PhD to MD - AMA

[JJRousseau]

It's well documented that this is the worst way to obtain the degree combo, but it's the path I took (and by choice in order to take up opportunities abroad that might not have arisen again). I had a lot of doubts going in, so I thought I'd make myself available as resource. For now, I can only speak to the admissions process, which feels a bit wonky as a PhD candidate or graduate, but I'm happy to answer any questions about the process. I'll bump every so often over the next few years, when I can speak to later stages in the MD and onward as a previous PhD.

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[Electricity]

Just out of curiosity, why is this worse than MD and then PhD separately? Seems better to me:

- Don't accumulate debt during PhD, so less time pressure
- Could help you get into a more competitive MD and residency program

 

[Lucca]

Just out of curiosity, why is this worse than MD and then PhD separately? Seems better to me:

- Don't accumulate debt during PhD, so less time pressure
- Could help you get into a more competitive MD and residency program

There are a couple of ways to get physician scientist training:

PhD ---> MD, aka @JJRousseau 's route:
Pros:
You are likely not accumulating debt during the PhD
It could help you get into a more competitive MD program (clearly, it helped JJR since he is going to HMS lmao)
Con:
You have to pay for the MD. (This is no joke, MDs are expensive af, and they only get more expensive the less lucrative your professional end goal is; i.e. doing science / primary care / academics / etc.)
Your scientific training is not integrated with your medical training and the PhD could take longer than the 3.5-5 year average for MD/PhD graduates.
Longer path overall

MD/PhD:
Pros:
Any program worth applying to is going to come tuition free + give you a stipend.
MD and PhD training are integrated so PhDs tend to be shorter than if they are completed individually (average PhD length varies by program, it could be that at some programs PhDs all tend to take 5-7 years instead of 3-5).
Cons:
Training4Lyfe, will likely do a postdoc anyways after residency, but not as long as disjointed route

MD-->Postdoc:
Pros:
Shorter time from beginning of scientific training to seeking independence
Clinical interests / training already solidified before scientific training begins allowing for more focused work
Cons:
You pay for the MD
At least from what postdocs in my lab tell me, postdoc work is a lot higher stakes than PhD work. Without a strong foundation in the type of research you will be doing, a postdoc might not be as productive as it needs to be to position you for a full time physician scientist career in the future.

 

[JJRousseau]

As Lucca pointed out, people really don't do PhDs following completion of the MD (I'm sure it has been done), rather they do a post-doctoral fellowship to obtain more research training. I said my path was the worst way, because I wasn't even considering a PhD following MD completion option as a path. And yes, as someone about to pay for the MD, that's a pretty brutal cost to the route I'm taking.


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[Lucca]

As Lucca pointed out, people really don't do PhDs following completion of the MD (I'm sure it has been done), rather they do a post-doctoral fellowship to obtain more research training. I said my path was the worst way, because I wasn't even considering a PhD following MD completion option as a path. And yes, as someone about to pay for the MD, that's a pretty brutal cost to the route I'm taking.


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Interestingly enough, in some European countries, residency programs will support their candidates obtaining PhDs. While I was at the NIH, a Danish MD oncology fellow worked in my lab as a part of his PhD work.

 

[JJRousseau]

Interestingly enough, in some European countries, residency programs will support their candidates obtaining PhDs. While I was at the NIH, a Danish MD oncology fellow worked in my lab as a part of his PhD work.

This is very true. In the UK, you can stay on your clinical progression as a junior doc while completing your PhD. Two of my colleagues were gastroenterologists doing exactly that.

 

[dl2dp2]

As Lucca pointed out, people really don't do PhDs following completion of the MD (I'm sure it has been done), rather they do a post-doctoral fellowship to obtain more research training. I said my path was the worst way, because I wasn't even considering a PhD following MD completion option as a path. And yes, as someone about to pay for the MD, that's a pretty brutal cost to the route I'm taking.


