“Two roads diverged in a wood, and I—
I took the one less traveled by,
And that has made all the difference.”
Do you have an interest/background in medicine and research, but balk at the prospect of spending eight years getting the MD-PhD degree? You can theoretically do all the same things (i.e. see patients and run a research lab) with only an MD degree. There are plenty of MD’s out there who are successful physician-scientists, and the MD-PhD is certainly the less common path, the road less traveled. So why bother getting a PhD as well?
These are all great questions, worth a fair amount of thought and reflection. Pursuing the rewarding, competitive, and singular pathway of a combined MD-PhD degree is a major decision that warrants a critical evaluation of its associated pros and cons. So without further ado, let’s dive right in.
Pros of the MD-PhD Degree
1 | Fully Funded
Medical school is expensive, with the average medical student graduating in 2017 with a debt of nearly $200,000. In contrast, many MD-PhD students graduate debt-free and may even have a small nest egg saved away. This is because Medical Scientist Training Programs (MSTP) and many non-MSTP MD-PhD programs waive tuition and provide stipends to their students that are comparable to a biology graduate student stipend (~$30,000 of disposable income a year). The stipend is adjusted to match the cost of living in the city in which your school is located.
2 | Options for Fast-Tracking
MD-PhD’s enjoy specialized tracks that enable them to shorten their PhD and residency training. The PhD portion of the dual degree is an average of 4 years (vs. an average of 5-6 years for single degree PhD’s in the biomedical sciences).
Furthermore, MD-PhD graduates can “short-track” their residency into fellowship training. In the case of the three-year internal medicine residency, the American Board of Internal Medicine (ABIM) has a pathway that enables residents with a demonstrated potential for basic science or clinical research to spend only two years doing clinical training before returning to full-time research. These so-called “research residencies” are typically populated by MD-PhD’s, with a few MD-MPH/MD-MS/MD graduates that have strong research credentials thrown into the mix.
3 | Competitiveness for Funding to Start a Lab
According to an NIH report about physician-scientists, MD-PhD’s overall had higher award rates for research program grants (RPGs) (24.6%) than MD’s (21.7%, p<0.01) or PhD’s (21.4%, p<0.01). Furthermore, the award rate for MD-PhD’s from an MSTP program was nearly three times higher than that for MD/PhD’s not from an MSTP program (36.2% vs. 12.3%). If you are interested in more details, there is a wealth of outcomes data in this report as well as the AAMC National MD-PhD Program Outcomes Study.
Cons of the MD-PhD Degree
1 | Delayed Autonomy
The additional four years that an MD-PhD student invests in obtaining a PhD represent a significant opportunity cost (time and money). The ramifications of this can be broad. For example, an MD-PhD student living on a graduate student stipend may not have the financial autonomy to start a family until after they obtain an income (and free time!) commensurate to their training level. Furthermore, the average age of young investigators obtaining their first RPG’s continues to rise (44.3 years for MD-PhD’s, 43.8 years for MD’s, and 41.9 years for PhD’s in 2014). The path of an academic researcher, especially an MD-PhD, creates an extreme delay in full professional autonomy.
2 | Disjointed Training
MD-PhDs are often likened to chimeras in their duality, which is exemplified by the disjointed path to obtaining the MD-PhD degree.
Students typically complete the first two pre-clinical years of medical school, transition to a 4-year PhD program, and then return to medical school to finish the last two clinical years before graduating with their dual degree. Subsequently, most pursue residency and fellowship training in their chosen medical specialties before finally becoming principal investigators (PIs) of a lab. This disjointed pathway forces many MD-PhD’s to play catch-up when they inevitably fall behind in either medicine or research. For instance, a common issue for MD-PhD’s is that their research skills become outdated when they return to clinical training for a number of years during the latter half of medical school and residency.
3| Balancing Clinical and Research Commitments
Juggling the considerable responsibilities of caring for patients and managing research projects can be challenging. Physician-scientists working at academic medical centers may be incentivized (or even pressured) to spend more time seeing patients, a task that earns more revenue for both the physician-scientist and the medical center. It also requires significant time and money for physician-scientists to maintain their clinical skills and board certifications. Consequently, many MD-PhD’s eventually dedicate themselves to either medicine or research and unfortunately let their less-used skill set fade into irrelevance.
Any aspiring student considering a dual MD-PhD degree should think deeply and critically about whether this demanding career path is right for them. There are pros and cons to getting the MD-PhD degree, some of which may be deal-makers or deal-breakers. Ultimately, I see MD-PhD’s as chimeras walking a road less traveled, obtaining unique toolkits to address gaps in the existing body of medical knowledge and therapies. If this aligns with your goals, it can be an outstanding career!
If you are considering an MD-PhD degree but are unsure, please consider the Med School Insiders general advising services. We have advisers who have completed this degree and can give you detailed, real-world advice and feedback!