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chkchkchickens

PhD to MD - is it possible/worth it?

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Hey guys, I was wondering if anyone here started their PhD before getting into med, and then did PhD/MD combined program?  Instead of getting into med first, then applying to a PhD program after your second year of med?

I really like my lab and am now thinking about maybe transitioning to a PhD.  If you are in your first year of a PhD and get in to med, do you just defer admission, finish the PhD, and then start the MD?  Or do immediately start on your MD, do the two pre-clerkship years, go back to the PhD, finish it, then do clerkship?

I just don't want to move into a PhD first and have to wait the ~5 years before I can apply to med, since I would have to re-write my MCAT.

Thanks!

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Most schools, once you apply as a graduate applicant, would require documentations that you are finishing your thesis/program requirements by matriculation into med school to be eligible. As for deferral, it's only reserved to very serious circumstances and I don't think they're gonna allow deferral for several years. Does the lab you like belong to a university with a med school? Why don't you apply there as an MD/PhD applicant? That would be so much more feasible. 

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If you really want to do med school, I would do that first. No MD/PhD, no PhD first. Do the med school thing while you’re young. Then if you really want you can do a PhD in residency or as a staff where in both cases you will be paid well to do that.

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So I was in your position but a bit later (maybe 2nd or 3rd year). The MD program told me to just finish the PhD, then start the MD. I did, but a slightly regret it. If MD is going to be a major focus on the future then the cost-benefit analysis for doing the PHT first listen to that great. There is a huge opportunity cost in the form of salary (25k vs 75) and relevance of you do it during residency vs as a grad student. 

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22 minutes ago, PhD2MD said:

So I was in your position but a bit later (maybe 2nd or 3rd year). The MD program told me to just finish the PhD, then start the MD. I did, but a slightly regret it. If MD is going to be a major focus on the future then the cost-benefit analysis for doing the PHT first listen to that great. There is a huge opportunity cost in the form of salary (25k vs 75) and relevance of you do it during residency vs as a grad student. 

Agree. Not to mention the opportunity cost of doing a PhD at any point with an MD is at minimum $1 million, closer to $2 million in billings for many specialties.

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6 hours ago, ZBL said:

If you really want to do med school, I would do that first. No MD/PhD, no PhD first. Do the med school thing while you’re young. Then if you really want you can do a PhD in residency or as a staff where in both cases you will be paid well to do that.

I am thinking about doing my phd now part time as I come into becoming staff - not sure exactly how that will work but I have to do research anyway so hopefully I am make it count for both. 

There really is no logical reason for me to get a phd. Still ha I think in the end for whatever reason I just want to go through that process. 

Edited by rmorelan

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21 hours ago, DrOtter said:

Most schools, once you apply as a graduate applicant, would require documentations that you are finishing your thesis/program requirements by matriculation into med school to be eligible. As for deferral, it's only reserved to very serious circumstances and I don't think they're gonna allow deferral for several years. Does the lab you like belong to a university with a med school? Why don't you apply there as an MD/PhD applicant? That would be so much more feasible. 

Yes, I am at a school with a med school, and it offers an MD/PhD program.  The way it works is that you can only apply strictly to the med program or strictly to the PhD program.  You have to get admission to both before you can do the combined program - you don't apply as an MD/PhD applicant all in one shot.

I am currently in a masters program, and I did my homework about what med schools need from graduate applicants in order to be eligible (some schools don't grant deferrals at all for grad students, some are case by case basis.  The school I am specifically referring to allows deferrals).  I just saw on the website for my school of choice that you can enter the MD program from a PhD, and was wondering if anyone had any more details about what that looks like.

I'm just at a point where I need to start thinking about whether I want to defend my Masters, get into med (which of course is a big if, and I have realistic expectations about), then decide on the combined program, or if I just transition to PhD and keep trying to get into med there.

I'm worried about getting into a PhD, and completely ending my chances at an MD because you can't defer entrance or get special permission.  I also don't want to live my life betting on getting into med and then that not actually shaking down.

Anyway, thank you for your feedback!

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20 hours ago, ZBL said:

Agree. Not to mention the opportunity cost of doing a PhD at any point with an MD is at minimum $1 million, closer to $2 million in billings for many specialties.

Thank you guys for all your feedback!  I had no idea that there was a difference in opportunity cost.  Do you mind expanding on that?  I'm very early in the decision to do the PhD, and I'm still trying to sort out the risks and benefits.

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20 hours ago, PhD2MD said:

So I was in your position but a bit later (maybe 2nd or 3rd year). The MD program told me to just finish the PhD, then start the MD. I did, but a slightly regret it. If MD is going to be a major focus on the future then the cost-benefit analysis for doing the PHT first listen to that great. There is a huge opportunity cost in the form of salary (25k vs 75) and relevance of you do it during residency vs as a grad student. 

