What do schools look for in MD/PhD applicants

[neurotransmitter17]

Hi all, I hope you're doing well. I attend an Ivy League university in the US but would like to come back to Canada. (Alberta resident) I was hemming and hawing about it, but I think I would like to pursue an MD/PhD. I have spoken to many people familiar with the US process, and they have advised me that if I add some more clinical and score over 517 (a tall order, for sure), I should have reasonable success. My states are (3.8 cGPA/ research from 2011 summer onwards, within undergrad 3 summer fellowships, research throughout 2015/16 year, Spring 2017 term, [was ill Fall 2016], only 15 hours clinical, RIP me). I am really keen on research and would like to pursue it as a career.

How do Canadian schools compare? Do you have any suggestions on what I can do to improve this summer? Thank you  

[insomnias]

As an Ivy grad: if you want to do MD/PhD, stay in the US if you can. Programs there are so much better funded. This will sound strange to everyone here, but apply to Canada as a fall-back and aim for the US. Every MD/PhD program I looked at charges tuition and offers a stipend much lower than any Canadian university. Additionally, research funding isn't as great anywhere in Canada as in an R1. Granted, Canadians have the advantage of being able to apply for NSERC/CIHR grants, whereas US F-1's can't. Further, the people you spoke to probably didn't factor in the fact that you're not a US citizen. That hinders your chances in the US a decent amount.

 

If you want to be competitive for Canada, you have to be competitive for Canadian MD and then have a lot of research. That means that you need high grades (high 3.8 OMSAS) + good ECs + good research + a good MCAT, probably in that order (depending on the school, the MCAT might move up in the list). If you can't make MD cutoffs, you're unlikely to get an interview. Clinical experience isn't a thing that's considered in Canada -- nobody cares about your shadowing. Clinical volunteering is more helpful. As in the US, research is key, but unlike the US, strong research can't compensate for a lack of ECs. Basically look up canmeds competencies and find activities that allow you to demonstrate that you embody / are capable of embodying all of them. 

 

Good luck

[neurotransmitter17]

Hi @insomnias, I saw this just now (2 months later). I think my ECs are ok (tutored underprivileged kids, part of a diversity group, chaired a diversity conference, ran an event to encourage kids to learn science), research is good (3 letters), GPA is what it is, and I think I can bring up the MCAT. I am trying to do more volunteering at a nursing home to add in more clinical volunteering. 

Do you think I have a shot at Canadian MD/PhD programs? I'm trying to decide between applying and delaying a year because my application in the US is going to be seriously delayed.

[BoopityBoop]

It's hard to say what each Canadian MD/PhD program look for, or how they weight GPA, MCATs, and CV's. They seem to be less transparent in that way.

I liked @insomnias post when they first posted it and I want to reiterate their point about funding. The federal research funding in Canada is at a low point, and it seems to be getting more difficult for any researcher/doctoral student to get public funding. When PI's don't have funding, they have a hard time doing really new innovative work that requires new equipment, and/or more man power. Being a student under a PI in financial constraint is a barrier in the student's own growth as a future scientist. Of course there are lessons to be learned in these stressful environments, but whether it's ultimately good for your career and training is hard to say. The funding situation will eventually pick up and get better once the current generation of students are faculty/PI's, but I expect that it will still be tough during everyone's training. That being said - I think the US is in a better state in terms of research and institutional support. Even beyond the NIH's MSTP funding, many institutions still guarantee tuition coverage + handsome stipend throughout your combined degree.

As for not getting an interview if someone doesn't make the MD cut-offs, I have to completely disagree. I think a below average GPA and MCAT score are more easily over-looked when the candidate shows that they are driven, demonstrated past success in obtaining student grants/scholarship, are published authors in international journals, and show their "knack"/vision in their supp app.

I remember someone on this forum made an analogy about MD/PhD applicants vs. MD applicants that I thought was brilliant. They said something on the lines of, "If getting into medical school was like recruiting a players for a professional soccer team, you are going to look for different things in an excellent goalie vs. forward." I.e. If you got Lionel Messi and made him try out to be a goalie, he'd either fail miserably or be lacklustre at best because the guy wasn't made to be a goalie.

