MappedCon presented by Blueprint Test Prep 2024 is this Friday, October 26, 925 Eastern. I'm starting the day in my track, the pre-med track, planting the seed of your personal statement. We have three tracks going all day long and a couple hours of amazing exhibitors where you can learn more about their programs. Again, MappedCon presented by Blueprint Test Prep, October 26, register for free. It's a virtual event and all the sessions will be up after. So even if you can't make it live, go register and get access to the sessions. Go to MappedCon.com right now, register. That's M-A-P-P-D-C-O-N.com. If you're applying to medical school in 2022 to start medical school in 2023, join me Wednesday or Thursday, Wednesday night at 9.30 p.m. Eastern or Thursday at 11 a.m. Eastern at premedworkshop.com. Go register today. I'm going to show you how to tell your story in your application. Again, that's premedworkshop.com. If you are applying to medical school in 2022, be there or B-square. The Medical School HQ podcast, session number 67. In reality is that they work maybe 10 weeks during the summer and full time. And then in the semesters, they are doing 10 to 15 hours a week. Hey, this is Z-Dog MD, rapper, physician, legendary turntable health revolutionary and part-time gardener. And you're listening to the Medical School HQ podcast hosted by the irredeemably awesome Ryan Gray. Welcome back. I am your host, Dr. Ryan Gray. And I believe that competition amongst your premed and medical student peers is detrimental to becoming a great physician. In this podcast, we show you how collaboration, hard work, and honesty are critical to becoming a superior physician in today's health care environment. Welcome back, folks. In today's podcast, my guest, Dr. Jose Cavazos, and I are going to show you what premed life is like as a possible MD PhD student, Dr. Cavazos, who is the assistant dean for the MD PhD program at the University of Texas Health Science Center San Antonio School of Medicine, brings you the voice of an admissions member telling you what a successful applicant looks like to him. We cover life after medical school as well for an MD PhD graduate. All that and a lot more. Dr. Cavazos, welcome to the show. Can you tell us a little bit about your background and getting into medicine? Okay, my name is Jose Cavazos. I'm a professor at the University of Texas Health Science Center in San Antonio. Professor of Neurology's, I am an epilepsy researcher and clinician, and I'm the assistant dean for the MD PhD program. Now, your question, Ryan, is how did I get to this spot? And my path is a little bit atypical in the sense that I started with an MD and then decided that I wanted to pursue more research and push for a PhD and then I did my residency. And after my residency, I then started faculty formally, you know, first in Colorado and now here in Texas. Okay, so you started off purely as an MD graduate and then later on in life figured out that you like the research. As I was going through the pre-medical education component, I just got fascinated with the basis, the fundamental and I felt that I was not getting enough critical thinking or, you know, substance, let's put it this way. And I often tended to go back to why. And those questions of the why kept bugging me quite often. And perhaps that's one of the signs that undergrads, pre-medical students right now, must be considering if they are fascinated by the specific reasons and I'm willing to contribute as to why certain pathophysiological process happened, etc, etc, you know, biomedical research and MD PhD programs are certainly one possibility. Okay, and we'll get into that a little bit more. I definitely want to get into what pre-med students should be thinking. But I want to hit on your path a little bit more. Where did you do your medical education? So I'm an international graduate. I went, I did my medical school in my hometown. I was born in Monterey, Mexico. Texas used to be part of my state. So I went and did my medical school there in my, I mean, I'm a dual citizen in my country, in Mexico. It's a seven year program. And so it is a pre-medical undergrad and medical together. You know, it's, as I said, it's somewhat a typical tool, but nevertheless, that's the way, I mean, compared to other graduates or paths of some of my colleagues. This is not an unusual path, but it is different than the MD PhD program. Okay. Now, I don't know how briefly you can talk about it, but I haven't had any international grads on that I can think of where you're going to be session 67. So 67 straight weeks. I did have a Caribbean student on so another international graduate. What was it like to come back to the states to practice any big hardships that you had to overcome? Or was it, did you find it easy and was maybe just a little bit more paperwork? More paperwork. I mean, there's no question about it. Every state has once everything, all the paperwork all the way to the back. I am licensed in just Texas at the present time, but you know, originally, you know, I did part of my training in Wisconsin. So I actually took the licensing test in the state of Wisconsin. I then went and obtained, you know, did my residency at Duke, and I got a medical license at North Carolina. And then subsequently, I went to Colorado and again, did the entire paperwork again. And lastly, I came to