What is an MD-PhD Dual Degree?

There are a lot of careers to choose from in healthcare…

I’ve found that planning my future is like wading through alphabet soup: there are acronyms everywhere. MD, JD, PhD… It almost makes me want to resign myself to being a BCSFL (Broke College Student For Life).

However, in the spirit of powering through, I decided to take a closer look at each of the options I was considering. It’s common knowledge that “MD” stands for “Doctor of Medicine” and “PhD” for “Doctor of Philosophy.” It always seemed obvious that a student who aspires to become a clinician would attend medical school to earn an MD, while one who aspires to become an academic researcher or professor would attend graduate school to earn a PhD.

Those distinctions seemed simple enough – until I stumbled upon the concept of a dual doctorate, an “MD-PhD.” Someone who takes on both of these titles essentially becomes a Physician-Scientist.

If you, like me, are intrigued by this concept, read on! I hope I can answer a few questions you might have.

“I’ve found that planning my future is like wading through alphabet soup: there are acronyms everywhere. MD, JD, PhD… It almost makes me want to resign myself to being a BCSFL (Broke College Student For Life).”

What Exactly Is an MD-PhD?

Logically, an MD-PhD is a combination of a medical doctorate and a philosophical doctorate. But what about the specifics? Why would someone want to pursue an MD-PhD? What are the advantages of obtaining a dual doctorate over just an MD? What would an MD-PhD cost me in terms of time, money, and academic commitment?

To answer those questions, I turned to the savior of my generation: Google. After a lot of digging, here is what I learned.

Broadly speaking, the process of earning an MD-PhD trains students for clinically-oriented research. In other words, MD-PhD candidates work to solve biomedical issues by conducting studies and developing new techniques in the lab or in the field. Some also treat patients in clinical settings, but they must have a strong focus on research.

While most MD-PhD students complete their dissertation research in a biomedical discipline, the PhD portion of the program can include any area of study, from sociology to health care economics. The Association of American Medical Colleges points out that most MD-PhDs wind up working in “academic medical centers,” e.g. medical schools or teaching hospitals.

“Broadly speaking, the process of earning an MD-PhD trains students for clinically-oriented research. In other words, MD-PhD candidates work to solve biomedical issues by conducting studies and developing new techniques in the lab or in the field.”

Do you want research or patient care?

If you’re considering an MD-PhD, you first need to ask yourself how you see research fitting into your future. Dr. Lawrence F. Brass, a professor at the University of Pennsylvania’s medical school, writes that “combined degree programs are intended to be preparation for a research-driven career; most MD-PhD graduates spend much more time on research than on clinical practice.” Clinical practice is a canvas for the art of research discovery, where “…research (is translated) into new therapeutic and diagnostic approaches.”

In other words, if you are primarily invested in research with an accompanying interest in clinical practice, an MD-PhD program may be a good fit for you. If you are pursuing medicine because of an inclination towards working with patients on a daily basis in a clinical setting, you may find yourself frustrated in academia.

“If you are pursuing medicine because of an inclination towards working with patients on a daily basis in a clinical setting, you may find yourself frustrated in academia.”

Of course, once you launch your career, you would be free to decide for yourself how much time to spend on research as opposed to medical practice. Regardless, it’s important to consider whether research is integral enough to your future career to justify the time, money, and energy investments that a dual doctorate program requires. If the idea of spending the rest of your career steeped in academia is not attractive for you, it doesn’t make sense for you to spend the time and money on a dual degree.

An important trap to avoid falling into is thinking that having MD-PhD (instead of just MD) is going to be worth the extra time and money simply for the prestige of having a dual degree, or because of the potential to make more money than a primary care physician. Pursuing a degree for these reasons is only going to lead to exhaustion and unhappiness– the telltale signs of physician burnout.

Speaking of the amount of time it takes to earn an MD-PhD, on average, completing an MD-PhD program takes 7 to 8 years – although the time frame actually ranges from less than 6 years to more than 8 years.

This variability stems from the fact that research is inherently unpredictable. In seeking to discover something new, you have to contend with several possibilities: the results you obtain may not match your initial theory, the data collection process may take longer than you predicted, or your observations may lead you down an entirely different path from the one on which you originally embarked.

Oh, the joys of science!

“It’s important to consider whether research is integral enough to your future career to justify the time, money, and energy investments that a dual doctorate program requires.”

Thus, MD-PhD programs are susceptible to the same complicating factors that may hinder, lengthen, or curtail the process of obtaining a PhD. So ask yourself: are you willing to embrace those possibilities and contend with the complicating factors? Do you love research enough to justify the extensive time and energy investments? Only you can answer those questions.

