are as important, but any high powered residency wants at least 1 and up to 50% of the class to be MD/PhD students. You are not giving them enough credit to know scientific quality.

I still do not think this applies to most surgical subspecialties (Plastics,Neuro,Ortho,Urology,Ophtho), Radiology and Dermatology.

 

[mercaptovizadeh]

As a former residency associate program director, I disagree... Step I scores are as important, but any high powered residency wants at least 1 and up to 50% of the class to be MD/PhD students. You are not giving them enough credit to know scientific quality.

You would know best, of course but my sense is that in the traditional fields of medicine, pediatrics, neurology (perhaps not pathology), there are two tracks - the physician scientist track and the more clinical track. When you apply to UCSF for IM or CHOP for peds or MGH for neuro as an MD/PhD, you are being compared to other MD/PhDs, and the MD-onlies are being compared to other MD-onlies. JHU could fill their entire IM residency with very competent, well-performing MD/PhDs. But they don't, because they recognize (well) that there's more to medicine than future basic/translational science investigators, there's personal connections to other applicants, etc.

I will further say that I had a colleague at a top-15 med school with a good PhD (1st author PNAS and multiple other 1st author papers), step 1 of ~250-260, honors in IM, pediatrics, psychiatry, and a number of electives (but not AOA), who did not so much as get an interview for IM at MGH or UCSF. And he then matched at his second choice. So this is happening to some degree in IM.

Now, when it comes to more unorthodox residencies, like ENT, ob/gyn, anesthesia, general surgery, etc. - I stand by the earlier statement that a decent MD/PhD (not saying stellar in research, just decent), cannot compensate for any deficiency in the step exam scores, clinical record, LORs, etc. It does get counted as an extracurricular (so you don't have to have volunteered at the free clinics as well), but your future potential as a researcher does not interest the PDs enough for them to forgive your 225 step 1 or lack of honors in X rotation that is sooooooo important.

I have a colleague applying to general surgery with a great PhD publication record (10+ total, IIRC, several strong 1st author) with a very well known pediatric surgeon-researcher. He got a pass in his surgery clerkship, I believe honors in IM, step 1 of ~230, not AOA. Did not so much as get an interview at places like MGH, BWH, JHU, UCSF, Stanford, etc., etc. And from what I was able to gather, he may have had assistance in securing the interviews that he did by various LOR-writers making pre-interview phone calls, etc.

 

[gbwillner]

The argument here is apples and oranges. If you want to go to a residency program in a surgical specialty (or really, any field with no research component) and NOT be in a PSTP type program/environment, then you guys are absolutely right about your MD portion being more important than your graduate program. But if that is your route, chances are you are done with science for the rest of your career anyway, and your PhD was time that was an opportunity cost loss.

If you DO want to do research, in IM/Peds/Path/Neuro... even surgery or other fields at an academic place where you are expected to do research and have opportunity for running a lab... You are better off with the better graduate experience. You will be judged by other MD/PhDs who know the quality of your training and output for residency, but more importantly later on when you are looking for a JOB. Yes, eventually the fairy tale never-ending training stops and you will have to get a job. And when you present a CV with high-impact publications and trained under a famous person who is in the Academy of Sciences it goes much further than "I went to awesome program X, and have 5 papers with unknown guy Y that are all case reports." Good luck ever landing a job with a decent start up in today's horrible, horrible science market. It's tough enough now even when your CV is perfect. And let's not forget the "top" places tend to have awesome graduate training.

When I interviewed for a job, most people recognized my PI, despite not being in the same field. When I write NIH grants, the reviewers recognize my PI AND the impact of my graduate school AND the impact of my papers. The R01 payline is like 6% right now. Believe me, you need every single advantage you can manage.

Honestly, if you are not 100% committed to research, I recommend you quit the MSTP, MD/PhD right now. With my 15 years experience in this track, I can tell you for certain there are no benefits to this pathway for any reason other than the sheer joy of having a physician-scientist career. And that's becoming less and less joyful by the minute in this economic crunch.

 

[ValentinNarcisse]

The argument here is apples and oranges. If you want to go to a residency program in a surgical specialty (or really, any field with no research component) and NOT be in a PSTP type program/environment, then you guys are absolutely right about your MD portion being more important than your graduate program. But if that is your route, chances are you are done with science for the rest of your career anyway, and your PhD was time that was an opportunity cost loss.

