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1. What is M.D.-Ph.D. training?

2. Why get a Ph.D. with an M.D.?

3. What research areas can I pursue?

4. What is the curriculum like in M.D.-Ph.D. programs?

5. How long will it take to complete the M.D.-Ph.D.?

6. How long will it take to complete training after I graduate?

7. What is a research residency?

8. What are my career prospects?

9. What financial support is available?

10. What factors should I consider when applying to and selecting an M.D.-Ph.D. program?

11. What if I decide to pursue an M.D.-Ph.D. after starting medical school?

12. What are the prerequisites for applying to M.D.-Ph.D. programs?

13. What will M.D.-Ph.D. admissions committees be looking for in my application?

14. How do I apply?

15. What is the interview process like?

16. What is the notification process?

 

1. What is M.D.-Ph.D. training?

M.D.-Ph.D. programs provide training in both medicine and research. They are specifically designed for those who want to become research physicians, also known as physician-investigators or physician-scientists. Graduates of M.D.-Ph.D. programs often go on to become faculty members at medical schools, universities, and research institutes.

Regardless of where they eventually work, M.D.-Ph.D. candidates are trained for careers in which they will spend most of their time doing research, in addition to caring for patients. The M.D.-Ph.D. dual career is busy, challenging, and rewarding, and it offers opportunities to do good for many people by advancing knowledge, developing new treatments for diseases, and pushing back the boundaries of the unknown.

2. Why get a Ph.D. with an M.D.?

M.D.-Ph.D. training organizes the experimental and clinical thinking of the physician-scientist. This synergy enables a physician-scientist to recognize new ways that clinical care or the understanding of disease mechanisms will benefit from research and to mount the appropriate effort. Likewise, the synergy achieved in dual-degree training enables the physician-scientist to see how the results of research discoveries and insights can be converted into clinically significant outcomes.

A practical benefit is that most M.D.-Ph.D. programs pay candidates a stipend and tuition scholarships during the training years. The financial support for those willing to undertake M.D.-Ph.D. training recognizes the additional time that a student must spend in training for this career. The extent of this support varies among programs. For example, some programs support only U.S. citizens and permanent residents.



This Q&A is an edited extract from the Association of American Medical Colleges' Web site Considering a Career in Medical Research and is reproduced here with permission. Portions of both documents were previously published on Science Careers as "An FAQ for M.D.-Ph.D. Applicants."

3. What research areas can I pursue?

Most M.D.-Ph.D. candidates earn their Ph.D. in biomedical laboratory disciplines such as cell biology, biochemistry, genetics, immunology, pharmacology, physiology, neuroscience, or biomedical engineering. The names of departments and graduate programs vary from school to school. At some schools, M.D.-Ph.D. trainees can also do their graduate work outside of the laboratory disciplines in fields such as computational biology, economics, epidemiology, health care policy, anthropology, sociology, or the history of medicine. Differences as to which graduate degree programs are offered and the quality of these programs are important elements to consider in applying for M.D.-Ph.D. training.

4. What is the curriculum like in M.D.-Ph.D. programs?

Although curricula vary, the educational courses and topics presented to medical school students are similar among M.D.-Ph.D. programs, because students must pass Step I and Step II of the United States Medical Licensing Examination. In contrast, graduate school activities are more varied, because graduate curricula and research opportunities differ by faculty expertise within a program. Thus, research experiences obtained during graduate school training are one of the differences among M.D.-Ph.D. programs.

Different programs have adopted a variety of approaches to integrate medical and graduate curricula for M.D.-Ph.D. training. The overall goal is to reduce total training time. The typical track is often termed the "2-3-2" or "2-4-2" track, reflecting the number of years that a student participates in each of the three sections of M.D.-Ph.D. training. In most programs, trainees master basic science courses, followed by an intense period of Ph.D. research and completion of the thesis. Clinical training is often the final component of the program -- a feature dictated by the need to be prepared for clinical residencies.

There are many variations on this general approach. For example, some programs offer significant integration between graduate school and medical school courses in years 1 and 2. The degree of clinical involvement during the basic science phase of training also varies among programs, as does the integration of clinical experiences during Ph.D. training. The structure and flexibility of training curricula is another factor that applicants should consider when choosing a program.

5. How long will it take to complete the M.D.-Ph.D.?

Most M.D.-Ph.D. students complete the requirements for the dual degrees within 7 or 8 years. Some students complete the program in 6 years, while others may take longer than 8 years. The variation is due to the amount of time required to complete Ph.D. requirements, because one cannot predict the progress of research or the amount of time needed to develop into an independent investigator, the primary goal of Ph.D. training.

Note that the average time to complete a biomedical Ph.D. in the United States is about 6 years. Thus, if pursued independently, obtaining a dual degree would take about 10 years. By integrating the didactic components of training, dual-degree students complete the program in 7 or 8 years on average.

