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A n unlikely meeting place

A casual lunch scheduled during the first week of September has become an annual event for students in the MD/PhD Program at the University of Toronto. Free food is always appreciated by starving students, but the group lunch is also valued because it gives current MD/PhD students who work at different research institutes and who are at differing stages in the program a chance to catch up with each other at the beginning of a new academic year. For incoming students, the lunch (their first of many) provides an opportunity to meet other MD/PhD students, many of whom will become their friends and mentors over the course of the program and may eventually become colleagues and collaborators later in their careers. At our first MD/PhD lunch, each of us--the two co-authors of this piece--met a fellow student who would become the ultimate friend and collaborator--our future spouse.

We got married almost 4 years after meeting at our first MD/PhD lunch. In the University of Toronto MD/PhD Program, the majority of students complete the preclinical courses of medical school (i.e., the first year and a half) and then pursues full-time graduate work, completes the PhD, and only then returns to medical school to complete the clinical component. So at the time of our wedding we were about halfway through the MD/PhD Program. We are now in the seventh year of the program and, as far as we know, we are the only married couple pursuing dual degrees in Canada.

Dual-physician couples are quite common, since many MDs marry fellow MDs after meeting in medical school or during residency. Using the University of Toronto medical school (which has approximately 175 students) as an example, there are at least 11 MD couples, including some couples where both people were in the same medical school class and others where one of the partners graduated with another class and/or from another medical school. As the number of MD/PhD students increases, the MD/PhD couple phenomenon is likely to become more common. We would like to share some of the challenges that we face as a couple in a MD/PhD Program, as well as the advantages of being a (soon-to-be) dual-degree couple.

Double the challenges

Many of the challenges that we face are similar to those encountered by other couples in which both people are working towards a higher degree, such as an MD or a PhD. Our main issue, however, is dealing with both sets of challenges at the same time.

Without a doubt, science is challenging; the years involved in the completion of a PhD are full of difficulties. During the initial years of PhD training, longs days are spent trying to become familiar with the literature while at the same time trying to become proficient in the lab, all in the hopes of initiating a project that will eventually yield a thesis. Then come years of collecting data, which usually consist of weeks of successful experiments separated by months of failed ones. The final years are committed to dealing with the frustrations of getting the research published, together with writing and defending a thesis.

Like other couples pursuing PhDs, we have not only had to deal with the difficulties associated with our own research project, but we have also had to be a reliable support for our partner who has had to deal with his/her own set of research-related problems. Luckily, we have found that our "bad days" in the lab do not often coincide.

When the PhD is finished, there's little time to celebrate; couples pursuing dual degrees, like us, must then transform ourselves into medical school clerks. As we have made our transition from PhD student in the lab back to being medical students, we have had to start considering one of the major challenges faced by almost all couples in medical school: the residency match. The match determines the location and the specialty in which each graduating medical student will undertake his or her residency training.

The match is not like most application processes in which an applicant applies to a number of programs, receives multiple offers of acceptance, and then selects the offer that best suits his or her academic needs and personal circumstances. Rather, the applicant applies to and ranks multiple residency programs and, in turn, each of the programs rank each applicant. In the end, a computer matches each applicant to one residency position. For couples who graduate from medical school in different years, the residency match can be particularly stressful. When the first to graduate enters the match, the couple can face difficult choices that will have a significant impact on their future. For instance, the couple may have to decide whether or not the graduate should apply to programs in his/her top choice of specialty at the cost of possibly having to live in separate cities for a few years. Or the couple may want to consider having the graduate apply to multiple specialties at the same school at the cost of possibly not getting his/her first choice in specialty. These can be tough decisions.

Fortunately for us, we have been able to avoid this complication by pacing our progress in graduate school so as to complete our PhD requirements at about the same time. As a result, we will have the opportunity to take advantage of the 'couples' match, which allows two applicants to submit a joint ranked list, which guarantees that both members of a couple will match at the same location. This is a good thing, but it has its downside: To successfully match, a couple has to consider many more programs and locations than graduating medical students who enter the traditional match. We anticipate that this will be a particular challenge for us, because we will not only want to apply to programs at the same location but we will also both want to apply to programs that provide strong research opportunities during residency.

More than double the rewards

Despite the challenges, in our case, the advantages of being a MD/PhD couple far outweigh the difficulties. A combined degree program is a lengthy and trying adventure and having a large group of supportive fellow "Mudd-fudders" along for the ride is helpful--an important consideration when choosing a MD/PhD program. Having one of them as a partner is superb. As anyone who is in or who has graduated from an MD/PhD program will attest, facing the barrage of questions from colleagues, parents, relatives, and friends about your career path--including "Why are you doing that?" "How much longer?" and "When are you going to be a doctor?"--can really affect your morale. Lucky for us, the impact of such questions can rapidly be neutralized by your partner. Other advantages include having an automatic study partner for exams, getting to go to meetings together (particularly for a couple in similar fields), sharing scientific successes (e.g., publications and awards), and having the rare chance to watch and experience, not just one, but two PhD theses blossom.

Finally, although an MD/PhD couple may face double the challenges, we find that the simple knowledge that you have a partner who understands helps to alleviate the weight of each challenge significantly (which, of course, holds true for most dual-career or dual-degree couples).

The dual-degree, dual-career couple

Nearing the end of our pursuit of dual degrees, we look forward to the challenges that we will face during our next stages of training. We are aware that perhaps the most difficult part of the road still lies ahead--finding a university/academic centre that will be supportive of academic couples, both with dual degrees, not to mention finding a centre that will actually have two positions available for us. (You can read more about the plight of the dual academic career couple here on Next Wave.)

For those who may embark on a journey as a dual-degree couple--if there are any others out there--we believe that, if the couple fits, taking the journey together surely is better than going it alone.