Getting straight through to med school - how likely?

Pre-Med & Medical School
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It’s become increasingly uncommon for MD/PhD students to matriculate directly from undergrad. Those that do matriculate directly are usually superstars who typically have very significant (and long term) research experience and often they have publications in high impact journals.

As of 2020, at least 75% of MD/PhD matriculants took 2 or more years between undergrad and beginning med school in order to enhance their application portfolio, typically by engaging in full time research. There are no differences in the use of gap years by gender, URM/disadvantaged status or program size the student was eventually accepted into.

Gaps between college and starting an MD-PhD program are adding years to physician-scientist training time

Per AAMC FACTS for MD/PhD students, acceptance into MD/PhD program has become increasing competitive in the past 5-6 years with significantly more applicants than there are positions. Overall acceptance rates into MD/PhD programs are down, in the 28-32% range.

The national MD-PhD program outcomes study: Relationships between medical specialty, training duration, research effort, and career paths

Median age for MD/PhD matriculants is 24.7 years old as of 2018.

Those who do choose to pursue MD/PhDs typically use their gap years to improve their research portfolios by doing full time research. Doing fellowships at the NIH (2 year program), HHMI (2 year programs) or other research institutes associated with research intensive medical schools are pretty common for those interested in pursuing a MD/PhD.

My advice, I would start planning for a gap year now. Instead of studying for the MCAT, I would be researching which research positions and fellowships would align with your research interests–and at some other place than Haverford. Your research mentor may be able to suggest some labs elsewhere that would be of interest to you.

The MD/PhD application process requires you to be accepted independently by both the PhD programs you apply to and the associated medical school. It’s a two step process with the PhD program driving the decision.

Have you started thinking about what your statement of purpose is for PhD applications?

P.S. I would listen to MITPhysicsAlum. Take a gap year for yourself to make sure that the MD/PhD pathway is the one you want and that it will take you where you ultimately want to go.

My younger D was AMGEN Fellow and NIH Summer Fellow, completed a senior research thesis that was published, spent 3 years as integral member of her undergrad research lab eventually rising to be the one who trained all the new grad students on procedures, equipment & software used in the lab, then post graduation worked for 2 years full time as research lab fellow at a top 10 med school before deciding that the MD/PhD route was not one she wanted pursue. She earned her MD, attended a academic residency and has continued to do significant research including two (recent) first author publications in high impact journals for her specialty.

What I’m trying to say, you lack the experience right now to know if a PhD is necessary to get you to where you want to go. You seem to be more interested in clinical applications than in the basic biochemistry–and that suggests that a MD/PhD may not be the optimal pathway for you.

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Thank you @WayOutWestMom and @MITPhysicsAlum for these pertinent points. I am now considering the gap years more intensely due to this information, and I will bring this to my career and pre-health advisors’ attention so they might guide me on steps from here - likely, internships/fellowships - where, when, and how. I have heard rumors of MD/PhD applicant successes being 100% acceptance rates for Haverford, give or take 10% from year to year. I am unsure how many of these are straight-through applicants, but I have heard talk of its possibility. If it is nevertheless difficult and possibly fruitless, then I will take the gap year, as I recognize now that it is not a “weak point”, rather the opposite.
A part of the Haverford Pre-med application process is to create an autobiographical statement that involves in-depth thought about why you want to pursue the MD(PhD) component followed with coaching on how to develop the statements of purpose, essays, and more. I have only just started thinking about all this application stuff, so the components are fairly new and I have not yet thought them through completely. I will likely report back soon for future questions and perhaps question-related updates.
For now, I shall see where this goes!

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Several other points about MD-PhD vs MD alone:

You don’t need a PhD to do research. Many MDs gain additional training in the lab. Some med schools (ie Duke) build one year into the curriculum for research. This does not extend your training time. Some students also work in the lab during the summers or during clinical rotations. Its possible, but not easy.

Getting an MD-PhD does make things easier for you afterwards, especially if you want to go into a competitive residency, or during grant reviews. Having both MD and PhD credentials is good for grant applications. This is especially important if you want an academic title after finishing.

However if your main goal is just to see patients and not do research, then an MD alone would suffice. But it sounds based on your research interests in metabolism, a MD-PhD makes a lot of sense.

I’m not sure how competitive MD-PhD programs are nowadays, but I imagine that having some extra research experience before you apply would be helpful. Good luck.

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@Kelvlixi_mab

You should also be aware that the career trajectory for MD/PhDs and MDs differs significantly.