Again, do you mind expanding on your experience?  I can PM you too if you don't want to post that on a public forum :)

Did you have any trouble with applying to med while you were early in a PhD? 

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1 hour ago, chkchkchickens said:

Thank you guys for all your feedback!  I had no idea that there was a difference in opportunity cost.  Do you mind expanding on that?  I'm very early in the decision to do the PhD, and I'm still trying to sort out the risks and benefits.

Every year that delays the start of your practice as a board certified MD is a year you miss out on billing 300-400K or higher per year. For a 4-5 year PhD that’s done before med school, during med school, or during residency, that’s a lot of money to miss out on. So you need to weigh the benefits that a PhD may give you for your career (residency matching, jobs opportunity/diversity, research/academia, etc), vs the potential financial drawback. 
 

in terms of doing a PhD before or during med school, or during residency, the issue is funding. A PhD before med school and you can apply for all the typical PhD awards, but you may not get them. A MD/PhD you can apply for the same awards, but also potentially receive additional funds to cover some med school costs, which is nice, again if you get them. Doing it in residency and you get paid a resident salary guaranteed which is more than any PhD award but also may not entirely make up for the scenario of being a fully funded MD/PhD (which is not a guaranteed thing). 
 

My advice is if you are unsure about the PhD, but for sure want to do med school then do the MD and residency first. The financial offset of doing a MD/PhD is paid for likely within 6 months of working as a staff. 

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58 minutes ago, ZBL said:

Every year that delays the start of your practice as a board certified MD is a year you miss out on billing 300-400K or higher per year. For a 4-5 year PhD that’s done before med school, during med school, or during residency, that’s a lot of money to miss out on. So you need to weigh the benefits that a PhD may give you for your career (residency matching, jobs opportunity/diversity, research/academia, etc), vs the potential financial drawback. 
 

in terms of doing a PhD before or during med school, or during residency, the issue is funding. A PhD before med school and you can apply for all the typical PhD awards, but you may not get them. A MD/PhD you can apply for the same awards, but also potentially receive additional funds to cover some med school costs, which is nice, again if you get them. Doing it in residency and you get paid a resident salary guaranteed which is more than any PhD award but also may not entirely make up for the scenario of being a fully funded MD/PhD (which is not a guaranteed thing). 
 

My advice is if you are unsure about the PhD, but for sure want to do med school then do the MD and residency first. The financial offset of doing a MD/PhD is paid for likely within 6 months of working as a staff. 

Wow, thank you so much for this! That is super helpful and will play a big role in my decision

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8 minutes ago, rmorelan said:

the other thing I will mention in case it hasn't is a PHD in medical school or residency takes much less time than a straight PHD. Say 3 years commonly vs 5-6. Not an unimportant feature ha!

It often does, but it should not! It is really at the expense of the quality of training. A proper PhD should be 4 years minimum (5-6 if counting time in a masters) - if one is investing time into a PhD it should be done to the full extent in my opinion. Many PGME departments are quick to let MDs fly through it with less course requirements or low quality projects, presumably thinking that MDs come to the table with some baseline research qualification over a BSc (which MDs dont - we just have content knowledge, just like BSc’s do), but the graduates really don’t come out as strong that way. After all, one year is usually coursework and planning your project, then there’s a candidacy exam (usually 3-4 months solid to study), and execution of a substantial research project (or series of projects) of appropriate scale, complexity and novelty for a PhD, plus writing, collaborating on other projects, supervising students etc. Three years is just too fast to do all that properly in a PhD and come out of it as an expert capable of leading a research team independently. 
 

 

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Will add that a lot of the 3 year PhD’s happen due to someone’s requirement to get a PhD rather than their choice - many specialties “need” this now to get an academic job, despite the fact most never do research once they’re a staff. So for those people, I can see why there’s a willingness to just get it done and check off the PhD box so to speak - doing the PhD for the wrong reasons really, which maybe is wrongly perpetuated by our current academic medicine situation. 

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2 hours ago, ZBL said:

It often does, but it should not! It is really at the expense of the quality of training. A proper PhD should be 4 years minimum (5-6 if counting time in a masters) - if one is investing time into a PhD it should be done to the full extent in my opinion. Many PGME departments are quick to let MDs fly through it with less course requirements or low quality projects, presumably thinking that MDs come to the table with some baseline research qualification over a BSc (which MDs dont - we just have content knowledge, just like BSc’s do), but the graduates really don’t come out as strong that way. After all, one year is usually coursework and planning your project, then there’s a candidacy exam (usually 3-4 months solid to study), and execution of a substantial research project (or series of projects) of appropriate scale, complexity and novelty for a PhD, plus writing, collaborating on other projects, supervising students etc. Three years is just too fast to do all that properly in a PhD and come out of it as an expert capable of leading a research team independently. 

