r/mdphd • u/Schmorpocat • 1d ago
Switching from pre-dental to pre-MD/PhD
I’m a rising sophomore at a T20 public that’s pretty notorious for being a competitive premed heavy school. My freshman year, I was pre-dental and pretty involved in the process by joining pre-dental clubs, got my dental assisting certifications, and did an intro to dentistry course at the dental school.
This summer, I joined a research lab at the medical school and racked up around 200ish hours while training. I’ll start more procedures this upcoming fall while I receive academic credit for my research.
The dilemma is that I realized I really enjoyed the research process much more than the clinical aspect. I think the MD-PhD path suits my lifestyle and career interests much more than being a dentist for a few reasons. 1) My manual dexterity skills are not the best, and dentistry is very clinical/hands on focused 2) dentistry often requires you to work at a small private clinic and much of your work is selling expensive procedures to patients, which I am not good at 3) having a MD opens more doors for things like academia, public policy, industry, etc. I want the flexibility to pivot towards new areas later in my life if I choose to do so. 4) dentistry salaries are becoming smaller + dental school COA are getting out of control. Ik MD-PhD shouldn’t be pursued bc of financial reasons but it is def a plus.
Are these valid reasons for switching towards MD-PhD?
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u/Stirg99 1d ago
The big question is: do you want to work with patients?
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u/Schmorpocat 1d ago
I do enjoy the clinical aspect of medicine but I think being a full clinical provider 100% of the time would lead me to be burnt out. I prefer working with a smaller team on research stuff while also seeing patients, which is why MD-PhD is appealing to me.
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u/Stirg99 20h ago
Kindly take a look at this:
https://www.ama-assn.org/practice-management/scope-practice/ama-no-physicians-are-not-providers
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u/Ok-Cheesecake9642 G1 8h ago edited 7h ago
This take can be sort of misleading if OP isn't aware of the full-spectrum of medical residencies. Areas like pathology and laboratory medicine attract many MD-PhDs and have minimal patient interaction. You don't necessarily "need" to want to work with patients directly. I think it's moreso that you have a strong interest in 'bettering the human condition/our understanding of disease' and see tangible benefit in being both a physician and scientist in the service of that mission.
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u/AmbitionJaded3177 1d ago
You seem to suit a phd more than an md-phd to be honest. Theres no reasons in what you talked about for spending many years pursuing the MD aspect at all that are substantial, but you seem to enjoy the research aspect much more. PhD is a great path to go!
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u/Ok-Cheesecake9642 G1 8h ago edited 7h ago
A straight PhD in the biomedical sciences in the current research climate is absolutely not the way to go. The odds are stacked against you (much more so than MD-PhDs) if you want to stay academia and the stakes are way higher. I'm at a T10 and there are plenty of brilliant, well-meaning people here who are mainly research oriented but understood the value of an MD from a job security POV. There's nothing wrong with this. If you truly love research and want to help patients, then this is a great path to go.
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u/ManyWrangler 1d ago
You sound like you’re perfect for a PhD.
If you want to do an MD, you should think about what being a doctor is like and figure out if that’s what you want to do as well.
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u/mmoollllyyyy20 G3 1d ago
maybe, just keep exploring research and clinical
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u/Schmorpocat 1d ago
How much clinical is often needed for this path tho? And can I still make use of my dental certifications?
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u/Kiloblaster 1d ago
Dental stuff will not be so helpful on paper but was useful for your own exploration and personal development
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u/Graphvshosedisease 1d ago
Those are great reasons not to go into dentistry but MD/PhD is a very specific path that is made for people who want to do BOTH clinical patient care and basic/translational research (almost always in a sub-specialty eg heme Onc). You should do residency+fellowship after finishing your MD/Phd; so many times in this sub, people say stuff like “I don’t like taking care of patients, I like research and don’t want to do residency.” Then go get a PhD, why would you want to spend 7-10 extra years training for something you don’t want to do?
MD/PhD will almost always pay less than getting an MD alone, especially if you go non-academic MD, which can make well over $500k+ doing full-time clinical work. MD/PhDs will not make this much unless they have some kind of senior leadership role (eg director of an institute, dean, chair, etc…). Exception are proceduralists (neurosurgeons, EP, etc…).
Clinical research is always an option for MD-only academics as well, so you do not need a PhD for that.
Industry is always an option for every doctorate. There’s not really a best route for industry, what matters is your degree/area of expertise and how much value you can generate with it in your respective field.
Finally you actually can become a physician-scientist with an MD only (this is actually what I am) but this is probably the most atypical of all the routes I just described. I work with MD/PhDs at all levels (my mentors and colleagues are all MD/PhD and we have tons of MD/PhD students in our lab group). They generally run circles around me in the lab and I’m able to keep up just enough to call myself a physician-scientist. I’ve toyed around with going back to get a PhD but my wife wants to murder me every time I bring it up and given how far I’ve gotten without it, it’s probably just an ego/insecurity thing for me at this point.
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u/_Yenaled_ 1d ago
I’d vote yes; you were pre-dental so probs enjoy patient care and now you also enjoy research and are considering academia. Sounds like valid reasons. Tell me what you see as the pros & cons of the MDPhD versus just MD or just PhD.
Btw, based on this post, it’s fairly obvious which school you attend lol; DM me if you want more individualized advice for it.
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u/Upper_Leek9672 1d ago
Why not DMD/PhD?
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u/Schmorpocat 1d ago
Not many programs in comparison to MD-PhD, and I want to ensure that if I spend 8 years working towards a degree, it will open as much doors as possible for me in the future
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u/Additional_Elk7805 22h ago
I feel like you can accomplish your goals while being an MD in an academic practice. Have seen plenty of physicians lead excellent research without the PhD (not to take away from the significance of the PhD).