Texas. So, you know, what I mean by paperwork is, is considerable and is actually much more, it's larger. Now, obviously, as an international graduate, you always have a, you always have a question as to the depthness of your knowledge. I can tell you that, you know, that certainly is something that I pushed me to be in the top 5% or 10% of my specialty. And I certainly, you know, if you look at almost, I mean, my scores across the board and the specialties, they are top notch. Yeah. Okay. Yeah. It's definitely something we'll, we'll cover more in depth later for. As a program director, I'm also a program director. So I also evaluate individuals who are coming from multiples of other schools. And I can tell you that one important aspect to understand about international medical graduates is that there's a lot of heterogeneity of the strength of their programs. Some are amazing. Some are not equivalent to the education and quality controls of the United States. Yeah. And that's something I tried to get across to students. Just because you go to Harvard doesn't mean you have a free ride anywhere. So you get out of it what you put into it no matter where you go. Exactly. And you mentioned you're a program director. I'm assuming it's for neurology. You haven't mentioned that you're a neurologist. Yes. I did set at the beginning that I was a neurologist, but nevertheless, I'm a program director for a sub fellowship, a fellowship of neurology. Okay. And that's clinical neurophysiology, which is the guys who read brainwaves and do EMGs. Okay. The squiggly lines. Yes, indeed. Now my wife, Alison, who's a co-host on the show sometimes, she's a neurologist. I think I mentioned to you in an email. I see. And we were both very skeptical at the start of her medical training, her neurology training about what those squiggly lines meant. But now she swears there's there's stuff in there that she can read. You bet. So let's let's talk a little bit about being a pre-med. And those considerations about going to an MD PhD program, obviously the decision to go to medical school is a big one all in of itself. How are pre-medical students supposed to know that an MD PhD is what they want to go into? Well, that's actually a bit of a revelation that happens when you are a pre-med undergraduate, perhaps to become rounded, do a little bit of research in the lab, typically a wet lab. And what happens is in those settings, you might be exposed to individuals who are a clinician scientist, or you might have a mentor who is a clinician scientist in some institutions that that may be one of the cases. You may be exposed to students who are undergoing this path. Now, truly speaking, let me let me just backtrack and say as program director for an MD PhD program, what you are looking for in an applicant is an individual who has got sustained research experience for several years. And that is one of the reasons why when you are when we are reaching out and doing recruiting, we go to the early classes, because what you want to say is indicate that this is a potential avenue. And if you want to go that route, you have to do a series of things. Now, there are people who are late bloomers and in there, as I said, as they are doing their requirements for having a balanced application and checking all the boxes of volunteering and clinical etc. There is a section for research. Let me do some stuff on it. So as people do that particular box, they may say, wow, I mean, this is fascinating. And in my particular case, I didn't have that experience as a pre-med. And so, certainly, that was what called me to say, well, let me take a gap here after my medical education to pursue some research, because I understood and during my scholarships, I was exposed to individuals who were clinician scientists. I did several, I mean, six months at Baylor College of Medicine in Houston. And, you know, some of the individuals who I was exposed work barely clinician scientists with, you know, a very different career, but than the traditional clinician educator or clinician taking care of patients. You mentioned what you're looking for as a director of an MD PhD program, several years of research. Now, if I do the math, a typical pre-med student is applying at the end of their junior year, or the summer. And if you do the math on several years of research, they either know starting out as a freshman very early on that they need to jump on this, or they're already behind the curve, it sounds like. Well, we have a mixture. Certainly, the most important aspect that we look is what are the opportunities that individuals have. So, it is not the same for an individual who is going on an R1 or an Ivy League type of institution where research labs are pushed all the way from first year in your freshman classes. And, you know, those opportunities are discussed quite openly by, you know, the faculty and in some extent, it is expected for some individuals to have those types of experiences, regardless if they are going to go straight into the MD path period or farm the or whatever other pre-held path. So, individuals who might be in a community college transitioning to a major university or something of that nature, you know, they are going to be starting their junior year, and they say, "Oh, wow, this exists," and they certainly will be behind. Now, we look at those candidates