Frequently Asked Questions
About the MD/PhD Program

Edward Inscho, PhD, e-mail:  einscho@mcg.edu
Director, Georgia University System MD/PhD Program

This document is meant to serve as a helpful guide to questions that many students have had about the MD/PhD program at the Medical College of Georgia and MD/PhD programs in general. Some of the statements herein represent the opinion of this program director and are not to be misconstrued as the policy of either the Georgia University System or the Medical College of Georgia.

What is the best undergraduate preparation for an MD/PhD program?
There is no one right preparation for MD/PhD. MD/PhD students have been successful with undergraduate majors spanning from English to Physics. However, several things are important. First, the student must have a solid background in science. Much of this is ensured by fulfillment of the requirements for medical school application. Second, and most importantly, students need to demonstrate aptitude and interest in research. This is generally demonstrated through active participation in research activities. Students should seek out positions in research laboratories starting as early as their summer after freshman year. In the present competitive atmosphere for MD/PhD positions, research experience and the resulting letters of recommendation are an absolute requirement for admission. Only a rare student will be admitted to any program without prior research experience.

We do not have any "cut-offs" for either GPA or MCAT scores. Nevertheless, experience shows that students with GPAs below 3.3 and MCATs lower than 28 combined will have only limited success. In addition, it should be noted that high GPAs are not always indicative of success in competing for MD/PhD positions. The committee considers the whole application including research experience, letters of recommendation, the student essay and the results from two interviews with members of the MD/PhD Admissions Committee. Interviews are conducted at the same time as interviews for regular medical school admissions.

What is the structure of the MD/PhD program?
The program at the Medical College of Georgia and Georgia University System MD/PhD program follows the general pattern applicable to most MD/PhD programs. The first two years are involved in pre-clinical medical school courses. Many of these courses also count toward graduate credit for the PhD degree. In the summer after the first year, students perform a research rotation under an MD/PhD program research mentor. Research can be undertaken in any eligible graduate lab at the Medical College of Georgia, University of Georgia (Athens), Georgia Institute of Technology or Georgia State University. Research rotation opportunities are also available in the summer before the first year, but we generally do encourage students to take the summer off before beginning medical school. Following completion of the Part I Medical Boards in the summer after the second year, students begin their graduate school years full-time. For those who have not found a laboratory mentor, this second summer is devoted to a second laboratory rotation. In general, the graduate years last for 3-4 years and usually the PhD dissertation is defended before the student returns to the wards for clinical clerkships. The clinical clerkships require 1.5 years and are completed along the usual lines for third and fourth year medical students.

What if I do not have research experience, but still want to get into an MD/PhD program?
For those who do not have research experiences at the time of application to medical school, but who think that they might want to pursue research careers, admission to a program following matriculation to medical school is a distinct possibility. Most programs will admit students from their first and second year classes. Thus, students without research experience should apply to schools with MD/PhD programs. Then, they should seek out research opportunities at their chosen institution in the summer before their freshman year and/or in the summer before their sophomore year in medical school. These research rotations could then provide the basis for application to the MD/PhD program at their institution.

What are the advantages/disadvantages of the MD/PhD program versus research post-doctoral fellowships after medical school and residency?
This is probably the most commonly asked question from students considering research or academic medicine careers. The answers are fraught with opinion and rhetoric. Nevertheless, the comparison can be simplified into a comparison of two different training environments. The MD/PhD programs attempts to provide a relatively efficient scenario for training of students with broad expertise in both medicine and basic sciences. The PhD degree provides a complete training in research through both course work and thesis activities. Thus, in general, dual degree recipients tend to have a broader scientific knowledge base. The PhD degree for these students is a training degree, just as the MD degree is, and prepares them for advanced training. In addition, the dual degree is often seen as attractive by residency programs looking for mature housestaff with investigative interests. This has been especially true in Neurology, Psychiatry, Surgery, Therapeutic Radiology and Internal Medicine subspecialties. Furthermore, since the majority of residency and fellowship programs have substantial research components (e.g. 1-2 years in general surgery), MD/PhD students have an opportunity to use this time to complete further training that launch their faculty research careers. It is during these residency/fellowship research years that most MD/PhD's can find the completely protected time to develop research initiatives that can be carried into faculty positions. Increasingly, this type of transition has become a requirement for a smooth transition in academic medicine.

All this being said, there are significant stated benefits to the post-doctoral fellowship tract. The most common stated benefit is that research training is initiated at a point when the trainee has largely determined their area of interest. This certainly is an advantage for some, especially for those who do not have the clear commitment to research during medical school. On the other hand, the two year duration of most post-doctoral fellowships (e.g. NIH NRSA fellowships) means that the fellow must remain incredibly focused to assure productivity. In addition, there is further pressure since the fellowship will be the only formal research training before faculty status. Now it must be noted that many fine academic physicians have been "bred" through the postdoctoral fellowship route, so there is no doubt that success is possible. Nevertheless, the many of those who have been successful in the past, often will state that they would have gone the MD/PhD route if they had it to do over again.

