Currently more than 30 medical schools receive
funding and about 75 more
launched MD-PhD programs on their own. All told,
about 2,500 students are enrolled
in such programs. The MSTP was inaugurated by
the National Institute of Health
(NIH) more than 30 years ago and it has supplied
the nation with a significant number
of its physician-scientists. Many program
graduates have succeeded in securing senior
administrative research appointments where they
have gained access to investigative
grants, laboratory staffs, and other benefits
that have furthered their careers. Some have
become Nobel laureates. In spite of the
seven-to-ten-year length of MD-PhD programs,
schools report that the program is as popular
with prospective students as ever.
The changes taking place in the health care
system have raised questions about the
future of the program. This is because research
funds are beginning to dry up due to the
cutback in funding by the government and in
reimbursement by the managed care sys-
tem. With reduced income for academic medical
centers, they have less funds to support
in-house research. There has been criticism by
some that combined MD-PhD programs
are no longer necessary. They argue that these
programs emphasize the basic rather than
clinical disciplines and that the physician can
perform research, as many do, without the
PhD component.
The majority of graduates of combined programs
ultimately end up with academic
careers, being engaged in research, teaching,
and perhaps some limited clinical duties.
These individuals have met the goals of the
original NIH concept. There still is very
strong support for the MD-PhD program within
the academic community as being a
vital approach in generating
physician-scientists.
In reaction to the existing climate, there
appears to be a tendency to readjust the
ratio of activities of MD-PhD candidates, with
increased clinical responsibilities dele-
gated to them. One program mandates a full
month of medical work on the wards before
even entering the lab. Others require a more
equitable sharing of time between clinical
and research work. The combined program
candidates generally respond positively to
this change, even when their research is far
removed from patient care.
One of the negative side effects of increasing
the clinical obligations of combined-
degree candidates at the expense of research is
that it will inevitably slow down lab
work and thus lengthen the PhD phase of the
program. This will further strengthen the
voice of critics who claim that the program
already takes up too much of the candidate's
career development segment.
Besides usually interrupting the candidate's
medical education with a three- to five-
year research interlude, an additional three to
five years of specialty (residency) training
usually takes place after receiving the dual
degrees. This brings the education-training
phase to a minimum of 10 years and maybe more
if a postdoctoral fellowship is elected
(which can in extreme situations almost double
the training time). Critics of the length
of the program suggest that medical students
interested in research have other options,
such as taking a research elective during the
school year, spending a summer or even
taking off an entire year for research, or
doing it on a postdoctorate (MD) level. While
these options are feasible, they can't provide
the solid background and training that is
essential for
physician-scientists.
A second major issue raised by the MD-PhD
program is the disruption caused by
the research phase right in the middle of
medical studies. Students find themselves
removed from their class (and classmates),
where the social environment is support-
ive, and they are transferred into the relative
isolation of the laboratory. Having to
transfer back and forth between two radically
different academic cultures--medical
student, graduate student, then medical student
again--can be destabilizing. The med-
ical training is in the context of a
hierarchical system, while that of graduate research
is basically egalitarian. In response, some
schools are allowing candidates greater
flexibility in planning their program. Thus, in
some cases candidates may start their
research immediately or after one year of
medical school, or complete either one of
the degrees first, or pursue a personalized
schedule. Nevertheless, there are, by the
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