Pros and Cons of the MD-PhD Degree
- By Lawrence Wang
- August 17, 2018
- Medical Student , Pre-med
- Clinical Rotations , Dual Degree , Research , Residency
“Two roads diverged in a wood, and I— I took the one less traveled by, And that has made all the difference.” -Robert Frost
Do you have an interest/background in medicine and research , but balk at the prospect of spending eight years getting the MD-PhD degree? You can theoretically do all the same things (i.e. see patients and run a research lab) with only an MD degree. There are plenty of MD’s out there who are successful physician-scientists, and the MD-PhD is certainly the less common path, the road less traveled. So why bother getting a PhD as well?
These are all great questions, worth a fair amount of thought and reflection. Pursuing the rewarding, competitive, and singular pathway of a combined MD-PhD degree is a major decision that warrants a critical evaluation of its associated pros and cons. So without further ado, let’s dive right in.
Pros of the MD-PhD Degree
1 | fully funded.
Medical school is expensive, with the average medical student graduating in 2017 with a debt of nearly $200,000 . In contrast, many MD-PhD students graduate debt-free and may even have a small nest egg saved away. This is because Medical Scientist Training Programs (MSTP) and many non-MSTP MD-PhD programs waive tuition and provide stipends to their students that are comparable to a biology graduate student stipend (~$30,000 of disposable income a year). The stipend is adjusted to match the cost of living in the city in which your school is located.
2 | Options for Fast-Tracking
MD-PhD’s enjoy specialized tracks that enable them to shorten their PhD and residency training. The PhD portion of the dual degree is an average of 4 years (vs. an average of 5-6 years for single degree PhD’s in the biomedical sciences).
Furthermore, MD-PhD graduates can “short-track” their residency into fellowship training. In the case of the three-year internal medicine residency, the American Board of Internal Medicine (ABIM) has a pathway that enables residents with a demonstrated potential for basic science or clinical research to spend only two years doing clinical training before returning to full-time research . These so-called “research residencies” are typically populated by MD-PhD’s, with a few MD-MPH/MD-MS/MD graduates that have strong research credentials thrown into the mix.
3 | Competitiveness for Funding to Start a Lab
According to an NIH report about physician-scientists , MD-PhD’s overall had higher award rates for research program grants (RPGs) (24.6%) than MD’s (21.7%, p<0.01) or PhD’s (21.4%, p<0.01). Furthermore, the award rate for MD-PhD’s from an MSTP program was nearly three times higher than that for MD/PhD’s not from an MSTP program (36.2% vs. 12.3%). If you are interested in more details, there is a wealth of outcomes data in this report as well as the AAMC National MD-PhD Program Outcomes Study .
Cons of the MD-PhD Degree
1 | delayed autonomy.
The additional four years that an MD-PhD student invests in obtaining a PhD represent a significant opportunity cost (time and money). The ramifications of this can be broad. For example, an MD-PhD student living on a graduate student stipend may not have the financial autonomy to start a family until after they obtain an income (and free time!) commensurate to their training level. Furthermore, the average age of young investigators obtaining their first RPG’s continues to rise (44.3 years for MD-PhD’s, 43.8 years for MD’s, and 41.9 years for PhD’s in 2014) . The path of an academic researcher, especially an MD-PhD, creates an extreme delay in full professional autonomy.
2 | Disjointed Training
MD-PhDs are often likened to chimeras in their duality, which is exemplified by the disjointed path to obtaining the MD-PhD degree.
Students typically complete the first two pre-clinical years of medical school, transition to a 4-year PhD program, and then return to medical school to finish the last two clinical years before graduating with their dual degree. Subsequently, most pursue residency and fellowship training in their chosen medical specialties before finally becoming principal investigators (PIs) of a lab. This disjointed pathway forces many MD-PhD’s to play catch-up when they inevitably fall behind in either medicine or research. For instance, a common issue for MD-PhD’s is that their research skills become outdated when they return to clinical training for a number of years during the latter half of medical school and residency.
3| Balancing Clinical and Research Commitments
Juggling the considerable responsibilities of caring for patients and managing research projects can be challenging. Physician-scientists working at academic medical centers may be incentivized (or even pressured) to spend more time seeing patients, a task that earns more revenue for both the physician-scientist and the medical center. It also requires significant time and money for physician-scientists to maintain their clinical skills and board certifications. Consequently, many MD-PhD’s eventually dedicate themselves to either medicine or research and unfortunately let their less-used skill set fade into irrelevance.