6. How long will it take to complete training after I graduate?

The career of each M.D.-Ph.D. graduate is uniquely based upon research and clinical interests, but in general, graduates spend 3 to 7 years in specialty and subspecialty clinical and research training -- that is, residency and fellowship.

In the past, M.D.-Ph.D. graduates traditionally entered residency programs in medicine, pediatrics, or pathology. However, the clinical specialty choices of current graduates are more diverse, with many graduates pursuing residency training in neurology, psychiatry, radiology, radiation oncology, and even surgery and surgical specialties.

After completing their specialty clinical training (e.g., in medicine or pediatrics), most physician-scientists pursue subspecialty clinical training (e.g., cardiology or hematology-oncology) and postdoctoral research that typically combines protected research time with intensive clinical training.

7. What is a research residency?

There are a growing number of so-called research residency programs that have been specially developed to foster the career development of physician-scientists. These are highly structured programs in which research is fully integrated into the clinical training. These programs differ in their overall structure, but all offer the following:

  • Shortened residency (specialty) training; in general, the integrated programs allow trainees to shorten their residency by 1 year, depending on the field of specialty;
  • Integrated research and clinical training; programs usually offer mentoring for trainees to choose a lab early in their training process, so they can embark on their research right away when they start full-time in the lab;
  • Guaranteed subspecialty fellowship position in the trainee's desired field; this is not offered at all institutions; and
  • Special financial support; a few combined programs also offer support toward both salary and research.
  • The American Physician Scientists Association maintains a list of these residency opportunities

8. What are my career prospects?

According to a recent study from the National Association of M.D.-Ph.D. Programs, about 75% of U.S. M.D.-Ph.D. graduates are in academic medicine or pharmaceutical company positions that make use of their interests in both patient care and research.

An M.D.-Ph.D. physician-scientist is typically a faculty member at an academic medical center who spends 70% to 80% of his or her time conducting research, though this can vary with specialty. Their research may be lab-based, translational, or clinical. The remaining time is often divided between clinical service, teaching, and administrative activities.

Thus, most M.D.-Ph.D. graduates pursue a career in which most of their time is spent on research. This research typically is conducted at academic medical centers, research institutions like NIH, or in the pharmaceutical/biotech industry. With career advancement, many M.D.-Ph.D. graduates ascend to significant leadership roles in academic medical centers, industry, government, and private organizations, reflecting their broad experience in health care and research.

9. What financial support is available?

More than 40 universities around the country offer M.D.-Ph.D. students a tuition scholarship and stipend from the National Institutes of Health's (NIH's) Medical Scientist Training Program (MSTP). Most M.D.-Ph.D. programs, whether supported by MSTP funds or not, support trainees with a stipend and tuition scholarship during medical school and graduate school training. However, there are variations on the amount or length of time that students are supported. For example, some programs limit the total numbers of years that the stipend and tuition are provided. Programs may also provide some support for travel to scientific conferences or for research expenses.

Although most M.D.-Ph.D. programs offer substantial support for their students, there are additional resources available for supporting M.D.-Ph.D. trainees. Most take the form of competitive applications submitted by the trainee and their research mentor. These include fellowships from private sources and from a number of NIH institutions as F30/31 National Research Service Awards predoctoral fellowships. See also AAMC's list of funding opportunities for M.D.-Ph.D. trainees.

10. What factors should I consider when applying to and selecting an M.D.-Ph.D. program?

Although the overall goals of M.D.-Ph.D. training programs are the same, the training approach and environment vary substantially among programs. Some of these differences, such as geographic region or size of the school, will help guide you in your selection of programs. Other factors -- such as the attitude of faculty and students, or the physical proximity of laboratories and hospitals -- can only be appreciated by visiting an institution.

Because M.D.-Ph.D. programs take 7 to 8 years to complete, it is highly advisable to apply to and interview at multiple institutions. Although there is no magic number, it is not uncommon for students to apply to 10 or more programs.

Choosing a program is a highly individualized process. Suggestions for consideration include:

  • the graduate training disciplines offered and range of faculty interests;
  • the medical school curriculum, including the clinical components and how they are integrated with graduate training;
  • program size;
  • perceived competitiveness of an institution;
  • personal interactions among students and faculty;
  • faculty accessibility;
  • program leadership and administration;
  • success of previous trainees; and
  • geographic location.

11. What if I decide to pursue an M.D.-Ph.D. after starting medical school?

The majority of M.D.-Ph.D. programs will consider applications from internal M.D. students; many will also consider applications from Ph.D. candidates early in training. For an overview, see AAMC's Summary of M.D.-Ph.D. Programs and Policies. However, at most institutions, the number of slots for such students is limited, and these applications may be considered with the full pool of applicants for that year. In most cases, it is advisable to apply for M.D.-Ph.D. training as soon as you're convinced that this is the proper path to pursue.

