MD/PhD Considerations

The Harvard Premedical Society put on a terrific program last night featuring MD/PhD directors from four different programs: Cornell/Rockefeller/Sloan-Kettering, Washington University at St. Louis, Baylor College of Medicine, and Harvard-MIT. Here are some things that I took away based on the directors' opinions:

Basics

• Types of research possible: (a) basic research, (b) disease-oriented research, (c) patient-oriented research, (d) population-oriented research.
• Keeping in mind the various levels of analysis (e.g. environment, body, molecular, etc.), a successful MD/PhD learns how to sync productively all these levels.
• Two pathways into the MD/PhD: (1) enter MD/PhD program directly from college, or (2) begin an MD program and apply for transfer into the school's MD/PhD program.
• A typical timeline is 2 years of the MD program (basic sciences with some research), then 3-6 years completing the PhD, and finally 1-2 years finishing up the MD (clinical work). (And then there are residency training and fellowships!
  
• MSTP programs are a subset of all MD/PhD programs. MSTP programs receive support from the NIH. They have been evaluated comprehensively on the quality of their training (to determine if it's valuable for the government to invest money in).

MD/PhD vs. MD or PhD

• What makes an MD/PhD different from an MD is an interest in the "why?"
• For the PhD component, find out which programs are good for the discipline you're interested in. This is important!
• Reputation of MD/PhDs: Clinicians say, "They're all basic scientists!" PhDs say, "They're all clinicians!"
• Pluses to the MD/PhD: Broad education and broad perspectives.
• Minuses to the MD/PhD: Long education and training, pressures placed on you by lab, striking clinical balance, and pressures on family.
• As an MD/PhD graduate, no one remembers your thesis research. The benefit of an MD/PhD education comes in the form of training and mentoring.

A Successful MD/PhD Application

• The most important quality of an accomplished research/applicant is being hardworking, not smart.
• MD/PhDs have the qualities of an MD (i.e. those that make a good clinician) plus dedication, talent, and performance in the lab.
• Students serious about the MD/PhD should consider doing summer research beginning the summer after sophomore year.
• Figure out which lab is the best for you. Once you have, be very involved in it over a significant length of time.
• In your application, you need to be able to tell a story about your science research.
• Contrary to popular belief, only about 15% of MD/PhD applicants have publications under their belts when they apply.
• Best advice: Apply early!

You're in, now where do you go?

• Many of the same considerations of MD applicants (e.g. nature of a school's patient population, curricular differences, etc.).
• Some MD/PhD programs require you to have a lab chosen in advance of entering medical school; this varies between programs.
  
• Think about working with a wide range of faculty. If you are set on only one faculty member, what will you do if he/she leaves the school?
• These are many years of your life! Consider proximity to family, location, community, etc.
• With the final decision, trust your gut feeling.

Odds and Ends

• About 25% of MD/PhD graduates spend 75% or more of their time performing research.
• Since international citizens are eligible for institutional funding only, applicants should contact admissions and ask: Do you fund international students? How many matriculate into your program every year?
• 30-50% of MD/PhD students ultimately do their theses on topics different than those they had intended to pursue.
• Does an MD/PhD application hurt an applicant's chances of being admitted to the MD program? No, said the panel. But if an applicant is denied by the MD/PhD program and is really interested in the MD, they should be proactive, writing to MD admissions and asking to be considered.
• If there is a hole in your research (or other) experiences in your application, you need to account for this. For instance, a year of research without a recommendation letter from that lab would raise a flag.

Selecting Medical Schools

US News and World Report?

Joni Krapec, Director of Admissions and Outreach at the University of Chicago Medical School recently spoke to students about how to choose medical schools. I was happy to hear her start the discussion with a critique of the U.S. World and News Report on "Best Medical Schools". So many times students come into our office with a list of the "top ten" medical schools taken from this list. Yet students (and their parents) usually don't consider the relevance of factors used to create this list. For example, research dollars weigh heavily in the US News and World Report ranking of medical schools. But does the fact that one medical school received more NIH dollars than another school last year tell you anything about the strength of the faculty who will be teaching you clinical skills?

