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Is an MD/Phd Program Right for Me? Advice on Becoming a Physician–Scientist

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Is an MD/Phd Program Right for Me? Advice on Becoming a Physician–Scientist M BoC | PERSPECTIVE Is an MD/PhD program right for me? Advice on becoming a physician–scientist Lawrence F. Brass* Departments of Medicine and Systems Pharmacology and Translational Therapeutics, University of Pennsylvania, Philadelphia, PA 19104 ABSTRACT We are living in a golden age of biomedical research in which it is increasingly Monitoring Editor feasible to translate fundamental discoveries into new diagnostic and therapeutic approach- David G. Drubin es to human illnesses. Inherited diseases are being cured with gene therapy. Cancer cells are University of California, Berkeley being eliminated with less toxic small molecule inhibitors and reengineered T-cells. Direct connections are being made between the central nervous system and prosthetic devices. Received: Feb 12, 2018 These efforts are being led by scientists and engineers, some of whom are also physicians. Revised: Feb 14, 2018 This article is intended to help anyone considering a career as a physician–scientist, but un- Accepted: Feb 16, 2018 sure about how best to begin. It is also intended for faculty, staff, and parents who are on the front lines of advising talented students about the options that they have for their future. With this in mind, I have tried to answer common questions about MD/PhD programs, but I have also included information about other paths to becoming a physician who does research. INTRODUCTION Because this is a perspectives piece, I will begin it with a confes- that we study in the lab. Some of these patients have medical prob- sion: I have been a physician–scientist for more than 30 years and I lems that are common in the United States. Some of them are true like what I do. I am also a graduate of one of the earliest MD/PhD “zebras,” the kinds of patients who get referred to a well-respected programs and have been director of the University of Pennsylvania’s academic medical center because physicians are unsure how best to MD/PhD program for 20 years. Being a physician who is also a sci- proceed or lack the resources to manage the patient’s problem. entist already makes me atypical. According to the American Medi- I also teach medical students and graduate students, and I direct a cal Association, only 14,000 U.S. physicians (out of nearly 1 million) very large MD/PhD program. In my spare time, I talk to lots of under- consider research to be their major job, and a search of National graduates and recent college graduates who are thinking about be- Institutes of Health (NIH) databases in 2012 turned up only 8200 coming physician–scientists and wondering whether they should be physicians who were principal investigators on NIH research grants applying to MD/PhD programs. I meet them at Penn, but also on (Ginsburg et al., 2014). To put that number in context, there were visits to other colleges and universities. This article is a distillation of 28,000 total investigators with NIH grants in 2012. In other words, some answers to questions that I am commonly asked. If you are an most NIH principal investigators are PhD scientists, not physician– undergraduate trying to decide whether to go to medical school, scientists (MD or MD/PhD). graduate school, or both, this article may help you. Whatever you My primary day (and sometimes night and weekend) job as a decide, I wish you success. card-carrying physician–scientist is overseeing an NIH-funded research team. My clinical responsibilities include taking care of WHAT IS THE PURPOSE OF MD/PHD TRAINING? patients with the kinds of bleeding and blood clotting disorders MD/PhD programs were established in the 1950s to combine train- ing in medicine and research. They were specifically designed for men and women who wanted to become research physicians, also DOI:10.1091/mbc.E17-12-0721 known as physician–investigators or physician–scientists. Most of *Address correspondence to: Lawrence F. Brass ([email protected]). the graduates of MD/PhD programs in the 60-plus years since then Abbreviations used: AAMC, American Association of Medical Colleges; MCAT, Medical College Admissions Test; MSTP, Medical Scientist Training Program. have become faculty members at medical schools and universities, © 2018 Brass. This article is distributed by The American Society for Cell Biology investigators at research institutes such as the NIH, or leaders in in under license from the author(s). Two months after publication it is available to the pharmaceutical and biotech industries (Brass et al., 2010). Re- the public under an Attribution–Noncommercial–Share Alike 3.0 Unported Cre- gardless of where they eventually end up, MD/PhD trainees are be- ative Commons License (http://creativecommons.org/licenses/by-nc-sa/3.0). “ASCB®,” “The