On the other hand, for most schools participating in the American Medical College Application Service (AMCAS), the M.D. application is completed as part of the M.D.-Ph.D. application. Thus, many schools allow students to indicate whether they wish to be considered for M.D.-only admission if the M.D.-Ph.D. application is not successful. Schools differ greatly in how admissions committees function. In some cases, the M.D.-Ph.D. committee is entirely separate and makes decisions independent of the medical school admissions committee. Thus, a student interested in pursuing an M.D. at a particular institution, regardless of their M.D.-Ph.D. status, is advised to make their wishes clear by following up as the process proceeds.

12. What are the prerequisites for applying to M.D.-Ph.D. programs?

Prerequisites for applying to M.D.-Ph.D. programs, which include the coursework required for medical school admissions, can be accessed at the schools' Web sites or through the Medical School Admission Requirements. Successful medical school and M.D.-Ph.D. applicants pursue undergraduate majors in many fields, not just the sciences.

Although only U.S. citizens and permanent resident applicants are supported by the predoctoral MSTP federal grants, a number of institutions will consider foreign M.D.-Ph.D. applicants. For an overview, see AAMC's Summary of M.D.-Ph.D. Programs and Policies.

Applicants are expected to demonstrate academic excellence in their undergraduate coursework. The median GPA for students entering M.D.-Ph.D. programs in 2008 was 3.7. However, this number varies among institutions, so the range of accepted GPAs is quite broad. Admissions committees consider the undergraduate institution and the difficulty of coursework undertaken in evaluating the GPA. The median combined MCAT score for 2008 entering M.D.-Ph.D. candidates was 34. Again, there is a significant range in scores among institutions.

In general, GPA and MCAT scores must be competitive with those of successful medical school applicants at a given institution. In addition to the MCAT, some institutions and graduate programs require GRE scores for M.D.-Ph.D. applicants.

13. What will M.D.-Ph.D. admissions committees be looking for in my application?

By far the most important factor in selecting M.D.-Ph.D. applicants is evidence of a passion for research. This translates to one or more substantial and significant research experiences in which a student has worked on his or her own project with input into how the work is accomplished. Successful applicants are those who understand and appear capable of meeting the demands and responsibilities of an M.D.-Ph.D. program. Applicants can demonstrate this in different ways, including an honors research thesis, recurring summer experiences, or a full-time research experience after graduation. A significant number of M.D.-Ph.D. applicants have spent one or more years doing postgraduate research to confirm their desire for a career in research.

Similarly, M.D.-Ph.D. applicants are generally expected to have some experience in the clinical realm such as volunteer work, shadowing, or specific training (e.g., EMT). Such experience conveys to the admissions committees knowledge of what it means to provide health care and a true interest in the clinical environment. Other beneficial and well-regarded experiences include leadership activities, teaching, and humanitarian and other community service activities. Such experiences demonstrate a motivation toward helping people and being a leader in a given field.

14. How do I apply?

Nearly all M.D.-Ph.D. programs participate in the AMCAS application process. Students designate themselves as Combined M.D.-Ph.D. Training Applicants and complete two additional essays in the AMCAS form: one related to why they are interested in M.D.-Ph.D. training, and the other highlighting their significant research experiences.

Many schools require individual secondary applications, and all schools require letters of recommendation. Applicants are encouraged to make sure that one or more of these letters comes from a research mentor who can speak to the applicant's abilities and commitment to research. Details about the specific number of required letters, secondary applications, submission of transcripts, and fees will be found on the school's Web site.

15. What is the interview process like?

Programs vary widely in how interviews are conducted. Applicants are advised to check program Web sites for details.

M.D.-Ph.D. admissions committees typically consist of a mix of physician-scientists and basic scientists. Although the degree of involvement varies substantially, the M.D. admissions committee, which typically is comprised of clinical and medical teaching faculty, may also play a major role in the M.D.-Ph.D. admissions process. Thus, candidates will be expected to discuss their research interests as well as convey their clinical experiences.

16. What is the notification process?

As program admissions committees come to decisions, applicants are notified of their status. Applicants are asked to acknowledge acceptances within a defined period of time and are allowed to hold more than one acceptance consistent with AMCAS policies.

Most programs will also place a number of applicants on waitlist status, in anticipation of changes in their roster that occur as students make final decisions and commit to one institution.

Accepted applicants are encouraged to take advantage of "revisit" opportunities and to be punctual in notifying schools of decisions to withdraw.

AAMC Recommendations for Medical School and M.D.-Ph.D. Applicants provides guidance, but communication between accepted students and institutions is also required.

M.D.-Ph.D. training organizes the experimental and clinical thinking of the physician-scientist. This synergy enables a physician-scientist to recognize new ways that clinical care or the understanding of disease mechanisms will benefit from research and to mount the appropriate effort.
10.1126/science.caredit.a0900127