That last question is critical. You have to know what it is you are thinking and if you are even thinking at all. If you embark on the MSTP path without resolving with yourself that therein lies your happiness and destiny, then you might be in for an unsatisfying, confusing, and frustrating time. Throughout your MD/PhD training and beyond, people will ask you why you are doing it. As an aspiring MD/PhD student you will be questioned about your decision, and even discouraged from taking the MSTP route. People will ask why you are going through the rigors of MD/PhD training when MDs can become competent researchers as well. It is indeed true that MDs do become competent biomedical researchers, but having formal basic science research training is invaluable. Technical training will refine and amplify skills, and an MD/PhD degree confers access to productive collaborations, research institutions, and competitive grants which make it easier and more likely for you to be productive in biomedical research. In addition, the 3-5 years spent in a rigorous PhD training program endows students with the skills to design and conduct experiments, generate and interpret data, teach, and present work in publications and at meetings. In essence, the time spent in a PhD program is not wasted and you graduate as a trained scientist. MD/PhDs are strategically positioned at the interface of science and medicine. This allows them to shuttle ideas from the bedside to the lab bench and vice versa. If you're interested in it, go for it and have a great time.

A key factor in evaluating one's suitability for the program is involvement in research. The research experience is an important tool by which the applicant can evaluate their own personal interest in the MSTP; it's obviously a requirement for acceptance into these programs. There is a wide misconception that the yardstick used by MSTP admission committees is the length of time the applicant has spent doing research. The actual measure used by nearly all MSTP committees is the quality of research done by the applicant. They measure your understanding of the research in which you are involved. You have to sit there and talk about your research while answering questions. You are not given a pipette and scored based on pipetting skills. No one is interested in how fast you can run a gel. The one thing that is evaluated is the depth of your understanding of your research and your research interest and passion. Certain things are required to derive satisfaction from your research experience, to convince yourself of your interest in the MSTP, and to impress your evaluators. Contrary to popular belief, these things do not include 3-4 years of research experience. What you need is to read and understand most of the recently published papers in your lab, and several related papers from other labs. You need a mentor who is supportive, friendly, and willing to spend time with you explaining what it is that he/she does. Such a mentor might be willing to let you have your own project and steer you in the right direction; and maybe even pay for you to fly out with him/her to conferences. You need to be surrounded by graduate students who are friendly, tolerant of your presence and patient with your multiple, never-ending questions. In addition, you need to be in a lab whose work you find very interesting. To accomplish all these, I estimate that you need to be in the lab for at least 9 months. If you have been in the lab for 3 years, that's great so long as you can show the understanding and perhaps even publications to back it up. Problems might arise if you say you have 3 or 4 years research experience and your only souvenir is that you are now the 2 time heavy weight world champion in pipetting.

In my favorite lab at the University of Alabama, we studied the regulation of GABA transporters using frog eggs (xenopus laevis oocytes) as expression vectors. We used electrophysiological membrane clamp techniques and classic biochemical techniques such as the western blot, polymerase chain reaction, and radio-labeled assay experiments. I had an amazing time and everyone was very willing to show me what was going on. I also got to go to San Diego for a neuroscience meeting. It was awesome.

For prospective MD/PhD students, the decision about where to matriculate bears a lot of weight. As an MD/PhD student, you'll be in town for at least 6-8 years. That's a long time to be in one place. So you want to carefully consider your options. Factors that should influence your decision might include proximity from home. It would be nice to be able to drive home on some weekends and on breaks. You might be in love with a certain person, food, music, culture, or community, and hence be inclined to matriculate within certain regions of the country. Finances are also a significant consideration. Cost of living varies widely across the country as does MSTP stipend packages. It can be the difference between sharing a one bed room apartment with 3 roommates and living comfortably in your own newly purchased 4 bedroom house for the same price. You also want to consider the faculty at the institution. Their research strength; their productivity, friendliness, and willingness spend time with students are very important. In particular, you want to go to a school that is strong in the areas of research you might be interested in for your PhD work. Schools do not require that you know what you will do your PhD in at the time of matriculation. In fact, at the time of matriculation, most MD/PhD students are not exactly sure where or with whom they'll be working in the PhD years. Finally, you should also consider the overall academic reputation of the institutions on your list. Several things correlate positively with institutional reputation. Amongst these might include funding, strength of research, caliber of faculty and students, facilities, exposure, and productivity. These are good things to have around especially for a fledgling MD/PhD matriculant who might not know exactly what it is he/she will end up studying. At a reputable school, a solid program probably exists in whatever it is that might catch your interest along the way. With that said, it is important to note that the strength of individual departments does not necessarily reflect the overall strength or reputation of the institution. Conversely, powerhouse departments exist at several universities whose overall reputation might be considered as being a notch or two below the premier universities. In addition, no one school has ongoing research in all areas of biomedical science. Therefore it is unwise to blindly jump into the most reputable school to which you are admitted.

So you apply to MSTPs, matriculate at one of them and then graduate in 6-8 years, then what? There is really no such thing as a typical MD/PhD. MD/PhDs can be found in any area of biomedical research and medical practice. Common routes after graduation in order of frequency include residency programs, postdoctoral fellowships, and industry. Different combinations of all three over time are also not uncommon. The residency programs that are most often chosen by MD/PhD graduates include internal medicine and pathology. Almost 100% of residents at some premier neurosurgery programs are MD/PhDs. This is probably due to the fact that these programs are focused on research since much remains to be learned about the brain; and people with scientific research training might be of help in uncovering some of these mysteries. There is also huge variability in how physician scientists divide up their time. Some do research exclusively and have no patient contact. Some might do exclusively clinical practice with no research. The majority do both things in some capacity. The aim of the MSTP is to bridge the gap between science and medicine so in my opinion, the ideal would be to combine both clinical practice and research in whatever proportion one finds personally suitable.
--Stephen Odaibo

