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September 5, 2005
Volume 83, Number 36
pp. 84-86


M.D.-Ph.D. training can take more than a decade, but it has great rewards for researchers


"I want to stay in school forever" is a common refrain from undergraduates. And it's close to the truth for those who enroll in a combined M.D.-Ph.D. program: four years of graduate school; four years of medical school; and, for most, additional time as a resident, intern, or postdoc.

8336ed4_opencxd PHOTODISC

COMPETITION Medical scientist training programs have seen a rise in the number of applicants.

For those who know they want a career in biomedical research, though, the grind is worth it. M.D.-Ph.D.s, who focus heavily on research, generally accumulate less debt, find academic research positions more easily, and have less difficulty obtaining funding than either M.D.s or Ph.D.s.

The largest portion of M.D.-Ph.D.s are a product of the Medical Scientist Training Program (MSTP). Founded in 1964 by the National Institutes of Health's National Institute of General Medical Sciences (NIGMS), the program provides monetary support for combined M.D.-Ph.D. education.

"The goal of the MSTP program is to produce physician-scientists. It's no more than it sounds," says Bert Shapiro, director of the MSTP program at NIGMS. "Ultimately, the idea is to produce people who can understand medicine and conduct research. The presumption is that they would do both."

The MSTP program was established because of a perceived, and continuing, shortage of researchers trained in medical science. "There appears to be a general consensus that there are not enough physician-scientists," Shapiro says. "This is a 40-year-old program; it's perhaps the oldest training program at NIH."

MSTP students graduate with an average of only $15,000 in debt, because their funding includes tuition assistance for both degrees, a small stipend, and supplemental support, according to the 2005 National Research Council report "Advancing the Nation's Health Needs: NIH Research Training Programs." Debt is a significant obstacle for regular M.D.s pursuing research careers, as they can easily run up debts well over $100,000 in medical school, especially at a private school.

And for MSTP graduates, "demand probably exceeds supply," Shapiro says. "The training is lengthy, but MSTPs have no problem finding jobs in research. With Ph.D.s, it's much more difficult."

MSTP PROGRAMS generally begin with the first two years of medical school, focusing mainly on basic science and anatomy. After completing their Ph.D.s, students then finish the last two years of medical school, which are more patient- and clinic-oriented.

Study areas for the Ph.D. portion of MSTP training vary widely. Though most students pursue basic biomedical science, Shapiro says an increasing number of students are pursuing engineering and quantitative sciences, particularly biomedical engineering. NIH is also emphasizing the broadness of the program, encouraging Ph.D.s in sociology, economics, medical anthropology, psychology, and other underrepresented areas critical to health care. Few students, in general, he says, pursue basic chemistry degrees during MSTP training.

For Martin D. Burke, who just started as an assistant professor of chemistry at the University of Illinois, Urbana-Champaign, however, the subject held a unique appeal and continues to be an underrepresented choice for the Ph.D. portion of MSTP training. During his introductory medical classes in Harvard University's MSTP program, Burke says he received "a broad, sweeping look at how life works at the molecular level."

"This is where, for me, the idea of chemistry became so attractive as a Ph.D.," he says. "As a chemist, you have the ability to make molecules--to manipulate matter at the level where things are really going on. This is highly enabling for a basic scientist."

"As a chemist, you have the ability to make molecules--to manipulate matter at the level where things are really going on. This is highly enabling for a basic scientist."

After completing his Ph.D. work in organic synthesis, Burke began hunting for faculty positions while finishing medical school. Both Burke's decision to skip a medical residency, which is required to see patients or practice clinical medicine, and his faculty position in a basic research department at UIUC are unusual.

"From the last figures we have, about 90% of MSTP graduates do residencies," Shapiro says. "Their most common employment is in medical schools, and their primary appointment is in clinical departments, with a secondary appointment in a basic department."

Burke is happy with his choice. "I was really excited to go. I really felt like I had gotten what I needed from the M.D.-Ph.D. program," he says. "I was itching to take that background and get started. I had been training in school for so long. I was thrilled to get an offer--it was an opportunity to get started right out of school, to build a group and tackle problems.

"I realized that the best way for me to make a broad impact was going to be basic science," he adds. "I really wanted to focus 100% of my energy on research. But that's for me--it's not necessarily the solution for everyone."