Final Remarks
Any aspiring student considering a dual MD-PhD degree should think deeply and critically about whether this demanding career path is right for them. There are pros and cons to getting the MD-PhD degree, some of which may be deal-makers or deal-breakers. Ultimately, I see MD-PhD’s as chimeras walking a road less traveled, obtaining unique toolkits to address gaps in the existing body of medical knowledge and therapies. If this aligns with your goals, it can be an outstanding career!
If you are considering an MD-PhD degree but are unsure, please consider the Med School Insiders general advising services . We have advisers who have completed this degree and can give you detailed, real-world advice and feedback!
Lawrence Wang
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Is an MD-PhD Right for Me?
New section.
Do you want the opportunity to train in both medicine and research? An MD-PhD allows you to do just that. But what does it mean to become a physician scientist? We asked AAMC experts to explain why you might want to consider this type of training.
As you prepare to apply to medical school, it’s valuable to explore other potential career paths beyond a traditional MD degree. One path to consider is an MD-PhD degree, which provides training in both medicine and research.
But how do you know if it’s the right career path for you? We asked AAMC experts to explain the advantages of training to be a physician scientist through an MD-PhD program.
Who are physician scientists? Physician scientists are focused on scientific discovery and patient care at the intersection of science and medicine, understanding human health and disease from a scientific and clinical perspective. Physician scientists have the unique ability to identify and study important questions in health care. There are four pathways to become a physician scientist:
- Complete MD training and then conduct extended research through fellowship training.
- Complete MD training and then return to graduate school to earn a PhD degree.
- Complete PhD training and then enter medical school to earn an MD degree.
- Work towards both degrees simultaneously in a dual MD-PhD degree program.
In each pathway, students are exposed to a career in scientific research while also treating patients in a clinical setting.
What are MD-PhD Programs? MD-PhD programs provide training for the dual degree by integrating research and clinical training experiences where students learn to conduct hypothesis driven research in a mentored environment. There are over 100 MD-PhD programs affiliated with U.S. medical schools, and the National Institute of General Medical Sciences partially supports approximately 45 programs, known as Medical Scientist Training Programs (MSTPs).
These programs provide unique training experiences, including MD-PhD specific courses and professional development workshops, visiting scholar seminars, retreats, opportunities to attend national conferences and join organizations, and mentoring for graduate and residency training. The students and mentors in these programs are a vibrant community, working to advance the trainees’ development as a scientist and physician.
How long does training take?
The MD-PhD career path is a commitment, as training to complete both MD and PhD degrees takes about 7 or 8 years.
How do I pay for a MD-PhD program?
Most programs offer financial support, including stipends, tuition waivers, and health insurance to help students cover the cost of their scientific and medical training.
Who are MD-PhD students?
Annually, an estimated 600 students matriculate into MD-PhD programs. This is only about 3% of all students who matriculate into medical school. PhD training for MD-PhD students is typically in biomedical sciences, such as molecular, cellular, or human or animal studies in biochemistry, cell biology and microbiology, immunology and genetics, neuroscience, pharmacology, and physiology. However, PhD training may also be in fields outside of the classical biomedical sciences, such as bioengineering, chemical biology, bioinformatics, public health, anthropology, and bioethics.
What do MD-PhDs do after graduation?
Most MD-PhD graduates train in a residency program and become licensed to practice in a specific field of medicine. From there, they typically go on to careers that blend research and clinical medicine, though their research topic may or may not be closely related to their field of medical practice. Most MD-PhDs work in academic medical centers, such as medical schools or teaching hospitals. MD-PhDs also conduct research in institutes such as the National Institutes of Health or other government or private agencies, or work for pharma or biotech companies.
MD-PhD careers provide unique perspectives on questions about basic scientific discovery, medical intervention, or translational research. During their career, MD-PhDs may remain focused as a basic or clinical scientist, or become an administrative leader within their academic medical center. Their training provides opportunities to be successful in either environment.
Is an MD-PhD path right for you? To find out more, visit the AAMC website for information on MD-PhD dual degree training .
- @AAMCpremed
Helpful tools and information regarding medical MD-PhD programs.
Information about applying to MD-PhD programs, emphasizing the application process during COVID-19.
Information about MD-PhD programs, emphasizing the career and application process.
Learn about MD-PhD Programs from program leaders.
Upcoming short presentations will describe features of MD-PhD training, alumni careers, and detailed logistics of the application process.
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