Learning About Medical Schools

When you were trying to figure out where to apply to college, you probably had a chance to visit some colleges and listen to admissions presentations before deciding where to submit your application. The process is different for applying to medical school. You won't be offered tours or informational interviews until you are invited for an interview at the medical school. So, in order to make up your list of medical schools, you will want to check medical school websites, seek advice from premedical advisors, review comments from alumni who are now in medical school,(check out our alumni evaluations) and study the AAMC Medical School Admissions Requirement (MSAR) book. Ms. Krapec pointed out that as an admissions director, she is asked to fill out lots of surveys on applicant data. However, she is only required to complete information for the MSAR, which is the official publication of the AAMC. So, if you are using other books on "best medical schools" be aware that the information may be out of date and incomplete!

Jeff and I will be offering a workshop on selecting medical schools March 10th and March 11th, so please feel free to join us at one of these workshops if you are planning to apply to medical school this summer.

Fin Aid for Med School

A couple nights ago, Bob Coughlin, Director of Financial Aid at Harvard Medical School, spoke about the ins and outs of financing a medical education.

He covered a lot of ground, e.g. explaining the differences between subsidized (does not accrue interest while still in school) and unsubsidized loans, how financial aid works for international students, and how family and/or spouse circumstances factor into an aid award.

The following were some of my own take-aways though the talk was certainly more comprehensive:

General info & process

• The median expense estimates for 2008-2009 are $43,360 for a public med school and $62, 243 for a private med school (notice the significant difference).
  
• Generally speaking, the process of applying and submitting paperwork for financial aid happens after being admitted to a medical school.
• Get to know your med school financial aid officer! Med school classes are small so fin aid offices can work more closely with students and their families. If you have unusual circumstances, let the fin aid officer know. There are usually appeals processes.
• There are two types of aid: need-based and merit. Merit aid comes from a med school's institutional funds.
  

Need-based aid

• For federal loans, you would be considered an independent. For institutional funds, you would be considered a dependent and/or your family information is taken into account. This varies school to school but parent information is typically requested even for older students.
• If you are married or will be in the immediate future, a med school will take your spouse's information into account. So they'll look at both your family (i.e. parents) and your spouse.
  
• Med students (U.S citizens/permanent residents) can always get federal loans, e.g. Perkins and Stafford, to cover expenses, regardless of your family situation.
  

Merit aid

• Merit aid is given at the discretion of the medical school and varies considerably from school to school. Such awards are not based on need, i.e. income, assets, etc.
• Admitted students are usually automatically eligible for merit awards so there is no separate process outside of the admissions process.
• It's to your advantage to find outside scholarships. Scholarship money takes away from the need-based aid in a package, meaning that it would typically replace loans (money you would ultimately have to pay back).
  
• Outside scholarships are minimal but can add up. Look to regionally-based scholarships as possible sources.
• Avoid fee-based search services. Instead, use free scholarship search engines (e.g. finaid.org) or simply google search.
  

Aid packages

• The med school aid package looks very different from most college packages: it's common for 3/4 of a med school package to be covered by loans whereas loans for college are usually capped at a much lower amount.
• 87% of 2008 U.S. medical school graduates borrowed money.
• The median public med school debt is $145,000; the median private med school debt is $180,000.
  
• When comparing aid packages from med schools, do not look just at the dollar amounts, i.e. how much grant and how much loan. Scrutinize the details and understand what the debt will look like after medical school and beyond, e.g. subsidized vs. unsubsidized, fixed vs. variable interest rates, etc. Also, consider the cost of living depending on location (e.g. NYC vs. Iowa).
  
• Avoid credit card debt (for med schools reasons but in general too)! Schools cannot factor in this type of debt when putting together your aid package.
• At HMS, all need above $24,500 is covered by scholarship.

International students

• Many medical schools do not consider international students for admission. Those that do may not provide funding (some schools will ask to see up front that you have 4 years of tuition in escrow!). The reason being, international students are not eligible for federal loans so a school would need to use exclusively institutional funds to cover expenses.
• Talk to your home government to ask about possible aid sources.
• The vast majority of med students will not need private loans (vs. institutional or federal loans) though some international students do require these to close the gaps.
  

Odds & ends

• There are few options if any to help students with the costs of flying to medical schools for interviews so it's important for applicants to plan ahead.
  
• However, an AAMC program called FAP (Fee Assistance Program) helps students with need to afford MCAT and AMCAS costs.
• There are several programs that offer medical graduates loan forgiveness in exchange for service, e.g. Public Service Loan Forgiveness and National Health Service Corps.
• Create a budget. Learn more about how you spend your money and where it is going.
• Given the low salaries for medical residents, graduates are not expected to be able to repay loans immediately (meaning loans can be deferred).
• Despite declining salaries, physicians make incomes far above the national average so loans can be repaid!