If you DO want to do research, in IM/Peds/Path/Neuro... even surgery or other fields at an academic place where you are expected to do research and have opportunity for running a lab... You are better off with the better graduate experience. You will be judged by other MD/PhDs who know the quality of your training and output for residency, but more importantly later on when you are looking for a JOB. Yes, eventually the fairy tale never-ending training stops and you will have to get a job. And when you present a CV with high-impact publications and trained under a famous person who is in the Academy of Sciences it goes much further than "I went to awesome program X, and have 5 papers with unknown guy Y that are all case reports." Good luck ever landing a job with a decent start up in today's horrible, horrible science market. It's tough enough now even when your CV is perfect. And let's not forget the "top" places tend to have awesome graduate training.

When I interviewed for a job, most people recognized my PI, despite not being in the same field. When I write NIH grants, the reviewers recognize my PI AND the impact of my graduate school AND the impact of my papers. The R01 payline is like 6% right now. Believe me, you need every single advantage you can manage.

Honestly, if you are not 100% committed to research, I recommend you quit the MSTP, MD/PhD right now. With my 15 years experience in this track, I can tell you for certain there are no benefits to this pathway for any reason other than the sheer joy of having a physician-scientist career. And that's becoming less and less joyful by the minute in this economic crunch.

I agree with most of your points, however I would contend that surgical fields need research and the development of new therapeutics. The burgeoning fields of stem cell transplant, DBS, and now 3D printing of organs could benefit from MD/PhDs trained as surgeons.

In regards to commitment to research, you cannot fault people for their views maturing as they learn more about how science works. We start these programs at 21-22 years old and finish when we are 28-29, a great deal changes during that time. There are tons of things you do not realize up front when you are just an undergraduate excited about science and medicine. Starting out, I never imagined assistant professors in medicine at places like Harvard/UCSF can be offered salaries in the low 100s when starting out. This is after MD/PhD, residency, fellowship, and maybe an instructor position. At that stage of life in your late 30s, you likely have a family and other responsibilities. On top of that, you have no assurance you will transition from a K award to an RO1. In order to be successful, you will constantly be submitting grants, a substantial portion of which will go to pay salaries (including your own), overhead to the university, leaving a small amount for actual work. While doing this, your clinical skills are atrophying to the point "successful" physician-scientists are uncomfortable with more than an infrequent clinical service highly focused patient on a particular disorder.

 

[Fencer]

When I interviewed for a job, most people recognized my PI, despite not being in the same field. When I write NIH grants, the reviewers recognize my PI AND the impact of my graduate school AND the impact of my papers. The R01 payline is like 6% right now.

I agree with gbwillner except on the research funding outlook. The sky is not falling!!! We must look at data (see also the definition of success rate): http://report.nih.gov/success_rates/Success_ByActivity.cfm

2013 New R01 - 14.3%
2013 Competing R01 - 31.4%​

See also: http://report.nih.gov/success_rates/index.aspx

Career development awards for clinician scientist:

2013 K08 - 35.8%
2013 K23 - 32.1%​

Source: http://report.nih.gov/DisplayRePORT.aspx?rid=551

 

[mercaptovizadeh]

The argument here is apples and oranges. If you want to go to a residency program in a surgical specialty (or really, any field with no research component) and NOT be in a PSTP type program/environment, then you guys are absolutely right about your MD portion being more important than your graduate program. But if that is your route, chances are you are done with science for the rest of your career anyway, and your PhD was time that was an opportunity cost loss.

If you DO want to do research, in IM/Peds/Path/Neuro... even surgery or other fields at an academic place where you are expected to do research and have opportunity for running a lab... You are better off with the better graduate experience. You will be judged by other MD/PhDs who know the quality of your training and output for residency, but more importantly later on when you are looking for a JOB. Yes, eventually the fairy tale never-ending training stops and you will have to get a job. And when you present a CV with high-impact publications and trained under a famous person who is in the Academy of Sciences it goes much further than "I went to awesome program X, and have 5 papers with unknown guy Y that are all case reports." Good luck ever landing a job with a decent start up in today's horrible, horrible science market. It's tough enough now even when your CV is perfect. And let's not forget the "top" places tend to have awesome graduate training.

When I interviewed for a job, most people recognized my PI, despite not being in the same field. When I write NIH grants, the reviewers recognize my PI AND the impact of my graduate school AND the impact of my papers. The R01 payline is like 6% right now. Believe me, you need every single advantage you can manage.

Honestly, if you are not 100% committed to research, I recommend you quit the MSTP, MD/PhD right now. With my 15 years experience in this track, I can tell you for certain there are no benefits to this pathway for any reason other than the sheer joy of having a physician-scientist career. And that's becoming less and less joyful by the minute in this economic crunch.

