MD/PhD

[Guest brandonite]

Hi all.

 

I'm looking into MD/PhD programs (more specifically, at Manitoba). I'd like to get into the use of diagnostic radiology in the detection of cancer, a field that the NRC research facility in Winnipeg has become a world leader in.

 

Anyway, I was just doing some research on the internet, and came across the CIHR (Canadian Institutes of Health Research, I guess). They seem to have a scholarship open to MD/PhD students for almost $20,000 a year, which you can receive for 6 years. Does anybody here know anything about this program? I'd be very interested in it, and the UofManitoba website is very unhelpful when it comes to MD/PhD programs.

[Guest Ian Wong]

One of my classmates received a huge stipend for an MD/PhD degree, which he ultimately declined in favour of simply doing the MD degree. I don't know if that was the CIHR stipend or not, but certainly the money can be out there if you look for it, or consult those researchers who are knowledgeable in seeking that funding.

 

There's a lot to be said about the MD/PhD degree, as you're pretty much hitting the top of the medical research heap with all that education! However, from talking with the three MD/PhD candidates in my class, you really need to be sure that research is solidly in your future, or else it really can seem as though you are wasting those three extra years of schooling (UBC's MD/PhD program is 7 years long in contrast to the 4 year MD degree).

 

As far as a CIHR stipend goes, it's not unsurprising that three years spent in clinical work could net significantly more than the $120,000 you would expect to receive through the stipend itself. I would caution you that by the time you reach the end of medical school, chances are good that you'll feel like many of us senior med students (particularly the Med 4's) who really just want to go out there and earn a decent living for a change! You really need to love research for the interest and sheer innovation itself, because financially it runs a distant second to clinical practice.

 

I don't think there's anything I've said above that you didn't already know, but really, four years of med school is a long time in and of itself. Seven years of it, and then adding a residency on top of it (Radiology would be five years, then start thinking about a 1-2 year fellowship) is really pushing the envelope in terms of formal schooling without actually having a "real" job. You get paid in residency, but it's nothing exciting, and certainly well under what you actually deserve considering your hours and responsibility.

 

Ian

UBC, Med 3

[Guest mdPhd grad]

hi ian

 

actually if you have a md/phd your earning potential is very very high relative to a clinician. i have an md/phd followed by a cardiology residency and most md/phd's have clinics in addition to holding a research/teaching position for which they are paid very well for =120k-270k. in addition to my own private practice, research position, you have a chance to get involved in drug trials and put your research out on the market while working with drug companies around the world. this also pays very well. you are highly regarded by your peers and have a chance to advance your speciality beyond anything that a simple clinician could ever imagine. all md's hold you with very high regard and constantly call you for advice and praise for your findings. i have had a lot of clinicians say phds are the true creators while we are just the admisnisters. i think you have to take a macro perspective to your career and realize that an additional 3 years in a 30 year career is just a blip of time. however to do a md/phd you have to be stellar, and not everyone has the intellectual ability . after all you have to think of brand new treatments and ways of curing illness, wheras the md just has to be efficient in knowing where look up symptomology and treatment in the reference manuals and manage patient issues.

 

good luck brandonite i commend your ambitions and welcome questions from you. i read your bio somewhere on here, and i must say you are extremely bright and the medical community - md/phd needs more students like you

 

good luck to all

 

terry

[Guest cheech10]

Hey guys,

 

To apply to an MD/PhD program, do you need to have finished your bachelors, or will they look at third year applicants? If they do look at them, will a third year have a chance if s/he has done previous research?

[Guest Kirsteen]

Hi cheech10,

 

There are two opportunities to apply to some MD/PhD programs (I say some because each program seems to have its own features and way of operating and I have only researched a few in Canada): 1) upon completing an undergraduate degree; 2) after first year medical school.

 

You would probably have to check within each program, but for an MD/PhD program such as UofT, the degree/course requirements are specified primarily by the department within which you wish to work. For example, if you wish to complete a PhD within the Institute of Medical Science, they have certain degree and mark requirements before you will be accepted to their department. (For these guys, I believe that you do need an Honours degree with a certain average in the last year (A-?) to move directly into their PhD stream.) From what I've read, it seems that the Honours degree is a pretty universal requirement, but I could be wrong. Also, some programs require that you start off in their Master's stream and then re-classify for the PhD.

 

Overall, it adds up to gaining a lot of acceptances: to the research department as well as to the MD/PhD program.

