what does it mean, to you, to be an md/phd?

• Periodical List
• Mol Biol Cell
• 5.29(eight); 2018 Apr 15
• PMC5896927

Mol Biol Cell. 2018 Apr 15; 29(viii): 881–885.

Is an Medico/PhD programme right for me? Communication on becoming a physician–scientist

David Yard. Drubin, Monitoring Editor

University of California, Berkeley

Received 2018 Feb 12; Revised 2018 February 14; Accepted 2018 Feb 16.

Abstract

We are living in a golden age of biomedical research in which it is increasingly feasible to translate fundamental discoveries into new diagnostic and therapeutic approaches to human illnesses. Inherited diseases are being cured with gene therapy. Cancer cells are existence eliminated with less toxic pocket-sized molecule inhibitors and reengineered T-cells. Direct connections are existence fabricated between the fundamental nervous system and prosthetic devices. These efforts are being led by scientists and engineers, some of whom are likewise physicians. This article is intended to help anyone considering a career as a physician–scientist, simply unsure most how best to begin. It is too intended for faculty, staff, and parents who are on the forepart lines of advising talented students about the options that they accept for their futurity. With this in listen, I have tried to answer common questions about MD/PhD programs, just I have also included information well-nigh other paths to condign a dr. who does research.

INTRODUCTION

Because this is a perspectives slice, I volition begin it with a confession: I have been a doc–scientist for more than thirty years and I like what I exercise. I am also a graduate of ane of the primeval MD/PhD programs and have been director of the University of Pennsylvania's MD/PhD program for 20 years. Being a dr. who is also a scientist already makes me atypical. Co-ordinate to the American Medical Association, merely xiv,000 U.S. physicians (out of well-nigh one million) consider research to be their major job, and a search of National Institutes of Health (NIH) databases in 2012 turned up only 8200 physicians who were main investigators on NIH research grants (Ginsburg et al., 2014 ). To put that number in context, there were 28,000 full investigators with NIH grants in 2012. In other words, most NIH main investigators are PhD scientists, not physician–scientists (MD or MD/PhD).

My primary day (and sometimes night and weekend) job equally a carte-carrying physician–scientist is overseeing an NIH-funded research team. My clinical responsibilities include taking care of patients with the kinds of bleeding and blood clotting disorders that nosotros study in the lab. Some of these patients have medical issues that are common in the Usa. Some of them are true "zebras," the kinds of patients who go referred to a well-respected academic medical heart considering physicians are unsure how best to proceed or lack the resources to manage the patient'due south problem. I also teach medical students and graduate students, and I straight a very large MD/PhD programme. In my spare time, I talk to lots of undergraduates and contempo college graduates who are thinking nigh becoming physician–scientists and wondering whether they should be applying to MD/PhD programs. I meet them at Penn, but also on visits to other colleges and universities. This article is a distillation of some answers to questions that I am commonly asked. If you are an undergraduate trying to determine whether to become to medical school, graduate school, or both, this article may help you. Whatever you make up one's mind, I wish you success.

WHAT IS THE PURPOSE OF MD/PhD TRAINING?

Dr./PhD programs were established in the 1950s to combine training in medicine and enquiry. They were specifically designed for men and women who wanted to become enquiry physicians, too known as physician–investigators or physician–scientists. About of the graduates of Physician/PhD programs in the 60-plus years since and then take get faculty members at medical schools and universities, investigators at research institutes such as the NIH, or leaders in in the pharmaceutical and biotech industries (Brass et al., 2010 ). Regardless of where they eventually terminate up, MD/PhD trainees are beingness prepared for careers in which they will spend most of their time doing research or translating that enquiry into new therapeutic and diagnostic approaches. Information technology is a busy, challenging, and hugely rewarding career. A study of what has happened to Doc/PhD programme graduates from 24 schools appeared in Bookish Medicine in 2010 and is worth reading not but for the data set, but also for the word of what the data mean (Brass et al., 2010 ). An even larger outcomes study that includes data on over 10,000 MD/PhD program graduates is scheduled for publication as a AAMC report in April 2018 (Akabas et al., 2018 ).

HOW CAN ONE PERSON DO Two JOBS?

When I was an undergraduate and trying to make up one's mind what to do with my life, my mentors told me that I could become a doctor or a scientist, but that trying to combine two decorated professions was futile. Many years later, I know that many current undergraduates are being told the same matter. Nonetheless well-meant, that advice misses the signal. The goal of MD/PhD plan preparation is not to prepare you for 2 unrelated total time jobs. Instead, you should think of physician–scientists as chimeras—blends of a medico and a scientist with the two parts plumbing equipment closely together. A more relevant question is: if you are going to get a physician–scientist, practise you have to get through an MD/PhD program? I will endeavor to answer that one a scrap subsequently in this article. Offset, I'll provide some definitions.

