What motivates you to do a MD/PhD program?

[jantyme]

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I just wanted to know why everyone wanted to go this particular route. I was planning on trying to get into a MD/PhD program and a medical doctor has tried to disuade me from it. In his opinion lots of people never finish the program and it is better to get your MD first and if you still want to pursue it then get your PhD after that. That way you can work nights or weekends in the ER or something while you are going to school. I just wanted to see whateveryone else's opinion was and if they were plannning on getting the dual degrees only through a combined program and what your perceived pros and cons are.

 

[coldchemist]

Check out the following website:

http://intransit.us


IMHO, the medical doctor who is giving you information doesn't know what he's talking about.

 

[Goober]

Originally posted by coldchemist

IMHO, the medical doctor who is giving you information doesn't know what he's talking about.

Actually I don't think that he is that far off base. In my class we had 8 MD-PhD. students. Only 5 completed the PhD portion and of those 5 only 2 are in academic medicine where they are actually doing research. If you aren't doing active research as a career, there's really not a whole lot reason to get a PhD.

 

[coldchemist]

I was thinking more about the difference between doing a combined degree program, and doing the PhD separately following the MD. Doing them separately is going to cost you a lot of money, whereas you can get them both for free in a combined degree program.

Ethical obligations aside, there is at least one really good reason to do the combined degree despite a career that doesn't involve a lot of active research: your odds of getting into the residency program of your choice are way higher.

 

[JD428]

Originally posted by jantyme
I was planning on trying to get into a MD/PhD program and a medical doctor has tried to disuade me from it.

I've also heard this from MDs, but I've never heard it from an MD who spends the majority of his/her time in research. Once comment I have consistently heard from MDs in research is that if MSTPs had been as well developed and organized when they were in school as they are now, they probably would have applied to them. Obviously, if you want to be primarily a clinical physician an MSTP would be an incredible waste of time and effort. But if you're looking for a medically-oriented basic science career, you should definitely consider the MSTP route.
I think I agree that the doctor you spoke with doesn't really know what he's talking about. Maybe students dropping out was a serious problem back when he went to med school, but I find it hard to believe that could be the case today, at leat at the NIH-funded programs.

 

[Neuronix]

What motivates me is an excitement for both medicine and research. If you know you like both and you have some idea of integrating the two in the future, the MD/PhD route may be good for you.

It is true that alot of people do not finish the program... I have no good numbers for attrition rates, but I'd suggest it's at least 25% at most programs. Still, this works in your favor for a number of reasons. At MSTPs, they cannot ask for their money back, so it is their best interest to keep you happy. Besides, what's the worst that can happen... You decide it's not for you and you go get your MD? That doesn't seem like a bad thing to me. Some people have the misconception that leaving a MD/PhD program means you're out completely, but that's not true. You're free to finish up your MD.

There's several disadvantages to doing the two degrees separately. First is the additional time involved with a non-integrated cirriculum. By doing the combined degree you are shaving a year or two off of med school and grad school (diminished elective requirements in med school plus diminished coursework, teaching, and rotation requirements in grad school). The second is of course the cost. This manifests itself in an unexpected way as well. After all those years of medical school and/or residency training, when you have all those dollar bills and the status of actually being a boss staring at you, will you really want to go back to square one as a grad student? That way it's good to do your research before you actually get out there, or you might never come back. Another thing is that MD/PhD students get a level of oversight and advisement that you just don't see with PhD-only students. This is more an indightment of the PhD system, with it's attration rate of more like 50%, than of the MD/PhD system.

I honestly don't know why you would want to work in the ER while in grad school unless you have some special job you can do. I don't know how you're going to stay employed only one or two days a week, the amount you'll make will be negligable, and what sort of job are you going to have as without an ER residency when you really aren't allowed to do anything?

Anyhow, it's just things to think about. You'll hear alot of dissuation from the MD/PhD route. Some of it is true, but alot of it is just that people don't understand what the MD/PhD is good for or have misconceptions about what's involveed.

Good luck!

 

[Gradient Echo]

Medical school does not train people to think like scientists, although many MDs manage to do it because of their previous scientific background or the fact that they are generally very bright.

I wanted the PhD because I want to work on research from the ground up, instead of handing it off to clinicians when it comes to human testing (PhDs) or just be the relay clinical guy who didnt really come up with the fundamental idea behind the research (MD).

By having both, I can have my cake and eat it too. It means that I can work on bench research and oversee it with patients directly.

