the M.D. or Ph.D.
that you have come so far and been admitted to an
M.D/Ph.D. program, decided on a school, and perhaps
even started classes, it seems that you have reached
the pinnacle of admissions glory. M.D./Ph.D. programs
are among the most competitive and difficult programs
to get into, but what often goes unmentioned is
the dropout rate. Although a fair amount of decision
making went into the M.D/Ph.D. admissions process
on the part of both the committee and applicant,
for reasons both in and out of an individual’s
control, he or she may decide to forgo obtaining
both degrees and opt for one or the other.
rarely is poor academic performance the reason for
dropping out of an M.D./Ph.D. program. The vast
majority of students admitted to these programs
possess the intelligence and skills necessary to
succeed. Occasionally, students experience various
hardships (i.e. personal or family illness, death
of relatives, etc) that dictate they postpone or
drop out of the program (personal factors). These
events are obviously beyond one’s control
and the timeframe cannot necessarily be predicted.
Marriage is another factor that may affect one’s
decision to stay in the program.
there are academic reasons for dropping either the
M.D. or Ph.D. portions of the combined program.
Some students find that after two years of exposure
to the vast amount of medical knowledge and some
brief clinical experience, their career goals lie
not at the bench of a laboratory, but in the arena
of patient care. Most M.D./Ph.D. applicants possess
clear-cut goals and specific scientific interests.
However, over time some students will find that
they are inclined to practice clinical medicine
and wish to avoid spending the extra three or four
years obtaining the Ph.D.
contrast, there are individuals who find that after
completing some preliminary laboratory rotations
and taking medical courses, they do not wish to
practice medicine and want a career solely in research.
These students may drop out of medical school and
opt for graduate training toward the Ph.D.
this latter scenario tends to occur less frequently
than pursuing the M.D.-only. There are several explanations
for this phenomenon. First and foremost, students
who complete the first two years of medical school
have only the two clinical years to go in order
to graduate (time factor). Second, it is possible
to do research with the M.D. but it is not possible
to practice clinical medicine with the Ph.D. Thus,
students who choose to pursue the M.D. can fully
participate in both medicine and research, whereas
Ph.D.’s tend to have sole research careers.
Interestingly, a 1998 NIH review of the Medical
Scientist Training Program suggests that M.D.-only
graduates on average tend to have a tougher time
securing grants and publishing than Ph.D. or M.D./Ph.D.
our knowledge, MSTPs do not require payback of the
stipend for students who drop out. However, certain
non-MSTP M.D./Ph.D. programs may differ in this
respect. You should check with the individual programs
in which you are interested. However, be careful,
as you don’t want to appear uncommitted to
the program during the admissions process. Some
programs may have payback clauses that will make
you financially responsible. A word of advice: programs
do not take this situation lightly. They invest
many thousands of dollars in your training to become
a physician-scientist. Therefore, you should carefully
consider your options before you are locked into
a decision. Don’t forget to look before you
realize that no matter how much you plan, things
may go awry that lead you to make career-altering
decisions. Remember that admissions committees are
highly attuned to sensing lack of commitment. If
you are uncertain as to your goals or whether you
really are interested in both medicine and science,
we recommend that you think long and hard about
applying M.D./Ph.D. We will guarantee that unless
you are a very motivated and committed person, you
will be miserable in an M.D./Ph.D. program and will
risk not completing it. To summarize: Jumping the
admissions hurdle shows that you are capable. It
is up to you to finish the race.