American Society for Cell Biology®,” and “Molecular Biology of ing prepared for careers in which they will spend most of their time the Cell®” are registered trademarks of The American Society for Cell Biology. doing research or translating that research into new therapeutic and Volume 29 April 15, 2018 881 diagnostic approaches. It is a busy, challenging, and hugely reward- Despite the high training costs, when I visit other MD/PhD programs ing career. A study of what has happened to MD/PhD program to conduct reviews, it is not uncommon to hear deans refer to their graduates from 24 schools appeared in Academic Medicine in 2010 MD/PhD program as “the jewel in the crown.” One can easily argue and is worth reading not only for the data set, but also for the dis- that the existence of MD/PhD programs is evidence of the high cussion of what the data mean (Brass et al., 2010). An even larger value that our society places on physician–scientists. outcomes study that includes data on over 10,000 MD/PhD pro- gram graduates is scheduled for publication as a AAMC report in ARE MD/PHD PROGRAMS LIMITED TO THOSE April 2018 (Akabas et al., 2018). INTERESTED IN LABORATORY RESEARCH? The answer varies from school to school. Not all schools offer PhD HOW CAN ONE PERSON DO TWO JOBS? programs in all disciplines. The majority of MD/PhD students re- When I was an undergraduate and trying to decide what to do with ceive their PhD in biomedical laboratory disciplines such as cell my life, my mentors told me that I could become a doctor or a sci- biology, biochemistry, genetics, immunology, pharmacology, neuro- entist, but that trying to combine two busy professions was futile. science, and biomedical engineering. The names of departments Many years later, I know that many current undergraduates are be- and graduate programs vary from school to school. At some schools, ing told the same thing. However well-meant, that advice misses the MD/PhD trainees do their graduate work outside of the laboratory point. The goal of MD/PhD program training is not to prepare you disciplines, in fields such as economics, epidemiology, health care for two unrelated full time jobs. Instead, you should think of physi- economics, sociology, medical anthropology, or the history of sci- cian–scientists as chimeras—blends of a physician and a scientist ence. This is not an exhaustive list, and you should check before you with the two parts fitting closely together. A more relevant question apply to see what is actually offered at any particular school. is: if you are going to become a physician–scientist, do you have to Although there is no fully up-to-date and reliable list of which go through an MD/PhD program? I will try to answer that one a bit MD/PhD programs offer training in which graduate disciplines, a later in this article. First, I’ll provide some definitions. place to start is at the Website of the AAMC MD/PhD section (which is a good source for other types of information as well).2 WHAT IS THE DIFFERENCE BETWEEN AN MD/PHD PROGRAM, A COMBINED DEGREE PROGRAM, AND AN ARE THERE OTHER WAYS TO BECOME A MSTP PROGRAM? A BIT OF HISTORY AND A WORD PHYSICIAN–SCIENTIST? ABOUT FUNDING Yes. Definitely. MD/PhD programs are a great choice for people who None. Programs designed to train physician–scientists go by all of decide early that that they want to be physician–scientists and have these names. For the most part, the terms are interchangeable, built the necessary track record of academic success and research although at some schools “combined degree” programs can in- experience before they apply. Not everyone does this, however, clude MD/JD and MD/masters programs as well—also VMD/PhD either because he or she did not learn about the option early programs, which train veterinary physician–scientists. A list of MD/ enough, he or she did not make a decision in time, or he or she does PhD programs can be found at www.aamc.org/students/research/ not have an academic and research experience record that supports mdphd/applying_MD/PhD/61570/mdphd_programs.html. The NIH an application. Not finding out early enough turns out to be a com- uses the term MSTP (short for “medical scientist training pro- mon problem. In my experience, college prehealth advisors know gram”) to refer to programs at schools that have been competi- much less about MD/PhD training than MD training—not surpris- tively awarded special training funds to help support MD/PhD ingly, since only 3% of medical school applicants in the United States candidates. There are currently 46 MD/PhD programs that receive every year apply for MD/PhD training. As a result, some people support from the National Institute of General Medical Studies. choose (or are obliged) to do MD/PhD training in series, rather than A list can be found at www.nigms.nih.gov/Training/InstPredoc/ parallel—finishing one degree and then starting the other.
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