too, you know, quite keenly, and essentially, the issue is from the time that they make a decision, that this is something that they want to pursue, the question is what they have done the most with their opportunities. I mean, some individuals, you can also argue that may be coming from an Ivy and very shallow record, and you will say, perhaps, you know, they did not take advantage of the opportunities. And so, the question is, what are these individuals made of? I want to ask a question about something you mentioned earlier for us that don't know the research side of the house. You mentioned wet lab. Can you expand on what that is real quick? Sure. A wet lab experience is the typical pre-medical basic science discipline. Let me say about chemistry, genetics, molecular biology, physiology, pharmacology, about chemistry, I mean, you know, so those are the traditional disciplines that individuals will eventually will get PhDs on, neuroscience, for example, will be in my case. I mean, I did that's my PhD on. Now, a wet lab means that you do research, in biomedical research, in a laboratory where experiments are taking place. And the reason why it's called wet lab is because, I mean, you typically are mixing solutions, and they are typically wet. But, I mean, in truth of, I mean, that is in compare, for example, to other types of experiences which are okay and adequate and sometimes what we're looking for, such as working with patients and doing clinical translational research. But even in those cases, what we're looking is for some research that is able to assess fundamental questions about the biology of what's going on. As you move closer to healthcare outcomes or community type of research, the level of the scientific inferences that you're able to develop is they tend to be less and less. And so, you essentially recognize, for example, that there is an association between, you know, let me just say something simple, smoke, tobacco smoking and lung cancer. So, and clinical association like that, in order to be proven, you have to do a series of scientific tests where you are able to dissociate the compounds that are associated with this problem. And assess the level of carcinogenesis, understand the mechanism, and understand how the pathophysiological processes about. And so, that's typically done in primary, you know, animal research or in biological sample research. I mean, it doesn't necessarily need to use animals, but biological tissues. Okay, good. Now we got that straight. One of the big questions we get all the time is, do I have to major in chemistry? Do I have to major in biology? And those are typically general going to medical school. If I want a PhD now, that same question still exists. Are you looking specifically for science majors or can a humanities major get all the prereqs and get their research in and still be considered on the same level as a science major? Yes, I mean, many cases, I mean, let me just tell you an individual who we would love to have as an accepted student in my program. She began as a music and philosophy major and actually completed that, but realized in her last year that she really loved research. And then in the subsequent post back and studies, premed, et cetera, did studies to have the premedical requirements. So it's possible. One obvious concern and of an individual who is coming with that track is a little bit how whether the quality of upper level courses beyond the premedical requirements is sufficient to be able to have challenged themselves to push themselves to the next level. Now, let's say that that conversion happened in their junior year, so that's understandable. You quite often MD PhD students do a one or one year or two year post back and where they are completely immersed in research to improve their qualifications. But many of our top candidates across the country are individuals who are just straight coming from undergraduate, typically from a solid undergraduate program where they have had research experiences throughout three years or at least two years solidly throughout their training. You mentioned that you took a gap year and you mentioned that a lot of students take a post back or maybe gap years in and what you just said immerse themselves in research. If a student out there is thinking, "Wow, I think maybe I want to do an MD PhD, but I don't have that much research," let me take a gap year before I apply. During that gap year, would you consider one day a week in that lab over that year immersion or would you consider full-time five, six days a week full-time? It would be some, I mean, it would be really more the five, six, you know, day type of immersion to make up for, I mean, when we're talking about an individual having, for example, two to three years of research experience coming from college, what we're thinking in reality is that they work maybe ten hours, I mean, ten weeks during the summer and full-time and then in the semesters, they are doing 10 to 15 hours a week as their continuity along with taking a full load of classes, et cetera, et cetera, which will be essentially being challenged to proceed with this. Now, we're looking, I mean, obviously early on, many of these undergraduates are doing these research experiences completely unpaid, but, you know, postdocs are typically, you know, funded positions. And so, for