Mid-Tier MD/PhD vs. Top-Tier PhD

[learntoheal]

Hello all!

Context

I am in a situation where I am considering between a mid-tier MD/PhD program (non-MSTP) and some top-tier PhD programs.

I am certain at this point that I want to become a physician-scientist, however, I haven't done as well in the admissions process due to a low uGPA. On the other hand, I have an excellent graduate GPA in my field (engineering) and am fortunate to have the option of top-tier PhD programs. I also have a strong preference for location, and the top-tier PhD programs are in my preferred location.

Questions

I believe that if I further remediated my uGPA through my PhD, I may get into a higher tier MD program after completing my PhD. Assuming the cost of education is not a factor, does completing a PhD at a top-tier institution give a significant advantage in developing a career as a physician-scientist?

Similarly, assuming all other factors are the same, would an MD/PhD with separate degrees from top-tier institutions stand a better/worse/equal chance compared to an MD/PhD from a combined program in getting funding, positions, etc.? If there is a advantage or disadvantage either way, what factors contribute to the difference?

I haven't been able to find a clear answer to these questions on other forums, but if this has been answered already, I apologize.

Thank you all in advance.

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[Electricity]

Honestly, if the cost of education is not a factor then this might make sense, but it would make the analysis much different for you than the vast majority of people. Are you independently very wealthy such that you won't need to earn a salary to support yourself? Also, is the MD/PhD fully funded with a stipend?

 

[learntoheal]

Yes, the MD/PhD is fully funded with a stipend.
I would probably have to incur some debt to finance my education, but location choice is more important to me than the cost (I am non-trad and older). Ultimately, I would consider all personal factors holistically.

For the sake of this question, however, I am purely interested in whether there is a professional impact of getting the degrees separately and how much the tier of institution matters.

 

[Electricity]

Tier of institution matters for getting into residency. IMO it almost certainly doesn't matter as much as the extra years, which you'd probably incur by doing the PhD first, unless you know that you want to go for a competitive specialty. (Look up the average number of years to graduation at your potential PhD programs. And it's hard to finish a PhD in addition to getting a Med school app together, so you might have to add a year.) Because with those extra years you can subspecalize and get more experience in the type of research you actually want to do. Whereas you generally have less choice of project in the phd.

ETA: Why don't you look up some of the graduating alumni from your MD/PhD program and see where they went for residency and what happened to their careers? That might help give you a sense.

 

[ValentinNarcisse]

Tier of institution matters for getting into residency. IMO it almost certainly doesn't matter as much as the extra years, which you'd probably incur by doing the PhD first, unless you know that you want to go for a competitive specialty. (Look up the average number of years to graduation at your potential PhD programs. And it's hard to finish a PhD in addition to getting a Med school app together, so you might have to add a year.) Because with those extra years you can subspecalize and get more experience in the type of research you actually want to do. Whereas you generally have less choice of project in the phd.

ETA: Why don't you look up some of the graduating alumni from your MD/PhD program and see where they went for residency and what happened to their careers? That might help give you a sense.

Medical schools, even top tier ones, will minimally care about your top-tier PhD. At the residency stage, they will care even less, even in competitive fields. Most people who complete MD after PhD have little to no interest in running a basic science laboratory and are generally turned off to academic careers. Also, this will take significantly longer to earn a PhD in a normal PhD program.

 

[Neuronix]

I believe that if I further remediated my uGPA through my PhD, I may get into a higher tier MD program after completing my PhD. Assuming the cost of education is not a factor, does completing a PhD at a top-tier institution give a significant advantage in developing a career as a physician-scientist?

Nobody cares about your grad school GPA. Everyone knows the grades in grad programs are a joke. There is no guarantee you'll get a "top tier" medical school acceptance after your "top tier" PhD. Your MCAT score will expire and you'll have to retake it though, very far from the undergrad classes that the MCAT is based on. Good luck getting a high score again.

Similarly, assuming all other factors are the same, would an MD/PhD with separate degrees from top-tier institutions stand a better/worse/equal chance compared to an MD/PhD from a combined program in getting funding, positions, etc.? If there is a advantage or disadvantage either way, what factors contribute to the difference?

No difference.

 

[tr]

Hello all!

CONTEXT

I am in a situation where I am considering between a mid-tier MD/PhD program (non-MSTP) and some top-tier PhD programs.

I am certain at this point that I want to become a physician-scientist, however, I haven't done as well in the admissions process due to a low uGPA. On the other hand, I have an excellent graduate GPA in my field and am fortunate to have the option of top-tier PhD programs. I also have a strong preference for location, and the top-tier PhD programs are in my preferred location.

QUESTIONS

I believe that if I further remediated my uGPA through my PhD, I may get into a higher tier MD program after completing my PhD. Assuming the cost of education is not a factor, does completing a PhD at a top-tier institution give a significant advantage in developing a career as a physician-scientist?

Similarly, assuming all other factors are the same, would an MD/PhD with separate degrees from top-tier institutions stand a better/worse/equal chance compared to an MD/PhD from a combined program in getting funding, positions, etc.? If there is a advantage or disadvantage either way, what factors contribute to the difference?

I haven't been able to find a clear answer to these questions on other forums, but if this has been answered already, I apologize.

Thank you all in advance.

The problem with this question is you are positing all other factors equal; but all factors are never equal, and the ones you are asking about are not the ones that matter.

Advancement in science depends on two things: ability to publish and ability to obtain funding. These in turn will depend on a large number of essentially unpredictable factors, such as your relationship with your graduate mentor, whether your chosen field is of interest to the NIH at crucial moments in your trajectory, what kind of support is available for research at your residency institution, etc.

The bottom line is the whole thing is a crapshoot either way, but if you get the MD at least you'll have a job if science doesn't pan out. I would never pay for an MD if I had the option not to, but I don't know your financial situation.

Honestly in addition to the price tag, trying to do the degrees sequentially doesn't make much sense. PhD doesn't improve your chances of getting into med school (it's still about undergrad GPA and MCAT, and your grad school courses don't figure into your undergrad GPA). You'll lose research momentum while in med school.

If you're hell bent on basic research and not interested in a clinical backup plan, I'd try to gauge which pathway will get you published most and fastest. That would involve doing a lot of sleuthing on the mentors available to you at each institution and their individual track records of graduating highly published students who end up with faculty positions.

