Yes, all other things equal a PhD will always help you. I don't think it's as big of a factor as most people believe it is.
And the PhD isn't a golden ticket anymore because there are more MD/PhDs than there used to be.
Agreed. Also, funding has been poor for research for some time. No longer are most departments looking for MD/PhDs to support/do experiments for their research faculty at their institution, since those faculty are becoming fewer and fewer in number. Also, departments are getting burnt out on MD/PhDs who have strong credentials but go off to clinical practices in part due to the poor funding environment. We used to be considered an investment--the successful ones of us might stay on and bring in big grant funding and prestige in the future. But this hope has dwindled significantly as fewer of us have significant research careers.
Couple that with increasingly competitive residencies and the fact that PDs want solid reliable clinicians.
Agreed. I have written two blog entries about this.
http://www.neuronix.org/2011/07/nrmp-puts-out-charting-outcomes-in.html
http://www.neuronix.org/2012/06/effects-of-score-creep-trends-in.html
PDs are generally clinicians who are looking for the easiest residents to train and who will do the most work with the least complaint. They are not looking for potential problems from residents who are trying to get back to lab as much as possible.
Having a weak clinical background with a PhD don't cancel each other out as much anymore.
My experience and the experiences I get talking to other MD/PhDs is that in order the most important things (in order) are:
1. Step 1
2. Clinical grades
3. Research experience
It's not even having a weak clinical background that hurts an MD/PhD. The MD/PhD still needs the same clinical background as their MD competition to stand out. Especially in my specialty (rad onc) where even the MD applicants often have significant research. How much a PhD "matters" varies from program to program, but a productive year out by your competition can essentially negate your PhD for many reviewers, and then their clinical performance beats the PhD who came back to clinics after 4 years of PhD and couldn't hack it the first six months.
Certain highly academic derm programs salivate over MD/PhDs. If your thesis is in something in relation to skin -- you can bet PDs will throw their panties at you.
This is another thing that's important. Most MD/PhDs are given the advice not to pick their research based on whatever residency they think they might want. Also, you go to research after MS2 and don't pick a specialty until MS3. So most MD/PhDs don't do their PhDs in their specialty of interest. This is a handicap. Many specialties don't care about a PhD that's not in their area. So I think DermViser is right--the PhD will be a significant asset for academic derm programs if it's in dermatology. It's the same for rad onc. But most PhDs are in something fairly basic that often is not directly clinically relatable, and those PhDs are again not particularly valuable to residencies.
I feel like a lot of academic pathologists might disagree with you, they seem to salivate at MD/PhDs
Pathology is an exception. Benchtop research, which most MD/PhDs have, is often directly applicable to pathology. Additionally, specialties that are not that competitive clinically to begin with will especially jump at PhDs. It's easier to meet what might be considered an acceptable step 1 score for the specialty (i.e. 220 for path vs a 240 for rad onc), and clinical grades don't matter as much when few people have AOA in the specialty to begin with. Similar things can be said for specialties like pediatrics or PM&R, which are not so competitive clinically to begin with. Your PhD may really begin to stand out there.