Chances for an MD/PhD

I don't have any wisdom on this, but I'm just curious, why do you say you would be putting in several extra years just to put yourself on par with other candidates? Wouldn't the MD/PhD potentially put you ahead of other candidates because of your research experience, including grant writing?

Hey Netminder, that's a fair question and I can see why you would ask. I need to be realistic with myself, however. My Step 1 score is mediocre at best for Ortho, and I still have 5-6 years until I'm applying for residency. This specialty is only going to get more competitive as the years go by, and the Step 1 scores will go up accordingly. By that time, I'm not sure my score will even make the cut-offs.
I have two comments about the research. More and more med students are getting involved in research because it is a valuable asset on any application, which may or may not dilute the importance of a "PhD" on my application. Second, I don't even know how important having a PhD is for Ortho. I'm a newbie to this specialty, so I'm seeking advice from anyone who's willing to offer.

I was similarly concerned about my Step I score (which is almost identical to yours), so I buckled down and aced my 3rd year rotations and crushed Step II. I also decided to apply broadly (~90 programs). So far I have had fantastic luck getting interviews and realized that I probably applied to too many programs.
Getting a Ph.D. could only help I would think but the biggest plus that I can see is that you are female (which does help from what I have heard from female colleagues) and you got above 230 on Step I, which seems to be the filter at a ton of programs (I had one PD tell me he set his filter at a 99 on Step I and II and then started sifting through applications).
The only downside I can see is that as you say, the field is only getting more competitive, so who knows where the cut-off will be in 4-6 years when you are done. But as long as your Ph.D. is applicable to ortho, I could only think that programs would see this as a positive on your application.
I'd suggest trying to think about the application process as little as possible over the next few years since its a long way off and will only jack your stress level way up. You'll have plenty of time to worry when you get around to it. Good luck though!

Your step 1 is fine, I would be as productive as you can in your PhD and if it is ortho relevant great, but make sure you learn how to be a good scientist. Also, contact your ortho department and get involved during your PhD years (2-4 years), you should be able to make it to their lectures and conferences/grand rounds)(normally early in the AM) and might be able to get involved in some clinical research while you are doing your PhD (you should have time to chip away at some clinical projects and write up some case reports, etc). Just remember to concentrate on your PhD because that's whats going to get you graduated, with good time management you should be able to get some ortho stuff done too. I did this during a basic science research year and it really helped out, oh and it will help you decide if ortho is right for you as well.

my $0.02

Thanks so much for the great advice! I will definitely try to relax about it and use the extra time I have to take advantage of opportunities I wouldn't otherwise get. That being said, I applied for the dual degree program because I obviously love doing research (when things are working
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). I've always been most interested in cancer research, and since I can't really see my project straying from that general topic, I wanted to ask about the possibilities for overlap between oncology and ortho. I noticed that there is a Musculoskeletal Oncology Fellowship available, but I don't know the details. Does anyone have any experiences here? How feasible is it to do research during residency, and to obtain one of these fellowships? And to follow up, is it possible to maintain a productive academic research lab and be a great surgeon? I've dabbled in Surgical Oncology but haven't found any one (at least at my institution) that really does this well. Thoughts???

I'm a PGY-3 at an SEC program so I can only speak for my perspectives from our program...

You should be golden. Our program has a cut-off of 230 but, whether fair or not, your femaleness is a *significant* advantage as the ACGME is coming down on Ortho programs to expand diversity in terms of both gender and race (this is per a recent closed-door discussion between myself and my chairman). Last year we had 2 females in our resident Top-10 based on their general coolness but, unfortunately, both went to bigger-name programs.

As for your PhD: I have a graduate degree in Engineering, and while this is useful in interviews to give a very-sincere "yes, of course I love research!" answer to that question which will be asked to you everywhere, it is COMPLETELY IRRELEVANT to your chief when on-call at 2am or that same person on your interview. On a personal basis, your thinking skills (and critical thinking skills in slashing most of the crap JBJS articles you'll have to review at journal club) will serve you beyond the limited recognition of your peers. Understand that most of your colleages will care little that you're a PhD and will expect you only to do a good job and work hard. On rotations (which are ESSENTIAL), you will be judged simply on your work ethic, coolness, and intellect (to a much lesser degree). Don't be special, just do your job.

In tying-in your love of cancer: Orthopaedics is a 5-year program and an oncology fellowship follows... you gotta get through a 5-year brick wall before endeavoring into sub-sub-specialty. While that area is underserved and programs would be technically proud of producing an oncologist, you need to understand that with the paucity of Orthopaedists, most programs would rather have a local/regional commitment than someone whose taking his/her training aways. Research is program-dependent: our residents don't have time beyond clinical responsibilities to perform research (as you and I know it) but some places do. I would caution you to pick responsibly, as programs expect you to work, not spend a bunch of time in the lab. They also expect you to pass your Boards which requires reading and experience.

At any rate, my response is getting long in the tooth. PM me for more discussion/questions.

Thanks for your input Merlin. It sounds like you've had a quite a bit of experience in this area, so I appreciate your advice. I hear you that no one's gonna give a crap about a PhD, I wouldn't. I'm not expecting to be a shoe-in for any residency position, no matter what I end up going for. It sounds corny but my work ethic got me in the position I'm in now, and I don't expect to be giving that up any time soon. I worked my butt off for that Step 1 score, and I'm not ashamed of it because I gave it my very best shot. So when I'm on call at 2am with my team, I will be working just as hard as the next guy/girl. It's unfortunate that some MD/PhD applicants get this air of arrogance when interviewing, and it paints us all in a bad light.
Regarding the "female" applicant thing, I honestly didn't expect that response. Every program site I checked out had only a handful of girls, so it's nice to hear that it may actually be an asset. It sucks to be on the other side of that coin though, and be passed up for a position that you are most likely more qualified for just because you didn't check the right box. I hear about that all the time in terms of med school applicants, but that's neither here nor there.
And finally, the "time line" thing. I gave up counting how many years it will take me until I'm an independent entity, whether that's as an Attending, PI, etc. The amount of time it will take me to complete the next step of my training is irrelevant to me at this point, as long as I'm happy from day to day. I'm well aware that it's gonna take me a long, long time to get to any finish line, so I just pretend the finish line doesn't exist. When the time comes, I will have to decide how important research will be to me. Who knows, I may never want to pick up another mouse again.