What are the pros/cons?: PhD during MD? PhD before MD? PhD after MD?

[TheDarkPassenger]

Hi everyone,

I know this has been briefly discussed in other threads, but I'd like to start a discussion around MD/PhD programs.

Option 1: enroll into a joint MD/PhD program, where you complete 2 years of MD, then transfer to your PhD (3 years), and then come back to complete the final 2 years of your MD.

Option 2: enroll into a joint MD/PhD program that starts you off in your PhD, and then transition into MD years (not sure how many years), and then back to your PhD years

Option 3: Complete PhD before pursuing MD

Option 4: Complete MD, then pursue PhD during residency

From those who are familiar with the different models across schools in Canada, which one do you prefer? Specifically, what are the pros and cons? Also,  in your opinion, do the different models produce a different breed of clinician scientists (and are they catered towards different types of applicants?)? 

Thanks in advance.

 

 

Perhaps current MD/PhD students can chime in as well.

[NeuroD]

Option 3 pays much less and is less likely to benefit your clinical practice or career development.

Option 4 pays a little more and is a little more likely to be useful to your practice than 1 and 2.

I knew people in options 1 and 2...seemed strange to me, and to them I think. You always feel guilty for not doing one when your working on the other. That being said... perhaps someone from those programs can shine more light. I think there are a couple good threads you could look up too.

[ZBL]

Just remove option 2, that’s a bad idea. You don’t want the last year of your PhD to be in your CaRMS year, when you need clinical connections, clinical reference letters, etc. Come to think of it, I doubt any school in Canada would even allow option 2. 

 

Among the others, option 1 and 3 will almost certainly help you match if you are pursuing a highly competitive research oriented specialty. Among those, option 3 is nice because it gets it all out of the way and then you will be more efficient in research during your MD. Option 1 is nice because you get clinical exposure first so your PhD can be in an area that will relate to your desired residency specialty. Option 4 ensures your PhD is related to your clinical specialty, but is a drawback because it happens during a time where you are supposed to be developing clinical mastery and so often times the PhD is half assed and you don’t get as much out of it. Also does nothing from a matching perspective, which is important since it’s your career after all. I would think option 1 gives a nice mix of what’s important.

 

From a financial perspective, options 1 and 3 are equivalent. Assuming 25K per year (untaxed as its scholarship) x 4 years MD and 4 years PhD = $200,000 earned. For many, this means LOC savings during med school. Then in residency you get the standard rate of the province, call it $335,000 gross for 5 years.  So factoring in tax during residency, and your MD/PhD money, your earnings over 13 years is roughly $460,000 excluding any other scholarships you may get.

 

Option 4 has zero dollars during med school, meaning you will plunge the LOC deep. Then the standard rate of residency for 5 years ($335,000 gross and taxed = $260,000 after tax) plus 4 years of residency salary for your PhD (~$280,000 gross, $220,000 after tax). So $480,000 after tax over 13 years, excluding any scholarships with the added caveat that your line of credit will have been used up significantly more initially (and this higher interest payments) because you had zero income in med school. 

Does a traditional MD/PhD pay less for your PhD? Usually. But in the long game you may come out ahead via LOC savings or a better match result (depending on specialty desired). Tax is the devil. 

[adhominem]

As someone doing my PhD first, I can say that there are some substantial advantages. First, you have a ton of flexibility regarding the time to completion of your PhD. In some of the split programs or during residency you have to rush to finish in a tight time frame, which can lead to burn out. It can also be a disaster if your project isn't working out very well. A PhD student with a very competitive funding package (university+provincial+federal funding) can make as much as ~72k per year tax free, plus any other little scholarships they may receive (at the U of A, at least). Of course, that isn't the norm but it is possible. People gunning for medicine tend to have the qualities that the Vanier looks for, so that always helps the funding situation too. Having the ability to stick around longer and not be rushed will allow you to be more productive and pump out more publications- arguably the most important thing when getting a PhD.