 

[MacGyver]

Originally posted by Goober
Actually I don't think that he is that far off base. In my class we had 8 MD-PhD. students. Only 5 completed the PhD portion and of those 5 only 2 are in academic medicine where they are actually doing research. If you aren't doing active research as a career, there's really not a whole lot reason to get a PhD.

First, you were not in an NIH funded MSTP, MD/PhD program, which makes a HUGE difference:

Originally posted by Goober
I started paying off my loans during residency. The first year I lived pretty cheaply. I had hospital subsidized apartment which was deducted from my salary before taxes, no deposit and free electricity. I ate most of my meals at the hospital since we had unlimited meal allowance and a decent doctors dining room seperate from the main hospital cafe. After the first year I did moonlighting once a month on the weekend which I found covered my monthly payment pretty easily. This approach won't work for everybody but I managed to pay off my 100k debt 3 years into practice.

Secondly, that outcome indicates that your school had a very poor MD/PhD program, because that is an anomaly that doesnt happen much in the well funded MSTP programs.

Either that MD/PhD program didnt screen correctly for people interested in MD/Phd for the right reasons, OR they failed to provide adequate support for them during their tenure and they dropped out. Its probably a combination of both.

At NIH funded MSTP programs, 95% of the students complete both degrees, and 85% go into academic medicine. 13% choose to go work for industry, where they are still engaged in research, and only 2% drop out or go into clinical work w/ no research.

 

[Neuronix]

Originally posted by MacGyver
At NIH funded MSTP programs, 95% of the students complete both degrees, and 85% go into academic medicine. 13% choose to go work for industry, where they are still engaged in research, and only 2% drop out or go into clinical work w/ no research.

I don't buy these numbers. Do you have a source for them?

 

[cmz]

Hrm. There's a rumor that at Baylor, the class 2 years ahead of me... 8 out of 16 dropped the PhD part and just finished up MD. Sassy, isn't it?

 

[biplane]

I'm at Cornell/Rockefeller, and over the last eight years (~100 students), I only know of 4 or 5 students that have dropped out. In my opinion, that is outstanding--and unexpected. Most bright 21-22 year olds don't totally know what it means to join an MD/PhD program, and people's goals change as they train.

As a post-note, I have heard that there are many programs where up to 25% of students do not graduate. The average person does not want to deal with the hassle of indefinite training, especially when given an easier way out. It is hard to know how to interpret that--whether they recruited people that were not as committed or whether there are structural problems with the program.

I'd advise you to make sure you go to a program where the support (both administrative and peer) exists to get you through the program. Most 1st-2nd year MD/PhD students think they are future Nobel prize material, and therefore most end up a little demoralized when reality intrudes. In research as in life, the key is understanding your goals and overcoming adversity to get there.

I personally believe this degree is great once you have had a chance to complete both. As previous posters have noted, you have a combination of skills that are unique. If you have any doubts about this, listen to some molecular biologists discuss why a mouse died of X or talk to a 60year old M.D. oncologist about telomeres, basic science whatever.

If you really want to do basic research, you can do a couple of things from your position: 1) do a Ph.D. 2) take an extra year in med school to get some publications out or 3) commit yourself to additional research training during your fellowship (postdoctoral or clinical) with NIH funded loan-relief. As you go from 1--> 3, the time in training shortens but the quality of scientific training is less uniform (i.e. you have to judge how ready you are and that can be hard to do). The rare (i.e. lucky, brilliant) person can publish ground-breaking science and launch their career in a year. An additional consideration is whether you will use your potential thesis in your future research. If your thesis applies to your clinical or future research specialty, then it is more valuable than if you totally change. You should also consider whether things are going well in lab--if you are "stuck" and in a malignant laboratory then it is more risky to commit to a Ph.D. [sorry this reply morphed into a reply to a different thread]

The bottom line is that you can have a research career from any of these pathways, but the risk-space calculation will be different for each person.

 

[MacGyver]

Originally posted by cmz
Hrm. There's a rumor that at Baylor, the class 2 years ahead of me... 8 out of 16 dropped the PhD part and just finished up MD. Sassy, isn't it?

What that tells me is that Baylor's MSTP is in disarray and just not a very good program.

The people who run an MSTP are supposed to screen out people who arent really interested in the PhD part, and they are also supposed to give great support for the people who are in the program.

If half of the class is dropping the PHD, that means that one or both of those things arent happening.