Again, you would know better since you're further along. But my impression is that equally what you do in a PhD 5-9 years prior (going from the shortest period of training in something like adult ID vs. the 9 year track in pediatric surgery) is going to be rather remote by the time you apply. I would argue that your personal experience is a distortion of the general case, which is that these people want to know "what have you done for me now?," not just "what did you do 5-10 years ago?" If someone wants to augment the rigor of their training, they can always do a post-doc after residency or fellowship to get experience in the techniques that interest them and produce some papers.

Choosing a national academy of sciences/Nobel prize winner lab to train in may work for some students, but not all. Many people struggle in these labs (where PIs are often scarce) and need the more small lab feel to thrive. And generally their papers won't be as high powered because their mentor doesn't have the name recognition or all the established methods and resources necessary to push papers into N/C/S. It doesn't mean their thinking process or creativity is inferior. It doesn't mean their potential is any less. It does, though, probably mean that they need some post-doctoral work in a high-powered lab to get into the gear that faculty search committees are looking for.

As nice as the traditional academic track sounds, I'd much rather work as a hospitalist, transition into moonlighting work while doing a post-doc in what I'm really interested in, then switch into pharma or go abroad for greener pastures. The current model is dying a quick death, no thanks.

 

[gbwillner]

Again, you would know better since you're further along. But my impression is that equally what you do in a PhD 5-9 years prior (going from the shortest period of training in something like adult ID vs. the 9 year track in pediatric surgery) is going to be rather remote by the time you apply. I would argue that your personal experience is a distortion of the general case, which is that these people want to know "what have you done for me now?," not just "what did you do 5-10 years ago?" If someone wants to augment the rigor of their training, they can always do a post-doc after residency or fellowship to get experience in the techniques that interest them and produce some papers.

Choosing a national academy of sciences/Nobel prize winner lab to train in may work for some students, but not all. Many people struggle in these labs (where PIs are often scarce) and need the more small lab feel to thrive. And generally their papers won't be as high powered because their mentor doesn't have the name recognition or all the established methods and resources necessary to push papers into N/C/S. It doesn't mean their thinking process or creativity is inferior. It doesn't mean their potential is any less. It does, though, probably mean that they need some post-doctoral work in a high-powered lab to get into the gear that faculty search committees are looking for.

As nice as the traditional academic track sounds, I'd much rather work as a hospitalist, transition into moonlighting work while doing a post-doc in what I'm really interested in, then switch into pharma or go abroad for greener pastures. The current model is dying a quick death, no thanks.

Everything matters. Not much else I can say. In regards to a job, your graduate school work PLUS post-doc work BOTH matter for getting a good job. You're fooling yourself if you think the post-doc is optional or only for people who need to brush up.

 

[gbwillner]

I agree with gbwillner except on the research funding outlook. The sky is not falling!!! We must look at data (see also the definition of success rate): http://report.nih.gov/success_rates/Success_ByActivity.cfm

2013 New R01 - 14.3%
2013 Competing R01 - 31.4%​

See also: http://report.nih.gov/success_rates/index.aspx

Career development awards for clinician scientist:

2013 K08 - 35.8%
2013 K23 - 32.1%​

Source: http://report.nih.gov/DisplayRePORT.aspx?rid=551

Sorry brah, the sky IS kinda falling. And it's not just because of the funding rates either. Yes, K08's still pay out at a much higher rate than R01s, and first time R01s are better than others (but still suck). The real issue is Medicare reimbursements getting slashed. Most clinical departments do NOT have a rosy outlook of the future. They are not hiring new staff and are contemplating cutting salaries. If anything, they are asking for staff to work harder for the same or less compensation. Insurance companies are following suit and renegotiating contracts with hospitals for more favorable terms to secure their profit ahead of the ACA. When patients can shop across state lines for health care, these groups no longer have monopolies on the residents and will lose money. They will pass those losses onto doctors and there is nothing anyone can do about it. Hospitals are passing on the losses to medical schools, who distribute the losses across departments.
Meanwhile, here you are with a nice, new K08 that is worth almost $900K. Lots of top-tier institutions are still PASSING on these people because they're pretty sure in 5 years they still won't get their $1M start-up investment back. The situation is DIRE.

