Md/phd Route

[duggar99]

Just looking for any insights from current med students (MD or MD/PhDs) who could discuss pros/cons of taking the MD/PhD route. Please comment sharing anything you or your peers have encountered/things I should consider! Thanks!

 

Here are a couple comments I'm thinking about to get things started:

 

- I know in the States, people really emphasize the sacrifice associated with doing this combined program which can last up to around 9 years and therefore seem to encourage (at least from what I've seen in online forums) that one chooses MD or PhD.   But in Canada, it seems like there is a greater push for the PhD portion to be contained to 3 years (at least for the schools I'm dealing with). Does that affect people's opinions on whether the programs can/should be done together? I also know many people enter medical school after doing masters/phd/working etc., so I guess I don't understand the emphasis on how much time it will take..?  

 

- What are some thoughts on doing 2 yrs med - 3 yrs phd - 2 yrs med, vs. 3 yrs phd - 4 yrs med? I'm leaning towards 3-4 because continuity with the same meds class is important to me, but I'm worried that in following that route I wouldn't be choosing my phd work based on my clinical interests (since I wouldn't really know what they might be) and also would not teach me to embed my research with medical training... I would also miss potentially starting med school with a few people I know.

 

- Finally, I am feeling that my personal interest in the MD/PhD route stems largely from a desire to do research (contribute something to science), achieve that degree and apply it to my clinical medical practise. I want to do an advanced research degree. But I'm not sure that I really want to actually run a lab after all of this. That is typically the goal for students in this stream... so I'm not sure whether joining the program without that goal in mind (at least at this point in time) is a good/bad idea. I really see myself as a clinician, but I do have an interest in doing a research degree. I'm not sure if that is an unfair reason to join an MD/PhD program?

 

Sorry for the long post. This is a very difficult decision for me and one I hope to make extremely thoughtfully. Please share anything you can that may offer wisdom!

 

Many thanks!

[A-Stark]

I don't think MD/PhD programs make a whole lot of sense. You can easily be involved in research as an undergrad med student, and it is much more straightforward and feasible to do a graduate degree during residency. There are numerous advantages to waiting until residency, not least the fact that you will have already obtained clinical experience in your specialty. You will also be paid a resident's salary during your research years/blocks, and if you change your mind at some point (say, converting a PhD to a masters), it won't be in the context of having delayed your med school completion unnecessarily. 

 

Some of the disadvantages:

 

1) Lack of clinical experience and exposure - much of med school involves obtaining experience to make a semi-educated decision on your preferred specialty. You may think you love neurosurgery as a first year student, but your perceptions may change as you experience some semblance of the lifestyle during clerkship. Or you'll still love it and can do that grad degree during residency as many do anyway. 

2) Opportunity (financial) cost - it's true that you get something of a stipend as a med student, but you will be paid better as a resident and have opportunities to moonlight. You will be paid during research time in residency (and with full resident benefits) and will be making a "real" income that is much better than anything you would get as an MD/PhD student. 

3) Diluted undergrad training - med school essentially teaches how to do basic patient care so that you can start a residency program where you really learn to be an independent physician. Time away from the learning environment - and clinical situations especially - makes you forget stuff and get rusty. People often find this even between graduation and July 1st! 

 

I suppose the only advantage of doing an MD/PhD is earlier more extensive research experience. But you have lots of time in med school to start projects and get involved in even bench research if that's your interest. 

[Edict]

Just looking for any insights from current med students (MD or MD/PhDs) who could discuss pros/cons of taking the MD/PhD route. Please comment sharing anything you or your peers have encountered/things I should consider! Thanks!

 

Here are a couple comments I'm thinking about to get things started:

 

- I know in the States, people really emphasize the sacrifice associated with doing this combined program which can last up to around 9 years and therefore seem to encourage (at least from what I've seen in online forums) that one chooses MD or PhD.   But in Canada, it seems like there is a greater push for the PhD portion to be contained to 3 years (at least for the schools I'm dealing with). Does that affect people's opinions on whether the programs can/should be done together? I also know many people enter medical school after doing masters/phd/working etc., so I guess I don't understand the emphasis on how much time it will take..?  

 

- What are some thoughts on doing 2 yrs med - 3 yrs phd - 2 yrs med, vs. 3 yrs phd - 4 yrs med? I'm leaning towards 3-4 because continuity with the same meds class is important to me, but I'm worried that in following that route I wouldn't be choosing my phd work based on my clinical interests (since I wouldn't really know what they might be) and also would not teach me to embed my research with medical training... I would also miss potentially starting med school with a few people I know.