 

[Neuronix]

Originally posted by MacGyver
If half of the class is dropping the PHD, that means that one or both of those things arent happening.

In Baylor's case, it may be due to the fact that not everyone has funding during the first two years. Penn used to only fund half of its incoming class and as a result the dropout rate was once much higher.

Still, I have a hard time believing that only 4 or 5 have left Cornell's program in the past 8 years. A certain amount of the dropout has to do with factors that are out of the institution's control.

 

[Goober]

Originally posted by MacGyver
First, you were not in an NIH funded MSTP, MD/PhD program, which makes a HUGE difference:



Secondly, that outcome indicates that your school had a very poor MD/PhD program, because that is an anomaly that doesnt happen much in the well funded MSTP programs.

Either that MD/PhD program didnt screen correctly for people interested in MD/Phd for the right reasons, OR they failed to provide adequate support for them during their tenure and they dropped out. Its probably a combination of both.

At NIH funded MSTP programs, 95% of the students complete both degrees, and 85% go into academic medicine. 13% choose to go work for industry, where they are still engaged in research, and only 2% drop out or go into clinical work w/ no research.

Actually my financial situation during med school has little to do with MD-PhDs at my school since I was never one of them 😛
I don't know what well funded means. I know they had full tuition plus $15,000 stipend for up to 8 years. Is that well funded- I don't know? Of the 5 that did finish the program they are all in academic institutions which would technically constitute an academic job but only 2 are really doing any meaningful research. The others really are clinicians who occasional publish a case study or something similar.

 

[biplane]

I know it sounds like very few people drop out of our program. I don't understand why there aren't more because, like you said, there are many other factors involved. Two people out of fifteen dropped out of my class and that was unprecedented. It hasn't happened since then either. However, we have a smaller class size than WashU or Penn.

I think it also has something to do with the kinds of science people are interested in here. Our program has an extremely basic science bent--the faculty are that way and they select similarly minded students. As a result, students in our program tend to commit to very basic projects--not many people here work for someone with patient care responsibilities also for example. I think that is important because it is dissatisfaction with the lab years that prompts drop-outs.

 

[Goober]

Originally posted by Neuronix
I don't buy these numbers. Do you have a source for them?

you are right to question the numbers 😀

here is a link to an NIH study that looked at the careers of MSTP graduates from the 70's through the 90's. They had 410 people that finished both MD and PhD, BUT also had 268 people who were in the MSTP but only finished the MD. I would find it very hard to believe that the number that complete both degrees is anywhere close to 95%.

Another interesting tidbit is that MD-PhDs are in academia 83% and the MDs-only were at 66%. The latter being much higher than I would have thought.

http://www.nigms.nih.gov/news/reports/mstpstudy/mstp-print.html

 

[MacGyver]

Originally posted by Goober
you are right to question the numbers 😀

here is a link to an NIH study that looked at the careers of MSTP graduates from the 70's through the 90's. They had 410 people that finished both MD and PhD, BUT also had 268 people who were in the MSTP but only finished the MD. I would find it very hard to believe that the number that complete both degrees is anywhere close to 95%.

Another interesting tidbit is that MD-PhDs are in academia 83% and the MDs-only were at 66%. The latter being much higher than I would have thought.

http://www.nigms.nih.gov/news/reports/mstpstudy/mstp-print.html

Those "MD only" are not just regular MDs though, they were clearly interested in PhDs, and most of them compelted some PHD training and got some publications in a lab before they decided to go MD only.

Besides, MSTP beat out MDs in every single category of research. More total publications, more NIH grants, more publications per year, etc.

 

[MacGyver]

Originally posted by Goober
Actually my financial situation during med school has little to do with MD-PhDs at my school since I was never one of them 😛
I don't know what well funded means. I know they had full tuition plus $15,000 stipend for up to 8 years. Is that well funded- I don't know? Of the 5 that did finish the program they are all in academic institutions which would technically constitute an academic job but only 2 are really doing any meaningful research. The others really are clinicians who occasional publish a case study or something similar.

Again, you must have attended a school with a sorry ass MD/PHD program. No MSTP program has drop out rates even close to that, or they would lose funding.

That poor performance is an indicator of YOUR SCHOOL'S PROGRAM IN PARTICULAR, NOT MD/PHD AS A WHOLE.

 

[Goober]

Originally posted by MacGyver
Those "MD only" are not just regular MDs though, they were clearly interested in PhDs, and most of them compelted some PHD training and got some publications in a lab before they decided to go MD only.