 

[dl2dp2]

Hello all!
I believe that if I further remediated my uGPA through my PhD, I may get into a higher tier MD program after completing my PhD. Assuming the cost of education is not a factor, does completing a PhD at a top-tier institution give a significant advantage in developing a career as a physician-scientist?

No. Degrees from top-tier biomedical PhD programs are roughly equivalent to or worth less now than mid/lower tier MD/PhD programs in almost every way on average. This is why you are getting what you are getting. It's a market economy. It used to be the case that if you do a molecular biology PhD at Harvard your chance of getting an R01 is better than if you did your MD/PhD at say UMaryland or something. Now, not so much. The latter pathway (UMaryland MDPhD -> top tier research oriented specialty training -> K -> R01) has a slightly better chance of success overall for someone who want to end in a bench "translational" research career compared to a former pathway (Harvard PhD -> some equally prestigious postdoc -> tenure track -> R01). The difference though is minor, and neither pathway has a very good shot overall. The prevailing statistic is something like ~15-20% for the MDPhD pathway, and likely slightly less than ~10% for the PhD pathway. A more exact estimation depends on your subfield etc.

Getting a PhD does not give you anything at becoming a *physician*-scientist, but you already know that.

Another thing: strong location preference is often a kiss of death for a career in biomedical research. But you probably also know that.

Similarly, assuming all other factors are the same, would an MD/PhD with separate degrees from top-tier institutions stand a better/worse/equal chance compared to an MD/PhD from a combined program in getting funding, positions, etc.? If there is a advantage or disadvantage either way, what factors contribute to the difference?

People drop out for various reasons. Likely if they don't drop out at some point later on there's a statistical difference between candidates who have a resume that's all "top tier" vs. someone who does not. However, whether these two things are causally related is unclear. Echoing previous poster, all else equal you go somewhere more prestigious. However, we are not talking about apples and oranges. Pure biomedical PhD programs are worth very little, and their value is decreasing. Things that are worth very little will do very little for your later career, no matter what it ends up becoming. Of course individual milages vary greatly (i.e. you might luck into a super advisor, your field might have unusual applications, etc.) I'm just talking averages, which is your question. Med schools are competitive. You lucked into a very competitive program (MD/PhD). You might never get into a med school again if you applied in 5-7 years, in which case your chance of becoming a "physician-scientist" becomes zero. Is that the risk you want to take?

 

[learntoheal]

Nobody cares about your grad school GPA. Everyone knows the grades in grad programs are a joke. There is no guarantee you'll get a "top tier" medical school acceptance after your "top tier" PhD. Your MCAT score will expire and you'll have to retake it though, very far from the undergrad classes that the MCAT is based on. Good luck getting a high score again.

I understand that my graduate GPA is only useful for getting me into PhD programs. My field is an engineering field. What I meant was taking additional undergraduate classes during the PhD to boost my uGPA and build a longer track record of good grades in pre-med classes. I am pretty sure I will get an equal or higher score on the MCAT, as I have already taken it, had it expire, and taken it again. However, the admissions part is something I would have to figure out on my own. I am primarily trying to understand if MD/PhDs from both types of paths have different career outcomes, and the importance of institutional tier.

Based on your response it seems in the end, an MD/PhD is earned either way, so there is not a significant difference professionally, and the impact of tier is negligible. Thank you for sharing your perspective!

 

[GadRads]

I am primarily trying to understand if MD/PhDs from both types of paths have different career outcomes, and the importance of institutional tier.

No, do the combined mid-tier MD/PhD. Focus on learning medicine as well as you can, get high Step scores and do well in MS3. Work hard in graduate school and publish as many good papers as you can within 3-5 years.

 

[Michelest2017]

I understand that my graduate GPA is only useful for getting me into PhD programs. My field is an engineering field. What I meant was taking additional undergraduate classes during the PhD to boost my uGPA and build a longer track record of good grades in pre-med classes. I am pretty sure I will get an equal or higher score on the MCAT, as I have already taken it, had it expire, and taken it again. However, the admissions part is something I would have to figure out on my own. I am primarily trying to understand if MD/PhDs from both types of paths have different career outcomes, and the importance of institutional tier.

Based on your response it seems in the end, an MD/PhD is earned either way, so there is not a significant difference professionally, and the impact of tier is negligible. Thank you for sharing your perspective!

If you get accepted to top PhD programs, I would NOT recommend turning that down for anything mid tier. Graduate school (md/phd) is meant to aim high. Undergrad - no one cares, but everyone tries to go to the absolute best graduate schools they can because that is the last chance for educational pedigree and top residencies WILL BE LOOKING. I can go online and look at current resident classes and clearly see top institutions, even for their previous degrees (mph/ms/mba) were top knotch.

Patients LOVE to hear you went to X, Y, Z top school - remember the patients in all of this. Even my mom loves to say her doctor went to "Duke" lol

First of all, pedigree can help. Having been to Harvard, I was able to secure funding for frivolous things that I didn't even know existed (imagine my shock!)... I also ended up with funding for a masters that I thought would have NEVER been funded.

Another thing I'm amazed at, is that at top tier institutions, it is much easier to get work published. For example, I was amazed at how easy it was to apply for grants, even after the deadline, when I sent an email from my Harvard student account saying I just learned about X,Y,andZ can I apply.

Whether we like it or not, some people do go by name and so I can definitely see why you might want to go to a top tier PhD program.

I highly recommend it. I hate to say it but the name can and does open up opportunities, many of which you won't even begin to know about until on campus. You'll have stronger reccs for med schools, can volunteer at places like MassGen (using Harvard as an example) for clinical hours, and everyone that reads your application going forward will at the very least, give it a good shake down.

So while it's not a tangible must have, I can definitely see why you posed this question. Having been to Harvard for my masters, where it ended up fully funding, and wanting to do a PhD there, I would say if you can do a top/top tier PhD then it is worth it...

When you apply to medical school - continue to apply for scholarships. I had a friend that won 60k for vaccine research while a medical school student and I think it was because of her previous PhD - so realize that there are PLENTY of other funding opportunities for graduate school if you continue applying and having the PhD can help.

** However, once you've been to a top tier school the pressure is on to continue going to top tier schools so you would need to make sure you actually take those undergraduate courses and end up with a high uGPA...

