MD/PhDs: Training for the future of medicine

By blurring the line between patient care and clinical research, this dual degree might be our best chance to tackle some of the most pressing health issues of our time.

Of the approximately 20,000 physicians trained in the U.S. each year, only 600 of them are MD/PhDs, also known as physician-scientists. The dual degree takes approximately seven to eight years to complete, followed by a three- to seven-year residency program for those looking to practice medicine.

The Warren Alpert Medical School set out to revitalize its MD/PhD Program in 2017. At the time, all students in the program were from Brown’s Program in Liberal Medical Education (PLME). Thanks to a gift from The Warren Alpert Foundation, Brown was able to open up the application process to external candidates. That got the ball rolling.

Resilience, brilliance, creativity

“It's really a rare breed,” says Jonathan D. Kurtis '89 PhD'95 MD'96, the Stanley M. Aronson Professor of Pathology and Laboratory Medicine, chair of Pathology and Laboratory Medicine, and director of the Warren Alpert Physician-Scientist MD/PhD and Advanced Training Program.

According to Kurtis, one of the hallmarks of Brown’s program is how it deliberately blurs the boundaries between the MD and PhD programs. During the first two years of medical school, MD/PhD students spend each summer in a research lab so they can gain basic science experience in addition to learning clinical medicine. Once they’ve passed the qualifying exam during their PhD, they spend every other week in a clinic doing family practice to gain experience with adult medicine, pediatrics, and some obstetrical care.

“We're trying to emphasize that students have to have the ability to think clinically while doing research and think about research questions while doing clinical medicine,” says Kurtis. “That's the life of a physician-scientist.”

The ideal MD/PhD is able to ask and answer questions at the interface of clinical medicine and basic science. That requires a particular set of traits. One of the most important qualities, according to Kurtis, is resilience.

“MD/PhDs have to be able to be rejected over and over again. With the actual research itself not working out, or the hypothesis they are testing being incorrect, or something as mundane as constant grant rejection,” he says. “Tuesday, I'm seeing patients; Thursday, I'm submitting an NIH grant; Friday, I'm crying because I didn't get it; and on Monday, I'm back up like a weeble, submitting it again. You’ve got to be able to bounce like that.”

Another must-have quality according to Kurtis: brilliance. Students pursuing an MD/PhD have to be able to learn and retain a tremendous knowledge base within basic science and clinical medicine. Until they know where the perimeters of the known world are, he says, they’re never going to be able to exceed them. He wants students to learn everything there is to know about a disease, then push beyond it.

Anytime you're on the edge of the perimeters of knowledge in a disease area where we have suboptimal therapy—you can start merging your science with science from another field. That is where you're going to have big impacts.

Tom Bartnikas, MD, PhD

The third attribute of the MD/PhD might be a little unexpected, but it is critical nonetheless: creativity. Kurtis describes medicine as an art that involves a huge social dimension, including interacting with your patients, understanding their life histories, and helping them work toward the optimal trajectory for their health status.

“You need a little bit of blue sky thinking and the ability to imagine things that haven't been thought of before,” says Kurtis. “But then you need to be able to put those thoughts into practice. That's the whole package.”

Prioritizing translational medicine

Since Dean Jack A. Elias arrived at Brown in 2013, there's been a big push to increase Brown’s capacity and capabilities for translational science—studying elements of basic science in biological contexts and then working through the steps to apply them to a particular disease. Brown has also been actively increasing the number of faculty doing translational research. Both these areas—along with the MD/PhD program—have been BrownTogether campaign priorities for the Division of Biology and Medicine.

In the Department of Pathology and Laboratory Medicine, for example, Brown has recently recruited several excellent investigators in cancer biology who are physician-scientists. According to Tom Bartnikas, MD, PhD (associate director of the MD/PhD Program and Manning Assistant Professor of Pathology and Laboratory Medicine), that is good news for students.

“The research of these faculty members is increasing the data sophistication and elegance of the cancer work being done on campus,” says Bartnikas. “And they, in turn, want excellent students in their labs.” He also notes that MD/PhD students are a perfect fit for this type of work because they operate and shine at the interface between basic science and clinical medicine to develop new approaches to diagnose and treat disease.

“Once you get into the lab and really make the science your own, you start exploring it very intimately,” says Bartnikas. “Then you start to see questions that other people haven't asked yet, and you think, maybe I could be the first one to explore that part of this disease process.” For Bartnikas, this “intellectual adventure” is incredibly compelling.

“It's almost more exciting when your original hypothesis doesn't turn out to be true, because then you stumble upon something that you didn't even know was out there, and that can take you in new directions you didn't anticipate. Anytime you're on the edge of the perimeters of knowledge in a disease area where we have suboptimal therapy—you can start merging your science with science from another field. That is where you're going to have big impacts.”

Growing the program

Four years ago, Brown had three applicants for three MD/PhD slots. Two years ago, when Brown opened up its program to external candidates, 150 applications came in for the same three slots. The next year, there were 250 applications. This makes for a tough admissions process, both for the applicants and the admissions team.

“We get way more applications than we can accept,” says Bartnikas. “That's a good situation, because it shows there's interest in the program, and Brown is able to bring in really top-notch students. The issue now is Brown’s ability to compete with other programs.”

The gift from The Warren Alpert Foundation gave the Medical School the ability to waive medical school tuition for all four years for MD/PhDs. Previously, it was only waived for two years.

“That was the biggest financial burden,'' says Bartnikas, “but our peer institutions give stipends to cover living expenses to MD/PhD students during the medical school years, too, and we don't. That's a big deal.”

Another goal of the MD/PhD program is to attract students who are underrepresented minorities (URM) in medicine. Funding, however, has made this effort a challenge as URM candidates have turned down offers from Brown in favor of other institutions with better financial offerings.

“Not being able to offer a stipend during the MD years is an unmet need,” says Kurtis, “If we could fund that, we would be more attractive to students, particularly those that can’t afford to take a less ideal offer.”

Potential for future impact

Kurtis is extremely optimistic about the program and the impact it will have on future patients and families. “Our students are doing incredible things in areas like neuroscience, cancer, and infectious diseases. Imagine if that MD/PhD student actually develops the next generation therapy for glioblastoma. Suddenly you take a uniformly fatal disease and now you've got a 20 or 30% survival rate. That's phenomenal. Now imagine an MD/PhD student who's working in iron biology who discovers a new treatment for iron deficiency, anemia, or leukemia. It's game-changing.”

He also notes that it has been a true joy helping to bring this program along the developmental path. In the next three to four years, he thinks we're going to see the program go through another inflection point. Kurtis views the MD/PhD Program as one of Dean Elias’ signature—and now legacy—achievements at Brown, noting the intense focus Elias put on the program and his desire to train the kinds of physician-scientists we need in the 21st century.

“We're a growing program,” says Kurtis, “and if we could get the last bit of resources in place, I think we could compete with any program in the country.”

For more information about how to support the MD/PhD Program, please contact:

Cailie Burns
Assistant Dean for Biomedical Advancement
+1 (401) 368-8155
[email protected]