WHAT IS THE Departure Betwixt AN MD/PhD PROGRAM, A COMBINED DEGREE PROGRAM, AND AN MSTP PROGRAM? A Bit OF HISTORY AND A Discussion ABOUT FUNDING

None. Programs designed to train physician–scientists go by all of these names. For the most part, the terms are interchangeable, although at some schools "combined degree" programs can include Medico/JD and Medico/masters programs as well—also VMD/PhD programs, which railroad train veterinary physician–scientists. A list of MD/PhD programs can exist constitute at http://world wide web.aamc.org/students/enquiry/mdphd/applying_MD/PhD/61570/mdphd_programs.html. The NIH uses the term MSTP (short for "medical scientist training programme") to refer to programs at schools that have been competitively awarded special training funds to assistance back up Doctor/PhD candidates. There are currently 46 MD/PhD programs that receive support from the National Institute of General Medical Studies. A list tin be found at http://www.nigms.nih.gov/Grooming/InstPredoc/PredocOverview-MSTP.htm.

When they first started, there were only a handful of Medico/PhD programs. I can clearly think reading a minor booklet about applying to medical schoolhouse that had a single page at the back well-nigh Physician/PhD programs. Over time, the number of programs has grown. Now there are ∼ninety agile Md/PhD programs that admit anywhere from a few students per year to 25 or more. The average size of an Medico/PhD program in 2017 was ∼90 students in all stages of preparation. Compared with the many thousands who apply to medical school in each year, but 1900 (∼3%) utilize to Physician/PhD programs. About one-third of the applicants are accepted, which is similar to the acceptance rate for medical school. 1 When I began medical schoolhouse, in that location were very few MD/PhD trainees—I was one of two in my inbound form. That has inverse considerably. At that place are currently ∼5500 men and women in preparation in MD/PhD programs.

Most Doctor/PhD programs provide tuition waivers for both medical school and graduate school plus a stipend to help cover living expenses. Such fellowships are exceedingly valuable for trainees and very expensive for medical schools and the NIH, then admissions committees work hard to pick the right students for their programs. Despite the high grooming costs, when I visit other MD/PhD programs to conduct reviews, it is not uncommon to hear deans refer to their MD/PhD program as "the gem in the crown." One can easily argue that the being of Md/PhD programs is evidence of the high value that our society places on medico–scientists.

ARE Doctor/PhD PROGRAMS Express TO THOSE INTERESTED IN LABORATORY Inquiry?

The answer varies from school to school. Not all schools offer PhD programs in all disciplines. The majority of Doctor/PhD students receive their PhD in biomedical laboratory disciplines such as prison cell biology, biochemistry, genetics, immunology, pharmacology, neuroscience, and biomedical engineering science. The names of departments and graduate programs vary from school to school. At some schools, MD/PhD trainees exercise their graduate piece of work outside of the laboratory disciplines, in fields such as economics, epidemiology, health care economic science, sociology, medical anthropology, or the history of science. This is not an exhaustive list, and yous should cheque earlier you utilise to encounter what is actually offered at any detail school.

Although there is no fully upward-to-date and reliable list of which Doc/PhD programs offering grooming in which graduate disciplines, a place to start is at the Website of the AAMC MD/PhD section (which is a good source for other types of information likewise). 2

ARE THERE OTHER Means TO BECOME A Physician–SCIENTIST?

Yep. Definitely. Physician/PhD programs are a great choice for people who decide early that that they want to be physician–scientists and have built the necessary rails record of academic success and enquiry experience earlier they apply. Not everyone does this, however, either considering he or she did not acquire almost the option early enough, he or she did non make a decision in time, or he or she does non have an academic and research feel tape that supports an application. Not finding out early enough turns out to exist a common problem. In my experience, college prehealth advisors know much less nigh MD/PhD training than MD training—non surprisingly, since only 3% of medical school applicants in the United States every year utilize for MD/PhD training. Equally a result, some people cull (or are obliged) to practice MD/PhD training in series, rather than parallel—finishing i degree and then starting the other. The disadvantages of this approach include taking longer to finish training and the probable need to cover the toll of medical school on your own.

