What is the MD/PhD Career Path?

Part 1: What is the MD/PhD career path?

What is a MD/PhD? Or is it an MD/PhD? Either way, it’s a dual-degree program that is usually 8 years in duration through which you earn both a medical degree (MD) and a doctoral degree (PhD) via an integrated curriculum that preserves the rigor and integrity of both degrees. These programs are called either Medical Scientist Training Program (MSTP) or MD/PhD programs. MSTPs are MD/PhD programs that have been awarded a T32 training grant and have guaranteed funding from the NIH throughout the award period, while other MD/PhD programs can vary in their sources of funding. At present, there are 50 MSTPs, including my program at the University of Wisconsin-Madison. MSTPs, by virtue of their larger funding pool, have 8–25 students in a cohort each year, whereas the MD/PhDs support 1–5 students.

An important benefit of pursuing dual-degree programs is that medical school and graduate school tuition is covered, and you receive a reasonable living stipend for the duration of your training. MSTPs tend to have a more comprehensive training plan and support network for developing physician-scientists: seminars, Responsible Conduct in Research courses, longitudinal clinical training, and elective courses. While MD/PhD programs can also include comprehensive training opportunities, the NIH funding requirements for MSTPs make these opportunities more commonplace. Therefore, I will focus specifically on MSTPs, as their structure is generally consistent across the different programs due to NIH funding requirements.

There are 2 major approaches to structuring an MSTP curriculum. The traditional approach is structured 2–4–2: preclinical training for 2 years, PhD training for 4 years, clinical training for 2 years. The modern, and in my opinion, superior approach, is the 2.5 (or 3)-4–1, which allows you to complete your core clinical rotations and complete your USMLE board exam(s) prior to transitioning into the PhD. In the modern curriculum, the PhD is more streamlined, and students are encouraged to defend their thesis in 3–4 years. This is possible because graduate coursework can be waived due to overlap with medical school coursework, although this depends on the MSTP and graduate program you choose/enroll in.

• A brief aside on choosing a graduate program: it doesn’t matter what you choose. What matters is how you spend your time during the PhD, which should be focused on learning the things that interest you most and becoming an expert in your field. For example, my graduate program is in Cellular & Molecular Biology (CMB) and my research is in Neuroscience. I selected CMB because almost all the course requirements were waived, and the Neuroscience program had several course requirements. Traditionalists might contend that these courses are essential for earning a PhD. I defend that the internet age means I can learn anything on my own time, at my own speed. I can choose any course being offered at my university across graduate and undergraduate departments as well as attend workshops on my specific interests worldwide. Instead of budgeting time between classes and homework, I can focus intently on becoming an experimentalist and honing my research skills. I believe that you are what you do, and during graduate school, you have the independence to do what interests you.

In graduate school, your funding source shifts from the MSTP T32 grant to your principal investigator (PI), who likely will not accept you to their lab if they don’t have the funding secure to support you. It’s good to have this conversion explicitly. You will be encouraged to apply for institutional training grants (e.g., other T32) and national (e.g., F30) grants, and these applications are cumbersome, yet crucial for gaining a sense for what PIs must do to support a functioning laboratory. It’s an excellent trial-run to see if you like a big part of the job in academia. I highly recommend that everyone apply for grants as graduate students, especially the F30 application.

As a graduate student, you are an employee, and aside from having more freedom to make your own schedule, it’s more like having a 9–5 job than medical school. I take weekends off, but sometimes duty calls. My research requires me to be in the lab, but others work remotely without a problem. A major advantage of having completed clinical training prior to the transition into PhD is that you can pursue longitudinal clinical training with choice mentors to maintain and progress your skills in fields of interest. This is in stark contrast to MD-only students who must rotate through specialties and make an important career decision with more haste. Some MSTPs even provide course credit for these clinical rotations, which further accelerates the completion of the MD. This highlights an important aspect of selecting which MSTP to pursue, as different programs integrate medicine and research in different ways; it is critical to do your due diligence in researching various MSTPs to find your ideal fit.

