A Guide to MD-PhD

 

A walkthrough for students interested in research

 

What is an MD-PhD program? 

 

Students interested in going to medical school who also have a passion for research and would like to receive rigorous training to become a scientist may consider applying to MD-PhD dual degree programs. As the name suggests, upon completion of an MD-PhD program, one will have two doctoral degrees: an MD and a PhD. The PhD is usually done in the basic biological sciences, as opposed to in clinical research, public health, or the social sciences (although, there are a few select programs that allow students to do their PhD in one of these other areas). Some common areas that MD-PhD students get their degrees in include Cell & Molecular Biology, Developmental Biology, Neuroscience, Immunology, Virology, Biochemistry, Structural Biology, Cancer Biology, Pharmacology, and Computational Biology.

 

MD-PhD programs are structured such that students complete their first two years of medical school, enter graduate school and complete the requirements for a PhD, and then return to medical school to finish the last two years of training. The pre-PhD years in medical school are mostly if not completely pre-clinical (i.e., lectures), whereas the post-PhD years in medical school consist of the clinical clerkships. In addition to following the regular MD and PhD curriculum, MD-PhD students may also be required to participate in other activities such as journal clubs and MD-PhD specific seminars. 

 

The main difference between MD students and MD-PhD students is that MD students are trained to become physicians while MD-PhD students are trained to become physician scientists. Although not all MD-PhD students end up following this path, the MD-PhD program is designed to train students who will continue towards a career in academic medicine in which they work at institutions dedicated to patient care, research, and teaching. They may do research, clinical work, or a combination of both. The overall goal is that they will use their knowledge of both medicine and the research process to contribute to the “bench to bedside” endeavor in which scientific findings eventually result in improved health outcomes. 

 

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How can I get involved with research with no prior experience? 

 

College is the time to start dipping your toes in research! First, try reaching out to professors on campus to see if you can get involved in their research in any way. It can be difficult to find a research position but be persistent! Oftentimes, mass emailing a bunch of labs you are interested in is the best way to find a lab with open spaces. Try not to be too selective about the particular research you do. The experience is going to be valuable in that you learn more about the process of doing research and get a feel for if it is something you enjoy. Definitely prioritize doing research in a lab with a good mentor! You can worry about honing in on an area that you are very interested in later once you are in graduate school. When you first start working in a lab for the first time, you will likely have to work on a volunteer-basis so that the principal investigator can see that you are committed. It is a big time investment to train a new student in the lab’s techniques, so you want to show that you can dedicate the time and are enthusiastic about the opportunity to work in the lab. Eventually, you will want to try and do lab work for credit and possibly even for pay (although whether or not you get paid is dependent on funding and what school you go to, as some universities do not pay at all for students in basic science research). 

 

Check to see if you can do research through work-study and reach out to the campus diversity office to see if they have any other resources/funding you can utilize. Some schools participate in the NIH-funded Maximizing Access to Research Careers (MARC) program. This program provides undergraduate students interested in exploring research with opportunities to conduct research with faculty at their university’s campus, work study pay for their research hours, exposure to conferences, and enhancement of presentation skills and professional development. Also, if you decide you are interested in pursuing a graduate degree, see if your campus has a McNair Scholars chapter, a federally funded program designed to prepare admitted students for graduate studies, and apply to join! 

 

Another option for getting research experience includes participating in summer research programs often termed REUs (Research Experience for Undergraduates). There are many summer programs designed for students from disadvantaged backgrounds and/or from racial/ethnic populations underrepresented in medicine (URM); many of them do not require any prior research experience. Look into the eligibility requirements for each program and put in lots of applications! The Leadership Alliance’s Summer Research Early Identification Program is a particularly nice program to apply to because it allows you to apply to multiple research sites with one application. Other summer programs can be seen here. Additionally, many NIH-funded MD-PhD programs also host summer programs such as the Gateways to the Laboratory Summer Program. Even if you have a lab you work in on campus, it may be worthwhile to spend the summer working somewhere else to diversify your research experience, see how a different lab works, and possibly get another letter of recommendation from a principal investigator. That said, if you really enjoy your school-year research lab, don’t feel pressured to leave it for other summer opportunities. Some students prefer to get a breadth of experience in different research areas, but others thrive by committing longitudinally to just one or two labs. In any case, you will want to spend enough time in a lab so that you develop a profound understanding of your research project to be able to discuss in your application and during interviews.