5-10 years ago, if you showed promise- during your post-doc/fellowship that you could be productive (write papers) that was sufficient to get a nice (~$1M) start-up package and an 80/20 research job, provided a good background and training. A K08 was a free ticket to any program you wanted. Now, you need the K08 just to walk in the door. And most academic jobs in clinical departments that I've seen loose interest in candidates as soon as they demand protected research time at or more than 50%.

 

[okemba]

Sorry brah, the sky IS kinda falling.

That's my perception these days...

Could you help me estimate percentages of what this or last year's MD/PhD graduates end up doing with their careers?

Pure Clinical - 50%
80/20 Research/Clinical TT Professorship protected-time start-up funds job - 10%
50/50 Research/Clinical - 40%

(These are nonsense guesses made by an undergraduate.)

Am I missing a major category (or seven)? How off are my percentages?

 

[gbwillner]

That's my perception these days...

Could you help me estimate percentages of what this or last year's MD/PhD graduates end up doing with their careers?

Pure Clinical - 50%
80/20 Research/Clinical TT Professorship protected-time start-up funds job - 10%
50/50 Research/Clinical - 40%

(These are nonsense guesses made by an undergraduate.)

Am I missing a major category (or seven)? How off are my percentages?

Unfortunately, I think those numbers are pretty accurate. Some do go into industry as well, but they probably make up 1-5%

 

[okemba]

Unfortunately, I think those numbers are pretty accurate. Some do go into industry as well, but they probably make up 1-5%

Ooookay. I was expecting my percentages to be completely off. Sad day.

I really don't understand this. The NIH is no doubt aware of this. I don't understand why they continue to fund these programs if they're not meeting their stated goals at all... its basically giving out free MDs to a bunch of (hard-working, decent) people, and not getting much if anything back on their investment research-wise from the vast majority.

???

confusion is had. Do you think the model is going to change at all in the next 20 years? Or will MD/PhD programs become just another footnote in the history of academic medicine?

Also, am I only the only person who thinks its borderline unethical to be running a lab where you know your PhD student and post-doc trainees are only going to learn biological experimental design and analysis skills and thus have almost no job prospects outside of the post-doc treadmill? And to completely not inform them that a PhD is not a key into the career of their dreams?

The vast majority of biology/biochem/BME PhD students I know seem to have this deluded notion in their heads that they should just (hard work)-(tunnel vision) it through their PhD, because at the end their "strong analytical skills" will give them a good shot at a TT-professorship or an industry job.

It seems kind of not nice. I mean, am I missing something, or are these hordes of intelligent people *not at all* making rational evaluations of their trajectory?

 

[Fencer]

The data that I have seen from NIH, AAMC, and/or MD/PhD program directors meetings show numbers that are considerably better than those with almost 40% of MD/PhD graduates getting eventual R-01 (or comparable) funding. Another group of MD/PhD graduates does clinical, translational and/or health care outcome research while been considered "pure clinical". The 40% of 50/50 alluded above, I suspect, includes about 20% of people who has an R-01 but does 50% of clinical work (I belong to this category), but there are other MD/PhD faculty producing quality clinical/translational/HCOR with those credentials. So my take is more at the lines of:

10-15% - multiple R-01s funded, T/TT with 80/20 (research/clinical) position
5-10% - K08/K23 funded, T/TT with 75/25 position
20% - single R01 (or like) funded, T/TT with 50/50 position
20% - clinical research, with NTT 30-50/50-70 position
20% - clinicians
5% - industry
15% - private practice

At 10 years from completing training (last post-doc/residency), about 35% of MD/PhD graduates have had at least one R-01 award or equivalent (i.e.: VA Merit award).


Here is the issue, the batting average for PhD graduates is also about the same in terms of getting R-01 funding (~35%). This was from the NIH workforce report.

 

[gbwillner]

The problem as I see it, Fencer, is that your data is probably averaged over many years, and does not account for drop-out. For example, where would someone fall in your list who acquired a K08, but then was unable to secure an R01 and quit science? Or got an early R01, but did not have it renewed?

The real question is "how are people doing NOW?" THose that graduated several years ago, did everything in their power to maintain the 80/20 track, and are looking for a position in academia? Why would a department support a new scientist when their "multiple R01 funded" guys are losing their grants, and need to support a large lab? I know of two high-profile scientists in my department who lost funding over the last year- one shut his lab down last year and the other is slated to do the same this July. Top institutions are dipping well into their endowments right now to save some of these labs... Where is the money to advance young scientists?

Re: your specific situation- are you the PI on the R01? It seems like it would be difficult to be one with only 50% effort. If you are an ancillary person like a collaborator, does that really count as independent research?