 

[Michelest2017]

Also, if you run your own private practice, and you put your diplomas on the walls for your potential patients to see....what do you think is going to sell the most?

1 thing people seem to forget about pedigree is the patient's opinion.... patients do ask where you've been to school...and you'd be kidding not to think a PhD from Yale, for example, isn't going to make a patient think twice about going to another doctor... this applies regardless of where you end up getting your MD,... you'd still be able to say you went to Yale, for example..and patients LOVE that kind of stuff

 

[puppies.]

the reason people (here) are not considering the patient's opinion on pedigree is that frankly it doesn't matter. this career path (at least in theory) sets you up for academic medicine, where acquiring a patient referral base is unlikely to be something you yourself are responsible for, compared to private practice. more importantly, the issue at play is your chance of obtaining independent funding throughout your training and in your career. pedigree can absolutely help with this, but (assuming this person sticks with medicine) pedigree of post-graduate/residency training is probably going to be more important than medical school/graduate school. while pedigree of these certainly helps get you noticed by top residency programs, you can absolutely end up at a top-tier place coming from a mid-tier MD/PhD program (in my program it is very common unless you decide you are headed for a very competitive specialty...where honestly you probably won't be doing much research anyway). keep in mind this person is deciding between doing a top-tier PhD now and rolling the dice for medical school in the future, versus taking a mid-tier MD/PhD spot...they are not guaranteed both a PhD and an MD at a top institution.

there are important nuances here to consider for both options (as has been discussed above), but your argument misses some key points

 

[Michelest2017]

the reason people (here) are not considering the patient's opinion on pedigree is that frankly it doesn't matter. this career path (at least in theory) sets you up for academic medicine, where acquiring a patient referral base is unlikely to be something you yourself are responsible for, compared to private practice. more importantly, the issue at play is your chance of obtaining independent funding throughout your training and in your career. pedigree can absolutely help with this, but (assuming this person sticks with medicine) pedigree of post-graduate/residency training is probably going to be more important than medical school/graduate school. while pedigree of these certainly helps get you noticed by top residency programs, you can absolutely end up at a top-tier place coming from a mid-tier MD/PhD program (in my program it is very common unless you decide you are headed for a very competitive specialty...where honestly you probably won't be doing much research anyway). keep in mind this person is deciding between doing a top-tier PhD now and rolling the dice for medical school in the future, versus taking a mid-tier MD/PhD spot...they are not guaranteed both a PhD and an MD at a top institution.

there are important nuances here to consider for both options (as has been discussed above), but your argument misses some key points

I agree with what you are saying...

At the same time, it's obvious the OP cares about pedigree and I would like to add that people who usually care about pedigree would be MUCH happier at a school with pedigree...I just don't think people should lie to themselves... if you care about pedigree, then go after the pedigree or else you're going to be unhappy

I think people that go to "mid-tier" tend to choose it as a first choice, not based on rankings, but because of a certain professor/location/or they simply loved the school.... which does not appear to be what this guy is even hinting at...

If I were in the OP's situation I'd literally only separate the degrees if I got into Harvard/Stanford/Rockefeller/MIT/Caltech - it'd literally have to be along those lines for it to be worth even considering separating in my opinion... so basically if you are going to forgo money for pedigree, it should be literally the best a person can do...or else you're just flushing money down the toilet...

I'm also going to bet that if someone has a PhD from Harvard/Stanford/Rockefeller/MIT/Caltech that they would probably get into medical school...

 

[learntoheal]

First of all, pedigree can help. Having been to Harvard, I was able to secure funding for frivolous things that I didn't even know existed (imagine my shock!)... I also ended up with funding for a masters that I thought would have NEVER been funded.

Thank you for your interesting perspective. You definitely nailed why I posed this question in the first place. I did research at a mid-tier institution as an undergrad, and have been researching at a top-tier institution post-grad for a couple of years now. Although the rigor of research is not significantly different, the access to collaborators, funding, and publications in top journals are significantly easier to obtain. Whenever the name of my institution comes up, people actually pay attention, which I did not observe during my previous experiences. Obviously I believe that scientific work should be judged on its merit, but I can't ignore my observations, which is why I wanted to pose this question on a public forum to see if others have similar experiences and how much they believe this is a factor in deciding where to study.

 

[learntoheal]

you can absolutely end up at a top-tier place coming from a mid-tier MD/PhD program (in my program it is very common unless you decide you are headed for a very competitive specialty...where honestly you probably won't be doing much research anyway)

This has come up earlier in the thread as well, and I am interested in learning more.

Tier of institution matters for getting into residency. IMO it almost certainly doesn't matter as much as the extra years, which you'd probably incur by doing the PhD first, unless you know that you want to go for a competitive specialty.

Although I realize that people change over time, I am currently interested in ophthalmology because it related to my current research, I have seen most MD/PhDs in my line of research follow this specialty, and I genuinely have an academic interest in the field.

I believe that ophthalmology is a pretty competitive specialty. Does it follow from the quoted statements that pedigree might be something I should consider if I want to ultimately want to compete for a residency in this field?

 

[Neuronix]

If you want to do MD/PhD, get into the best MSTP you can get into. It's as simple as that.

Doing the degrees separately to attempt to go up the USNews ranking list is not worth the time and cost.

 

[puppies.]

This has come up earlier in the thread as well, and I am interested in learning more.

Although I realize that people change over time, I am currently interested in ophthalmology because it related to my current research, I have seen most MD/PhDs in my line of research follow this specialty, and I genuinely have an academic interest in the field.

I believe that ophthalmology is a pretty competitive specialty. Does it follow from the quoted statements that pedigree might be something I should consider if I want to ultimately want to compete for a residency in this field?

sure. over the past 5-6 years, my mid-tier MSTP has consistently sent people to top places in IM, peds, neuro, and path. this includes several people who have decent but not amazing publication records and clinical scores, along with a few superstars. most of the people in these specialties who stick around our institution (or nearby institutions) are doing so for personal reasons, and often have decided they are not headed down the traditional physician-scientist track anymore. it's a bit more hit-or-miss for people interested in more competitive things (surgical subspecialties, mostly), but we have had people go to some top places in these specialties as well. in the time i've been in the program, only one person went into ophtho, and stayed at our institution. again, not infrequent that people will decide to stick around for family/personal reasons even if they could have matched to somewhere higher; i have no idea if that was the case with our one ophtho person.

note that you appear to be getting advice from people here with a variety of backgrounds: many who have gone through (or are finishing) MD/PhD training, and someone who seems to be in the process of getting a master's and thinking of continuing on to get a PhD without the MD. there is no problem with getting advice from people with varied experiences, but weighing this advice appropriately is something you may want to consider vis-a-vis your own career desires.

finally, i know back when i was applying it would have been a big red flag to have been accepted to an MD/PhD program, turn it down, and apply to more MD/PhD programs the next year. i'm not sure if it's still a red flag if you take the time to get a PhD and then apply to MD-only programs, but it's another factor to think about.