 

If you are a community college student transferring to a 4-year university, especially consider applying to summer undergraduate research programs--some of which cater to URM students in institutions with no research available (such as community colleges or small liberal arts schools) and thus do not require any research experience. Most academic research institutions will have some type of REU and you can also check the National Institutes of Health (NIH) and National Science Foundation (NSF) websites for a more comprehensive list. In addition, as you prepare to transfer, keep a lookout for summer research experiences for transfer students at your new university, the applications for these tend to be in the Winter/Spring before you transfer. Completing a summer research experience for transfer students is a great way to integrate into your new community and find people with similar interests.

 
 

Should I apply to MD or MD-PhD programs? 

 

Making the decision to apply to MD or MD-PhD programs can be challenging, and some students even end up applying to a combination of them depending on which schools’ research interests them. The primary factor you should consider is your desire to do research. Ask yourself these questions: Do I enjoy research? Do I have an inquisitive nature? Does the idea of studying a small area in much depth interest me? Do I have an interest in advancing biomedical knowledge to improve human health? If you answered yes to many of these questions, the MD-PhD route might be a good fit for you. Many medical students take a research year anyways to strengthen their residency applications, so if you like research enough and value improving your ability to think deeply about questions, consider applying to MD-PhD programs. If you are still unsure about what to do, you might want to take a gap year to do full time research so that you can confirm whether or not you really like the research process. Doing a PhD in between your pre-clinical and clinical years of medical school is obviously a time investment, but it will only help your career in the long-term. 

 

The next factor you should consider are your long-term career goals. If you aspire to make new discoveries or advance the way diseases are prevented, detected, and/or treated, the MD-PhD training may be invaluable. Additionally, if you want flexibility in what you can do in the future, an MD-PhD dual degree can allow you to traverse between the clinical and research worlds. An example of a student who is probably less likely to consider applying to MD-PhD programs is one who has clear goals in sight that primarily involve patient care. Many desirable medical specialties already have long residencies/fellowships, and getting a PhD might not add as much if you want to focus on your medical practice. So, if you value patient interaction and do not plan to trade in time with patients for time doing research, applying to MD programs may be the better route. 

 

Lastly, money matters, especially for FLI students, and many pre-medical students are concerned with financing their education. Although the financial situation of MD and MD-PhD students can greatly differ, money should not be a major factor in the decision to apply to MD or MD-PhD programs. Most MD students take on much medical school debt on top of any undergraduate debt they may have, but they can more quickly start paying off their loans once practicing as a physician. MD-PhD students attending NIH-funded medical scientist training programs (MSTPs) are fully funded throughout their training; their medical school tuition is paid for, and they receive a modest living stipend. The catch is that MD-PhD students will not be able to make “real money” (i.e., non-stipend money) until after they complete the MD-PhD program which usually takes around 7-8 years. In addition, graduates of MD-PhD programs typically have lower salaries than their MD-only colleagues, since the primary time investment of an MD-PhD is in research rather than clinical work. Overall, both the MD and MD-PhD paths lead to stable careers with a substantial income. Thus, the decision should really be made based on enthusiasm for research and career interests. These career options largely include those that traditional MD or PhD only graduates may choose, such as a position in academic or industry research. The MD graduates also have the option of being full time clinicians . However, the time dedicated to research training during the PhD years is invaluable to one’s growth as a physician scientist. 

 

 
 

What are the differences in MD-PhD vs MD applications? 

The process of applying to MD and MD-PhD programs is very similar. Both use AMCAS as the application processing service and follow the same application timeline. Also, applicants for either program can choose to apply “straight through” from undergrad, take gap years, or apply as non-traditional students. A large difference is that the MD-PhD application pool is significantly smaller compared to the MD application pool. To provide a rough idea, a school’s MD program may receive 7,000 applications for a class size of around 100-200 students, whereas its MD-PhD program may receive 700 applications for a class size of around 5-20 students. 

 

Although taking a gap year is not necessary to apply to MD-PhD programs, they are highly recommended for students who do not have extensive research experience during college, as the application and interviews center around discussion of specific research projects. One option is to work as a research associate or technician in a lab at an academic research institution. Another great opportunity to advance your research skills during your gap year is through the NIH Postbaccalaureate Intramural Research Training Program (Postbac IRTA/CRTA). In this program students are immersed in a life of research, allowing them to figure out if they like doing intense research on a full-time basis and gives them ample time to get a good understanding of a project they can call their own, which is especially important when it comes time to talk about their research with others in interviews. Additionally, taking a gap year to work as a full time researcher allows one to get a letter of recommendation and make some money for future application and travel expenses. The program is also highly regarded by MD-PhD program directors.   