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If you do decide to stay in research tho, there is LRP from NIH that is kind of helpful...

 

[JJRousseau]

If you do decide to stay in research tho, there is LRP from NIH that is kind of helpful...

No doubt, I will look into LRP when I get to that stage of my career, but to my knowledge those programs are competitive, so no guarantees.


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[Naruhodo]

It's well documented that this is the worst way to obtain the degree combo

Hahaha, bring on the debt!
Seriously though, I know someone who did BS(math)-->MD-->general surgery intern-->2-years neurosurg residency-->PhD in bioengineering-->2-year medical genetics residency-->Cancer biology postdoc-->1-year clinical biochemical genetics fellowship
The guy calls his own career schizophrenic, but there is no doubt that he is brilliant and his patients adore him. I couldn't believe it when I heard him say that "the only thing I was ever any good at was research" because the exact opposite seems true to me (this guy is good at everything he tries). But it is funny how people's self-perception can differ from how others view them.

 

[MochiiGirl]

Hey @JJRouseau,

I'm a PhD candidate gearing up for graduation then going for my MD and I was wondering, at what point in your PhD did you decide to go for your MD and how much clinical and shadowing experience did you do before applying?

 

[Naruhodo]

Hey @MochiiGirl,
I am not JJRouseau but took a similar path. Honestly, I knew even before starting my PhD that my goal was MD-PhD. During my PhD I really didn't have time to juggle shadowing (and the clinical volunteering I'd done before grad school was too old by that point). For me it made the most sense to do a clinically-oriented postdoc, get a bunch of clinical hours the first year and apply during the second year. However, I know plenty of folks have success applying straight from PhD, and particularly if your program is set up in a way that there is natural overlap or nearby facilities that route may work for you. I'd say try to make sure you have more than 100 recent (ie. within past five years) clinical hours. Best of luck!

 

[MochiiGirl]

Hey @MochiiGirl,
I am not JJRouseau but took a similar path. Honestly, I knew even before starting my PhD that my goal was MD-PhD. During my PhD I really didn't have time to juggle shadowing (and the clinical volunteering I'd done before grad school was too old by that point). For me it made the most sense to do a clinically-oriented postdoc, get a bunch of clinical hours the first year and apply during the second year. However, I know plenty of folks have success applying straight from PhD, and particularly if your program is set up in a way that there is natural overlap or nearby facilities that route may work for you. I'd say try to make sure you have more than 100 recent (ie. within past five years) clinical hours. Best of luck!

Hey Naruhodo, thanks for your helpful reply! I kinda figured it out later that I wanted to do an MD so I am late on everything. The good news is that I'm interviewing for a clinical research position that's on a volunteer basis and will start shadowing at the end of the year... so I should have these prerequisites by the next year's application cycle. Let's see how I do juggling defending on top of everything else I'm glad to see diverse ways of going about to get the MD after a PhD here. The pre-med advisors available at my school don't have experience with this non-traditional route.

 

[Naruhodo]

I'm glad to see diverse ways of going about to get the MD after a PhD here. The pre-med advisors available at my school don't have experience with this non-traditional route.

Oh yeah, no question. I'm not even the only PhD in my med school class.

 

[JJRousseau]

Like Naruhodo, I knew going in. I topped what was already a pre-Med undergrad resume with about 100 hours of clinical volunteering in the year I applied. Though during my PhD I did sport and had leadership positions in the sport as well as the grad student body. I think you still need the rest of the pre-Med package - the PhD is not a substitute. You will not have a fun cycle if you assume you are an exception to the typical expectations.


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[QofQuimica]

Like Naruhodo, I knew going in. I topped what was already a pre-Med undergrad resume with about 100 hours of clinical volunteering in the year I applied. Though during my PhD I did sport and had leadership positions in the sport as well as the grad student body. I think you still need the rest of the pre-Med package - the PhD is not a substitute. You will not have a fun cycle if you assume you are an exception to the typical expectations.