The major point of evaluation for these two pathways is to look at success rates for dual MD/PhD programs and NIH NRSA Postdoctoral fellowships in creating academic physicians. A recent review from NIH looked at dual degree program graduates from 1975 to 1990. The statistics show that an amazing 85% of graduates are still practicing in an academic setting. In contrast, NIH Postdoctoral Fellowships have had a much poorer track record with most programs showing only a 15-20% success rate of physicians maintaining academic medical careers. Several reasons have been stated to explain this difference. First of all, dual degree candidates may be more motivated at baseline, since they decide early in their training to pursue an academic career. Therefore, the results may represent self-selection. Second, some have stated that, in subspecialty fields such as gastroenterology, the lure of financial reward in private practice has eroded the impetus to carry on academic careers. Third, others have cited the different investment of mentors in graduate student and postdoctoral fellow success. Thus, since the success of a graduate student requires a thesis defense, the advisor is tightly and publicly committed to the success of that student. In contrast, the postdoctoral fellow is more invisible, and while a lack of success by fellows may be recognized by NIH review sections, it will seldom be registered by an academic faculty. Finally, still others have felt that the 2 year postdoctoral fellowship, in many cases, is not sufficient scientific training for the high level of competition for research funding. In this manner, advanced research training is seen as much a requirement for a successful academic career as specialty clinical training is for patient care.

Do I need to do my PhD in the area I will be doing my residency?
The answer is simply, NO. The goal of the MD/PhD student should be to get a thorough, high quality research training experience. In present day research, techniques and approaches now cross fields and disciplines. A student with outstanding research productivity from a PhD program will always have an advantage in any residency program competition. The most important thing to remember is that the majority of medical students do change their minds about their chosen fields, and MD/PhD students are no different. Since your final pathway for research may be several years removed from the end of the PhD training, outstanding scientific training will prepare you for adoption of new directions and new techniques that await you at the end of clinical training. Once again, since residencies usually contain research components, this time can be used to focus on directed research pathways that will meld with your clinical research pathways.

If I decide against residency training, have I wasted my time?
Most dual degree graduates do go on to residency training, and feel that this intensive clinical training solidifies their medical knowledge and provides fertile influences on their research careers. Nevertheless, many graduates do choose to forego residency training in lieu of strictly research postdoctoral fellowships. In general, these graduates also feel that their MD training has been important, if only because it gave them a broader background in pathophysiology, pharmacology and physiology than they would have expected from a straight PhD graduate program.

Can you do both research and medicine well?
Never listen to anyone who tells you that you CAN'T do something. They are clearly talking about themselves. Indeed, you CAN do anything you want to if you have the determination and talent. You are in charge of your own life, and a major advantage of the MD/PhD program is that it provides complete training in both science and medicine. This gives the graduate extensive flexibility to arrange his/her life as seen fit. How one chooses an admixture of research and clinical medicine is up to the individual. There is no perfect or correct pathway, and the format that you choose will depend on how you structure your own life.

Do MD/PhD's make good physicians?
A brief perusal of the top residency training programs around the country will demonstrate the large number of clinically excellent MD/PhD physicians. MD/PhD student success in obtaining residency positions also testifies to the inaccuracy of this statement. MD/PhD students returning to the wards often stand out because of their increased maturity and organization. The process of the PhD degree requires that a student learn to justify their thought process at every turn. More importantly, the thought process behind hypothesis-driven science, which is at the heart of research training, is identical to that for differential diagnosis as a physician. This means that MD/PhD students have a significant advantage in the intellectual skills required of excellent physicians.

Do MD/PhD's do good research?
Figures from NIH indicate that MD/PhD graduates from dual degree programs are marginally more successful at obtaining funding. As time goes by and competition becomes stiffer, this advantage may increase, but time will tell. In any case, it is clear that MD/PhD graduates perform research at as high a level as their PhD counterparts.

Do you get a real PhD when you are an MD/PhD student?
Absolutely. At the Medical College of Georgia, and at most MD/PhD programs, students must complete all of the requirements of a regular PhD candidate including written and oral comprehensive qualifying exams and completion and defense of a PhD dissertation. In addition, the belief that the "time" for degree is shortened is also fallacious. Many of the first and second year medical school courses, including biochemistry, cell biology, physiology, neurosciences, pharmacology and microbiology also count for graduate credit. Thus, MD/PhD students actually complete far more credit hours of advanced coursework than the average graduate students. In addition, the students usually perform  3 to 4 years of research in a 7 to 8 year program. This is the same amount of time that is recommended in most PhD programs. Thus, the MD/PhD spends 4.5 to 5.5 years in PhD-associated work. Perhaps a counter question should be leveled as to why a PhD degree takes over 5 years in many programs.