what is the rationale for not requiring payback for people who back out and just finish the MD?
I think that if payback was required there would be two problems.
1) Those who decided against a research-based career early in their training would feel intense pressure to finish a half-hearted PhD. A PhD that they would never use. Basically, a payback clause would be forcing them to pay ~$120k for their bad decision to start an MD/PhD program.
Their other alternative would be to complete a PhD. I know that if the student had not started the MD/PhD program they would still owe the same $120k. But, that is in a gradual process for which there are dedicated loans and within a common pathway of MD support. Those leaving the MD/PhD program who are required payback will need $120k to pay off the MD/PhD program. You can't backdate your loans. So then what? Assuming a court would enforce such a contract, would the program have to sue the student in court and garnish future wages? Or do they accept an IOU from the student? Do they hold the student's degree or education until they can find $120k? What if the student turns out to have cancer and is now very concerned about the long physician-scientist training? Does that student then get to leave the PhD for free or are they still left paying the $120k?
Given these scenarios, the most likely outcome is for the student to finish a PhD they're not interested in. That's bad for the lab that they go to in that they are getting a half-motivated student. It's bad for the graduate student who could be in that training position instead. Further, PhD training still involves large amounts of federal funding that shouldn't need to be spent on someone who already decided against a career that doesn't use the research training. It's better for the government to just cut their losses than start paying on PI grants of training grants for a graduate student trainee that will never perform research again.
2) Those who had serious difficulties in their PhDs would have insult added to injury. Many bad things can happen to graduate students (including MD/PhDs) that are out of their control. Their PIs can die, move, or lose funding. Their projects can be based on false premises not discovered until much later. Their project can be scooped. There are many other common stories that are heard in this forum and in the real world. If you've been working hard on a PhD for 3-5+ years with no end in sight, you should have that option to go back to medical school without paying a large financial penalty. I think it would be immoral to essentially force a student to stay in graduate school in perpetuity or make them pay a large fine if their PhD is a failure.
I understand that the system currently can be abused. Everyone worries about the so called "two and screw"--i.e. two years of free medical school within a MD/PhD program, then drop the PhD portion with no time lost and resume medical school. But I think the alternative would be unjustifiably punitive. I trust that 99% of MD/PhD students are honest, ethical individuals who would not consider the "two and screw" without
very good reasons. As it is, this seems far more uncommon than scenarios #1 (loss of interest in PhD training, typically after some time in the PhD) or #2 (PhD failure) above. Perhaps it is because of the extensive research experience required of MD/PhD applicants. Applicants should know what they are getting into after so many years in an undergraduate laboratory. Further, those who are half-hearted about a PhD before starting an MD/PhD program will likely not put in the years of lab work required as an undergraduate.
