Demystifying the MD/PhD

  • /Reviewed by: Amy Rontal, MD
  • MDPhd.jpg

    Somewhere in your training process you will probably encounter someone with an MD/PhD degree or someone who is in training for one.

    Everyone knows that, for the most part, MDs are physicians who take care of patients, whereas PhDs are scientists who traditionally tend to spend their time running a lab with classroom responsibilities on the side.

    What does an MD/PhD do?

    There is no secretive, mystifying career path for MD/PhD trainees and graduates. If MDs see patients as physicians and PhDs conduct research as scientists, MD/PhDs are combination “physician-scientists.”

    Often times, MD/PhD careers are obfuscated by the long training process, different residency tracks and confusing job descriptions.

    Why do MD/PhDs want to practice medicine and run a lab?

    MD/PhDs are interested in translational research, which is a process that brings bench top research to bedside therapeutics. The ability to treat patients and perform research gives you a unique skill set wherein you are able to draw on clinical experiences to design your research hypotheses, and apply those research hypotheses and your experimental findings directly to the patient population you treat.

    Besides being a “cool” thing to do, an MD/PhD’s role is important. There is a growing body of evidence that suggests that the rate at which new therapies are being developed is actually declining despite increased investment in research and development, both in academics and in industry. There are plenty of explanations offered, but a compelling one is that most physicians see patients but don’t have the research expertise to push therapies forward, while most scientists have the research expertise but don’t have the clinical expertise to implement them. Thus, MD/PhDs have a unique role in bridging this gap between science and medicine.

    How do I become an MD/PhD?

    The most common way to become an MD/PhD is to enroll in an MD/PhD program. MD/PhD programs exist to provide streamlined training for students to achieve both degrees in a reasonable amount of time (seven or eight years). Most programs provide a scholarship that pays tuition and fees for both medical school and graduate school on top of an annual stipend that can range from school to school.

    The less common route to becoming an MD/PhD is to go to school to get an MD and then get a PhD at a later time, or vice versa.

    How do I get into an MD/PhD program?

    The admissions process for MD/PhD programs is very similar to that of medical school. First, you indicate you are applying to MD/PhD Programs instead of MD programs when you submit your AMCAS application.

    For MD/PhD admissions, you have to write a few extra supplemental essays describing your career goals in addition to the traditional MD essays. At each school you apply to, you will then be reviewed either by the MD/PhD program admissions committees or separately by both the MD admissions committee and PhD admissions committee.

    You will be invited to interview, where you will meet with faculty from the MD, PhD, and MD/PhD programs (typically, they will also wine and dine you which is more typical of PhD admissions but rare in MD admissions). Qualified students who demonstrate a commitment both to medicine as well as research and demonstrate the willingness to do both are accepted to matriculate in the coming fall.

    Although there is no “cookie-cutter” MD/PhD applicant, successful applicants meet many of the same criteria that successful medical school applicants do, but in lieu of (or in addition to) extensive clinical experiences, they will have more research experience.

    Read our blog post on MD/PhD admissions for more information!

    What is MD/PhD training like?

    For the most part, MD/PhD training is medical school and graduate school integrated into seven or eight years. Typically, students will do two years of their MD training and their USMLE Step 1 before taking three to four years (or more) to complete their PhD. Upon completion of the PhD, students will return to medical school to complete their last two years and earn their medical degree.

    The unique feature of an MD/PhD program’s training is that although students are technically only enrolled in one degree program at once, they are also fulfilling degree requirements of the other program simultaneously. This means that during medical school, students are taking graduate school coursework and during graduate school, students are staying connected to the medical school through shadowing and other clinical opportunities.

    After training, MD/PhDs take a variety of routes. Most go on to residency programs to become licensed physicians with research tracks to allow them to become physician-scientists. There are MD/PhD-specific residency routes that also contain research years to provide MD/PhD students with research experience to run their own lab in the future. Some MD/PhD trainees will go on to only do a residency without research, while some will go on to do a post-doctoral fellowship without clinical training. Others will begin working in industry immediately after graduation.

    It may be clear then that although MD/PhD programs are intent on training physician-scientists, not everyone goes on to do this. The majority do, but career goals evolve over time and certainly MD/PhD trainees and graduates go on to do many more things besides becoming physician-scientists.

    Do I really need an MD/PhD to be a physician-scientist?

    No, you do not need to earn an MD/PhD to be a physician-scientist. You can do research and see patients with just an MD, and many people do this.

    However, consider that as an MD, applying for research funding and academic positions will be much harder when your competition is PhDs who have several more years of experience doing exclusively research. In an environment in which research funding is becoming increasingly competitive, MD/PhDs have a unique advantage over both their MD and PhD counterparts. That being said, plenty of MDs are successful physician-scientists who achieve as much if not more than their MD/PhD counterparts.

    Are MD/PhDs paid more?

    Unfortunately, MD/PhDs are not paid more than their MD counterparts. Research doesn’t pay as well as seeing patients does, so MD/PhDs who spend their time doing research naturally compromise some of the salary they would make as a physician. At the end of the day, MD/PhDs are fairly compensated but do not make the salary that an equal who spent 100% of their time seeing patients would make.

    The biggest advantage financially to doing an MD/PhD is to graduate without debt. Moreover, there are certainly ways to leverage MD/PhD degrees towards career paths that are better compensated financially, but these options are unique and differ on a person-to-person basis. One should not go into an MD/PhD program for a lucrative career path. Hopefully it rewards by other means!

    What else can I do with an MD/PhD?

    While becoming a physician-scientist to see patients and do basic or translational research is the traditional route most people will take, there are plenty of other options. Many MD/PhD graduates go on to work for large research institutions like the NIH and don’t see patients at all. Others go on to work in industry, where they become leaders in drug development and draw from both their clinical and research training.

    Some graduates may become involved in startups and form their own company. A small fraction of MD/PhD program graduates will also go on to private practice. There is no preferred career pathway, although graduates are certainly encouraged to take advantage of both degrees, and not just one of them. At the end of the day, an MD/PhD will open more doors, but in the meanwhile it is important to think about whatever your career goals may be and whether they warrant several additional years of training.

    To learn more about becoming a physician-scientist, check out APSA (the American Physician Scientists Association) and read these articles about physician-scientists.