example, one of the premier places that will be actually recruiting there in a couple of weeks is at NIH. And so the NIH has an immense, you know, variety of research laboratories. They have a program called the IRTA program and it is a program where qualified students who have just finished their undergraduate training, or they are about to finish, they apply to this program and they are able to be selected and paid to work in a lab, in a world-class, research lab. And so, those are amazing opportunities that many students have. As long as the government doesn't shut down anymore, please. Well, that's another story. Indeed, I mean. So, MD-PhD, obviously, is a very unique, very hard path, a different path, a longer path. Do you have to be an MD-PhD to be a physician scientist? No, but it gives, I mean, so, so, let's start talking about what MD-PhD programs are. MD-PhD programs, essentially, you still are going to be going out to a series of interviews. That's the last, I mean, and maybe invest five or six thousand dollars in between interviews, applications, etc. In I'm guess. But once you're done with that, you enter a situation where your entire tuition fees for the MD, for the PhD are entirely paid. In addition to that, you are giving a stipend, certainly a pre-doctoral student stipend, typically, somewhere in the range of 22 to 32, perhaps, in some cities. In my program, we provide 26,000. But given San Antonio's low cost of living, that's actually probably much more than the 32 that may be getting in New York City. So, in terms of being able to afford some decent living situation, in any case, after completing your PhD and MD, and you're paid that throughout each of the seven to nine years of both medical and PhD education. Now, that's the majority of the MSTPs, or actually, all the MSTPs, as well as many of the fully funded MD PhDs. Explain real quick the MSTP. So, there are 45 programs in the United States that receive NIH funding in a training award called the Medical Scientist Training Program. These are programs. This is a NIH T32 application to the National Institute of General Medical Sciences. It's an application that essentially is a review, a programmatic review by a study section that the training that goes on in that particular institution is fantastic. There are other NIH awards, which are, for example, F30s. These are individual awards that are obtained by MD PhD students. My program, for example, has one of the highest number of F30 awards per MD PhD student. The reason for that is because, as we don't have an MSTP funding, we're a relatively young program. Those programs typically have been around 15, 20 or more years before they obtain that type of funding. You go for other types or you apply for other types of funding. My program, in particular, it's going for applying for the MSTP funding, but that essentially is they are funding about 20% of the slots of the positions that exist in a particular program. Now, if you look at MD PhD programs, there are programs that have the mega programs. There's a couple that have over 150 MD PhD students. That's over starting from, including all the students from year one to year seven, nine, ten, in some rare cases. Then there are about 10 more programs that are over 100 positions total. That means that the mega programs, they may have 25 positions per year. The medium-sized programs or the large programs may have between, there's actually 13 programs with more than 13 positions per year. Most programs are going to be somewhere in the five to 10 positions per year, and the size of the program is about 60 to 80. That will say, out of just 45, the great majority or at least 50% are in that sweet spot. Are there any programs where a student has to pay for their MD PhD program or are all the spots paid for? Well, there are 109 programs or 109 schools indicated that they had MD PhD students in 2012. I have not looked, the data for 2013 was just released, but there are some of those who are not fully funded, and they are giving them some, they are paying for the PhD portion but not the MD. Some of actually the Ivy Leagues have some extra spots that because they're prestige, some people would rather have it from those places, and they end up paying for the MD portion of tuition, which can be rather hefty. Exactly. The advantage of an MD PhD student is that they don't really accumulate debt during their MD or PhD. They do not accumulate debt, obviously after they become residents or postdocs, and then they have the ability to use the NIH loan repayment program to pay back even the undergraduate loans. In a sense, it's a mechanism that allows not to consider, not to think about financial considerations if you keep doing this program or keep doing this career path. Now, in the end, we do not make as much, I mean, as private practitioners. There's reasons why you do this, because you love to do research. You want to be challenging and being able to influence health and have a footprint that is much larger than just helping this particular patient. Now, as clinician scientists, we're able to still see patients and still be able to do research, and that's a very rewarding career for many of us. I mean, most of us are going to be in academic careers, and many of us are doing basic science investigations. Some of us do clinical science investigation, and some of us are