 

The key difference in the primary application to MD and MD-PhD programs is that MD-PhD programs require an MD-PhD statement and research statement in addition to the personal statement. The MD-PhD statement is a one-page explanation of why you want to pursue a dual MD-PhD degree as opposed to doing an MD or PhD alone. The research statement is a description of all the research projects you have been involved in. The level of detail in which you describe your projects in this statement is up to you. The secondary application is usually identical for both programs. Sometimes, MD-PhD programs will require you to list researchers at their institution whose work you are interested in, and this information helps them match you with those people to interview with. 

 

The interviewing process between MD and MD-PhD programs varies significantly. Because MD-PhD programs have fewer interview days, they may not be as easy as MD interviews to reschedule. Some MD-PhD programs will pay for the applicants’ travel and lodging. As for the actual interviewing experience, MD-PhD applicants usually have many more interviews per school that sometimes span over the course of more than one day. They may have 1-2 medical school-specific interviews with physicians and around 3-5 research interviews with scientists of your choice. Often, the research interviews are fairly casual and involve spending around half the time explaining your research and the other half of the time listening to the interviewer talk about his or her research. To prepare for these interviews, it is essential that MD-PhD applicants think about the research narrative that they will share with their interviewers and practice succinctly explaining their research. 

 

Timeline of the MD-PhD

 

The amount of time it takes to get an MD-PhD differs by program and by your research projects. Some schools do not require research rotations the summer before the first year of medical school, but some do (as seen in the sample timeline below). The most common timeline for MD-PhD programs is 2 years of pre-clinical medical school, followed by 3-4+ years to complete your PhD, and finally 2 years to complete your clinical clerkships. The example below shows the timeline for the Tri-Institutional MD-PhD Program, which includes 1-2 elective clerkship rotations before starting your thesis research, and this may be different in other programs. Most schools have their timeline on their website, or you will learn more about it during your interview. 

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Why MD-PhD and Advice from Current Students

 

Most MD-PhD students decide to go the double degree route because they had research experiences that they loved and they want to continue their training as a scientist. We asked a few current MD-PhD students to share why they chose to pursue a double degree, along with some advice for you. 

 

“Progress in medicine is stimulated by leaders oriented towards progress in science. To be best equipped to bridge research and medicine in the context of therapies, I’ve decided to pursue an MD/PhD.” 

 

“My time as an undergraduate researcher allowed me to cultivate my technical skills as a scientist and as a critical thinker. As a physician scientist, I would have a platform to advance research in medicine and to truly vouch for the most vulnerable patients”

 

“Think of the identities you have right now, and you aspire to have, and how being an MD-PhD physician will be part of those identities.”

 

“After spending 2+ years as a research assistant, I still felt I had so much to learn, which is why I decided to apply for MD-PhD programs. The structured, protected training I will receive as a graduate student will guide me to becoming the physician-scientist I aspire to be.”

 

“Talk to current MD-PhD students at your current university (or through mentorship programs--look for conferences!!) about your journey and advice for your next steps. Even if you have a clear idea of what to do, it's great to have someone to validate your plan and be there when life happens!”

 

“Get a travel credit card for interviews! I have so many points I am dying to use once I can travel again! Some schools will have you purchase your flight tickets and then reimburse you, make sure to ask even if they don't offer it first!”

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Conclusion

 

The decision to pursue an MD-PhD is not an easy one! You should take your time to think through your interests in medicine and science. Although the requirements for applying to MD or MD-PhD programs are similar, the MD-PhD application will focus more on your research experience and desire to integrate research into your career. Explore research opportunities at your university campus or at various campuses throughout the country to learn more about the process of doing research. Furthermore, many MD-PhD programs, like the NIH-funded MSTP programs, are fully or partially funded, meaning that you will not have to worry about paying off medical school loans. While this should not be the driving reason to pursue an MD-PhD, being a fully funded student relieves the burden of having to pay off student loans immediately post-graduation. The MD-PhD dual degree allows students to develop the skills to push the boundary forward in biomedical research. Another option is to pursue an MD-only route and do a research intensive residency following medical school; however, a PhD will give you the protected time to train as a scientist and develop a research skill set without the burden of clinical responsibilities. Whichever route you decide to take, whether it is an MD-PhD or an MD with a research intensive residency, you will be able to integrate your research and medical practice as a physician-scientist! 

 

Helpful Links

 

Interesting Research Articles (MD-PhD Education)

 

Opinion Articles

Contributors: Monica Acosta, Abby Shilvock, Ellie Benitez