MD-PhD students in the 1990s: finding a niche for the dual degree

Given the success of MD-PhD students in the past and the uncertain future of science and clinical medicine, this article has attempted to review the progress of MD-PhD programs and examine the experiences of some of today's MD-PhD students. Most candidates responding to the questionnaire remain committed to research and its applications. Their future plans are in line with the paths their predecessors have chosen, namely, careers devoted to academic medicine. For many of these dual-degree candidates, however, academia encompasses basic research and patient care. There seems to be little doubt that MD-PhD graduates will continue to seed the faculties of leading US medical schools and research institutes. However, some dual-degree recipients will opt for strictly clinical careers, perhaps leaving the laboratory altogether. Indeed, according to the author's survey, 14% of respondents intend to concentrate primarily on patient care. A few of these students seem disenchanted with the benefits conferred by a dual degree. "I don't see the advantages of a combined program that I saw when I was applying," one student explained. "The PhD degree confers no benefit as far as I can tell in how one practices medicine or in how well someone will conduct basic research." Detractors of combined-degree programs have questioned how anyone can succeed in science or medicine if not exclusively dedicated to one program. That achieving this balance was the foremost concern of the students surveyed suggests that doubt lingers for them as well. "I have often wished for more MD-PhD role models," wrote another student. "What have other people done with their combined degree? My career objectives are still vague because I am still not sure of what niche I will fill as an MD-PhD. Perhaps we can fill any niche." Perhaps that was the idea all along.