medical research phd vs md

PhD vs MD vs MD PhD – What’s right for you?

• Cracking Med School Admissions Team

For some students, choosing between a career in medicine and one in science seems like an impossible task. Many times, students will engage in research during college and develop an interest in medicine and do not want to give up the ability to do both by pursuing either a PhD or MD. Recognizing this desire, many medical schools have also created MD-PhD combined programs that allow students to get both degrees. With the plethora of options offered for graduate degrees coming out of college, many applicants are unsure of which program is best for them.

In this blog post, we will cover the following topics:

• PhD vs MD vs MD PhD?

What are the differences between PhD vs MD?

• MD vs MD PhD – which is right for a future doctor?
• Pros and Cons of MD PhD
• Complete List of MSTP Programs
• Resources for future MD PhD Applicants

Our Students Were Accepted at These MD PhD Programs!

PhD vs MD vs MD PhD

Before we analyze the differences between these programs, we will clearly define what each program consists of.

What is a PhD? PhD programs are funded graduate doctoral degree programs ranging from 4-8 years offered by research universities to teach and mentor graduates to contribute to research in their field, develop societal solutions, and train the next generation of scientists.

What is an MD? MD degrees are granted by allopathic medical schools in the United States, last four years, and prepare graduates to enter the world of medicine as physicians, usually through continued training in residency and fellowship programs.

What is an MD PhD program? MD/PhD programs are funded programs that last 7-9 years and train graduates to be clinical and academic leaders as both physicians and researchers who work closely with patients but also dedicate a significant amount of their time to researching areas adjacent to medicine to improve knowledge and treatment protocols.

When deciding PhD vs MD vs MD PhD, most students will first need to decide what aspects of science are most interesting to them – do they enjoy the interpersonal interactions or working with the biology itself to make new discoveries? First, let’s look at the differences between a PhD vs MD. There are three core differences between getting a PhD and an MD: career opportunities, admissions and training, and cost.

Career Options

As rigorous and prestigious degree programs, both MDs and PhDs have a plethora of career opportunities available to them. Most graduates from MD programs elected to continue their training by completing a residency and fellowship to become specialized and practice medicine. Nonetheless some graduates also choose to pursue alternative careers in public health, business, or education. In fact, 32% of graduates from Stanford’s MD program [1] chose not to a pursue a residency, many drawn by the allure of alternative ways to produce impact in society.

PhD graduates tend to have slightly more options, in both the academic and professional spheres. Many PhD candidates choose to pursue the established path of joining a research university to perform their research while teaching undergraduate and graduate students. This path often is best suited for those extremely passionate about their research topics who seek to mentor younger researchers and students but suffers from department politics attached to rising up professorial ranks and difficulties in receiving funding in certain disciplines.

Many other graduates choose to pursue non-academic work, whether it is joining an established industry company, starting their own companies, or working in public sector agencies. In these endeavors, they are able to leverage much of their subject matter expertise to conduct research, assess business operations and growth options, and contribute to public health or public works initiatives. At the same time, many graduates who take this path may find themselves drifting away from their academic routes and may find a slightly more fast-paced lifestyle than in academia.

Whether you pursue and MD degree or PhD degree, there are several post-graduate career options. 

Admissions and Training

Admissions and training processes and timelines are also highly variable between MD and PhD paths, and require different planning for each.

MD Admissions and Training: MD programs often have extremely long admissions timelines, often starting two years before matriculation when many students begin studying for the MCAT (the medical school admissions exam). In addition, the increasing expectations of applicants has resulted in an increasing number of students taking gap years to adequately prepare to apply. After applying and matriculating, medical students have four years of medical school, followed by anywhere from 3-10 years of post-graduate specialization training. Furthermore, applications often have multiple components, require in-person interviews, and have delayed decision timelines.

PhD Admissions and Training: In contrast, PhD programs have relatively simpler timelines, with most students applying the winter before they plan to matriculate, with many schools not requiring standardized testing (GRE) to apply. After applying, many students receive interviews within a few weeks and an admissions decision soon after. After matriculating, program length can differ significantly, but usually consists of 5-8 years of graduate research and training before one is able to complete their degree.