MD/PhDs pause between their pre-clinical and clinical years of medical school to take the necessary coursework for the PhDs and engage in full time research in order to complete their dissertations. This adds anywhere from 3-5 years to the normal 4 years med school takes.

MD/PhDs typically enter research-based residencies at academic programs in their intended specialties. Research-track residencies typically build in another 2-3 years of research activities into the 3 to 7 years already required for residency. Ditto for fellowship (extra research years built in) if you intend to subspecialize. (And every MD/PhD I have ever met has subspeicalized.)

The effect of this is to lengthen significantly the time it takes until you’re earning a physician’s salary. Although MD/PhDs usually do not incur student debt to pay for their medical education, they are not paid extra for the PhD during residency & fellowship. (Residents and fellows are not paid particularly well. The median resident salary is in the mid $50K range–which is sufficient so long as you aren’t living in a HCOL area or trying to buy a house or support a family.)

Your success as a MD/PhD depends on how successful you are writing and receiving grants. The typical age for a MD/PhD’s first R01 grant is now in their mid-40s.

After residency & fellowship, MD/PhDs typically follow one of three career paths: 1) full time research at NIH or similar institution; 2) full time consulting/research for private businesses; 3) academic faculty at research hospitals. #3 is by far the most common.

Academic faculty are paid lower salaries than physicians in private practice. Over a career, the income differential for MD/PhD vs MD can be several million dollars. (This includes the opportunity cost for the extended training a MD/PhD career track takes.)

As mentioned above, it’s not necessary to have a PhD to engage in research as a physician. Residency and fellowship programs at academic centers offer research electives and some even have mandated research requirements included in their graduation requirements. ( For example, D1 did her residency at highly research oriented program–Yale-- and their program required not just original research but publication(s) based on that research as a graduation requirement.) D2 is currently in fellowship, but was heavily involved in research during her residency and elected to take a research rotation every year (except intern year when it’s not offered). She will be pursuing a academic career and her contract guarantees 1 day/week release time for research. (NOTE: the the 20% guaranteed research time is not terribly different from 25% MD/PhDs get at many hospitals.)

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So, do MD/PhD’s do barely any clinical work? I would…like to be able to apply my research to the clinic. While MD’s may participate in research, would they do it AFTER their MD, or no? If yes, is there a particular type of research they are allowed to do?
I also wonder about the whole MD total cost alone, being a FGLI student. The MD/PhD cost being lower or even free was a minor attractant for me (I do like research components). Would my resultant salary after the schooling be enough to remedy the debt, or would I drown in it as many people like to joke about?
Does The balance of clinical and research work I would do depend on whatever organization I work for or what program I pursue? Does the MSAR list all the MD PhD programs in the country so I can do all my investigation there?
I apologize if this is a lot of questions - I began this more deep consideration less than a week ago. If there are any more comprehensive resources detailing the differences of an MD and MD/PhD - websites, books, videos, etc. Do provide! I just really like both research and clinical work and due to my research/clinical interests somewhat detailed above, I am unsure if I can really choose between the two.

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Here’s the thing. An MD/PhD will not have the time to devote 100% of her time to clinical and 100% of her time to research. One and most likely both will fall behind relative to people who focus on one or the other. On top of that, an MD/PhD starts her career later because she’s in school so long.

The usual way this is handled in clinical and research is to have teams, so all the knowledge doesn’t have to reside in a single head.

Does this mean nobody should get a MD/PhD? Of course not. But there are plenty of disadvantages, and it’s a very specialized pathway. You need a very good story why this is the right path for you, because you will be asked this over and over, by people who have learned to be skeptical.

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So, do MD/PhD’s do barely any clinical work?

It depends on the exact terms of your contract, on your research funding and your specialty.

Hospitals are not charitable organizations, If you’ve been hired to work for them, they expect you to generate revenue for the hospital. This is done by either doing billable consultations and procedures (i.e. seeing and treating patients) or by getting grant monies and paying the hospitals for release time for your research hours and for lab space rental.

Seeing patients clinically does not mean that all or even the majority of them will be patients who might benefit from your research findings.

While MD’s may participate in research, would they do it AFTER their MD, or no?

Med students can participate in research if they choose to. For some competitive specialties, doing a research year is the norm. (An added research year makes med school 5 years instead of 4.)

Residents and fellows can do research of they choose. (And if they are at a training program that allows it. Not all programs do.)

Attending MD-only physicians can get involved in research if they choose to.

There are 3 types of research attendings do: clinical practice research (what is the best model to manage X condition); translational research which seeks to apply basic lab findings to clinical practice; and basic lab bench research.