 

[Michelest2017]

Just to clarify, my background is one of doing the PhD (entry Fall 2017) and then MD (goal to finish PhD to MD in 7-8 years).

I've never applied/been accepted into a joint MD/PhD program so that is something to consider.

I actually never intended on doing a PhD after masters, only MD. I applied last minute and will be interviewing at top places in the new year, so I never intended to do a program that would allow me to get a free MD so that's something to consider as well.

 

[puppies.]

ah, that makes sense. i have encountered a few people on the residency interview trail who did something similar (PhD then MD), and they seem to be doing quite well in terms of where they're looking for residency. the big unknown remains getting into the MD program

 

[learntoheal]

If you want to do MD/PhD, get into the best MSTP you can get into. It's as simple as that.

Doing the degrees separately to attempt to go up the USNews ranking list is not worth the time and cost.

Makes sense. When factoring in the time, cost, and risk, there is not really a justifiable reason to pursue the degrees separately, which is why I am leaning towards the combined program. The program I am considering is not an MSTP, however. Based on reading around in this forum, I've seen mixed reviews about whether this matters for obtaining residency, but I can't imagine this factor alone mattering enough to choose a PhD-to-MD. I hope that this aligns with your experience too.

The main personal reason (as opposed to the professional reasons already stated) I am even considering the alternative is due to the nature of my fiance's career, which would take a significant hit if she moved, at this time, to the location of the joint program I am considering, although she would have an opportunity to move in a few years. Consequently, I am wondering whether I can theoretically have my cake and eat it too by obtaining the PhD where she is, and then moving later to wherever I might get in for MD (still an MD/PhD, right?). The reason I am downplaying the additional cost is that both she and I have accumulated savings from working several years after undergrad, her work pays extremely well, and the career earnings of an MD/PhD are enough to compensate. I hadn't disclosed this previously, mostly for anonymity, and I'm not sure if it really affects the discussion, but wanted to put it out to give some insight into how I could possibly consider an non-traditional path.

 

[Fencer]

Combined programs are the most efficient - time and money- to complete. Very few program directors will care if you were in a MSTP or non-MSTP MD/PhD. They will care on your Step I score, AOA status, clerkship grades, and LORs in their specialty. PSTPs will care about your papers and fellowship grants too, more than "status" of your program. While the recent poster has chosen to break down the programs, and as per the poster, it is apparently working for them, this strategy will decrease their future flexibility by having to foot the cost of medical school at a time when bills start to matter (i.e.: family and/or other responsibilities). Certainly the NIH loan repayment program might help...

 

[Neuronix]

The program I am considering is not an MSTP, however. Based on reading around in this forum, I've seen mixed reviews about whether this matters for obtaining residency, but I can't imagine this factor alone mattering enough to choose a PhD-to-MD. I hope that this aligns with your experience too.

There are very few people out there who know the difference between MSTP and non-MSTP or which programs are MSTP or are not MSTP. Those people are not typically the ones picking residents.

I can see that you're trying to justify a decision to stay close to your spouse, but on a professional basis it's not advisable. On a personal basis, you will still have to make that decision either way.

 

[Michelest2017]

There are very few people out there who know the difference between MSTP and non-MSTP or which programs are MSTP or are not MSTP. Those people are not typically the ones picking residents.

I can see that you're trying to justify a decision to stay close to your spouse, but on a professional basis it's not advisable. On a personal basis, you will still have to make that decision either way.

Combined programs are the most efficient - time and money- to complete. Very few program directors will care if you were in a MSTP or non-MSTP MD/PhD. They will care on your Step I score, AOA status, clerkship grades, and LORs in their specialty. PSTPs will care about your papers and fellowship grants too, more than "status" of your program. While the recent poster has chosen to break down the programs, and as per the poster, it is apparently working for them, this strategy will decrease their future flexibility by having to foot the cost of medical school at a time when bills start to matter (i.e.: family and/or other responsibilities). Certainly the NIH loan repayment program might help...

Getting a PhD is still going to cost him at least 4 years of salary he could (later on) be earning as a doctor... so MSTPs aren't necessarily just free MDs ...there are still hidden costs associated

On some level, when someone pursues a PhD, whether joint or not, they will have to include more considerations other than finances

If someone really wants to save money on medical school, they should attend 4 years of medical school at a medical school that provides merit aid... so improving your profile for merit aid at low-tier/mid-tier medical schools is probably the best bet to really come out with the lowest amount in loans + not losing 4+ years of salary in a PhD program

Or the OP could just improve his med school profile (Ugrad gpa etc) and get into the best medical school he can and only attend 4 more years of school... this way although you end up with loans, you aren't forgoing 4+ years of a doctor's salary for a phd/md ... and will attend a more prestigious school (hypothetically)

 

[Michelest2017]

Combined programs are the most efficient - time and money- to complete. Very few program directors will care if you were in a MSTP or non-MSTP MD/PhD. They will care on your Step I score, AOA status, clerkship grades, and LORs in their specialty. PSTPs will care about your papers and fellowship grants too, more than "status" of your program. While the recent poster has chosen to break down the programs, and as per the poster, it is apparently working for them, this strategy will decrease their future flexibility by having to foot the cost of medical school at a time when bills start to matter (i.e.: family and/or other responsibilities). Certainly the NIH loan repayment program might help...

Yes, NIH lrp is amazing and my roommate who is now in residency has it... same work expect a large percentage of her medical school loans are being forgiven for 10- 20 hours of dedicated research on a special topic for NIH every week

 

[tr]

Makes sense. When factoring in the time, cost, and risk, there is not really a justifiable reason to pursue the degrees separately, which is why I am leaning towards the combined program. The program I am considering is not an MSTP, however. Based on reading around in this forum, I've seen mixed reviews about whether this matters for obtaining residency, but I can't imagine this factor alone mattering enough to choose a PhD-to-MD. I hope that this aligns with your experience too.