 

- Finally, I am feeling that my personal interest in the MD/PhD route stems largely from a desire to do research (contribute something to science), achieve that degree and apply it to my clinical medical practise. I want to do an advanced research degree. But I'm not sure that I really want to actually run a lab after all of this. That is typically the goal for students in this stream... so I'm not sure whether joining the program without that goal in mind (at least at this point in time) is a good/bad idea. I really see myself as a clinician, but I do have an interest in doing a research degree. I'm not sure if that is an unfair reason to join an MD/PhD program?

 

Sorry for the long post. This is a very difficult decision for me and one I hope to make extremely thoughtfully. Please share anything you can that may offer wisdom!

 

Many thanks!

 

I believe if you see yourself as a clinician doing clinical research you should not pursue the MD/PhD program. It is much better to take time out for a PhD during your residency training as A-Stark mentioned previously as you would be able to focus your research onto your specialty. 

[NLengr]

i agree with the above also.

[ralk]

Different schools have different rules for PhDs. Western does seem to keep students to the 3 year format, though I can't speak to the rules/norms at other schools.

 

The 2-3-2 and 3-4 format each have their own pros and cons. 2-3-2 does give you a bit more flexibility to choose a project that works for you that might align more with your ultimate clinical interests, but does mean three years between pre-clerkship and clerkship, including a split between your pre-clerkship and clerkship classmates. 3-4 means more continuity, but you're committed to a project without much exposure to the rest of medicine. It's worth noting that you don't have a ton of clinical experience after pre-clerkship, so you're not necessarily matching your clinical interests with your PhD project perfectly with the 2-3-2 model either.

 

As A-Stark says, you can get involved in research without doing a PhD, both during and after medical school, so you really have to ask yourself what the advantage of doing a PhD is for you. The two main advantages to doing a PhD that I can see are cementing your application for related fields (though there are much easier ways to do this) and serving as the start of a research-heavy career. If you're not sure what you want to do clinically (or at least have it narrowed down to a few fields that a single project could apply to) and intend to be primarily a clinician, what's the advantage of doing a PhD? You'll get a few extra letters behind your name and a fairly unique experience, but it's three years of your life that could be spent in other, potentially more productive ways.

 

I think I'm in a similar mindset as you are and I'm very confident in saying a PhD isn't for me, particularly during med school. The three years wouldn't be worth it, particularly since I already have tons of opportunities to be involved in research (I have two projects on the go right now, one which is fairly substantial) and a still-developing idea of what I ultimately want to do. I have classmates - good classmates - who have chosen to pursue a PhD and they seem largely happy with their choice, but it wouldn't be for me. All I'd say is be very clear about what you hope to get out of doing a PhD at this stage - it's not a small commitment.

[NewfieMike]

unless you want to run your own basic science lab, I see no point in getting a PhD in combination with medical school. I even know some MD's who run their own labs (without having a PhD) but this is less common.

 

I did a PhD because I am completely committed to a career as an academic physician, running my own lab. I'm tremendously happy that I did my PhD in combination with an MD and not during residency largely because at this stage in my life I have no other life responsibilities that would distract me from putting 100% into the lab. I know that financially it makes a lot more sense to do it during residency, but the often forgotten perk is MD/PhD studentships (mine is 6 years, 32k/year non-taxable and I get paid during medical school).

 

Calgary was sort of a rare bird in that I was allowed to do my PhD and MD in any order that I wanted, so long as clerkship was a single block. So I opted to finish my PhD before ever starting med. Technically I'm the same as any finishing grad student who gets a med acceptance, but I get the perk of the studentship that continues during med.

[lost__in__space]

NewfieMike, you don't need to want to run your own lab to do the MD/PhD route. There are many career paths for the dual degree:

 

1. If you do your PhD in engineering, you can open up your own biomedical engineering company (my goal). If you do your PhD in philosophy (another student in my program), you can be a medical ethicist at the hospital. If you do your PhD in public health (a few students in my program) you can work at Health Canada designing policy. Lastly, if you do your PhD in business (one student in my program) you can be on the board of directors for a hospital, become a CEO of a health company, etc. etc. etc. The possibilities are endless. MD/PhD is not just for basic sciences!!!!!

 

 

2. If you want to be an academic surgeon in downtown Toronto, you most likely need a PhD (you can obtain this in the Surgeon Scientist program as well)

[Candie]

NewfieMike, you don't need to want to run your own lab to do the MD/PhD route. There are many career paths for the dual degree:

 

1. If you do your PhD in engineering, you can open up your own biomedical engineering company (my goal). If you do your PhD in philosophy (another student in my program), you can be a medical ethicist at the hospital. If you do your PhD in public health (a few students in my program) you can work at Health Canada designing policy. Lastly, if you do your PhD in business (one student in my program) you can be on the board of directors for a hospital, become a CEO of a health company, etc. etc. etc. The possibilities are endless. MD/PhD is not just for basic sciences!!!!!