Despite recruiting students with similar skillsets and backgrounds, medical school and graduate PhD programs have radically different cost structures. While pursuing an MD is a costly endeavor (often ranging from $200-400k), PhDs are usually fully funded and most students receive a generous living stipend. With this in mind, one would assume that most students would naturally gravitate to a PhD. However, while the median biology PhD starting salary is $100k [2] , the median starting salary for a physician is double – at $200k [2] – such that many physicians recoup the cost of their education in the long term. Although the ultimate decision will depend on your desire to take on loans and your career and training area preferences, cost is undoubtably an important component of this decision as well.

What are the differences between MD vs MD PhD

Differences between MD and MD-PhD admissions are neither widely discussed nor well understood, mostly because only 6-7% of students applying to medical school choose to pursue this path. [4]  

MD-PhD programs are one of many dual-degree programs offered by medical schools and allow you to receive medical training while developing expertise in a particular research area. Your research focus can range from hard science like molecular biology and genetics to the social sciences like sociology. Since you would be getting two degrees, a MD-PhD program is designed to take 7-8 years, instead of 4 years for medical school and 5-6 years for a PhD. Usually, MD-PhD candidates will spend their first two years doing pre-clinical coursework with MD students. After completing their pre-medical requirements and taking the STEP 1 exam, MD-PhD students will usually take 3-5 years for their doctoral studies before they return for their final two years of clinical rotations.

In the United States, there are approximately 130 MD-PhD programs and 45 of these programs are known as Medical Scientist Training Programs (MSTP) programs. MSTP programs are funded by the National Institute of Health (NIH) and are very competitive as they offer full tuition coverage, support with living expenses, and a stipend. While some MD-PhD programs are funded by institutions, many of them may not offer the same financial support as an MSTP program.

Since the key difference between the MD and MD-PhD program is the emphasis on research, make sure that you will be able to demonstrate a longstanding commitment to research and that you have tangibly and significantly contributed to research projects, which can take the form of presentations or serving as an author on papers. Also, make sure that your research mentor is prepared to submit a strong recommendation to attest to your readiness for such a rigorous program.

Only 6-7% of medical school applicants apply as an MD PhD candidate

AMCAS most meaningful activity example #2: This applicant chose to write about his work in the emergency room. You can see both the 700 character AMCAS activity description and the 1325 character AMCAS most meaningful essay.

Pros and Cons of Applying MD PhD

Pros of applying md phd vs md, why md phd #1: tuition funding .

There is no doubting it – medical school is very expensive. Since many MD-PhD programs are fully funded with a living stipend on top, many MD-PhD candidates feel that they are being “paid” to pursue this education. While many of their medical school classmates will graduate with tens or hundreds of thousands of dollars of debt, most MD-PhD candidates will not incur any cost during the course of their degree, attracting many looking to avoid accumulating further debt in addition to whatever was accrued during college. Although this funding seems attractive at first, it is important to remember that it comes at the cost of four more years, which could be time spent earning an attending’s salary. Depending on your choice of specialty, receiving this funding could actually be a negative if you aren’t interested in research.

Why MD PhD #2: Allows you to pursue 2 passions

If you are unable to decide between science and medicine, or want to pursue both, applying to an MD-PhD program will allow you to bridge these two disciplines and enjoy the best of both worlds. Many MD-PhD candidates believe that their professional careers would be incomplete without both research and medicine or seek to combine these two passions in their career. These are the exact candidates that MD-PhD programs exist for as they open up many opportunities that may not be available for regular MD students. Especially if you hope to have a career in academia or research-based medical universities, the skills and competencies of doing research and applying for grants is highly prized.

Why MD PhD #3: Receive great research and medical training in a shorter time period

It is undeniable that the condensed time frame of the MD-PhD program is highly appealing to those who seek to pursue both degrees. Instead of taking 9-10 years if completed separately, an MD-PhD program is highly integrated and structured to allow you to focus on one pursuit at a time while still providing continuity so that you can do research during your medical training and medical volunteering while completing your doctoral work. This blend allows for the shorter time period and still allows you to benefit from receiving high quality science and medical instruction.

Cons of Applying MD PhD vs MD

Why not apply md phd #1: time to complete degree .