My supervisor has told me that a break in the middle of your MD can be a detriment to your performance and you lose all the study buddies you have made in your year. That can make the clinical years much more difficult after coming back from your hellish 3 year PhD. That is also worth consideration as well. 

[xiphoid]

Queen's is similar to option 2, but not entirely. You start with 2 years of your PhD, then do 2 years of your MD (preclerkship), then back to finish your last year of PhD, and then you do your last 2 years of MD (clerkship).

[NeuroD]

19 hours ago, adhominem said:

As someone doing my PhD first, I can say that there are some substantial advantages. First, you have a ton of flexibility regarding the time to completion of your PhD. In some of the split programs or during residency you have to rush to finish in a tight time frame, which can lead to burn out. It can also be a disaster if your project isn't working out very well. A PhD student with a very competitive funding package (university+provincial+federal funding) can make as much as ~72k per year tax free, plus any other little scholarships they may receive (at the U of A, at least). Of course, that isn't the norm but it is possible. People gunning for medicine tend to have the qualities that the Vanier looks for, so that always helps the funding situation too. Having the ability to stick around longer and not be rushed will allow you to be more productive and pump out more publications- arguably the most important thing when getting a PhD.

My supervisor has told me that a break in the middle of your MD can be a detriment to your performance and you lose all the study buddies you have made in your year. That can make the clinical years much more difficult after coming back from your hellish 3 year PhD. That is also worth consideration as well. 

I would just warn you that Vaniers are statistically uncommon, so don't bank on getting one. Secondly, most programs don't let you add up additional scholarships, rather the money goes into the program. The chances of making 72k tax free in a pure PhD is extremely low.

I would also add that doing a PhD to match is kind of extreme. The truth is I'm not really worried about matching (though that I may be overconfident, we'll find out in a few weeks haha)...but I would never have intentinally spent 5 years grinding at research in my field just to be able to match. Strong efforts in med school are sufficient, and way more efficient.

I do agree that PhD during residency tends to be a little less "legit", and more above getting the letters behind it name as quickly as possible. Not always true, but moreso than other PhDs.

[Al22]

The best option really depends on what kind of research you want to do.

If you want to do fundamental research in biomedical science or biochemistry chances are you won't get very far with only 3 years of work. I know a few MD who are clinician researchers in fundamental science, they either did their PhD before their MD or after their residency. I think maybe one did a fellowship in their medicine field at the same time they were doing their PhD, and then they did a post-doc, now they have a very productive lab. 

If you want to do public health or epidemiology or something like this then I guess you could do it in those MD-PhD program, and get paid more while you do it.

It really depends on your carrer goals. As it was mentionned, not one would do this simply to match better.

I also agree that your PhD would probably be more productive if you were not doing your MD at the same time. You have more time and energy, you can afford to make mistakes and learn from them, you have more time to go to conferences, to publish, etc.

(But of course I am a bit biased, because of my GPA I have to finish my PhD if I want to have better chances at getting in med school in my province...  )

 

[ZBL]

On 11/30/2018 at 4:35 AM, PhD2MD said:

I would just warn you that Vaniers are statistically uncommon, so don't bank on getting one. Secondly, most programs don't let you add up additional scholarships, rather the money goes into the program. The chances of making 72k tax free in a pure PhD is extremely low.

I would also add that doing a PhD to match is kind of extreme. The truth is I'm not really worried about matching (though that I may be overconfident, we'll find out in a few weeks haha)...but I would never have intentinally spent 5 years grinding at research in my field just to be able to match. Strong efforts in med school are sufficient, and way more efficient.

I do agree that PhD during residency tends to be a little less "legit", and more above getting the letters behind it name as quickly as possible. Not always true, but moreso than other PhDs.

I concur vaniers are rare, and not to be counted on. 

 

I also concur that that you don’t NEED a PhD to match in general; however, there are a few caveats:

1. Specialty dependent - things like NSx, Derm, Plastics absolutely do like MD/PhDs, so for those while PhD is not required, it can help quite a bit.