But my best advice is this: it never hurt to put in an application and see what happens! Cast a big net, and you can get choosy AFTER you receive all the offers and invitations.

[neurotransmitter17]

Thank you @BoopityBoop for your answer! You seem very knowledgable about the topic  and I really appreciate you sharing your thoughts.

I didn't know that the funding situation was that bad. I worked in 3 different labs in Alberta from 2011-2014 and at least two were doing quite well and making big investments, but these professors had been specifically recruited by the university or otherwise 'special,' so I imagine they had a different situation. Regardless, I agree with your point; insufficient funding can really shape a research experience. 

I know that the US does give money but I am scared that my application is just point blank far too late. I am writing my MCAT on August 24th and my AMCAS application will be submitted around then at the earliest, and I'm not sure how competitive I will be in the cycle. I will consult with my premedical advisor to check it out further, but she has not been terribly encouraging. As a result, I think my best shot for this cycle is in Canada (assuming that there is no bias against Canadians who study in the states as I have heard there is)

My rationale for not delaying unless absolutely necessary is that I really want to get started on the clinician scientist path and don't want to take time off. I am not really sure how a 1 year research tech job will allow me to publish in a measurable way by the time of application, and I would rather not take time to do a masters if I'm already going to be doing such a long training program. Besides, because the US applications are ideally submitted in June, I'm not quite sure how much I can get done in 1 school year - at best I'm going to get two third/fourth author papers. 

With my circumstances, are there any schools worth avoiding/looking more carefully at? I don't have any publications but I've had continuous research fellowships from 2012 (my grade 10 in high school) from AIHS, Department, special scholars program, an endowed fellowship, and twice from the career center. I've worked in the lab for credit for 2 terms. I am a bit nervous honestly, it seems like most people have multiple publications already and whatnot  but that was really hard in the labs I worked in

[BoopityBoop]

@neurotransmitter17

May I suggest that you also consider applying to master's program in addition to MD/PhD programs? I understand that you see a Master's as a waste, and it's very easy too! By doing a master's, however, you will get those needed publications for your future MD/PhD application (if not successful this year), and you will also get a better idea if research is something you NEED to do. If during your first year of master's you're even more assured that you love research and torn between doing an MD or continuing to a PhD, the opportunity is there to transfer into the MD/PhD program. By transferring, you're basically continuing your idea/project for your MSc thesis into a PhD (that is if you want to stay in the same field). 

While I understand your eagerness to get on the clinician-scientists path, I don't know how it would look when someone straight out of undergrad is applying to a MD/PhD with no publications. Ask yourself, "If I were to apply for a PhD program, would I be a strong candidate?" if yes, then ask, "If I were to then apply for the MD program, would I also be a strong candidate?" From what I gather, you sound like may be a great MD applicant, but with limited research experience (i.e. no research experience) you can appear to be a big gamble from the MD/PhD admissions perspective. The successful MD/PhD applicants I've seen coming from undergrad have really spent a good 2-3 years of their undergrad in a lab with several publications (even if it's not first author).

A PhD requires a lot of self-directed learning and problem solving. With med school, there is a strict curriculum - all a student has to do is put in the hours studying, pass the tests, demonstrate they can apply the knowledge in a clinical setting and they'll get their MD. But that is not the case with a PhD - hence the reason some people take 5-6 years doing their PhD's or many drop out half way. PhD's need to demonstrate that they are efficient, resilient, driven, but most importantly, that they have the vision and creativity to survive as an independent researcher someday.

I know it is hard, but I hope you are able to see yourself as an applicant through the lens of an MD/PhD admissions committee. They are looking for someone who they think would survive the 7-8 years, has the proven track record to be able to think of and execute great projects, and has the potential to secure grants/scholarships throughout their studies AND in their future career.

Also remember that this is the opinion of a stranger on the web and not the words of the MD/PhD gate keeper. For all I know, you can get accepted into the program of your dreams and I'd be totally wrong and would need to re-evaluate/reflect on my understanding of a great MD/PhD candidate/applicant. 