Although the condensed format is ideal for those who have their hearts set on getting both an MD and a PhD, if you are unsure about pursuing both degrees or have a clear preference for one, the significantly longer educational period is a major factor to consider. A major aspect of the admission process for the MD-PhD is determining if you are prepared to make an almost decade-long commitment to a discipline, institution, and city. The projected 7-8 years to complete an MD-PhD is just that – a projection. Many times, there are factors both inside and outside of your control that can cause this number to vary greatly and increase to up to 10 years. Furthermore, since many people start their MD-PhDs at 23 or 24 years old, they often complete their residency in their late 30s, a fundamentally different time of your life where many of your friends from college may already have families and have been in the workforce for over a decade.

Why not apply MD PhD #2: You can still do research without a PhD

Although MD-PhD students learn how to apply for grants and the research skills necessary to drive their future academic careers, many MD students often pick up these skills if they take a research year, pursue a master’s degree, or spend a significant amount of time doing research in residency and beyond. In fact, while many researchers in academic institutions are PhDs or MD-PhDs, there are also numerous MDs who spend a large amount of their time dedicated to both clinical and basic science research. Furthermore, if your research interests are solely clinical in nature, you may be better served developing these skills in a residency or pursuing a master’s degree than pursuing an MD-PhD, which is usually more suited for basic scientists. Another downside to the MD-PhD is that while you will be focused on trying to pursue two separate paths as a clinician and scientists, many of your peers will be spending all of their time focusing on one of the two, which may put you at a disadvantage compared to them.

Why not apply MD PhD #3: May limit specialty choice

Finally, while MD-PhD students can technically pursue any residency after they graduate medical school, there is often a push to place them in less competitive and non-surgical specialties where they will have less clinical time and therefore more time to dedicate to their research work. Since surgical specialties are highly procedural, research is often a secondary consideration and usually not as prized as surgical dexterity. Furthermore, since you are more valuable to an academic center as a surgeon performing high value elective procedures than as a researcher, there is often a push to have surgeons focus on their clinical work. Similarly, many MD-PhDs may be encouraged to pursue less competitive specialties where they have more time to focus on their research work or where their research funding may be more valuable than the money they bring in from being a clinician. Although an MD-PhD student is free to pursue any specialty that they desire, these pressures are commonplace and often can stifle strong clinical preferences in favor of research potential.

List of MSTP Programs

As stated earlier, MSTP MD PhD programs are fully funded by the National Institutes of Health. 

As of 2021, here is the list of MSTP MD PhD programs by state.

University of Alabama at Birmingham School of Medicine http://www.uab.edu/medicine/mstp

Stanford University  http://med.stanford.edu/mstp.html

University of California, Davis School of Veterinary Medicine https://vstp.vetmed.ucdavis.edu/

University of California, Irvine School of Medicine http://www.mstp.uci.edu

University of California, Los Angeles & Cal Tech California Institute of Technology David Geffen School of Medicine http://mstp.healthsciences.ucla.edu

University of California, San Diego School of Medicine http://mstp.ucsd.edu

University of California, San Francisco School of Medicine https://mstp.ucsf.edu/

University of Colorado Denver http://www.ucdenver.edu/academics/colleges/medicalschool/education/degree_programs/mstp/pages/MSTP.aspx

Connecticut

Yale University School of Medicine http://medicine.yale.edu/mdphd

University of Miami Miller School of Medicine http://mdphd.med.miami.edu

Emory University School of Medicine M.D./Ph.D. Program http://med.emory.edu/MDPHD

Northwestern University Medical School http://www.feinberg.northwestern.edu/sites/mstp

University of Chicago Medical Scientist Training Program https://pritzker.uchicago.edu/academics/mstp-landing-page

University of Illinois at Chicago College of Medicine http://chicago.medicine.uic.edu/mstp

Indiana University School of Medicine, MSTP https://medicine.iu.edu/education/dual-degrees/

University of Iowa Carver College of Medicine https://medicine.uiowa.edu/mstp?