There are about 350 MSTP graduates per year, according to "Advancing the Nation's Health Needs," but only about 900 M.D.-Ph.D. students across all years of study are receiving NIH funding at any one time. "About 20% of dollars go through our program," Shapiro says. "Schools make up the rest from multiple sources," including research grants, special school funds, MSTP-specific endowments, money from various academic departments, special scholarships, and dedicated fundraising.

The money is spread across approximately 40 institutions that NIGMS has "reviewed and considers to be excellent programs," Shapiro adds. Regardless of the ultimate sources of funding, all MSTP students generally receive similar levels of support. He also points out that the MSTP program has been growing, with the number of students in the program outpacing increases in NIH funding.

Despite the increasing number of slots and the long training time, admission to MSTP programs is highly competitive. To be a strong candidate, students need to demonstrate both impressive coursework and enthusiasm for basic research.

"The primary difference between an MSTP and an M.D. applicant is the amount of research experience they have," says Brian Sullivan, administrative director for the MSTP at Washington University St. Louis. Its 50 MSTP slots are the largest number awarded by NIH, he says. "But it's not just amount of research; we're looking for individuals who've had truly significant research experiences and who've shown the ability to be independent. They should have a very high potential to be successful biomedical researchers."

He says the average grade point average for a successful Washington University MSTP candidate is around 3.85, with a 35 (out of a possible 45) on the Medical College Admissions Test (MCAT). Publishing a research paper helps a candidate, but it's not required.

"It might be anticipated that these students are really outstanding," Shapiro says. "They're the best med students and the best grad students. Admission is very competitive."

For example, "some institutions, such as Johns Hopkins University, receive more than 500 applications for the 10 or 12 available positions," according to "Advancing the Nation's Health Needs."

"We have seen growth in the number of people applying for the MSTP program--40% in the past five years--and a lot of other programs are seeing the same thing," Sullivan adds. "There's more interest than ever."

MSTP applicants must complete the basic M.D. application process. Though exact requirements vary, medical schools generally require two semesters of physics, biology, calculus, and English at the undergraduate level, along with four semesters of chemistry (a year each of basic and organic chemistry); often, medical schools also insist on additional biochemistry and behavioral or social science classes.

8336ed4_burke.tifcxd COURTESY OF MARTIN BURKE

FORMULA FOR SUCCESS Burke joined the chemistry faculty at the University of Illinois, Urbana-Champaign, after completing an M.D.-Ph.D. at Harvard.

Students must also take the MCAT, a nine-and-a-half-hour test assessing verbal reasoning, writing, and knowledge of the biological and physical sciences. Most MSTP programs have supplemental applications, in addition to the basic forms required for the M.D. program.

School visits are also longer for MSTP applicants--two days, with more demanding interviews and a tour of research facilities. Medical schools will generally reimburse prospective MSTP students for their travel expenses, though, unlike straight M.D. applicants, who can run up huge bills flying to interviews and school visits.

The goal, Sullivan says, is to ensure that applicants will remain focused on research throughout their training. "We're trying to create basic science researchers, training people who will be faculty members at academic medical centers. They would go on to replace faculty leaving medical schools," he says. "We've been pretty successful at that."

Sullivan points out that while M.D.-Ph.D.s tend to get their faculty positions a few years later than M.D.s, on average, they are more competitive for grants, achieving R01 funding--NIH's gold standard for research grants--more quickly, making up for some of the long training time.

LIFE CAN BE tough for such scientists, though, as they balance a number of conflicting time demands. As both physicians and scientists, M.D.-Ph.D.s must juggle two different kinds of work. "There is a lot of pressure on newly minted faculty to see a lot of patients," Sullivan says. "That makes it very hard to compete for grant support, versus someone who's spending 100% of their time in the lab."

Still, Shapiro points out, MSTP funding will continue to hold strong, as the shortage of researchers with good clinical training continues. "There is an increasing awareness that there are not enough clinical researchers," he says, "researchers who speak both languages, who are more aware of taking problems from the bench to the bedside, and who are good collaborators, in both directions."

Chemical & Engineering News
ISSN 0009-2347
Copyright © 2010 American Chemical Society


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