Why do you need an MD and a PhD?

MD/PhD admissions
By Elliot

Statistical Mediation & Moderation in Psychological Research-Jan-28-2021-07-12-21-91-PMApplying to MD-PhD programs is always about striking a balance.  As an aspiring physician-scientist, you are in a unique situation that is necessarily distinct from straight MD and straight PhD applicants.  Being able to tactfully and thoughtfully navigate this balance is fundamental to being a successful MD-PhD applicant, particularly during the interview phase of the application process.

This question is one you will only get if you are applying to MD-PhD programs, but it is one every MD-PhD applicant must be able to answer well in order to gain admission.  As with all interview questions, it is helpful to start by thinking about why the interviewer is asking you this question.  MD-PhD programs are limited in the number of offers they can extend by the funding they receive from the NIH.  Therefore, it is important for them (and their future funding) to ensure that their students fulfill the NIH’s idealized concept of a physician-scientist.  This image is of an individual who will work at the interface of basic science and clinical medicine, in capacities that neither straight MDs nor straight PhDs are able to from their training alone.  Of course, in reality there are many exceptions and examples of successful MD “only” or PhD “only” physician-scientists who are capable of pursuing meaningful careers at the interface of science and medicine, but in answering this question your task is to convince the interviewer that you will absolutely need both the MD and the PhD to be the physician-scientist you hope to become.

MD-PhD programs prioritize this question because many applicants fall into the trap of being too heavy in one direction.  Admissions directors are able to picture them as excellent scientists who ultimately do not have a yearning or need to treat patients, or as master clinicians who would rather practice medicine than spend the majority of their time scrambling for research grants and funding.  This question is your opportunity to shatter this misconception.  While the idealized model of the 80-20 academic physician-scientist has been the archetype for decades, there are increasing examples of MD-PhDs who pursue a diverse set of careers.  Feel free to articulate what this career might look like for you while answering this question; and if what you imagine does not follow the stereotypical 80-20 allocation, you will need to thoroughly explain how your career truly requires both the MD and the PhD.

With this in mind, it is helpful to begin by brainstorming reasons why an MD degree alone or a PhD degree alone will not be enough, and what unique benefits having both an MD and a PhD will have.  Some common responses are that without a PhD, you will not have a foundational grounding in the scientific method, or the first-hand experience of tackling an unknown and difficult scientific question for years on end, or have gained the problem solving and creative thinking abilities needed to become a true scientist.  Or without the MD, you will not have the knowledge of clinical context to inform your scientific pursuits, or the ability to treat patients and therefore witness the limitations of modern medicine requiring scientific inquiry, or the experience of seeing the realities and difficulties of implementing basic science discoveries in clinical care.  Most significantly, having both an MD and PhD puts you in an incredibly unique and privileged position: you will have a lens into the all too often siloed worlds of academic medicine and basic research, you will be able to pursue and implement translational research that directly impacts patients, and you can quickly pivot to new fields of research as the clinical or scientific need or interest arises.  Ultimately, your reasons will have to be personal and tailored to your own experiences and future career aspirations, but hopefully these examples provide a catalyst for your brainstorming. 

Once you have constructed a solid thesis for your need for both an MD and a PhD, your next task is to paint your response using the brush of examples from your own life that illustrate this need.  Note that this is different than simply describing your research projects and tribulations, or recounting a shadowing experience and a patient or physician you met (there will be other opportunities to discuss these during the interview).  The examples and stories you use for this answer must be directly relevant to your central and personalized argument for pursuing both degrees.  What scientific experiences have you had that would have greatly benefited from clinical insight?  What clinical encounters have demonstrated the need for basic research or informed your scientific hypothesis?  As with all interview responses, the more emotional valence in your examples and stories, the more memorable your response will be, and therefore the more memorable of an applicant you will be to the committee – which is necessary when selecting the few MD-PhD acceptances amongst the relatively enormous pool of applicants.  Some strategies to make your responses more memorable are to include specific details, to articulate how the experience made you feel, and to structure your story with a full hero’s journey, from climax to resolution.  

In the end, this question should be even more helpful for you than your interviewer.  Regardless of how the interview goes, this question is an important one to ask yourself before you even decide to apply to MD-PhD programs.  The path of the MD-PhD is longer, more expensive (considering opportunity cost), and often more arduous than other career paths, and ensuring that it really is right for you is to your benefit.  Once you have convinced yourself that you absolutely require both degrees, conveying this to your interviewer should be a piece of cake.

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