The Guide

About the authors

This guide book was originally written by Jeremy Cholfin when he was a MSTP student at UCSF, with contributions from classmates Miles Berger and Hosein Kouros-Mehr. This guide has been periodically updated by Prabhajot Dhadialla (TriI) and Branden Tarlow (OHSU).

MD PhD Guide: On The Road to Medical Science

Dropping the M.D. or Ph.D.

Now that you have come so far and been admitted to an M.D/Ph.D. program, decided on a school, and perhaps even started classes, it seems that you have reached the pinnacle of admissions glory. M.D./Ph.D. programs are among the most competitive and difficult programs to get into, but what often goes unmentioned is the dropout rate. Although a fair amount of decision making went into the M.D/Ph.D. admissions process on the part of both the committee and applicant, for reasons both in and out of an individual’s control, he or she may decide to forgo obtaining both degrees and opt for one or the other.

Factors

Extremely rarely is poor academic performance the reason for dropping out of an M.D./Ph.D. program. The vast majority of students admitted to these programs possess the intelligence and skills necessary to succeed. Occasionally, students experience various hardships (i.e. personal or family illness, death of relatives, etc) that dictate they postpone or drop out of the program (personal factors). These events are obviously beyond one’s control and the timeframe cannot necessarily be predicted. Marriage is another factor that may affect one’s decision to stay in the program.

Alternatively, there are academic reasons for dropping either the M.D. or Ph.D. portions of the combined program. Some students find that after two years of exposure to the vast amount of medical knowledge and some brief clinical experience, their career goals lie not at the bench of a laboratory, but in the arena of patient care. Most M.D./Ph.D. applicants possess clear-cut goals and specific scientific interests. However, over time some students will find that they are inclined to practice clinical medicine and wish to avoid spending the extra three or four years obtaining the Ph.D.

By contrast, there are individuals who find that after completing some preliminary laboratory rotations and taking medical courses, they do not wish to practice medicine and want a career solely in research. These students may drop out of medical school and opt for graduate training toward the Ph.D.

However, this latter scenario tends to occur less frequently than pursuing the M.D.-only. There are several explanations for this phenomenon. First and foremost, students who complete the first two years of medical school have only the two clinical years to go in order to graduate (time factor). Second, it is possible to do research with the M.D. but it is not possible to practice clinical medicine with the Ph.D. Thus, students who choose to pursue the M.D. can fully participate in both medicine and research, whereas Ph.D.’s tend to have sole research careers. Interestingly, a 1998 NIH review of the Medical Scientist Training Program suggests that M.D.-only graduates on average tend to have a tougher time securing grants and publishing than Ph.D. or M.D./Ph.D. graduates (http://www.nigms.nih.gov/news/reports/mstpstudy/mstp-print.html).

Payback

To our knowledge, MSTPs do not require payback of the stipend for students who drop out. However, certain non-MSTP M.D./Ph.D. programs may differ in this respect. You should check with the individual programs in which you are interested. However, be careful, as you don’t want to appear uncommitted to the program during the admissions process. Some programs may have payback clauses that will make you financially responsible. A word of advice: programs do not take this situation lightly. They invest many thousands of dollars in your training to become a physician-scientist. Therefore, you should carefully consider your options before you are locked into a decision. Don’t forget to look before you leap.

Exercise Caution!

We realize that no matter how much you plan, things may go awry that lead you to make career-altering decisions. Remember that admissions committees are highly attuned to sensing lack of commitment. If you are uncertain as to your goals or whether you really are interested in both medicine and science, we recommend that you think long and hard about applying M.D./Ph.D. We will guarantee that unless you are a very motivated and committed person, you will be miserable in an M.D./Ph.D. program and will risk not completing it. To summarize: Jumping the admissions hurdle shows that you are capable. It is up to you to finish the race.