Best of luck, and PM me if you want to talk more!
BoopityBoop

[VolumeOverload]

So I can offer perspective as an actual MD/PhD student at a Canadian university and dispel some of the concerns raised in this discussion:

First, yes, the US has lots of well funded programs but it's not as hopeless in Canada as many are making it out to be.  I made a post in the past about this but to reiterate, many MD/PhD programs in Canada have financial supports in place.  In Calgary, the program covers medical school tuition.  If you are externally funded through our provincial agency (which pays $32,000/year), after tuition payments you actually have a fair bit of money left over to sink into living expenses.  To that end, I will have zero to very minimal debt after graduation.  At the University of Toronto, their MD/PhD students get a stipend of $32,000/year (~14k of which will go to tuition fees).   Most if not all Canadian MD/PhD programs have some form of financial assistance exclusive to MD/PhD students.  These stipends are often enough to offset tuition and leave a sizeable amount for living expenses (I've listed two examples above, others include UBC, UManitoba and McGill just to name a few.)  In the US, do you pay international student tuition?  My understanding is that it can be astronomically high in which case you should double check that the financial assistance offered to MD/PhD students is also available to international students.  If not , the financial benefits of staying in the US discussed above are irrelevant. 

I agree that being in a lab under financial constraint is problematic, but the simple answer is don't choose to do your formal graduate training in a lab that is under financial constraint!  The signs for that are typically fairly obvious. It's not like you are randomly assigned to a PI.  Do your research ahead of time and find someone who will be a good fit with your career aspirations. The MD/PhD students from across the country meet once a year in Toronto (CITAC) and I have yet to find someone who was working on a sinking ship. You have an extensive research background and your grades are good - that alone opens a lot of doors when trying to find a placement.

Second, I'm not sure how relevant the soccer analogy is when applying to Canadian programs.  All applicants, regardless of whether they are MD or MD/PhD have to go through the same MMI/MPI as part of the MD stream.  Some schools like Toronto have a separate interview for the PhD portion.  If we go back to the soccer analogy, in that situation you have to demonstrate that you are both an excellent forward and an excellent goalie.
 

[VolumeOverload]

20 minutes ago, BoopityBoop said:

@neurotransmitter17

... From what I gather, you sound like may be a great MD applicant, but with limited research experience (i.e. no research experience) you can appear to be a big gamble from the MD/PhD admissions perspective. The successful MD/PhD applicants I've seen coming from undergrad have really spent a good 2-3 years of their undergrad in a lab with several publications (even if it's not first author)...

OP said they've been involved in research in some capacity since 2011.  I would argue they appear to be an excellent PhD candidate...

[neurotransmitter17]

Thank you both for your insight. I want to clarify, I have been working in research from 2011 (after my grade 9 year). I did 1 summer in a lab before moving, then I stayed 1 semester with another lab, then 1 summer in the lab of someone pretty famous, then 2 full years (2 academic years + 2 summers, including the one after high school) in another lab of a fairly prominent clinician scientist with whom I am very close to and who wrote me a reference. I then moved to the US, where I spent 1 year + 1 summer in one lab, then now 1 semester + 1 summer in my current lab. I have been around in research for quite a while.

My work during high school was really intensive because I hardly went to school and basically was in the lab a lot and ran and designed a bunch of experiments, analyzed a lot of data, etc. Despite my work, we were working on some really new stuff that required a lot of optimization; I started the project and even now it hasn't yet been published. This PI publishes in big name journals but his work really takes time. The first undergrad lab I was in was BME oriented and again, takes a long time to publish but high quality work. In this current lab, I anticipate being an author on a paper that should be sent in soon, but again - I'm not writing it, but I'm doing my share of data collection.  

I have provincial fellowships in 2012, 2014, and then undergraduate fellowships in 2015, 2016, and 2017 along with coursework for credit. 

From this, I know I 100% want to do research as a career in conjunction with clinical work. I am definitely going to be applying to masters programs just in case, but transferring it into a PhD/MD is highly contingent on my acceptance into the MD program, which in of itself is challenging. Also, if I'm going to be taking time off to do a masters, I may as well just work for a year and then apply to the US. The main reason I'm likely not doing many US apps is because my MCAT is going to be late. 

@VolumeOverload, thank you for sharing your experiences. I think the US fees are equally waived for international students, but I am not terribly encouraged by the admissions statistics, especially if one applies late in the cycle like I would be doing. And I agree that reduced funding is fairly obvious with reduced #s of personnel, few recent publications, and even with a conversation. In the US there is not a huge expectation to publish for typical students and in many cases, it's quite hard. do you think I should I just go for it in Canada or do you also think publications are really necessary? 