The main personal reason (as opposed to the professional reasons already stated) I am even considering the alternative is due to the nature of my fiance's career, which would take a significant hit if she moved, at this time, to the location of the joint program I am considering, although she would have an opportunity to move in a few years. Consequently, I am wondering whether I can theoretically have my cake and eat it too by obtaining the PhD where she is, and then moving later to wherever I might get in for MD (still an MD/PhD, right?). The reason I am downplaying the additional cost is that both she and I have accumulated savings from working several years after undergrad, her work pays extremely well, and the career earnings of an MD/PhD are enough to compensate. I hadn't disclosed this previously, mostly for anonymity, and I'm not sure if it really affects the discussion, but wanted to put it out to give some insight into how I could possibly consider an non-traditional path.

I think the finances make a huge difference actually. One of the main roadblocks preventing people from entering research careers is that the finances really do not work out if you have med school loans. Most of the people who were my co-residents are paying the equivalent of a second mortgage/rent/daycare bill on their loans. I was flabbergasted when I heard what some of these loan payment amounts are like. There is no way I could have justified doing a research fellowship after residency for a third of the salary I would have been making as a salaried psychiatrist in the community if I'd been carrying that kind of loan burden. And my spouse is quite gainfully employed fwiw.

The NIH LRPs are intended to solve this problem but they are also competitive, no guarantee you would get one and by doing the fully funded combined degree you avoid that headache in the first place.

Overall I think that by doing the degrees sequentially you are hugely increasing your risk of falling off the track at some point in the future. You might do the PhD and then find yourself too exhausted or financially straitened to take on four more years of school and a huge loan burden (or you might not get into a school whose location works for you). You might do the PhD, get into an acceptable MD program, and find yourself overwhelmed by the all-absorbing nature of clinical work and not have the time or energy to sustain an interest in research. You might do the PhD, do the MD, and then not find a residency that both supports a research focus and is in an acceptable location for you and your fiancee/wife. You might get through residency, and then find yourself in your forties with a loan burden, maybe a mortgage, maybe children, very little in the way of recent impactful research (since you've been spending all your time in clinical training), and totally unable to justify making $90K/year to get back on the research wagon instead of making $250K (at a minimum, or much more depending on your specialty)/year in clinical practice.

Given all the above I'd say your chances of actually making it to research assistant professor by going PhD to MD are slim to none.

Still pretty slim with the combined degree as for all of us, but at least you wouldn't be throwing so much money and time away. By doing the combined degree you lessen the financial liabilities, reduce the time spent in school, and you have a support system in place for maintaining at least some kind of research trajectory through the clinical years. Combined degree programs know about this problem of getting sucked into clinic and losing your research momentum, and they have ways to help you deal with it.

On the other hand obviously the argument for staying near your fiancee is compelling. Given that, if I were in your shoes I might still do the PhD. I just wouldn't harbor any illusions about it being the better choice professionally.

 

[dl2dp2]

On some level, when someone pursues a PhD, whether joint or not, they will have to include more considerations other than finances

Frankly, the pitfall of a PhD (only) is often precisely people not considering ENOUGH of the financial implications. NIH salary scale for a postdoc basically would qualify you for food stamps for a family of 4. Think about that.

 

[Michelest2017]

Or the OP could just improve his med school profile (Ugrad gpa etc) and get into the best medical school he can and only attend 4 more years of school... this way although you end up with loans, you aren't forgoing 4 years of a doctor's salary for a phd/md ... and will attend a more prestigious school (hypothetically)

Frankly, the pitfall of a PhD (only) is often precisely people not considering ENOUGH of the financial implications. NIH salary scale for a postdoc basically would qualify you for food stamps for a family of 4. Think about that.

 

[GadRads]

There is also no guarantee that, assuming you do the PhD, you will eventually get accepted into a medical school that will be in the same location as your fiancee's job. Based on all the data you have provided, it still makes far more sense to do the combined program. If you do well in medical school, obtain high Step scores, get good MS3 grades, do good research and publish during your PhD, have good letters, and interview well, you will match without issue, even in competitive specialties.

 

[Maebea]

Frankly, the pitfall of a PhD (only) is often precisely people not considering ENOUGH of the financial implications. NIH salary scale for a postdoc basically would qualify you for food stamps for a family of 4. Think about that.

I realize that America has moved into a fact-free era, but as scientists we ought to resist the zeitgeist. The gross monthly income limit for a family of 4 to receive food stamps is $2,633; the gross NIH monthly PG1 salary is $3957. For a PG1 postdoc to qualify for food assistance, s/he would need to have a family of 7.

 

[dl2dp2]

I realize that America has moved into a fact-free era, but as scientists we ought to resist the zeitgeist. The gross monthly income limit for a family of 4 to receive food stamps is $2,633; the gross NIH monthly PG1 salary is $3957. For a PG1 postdoc to qualify for food assistance, s/he would need to have a family of 7.

"Food stamp" is figurative and not quite an exact term. I meant you'd be eligible for a variety of federal services targeted for low income families. e.g.

https://www.fns.usda.gov/wic/wic-income-eligibility-guidelines

https://grants.nih.gov/grants/guide/notice-files/NOT-OD-16-131.html

This level of income would also make you eligible for public housing and Medicaid in various states.

If you are talking specifically about "food stamps" proper, i.e. SNAP, it also has a federal vs. state distinction. In some States, for example RI, the state limit for SNAP are set higher even though the federal limit is lower:
http://www.dhs.ri.gov/Programs/SNAPEligibility.php
So if it turns out that your school is in RI, and you are paid at NIH minimum, then yes, you would be able to get food stamps as a single post-doc earner 4 people family.

Turns out federal "food stamps" in particular has a lower threshold for eligibility than other benefits. That's a curiosity in and of itself which I wasn't previously aware...thank you for pointing that out.

 

[Michelest2017]

Combined programs are the most efficient - time and money- to complete. Very few program directors will care if you were in a MSTP or non-MSTP MD/PhD. They will care on your Step I score, AOA status, clerkship grades, and LORs in their specialty. PSTPs will care about your papers and fellowship grants too, more than "status" of your program. While the recent poster has chosen to break down the programs, and as per the poster, it is apparently working for them, this strategy will decrease their future flexibility by having to foot the cost of medical school at a time when bills start to matter (i.e.: family and/or other responsibilities). Certainly the NIH loan repayment program might help...

