How to MD/PhD programs differ?

Not all MD/PhD programs are the same.

According to the Association of American Medical Colleges, there are 125 schools that offer MD/PhD training in the United States. There are also a few DO/PhD programs, though I could not find a comprehensive list of these.

These programs vary quite a bit. I was certainly not aware of all of the things to consider when deciding where to apply for MD/PhD training. This is just a general overview of some of the major ways programs can differ based on what I know and is by no means a comprehensive list of the variations that you’ll find.

Structure

The “assumed” structure of a MD/PhD program is what we call a 2-4-2. This means that students take the first 2 pre-clinical years of medical school, take USMLE Step 1, then take a break from medical school to complete their PhD in hopefully 4 years (sometimes more, sometimes less), and after that they return to medical school to complete their 2 clinical years.

I say the “assumed” structure because my MD/PhD program is one of those that is quite different. We begin with our PhD and progress through our PhD training on the same timeline as PhD-only students, except that we also take the first year of medical school decompressed during that time. Check out my post My MD-PhD timeline for how that worked out for me. Only after completing our PhD do we continue with our second year of medical school, take the Step 1 exam, and then go on to our 2 clinical years of medical school.

I have not heard of another school that does it quite like mine, but I have heard of one that has students take their first year of medical school all at once, then take a break for their PhD, then return to do their last 3 years like my school.

While some schools – like mine – frontload research training in their MD/PhD program, others have a structure that puts more medical training before students do their PhD. As some schools are shortening their pre-clinical curriculum to 1.5 years, students are able to complete a couple clinical clerkships to solidify their medical knowledge before transitioning to their PhD phase. Other schools have students complete the first 3 years of medical school (through their core 3rd year clerkships) before doing their PhD and returning for their 4th year of medical school.

There’s pros and cons to all of these approaches. I liked doing more research first so that I could approach my medical training from a research perspective. Now that I’ve done more medical training, I feel like it also would have been nice to have at least the first 2 years of medical school done before doing my PhD so that I could approach my research from a more clinical perspective. This is why it is important to research all of the schools you’re considering and, importantly, try to talk to students at those schools to find out what they think about their program. Regardless, all of these should, on average, take 8 years to complete.

Size

MD/PhD programs also dramatically differ by size. So, depending on where you go, you may or may not be part of a large community of students going through the same challenge of being both a medical student and graduate student. Of the 125 schools on the AAMC list, some of these have quite large MD/PhD programs. For example, Washington University in St. Louis has approximately 200 MD/PhD students. On the other hand, some of the schools listed only have a listed option for students to do a MD/PhD training without any listed students in the program on their webpage.

I began in a cohort of 10 MD/PhD students. At the time, my program had 120+ students overall and had been training MD/PhD students since the 1970s (so we had a large alumni network). I enjoyed having this larger community. With 125 students in the M1 class, it meant that there was at least a few other people in the room who understood the challenges of balancing MD and PhD training. We have had yearly retreats to facilitate community building and collaboration across the campus. These have slowly shrunk in size due to our campus of our college of medicine closing down, but our sense of community remains. I’m in the last graduating class from our campus, and all 12 of us are MD/PhD students, which is a quite unique experience.

If you end up at a smaller program, there’s other sources of community including the #DoubleDocs hashtag on Twitter and the American Physician Scientists Association (and their Twitter lists) that you can use to find fellow physician-scientist trainees.

My MD/PhD program at our 2019 retreat.

Funding

This is so important. Medical training is ridiculously expensive and committing to the extra years of research training cuts away at your years where you can make actual attending physician-level money. Luckily, *most* MD/PhD programs that I’m aware of offer tuition waivers to relieve the burden of medical school debt. However, I have heard of at least one program where students are responsible for a portion of their medical school tuition.

Importantly, all programs should provide a stipend for all years of training. Usually, these are similar to the stipends of normal PhD students, so somewhere around $20,000-$30,000 for the year (this depends on the school, department, and cost of living in the area). Some programs have a Medical Scientist Training Program (MSTP) grant, which they use to fund their students and provide a stipend throughout the entirety of their MD/PhD training. People often use “MSTP” as an equivalent of the term “MD/PhD program”, but there are only 50 schools with this funding status. So, these terms are NOT the same (as a non-MSTP MD/PhD student, this is definitely a pet peeve).

Other programs rely on different funding mechanisms to support their students. For example, my program provides a stipend while we’re in our medical school years, but during our PhD years, we are funded like any other PhD student. This means if our advisors are able to afford a research assistant appointment for us, then we get our stipend that way. Otherwise, we have to work as teaching assistants on top of doing our research to get our stipend. PhD programs often have teaching as a requirement for getting a PhD, so this was fine for me though I did have to do more than my department required. Some MD/PhD programs waive these teaching requirements.

Another funding option that MD/PhD students are encouraged to apply for is the Ruth L. Kirchstein Individual Predoctoral National Research Service Award (NRSA). The F30 award is specifically for MD/PhD and other Dual Degree Fellowships. There is also a F31 award for predoctoral students but not specifically those also completing a medical degree. Note that these are funded by the National Institutes of Health and are only available for U.S. citizens or permanent residents. I was fortunate to be awarded a F30 grant and will hopefully be able to write more about these awards in another post and will update with a link when it is published.

Other things to consider

Is the program in an area of the country that you want to live? Are there people doing research there that you’d want to work with (see my post How to pick a research lab)? How good are the hospitals that you’ll train at? Are there opportunities to experience rural/urban health? Do they effectively promote diversity and inclusion in their program/at their campus? Do students feel like the administration listens to them?


Featured photo: Adapted from @MDPhDToBe on Instagram

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