Besides, MSTP beat out MDs in every single category of research. More total publications, more NIH grants, more publications per year, etc.

I don't understand your point. Yes I agree that MDPhDs have completed more research and have more publications but that was not what I was arguing. You were claiming that 95% of MSTP finish both degrees. Where did this number come from? Did you simply just make it up? I mean if the NIH's own study has 410 MDPhDs and 268 MDs that dropped out of the PhD portion how did you come up with 95%? The NIH own figures seem to indicate the dropout rate is closer to 39%. Did the NIH publish another study to refute this study?

Personally I don't really care what the completion rates are for MD-PhD programs but you seem to be trolling without any facts to back up anything you say.

 

[Habari]

I mean if the NIH's own study has 410 MDPhDs and 268 MDs that dropped out of the PhD portion how did you come up with 95%? The NIH own figures seem to indicate the dropout rate is closer to 39%. Did the NIH publish another study to refute this study?

the period covered by the nih study took place during a time marked by relatively high attrition. this trend continued until the early/mid 90's when rules for funding became more stringent and programs were placed under greater scrutiny. admission for the programs have become markedly more competitive, and programs are able, in general, to choose students who seem more committed to finishing the dual degrees. when i have time i'll find the source on this [i actually think it was an admin at a prominent mstp in MO]. i'm not sure if more recent studies have been done.

 

[jantyme]

Thanks for all the info. I looked up that study and it was very interesting.😀

 

[Goober]

Originally posted by Habari
the period covered by the nih study took place during a time marked by relatively high attrition. this trend continued until the early/mid 90's when rules for funding became more stringent and programs were placed under greater scrutiny. admission for the programs have become markedly more competitive, and programs are able, in general, to choose students who seem more committed to finishing the dual degrees. when i have time i'll find the source on this [i actually think it was an admin at a prominent mstp in MO]. i'm not sure if more recent studies have been done.

Even if what you are saying is true, it would be impossible to draw any conclusions about more recent graduates because these programs take 7-8 years to complete. From the mid 1990s to now would only represent a very small sample size to determine a definite trend. Anybody quoting some MSTP admin would only be anecdotal evidence at best.

 

[Maebea]

Originally posted by Goober
Even if what you are saying is true, it would be impossible to draw any conclusions about more recent graduates because these programs take 7-8 years to complete. From the mid 1990s to now would only represent a very small sample size to determine a definite trend. Anybody quoting some MSTP admin would only be anecdotal evidence at best.

This is a good point. The study was written in 1998. If you figure 3 years for residency and another few years for clinical fellowship, the data would only approach any sort of accuracy for pre-1993 grads.

Regarding what Habari was told, if he is quoting who I think he is quoting, then that person does have some hard data on residency choices by MD/PhD grads. The administrator did a survey that included 39 MD/PhD programs around the country. The survey looked at residency choices of grads, and showed a definite trend away from the "traditional" MD/PhD-friendly residencies of Medicine, Pathology & Pediatrics. Broken into 5-year cohorts, the percentage going into these 3 areas is as follows:

1976-1980 74%
1981-1985 66%
1986-1990 61%
1991-1995 57%
1996-2000 51%
2000-2002 48%

(As far as I know, this study has not been published anywhere.)

Granted, the choice of residency does not necessarily equate with whether or not one will do research. But MD/PhD programs are concerned about this trend because their bias is that it is harder to do research in some specialties. Also, they are fearful that highly lucrative private practice fields like derm, ophthalmology, and rads will pull MD/PhDs away from academic positions. Why should they care? Well, the NIH wants to make sure it is getting its money's worth, and they might cut funding if it appears that MD/PhD programs are preparing indviduals for lucrative practices rather than research careers.

 

[jantyme]

bump😀

 

[Joe N]

First of all I'm surprised at the MSTP vs non-MSTP angle. I can't quote the studies, but it's commonly accepted that MSTPs leave the clinic (remain in clinical departments) and go into basic science research vs. non-MSTPs, who stay more clinically oriented. This is probably due to the strength of MSTP programs and the high level of students that they recruit.

Regardless of where you go attrition is considerable. Don't let this happen to you.

Back to the original question. What motivated me? I had the ego to think I could make a difference and the fortitude to go for it. It's a life long challenge with no guarantee of compensation, but as interesting as you make it. When I'm 65 they will kindly ask me to leave the clinic, but when I'm 85 they will have to drag me- kicking and screaming- from my lab.

Joe