This is excellent advice. Any current grad students/post docs thinking about going to medical school would be wise to heed it. I would add that applicants with PhDs should also take the MCAT seriously and not half-a** any prereqs you still have to take. Med schools care a lot more than grad schools do about UG GPA and test scores.

FWIW, I was also PhD-to-MD and decided to apply to med school two years before graduating with my PhD after getting involved with a clinical research project.

 

[evo]

Slightly off-topic but I think PhD to MD is actually the best way MD/PhD programs should run.
There's no good time to insert 3-4 years between medical curriculum. When you insert between MS2-MS3 you get destroyed 3rd clinical year, when you insert between MS1-MS2 you get destroyed by step 1. When you insert between MS3-MS4 you get destroyed your intern year.

Even from a curriculum structure standpoint, PhD classes are natural progression of college courses and if you liked biochem, bio, or ochem in undergrad, you will continue to like those classes.

MD curriculum on the other hand, are completely practical and patient centered. You learn what you need to know to actual make some sort of impact on patient care. After completing 2 years of medical school, suddenly the basic biochem and biology courses are no longer interesting because they are most of the time not even remotely connected to patient care and are designed to intellectually challenge grad students. As a result, when you are forced to re-learn all you ochem and biochem stuff after you are no longer interested in them and know that they have nothing to do with your actual research project, it is frustrating like I don't need to know all the bond angles and distances of alpha helix, never gonna explain that to my patients.

So, the best time I think is actually to do a PhD right before MD so that the flow is uninterrupted. Again just my opinion others may think differently.

 

[CazadorFalconry]

Is it safer to apply to med school after completing PhD? Do med schools see the not-yet-completed PhD as a risk, or is it ok if you have put a planned graduation date prior to med school matriculation?

(Edit for typo)

 

[evo]

I think you should at least have an idea through ur committee and mentor ballpark of when u gonna graduate. You want everyone to say u can get out before august so that u can tell medschool that. My med school in particular hates uncertainty and wants an absolute date which may not be possible, but do whatever u can

 

[Naruhodo]

Interesting perspective Evo. I don't know whether there truly is a "best" way to do it - there is just however you manage, with all the lessons along the way. As much as you can try to plan and figure it all out beforehand, a key part is going through each training step to see what you discover about yourself. Your goals may shift along the way (or not, but you get a clearer picture of what you are in for), and that is probably a good thing.

I do agree with Evo that you will want your mentor/committee on your side when applying. If you are having a hard time pinning down a realistic timeline to graduation, I'd hold off. The last thing you'd want is an acceptance that you have to turn down because of timing.

 

[Endoxifen]

Is there no situation in which you can receive funding for your MD? Certainly you can't rely on merit scholarships, but it seems ridiculous to me that there's no money or tuition wavers to be found at all for students with PhD's, especially at top research institutions.

 

[Lucca]

Slightly off-topic but I think PhD to MD is actually the best way MD/PhD programs should run.
There's no good time to insert 3-4 years between medical curriculum. When you insert between MS2-MS3 you get destroyed 3rd clinical year, when you insert between MS1-MS2 you get destroyed by step 1. When you insert between MS3-MS4 you get destroyed your intern year.

Even from a curriculum structure standpoint, PhD classes are natural progression of college courses and if you liked biochem, bio, or ochem in undergrad, you will continue to like those classes.

MD curriculum on the other hand, are completely practical and patient centered. You learn what you need to know to actual make some sort of impact on patient care. After completing 2 years of medical school, suddenly the basic biochem and biology courses are no longer interesting because they are most of the time not even remotely connected to patient care and are designed to intellectually challenge grad students. As a result, when you are forced to re-learn all you ochem and biochem stuff after you are no longer interested in them and know that they have nothing to do with your actual research project, it is frustrating like I don't need to know all the bond angles and distances of alpha helix, never gonna explain that to my patients.