I just wanted to re-note, that I have not been accepted to an MSTP so that factors into my decision as well...

However, I am not applying to MSTP because I do not think I'd be able to get into a top MSTP in the next 3 years and by then I could be 1 year shy of being done with my PhD, so for me it's more of a timing issue... + the fact that I've been told, if I work hard enough I could finish my PhD in 3 years, 4 at the most. Also, 1 PhD program I'm interviewing at offers subsidized housing in one of the most expensive neighborhoods in my city, so I would like to take advantage of that ASAP!

I am also a maniac when it comes to applying for funding. I have no student loans with a bachelors + masters from top private schools (little to no financial aid was even offered!). I literally apply for AT LEAST 2 scholarships/funding sources a week (all year round) so I trust in my abilities to get funding for medical school and walk away with little debt. I get rejected from something every week, but the few I do get, help a lot! I was not tech. offered any merit aid undergrad but fought with financial aid and eventually got some money.

* I encourage everyone to fight for money no matter where they are going to school, you'd be amazed at how much money people walk away from by not constantly searching/applying/fighting with people over the nitty gritty.

Basically, either way it's a lot of work, but I get to go to the schools I want, live where I want, and work with who I want. I feel it's worth the fight. I could never live 8 years in a city/place I hated and name/pedigree matters to me personally.

 

[Michelest2017]

Hello all!

Context

I am in a situation where I am considering between a mid-tier MD/PhD program (non-MSTP) and some top-tier PhD programs.

I am certain at this point that I want to become a physician-scientist, however, I haven't done as well in the admissions process due to a low uGPA. On the other hand, I have an excellent graduate GPA in my field (engineering) and am fortunate to have the option of top-tier PhD programs. I also have a strong preference for location, and the top-tier PhD programs are in my preferred location.

Questions

I believe that if I further remediated my uGPA through my PhD, I may get into a higher tier MD program after completing my PhD. Assuming the cost of education is not a factor, does completing a PhD at a top-tier institution give a significant advantage in developing a career as a physician-scientist?

Similarly, assuming all other factors are the same, would an MD/PhD with separate degrees from top-tier institutions stand a better/worse/equal chance compared to an MD/PhD from a combined program in getting funding, positions, etc.? If there is a advantage or disadvantage either way, what factors contribute to the difference?

I haven't been able to find a clear answer to these questions on other forums, but if this has been answered already, I apologize.

Thank you all in advance.

"A young researcher would be crazy not to try for the LRP!"

https://www.lrp.nih.gov/

I have a list with over 50 things just for medical school like the above. I treat applying for things like a job. I say this to say I didn't even apply for MSTP because I know it's not the only way to get funding for medical school + school pedigree matters to me.

 

[Michelest2017]

.

 

[smithers12]

if you are a non-trad as it is, i would strongly consider the amount of time a combined program would save you. does your non-MSTP have mechanisms in place for shortening the time to graduation? for instance at my institution we are required to have an MSTP-affiliated faculty sit on our committee. a PhD-only route will almost certainly take you more time to complete.

such security offered by a combined program is really something i would advise you to think about. let's say you're on a PhD-only route and 1/2 of the way through your PI gets hit by a bus - now what? do you think your committee members are really going to care if you have to start your PhD all over again? in a combined program, you have 1) people with a vested interest in having you graduate as quickly as possible, and 2) the option of giving everything up and going back to medical school - a solid plan B that few in this country have the opportunity to take advantage of.

unless the non-MSTP pidgeonholes their graduates into certain fields/locations (look at their match list), or does not have a track record of pushing students out quickly, just go to medical school and never look back. i would advise you to forgo whatever artificial concept of "tiers" you might have in your head. they just don't matter.

 

[OxToCA]

I think that you should do the PhD at a well known university and then apply to MSTPs through the NIH's graduate partnerships program https://mdphd.gpp.nih.gov/prospectiveStudents/track3.asp. You could not only attend the university that you want to, but you'd be more competitive for grants to fund your doctoral research per statistics in the picture described at http://news.emory.edu/stories/2015/03/er_nih_predoctoral_fellowships/campus.html In all fairness, I believe that Neuronix is at Penn and may be slightly biased

 

[Neuronix]

It has been a long time since I was at Penn...

 

[smithers12]

i'm pretty sure neuronix would be the first person to tell you how little a so called "top tier" phd mattered in the match process

 

[MDviaMBB]

i'm pretty sure neuronix would be the first person to tell you how little a so called "top tier" phd mattered in the match process

I wonder if anyone's ever tried to increase their chances for matching opthalmology by doing a PhD at an Ivy before medical school? lol

 

[Neuronix]

i'm pretty sure neuronix would be the first person to tell you how little a so called "top tier" phd mattered in the match process

To your point, one of our grads failed to match ophtho twice. Not sure what they're doing now...

That was part of the group that had four people not match in a single year.

I didn't even get an interview at my home program (different specialty, easy to guess), and I thought my application was actually fairly strong.


The PhD helps but isn't everything. At most programs you have a chair who is strong in research and a lot of clinical faculty and a program director who are 100% clinical. This leads to the chair wishing for research but the clinical faculty actually doing the application screening and most of the interviews and ranking way more interested in clinical metrics.

Unfortunately, with NIH funding lacking, decreasing reimbursement, increasing difficulty in doing research at all (increasing IRB/IACUC hassles), and increasing clinical documentation hassles (PQRS, billing stuff, etc), residents are clinical monkeys. They still expect you to be very strong clinically, and most programs will typically pick a very strong clinical resident with a more affable personality over a good MD/PhD. When I write good, good is an average MSTP graduate, not someone with problems, and you're competing with an extremely talented, ambitious group of people.

Further, the research of an MD with one year of clinical research in that specific specialty is typically more favorably viewed than a strong PhD with research not directly applicable to that specialty. Programs are not interested in investing and you and your ideas, and only want to know how you will directly support their faculty's research projects.

At the end of the day programs mostly evaluate your MD and clinical potential. Most programs are just not interested in having their residents trying to run to the lab every day like it used to be. They don't really see the potential in basic science research since startup packages and serious research funding are almost impossible to come by. This is even moreso at the top programs where the attendings are struggling to do research and need the clinical support.