 

 

2. If you want to be an academic surgeon in downtown Toronto, you most likely need a PhD (you can obtain this in the Surgeon Scientist program as well)

 

Do all med schools have such a diverse range of possibilities for the MD/PhD combination? I feel like most have relatively few options and most PhD links are with basic sciences or epidemiology etc. 

 

Also, is it ever feasible to apply for or switch into the MD/PhD program during preclerkship? 

 

Just curious, thanks! 

[A-Stark]

I've mostly already made my points here, but you don't need a PhD let alone an MD/PhD to do work in medical ethics or biomedical engineering. Or to become a hospital CEO. Maybe I'm just not very ambitious, but there is a tremendous amount of work that must go into becoming a good clinician (and someone who can sit and pass Royal College exams). All the admin/research/leadership stuff happens along with this and can be accomplished without a PhD per se and, if one is needed, can be done with a greater career focus in residency or afterwards.

 

And while 32k/year sounds good for research pay, it's only about half my R2 salary. I have no shortage of debt, but also no shortage of what have turned out to be extremely lucrative tax credits.

[NLengr]

I've mostly already made my points here, but you don't need a PhD let alone an MD/PhD to do work in medical ethics or biomedical engineering. Or to become a hospital CEO.

 

You certainly don't need one to become a hospital CEO. The vast majority of hospital CEO's don't have one.

 

I agree that a PhD doesn't really help you one iota when it comes to being a good physician at providing patient care. 

[LeBronto2019]

Not sure if any of you are from UofA but has anyone heard about the MD STIR program (special training in research)? It's not as much of an investment as a PhD (or even master's) but it gets your foot in the door and since it shows up on your degree/transcripts, it might play some role in doing research later. I'm not planning to become an academic physician but just thought I'd ask. 

[Lactic Folly]

MD with STIR designation basically formally recognizes two summers of research. There are a couple of extra components (written report, oral presentation), but beyond that, I don't see that it's much different from having done, well, two summers of research.

[ralk]

Not sure if any of you are from UofA but has anyone heard about the MD STIR program (special training in research)? It's not as much of an investment as a PhD (or even master's) but it gets your foot in the door and since it shows up on your degree/transcripts, it might play some role in doing research later. I'm not planning to become an academic physician but just thought I'd ask. 

 

I think a lot of schools have similar programs, though I don't know how many of them show up on transcripts. I'm doing one here at Western - never even thought that it might appear on my transcript and I don't think it will - but it basically comprises all the elements of STIR that you describe.

 

Bottom line is that there are many opportunities to get involved in research besides doing grad work. Things like STIR are one and there are many, many others, either formally through the school, or informally through collaborations with faculty, physicians, and residents.

[lost__in__space]

I've mostly already made my points here, but you don't need a PhD let alone an MD/PhD to do work in medical ethics or biomedical engineering. Or to become a hospital CEO. Maybe I'm just not very ambitious, but there is a tremendous amount of work that must go into becoming a good clinician (and someone who can sit and pass Royal College exams). All the admin/research/leadership stuff happens along with this and can be accomplished without a PhD per se and, if one is needed, can be done with a greater career focus in residency or afterwards.

 

And while 32k/year sounds good for research pay, it's only about half my R2 salary. I have no shortage of debt, but also no shortage of what have turned out to be extremely lucrative tax credits.

 

You definitely don't need a PhD to work in biomedical engineering... but the training the PhD has provided me so far has opened my eyes to the possibilities the dual degree can afford me. There are so many research grants that an MD can obtain or oversee, that a PhD alone can't. As a PhD, I can't be in the OR to test my new tool tip designs myself. But I wouldn't have learned about force sensing or how tool tips are designed in the first place if not for my PhD training. It's one thing to test a tool and give feedback but now I actually have the skills to design the tool myself and go through the iteration process until I perfect it. I want to know how the tools I work with the OR were made and why they were designed that way. I then want to make them better through engineering. ALSO if you are out of the engineering world for many years (i.e. 4 years of medical school + maybe 1 or 2 before starting surgeon scientist program if you want to do your PhD then) you will lose your technical/math skills. That is a big bonus I see for doing the MD/PhD program specifically for engineering during medical school.

 

Also, I think grad school in general gives you a lot of transferrable skills. You can get them in many other ways but for me grad school is what will most definitely make me a better physician. I've learned communication skills, listening skills, presenting skills, how to ask good questions, how to use IEEE to look up tool specifications, what testing standards there are for tools, etc. etc. etc. You don't have the time in medical school or residency to pick up highly technical skills in engineering and my PhD gave me that protected time to do so. Plus I met my husband in grad school so that is most definitely an important perk!

 

I think UofT's MD/PhD program is an excellent example of a program that lets you do a PhD in whatever you might desire. I can't speak for the other schools.