Why MD PhD?

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yjj8817

yjj8817

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Why is it that some people choose to go to this route? Can't you do a very similar thing by just earning your MD and going into academic medicine? What exactly is M.D. Ph. D. degree?
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yjj8817 said:
Why is it that some people choose to go to this route? Can't you do a very similar thing by just earning your MD and going into academic medicine? What exactly is M.D. Ph. D. degree?
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From my understanding:

First, there is no "MD/PhD degree". They are two separate degrees; however, there are dual degree programs that allow you to earn both in a shorter period of time than it would take to earn them separately.

Second, the majority of MD/PhDs to go into academic medicine. They go into academic medicine, however, with the hopes of having a career that devotes a significant amount of time to research.

To do research as part of your career (ie, to be a PI/Principal Investigator, have protected time, etc), though, you need grants. To get a grant, you need to have previous research experience -- actual experience, too, not the type you get being an assistant as undergrad or med student.

Doing a PhD, by the nature of the degree, gives you this experience. Now, there are ways to get it other than doing a PhD, the most common of which is doing a post-doc(s) for a few years. As such, you have many MD-only researchers who completed such things post-residency. Either way, however, to launch a successful research career, you will need to dedicate a few extra years to it.

To conclude, someone does an MD/PhD because they want to do research and know this early on/as a pre-med and would prefer the combined degree program, for various reasons (ex, not losing clinical skills) over post-docs after completing residency.
 
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So your patients can call you Doctor twice.
 
I agree with everything Starlightembers said. To add to that, MD/PhD programs try to expose the students to research and situations where research can be directly applied to clinical medicine. In essence taking work from the "bench to the bedside". We tend to do a lot of translational work.
 
I was under the impression that the Stipend \ Tuition waiving was a big reason
 
walph said:
I was under the impression that the Stipend \ Tuition waiving was a big reason
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It helps but I don't think it is the major reason people do it. I would argue it makes horrible business sense, unless maybe you go into FM (rare for an MD/PhD). Grad school is almost universally a "paid position", so all you have to pay for is medical school.

Lets say cost of attendance is 50K a year, you save 200K over minimum of seven years doing an MD/PhD (eight is more likely). You have lost an additional three-four years of income, which will likely be at 200K/year or much more depending on a couple factors. You could have earned over 800K in the same time span. 800k earned vs. 200k saved?

The three/four/five/more years you spend in the grad years are not a good trade off for the paid-for MD degree. I think you're very misguided if you enter an MD/PhD program strictly for money reasons. It being paid for helps you make choices of how YOU want to conduct your career split, i.e, you get paid more for doing clincal work compared to doing research work. If everyone had debt, they'd be less likely to engage in meaningful research or they might choose specialties they wouldn't have, just to earn more money to pay back loans.
 
I know for me, my area of research doesn't overlap well with the medical school curriculum (applied mathematics/statistics/computer science). I needed the human biology and clinical approach, as well as the mathematics to model clinical and biological phenomena. You aren't going to get much in the way of combinatorics, manifold topology, or evolutionary computing in a medical school curriculum.

Many of the students in my program doing the traditional PhD in biology are mainly doing it for extra research experience with the hopes of spending >80% of their career in research. To get a PI-level NIH grant these days, you need several publications before applying. Doing a PhD (at least in my program) requires three publications before graduation, which is a help when applying to research residencies and post-docs.
 
walph said:
I was under the impression that the Stipend \ Tuition waiving was a big reason
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This is an awful reason to spend an extra 3 - 4+ years of your life working on a PhD.

tiedyeddog said:
Wow, that seems like a lot... Do they all have to be first authors?
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This is pretty typical for PhD programs, actually, not just those affiliated with MD/PhD programs.
 
Ours allows 1st and 2nd author, provided the 2nd are in high impact journals (some others require 3 1st in high impact journals). For math, it's usually just one 1st author publication (kind of the publish-your-dissertation sort of paper).
 