Johns Hopkins University School of Medicine https://mdphd.johnshopkins.edu/

University of Maryland School of Medicine http://mdphd.umaryland.edu

Massachusetts

Harvard Medical School/Massachusetts Institute of Technology

There are two MD/PhD programs through Pathways and HST. Read more about Harvard Medical School here:  https://crackingmedadmissions.com/how-to-get-into-harvard-medical-school/ http://www.hms.harvard.edu/md_phd

Tufts University School of Medicine http://sackler.tufts.edu/Academics/MSTP-Welcome

University of Massachusetts Medical School http://umassmed.edu/mdphd

University of Michigan Medical School http://medicine.umich.edu/medschool/education/mdphd-program

University of Minnesota Medical School http://www.med.umn.edu/mdphd

Mayo Medical School https://college.mayo.edu/academics/biomedical-research-training/medical-scientist-training-program-md-phd/

Washington University School of Medicine http://mstp.wustl.edu

Albert Einstein College of Medicine http://www.einstein.yu.edu/education/mstp

Columbia University College of Physicians and Surgeons http://www.cumc.columbia.edu/mdphd

Icahn School of Medicine at Mount Sinai http://icahn.mssm.edu/education/graduate/md-phd-program

New York University School of Medicine http://www.med.nyu.edu/sackler/mdphd-program

Stony Brook University https://medicine.stonybrookmedicine.edu/mstp

University of Rochester School of Medicine and Dentistry http://www.urmc.rochester.edu/education/md/md-phd

Weill Cornell/Rockefeller/Sloan-Kettering Tri-Institutional MD PhD  Program http://weill.cornell.edu/mdphd

North Carolina

Duke University Medical Center https://medschool.duke.edu/education/degree-programs-and-admissions/medical-scientist-training-program

University of North Carolina at Chapel Hill School of Medicine http://www.med.unc.edu/mdphd

Case Western Reserve University School of Medicine http://mstp.cwru.edu

Ohio State University College of Medicine http://medicine.osu.edu/mstp

University of Cincinnati College of Medicine MSTP http://www.med.uc.edu/MSTP

Oregon Health and Science University School of Medicine http://www.ohsu.edu/mdphd

Pennsylvania

Penn State College of Medicine http://www.pennstatehershey.org/web/mdphd

University of Pennsylvania Perelman School of Medicine http://www.med.upenn.edu/mstp

University of Pittsburgh http://www.mdphd.pitt.edu

South Carolina

Medical University of South Carolina https://education.musc.edu/colleges/graduate-studies/academics/dual-degree/mstp

Vanderbilt University School of Medicine MSTP https://medschool.vanderbilt.edu/mstp

Baylor College of Medicine MSTP https://www.bcm.edu/education/programs/md-phd-program

University of Texas Health Science Center Houston Department of Internal Medicine https://gsbs.uth.edu/mdphd/

University of Texas Health Science Center San Antonio Department of Neurology, Pharmacology, and Physiology https://lsom.uthscsa.edu/mimg/

University of Texas Southwestern Medical Center at Dallas https://www.utsouthwestern.edu/

University of Virginia Health System MSTP Program http://mstp.med.virginia.edu

University of Washington School of Medicine http://www.mstp.washington.edu

Medical College of Wisconsin MSTP https://www.mcw.edu/education/medical-scientist-training-program

University of Wisconsin School of Medicine and Public Health http://mstp.med.wisc.edu

Read our medical school profiles to learn more about each individual school. 

Now that we have reviewed what MD, PhD, and MD-PhD degrees consists of and how to apply, as well as some of the pros and cons of pursuing a MD-PhD program, we hope that you can make an informed decision about your graduate education! Even if you choose not to pursue an MD or PhD, many institutions have accelerated programs that allow MD or PhD graduates to complete the other degree in a shorter timeframe. Similarly, many medical schools even allow students to apply to add a PhD portion onto their education before they begin their clinical training. Regardless of whichever path is right for you, all three offer incredible opportunities to pursue scientific passions and work towards solving societal issues.

Here are some Cracking Med School Admissions Resources you will find helpful as you think about MD PhD programs:

• How To Shadow A Doctor
• Resume, CV, and Cover Letter Edits
• Premed Timeline: Planning For Medical School Applications

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• PhD vs MD – Differences explained
• Types of Doctorates

A MD is a Doctor of Medicine, whilst a PhD is a Doctor of Philosophy. A MD program focuses on the application of medicine to diagnose and treat patients. A PhD program research focuses on research (in any field) to expand knowledge.