Shoot the messenger if you like. This is the reality out there in most programs and most specialties. There are exceptions, but you have to fight tooth and nail for it, give up a lot of salary, be ready to move anywhere, anytime, and struggle to have even a chance at a research career as you push age 40+.

 

[smithers12]

"most programs will typically pick a very strong clinical resident with a more affable personality over a good MD/PhD"
yea, only now am i realizing what an uphill battle we face every step of the way. PhD-onlys think we are shortchanging our degree, MD-onlys think we are taking an extended vacation, and most recently i learned that residents view our extended training as a liability. combined with old age, time spent in the lab makes us "less attuned" to the urgency that the hospital environment demands (these are real words from a chief resident). it's tough out there

 

[puppies.]

currently on the interview trail for IM/PSTP, and there is definitely interest in reviving the "physician-scientist" archetype and expanding PSTP-type programs at top IM residencies across the country. to be fair, my grades/scores are such that a clinically-focused PD probably isn't going to blink about inviting me to interview (from a "is this person competent clinically" perspective), but as i mentioned earlier several slightly-above-average people from my program have done very well in IM in recent years too. i don't think the PhD will make up for someone who's below average clinically, and you still have to at least say you want to go the physician-scientist route, but i think it might help in IM more than it used to.

 

[MDviaMBB]

The last PI I talked to at Harvard told me that the NIH is losing funding, left his lab to work at a pharmaceutical company later that month, and said in fewer words to do a translational PhD at a well known university. An industry conference I attended a few weeks afterward had some type of lobbyist there hired by the NIH to solicit support for maintaining their funding; and yes, it does bother me that the NIH has to do that in the first place. The OP also never directly asked about increasing their chances for matching a residency by doing a PhD at an Ivy.

So, if you don't mind me borrowing your non-sequitur, I want to become a clinical assistant professor that works with industry partly to avoid what Neuronix is talking about. In that role, I could participate in clinical trials, medical device studies, outcomes research, etc.; there is a lot of non-NIH assistance out there for clinical assistant professors, too (e.g. university support, young investigator awards, institutional review board [IRB] approvable protocol development https://synergy.dartmouth.edu/advanced-certificate, and so on). Doing so is easier and more viable than running a lab. It might be a good time to mention that Obama signed the cures act a week ago allocating 4 billion to the nih http://health.usnews.com/health-car...ntury-cures-act-saving-lives-through-research for translational research, as well.

IMO, pursuing basic science as an MD/PhD is also counterintuitive. Why would you want to study biochemical minutiae for 4 years, medicine for 8, and then spend the rest of your career investigating biochemical minutiae while competing in an oversaturated market with who knows how many PhDs that have more direct training and experience than you do via longer PhDs, post-docs, etc? I'm not saying that you can't, or that there isn't a need for MD/PhDs in basic science, but it is what it is. Read between the lines of what Neuronix said about maintaining a basic science lab as an MD/PhD, added to which MD/PhD's training structure prepares them for 4/12 = 33% research and 8/12 = 66% clinical work; that looks an awful lot like a 25% research/75% medicine clinical assistant professor to me, and IMO, we should be supporting the NIH and academia by generating industry involvement/support through finding billable procedures, developing drugs, etc via our clinical knowledge, not the other way around.

 

[GadRads]

"most programs will typically pick a very strong clinical resident with a more affable personality over a good MD/PhD"
yea, only now am i realizing what an uphill battle we face every step of the way. PhD-onlys think we are shortchanging our degree, MD-onlys think we are taking an extended vacation, and most recently i learned that residents view our extended training as a liability. combined with old age, time spent in the lab makes us "less attuned" to the urgency that the hospital environment demands (these are real words from a chief resident). it's tough out there

What was the transitive link between extended training and being a liability? I honestly don't get this antagonism against MD/PhD's.

 

[phonyreal98]

What was the transitive link between extended training and being a liability? I honestly don't get this antagonism against MD/PhD's.

They hate us cuz they ain't us!

 

[smithers12]

What was the transitive link between extended training and being a liability? I honestly don't get this antagonism against MD/PhD's.

They hate us cuz they ain't us!

this was during a surgical subspecialty rotation where MD/PhDs are definitely not the norm (but also make up a not-so-insignificant number).

i listed the reasons above. the PhD is a long, "protracted" process so the work can always be put off tomorrow. not the kind of attitude that a high volume high acuity hospital service demands. this is definitely not a shared mentality, but the bias is out there, so work to overcome it

 

[HereWeGo17]

Tier of institution matters for getting into residency. IMO it almost certainly doesn't matter as much as the extra years, which you'd probably incur by doing the PhD first, unless you know that you want to go for a competitive specialty. (Look up the average number of years to graduation at your potential PhD programs. And it's hard to finish a PhD in addition to getting a Med school app together, so you might have to add a year.) Because with those extra years you can subspecalize and get more experience in the type of research you actually want to do. Whereas you generally have less choice of project in the phd.

ETA: Why don't you look up some of the graduating alumni from your MD/PhD program and see where they went for residency and what happened to their careers? That might help give you a sense.

Some of this is copy-paste from another thread in the Allopathic forum (https://forums.studentdoctor.net/th...want-to-go-into-a-surgical-specialty.1238163/):

This is just my own experience, but I've found that the tier of medical school doesn't matter at all in terms of residency application. I attend a non-MSTP program in a decidedly mid-tier institution, but I've had no issues at all in getting interviews at all of the "big name" residency programs (e.g. Hopkins, Vandy, MGH/Brigham, Cleveland Clinic, Cornell) in one of the most competitive specialties in medicine. This assumes though that you are already a good medical student in the absence of your research experience. If applicant A has great grades from classes/clerkships, stellar Step scores and LORs but no research experience, and applicant B has a PhD and dozens of publications but crappy grades/Steps/LORs, residency programs will pick applicant A 100% of the time - and they should. But all else being equal, having the PhD on top of everything definitely makes you more attractive to academic programs. I actually got many more interviews at top-tier programs than fellow MD/PhD applicants I met from Yale, Hopkins, etc, because I did better in the medical school side of things. I'm not telling you about myself to brag, but I want to counter what I hear all the time on SDN and elsewhere that "students at top medical schools have a massive leg up in residency applications." I believed this idea and was very nervous going into the application season, but I was very pleasantly surprised.