On the ground, right now, it is a disaster. Maybe as the pool thins out a bit things improve in the future, but right NOW is a TERRIBLE time to seek an 80/20 job. Not five or ten years ago, maybe. But it is right now.

 

[okemba]

I know of two high-profile scientists in my department who lost funding over the last year- one shut his lab down last year and the other is slated to do the same this July.

So these are tenured professors. What are they going to do after they shut down their labs?

 

[Fencer]

If it is terrible for us, what would it be if you were, instead of MD/PhD w 4 yrs residency, a PhD with 4 yrs of postdoc? The need for translational science and Bench to/from Bedside research is not going away. Somebody has to do it. Clearly, annual number of biomedical PhD graduates and total number of PhD faculty in R1 and SOM institutions grew at an incredible rate between 1990 and 2010. These institutions benefited from the increased NIH funding that occurred from those years. Although some MD/PhDs might not be funded, there are more likely to survive cuts in the current academic world than PhDs... the resilience of MD/PhDs allow them to be ready to submit another grant (that was misunderstood by a study section). I don't disagree that it is a hard time for many laboratories, but to say when the future is bright when NIH R-01 funding is 22.7% (1997) as compared to terrible because it is 14.3% (2013) is non-sense.

Indeed, the country has an unbalanced budget, large public debt, and too many unfunded liabilities, these things are putting pressures in health care and biomedical research. I will be lobbying in Congress next month to discuss with legislators (mostly their staffers) these issues. Academic salaries for my clinical and clinician-scientist Attendings (~ mid 80s, Houston) were significantly higher than what they are now, at least a 50% net decrease. They still are comparatively to other countries, considerably higher. The bottom line is that the glass is half-empty or half-full depending upon your point-of-view. I choose to be more optimistic and I enjoy doing science, teaching and clinical work for as long as I can.

 

[gbwillner]

If it is terrible for us, what would it be if you were, instead of MD/PhD w 4 yrs residency, a PhD with 4 yrs of postdoc? The need for translational science and Bench to/from Bedside research is not going away. Somebody has to do it. Clearly, annual number of biomedical PhD graduates and total number of PhD faculty in R1 and SOM institutions grew at an incredible rate between 1990 and 2010. These institutions benefited from the increased NIH funding that occurred from those years. Although some MD/PhDs might not be funded, there are more likely to survive cuts in the current academic world than PhDs... the resilience of MD/PhDs allow them to be ready to submit another grant (that was misunderstood by a study section). I don't disagree that it is a hard time for many laboratories, but to say when the future is bright when NIH R-01 funding is 22.7% (1997) as compared to terrible because it is 14.3% (2013) is non-sense.

Indeed, the country has an unbalanced budget, large public debt, and too many unfunded liabilities, these things are putting pressures in health care and biomedical research. I will be lobbying in Congress next month to discuss with legislators (mostly their staffers) these issues. Academic salaries for my clinical and clinician-scientist Attendings (~ mid 80s, Houston) were significantly higher than what they are now, at least a 50% net decrease. They still are comparatively to other countries, considerably higher. The bottom line is that the glass is half-empty or half-full depending upon your point-of-view. I choose to be more optimistic and I enjoy doing science, teaching and clinical work for as long as I can.

Dead on about PhD only candidates right now... Their outlook in terms of academic basic science is abysmal. Sure, the cream of the crop will still succeed. But as a whole, yikes. That doesn't mean we should put on a cheery disposition in comparison. Our investment into our academic training is greatly diminished in the current circumstances. The glass half empty/half full analogy is invalid- the glass is 1/8 "full" at best right now.

Re: the "need" for translational science- both you and Valenin above have brought this up- because you perceive a need doesn't mean it holds value. It clearly does NOT given the lack of interest in funding young investigators beyond their training. We all know what we do is of intense importance to the economy for the knowledge and subsequent technologies that are developed based on our work; yet industry isn't going to start funding science that is not of direct benefit to them, and the US taxpayer (and their representatives) are in no mood to spend any money for anything.

Look, I've been a regular contributor to this site for a long time and I've always had an extremely positive attitude about our career choice and outlook. Things have taken a dramatic turn for the worse in the last 2-3 years. You no longer really have any control of your fate. By that I mean that in the past, if you just worked hard enough writing papers and grants you would get a 80/20 job and have a good chance at a successful academic career. Actually, when I started residency most advisors told me NOT to write grants- that departments should take a chance on me based on my abilities and the grant writing should be done as Asst. Prof. How times have changed! The rate limiting step is no longer under our control for the most part. The money crunch happening right now due to reimbursement cuts AND extremely low grant funding rates means that regardless of your ability or promise, you may still not get a chance to have a good shot at a scientific career because departments know that they will likely not recoup their investment in your start-up. Furthermore, even if they believe in you 100%, they may be too cash-strapped anyway to afford you that chance.