After defending your PhD thesis, you return to the hospital to complete the remainder of your clinical training. The final year of medical school is less intense. You don’t have to study for exams, allowing you to focus on caring for patients, taking clinical electives, completing translational research projects, finalizing publications, and applying to residency, postdoctoral positions, or whatever else you might want to do.

FAQ:

What can I do my PhD in?

- Anything from medical anthropology to medical physics to public health. You are generally unrestricted so long as it satisfies the mission of physician-scientists. Keep in mind that the decision of which graduate program to pursue will determine the graduation requirements as well as whether you have duties related to program-specific seminars, journal clubs, teaching roles, and other responsibilities. Also, it is important to note that not all MSTPs have graduate programs that support the type of research you might want to do (especially regarding social sciences). This is another important part of due diligence. As you complete secondary applications, aim to identify faculty who could support your research interests and be a good fit for your research training.

Do MD/PhDs have to go to residency?

- No, but it’s encouraged that you do. There are numerous options available depending on how you want to divide your career. If you want 100% research and to never touch a patient, you can go into a postdoctoral position directly, or consider specialties with less patient interaction, such as pathology. There are also residencies called the Physician Scientist Training Program (PSTP), which prepares you for the classic 80/20 split of research/clinic, supports broad specialties, and lets you focus more on establishing a research career. Since you also have a PhD, you could apply to jobs geared toward scientists, such as industry jobs. With an MD/PhD, you have options.

What can I do with an MD/PhD?

- As I’ll discuss in Part 2: Why you should consider the MD/PhD career path, the dual degree training empowers you to choose whatever interests you. Your skills are broad and allow you to tap into academia, industry, private practice, government, entrepreneurship, etc. Your skills are transferable to most fields, but to reach their mature form, a residency program is needed for you to become a board-certified physician that can treat patients.

Do I need a PhD to do research?

- No. MDs have always been responsible for cutting-edge research without needing a PhD. However, if you want to do research as a MD, you will eventually have to put in the time for developing grant writing skills, starting a lab, and designing projects/experiments in addition to seeing patients, which are all essential to becoming an effective independent investigator. The integrated MD/PhD provides protected time early in your career development to establish the skills for becoming an independent investigator.

What can I do if I want MD/PhD but don’t have enough research experience or my GPA is too low to apply competitively?

- There are two NIH-supported post-baccalaureate options for conducting paid research: PREP and IRTA. The goal of PREP is to increase the diversity of the biomedical sciences graduate student population; IRTA is more broad, with the main requirement being that you have completed college before applying. PREP offers research training across diverse disciplines, preparation for graduate school applications, and opportunities for additional coursework at the institution that you apply for. See this page for all the PREP-participating institutions and specific information about stipends and benefits at each program. For IRTA, the program is more geared toward research training, though given the numerous participating institutions, it is most likely that support for clinical training and application preparation is also available. See this page for information on IRTA. For both programs, the admissions cycle is not straightforward. You must research each program on a case-by-case basis and determine when the application cycle occurs. You are encouraged to go through the list of trainers, find the PIs who match your interests, and reach out independently to discuss opportunities for you to join their lab for 1–2 years via PREP or IRTA as you prepare to apply for the MD/PhD. Many programs and PIs are more inclined to select you if you elect the 2 year training option.

Alternatively, if your GPA is too low to apply competitively (depends on college major(s), but generally a GPA < 3.3 should be considered low), you can boost your GPA through institutional post-bacc programs. These are expensive, costing another 10–40k in tuition for 1–2 year programs. The post-bacc programs offer courses that will improve your undergraduate GPA and provide opportunities for you to take courses that will prepare you for medical school basic science. Unlike a Master’s degree, the grades you earn during the post-bacc are included in the overall GPA calculation in your application to graduate school. In addition, there are clinical and research opportunities to boost your experiences for graduate programs as well as obtain letters of recommendation.

If your grades are not of concern (GPA >3.5), I recommend the NIH post-bacc options above to 1) earn a stipend, 2) obtain more focused research experience, and 3) prepare for graduate school applications without needing to devote your time to studying intensively for coursework.

What should I do to get into MD/PhD programs?

- Continue reading to Part 3: How to get into MD/PhD