The first 2 types are pretty common, although there are certainly MD-only physicians who do do basic lab bench research.

I also wonder about the whole MD total cost alone, being a FGLI student. The MD/PhD cost being lower or even free was a minor attractant for me (I do like research components). Would my resultant salary after the schooling be enough to remedy the debt, or would I drown in it as many people like to joke about?

The costs of medical school vary enormously. Some medical schools have tuitions that are quite moderate (TX, NM, Brody in NC, South AL, for example. D1 and D2 attended our state’s public med school where a year of med school tuition is $16K–a huge bargain.)
Other med schools are extremely expensive (think over $105K/year). So which med school one attends can make a significant difference in your overall debt burden. Your other major costs, aside from tuition, are living expenses, which are somewhat under your control, even if you attend a school in HCOL area.

Additionally, there is need-based aid for med school. Many medical schools have scholarships and grants for FGLI students. Some med schools (NYU, NYULI, Kaiser Permanente, and Cleveland Clinic/Learner SOM, for example) give free tuition to all accepted students. Other med schools promise to meet 100% of need without loans for students whose family EFC is below a certain ceiling. (Columbia, for example). Other med schools offer a combination of need + merit. And all med students are eligible to take up to the med school’s published cost of attendance out in federal student loans. Fed student loans have multiple repayment options, all of which are quite manageable.

Besides aid from the med school directly, there are several scholarship for service programs. NHSC pays tuition, fees + a living expenses stipend (around $1500/month) for 2, 3 or 4 years. In return the student agrees to work in a qualifying low income clinic/hospital for an equal number of years once residency is completed. NHSC is a national level program, but a number of states offer their own similar program. The VA will repay up to $40K of student loans for physicians who work at the VA after residency. So will the IHS and federal prison system. Some private practice attending jobs come with loan repayment benefits.

There are lots of ways to pay for med school without taking on huge debt.

How to Attend Medical School for Free

White Coat Investor is an excellent website that offer practical advice on how to manage med school debt.

And yes, physicians are able to pay off their med school debt, unless they manage their money poorly. (The gist of the advice is that once you become an attending and make a “doctor’s salary” that you continue to like like a resident and direct most of your income toward repaying your student loans for the first 3-5 years.)

Does The balance of clinical and research work I would do depend on whatever organization I work for or what program I pursue?

Yes.

Does the MSAR list all the MD PhD programs in the country so I can do all my investigation there?

They’re all listed in there, but you’ll need to do additional research about specific programs and what fields of research they support. (Did you know you can do a MD/PhD in non-science fields–public health, economics, sociology, history of science, medical humanities, etc–at some programs.)

To be a successful MD/PhD candidate you have to match your research interests to a specific research areas that offered at a particular med school. Finding which schools those are will take some effort on your part. You’ll need to look up associated research faculty at the university, read about their labs and probably read of few of the paper published from those lab.

If there are any more comprehensive resources detailing the differences of an MD and MD/PhD - websites, books, videos, etc

Here’s a place to start: MD-PhD Dual Degree Training

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My kid does not have a MD/PhD. But the kid did do a fifth year of medical school as a med school fellow at her school. This extra year was a teaching, mentorship, and research year. She is a DO so extra OMM studies and practice were done as well.

This kid wants to work with patients first and foremost, but also has the background to mentor and teach…and do research if desire.

Many medical schools offer a fifth year as a research year.

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In your earlier topic, @MYOS1634 gave some of the finest information and guidance I’ve seen on CC.

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I will go further and say @MYOS1634 consistently gives some of the finest information and guidance I’ve seen on CC.

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If you do the math, the MD/PhD free tuition plus the stipend isn’t the path to take if you’re looking to save money. Yes, you won’t need loans, but you will be in school far longer, and it will take 4-6 years longer to start earning a physician’s salary. People choose this path because they want to do a level of research that requires (or is greatly helped by) having a PhD, but also realize that doctors who spend time doing research generally earn less than those who do 100% clinical time. (This is not counting the number of MD/PhD students who end up in industry or consulting). I’m not trying to discourage you, but it’s good to know this information going in.

There is a very useful page on SDN where a director of an MSTP program posts regularly, so you can find admissions stats for the current year (in progress) over there.

Many medical schools offer either a year of research or a long term ongoing research project. I think you have to determine if you think this would be enough, or if you really need to go for that PhD, which is an entirely different level of research. My daughter chose the latter and has no regrets.

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@Kelvlixi_mab

One more thing I want to mention since you mentioned an interest in advocacy.