able to really bridge the gap between bench research and all of these publications and discoveries and be able to bring it up to patients. But you mentioned a couple of things that an MD-PhD that's out and working now out of school can do. Are there any other unique things that an MD-PhD graduate can do that maybe a normal physician can? Well, another thing is industries, and I'm talking about pharmaceutical industry, but also device industry, is fairly interested in individuals with this type of training who are able to translate premium research discoveries into clinical platforms and got an idea of doing, taking preclinical trials and getting phase one and phase two studies done. That is a very spectacular expertise. Many of these individuals, many of these individuals go into pharmaceutical of this type are individuals who have practiced for a couple of years, maybe two, three years, or they have done some clinical medicine, but at the same time they have gone into do postdocs or projects where they do this type of discovery. Now, some of us do move eventually into administration like I am. This is a little portion of my time, relatively speaking. Every week I still see patients, every week I interpret some squiggle lines, EEGs, which is what I do as one of the neurophysiologists. Every day or every week, I'm also involved with research proposals, reviewing papers, etc. There's a lot out there. Now, you did say, and you asked the question about individuals who just do the MD and then go on for research. Why are not they? I mean, if you look at the average age of an individual who gets the first R01, and it's a physician, the age for those who are MD/PhD and MD is exactly the same. What happens for the MDs who are obtaining further research, R01, NIH grants, etc., is that they earn their stripes by doing additional research training as postdocs after their completion of their residency or during their residency. There's not shortcuts. The advantage of doing the MD/PhD in a sense is that we accept a student for the program. We don't accept it necessarily so that they become medical physics or biochemistry or geneticist or whatever. What we're looking for is the best candidate, and you're able to take that risk of doing a rotation in another field that may not be necessarily what you have been exposed as an undergraduate in the researcher. In the country, once you have done and finished or you're doing your residency, you typically are more advanced in terms of your lifetime career. You may be already having a significant order, you may have children, you may. The amount of risks that you take are much smaller, and so you go more for a sure thing. On the other hand, if you persist, you have a very high chance of succeeding, but not as many people enter successfully at that level. Okay. You mentioned just now what you would consider a strong candidate for an MD/PhD program. I know it's hard to say this is the perfect candidate that we want because every application is different. One question we get all the time is, what is the minimum amount of research do I need? Is there a number that you guys look for, or is it just more quality type research? It's more about quality and deafness. There are people, for example, that have done five years of research, including some pulse back or whatever, but they were acting as technicians, and their thinking is still at technician level. There are individuals who do a year and a half of research, but gosh, they came up with independent ideas. I mean, the letters of recommendation from their research advisors are critical. Now, on the side of the usual thing that we compare to MDP to other MD applicants, we do need to convince the medical school that this individual is interested in becoming a clinician too. So they need to have done some shadowing, but rather than doing 500 hours of shadowing and things or volunteering and etc. We're looking for 100 hours of shadowing, a little bit of volunteering and mostly research, research, research, and it is quality as you indicated. I'm glad you brought up the technician portion, because we get the same problem with undergrads who "volunteer in the hospital" and what they're doing is like I did. I made the mistake of going and showing up saying, "Hey, I want to volunteer," and I got put at the information desk showing people where the elevators were. How does a student start off and get that quality research experience? How do they be a little bit more forthright and say, "This is what I want to do, give me the good stuff," or should they start in more of that technician role, get a little experience, and then have those conversations of, "Okay, now I want to be higher up on the totem pole." So typically, that's the way it works. I mean, it is pretentious to come seriously. I mean, as an undergrad with, "Oh, give me the good stuff." By the way, I don't know anything, and I don't have any experience whatsoever. So you need to earn your stripes. No, we are not expecting necessarily publications. They are abundance, and how generous some research advisors are in terms of putting individuals as third, fifth, whatever, 10th out versus having a single publication, but they are first out or second out. Or they had a significant take on a particular project. So often, even if it is, I'm going to start working with this postdoc or this