2. Doing your MD/PhD with clinician-scientists can have huge advantages in CaRMS. Firstly, you’ll get better letters (from them knowing you for years in the lab, plus if you do a 2 week clinical elective with them). Secondly, you gain exposure to clinicians in the area of your research. If that is also the area you want for residency, then it becomes much easier for them to check the box for “do we like this person/do we want to work with them in residency.” Familiarity goes a long way, so this can significantly increase your chances of matching at your home program, which for many people will be their top choice. 

[NeuroD]

2 hours ago, ZBL said:

I concur vaniers are rare, and not to be counted on. 

 

I also concur that that you don’t NEED a PhD to match in general; however, there are a few caveats:

1. Specialty dependent - things like NSx, Derm, Plastics absolutely do like MD/PhDs, so for those while PhD is not required, it can help quite a bit.

2. Doing your MD/PhD with clinician-scientists can have huge advantages in CaRMS. Firstly, you’ll get better letters (from them knowing you for years in the lab, plus if you do a 2 week clinical elective with them). Secondly, you gain exposure to clinicians in the area of your research. If that is also the area you want for residency, then it becomes much easier for them to check the box for “do we like this person/do we want to work with them in residency.” Familiarity goes a long way, so this can significantly increase your chances of matching at your home program, which for many people will be their top choice. 

I worry that degree inflation and med students competitiveness is going to get even more out of hand....so let me just make this clear to anyone stubmling across this forum. And this come is coming from someone with a basic sciences PhD. 

 

You DO NOT need a PhD to match to ANYTHING. More non-PhDs than PhDs match to even the most competitive specialties. Of course there's a benefit to having one. There would also be a benefit to having a PhD, but that's not a reason to pursuing one!

[CardiacArrhythmia]

1 hour ago, PhD2MD said:

I worry that degree inflation and med students competitiveness is going to get even more out of hand....so let me just make this clear to anyone stubmling across this forum. And this come is coming from someone with a basic sciences PhD. 

 

You DO NOT need a PhD to match to ANYTHING. More non-PhDs than PhDs match to even the most competitive specialties. Of course there's a benefit to having one. There would also be a benefit to having a PhD, but that's not a reason to pursuing one!

Exactly, you won't need a PhD to be competitive for matching to a speciality. It's also informative to say that although a PhD is not required for residency, it will likely be a requirement (or at least a willingness to do one) to be competitive for employment at major academic institutions - a PhD for employment provides a (hopefully) proven track record for academic research output. 

[NeuroD]

13 hours ago, CardiacArrhythmia said:

Exactly, you won't need a PhD to be competitive for matching to a speciality. It's also informative to say that although a PhD is not required for residency, it will likely be a requirement (or at least a willingness to do one) to be competitive for employment at major academic institutions - a PhD for employment provides a (hopefully) proven track record for academic research output. 

And even in that scenario, still not necessary. My mentor is the youngest ever person to receive a prestigious chair at our research intensive institution. He does not have any graduate degrees. He just does good research.

[Lactic Folly]

How did he acquire his research skills?

[affyuser]

As someone who did a basic science PhD before med school, it definitely has advantages when it comes to increasing competitiveness for both the med school and Carms apps. Plus being of value in any kind of research scholarship app during med school and residency. On the flip side though, the PhD tends to be significantly longer than the typical length during MD/PhD or clinician investigator programs in residency or fellowship. It can also be a challenge trying to fit your PhD research topic and skillset into future career goals especially when there is often a decade separating PhD completion and entering the academic medicine job market after med school, residency and fellowship. Also having a PhD supervisor supportive of your application to med school is key, there are PhD supervisors who frown on their trainees going down the med path after and have heard of some even refusing to write ref letters, which can sink your app to places like UofT med where a grad supervisor letter is mandatory. 

[NeuroD]

54 minutes ago, Lactic Folly said:

How did he acquire his research skills?

He made it a focus of his residency and fellowship, and found good research mentors.

[Al22]

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