 

Cheers,

Kirsteen

[Guest cheech10]

Kirsteen,

 

Thanks for the info. I'm a third year applicant now, but I am considering deferring any acceptance I might get to complete my Honours degree. Is UofT one of those schools which allow you to enter the MD/PhD program after first year?

[Guest Jess]

Hi Cheech10,

 

I can't speak for all the schools, but the MD/PhD people at U of T have told me that you need to complete a bachelor's degree to get into the program, BUT you can always get into meds as a third year applicant and apply to the MD/PhD program after your first year of medicine. Also, previous research experience is not necessary, but personally I think it would be helpful.

[Guest cheech10]

So if I apply after first year med, I wouldn't need an 4 year bachelors? Something to think about. As for research experience, I've worked last summer and continued on in the same lab through this school year, and this summer I'll be working on another project in that lab, so I do have some experience. So if I could apply to the combined program after first year, that would be great because so far my research has been a lot of fun and I think I would like to continue it.

[Guest RAK2005]

I can only give my personal experience on this topic, but I had considered doing a combined program a couple of years ago. However I must give some pieces of advice:

 

1) Doing 4th year and summer research projects are VASTLY different that doing graduate work (either MSc or PhD). You will see a greater amount of control of the projects (varies with the supervisor), much greater time committment, and pressure to get data out into publications before you get scooped.

 

2) PhD theses require considerable experience in manuscript (for pubs) writing, data collection and analysis etc. which most don't get until after considerable time in the field.

 

3) MOST combined MD/PhD programs will look favourably on those with MSc degrees, unless the PhD program is VERY familiar with the applicant (i.e. your PhD supervisor-to-be was your fourth year project supervisor and knows that you are capable of doing the combined degree)

 

4) Time committment is essential to both areas. I know a few people doing both degrees, and it is REALLY hard to split time b/w your thesis and med school work. It is hard to please a supervisor that needs your presence in the lab while your swamped with meds assignments.

 

Bottom line is that with little experience (I would consider less than a year full time as little experience) you may find that supervisors for a PhD may be skeptical about your interest, and likely would want to find out how much you know about the field. If you are really knowledgable you may find that programs may be intereseted, but in general taking on a 4th year student directly into PhD studies is sometimes risky at best, never mind a MD/PhD ! Most programs will allow you to start a MSc and then "roll-over" into the PhD after a year, pending a committees approval of your progress in the current program.

 

I am not trying to sound negative, but only realistic. If I was in third year, I would concentrate on getting into meds, and then (if you still are interested) try applying to a PhD within med school.

 

If you are truly passionate about the research go for it, just be prepared to hear that you may need more experience before they accept you.

[Guest JD]

I've asked U of T about this (but it was quite a while ago, and things could have changed), and they said that although people who enter meds from 3rd year can apply to MD/Ph.D. after first year, but it's pretty rare that you'd actually get it...

[Guest Kirsteen]

Hi again Cheech10,

 

Yes UT, as well as UBC, allow medical students to apply to the MD/PhD program during the first year of medical school.

 

Again, if UT is one of the schools that you're considering I'd highly recommend going and talking to the MD/PhD folks. There are quite a few hoops through which to jump in order to finally get working on the project, as well as the supervisor, that you'd like; so it's best to make sure you know these in advance so that you can best prepare if, indeed, you do end up selecting this route.

 

Cheers,

Kirsteen

[Guest Ian Wong]

Hi Terry,

 

Welcome to the forums! It's great to have someone on the forums who's already been there and done that through school, residency, and clinical practice. I really invite you to register and contribute as your time allows as we would love to learn more from your experiences. If you're interested in further information, I can be reached at: mdpremie@yahoo.com

 

As far as the MD/PhD goes, I can only comment through my conversations with the current MD/PhD's that I know. The three in my class are all working on very significant areas in medicine (cancer research, ischemic brain responses to stroke, maternal-fetal genetic analysis), but none of the three have any illusions as to being as financially well-compensated as a pure clinician. All three plan on continuing to do research in their careers after their residencies. Perhaps that extra income in working with private industry and developing new technology is what they haven't been expecting.

 

I guess that would be the most lucrative area of research; coming up with a better mousetrap, and then patenting it and bringing it to market. The coolest work that I've heard about cardiology-wise is the coating of PTCA stents with anti-neoplastic agents to prevent re-stenosis. If I'm not mistaken, there's a Vancouver connection to the development of that project. A local cardiac surgeon (with a PhD in Engineering) is currently playing around with a personal idea of using magnetism to anastomose the vessels during a coronary artery bypass surgery to avoid the need to suture-anastomose each vessel, thereby saving a significant amount of time per surgery.