Starlightembers said:
Second, the majority of MD/PhDs to go into academic medicine. They go into academic medicine, however, with the hopes of having a career that devotes a significant amount of time to research.
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This is a very common misconception. In fact, >50% of MD/PhDs don't do any research at all after residency. This was published by the Howard Hughes Medical Institute several years ago. They found that the programs where people take one year off during medical school were just as likely to pursue research after residency than non-MSTP MD/PhDs, but even the MSTPs were <50%.

The programs were intended to be a research track and they should absolutely sell it that way, but it is tragically not what is happening.
 
free tuition?
monthly stipend?
no debt?
or is it Doctor Doctor?

The last one was just me being me I guess :/
 
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thesauce said:
This is a very common misconception. In fact, >50% of MD/PhDs don't do any research at all after residency. This was published by the Howard Hughes Medical Institute several years ago. They found that the programs where people take one year off during medical school were just as likely to pursue research after residency than non-MSTP MD/PhDs, but even the MSTPs were <50%.

The programs were intended to be a research track and they should absolutely sell it that way, but it is tragically not what is happening.
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No matter how much research they actually do, the majority do indeed go into academics and it is fair to say that, upon entering the program, the majority have the goal to enter academics with a research focus. I will attempt to find the links for you that show this.
 
thesauce said:
This is a very common misconception. In fact, >50% of MD/PhDs don't do any research at all after residency. This was published by the Howard Hughes Medical Institute several years ago. They found that the programs where people take one year off during medical school were just as likely to pursue research after residency than non-MSTP MD/PhDs, but even the MSTPs were <50%.

The programs were intended to be a research track and they should absolutely sell it that way, but it is tragically not what is happening.
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one of my recent interviewers brought this up with me (the number he quoted was only ~25% of MSTP graduates end up doing research). i never knew it was such a low number but sadly, life often gets in the way!
 
soundnin said:
one of my recent interviewers brought this up with me (the number he quoted was only ~25% of MSTP graduates end up doing research). i never knew it was such a low number but sadly, life often gets in the way!
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I think it has to do with unrealistic expectations about how you can conduct your career. Of course, everyone who enters MSTPs, or the like, has very high hopes of having clinical and research duties as an attending. I think a very, very small fraction of them enter knowing they don't want to be a clinician-scientist.

Applicants usually base their self made concepts of how their career will go off seeing a couple of MD/PhD's who have been at least somewhat successful. They tend not to see the ones who either a. are straight clinical, academic or are b. private practice. It's a real crap shoot, because applicants have a tough time discerning if in 15 years they will be able to juggle both duties, often without knowing what speciality they'll be going into. And, in the end, clinical duties will win out, sadly enough. It's not impossible, just very hard. I have seen a couple people who are awful at being a clinician and a research because of the time split, but I have also seen a few be super successful at both. It seems like to me getting a great mentor early on helps people when they actually start running their lab.

I still, deep down want to switch over to our MD/PhD program from straight MD but I am also positive I'll be going in some subspecialty of surgery and fear that will make it impossible to be a decent surgeon-scientist. I have seen more surgeon MD/PhDs fail at this than be successful. :\
 
Starlightembers said:
No matter how much research they actually do, the majority do indeed go into academics and it is fair to say that, upon entering the program, the majority have the goal to enter academics with a research focus. I will attempt to find the links for you that show this.
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I think the point he was trying to make is that is still wasted government money (for MSTP programs) and resources. It doesn't matter if they go into academics, the program is still pointless if they don't engage in meaningful research as attendings. If this helps applicants push themselves to apply, I don't know. I am sure some small amount of Mud Phuds do the program to help on their residency apps anyway, but I would hope not a huge amount of them do it.
 
is it because a lot of md/phds go into PP because they were secretly gunning for $$$$ the whole time?
 
synthmonsterjax said:
is it because a lot of md/phds go into PP because they were secretly gunning for $$$$ the whole time?
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No, I would think hardly anyone starts out gunning for the dollar bills. I think maybe after 12+ years of the MD/PhD and then residency, life goals in general probably change. People get tired of being poor, or being in academics in general, and just want out.