So, the best time I think is actually to do a PhD right before MD so that the flow is uninterrupted. Again just my opinion others may think differently.

in my personal opinion it should actually be the opposite way round: get your scientific training after the MD. In parallel to residency or after residency before fellowship. Your clinical interests are already well defined and you are more knowledgeable about what kind of projects/science you can best apply to your clinical field. With the pace of science being what it is, especially in technologically advanced/dependent fields like the physical sciences, having half a decade between your scientific training and your early scientific career might hamstring you.

In a debt-free world, I think MD+postdoc would be the way to go.

 

[oprm1]

It's well documented that this is the worst way to obtain the degree combo, but it's the path I took (and by choice in order to take up opportunities abroad that might not have arisen again). I had a lot of doubts going in, so I thought I'd make myself available as resource. For now, I can only speak to the admissions process, which feels a bit wonky as a PhD candidate or graduate, but I'm happy to answer any questions about the process. I'll bump every so often over the next few years, when I can speak to later stages in the MD and onward as a previous PhD.

Here is someone's career trajectory: PhD (4 years) > postdoc research training in anesthesiology (3.5 years) and in addiction psychiatry (1 year)> MD (4 years) > residency in psychiatry (4 years).
Questions:
1. Will this individual require the additional fellowships after residency if s/he pursues the subspecialties in addiction psychiatry and pain management?
2. If this individual did not take any fellowship but is hired as a psychiatrist in an addiction clinic, can s/he prescribe analgesics, such as opioids?

 

[JJRousseau]

I can't speak to psychiatry training in particular re: whether a fellowship is needed for an addiction clinic/pain management jobs, but my understanding (haven't quite graduated yet) is that you'll be able to prescribe any meds as soon as you graduate and start as a resident. Someone else might be able to speak to the first question much better than me.

 

[tr]

Here is someone's career trajectory: PhD (4 years) > postdoc research training in anesthesiology (3.5 years) and in addiction psychiatry (1 year)> MD (4 years) > residency in psychiatry (4 years).
Questions:
1. Will this individual require the additional fellowships after residency if s/he pursues the subspecialties in addiction psychiatry and pain management?
2. If this individual did not take any fellowship but is hired as a psychiatrist in an addiction clinic, can s/he prescribe analgesics, such as opioids?

1. Yes
2. Sure, if their career ambition is to run a pill mill. #sad

 

[4lphabet]

How did you approach doing research throughout med school (e.g. did you think of yourself as a part-time post-doc or just focus on being a medical student). I'm worried about essentially wasting my training & losing the skills I've built up over the past <n> years.

Also, did you moonlight to offset costs given the advanced degree?

 

[Naruhodo]

How did you approach doing research throughout med school (e.g. did you think of yourself as a part-time post-doc or just focus on being a medical student). I'm worried about essentially wasting my training & losing the skills I've built up over the past <n> years.

Also, did you moonlight to offset costs given the advanced degree?

Hi @4lphabet I am happy to take a stab at answering your questions. I did join a lab during med school, because I wanted to keep a toe in the water so to speak. That being said there were definitely time constraints with being in medical school, and except for the summer between my 1st and 2nd year, I just couldn't be in lab that much. Also, unless you're very lucky you won't be treated like a postdoc, but rather viewed as a medical student (which you are), so do your best to leave ego at the door, as it won't help you and can make interactions more tense. I didn't really get to do the kind of science I had done previously (again, see time constraints and how much investment a lab wants to put into someone who is essentially a part-time person), but I did end up with a wonderful friendship with a labmate that helped sustain me (and my passion for science) through the rest of medical school. So be open to what you may find, even if it doesn't fit how you see yourself or what you know you're capable of based on past experiences.

I desperately wanted to moonlight, but again, few places are going to pay a part-time person (especially given the time requirements of med school). Your success in med school and the career it will open up to you is more important than whatever money you'd likely make. But also, at least for me, the positions just weren't there. Try to make your peace with the role that you're in, and remember it was what you chose.