I am frequently asked about the strategy of starting medical schoolhouse then applying to graduate school as a medical pupil. Some schools volition consider you for transfer into their MD/PhD programs after you have completed a year or 2 of medical schoolhouse or graduate school at the aforementioned academy. Although it is very rare that an MD/PhD program will consider accepting a medical or graduate student from a different school, information technology does occasionally happen when kinesthesia move from one institution to some other and desire to bring their students with them. The rules and requirements vary from schoolhouse to school.

Other programs worth checking out include the NIH MD/PhD program that provides support for the PhD stage at the NIH campus or in Oxford/Cambridge, with the MD training taking place at ane of the participating MSTP-designated programs. Annotation that not all of the MSTP programs have chosen to participate, and then if you have your center set up on a specific medical school, you should be sure to inquire. 3

Another option is to complete medical schoolhouse and residency training before doing an extended period of supervised research. A number of Nobel Prize–winning physician–scientists did just that. Notwithstanding, with the increase in the number of MD/PhD training programs nationwide, near people who make the decision to go physician–­scientists while still in college should think hard about doing both degrees together in an integrated Doctor/PhD programme that combines graduate schoolhouse and medical school into a joint program that currently takes 8 years on boilerplate to complete (Akabas et al., 2018 ).

DO I Actually NEED A PhD TO DO Enquiry? CAN I SAVE Time By SKIPPING IT?

The answer to the kickoff of these questions is "Conspicuously not." However, while medical school volition put you lot firmly on the path to becoming an accomplished clinician, information technology does non provide grooming in how to do research. At some point y'all will benefit from that additional piece of your education if yous intend to become a dr.–scientist.

Every bit noted in a higher place, in years by it was not uncommon to learn how to do research by doing an extended postdoctoral fellowship later on (or instead of) a clinical residency. I am often asked whether it is possible to save time on the path to condign a physician–scientist by skipping graduate school and just going to medical schoolhouse. The available data advise that the respond to this i is "No." Md–scientists get their beginning jobs in academia and their first contained NIH grants at approximately the same age regardless of whether they completed an MD/PhD program or went solely to medical school then did a more extended postdoc (Ginsburg et al., 2014 ). Equally a result, I commonly tell undergraduates that if they are gear up to make the delivery before starting medical school, MD/PhD programs offer many advantages, including integrated training, mentored research training, and medical school tuition waivers. On the other hand, if yous are certain you lot want to be a dr., just less sure about existence a scientist, then my advice is to become to medical school and figure out the rest of what yous need when you know more than nearly the opportunities that being a physician provides.

HOW DOES Physician/PhD TRAINING WORK AND HOW LONG DOES IT Have?

The answer varies from schoolhouse to schoolhouse, but historically students begin with 2 years of medical school, switch to graduate school in the 3rd year of the plan, and and then return to finish medical school after completing (and defending) a thesis research project. When I was an Medico/PhD pupil in the 1970s, there was little, if any, advice between the medical and graduate phases of the plan. That has changed considerably. At present most programs emphasize integration of the Doctor and PhD parts of the training, with graduate school courses during years 1 and ii and clinical experiences during graduate school. Some programs allow completion of 3–12 months of clinical training before the start of total-time graduate training. Be certain to ask how things are organized at schools that you are considering. In programs leading to a PhD in laboratory science, Physician/PhD trainees commonly spend the summertime between the beginning and second years of medical school working in the laboratory of the faculty member they are considering equally a potential thesis counselor. Some programs also ask students to do one of these "lab rotations" in the summer earlier starting medical school classes too. Depending on the number of clinical months completed before starting the thesis research, students returning to medical schoolhouse will need 1–2 years to finish their training and meet the requirements for medical licensure. The stated goal is to complete an MD/PhD program in 7 or 8 years. Withal, numbers from across the land show that some students finish in 6 years, while others accept ten years (or more than). The average currently is viii years (Akabas et al., 2018 ). Note that medical education in the Us continues to evolve. I trend is away from the archetype 2 years of preclinical educational activity followed by 2 years of clinical education. The earlier first in clinical training made possible past shortening preclinical time enables some Dr./PhD programs to offer full-time clinical experiences before the start of graduate schoolhouse. However, some schools are choosing not to do this. The merely way to find out what is being done is to ask, if it is not evident from the program's Website.

HOW LONG DOES Information technology Have TO COMPLETE Grooming Later on GRADUATING FROM AN MD/PhD Programme?