[VolumeOverload]

1 hour ago, neurotransmitter17 said:

 

@VolumeOverload, thank you for sharing your experiences. I think the US fees are equally waived for international students, but I am not terribly encouraged by the admissions statistics, especially if one applies late in the cycle like I would be doing. And I agree that reduced funding is fairly obvious with reduced #s of personnel, few recent publications, and even with a conversation. In the US there is not a huge expectation to publish for typical students and in many cases, it's quite hard. do you think I should I just go for it in Canada or do you also think publications are really necessary? 

Ultimately publications are important anywhere you go and you'll want to go to a lab that will give you the best opportunity to get them, regardless of whether it is in Canada or the US.  People often incorrectly assume that means going to work with the biggest names in the field.  That certainly looks great on paper but realistically, those PIs tend to have megalabs full of post docs that are constantly churning out data and publications.  I'm sure you've seen this firsthand as well.  At this stage in your career training, lots of facetime with the boss is an asset so you'll want to find a lab where you can have a balance between strong academic productivity and mentorship opportunity. In my opinion, megalabs are great for postdoc'ing during a research fellowship (in Canada, that would be during residency through the Clinician Investigator Program).  Based on your previous post, I'm going to assume your expertise is in basic science.  Working with a young-ish PI who has a translational research focus with a medium-sized lab would be a winning combination.

The culture in the US is hardcore and I commend the students that do their training there.  Some people perform better under constant pressure.  Personally, I don't think that kind of environment is necessary to be successful. In my opinion, a strong PhD consists of 3-5 first authored publications in good journals over the 3-5 years you are in training.  It's more working with the right person than at the right institution that will get you that. 

The institutions in your home province have excellent programs and research cultures.  The vast majority of Canadian programs are exceptional too.  If your circumstances make applying in the US a challenge and you don't want to wait another application cycle, it is my opinion that you are not shooting yourself in the foot by choosing Canada.

[neurotransmitter17]

@VolumeOverload Thank you again for your insight!  I apologize for not being as clear as I ought to have been - in my question I was wondering if you thought that I am a good enough candidate to apply for MD/PhD this year without many publications? But I appreciate your insights on the quality of Canadian programs - 

I totally agree with you about publication necessity and megalabs. I was at two of them and each had 9-12 postdocs + research assistant professors and other support staff. I know building a real research career is really competitive and the people I know who've done it at least in one institution back home had a significant # of publications or a few really high quality ones (think Nature).  

I honestly haven't interacted with very many MD/PhD students at my undergrad institution but the one guy I did meet was definitely a very intense personality. I must saw my undergraduate institution has a really bad stress culture so I can easily see it transferring over.  

Also, if you don't mind me asking, do you know if any MD/PhD programs in Canada prefer particular kinds of students/are more open? I have heard that some Canadian schools look quite disfavourably on students who went abroad for their undergrad because they purportedly think that they won't want to stay in Canada, from my premed advisor, but that's not true for me, though I haven't any way to really show it. 

[insomnias]

On 2017-08-09 at 1:12 PM, neurotransmitter17 said:

Do you think I have a shot at Canadian MD/PhD programs? I'm trying to decide between applying and delaying a year because my application in the US is going to be seriously delayed.

Yes, I think you'll get at least one interview. Whether you can turn that interview into an acceptance is up to you, and your ability to excel in an MMI/MPI. I got two interviews and did terribly at the med school portion of them. Luckily, as others here are suggesting to you, I backed up with a master's, and now I'm re-applying to Canada + adding the US with two papers.

On 2017-08-09 at 8:19 PM, BoopityBoop said:

@insomnias

As for not getting an interview if someone doesn't make the MD cut-offs, I have to completely disagree. I think a below average GPA and MCAT score are more easily over-looked when the candidate shows that they are driven, demonstrated past success in obtaining student grants/scholarship, are published authors in international journals, and show their "knack"/vision in their supp app.

