By Mary Ann Littell

Students with a love of science and medicine are often faced with difficult choices. Do they opt for a career in research? Or teaching? Or do they pursue a career in healthcare? Some choose to do it all.

The MD/PhD program, a joint venture of UMDNJ's New Jersey Medical School (NJMS) and Graduate School of Biomedical Sciences (GSBS), trains students for careers in academic medicine by providing a bridge between clinical medicine and basic scientific research. "Students entering the program are strongly committed to basic research," says program director Jeffrey Wilusz, PhD. "Of course, you can do research with just an MD, or just a PhD. What the combined degree offers is a link between basic science research and clinical medicine. It pushes the bench-bedside connection."

The NJMS program has been in place in some form since the 1980s. "Back then, it was not organized as a formal independent program," explains Wilusz, who is also assistant dean of the MD/PhD program and professor of microbiology and molecular genetics at NJMS. "Interested students tried to incorporate their research into existing PhD training programs, which didn't always work out. The dropout rate was high."

In 1996, at the request of the students, Wilusz took over the program. Since then, he has provided it with structure and organization. There are 15 students currently enrolled, but the goal is to expand the program to 20 students or more. Until recently, the program accepted only one or two MD/PhD candidates per year. Now, however, a special admissions committee has been created to screen applicants, and five new students are projected for September.

"We pay a lot of attention to the admissions process," Wilusz says. "The best candidates are those who are truly committed to an academic research career, not overachievers who want the extra degree to build a good resume." Most students learn about the program on the NJMS Web site, where the program description includes Wilusz's email address. He hears directly from interested students, and answers queries personally.

One advantage of MD/PhD programs is that the degrees are earned in less time than it would take to obtain them separately. Students begin with the first two years of medical school, where the curriculum provides a solid basic science foundation. Next, they enter the PhD phase of the program. Most, but not all, take an average of three years to obtain a PhD (as compared to the national average of five and a half years in an independent program). They then return to medical school for the final two years of clinical training. Career options are varied. According to Wilusz, the MD degree drives the career choice, with almost all graduates doing a medical residency. After that, most go into academic medicine.

Twenty-eight-year-old Trevor Reichman is currently enrolled in the MD/PhD program. The Chatham native majored in biology at Bucknell University and planned to go to medical school. As an undergraduate, he spent time working in a lab with a professor who mentored a small group of students. "I worked on simple projects, but it was a great introduction to molecular biology," he says. "I found that I loved to do research and wanted to do more." His lab experience made him consider going for a PhD, but when he realized he could do both at the same time, he thought, "Why not?"

Reichman, who is currently a sixth year student, will complete his PhD work in July, and then finish the remaining two years of medical school. Ultimately, he'll have spent a total of eight years obtaining the combined degree. "By the time I'm finished, most of my friends will have already been working for several years, while I'll be looking for my first job," he comments.

That's not to say that given the chance, he'd choose to do things differently: "I'm glad I did it. You can investigate anything you're interested in, and the faculty is very supportive of your ideas."

When students enter the PhD program, they select one of six GSBS basic science departments, depending on their research interests. Reichman spent some time looking at the different departments, and eventually joined the department of biochemistry and molecular biology. "It took me some time to find a lab which was a good fit for me," he remarks. Because of the delay in starting his thesis work, it will take him longer than the three year average to complete his PhD. His work focuses on the functional characterization of a conserved family of RNA binding proteins that are thought to be involved in the regulation of gene expression in eukaryotic cells.

The work is demanding and intensive. A typical week for Reichman includes several 12-hour days. He lives in Manhattan, commuting to Newark by car because his hours are long and sometimes irregular. He's there early, and it's not unusual for him to work until 7 or 8 at night. He puts in time on weekends, too.

Reichman admits that research has its ups and downs: "You think about something, study it, and plan your approach – and then almost inevitably, it doesn't work out. You have to start all over again from scratch, trying a different strategy. It can be very frustrating." However, he says a strong feeling of camaraderie exists among those in the program.

Wilusz agrees that for many students, the research road can be a bit bumpy at times. "The transition from medical school to research is a difficult one, because it requires a complete change of focus," he remarks. "For the first two years of medical school, you're memorizing a lot of information required to pass the board exams. Then while your medical school classmates go on to the cool part of medicine – the clinical training – you go to a research lab and start all over."

Each student has a mentor; Reichman's is Michael Mathews, PhD, chair of the department of biochemistry and molecular biology. Mathews' laboratory is focused on studying several different cellular pathways that control gene expression. More specifically, the lab studies how several viral gene products interact with and modulate these different pathways, resulting in altered cellular growth and viral replication. "He is an excellent mentor, and very helpful," says Reichman. "For the most part, he leaves us to our work, but when he sees someone heading in a wrong direction, he steps in to provide some course correction. And it seems that no matter when I'm here – and I come in at some very weird hours – he's always in the lab too."

All students in the PhD portion of the dual degree program receive a living stipend, averaging $18,500 per year. Right now, the funding is provided through a commitment from NJMS dean Russell T. Joffe, MD. The stipend is critically important to the success of the students and the program, says Wilusz: "Otherwise the cost would be prohibitive. Medical school is costly enough. Students would be so overburdened by expenses and loans that they wouldn't be able to concentrate on their work."

For now, Reichman is looking forward to completing his thesis in the next few months. The work is presented and defended to a thesis committee in a seminar format. Then it's on to the final two years of medical school and a residency, probably in a large city. "I am really interested in the field of surgical oncology, so I will probably apply for a general surgery residency and then a fellowship in surgical oncology," says Reichman. "I have always been interested in the study of cancer, and it seems like a great opportunity to combine both my research and patient care." When he's finally finished, he plans a career in academic medicine and would like to continue doing research and teach.

Wilusz's ultimate goal for the program is to have it become an NIH-funded Medical Scientist Training Program (MSTP). Currently, there are approximately 35 such programs across the country, all offering the MD/PhD dual degree. The medical school plans to apply for NIH-MSTP status in 2002. "What we've created is very good," Wilusz states. "The program has grown steadily, and our students are fantastic – the best group you'll find anywhere. With NIH-MSTP status it will be able to grow even more."