Corny as this may sound, the process is never really finished. Your education will go along throughout your career. A more pragmatic answer is that preparation volition extend across medical school and graduate schoolhouse as you complete your mail service graduate education. Hither are some typical numbers: Doctor/PhD program, 8 years. Residency, 3–6 years. Postdoctoral fellowship, 3–half-dozen years. For nearly people the term "postdoctoral fellowship" includes another year or two of clinical training, followed by a render to enquiry for ii or more years (Figure 1). For example, I completed an MD/PhD program in 6 years, followed by a residency in internal medicine (3 years) and a fellowship in clinical hemato­logy and oncology that was combined with postdoctoral training back in a lab (3 years). Later that I became an assistant professor and started my own lab. That timing was fairly typical when I did it. At present it would be considered fast. On the other manus, my chore clarification when I finished included running a research team, looking afterwards postdocs and graduate students, and taking intendance of ill people with complicated medical problems, so maybe all of that preparation fourth dimension was necessary.

Paths to condign a physician who is also a scientist. Integrated MD/PhD training programs that combine enquiry and medical preparation are not the just path to becoming a medico–scientist. Alternatives begin with doing a research year in medical schoolhouse (MD+ in the effigy) or only doing the standard four-twelvemonth medical schoolhouse pedagogy. These save fourth dimension at the start, just commonly require a longer period of postgraduate clinical and research preparation to reach the point where a task as a md–scientist in academia becomes viable. As a outcome, doctor–scientists often go far at the "get a job" betoken at about the same historic period whether they began every bit medical students, MD+ students, or MD/PhD students, although unremarkably with greater student debt if they have non been in an MD/PhD program. Run across the text for details.

WHAT HAPPENS TO THE GRADUATES OF Medico/PhD PROGRAMS?

Short-term, near all do boosted clinical training. Those who do non are ordinarily headed toward careers at enquiry institutes or outside clinical medicine entirely. Those who exercise employ for residencies often find that their MD/PhD training makes them specially appealing to residency programs at top institutions. Long-term, about plan graduates end up with careers in which they combine patient intendance and research. The inquiry may be lab-based, translational, or clinical. Most (75–80%) end up at academic medical centers, at research institutions such as the NIH, or in the pharmaceutical/biotech manufacture (Effigy ii; Contumely et al., 2010 ; Akabas et al., 2018 ). A much college percentage of Physician/PhD program graduates accept concluded up in academia than of medical school graduates in general (Brass et al., 2010 ). Those who build research careers and use for NIH enquiry grants detect that having the PhD in improver to the Physician improves their chances of obtaining funding (Ginsburg et al., 2014 ).

Where are they working? Information from 2202 MD/PhD programme alumni who have completed all phases of postgraduate clinical and research training. Adapted from Brass et al. (2010) . Industry includes the biotech and pharmaceutical industries. Pvt Practise refers to total-time clinical practice exterior of an academic medical center.

HOW Practise I Use?

The procedure of application varies from school to school. Some schools have an MD/PhD-focused committee that will screen your awarding and coordinate the interview and admission process. Other schools consider MD/PhD applicants only after a decision has been made virtually MD admissions. Finally, some schools consider students for the Medico/PhD program only after they have completed a year or more than of medical school. Schools that subscribe to AMCAS volition inquire you to indicate your interest in an MD/PhD program and then to provide additional data as part of a secondary application.

WHEN Practice I Utilize?

Most people apply after finishing their junior year in college, but a growing number of applicants finish college and work for a yr or more before applying. Some people apply the time subsequently college to take courses needed for medical school admission or to gain more full-fourth dimension laboratory research experience. Some people simply were not ready to brand decisions nearly their future careers and postponed choosing beyond the finish of college. Information technology is a mistake to assume that MD/PhD programs are interested merely in applicants who take worked in a lab for a year or more than after college. That is clearly non the case, and some of us who straight Doctor/PhD programs are concerned about the growing percentage of applicants who have waited to utilise afterward they graduate in the mistaken impression that it will ameliorate their resumes. My advice is that for a training path that lasts every bit long as this one does, it is best to go started equally soon as possible.

WHAT DO ADMISSIONS COMMITTEES Expect FOR?

The answer clearly varies from schoolhouse to school, merely some basic principles use. In general, admissions committees will look for prove of academic success, extended research experience, letters of recommendation from people who know you lot well, and your plans for the time to come.