I remember someone on this forum made an analogy about MD/PhD applicants vs. MD applicants that I thought was brilliant. They said something on the lines of, "If getting into medical school was like recruiting a players for a professional soccer team, you are going to look for different things in an excellent goalie vs. forward." I.e. If you got Lionel Messi and made him try out to be a goalie, he'd either fail miserably or be lacklustre at best because the guy wasn't made to be a goalie.

Yeah, I remember that thread. I agree that good research experience can certainly make up for poor stats, but there are some schools at which this won't work -- McGill, Ottawa and McMaster come to mind.

20 hours ago, VolumeOverload said:

So I can offer perspective as an actual MD/PhD student at a Canadian university and dispel some of the concerns raised in this discussion:

First, yes, the US has lots of well funded programs but it's not as hopeless in Canada as many are making it out to be.  I made a post in the past about this but to reiterate, many MD/PhD programs in Canada have financial supports in place.  In Calgary, the program covers medical school tuition.  If you are externally funded through our provincial agency (which pays $32,000/year), after tuition payments you actually have a fair bit of money left over to sink into living expenses.  To that end, I will have zero to very minimal debt after graduation.  At the University of Toronto, their MD/PhD students get a stipend of $32,000/year (~14k of which will go to tuition fees).   Most if not all Canadian MD/PhD programs have some form of financial assistance exclusive to MD/PhD students.  These stipends are often enough to offset tuition and leave a sizeable amount for living expenses (I've listed two examples above, others include UBC, UManitoba and McGill just to name a few.)  In the US, do you pay international student tuition?  My understanding is that it can be astronomically high in which case you should double check that the financial assistance offered to MD/PhD students is also available to international students.  If not , the financial benefits of staying in the US discussed above are irrelevant. 

I agree that being in a lab under financial constraint is problematic, but the simple answer is don't choose to do your formal graduate training in a lab that is under financial constraint!  The signs for that are typically fairly obvious. It's not like you are randomly assigned to a PI.  Do your research ahead of time and find someone who will be a good fit with your career aspirations. The MD/PhD students from across the country meet once a year in Toronto (CITAC) and I have yet to find someone who was working on a sinking ship. You have an extensive research background and your grades are good - that alone opens a lot of doors when trying to find a placement.

Second, I'm not sure how relevant the soccer analogy is when applying to Canadian programs.  All applicants, regardless of whether they are MD or MD/PhD have to go through the same MMI/MPI as part of the MD stream.  Some schools like Toronto have a separate interview for the PhD portion.  If we go back to the soccer analogy, in that situation you have to demonstrate that you are both an excellent forward and an excellent goalie.
 

Thanks for your perspective; it's nice to hear from somebody who's actually a Canadian MD/PhD student. I agree that Canadian MD/PhD students are by no means in dire straits. Still, when I crunched the numbers, US MSTPs definitely win out: tuition waivers for your entire degree (only contingent on passing each course + not dropping out of the PhD), health and dental insurance, stipends that are usually >$25k (though, unlike Canadian stipends, these are taxed -- I believe the first 5 years you live in the US you don't pay tax, thanks to the tax treaty with Canada though), and the name (assuming you're applying to top 10/20 schools), a TL2022A that says your tuition is ~$90k which means a ton of your income if/when you return to Canada won't be taxed (unless you're Ontarian), and the ability to do your residency/rotations at top-tier hospitals, it's difficult to decline a US MSTP for a Canadian MD/PhD. I can certainly foresee situations in which somebody would do it (and I'm hoping I only get accepted to one university so that I don't have to make that decision and ask myself "what if..."), but it would be a tough call.

Quote

Also, if you don't mind me asking, do you know if any MD/PhD programs in Canada prefer particular kinds of students/are more open? I have heard that some Canadian schools look quite disfavourably on students who went abroad for their undergrad because they purportedly think that they won't want to stay in Canada, from my premed advisor, but that's not true for me, though I haven't any way to really show it. 

I never found this to be a problem. Science is too international to be that closed-minded, especially when everyone and their mother did their postdoc at the NIH/Harvard/UMich/another US R1/Oxford/Cambridge.

In summary, I'd go with what everybody else has said: apply to Canada MD/PhD this year + master's programs. If you don't get in, do a master's, publish a bit, and then re-apply to both Canada and the US. Still--here's hoping you get in this year!