BTW, I know this sounds kind of hypocritical, to say that "tier of medical school doesn't matter" but discussing your chances at "top" academic residencies. I agree with most people that you will get great clinical training in most residency programs - however, if you are MD/PhD dead-set on an academic career, all my mentors say you should try to get into an academic residency program. I absolutely love the people in my home program, and they are as well trained clinically as anyone else in the country. But I still have them near the bottom of my rank list, because they don't do much in terms of academic research. The faculty at my home department actually encouraged me to do so as well ("We would love to have you if you decide to come here. But honestly, based on your resume and career goals you are better served by attending a well-known academic program."). I think that's a sign of great mentorship!

 

[phdplusmd]

Some of this is copy-paste from another thread in the Allopathic forum (MD/PhD a bad idea if I want to go into a surgical specialty?):

This is just my own experience, but I've found that the tier of medical school doesn't matter at all in terms of residency application. I attend a non-MSTP program in a decidedly mid-tier institution, but I've had no issues at all in getting interviews at all of the "big name" residency programs (e.g. Hopkins, Vandy, MGH/Brigham, Cleveland Clinic, Cornell) in one of the most competitive specialties in medicine. This assumes though that you are already a good medical student in the absence of your research experience. If applicant A has great grades from classes/clerkships, stellar Step scores and LORs but no research experience, and applicant B has a PhD and dozens of publications but crappy grades/Steps/LORs, residency programs will pick applicant A 100% of the time - and they should. But all else being equal, having the PhD on top of everything definitely makes you more attractive to academic programs. I actually got many more interviews at top-tier programs than fellow MD/PhD applicants I met from Yale, Hopkins, etc, because I did better in the medical school side of things. I'm not telling you about myself to brag, but I want to counter what I hear all the time on SDN and elsewhere that "students at top medical schools have a massive leg up in residency applications." I believed this idea and was very nervous going into the application season, but I was very pleasantly surprised.

BTW, I know this sounds kind of hypocritical, to say that "tier of medical school doesn't matter" but discussing your chances at "top" academic residencies. I agree with most people that you will get great clinical training in most residency programs - however, if you are MD/PhD dead-set on an academic career, all my mentors say you should try to get into an academic residency program. I absolutely love the people in my home program, and they are as well trained clinically as anyone else in the country. But I still have them near the bottom of my rank list, because they don't do much in terms of academic research. The faculty at my home department actually encouraged me to do so as well ("We would love to have you if you decide to come here. But honestly, based on your resume and career goals you are better served by attending a well-known academic program."). I think that's a sign of great mentorship!

Reading this thread... *Wow* is all I can say the moment, there so many opinions it's impossible to address all of them... the opinions are really strong too. Some I agree with, like HereWeGo's post, some I read I take great exception to: "value of PhD is very little" or "chances to become a research asst professor as PhD are slim to none." Everyone's path is so unique to them, their advantages and disadvantages, habits, abilities, personal resources, time, lifestyle .... etc... are so unique and different, I think one should know themselves first before accepting specific advice found on these forums.

In fact, it's really difficult to give advice! One long ago mentor told me, "I can only tell you what I did, my situation is different than yours and I don't think it wise to advise you because of it." True words. I think it's useful to know of cases similar to your own that come before you. So maybe I can't give advice but I can contribute a bit.

I was a top-tier PhD candidate that never applied to MD PhD, I didn't think i would have been competitive and my undergrad advisor dissuaded me from applying, so off to grad school I went.

Nearing graduation I had an existential crisis, yes I really did want to apply to med school, so I did. It's true I did feel that there was some truth to the statement' 'low value of PhD' but only in the life financial game, not when it comes to applying for med school. I was accepted off the waitlist to a top-tier school, and routinely on the interview trail, while I was a wonky PhD pre-med candidate, the PhD was routinely referred to as a bonus for academic med school and for academic residency programs. I did not go into a competitive specialty but did go to the top tier place in the country for it. I've seen other PhDs do MDs here and get into a competitive specialty here, so it can be done, and seems to be done routinely.

Now on the "chances to become a research asst professor as PhD are slim to none." Well, I think a combination of tenacity, positioning, and mentors matter greatly and I have done the impossible according to this poster. But I have been funded continuously since residency for a postdoc, my K08 (attending salary levels), NIH LRP (all loans paid off), and soon will be applying for an R01. It's possible, it takes time, there will be setbacks, there's great anxiety, and there's no guarantee (I accepted it), but the path is what counts in my mind, not the ultimate destination.

I would be wary of advice that closes off possibilities/opportunities for you to go for (why not try? after all you all are on the MD path now and had to make the same fateful decision at some point), and know that there may be people out there who have walked it before you.

 

[dl2dp2]

R
Now on the "chances to become a research asst professor as PhD are slim to none." Well, I think a combination of tenacity, positioning, and mentors matter greatly and I have done the impossible according to this poster. But I have been funded continuously since residency for a postdoc, my K08 (attending salary levels), NIH LRP (all loans paid off), and soon will be applying for an R01. It's possible, it takes time, there will be setbacks, there's great anxiety, and there's no guarantee (I accepted it), but the path is what counts in my mind, not the ultimate destination.

You have a great attitude. I'm in your boat (got off a T, on a K, aiming for an R) but from my perspective looking backward I don't have the same attitude. What I see is a lot of STRUCTURAL injustices. The vast vast majority of my PhD friends from a top program are not on track. MD/PhDs who judiciously pick specialty and have the means to persist eventually get Ks, and once you have a K things get somewhat easier, primarily because a lot of the competition starts to drop out at this stage. People who "succeed" tend to have: 1) money 2) supportive family. The system penalizes poor people, minorities, women, people with disabilities (i.e. mental health issues), etc.

NIH overtrained PhDs, that much is not in doubt, and the promotional system is highly inequitable. Every chance I get I advocate for systemic reform. When that's not feasible I basically try to cut as many corners as I can to get ahead and tell people I care about to do the same. It's not a "fair" system.

That said, just because I'm "cynical" doesn't mean I don't enjoy playing the game. A lot of the time the game itself is rigged against you, but it's still fun to play. You just need to know the rules. In fact, you can say philosophically that's what most of life is.