1. Evidence of academic success. This includes your GPA and MCAT scores, just is non express to them. Admission committees use a holistic arroyo and will undoubtedly consider where you went to college and what types of courses you took. They will not necessarily be dismayed if you got off to a slow start, equally long as y'all did well later. They will place the greatest emphasis on courses that are relevant to your called area of graduate schoolhouse preparation. I have non encountered a program director who seriously believed that the MCAT tests your ability to exist a doc–scientist. Even so programs employ MCAT scores in a variety of ways, including seeing how you compare with the national puddle of applicants and predicting how you will exercise on the numerous standardized tests that all of u.s.a. accept to take in medical school and across.

2. Extensive research experience. If yous plan to become a PhD in one of the laboratory sciences, then prior laboratory experience counts heavily, particularly if you spent a yr or more in the same laboratory. Summertime laboratory feel tin can be helpful because they are usually opportunities to do research total time, but summers are short. Whenever possible, you should endeavour to do research during the bookish year, or at least spend multiple summers in the same lab. If you are planning a PhD outside of the laboratory sciences, seek equivalent experiences. The idea is to exist sure you similar the experience and to create a track record upon which your by performance can exist judged and your future success predicted.

3. Messages of recommendation. The most important letter(s) are from the faculty members or other senior investigators with whom yous worked. The messages should ideally comment on your talents, skills, and potential for success every bit an independent investigator. If yous are working with a senior faculty member, information technology is very helpful if he or she can compare y'all with other students with whom he or she has worked. Note that such a letter of the alphabet is non necessarily the almost advisable for an MD-only application. MD/PhD program admissions committees are usually almost interested in your talent and ability equally a physician–scientist, although they will definitely also consider whether y'all are likely to become a successful and caring physician. Fortunately, medical schools allow y'all to submit more one letter of recommendation.

4. Your plans for the future. Because training to be a doc–­investigator is and then plush in terms of your fourth dimension and the school's resources, your career goals should exist compatible with Physician/PhD training. Becoming a full-fourth dimension practitioner is a commendable goal, only does non require a PhD in addition to an MD. Your goal as a trained md–investigator should be to spend at least 75% of your fourth dimension on research. You do not need to know the specific problem you want to piece of work on at this point (many do not, and it is probable to change), or with whom yous would like to train, but your delivery to becoming an investigator should be conspicuously communicated in your essays and interviews, and y'all should have given idea to what will be required.

HOW Practise I DECIDE WHERE TO APPLY?

Some applicants take decided that they want to piece of work in a particular field or with a item faculty member. For them, choosing where to apply is defined by where that kinesthesia fellow member works or where the field is best represented. Most applicants have only a general idea of what they might want to work on in the future and know that their interests are likely to evolve equally they are exposed to new things. For them, pick volition be defined by bug such every bit the reputation of the schoolhouse (hopefully not based solely on U.S. News and World Report rankings!), the success of the graduates of the program (be sure to ask!), and geography. Schools vary in the difficulty of gaining admission. The directors and nonfaculty administrators of MD/PhD programs nationwide are a big pool of resource that yous can tap. Nearly of us get electronic mail from hereafter applicants all the time. Take reward of our willingness to talk with you. Ask questions near the things that are important to yous.

FINAL THOUGHTS

I began this perspective with the confession that I am a md–scientist and I similar what I exercise. Information technology is not unusual these days to meet articles and stance pieces that lament the difficulty of becoming and remaining a medico–scientist. I volition non cite them here—you can notice them on your own. Fortunately, our social club is yet willing to make a big investment in biomedical research through the NIH and through numerous foundations. If you want to become a doc who discovers the new stuff, there are jobs waiting to exist filled. However, you will need expert preparation and great mentorship every bit you learn the skills needed to be a dr. and a research team leader. Expert luck with your decision.

Acknowledgments

My thank you to my colleagues who directly Doctor/PhD programs, the NIH for supporting md–scientist training (including my own), and the hundreds of Doctor/PhD candidates and alumni who have taught me so much over the past xx years.

Abbreviations used:

AAMC	American Clan of Medical Colleges
MCAT	Medical College Admissions Examination
MSTP	Medical Scientist Preparation Plan

REFERENCES

• Akabas MH, Tartakovsky I, Brass LF. (2018). The National MD–PhD Program Outcomes Report. American Association of Medical Colleges Reports.
• Brass LF, Akabas MH, Burnley LD, Engman DM, Wiley CA, Andersen OS. (2010). Are Dr.–PhD programs meeting their goals? An analysis of career choices made by graduates of 24 Doc–PhD programs. Acad Med , 692–701. [PMC free article] [PubMed] [Google Scholar]
• Ginsburg D, Shurin SB, Mills Southward. (2014). NIH Physician–Scientist Workforce (PSW) Working Group Report. [Google Scholar]

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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5896927/

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