MD vs MD PhD

I am sure there are a number of us involved with MD/PhD programs on the listserve, but since I have seen any of them comment yet I will provide a few thoughts.

First, I would suggest anyone who is interested in the outcomes of MD/PhD training look at the link below which goes to an extensive analysis that NIH did a few years ago of the outcomes of MSTP graduates. This study was probably the best ever to look at some of the career progression questions we all wanted to know, with major attempt to compare them to other PhD and
MD cohorts.

http://www.nigms.nih.gov/news/reports/mstpstudy/mstpstudy.html

At risk of oversimplification, the study found: these individuals are
highly successful at obtaining research funding (equivalent or better than a comparison PhD group); are more often to have primary appointments in clinical departments (potentially contributing to disease-oriented research); publish at a high rate; publish in similar journals to their PhD counterparts but more often in "mixed" journals which tend to be on the interface between basic and clinical research; and a substantial proportion
continue to engage in clinical care to mixed degrees. Not surprisingly, all of the research career outcomes are in strong contrast to an MD comparison cohort, which only makes sense since the MD/PhDs have differentiated off to primary research careers.

In terms of the MD/PhDs being prepared to do clinical research, not really. Rightly or wrongly, they generally focus on laboratory research but often on disease-oriented questions. The selection process for admission to MD/PhD programs clearly focuses on individuals interested in laboratory research.

The fact that MD/PhDs are not focused toward, trained for, or doing clinical research in large numbers was one of the reasons that NIH several years ago created the Clinical Research Training Curriculum Awards (K30) to develop new models to train clinical investigators. These models generally look toward clinical research training at the end of the clinical training, but some of us are also experimenting with a new type of Masters in Clinical Research in the middle of medical school. This is a parallel to the MPH option many have done in the past but with a different focus on actual clinical study design etc. Anyone interested in these new K30 programs could find links to all of them at:

http://grants2.nih.gov/training/k30.htm
 
The issue of whether or not the number of training positions for MD/PhD students is going to or should increase is a topic of lively disc ussion each year at the MD/PhD Program Directors meeting. We have heard nothing at any of those meetings, including as of last summer, that there is a significant movement afoot to substantively change the fraction of the NIH research training budget and mission toward more MD/PhDs in addition to or in place of other training support. There are always small movements in the amount of training dollars going in different directions from year to year, but no major shifts have occurred in the recent past. Whether or not medical schools are planning to put their own dollars into support of these programs is a topic I have no knowledge of.

The issue of whether or not the MD/PhD is as strong a research training as a PhD is another hotly debated topic in many different venues. I can provide only my own personal experience, corroborated I think with general conversations with some of my colleagues. In my opinion, the spectrum of quality for MD/PhD dissertations and PhD dissertations is indistinguishable. As in all fields, these range from just acceptable to unbelievably creative, insightful and voluminous. But over time, the brilliance of the future scientist is determined on individual traits. Those who will excel will do so with either kind of PhD training. In theory, the MD/PhD acquires a broader view of questions to ask, sacrificing extra time to get their. The PhD more rapidly moves into probing research questions, sacrificing some of the knowledge base to see linkages to disease-related questions and sometimes across bigger fields. Neither is better or worse, just filling a different niche.

In terms of the suggestion that MD/PhDs are better trained to
administer/lead research teams vs. doing the research themselves, this is the model of virtually all successful primary research investigators in academia. Once a PhD or MD/PhD is hired as a principal investigator the expectation is that their ideas, skills and insights will quickly outpace their ability to study these in their labs themselves. The only way to amplify what they can do is through getting grants and attracting other talented scientists to work with their teams.

My 2 cents worth. It would be good to get the views of a few others in the MD/PhD programs.

Richard McGee, PhD

Richard McGee, Ph.D.
Associate Dean for Student Affairs
MD/PhD Co-Director
Associate Professor of Pharmacology
Mayo Graduate School
Mayo Clinic
200 First St. SW
Rochester, MN 55905
507-284-0339 phone
507-284-0999 fax
rmcgee@mayo.edu . email
 

I am not an expert on the outcomes of MD/PhDs. I do work with some of these students in their first two years of medical school, but usually do not keep in touch with them past this time.

There are recent changes to take into accounting. Some medical schools have proposed tripling the number of MD/PhDs. This happened shortly after the Bush Administration proposed a doubling of the National Institutes of Health budget over the next few years. I know that some medical schools have changed admission requirements to allow more out of state students to
apply, some of these same schools proposed the tripling.

What this means is that at least some medical school deans see that more MD/PhDs will likely mean more NIH dollars coming their way - a major source of dollars to sustain their medical school.

I have no problem with this as long as it is not done by simply focusing more and more on the intellectual (MCAT and GPA) at the exclusion of the serving types that will likely do primary care and underserved practices.

Most in medical schools believe that the triple threat physician dead (research, clinical, teaching). Yes we do see more and more focus, however some of the major discoveries in research come from physicians or researchers whose experiences and interests encompassed 2 or 3 of these areas. Studying a subject area often involves contact with it as a clinician, teaching it to others, and researching it in conjunction with others.

A broad focus is good for discovering new concepts.

A narrow focus is good for getting degrees, promotion, tenure, grants, and publications.

In my own case, I get much more from underserved students and college advisors and fellow rural medical education faculty involved with such populations than I get from deans and chairs and other "experts" in medical education. I have to look at the whole process involving research, service, and education to continue to be of value.

That the government chooses not to fund such efforts, zeroes out primary care research, focuses on primary care service for the underserved without researching what really works, etc . , funds medical education in some ways but has no funding focus for education to prepare physicians for the underserved is sad but something to work on.

That the government chooses to fund and expand funding for NIH is good for those interested in MD/PhD efforts. An MD degree can add some broadening to an otherwise PhD focused career or it can delay research efforts. Which way this impacts, I would think, is usually the result of decisions and attitudes made by the individual and determined by the research subject area rather than a general rule to be followed by all.

Robert C. Bowman, M.D.
UNMC Family Medicine, Rural Medical Educators Group of NRHA
rcbowman@atsu.edu

 

Stereotypes.

I have worked in a HHMI cancer research lab both with and for MD/PhDs. In fact I got to meet several Nobel Laureates because of this experience. I have seen just as many inexperienced PhDs as I have MD/PhDs. The combination is difficult to do but will open doors are not open to either discipline. If a person does not want to go into research as a physician then they shouldn't consider it. The MSTP program is a good one funded by NIH. But I should leave that and it's importance to the MSTP schools out there.

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