 

Certainly a good degree of lateral thinking is necessary to come up with these newer methods of attacking existing old problems. Also certainly, this type of venture can be very financially rewarding.

 

I don't know much about cardiology, but from the 4 local cardiologists that I've worked with here, not one bills under $450,000, and not all of them are primarily invasive cardiologists. A rural internist who I've worked with who reads the local hospital's EKG's and conducts stress tests also bills $300,000. Of course, that income doesn't take into account one's overhead, and all of these individuals are well-established, and have the clinical efficiency that a new graduate wouldn't yet have developed.

 

Still, without an affiliation to private industry, I don't think someone who combines research with clinical work can usually be expected to make more money than a pure clinician. Perhaps I'm wrong, or perhaps just not experienced in the real world, but I haven't seen it yet.

 

As re-iterated in my last post, money shouldn't be the decisive factor behind going into, or not going into a research-oriented career. The bottom line is your own personal and intrinsic satisfaction, and finding a career that fulfills that expectation. However, I've always been under the impression that doing research (at least the non-private stuff) usually pays less than clinical work.

 

Ian

UBC, Med 3

[Guest cheech10]

Thanks for all the input folks. I know I'm in 3rd year now and most schools would like students with more experience in their MD/PhD programs, and that's why I haven't applied. Actually, it was my supervisor that suggested that I apply, and the physician I was shadowing, who is a researcher, also encouraged me. I know that waiting and applying in 4th year with more experience would give me a better shot at it than applying after first year meds, but I feel I have an excellent shot at getting in after third year and I don't want to pass up a chance at being accepted, especially since that's my first goal. And after a bit more research experience I'll be able to decide if I'm certain I won't do research, in which case I won't have to defer acceptance, or if I'm not sure, I can defer it and decide later. I'm not sure yet so I don't want to lock myself into a long program only to find out it isn't what I want. I just wanted to keep my options open for now since my admittedly limited experience has been great. So thanks for all your help everyone!

[Guest brandonite]

Thanks to everyone, especially you, MDPhd grad.

 

Ian - I am considering and MD/PhD, but I haven't made my final decision. I'll do that sometime during 1st year. Basically, I think that an MD/PhD opens a lot of doors to you that a MD can't. You can easily go back and forth between academic medicine, research (both basic science and clinical), and clinical activities. I like the idea of being able to both develop research, and then immediately be able to apply that to patients. Just generally being at the forefront of medicine sounds exciting to me.

 

MDPhd grad - thanks for your input! I have never actually talked to a person who has gone through a MD/PhD program before. I've talked to a bunch of people who are applying this year, and I've heard both stories - some people say that it's impossible to combine real research (especially basic science research) with clinical medicine, and that MD/PhD's have to choose between them. Others say that it's entirely possible to do both. I'd say right now that if I was pushed to choose between them, I would choose clinical medicine over research. But I don't want to have to make that choice, as I think I'll really enjoy both. I've actually considered cardiology as another area I'd like to persue (cancer radiology being another). There is also a large cardiology program in Manitoba - they just broke ground on a $25 million dollar centre here. What's your opinion on the cardiology program at Manitoba? I probably could go elsewhere (strong GPA/MCATs/ECs), but I would like to stay close to home for personal reasons.

[Guest Kirsteen]

Howdy again,

 

I've been chatting with a few folk this past couple of years who have a fair bit of research (both clinical and basic) or medical training--and some with the two. Largely, it seems that the world is the potential oyster for an MD/PhD for many of the reasons already stated; however, it also seems that actually opening that oyster, (due to the constraints around actually going forth with the MD/PhD), poses a bit of a problem.

 

Some may view an ideal situation as holding the MD/PhD and exercising both sets of training to their fullest, i.e., being an excellent clinical practitioner as well as being near the top of the scientific heap. Some feel that this is impossible to achieve given that you'd have to sacrifice one half of your "non-job" life, given that both careers are exceptionally demanding and careers of themselves. However, it seems that it can be done (although examples of the model I'm about to describe appear to be few and far between). I work alongside another supervisor who is an MD/PhD and a leader in the field of reproductive science. He supervises a very productive and busy lab as well as running a thriving clinical practice. His secret: to employ excellent, experienced post-docs who essentially run the operation of the lab. He provides direction, they do the labwork. It's an interesting model, and from what I hear from the surrounding faculty scientists, a successful one. (I've found that, if any, it's the scientists who tend to be the larger skeptics of MD/PhDs.)