In addition, many people report increasing distrust of their doctors as a result of learning all this information, and that is a distrust I wish to remedy.

There are health policy and public health fellowships available to physicians. These allow a physician to focus on a specific area of patient advocacy, health care policy, public health policy, health services research, bioinformatics, etc.

See: Public Health Pathways for Postresidents

There are also specialized graduate degree programs for physicians who wish to get involved with all levels (including the national level) of healthcare policy.

I will also mention that can add a PhD to existing MD.

One of D2’s friends is doing this. She earned her MD, completed an IM residency, then entered a critical care & pulmonology fellowship, but found a topic she was thoroughly interested in from experiences she gained during her fellowship and took a LOA to work on her PhD at UCLA. Once she completes her thesis in 2 more years, she’ll return to finish her fellowship.

Her PhD work is fully funded and pays her a reasonable living expenses stipend so she not incurring any debt for her PhD.

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One more option:

Physician Scientist Training Program.

A specialized training program for MDs who wish become physician-scientists.

Physician-scientists are physicians who devote regular components of their professional effort seeking new knowledge about health, disease, or delivery of patient care through research. Physician Scientist Training Programs (PSTP) are post-graduate training programs that aim to recruit highly qualified candidates who are committed in pursuing a career as an academic physician scientist. These programs may integrate residency training, clinical fellowships, and basic and clinical postdoctoral training to facilitate the transition period between MD/PhD, DO, and MD degrees and first faculty position.

Specialties that offer PSTP programs: anesthesiology, dermatology, emergency medicine, internal medicine, pathology, pediatrics and psychiatry.

You’ll note that surgical specialties aren’t included and that because surgical skills atrophy quickly with lack of use. Any time you spend in the lab takes away from your time in the OR and vice versa. It’s difficult to find a workable balance between the two.

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Just to be clear, though - you aren’t recommending that the OP pursue a MD/PhD/MPH. At some point she needs to stop being a student and start her actual career.

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This poster is making it sound like it’s either research or clinical with an MD only…and my point above…that just isn’t true. For some specialties, residencies are 6-7 years in length and include a research year.

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Not all. Eternal students serve no one’s best interests.

However, if a physician wants to make a career in healthcare policy, a MPP can be useful.

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This point seems obligatory to concede. However, you may consider whether you can find cultures or subcultures (either contemporary or historical) with effectively zero incidences of conditions such as T2D, MetS and arterio/atherosclerosis. For this, you might benefit from the anthropology offerings at your college.

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I would seriously not worry about the PhD at this point. You already have your hands full just getting into medical school. And even if you get into medical school, you’ll be studying so much, a PhD will be the last thing on your mind.

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I have read on this - Weston A Price’s book “Nutrition and Physical Degeneration” is one of the best examples of this. Though he was a dentist I believe, he studied the jawbone and tooth development of indigenous cultures from all across the world as well as their response to infectious disease and compared it to a sect of the same population that had branched off and been exposed to Western foods - particularly sugar and refined carbohydrate. Not only did the indigenous populations who had stuck to dietary tradition have virtually no incidence of dental caries, tuberculosis and other infectious diseases of the time were absent in their populations, and their facial development was pristine. And of course we know nowadays that populations such as the Maasai and Inuit, despite eating high quantities of meat and fat and virtually zero carbohydrate, have nary an incident of cardiovascular disease, metabolic syndrome, cancer, and many other diseases endemic to Westernized societies. There are many things different about Westernized and indigenous - not just diet - but diet is hardly negligible and deserves further attention in our own populations rather than being given little over a few weeks worth of education in medicine. ‘Let food be thy medicine’ should be another Hippocratic tenet to follow. I could argue further with this but I will let it rest for now - this is just to give you a small idea of how passionate I am about metabolic health and the relation of lifestyle factors to it. I am somewhat hesitant about voicing this passion to interviewers however because I am afraid of being viewed as a “quack”, despite the fact that I am just as eager to learn about pharmaceuticals and their use, just to balance it appropriately. At the same time, I must be honest - the issue of nutrition in medicine, while only a part of medicine, is what brought me towards it in the first place.

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My health advisor I do recall now said, that if I should choose to go strictly the MD route (which I am…unsure of due to simultaneous interest in the research component), my summer time must be spent much differently - instead of research, getting into an actual clinic as a shadower, scribe, or involved in some way, to have plenty of personal experience actually working with patients to elaborate on in the interview when prompted. Is this true? Should I seek if pursuing the route I specified a research component that is either involved at a hospital or has significant clinical relevancy? What would a job like this look like? Can I really secure something so short a term?