Let's talk about pathology, since that is my specialty. In the past year, medicare has decided that they are cutting reimbursement for 88305 globally by 30% (50% technical component). "Big deal", you might say, "all fields are getting some cuts." But 88305 is by FAR the most common surgical pathology billing code. At some private groups it probably makes up over 90% of their billing. So that's just Medicare, so what? Well, most private insurers pay a multiple of Medicare rates, so when it comes time for renewing their contracts, they also cut their rates by 30%. Actually, even more, because private insurers are scared sh#tless that they will lose their shirts in this new interstate market, and they will want to preserve their profit margins as much as possible. This sounds like I am being hypothetical- let me tell you this is happening right now at my hospital, which is a top-tier place, and is likely happening across the country. So now your hospital tells your department that it's getting 30% less money to operate AND they have to do the same amount of clinical work. The department will first seek to increase revenues by 30% and decrease spending. That is NOT easy to do. So they will eventually have a choice- cut staff salaries, or reduce staff non-clinical time so they can generate revenues. It's an easy choice, really- the latter. That means the academic goals of the department are in peril. Why hire that awesome MSTP who is demanding 50-80% protected research time, when you can hire joe blow who will be 100% clinical and raise departmental revenues? Let me tell you, departments are going for the latter.

At the end of the day, MSTP and PSTP are vanity projects for the good of humanity, but departments are just seeking shelter from the storm outside. To add insult to injury, Medicare is now slashing reimbursement for FISH studies. And some private insurers like Cigna have just announced they will stop paying for clinical pathology professional services altogether. It's not a glass half-full unless you are delusional. And more MSTPers go into pathology than any other field behind IM and Peds.

 

[gbwillner]

So these are tenured professors. What are they going to do after they shut down their labs?

100% clinical and administrative work

 

[Fencer]

Dead on about PhD only candidates right now...
Re: the "need" for translational science- both you and Valenin above have brought this up- because you perceive a need doesn't mean it holds value...
... The rate limiting step is no longer under our control for the most part. The money crunch happening right now due to reimbursement cuts AND extremely low grant funding rates means that regardless of your ability or promise, you may still not get a chance to have a good shot at a scientific career ...
Let's talk about pathology ... medicare has decided that they are cutting reimbursement for 88305 globally by 30% (50% technical component).... your department that it's getting 30% less money to operate AND they have to do the same amount of clinical work. The department will first seek to increase revenues by 30% and decrease spending. .... eventually have a choice- cut staff salaries, or reduce staff non-clinical time so they can generate revenues. .
... It's not a glass half-full unless you are delusional...

Dear gbwillner,

I hear and feel the same pain as you do. In Neurology, CMS also cut 30% rates for EMGs for 2013 (announced in Nov '12) and threaten to do the same for EEGs in 2014. Our professional societies heavily lobbied against these cuts and we were able to show the impact to practices and academic centers. I was on the Hill, talked to CMS people, had email campaigns, and engaged people involved in the process during 2013. The final rules for 2014 were dramatically better and most of the 2013 cuts were reversed. The impact of the ACA to academic centers is significant, and diminishing their ability to use strategic funds to invest in research. As we hear often in administrative meetings, research doesn't pay. The institution ends up paying about 20-40% additional costs to the total award (direct+indirect). Having said that, I am also have to be involved in the development (i.e.: endowments) side of the institutions. See this story: http://chronicle.com/article/Gifts-to-Colleges-Hit/144707/
Think about the population dynamics in the country, the baby boomers (I am at the tail end) are getting to retirement with the mindset of doing legacy projects. Honestly, the negative spiral is not rational. Many institutions are undergoing restructuring and sustainability studies. The overall research structure at many institutions is clearly changing. However, a need will remain (fact), and the marketplace will figure out a model to fulfill the need. It is that plain, and it is not delusional... I still believe that the people best positioned to make the most out of this opportunity are those who do a MD/PhD training (opinion).

Fencer

 

[Patros]

Welp, still waiting on an answer to OP's question. Only thing I have taken away so far is that nobody can agree on how to compare MD/PhD programs, and researchers are getting screwed over.