graduate student to take this particular project to another piece, but it is rather than, "I'm just washing dishes for the lab," which is another common equivalent to what you were indicating, is I want to take a particular area of the science and really help out. So what you do is, certainly, you might start as the lab washer, but you open your eyes to everything that goes on, and you start asking questions. You start reading about it. You start talking yourself into the research lab of what's going on, and it may not be necessarily that you are having those conversations with the PI. You might be having those conversations initially with your supervising graduate student or supervising who have postdoc or even technician. And then, as you understand better, what goes on in a particular area of the science, then you start thinking and owning some aspects of that research. And then you need to make it known to the PI, what your aspirations are, and most PIs are very open to these, because some of them say, "Maybe this kid comes back into our MD/PhD program if they are in one of those places, and even do their PhD in my lab." So, certainly that's a very good thing that can happen. There's a great quote that I love that says, "The harder I work, the luckier I get." And that's exactly what you said. "You put in the efforts and opportunities will come if you want them." Do you have any final words of wisdom for a pre-med student out there that's possibly looking at an MD/PhD program? Well, obviously, SDN has a fantastic and very active physician scientist forum. Sometimes it's depressing because some NIH is not giving grants, etc. But the reality is that even in 2013, 14% of the ideas that were submitted to the NIH, which by the way, they were a record number, got funded. And the reality is that MD/PhD students and graduates are going to have a better chance of competing for those awards and being able to stay in academia during the tough years, as compared to the very painful days. Those happen. I mean, we had doubling of the NIH in 2003, but we're losing those efforts by inflation and other measures. Lastly, obviously, the YouTube link, some people may be able to take a look at what the stats are. Look at the AAMC website. There is a very nice portion for MD/PhD students and applicants. And lastly, email. Email 10 Fairs in July. There's a great fair at the NIH that is open to all pre-med students who may want to see all of the MD/PhD program directors are pretty much up there. And so it's a great opportunity to see and compare and talk to MD/PhD students, directors, administrators, etc. Wow, I hope you got a ton of great information out of that. Dr. Kavazos was kind enough to take some time out of his day and share what it's like. Obviously, I know you like to hear information from admissions members, because when I was a pre-med, that's who I wanted to hear information from. So Dr. Kavazos, as the assistant dean for the MD/PhD program and also the assistant dean for the medical school as a whole, shared with us his thoughts on what a successful applicant looks like. And so take this information with the realization that it's one person. It's one admissions member. So every school looks for something different. Every admissions committee has a different job, a different role when they're evaluating students. And so that's why it's hard to give concrete advice to you, because every school is different. Every year it's different. So take that with a grain of salt, but a lot of great information that I hope you can use today as you move forward on your path to becoming a physician. I do want to thank three awesome listeners for taking a couple minutes and leaving us five star ratings and reviews in iTunes. We had Lesa RF, who said the best podcast for pre-meds, especially non-traditional such as myself. The subject is A plus plus plus plus plus. That's awesome. I wish I could put that into my amcast application. We had Pierson said excellent podcast, terrific podcasts for diverse medical and pre-medical audience. And RJ STO2 says, "I'm new to this podcast and have selected podcasts randomly, but everyone I've chosen has incredibly benefited my journey." Awesome. Thank you RJ STO2. Thank you to those three people. If you haven't taken a minute or two to leave us at rating and review, that's okay. You can do it right now. Literally, it takes about a minute or two. You go to medicalschoolhq.net/itunes and you can leave the rating and review there. If you listen on Stitcher, you can rate us in Stitcher's app or online. And yeah, so we greatly appreciate it. That increases our visibility in iTunes. So when other students are out there looking for something to listen to, they can find us. We want you to continue this conversation. If you liked what Dr. Kavaz was had to say, if you want to share some stories or questions about the MD-PhD world, go to medicalschoolhq.net/67 as an episode 67. That is our show notes page. And at the bottom, there's a comment section where you can leave some comments and we can continue this conversation. You can also say hi to us on Twitter. I'm @medicalschoolhq. Folks, as always, I hope the information provided to you today will help better guide you on your path to becoming a physician. And as always, I hope you join us next time here at the Medical School Headquarters. [Music] [Music]