If anyone is applying to MD/PhD programs knowing they want to go into PP they're misguided... It's a waste of time, future wages, and taxpayer dollars.
 
tiedyeddog said:
No, I would think hardly anyone starts out gunning for the dollar bills. I think maybe after 12+ years of the MD/PhD and then residency, life goals in general probably change. People get tired of being poor, or being in academics in general, and just want out.

If anyone is applying to MD/PhD programs knowing they want to go into PP they're misguided... It's a waste of time, future wages, and taxpayer dollars.
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oh that's true. but it's interesting that among this crowd (of super accomplished, talented, energetic, etc. people), the tendency is for the idealistic "i'll be a physician and a scientist" viewpoint to turn into a more "realistic" one. i wonder if there's any exchange in the other direction. certainly something to keep in mind if i consider md/phd. seems like life is simpler if you stick to fewer roles and do them well.
 
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synthmonsterjax said:
oh that's true. but it's interesting that among this crowd (of super accomplished, talented, energetic, etc.) people, the tendency is for the idealistic "i'll be a physician and a scientist" viewpoint to turn into a more "realistic" one. i wonder if there's any exchange in the other direction. certainly something to keep in mind if i consider md/phd. seems like life is simpler if you stick to fewer roles and do them well.
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I guess people eventually figure out you can't eat your dreams. :p

A few make it work, not everyone does or wants to.
 
tiedyeddog said:
No, I would think hardly anyone starts out gunning for the dollar bills. I think maybe after 12+ years of the MD/PhD and then residency, life goals in general probably change. People get tired of being poor, or being in academics in general, and just want out.

If anyone is applying to MD/PhD programs knowing they want to go into PP they're misguided... It's a waste of time, future wages, and taxpayer dollars.
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Absolutely agree. Another reason is that most MD/PhDs end up matching into competitive, lucrative, life-style specialties at top institutions from which they're heavily recruited to top private practices. It's hard to turn down the top private practice gigs at double the pay for an uncertain future (in terms of pay, grants, etc) in academics, especially if they have a family.
 
tiedyeddog said:
I think the point he was trying to make is that is still wasted government money (for MSTP programs) and resources. It doesn't matter if they go into academics, the program is still pointless if they don't engage in meaningful research as attendings. If this helps applicants push themselves to apply, I don't know. I am sure some small amount of Mud Phuds do the program to help on their residency apps anyway, but I would hope not a huge amount of them do it.
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Those in academics make less, especially those with clinical time. For those who do stay true to the original intent of the program, the waiver and stipend allows pursuing that career more feasible. That is the point of it -- not to attract applicants. I agree the statistics are unfortunate, however.
 
Salaried physicians in academic center do not earn $200k right off the bat. Depending on specialty, it is more on low $100k ranges for an instructor or assistant professor. If you have a lot of debt, and stay in academic medicine, you will starve. MD/PhD does sound appealing for people wanting academic medicine because it is debt free. MD/PhD training does give an edge for people to obtain RO1 grant. It is out of question for a MD to get a RO1 without extensive post-doc training which is even more unpalatable than a MD/PhD, because you will have the debt to pay while doing research.
 
Underarchiever said:
Salaried physicians in academic center do not earn $200k right off the bat. Depending on specialty, it is more on low $100k ranges for an instructor or assistant professor. If you have a lot of debt, and stay in academic medicine, you will starve. MD/PhD does sound appealing for people wanting academic medicine because it is debt free. MD/PhD training does give an edge for people to obtain RO1 grant. It is out of question for a MD to get a RO1 without extensive post-doc training which is even more unpalatable than a MD/PhD, because you will have the debt to pay while doing research.
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This. Exactly.

tiedyeddog said:
I think you mean research time. More clinical time = more dollar bills.
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Blah. Yes, that is what I meant.
 
Underarchiever said:
Salaried physicians in academic center do not earn $200k right off the bat. Depending on specialty, it is more on low $100k ranges for an instructor or assistant professor.
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Depends on the specialty. 200k starting in academics would be on the low side for some specialties.

Underarchiever said:
If you have a lot of debt, and stay in academic medicine, you will starve.
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Depends on the amount of debt and whether it is government-backed. 10 years at a non-profit discharges the government-backed debt.