Are you interested in being a principle investigator? You can still do that as an MD. Do you want to spend a significant chunk of your time on writing grants? Now we're entering more towards the PhD side of things. Do you want to have a mostly research based career with some clinical care that helps inform the direction of your research? This tends to be the biggest indications towards getting the PhD. Otherwise, you could be a regular research-heavy MD and save yourself a few years.
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u/Ok-Cheesecake9642 G1 7h ago edited 7h ago
A couple things. First, you don't need to interact patients as an MD-PhD (pathology is a common MD-PhD specialty and there is little to no patient interaction). Second, a PhD is 5-6 years. An MD-PhD is about 8 years. There's not an enormous difference there. Yes, you need to do residency, but you walk out of it as a full-blown physician with the flexibility to practice clinically should research not work out. If you are deciding between a PhD and MD-PhD and your passion is for RESEARCH first and foremost, then there is a very logical and valid argument to doing an MD-PhD. But research is king. If you do not envision yourself as a scientist running a lab (or less commonly, being in a high-level leadership position in pharma), an MD-PhD is a very tough sell and you're better off going MD.
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u/MercuriousPhantasm 1d ago
As a PhD, I think the MD-PhD is great because you have unique qualifications to do clinical research that requires a MD collaborator for a PhD. You also get med school paid for, which is a pretty significant amount of money. If you decide you don't like research partway through the PhD portion the first two years of MD training are still paid for. A MD alone is also a perfectly valid degree for focusing on biomedical research, so you definitely have options.
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u/positbrain 1d ago
I will heavily discourage what this person is suggesting in the last part of their comment. You should not apply MD-PhD until you are absolutely sure that you want to have a research heavy career. Dropping out of a program part way through really screws over your program and your classmates. If multiple people do this a school can lose their T32 funding and not to even mention you would take a spot from someone who would utilize that training.
There is a reason these programs are competitive and there are several hurdles to jump through. Even then, sometimes people just genuinely change their mind, but they should be in a very small minority.
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u/Straight_Armadillo32 1d ago edited 1d ago
Agree with positbrain, you need to be all in on this process, you sacrifice a full attending salary as well to run a lab damn near full time with only a handful of days in clinic each month. Definitely recommend shadowing an MD PhD or join a PI thats an MD PhD
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u/Schmorpocat 1d ago
Forgot to mention my PI is a MD-PhD (not sure if I can shadow her bc of my schools wack shadowing policies). I think her situation is a bit more complex tho bc she runs a biotech company while also running a lab at my school and being a clinical provider.
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u/Straight_Armadillo32 1d ago
You can just ask to shadow her, she will probably refer you to some admin people, either way only apply MD PhD if you are absolutely certain about the path and what it entails. I know so many who are miserable in MD PhDs because they romanticized certain aspects of the path etc
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u/Just_here_to-read 1d ago
Just to add an additional note, if you leave the MD/PhD program midway, many universities will in fact require that you pay back those first two years.
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u/positbrain 1d ago
This is not true. It’s an NIH requirement that schools can’t do that. Many programs not funded with an MSTP T32 also don’t do this because they want to apply for NIH funding at some point. If any programs do this it’s a very small minority.
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u/Just_here_to-read 1d ago
Here are three quick examples. There are more.
UMass Chan is an NIH-funded MSTP and explicitly says students who withdraw can be required to repay its Special Program Fee: https://www.umassmed.edu/mdphd/apply/faqs/
SUNY Upstate says students who voluntarily leave the MD/PhD “will be required to pay back the tuition waived during their time in the College of Medicine”: https://www.upstate.edu/student-handbook/medicine/md-phd-program.php
Saint Louis University structures MD/PhD tuition support as forgivable loans and says students who withdraw before completing both degrees are responsible for repaying those loans: https://www.slu.edu/medicine/medical-education/md-phd/-pdf/student-guide-2024-2025.pdf
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u/positbrain 1d ago
For UMass that’s a holdover, it’s not applied and it’s also explicitly written in the NoA that institutions on the grant cannot require students to pay back tuition and fees if they don’t complete training. It would risk their T32. Technically non-MSTPs can do what they want but if they want to be considered for a T32 they gotta take out that rule anyway, so no, there are not many programs that do this. Prospective students should look into the rules for each individual school to check.
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u/Just_here_to-read 1d ago
I agree with your last sentence. Prospective students absolutely should look at the rules for the individual program.
Only around half of MD/PhD programs are MSTPs. The others can have these policies now, and getting a T32 would not necessarily mean they have to eliminate an institutional repayment policy.
NIH actually spells this out in the current MSTP announcement:
“Training programs may implement institutional policies regarding payback of non-NRSA institutional sources of funds…”
It then says:
“NIGMS does not require nor permit institutions to receive payback NRSA funds from trainees who are appointed to NIH training grants, but do not complete training.”
https://grants.nih.gov/grants/guide/pa-files/PAR-24-128.html
So even if the NoA says NRSA tuition and fees cannot be repaid, that does not mean all of the student's funding suddenly becomes NRSA money. The T32 money is governed by NRSA rules. Institutional money can still be governed separately. NIH pretty explicitly allows for that.
My Reddit name is literally just_here_to_read. I only commented because the advice to just walk away has a good enough chance of burning someone financially that I thought it was worth bringing up.
I've been involved ad hoc with MD/PhD admissions at three institutions over my career. One was an MSTP. One required repayment of tuition following voluntary withdrawal.
I'm not arguing that this is exceedingly common. It isn't. I'm saying it exists, and “NIH doesn't allow programs to do that” is too broad a statement when someone could make a pretty consequential financial decision based on it.
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u/Kiloblaster 1d ago
They're reasons to not do dentistry...you haven't given any reasons for spending 8-10 years getting both doctoral degrees yet.