 

There may be some change on the horizon too, with respect to MD/PhDs. Recently, a large committee of individuals from across Canada came together to brainstorm about the future of the Canadian clinician scientist. It seems that realizations have been made regarding the dichotomy of the value of the individual who holds an MD/PhD, yet the problems they encounter in actually applying this knowledge and experience optimally. From what I can gather, steps are being taken to try to alter the environment for MD/PhDs, e.g., create more of them, and with that increase in trainees, increase funding, protect more research time, etc.

 

A last note, there is also an alternative route for would-be clinician scientists: if you'd like to take a little more time to get a better idea of the area in which you'd like to do your research (which I sometimes feel I'd like, as there are so many appealing areas out there, but seemingly little time to explore them before the big choices must be made), an option is the CIP (Clinical Investigator Program) which is offered as a post-graduate training program at some universities (UT is one of them). Essentially, you gain research experience, (and I believe this can lead to a higher degree), but you receive resident-like pay, e.g., $40K/yr and benefits.

 

Overall, an exciting field that's ripe for exciting, positive change.

 

Cheers,

Kirsteen

[Guest BennyG]

Hi everyone,

 

Probably the main criticism of MD/PhD programs by non-MD scientists is the issue of the quality of the PhD degree obtained. PhD completion lengths in the biomedical sciences these days are rarely less than or equal to four years. In addition, a thesis, with its associated laboratory work and need to produce results, is not something that can be arbitrarily truncated at a certain point just because the student needs to finish the program and/or go back to medical school. Given these realities, it is not surprising that scientists can sometimes be skeptical of the quality of a three-year PhD (4 years med school, 3 years PhD in most MD/PhD programs) or a PhD produced in spurts as the student oscillates between medical school mode and graduate school mode.

 

Like many of the posters to this thread, I have also spent quite a bit of time in the professional and social company of MDs, PhDs, and MD/PhDs. My assessment of the scientific quality of MD/PhDs is that it is highly variable, perhaps even more variable than the quality of MDs. There are some MD/PhDs who are remarkably brilliant and dedicated individuals and it is no surprise that they flourished in such an intellectually rigourous program. Others, however, have such poor scientific skills that any mediocre post-doctoral fellow or senior graduate student can do a better job. It truly depends on the person and, perhaps, the program.

 

On the topic of post-docs, a person interested in pursuing an MD/PhD must be prepared for the possibility of having to do a post-doctoral fellowship, which adds another two years to the training. This also assumes that you only do ONE post-doc, which is not the standard in today's fiercely competitive biomedical marketplace. Having the MD may obviate this requirement, but it is never certain. All the (relatively) new MD/PhDs that I know did a post-doctoral fellowship or some other form of post-PhD scientific training. Therefore, we now arrive at 4 years medical school, 3 years PhD (at least), 2 years post-PhD training (at least) and residency (4 years, unless you want to be GP with a PhD). That is 13 years.

 

Another point about post-docs: a MD/PhD scientist who stuffs his/her lab with high-quality post-docs may be a productive scientist, but is likely not a good supervisor for an MD/PhD student. They probably take an extremely hands-off approach to supervision, either due to alternate time committments (clinics, etc.) or lack of thorough scientific skills. Such shortcomings are not a problem for good post-docs, who only need access to funds, equipment and lab space to do their magic, but should be unacceptable to a student, who needs mentorship and guidance.

 

On the other hand, very poor MD/PhD scientists may be becoming, these days, as rare as poor PhD scientists, simply because of the competitive nature of obtaining academic appointments. A strong publication record is required and a person is unlikely to have published prolifically if he/she is that painfully incompetent as a scientist. In the end, I think that the field of study is as important as the particular letters after your name. To be successful in purely basic biomedical research, you do not need an MD. To be successful in purely clinical research, you do not need a PhD. It appears to be that there is a fine overlap area where MD/PhDs make the most impact, which makes sense since that it what their training prepares them for. I can't actually define what that "overlap area" is in terms of subject matter or methodologies, although I think that those of you who have spent a lot of time in research know what I am referring to.

 

Although I have years of research experience and hold an M.Sc., I have decided to not apply to the MD/PhD program right now, preferring to wait until I am (hopefulleee) in medical school to make the final decision on the direction and structure that I would like my medical career to have. To those who have come to a decision earlier than me, good for you and good luck in your endeavours. All I am suggesting is that you consider your options carefully, and weigh the advantages and disadvantages honestly.

