Monday, March 07, 2005

What exactly is a MD/PhD program?

Because I've gotten the question more than once, I thought I'd write a quick post on what exactly a md/phd program, mstp (medical scientist training program), or pstp (physician scientist training program) entails. (I should note that those three names usually refer to the same thing.)

Generally, a md/phd program will take 7-8 years. The first two years are made up of the preclinical years of medical school (this is where I am now.) Summers during these first two years are often used for research rotations in order to learn new skills, and decide upon the lab that you are going to work in. The next three to four years (and sometimes more) are spent in a graduate program in pursuit of a PhD. At my program, we pretty much have the option of entering any graduate program offered here, (though they may not be too pleased if we choose to study English) and we don't have to choose the exact program until we are ready to start working on the PhD. After successful completion of a PhD, the student then goes back to medical school to complete the clinical rotations.

In order to get this all done, most schools have a few things in place to make things a bit easier on the student. Generally, the medical school coursework will "count" for most of the required graduate coursework, though students sometimes have to take a couple classes to cover things not addressed in medical school, such as statistics. Many schools will allow MD/PhD students to have one less paper published than a regular PhD student. For the clinical years, electives are often not required (mostly to allow for a flexible start time into the third year of medical school). My school requires us to do a "senior project" in the final year (fourth year of medical school) to keep in touch with research. The senior project is often more clinically based than the graduate work, or can be used to explore a different area of research. Coming out of school, there are many different options in residencies/fellowships that allow for protected research time, and some tracks are even shortened from what "normal" residencies might be (this is often done under the assumption that most md/phd's will spend, on average, less time doing clinical work during their careers.)

Programs vary in size from one or two students per medical school class to up to 25 students at Washington University in St. Louis. As a medical student in an MD/PhD program, we have several perks, such as an office, a weekly journal club, career retreats (our spring retreat will be held at an amusement park), extra social activities, and the fact that we are considered "special." (Though sometimes this is a disadvantage when everyone looks to you as the "smart one!") Being in a program within a program gives a built-in support network, and often the opportunity to get free/cheap books.

Funding for MD/PhD programs vary by institution. There are currently 39 schools that receive funding from the NIH. Some schools use purely institutional support. Many programs fully fund all years in the program, which means that a student will not pay any tuition, and will receive a modest stipend throughout the 7-8 years. Some programs only fund the graduate portion, and still others don't fund students at all. (Some institutions do a combination of all three, depending on the student.)

Obviously, due to the small nature of most programs, and the availability of funding, admission to one of these programs is highly competitive. I've heard that 33 is the magic number on the MCAT, along with excellent undergraduate grades and substantial research experience to be a competitive candidate (although this is a big generalization; it is possible to get into a program with much less, or be rejected with much more.) One thing that is really important when preparing an application to a MD/PhD program is finding a balance between clinical work and research. Otherwise, why wouldn't you pursue a straight MD or PhD?

Obviously, doing a formal program like this is not the only way to get both your MD and PhD; many people have done them years apart. Also, having both degrees isn't always necessary to pursue clinical research, but in my experience, having both degrees opens a lot of doors in terms of professional opportunities, grant competitiveness, and more.

For your information, you can see a list of all of the U.S. MD/PhD programs here.

And in closing, for an idea of how md/phd's can spend their time, see Speaking two languages and Wearing two hats at Orac Knows (Do you know of any other good explainatory md/phd posts in the blogosphere? Please send me a link!)