Now, pursuing an MD-PhD is certainly not the only path you can take to become a physician-scientist. Many successful researchers – and Nobel Prize winners – never obtained their PhDs. However, as Dr. Brass points out, graduate school is meant to train students “in the art and science of investigation, including the skills needed to be an independent investigator.”

In contrast, an MD program generally does not include academic research training – meaning that an MD who later pursues a research career will have to spend extra time learning advanced research skills and techniques. Additionally, completing academic research in an MD-PhD program gives students a head start with research grants and publications. A report by the National Institutes of Health revealed that, in 2012, MD-PhDs were awarded Research Project Grants (RPGs) at higher rates than either MDs or PhDs; 24.6% of MD-PhD applicants were awarded, as opposed to 21.7% of MDs and 21.4% of PhDs. More on how to finance your dual degree later on.

If you’re interested in becoming a physician-scientist but aren’t prepared to commit to an MD-PhD program at the time of application, take heart that there are institutions that allow first or second year medical students to transfer into their MD-PhD programs, and even programs that only consider MD-PhD candidates following a year or two of medical school. 

Furthermore, it is possible to complete “…an extended postdoctoral fellowship after (or instead of) a clinical residency” following MD programs as yet another alternative for aspiring physician scientists who don’t complete an MD-PhD program.

Bottom line: you don’t need an MD-PhD to receive research education and training, or to conduct and publish valuable scientific research, but obtaining a dual doctorate would definitely give you an edge

“Ask yourself: Are you willing to embrace those possibilities and contend with the complicating factors? Do you love research enough to justify the extensive time and energy investments?”

Financing an MD-PhD

Let’s say you determine that conducting research is a vital part of your future career and that the best way to achieve your goals is by obtaining an MD-PhD. You still need to consider one more question: how will you finance your higher education and training?

Fortunately, most institutions provide some support for MD-PhD students in the form of stipends and tuition scholarships, though the amount and duration vary by institution.

ProFellow, a reputed global fellowship database, lists nine institutions that provide full funding for all students admitted to their MD-PhD programs:

1. Dartmouth University

2. Duke University

3. Harvard/MIT (joint program)

4. Johns Hopkins University

5. Mayo Clinic

6. University of Florida

7. University of Pennsylvania

8. University of Southern California

9. Yale University

It goes without saying that these programs are extremely selective, especially since some of them will also require you to have taken the GRE as well as the MCAT. On top of that, many of them are Ivy League institutions with extremely low acceptance rates. Here are Harvard’s guidelines for admission into their MD-PhD program. Note that Harvard actually does not require applicants to have taken the GRE, but mentions that most programs will.

Don’t count yourself out right away, though; if you have the right credentials and have steadily built up clinical and research experience, earning a seat is certainly not impossible. The credentials to earn a seat in one of these programs may be higher, but the overall number of students applying for them will be lower than the number of students applying to a normal MD program.

The National Institutes of Health also sponsor the Medical Scientist Training Program (MSTP), a scholarship opportunity for nearly one thousand MD-PhD candidates across the United States that finances full tuition, living expenses, and a stipend for the duration of full time MD-PhD studies, and that requires a separate application after being admitted to one of the 48 MD-PhD programs covered by the MSTP.

Given that the number of MD-PhD applicants is a modest count of 1,900 yearly, it is likely that if you meet the very competitive admissions qualifications for these NIH-funded programs, you will exit your dual-doctorate education debt-free. At Duke University School of Medicine, for example, this scholarship was valued at nearly $90,000 for the 2016-2017 school year, or $720,000 over the course of a typical eight years of MD-PhD study.

Yes, you read that right. $720,000.

In comparison, the average MD graduate in 2016 owed $190,000, an amount that would easily accrue to double that value over a 30-year repayment period. The funding of these programs drastically offsets the opportunity cost of the time investment of a dual doctorate. This should be taken into special consideration as an undergraduate pre-med interested in becoming a physician scientist, as your MD education likely won’t be covered if you decide to pursue your PhD after completing your MD, in place of completing the degrees concurrently in an MD-PhD program.

Conclusion

Now you know: I wasn’t joking when I said planning for the future means battling a plethora of acronyms. However, before you chart your course, you need to identify your interests, values, and priorities. Remember to ask yourself these fundamental questions:

How important is research to you?

What are you willing to commit time and energy to, without sacrificing your sanity?

What practical aspects do you have to consider when deciding your higher education and training?

Piece together these answers, one by one, and your vision of the future will gradually begin taking shape. Remember that in some cases, you can transition into a dual MD-PhD program after you have already begun medical school, so if you find yourself on the fence, consider applying to a medical school where this is an option, and take the time to feel out the program for yourself.

So what will it be? An MD? A PhD? An MD-PhD? The world is your oyster – or, I suppose, your bowl of alphabet soup.