Pros

On May 10th, 2002, I began to clean out my desk at the National Center for Physical Acoustics, where I had been working under Dr. Robert Hiller for two years studying a light emitting acoustical phenomenon, sonoluminesence. Dr. Hiller was darting around the lab while I copied my files from the computer. "You did some good work while you were here. I hate that you're leaving," he said. He gazed at the apparatus that we worked on together: a collage of tangled wires, spherical flasks, piezoelectric materials, bandpasses, amplifiers, laser traps, and duct tape. The room was dimly lit and from the center of one of the spherical flasks a hazy blue glow could be seen emanating into the periphery. He shut down the experiment, flipping around a dozen single throw switches towards the floor. Each switch extinguished a corresponding component, and as he progressed, the flask was less alive. The last switch was more obstinate than the rest, dislodging itself from its recessed housing under the force of his thumb. The lever from the switch flew over the card table and spun in periodic precession until it landed around five feet away in Dr. Hiller's coffee mug. I blushed, I had built that part; it was fitting that it broke the day I was leaving. It was no matter to Hiller. He scratched the surface of the components affectionately. "You built most of these, didn't you?"

I laughed. "Pretty obvious, isn't it?"

"I don't think I've ever had anyone break more stuff. But that's the nature of it, isn't it? Get the engraver and put your name in the corners of each of them. These are yours, your work, your contributions to the world."

In regards to science, I am a romantic. I guess I had to be to break so many things and not get discouraged. I never did though. I worked at NCPA for two years building an experiment that I never used to collect data. It took two years just to build it. Now that I'm leaving, someone else will come in and take over the experiment, probably use it to publish a paper, but that doesn't bother me at all. Looking back on that, I realized that to enjoy research, the process must be its own reward. Not to say that the work wasn't frustrating, at times it was. But any aggravation dissolved in those few moments when I realized that we were working to discover something that no one else knew.

I began to consider the MSTP fifteen months previous to graduating, during the middle of my junior year at the University of Mississippi. Being a physician appealed to me, but I was reluctant to give up bench work. The MST program appeared to be a great way to achieve a research focus as a physician. The funding from the National Institute of Health was generous, allowing students to be engaged in a program that would last as long as the average MD/PhD program (7-8 years) without becoming burdened with debt. This program, of course, had a large time commitment, one that I did not take lightly.

I had several friends vilify me when they found out how long the program was. "You're a sadist," they said. For the most part, these are the same friends that are already planning their retirement, which is telling. I can't imagine retiring. In fifty years, I hope to be the senile professor that the university slowly transitions into emeritus faculty because he won't leave. It will be hard to get rid of me. They'll have to pry the test tubes from my dead hands.

One of the investigators said something at an MSTP dinner when I first arrived at Duke that I thought was insightful. I think it is some of the best advice I have heard for someone considering entering an MD/PhD program. Those who are suited for this vocation will understand what he means. When speaking of a career in research and academic medicine, he said, "It has to be something that you enjoy, something so much a part of you that you don't think that you are fully yourself unless you are doing it." --Mike Angelo

Cons

When I was applying to medical school, I seriously considered pursuing an MD/PhD dual degree. I had majored in chemistry, and had worked during my undergraduate years in a basic science laboratory. Research appealed to me; I enjoyed the idea of focusing my effort on one particular field of science and studying problems for which there currently were no solutions. In fact, I did think briefly about getting just the PhD degree. However, my experience volunteering in the local VA had shown me the rewards of interacting with patients in a hospital setting.

The MD/PhD degree seemed an ideal way for me to integrate several interests: research, patient care, and teaching. My only initial reservation was the time it would take to earn both degrees. Medical school alone lasts four years, and earning a basic science PhD takes on average four to five years. If I factored in at least three years for residency, and another three for fellowship, I figured that by the time I finished with my formal education, I would be in my mid- to late-thirties. Even though I wasn't totally committed to the dual degree plan, I decided to go ahead and apply to several MSTP programs to keep my options open.

At most medical schools, getting an interview through the MST program automatically qualifies you for a medical school interview. Being accepted by the MD/PhD committee usually grants you acceptance into the MD program as well. Schools have a certain number of funded positions for the MSTP program, and dual-degree applicants compete with each other, not with regular MD applicants, for medical school admission. And if you happen to be rejected by the MD/PhD program, you can still be independently considered as an MD applicant. However, this isn't the case at all schools. At some institutions, applicants for the MD/PhD program are grouped into a separate category from MD applicants. Perhaps this is a way for schools to weed out MD/PhD applicants who aren't truly committed to pursuing the dual degree. If you are rejected from the MD/PhD program, you are rejected from the school, since you aren't considered an applicant in the MD-only category.

During my interviews, I talked to several MD/PhD students and professors with dual degrees. I tried to get an impression of what the students experienced, and what they generally ended up doing after graduation. I discovered that I had been rather na??ve about the career track. Most of the professors I talked to primarily spent their time in their laboratories. A few were able to set aside half a day a week to work in clinic. Those who chose to focus their careers on clinical medicine generally ended up doing clinical research or no research at all.

I started to think about what I really wanted in my future career. I enjoyed working in a lab, but I wasn't sure if I had the passion to pursue it full time. I figured that if I really wanted to devote myself to basic science research, I might be better off just doing the PhD. Ten years seemed like an awfully long time to spend in medical school and residency and then see patients for only half a day a week, although I didn't want to give up the idea of doing research.

When March rolled around, I had been accepted to a couple of MD programs and a couple of MSTP programs. At that point, I chose to take the MD path. However, I was able to spend my third year of medical school at Duke pursuing my interest in basic science research, and I still believe that research will be part of my future career.