I thought the point of removing some of the comprehensive components was that the med degree itself was standing in their place? If viewed as an entire 7 year program (4 year med + 3 year of research or even just preclerkship and the research period) it isn't too far off. 

Some of the md/phd route do seems a bit fast to me at times (the record I saw was 2 years although a lot of people helped stream line that - it is amazing what some software programming can do ha particular if you are applying it in fields that don't see that coming) - although to put it in perspective I guess in the UK and Europe in general  the total degree time to get a phd is often 3 years. That includes degrees at Oxford as an example, including those in the hard sciences, and including those without a masters degree (which are also only one year). The other major universities are the same. It is really a north american thing that phds take forever and ever - the place that created them in the first place keeps them at a much more reasonable time frame.  You can guess the sort of places I am considering getting more grad work from ha. 

Plus any doctor doing an MD/PHD wouldn't need to necessarily come out ready to lead a research time independently if for no other reason than they have 5 more years of residency plus fellowships (which often again are in research). There are many MDs out there without a phd at all leading world class research teams. Ha, the chief academic officer at partners (so running the academic branches at Mass Gen and Brigham and Women's Hospitals - standardly considered world class places ) does not have a phd and that is just the start.  

I guess I am saying we have to careful the other way as well - the total time to complete a major research project which was supposed to the point of a phd is vast shortly than the endless phd pathways we have now (and don't get me started on numerous post docs on top of it ha). 

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Yes I think the rationale for cutting it short is the MD, but in my view (and many PhDs) is that this is incorrect. Medicine teaches medicine, just as a BSc in computer science or physics teaches those things - doesn’t prepare someone any more or less for a PhD which is a research degree at its core. I think some PGME/CIP programs have a belief that an MD gives some preliminary research training, but that’s really not the case. An MD is no more prepared for a medically oriented PhD than a physics BSc for a physics PhD for instance. 
 

Many years ago, before there was such competition for academic medicine, many physicians undertook research fellowships instead of PhDs and today are leaders at big centres. That will essentially never happen in today’s day - so many academic departments require grad training essentially to be considered. There are remarkably few MD-only academics leading basic science or applied science labs, and in terms of NIH funding MD/PhDs are routinely more successful than their MD-only counterparts, even those with research fellowships. In many cases, the post-MD research fellowships are very different from the way PhD research would be done as well. I think there’s also a difference between managing a research team of people with specific areas of expertise, and being the person with that expertise yourself - no right or wrong avenue, but the latter is significantly more challenging for an MD-only to accomplish, while either one can potentially do the former. 
 

Now, despite all that, I totally agree there’s a fine balance between doing what you need to do in a PhD and getting out, taking so long that you are wasting time and not getting anything more out of it. and blowing through it too fast such that you don’t get enough out of it. I think 4-6 years in total of grad studies is the sweet spot (including any time spent in a masters). Keep in mind that at most PhD granting institutions, the typical scenario is someone without a MD - so while the PhD may be shortened, there’s usually the expectation of a few years of post-PhD fellowship on top of it so it eventually adds up, whereas for MD/PhDs many times we get away without doing a research fellowship afterwards. Bottom line I think is there’s no fast route to all of this stuff, and the career of a physician with MD and PhD training (regardless of when that’s undertaken) is significantly, significantly delayed from our MD-only colleagues. 

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One huge difference between North America and Europe when it comes to PhD and graduate research is that grad students there are often not bogged down by TA-ship and other numerous non-research commitments that can easily take up a third of students' time from dedicating to research. In fact, I know a couple of friends who got straight into a 3-year PhD track at Oxford and Cambridge after undergrad and they are discouraged by their lab heads from working just so they can properly devote themselves to their theses and finishing in time. They do have sweet funding and scholarships to cover costs and living stipends, but those funding packages are certainly not contingent on them teaching or doing any extracurriculars outside the lab, things that are the norm here in the US and Canada that prolong one's PhD to 5-7 years, while both roads lead to the same substantial thesis and publication records. So the longer PhD programs here, when compared to those in the UK for example, have no real advantage when it comes to "expertise" or "knowledge", just teaching and demonstratorship and obligations outside the lab that prolong their studies.

Now my question for the previous posters, do MDs who go into PhD programs get to skirt around these commitments and hence, get to shorten their research training? Or is it their "research" component that is compromised when compared to regular PhD students?

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