My friends like to joke that I’m in 21st grade. They’re not wrong, and even after 4 years of undergraduate college and 5 years of graduate school, I’m still not done. And I’m not alone on my journey. According to the AAMC, 5,344 students were enrolled in MD/PhD programs across the United States in 2017, and this number is on the rise. MD/PhD programs are becoming increasingly popular due in part to a growing interest in research, financial benefits, and the wide variety of career choices upon completing the program. Although there are more than 100 programs across the country, no two programs are exactly alike and there are a number of factors a candidate should consider before deciding on a program. Some considerations, such as location, cost of living, and proximity to family and friends, are important for both a traditional 4 year MD student and an MD/PhD student. However, the latter will ultimately be committing roughly 8 years to graduate education, making the decision where to go even more important. The following are some specific factors potential MD/PhD candidates should consider before selecting a program:

What size MD/PhD program is right for you?

The size of MD/PhD programs varies widely. For example, the University of Pennsylvania has more than 180 MD/PhD students throughout all years in their program, compared to Marshall University which has just 5 (AAMC 2017). While some programs like the University of Oklahoma matriculate just one new MD/PhD student per year other programs like UCLA can admit up to 17 new students per year. So why does this matter? For some students, it may not. For example, if you plan to matriculate at your home town university with plenty of established friends and family, you may not mind being the only MD/PhD student in your year of the program. However, if you are traveling to a completely new city and won’t know anyone, you may appreciate the comfort of having many more comrades in your program. Remember that after two or three years, all your medical school friends will move on and eventually start residency. For many people, their MD/PhD peers become some of their closest friends during the 7 to 8+ years they spend together. At my school, we regularly have social events with our dual degree students, and the students above me have served as wonderful mentors when I’ve had questions about finding a lab or transitioning back to medical school.

3 MD  PhD  1MD or 2MD  PhD  2MD?

It’s important to realize that not all dual degree programs are structured similarly. In fact, most are pretty different. Some programs have students complete the first three years of medical school, then complete all of their PhD before returning to finish their final year of medical school. Other programs require students to complete two years of medical school (the preclinical years), complete all of their PhD, and then return to finish their last two years of medical school (the clinical years). Both structures have their advantages and disadvantages, so it’s important for you to consider what is best for you. For example, the 3 MD  PhD  1MD type of structure allows students to have a more succinct, continuous medical education before starting their PhD. For many, this has the added advantage of actually giving them a year in the clinic and exposure to all the different medical specialties to start to form some career plans and choose their PhD area accordingly. Many, many students enter medical school convinced they will pursue surgery only to realize they want to do psychiatry, for example. Very few students are certain from the start what they want to do, and the clinical years are when most students start to make this decision as they get exposure to the different fields.

The 2MD  PhD 2MD students are at a disadvantage in this regard, because they don’t get to complete a clinical year before starting their PhD. For some students, this may mean completing a PhD in a field that will be completely unrelated to what they end up pursuing a medical residency in. However, proponents of the 2MD  PhD 2MD structure argue that students become very rusty in their clinical skills after taking many years off to do a PhD, and having just one year of medical school left before residency is difficult. Both program structures have their pros and cons, and it’s important to keep this in mind when interviewing at different programs.

Does the program offer funding or financial support?

Most MD/PhD programs waive students’ medical and graduate school tuitions and provide a stipend. However, this isn’t necessarily the case. Some schools still require students to pay fees which can average a few thousand dollars a year. Other programs don’t provide scholarships for the first two years of medical school while some require students to find their own financial support during the PhD years. Unfortunately, money matters, especially when you are committing 7 or more years to higher education. Do you research and ask questions when interviewing so that you are not blindsided by unexpected costs.

Do I want blended or separate MD and PhD years?

Medical school is tough, and in some regards dual MD/PhD programs are even tougher. Some programs require students to add PhD classes to a traditional MD student’s schedule. Other programs keep the MD and PhD years entirely separate and credit most of the MD classes towards the PhD curriculum. Some schools have clinical requirements during PhD years, while other schools make this optional or not even possible. For example, at West Virginia the MD and PhD curriculums are separate and students have no additional requirements during the MD years. Many of the MD classes count towards the PhD, so depending on the PhD area you choose, you may not have to take a whole lot of additional classes and can jump right in and start your dissertation research. There are no clinical requirements during the PhD years, but it is possible to get elective credit for rotations if you desire a refresher before returning to medical school. Other programs have monthly clinical requirements for students during the PhD years, or require students to complete a full year of PhD coursework before starting their dissertation research. As an applicant, you must consider whether a blended or more separate program is better for you.

Can I join the PhD program after I’ve started my MD?

A quick search on the AAMC website yields a list of every medical school in the country with an MD/PhD program and whether or not they allow internal medical students to join the MD/PhD program late. Many students may be surprised to learn that most MD/PhD programs allow internal transfers of medical students into the MD/PhD program after they’ve completed one or two years of medical school. Some programs even require all students to complete a year of medical school before making a decision about their acceptance into a dual degree program. A few osteopathic medical schools also offer dual degree programs. So if your passion for research flourishes late, it still may be possible to join that dual degree program.

In the end, all MD/PhD programs require years of dedicated research and medical education. In order to find a program that you will be happy at, do your research, ask questions, and speak to other students at interviews. Your ideal program is out there — you just have to find it.