 

Best of luck!!

[Guest Kirsteen]

Hi BennyG,

 

Adding to your points, I too would not necessarily recommend selecting an MD/PhD supervisor who loads his/her lab full of post-docs. Indeed, the person with whom I'm currently working, (although we do share our lab with an MD/PhD-headed group), is a fantastic mentor and scientist with no MD attached to his name. I would much prefer to learn the ways of research from a seasoned master who him/herself will be around while I'm there. This is also where selecting an apt committee comes into play: if you manage to work with some great individuals, more opportunity for better guidance and enriched learning experience.

 

Added to that, a good pal of mine is in the throes of fiishing her PhD in clinical chemistry at UT. When she started her research she set a goal to complete it (the PhD) within 3.5 years. She's set to wrap-up in March (on time) after having secured a massive and prestigious grant a couple of years back, and will be off to do a post-doc at the Karolinska Institutet in Stockholm. Two things to learn from this scenario: one, she completed a full, "traditional" PhD within a relatively short period of time by truly knuckling down and spending those 3.5 years hard at work (none of this, stoating into the lab at 11:30 am and then nipping off to have coffee/lunch for the next 30 mins, which seems to be bizarrely common); she managed to do this under the "non-supervision" of an MD/PhD.

 

In short, there are so many potential experiences out there, and ways to approach attaining a goal. Careful consideration of all the factors and resources prior, is essential to emerging with the scenario that best fits you.

 

Cheers,

Kirsteen

[Guest mdpd grad]

With regards to the cardiology research at the faculty of medicine, Manitoba fairs well. I think they are ranked somewhere in the middle in terms of grant offerings and innovative research. (This is from a cardiology research pub). However this may improve with the injection of capital and commitment that they have put forth in the recent past. As far as excellent research schools, money and funding play a big role. This dictates the calibre of researchers, profs, lab technology, future research and grant availability. Consequently, excellent research schools are also the top clinical schools because of their ability to hire and retain the best profs. Currently UofT is on par with alot of US institutions in terms of clinical and research excellence. Hands down for someone interested in research and medicine, UofT will afford the greatest opportunities to land competitive residencies and post doc fellowships globally and here at home. I think UBC comes in second followed by MAC, Queens, Western, McGill, Calgary, and then the rest (again from research pub). I think another important factor when considering an md/phd program or md program is the ability of the school to open doors for you through networking contacts. Again with UofT the grads end up at Harvard, Johns Hopkins etc and all over Canada. This again will play in your favour for collaboration and faculty/clinical positions once you graduate (people know the school and know its top notch+favour grads from their alma).

 

Of course family and friends and being close to home are considerations that should enter the thought process and I don't think Manitoba is not a good school by any means. Right now the funding is not there which does not allow them to be competitive in a broader sphere. This results in their inability to generate groundbreaking research and attract the best and the brighest students and faculty. However down the road if funding economics change dramatically for the school in the future, it could be a whole new ball game!

 

Good luck Brandonite, I wish you well

please feel free to ask me any further questions!

 

Terry

[Guest duracell]

I only know about MD/basic-PhD combos and believe that it may be a tad easier for MD/clinical-PhDs to span their worlds. The combined degree programs with basic science dept.s, in my experience, produce a highly variable crop. Especially by the end of the PhD component, typically there are the embittered ones who will never enter a lab again, or the merely angry ones who blame (maybe rightly) their bosses who just never understood! The latter ones may enter a lab following their clinical years of MD; time heals. My boss, who himself is an MD-PhD, told (nay, advised) me that he has never seen an involved clinician who has time to be a good scientist. He, of course, is a full time researcher. I reluctantly have to admit that he does have a point. There are only 24 hours a day and 7 days a work week (yup!).

 

And yes.. don't forget, most basic science dept.s don't allow you out with a doctorate with 3 yrs of grad school just because you are in the combined program. At least at UofT, a basic PhD (biochem, medgen, LMP, etc.) takes at least 4 years on top of the MD years. Inst. of Med. Sci. may allow you out in 3 if you undertake a clinical/epidemiological thesis... but I am not certain of that.

[Guest kiki]

So good to read you! I totally agree with you, md/phd is a great formation and the time put into it is worth it. As for me I hold a PhD and did a research fellowship in the States. I am applying this year to Med school and I truely hope to fulfill my dream of being a clinician-researcher.