Underarchiever said:
MD/PhD training does give an edge for people to obtain RO1 grant.
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Definitely agree

Underarchiever said:
It is out of question for a MD to get a RO1 without extensive post-doc training
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It isn't done very often, but is not out of the question. If we're talking about bench research I agree that you'll have to show significant training in that area and have a great proposal. There are no short-cuts, but there are definitely longer ways to get to the same goal.

Underarchiever said:
which is even more unpalatable than a MD/PhD, because you will have the debt to pay while doing research.
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If the MD is smart, they'll take advantage of the NIH Loan Repayment Program and get $35k/yr towards their loans (on top of their pay, obviously). Not to mention it adds to the time of working at a non-profit to discharge the debt completely. Income-based repayment will make the debt payments negligible during the post-doc.
 
Yes - it is sad that >80% of MSTPs don't end up doing research. But like thesauce said, MSTP graduates have the highest percentage of people engaged in research even though it is ~50%. It is there is more than just being money-hungry - I think.

There was a study published that showed that ~80% of the MSTP graduates applied for NIH grants and most of the graduates have planned substatial involvement in research (OR: 10.3). Not everyone got funded and I think the biggest factor is that the unfunded MSTPs proceed to take on clinical responsibilities till the next cycle rolls along. There have also been studies that show that receiving an NIH grant early in the career is indicative of career research involvement. It could just be a pattern that develops until the unfunded ones settle on private practice/clinic etc.

But yes, the attraction of lucrative residencies can't be ruled out. There was a study that showed that MD/PhD graduation was positively associated with planned training in dermatology, neurology, ophthalmology, pathology, pediatrics, or radiology. Also, MD/PhD graduates with debt (usually ones with families during training), are more likely to end up going into clinical practice.

It is definitely a complex picture with a whole bunch of factors playing into it.
 
I did see one or two pure MD succeeding in RO1 grants without significant post-doc experiences. But that was in the subject of specialized area. Most MDs are co-investigators in grants for basic or translational scientists. In rhe last 10 years, I have not seen one MD without post-doc experience succeeding in obtaining RO1 funding in our institute. Thirty years ago, it is a lot easier for a MD to do science and to obtain funding.
 
If an assistant professor starts out more than 200k, it usually means that the position requires heavy services such as transplant surgery. It will not have much room for science. It is not compatible with bench research. I doubt a MD/PhD degree much usage for these specialties.
 
so if you wanted to obtain M.D. Ph. D., you go through the MD PhD program offered by one school? you don't earn M.D. and Ph. D. degrees at different schools right?

and after that you earn your residency for clinical experience?
 
yjj8817 said:
so if you wanted to obtain M.D. Ph. D., you go through the MD PhD program offered by one school? you don't earn M.D. and Ph. D. degrees at different schools right?
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Yes.

yjj8817 said:
and after that you earn your residency for clinical experience?
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Yes, you'd still need to complete a residency if you want to be an autonomous physician. You'd also have to complete a separate research fellowship if you want to run your own lab (for all practical purposes).
 
yjj8817 said:
so if you wanted to obtain M.D. Ph. D., you go through the MD PhD program offered by one school? you don't earn M.D. and Ph. D. degrees at different schools right?

and after that you earn your residency for clinical experience?
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You can obtain your MD and PhD at differing schools, but it's probably not the best way to go about getting an MD/PhD. Going the traditional route simplifies everything and can possibly shorten the process of getting both degrees. In many cases you'll be eligible for stipend support throughout the duration of the process, as many people have already mentioned.

If you approach each degree separately, you will have to go through two admission cycles, one for each degree. Most stand-alone PhD programs will offer free tuition, a livable stipend, and free health insurance to all admitted students. So, in either situation, your PhD degree will be paid for. Your MD will be a different story. Applying to med school with a PhD in hand isn't going to necessarily open the floodgates of financial aid, even if you practically bleed clinical and translational research. So you'll likely be paying for most, if not all, of the four years of medical school.
 
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