Introduction

This article will outline the key differences between a MD and a PhD. If you are unsure of which degree is suitable for you, then read on to find out the focuses and typical career paths of both. Please note this article has been written for the perspective of a US audience.

What is a MD?

MD (also seen stylized as M.D and M.D.) comes from the Latin term Medicīnae Doctor and denotes a Doctor of Medicine.

MDs practice allopathic medicine (they use modern medicine to treat symptoms and diseases). A common example would be your physician, though there are numerous types of medical doctors, with different areas of speciality and as such may be referred to differently.

What is a PhD?

A PhD (sometimes seen stylized as Ph.D.) comes from the Latin term Philosophiae Doctor and denotes a Doctor of Philosophy.

A PhD can be awarded for carrying out original research in any field, not just medicine. In comparison to an MD, a PhD in a Medicinal field is focused on finding out new knowledge, as opposed to applying current knowledge.

A PhD in Medicine therefore does not require you to attend medical school or complete a residency program. Instead, you are required to produce a thesis (which summarizes your research findings) and defend your work in an oral examination.

What is the difference between a MD and a PhD?

Both are Doctoral Degrees, and someone with either degree can be referred to as a doctor. But for clarity, MDs are awarded to those with expertise in practicing medicine and are therefore more likely to be found in clinical environments. PhDs are awarded to researchers, and are therefore more likely to be found in academic environments.

This does not mean that MDs cannot pursue a research career, nor does it mean that a PhD cannot pursue clinical practice. It does mean, however, that PhDs are more suited to those who would wish to pursue a career in research, and that MDs are more suited to those who prefer the clinical aspects of medicine or aspire to become a practicing physician.

It should also be noted that a medical PhD doctorates possess transferable skills which make them desirable to various employers. Their familiarity with the scientific method and research experience makes them well suited to industry work beyond medical research.

Program structure and time

The standard MD program structure sees students undertake 2 years of coursework and classroom-based learning, before undertaking 2 years of rotational work in a clinical environment (such as a hospital). Getting an MD requires attending a medical school (accredited by the Liaison Committee on Medical Education) and completing a residency program. Both of which prepare students to diagnose patients and practice clinical medicine.

The standard PhD program lasts 5 to 7 years and sees students undertake original research (monitored by a supervisor). Getting a PhD requires the contribution of novel findings, which leads to the advancement of knowledge within your field of research. With the exception of some clinical PhDs, a PhD alone is not enough to be able to prescribe medicine.

PhD doctorates are required to summarize the purpose, methodology, findings and significance of their research in a thesis. The final step is the ‘ Viva Voce ’ where the student must defend their thesis to a panel of examiners.

To summarize, a MD program usually lasts 4 years, whilst a PhD program lasts 5 to 7 years. Before being licensed to practice medicine, however, you must first complete a residency program which can last between 3 to 7 years.

What is a MD/PhD?

A MD/PhD is a dual doctoral degree. The program alternates between clinical focused learning and research focused work. This is ideal for those who are interested in both aspects of medicine. According to the Association of American Medical Colleges, an estimated 600 students matriculate into MD-PhD programs each year .

The typical length of a MD/PhD program is 7 to 8 years, almost twice the length of a MD alone. As with a MD, MD/PhDs are still required to attend medical school and must complete a residency program before being able to practice medicine.

In comparison to PhD and MD programs, MD/PhD positions in the United States are scarce and consequently more competitive. The tuition fees for MD/PhD positions are typically much lower than MD and PhD positions are sometimes waived completely.

Those who possess a MD/PhD are commonly referred to as medical scientists. The ability to combine their medical knowledge with research skills enables MD/PhDs to work in a wide range of positions from academia to industrial research.

Finding a PhD has never been this easy – search for a PhD by keyword, location or academic area of interest.

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How to Decide Between an M.D. and M.D.-Ph.D.

The two medical programs differ in several ways, including time, expense and purpose.

M.D. vs. M.D.-Ph.D. Programs

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While M.D. degree recipients typically go into some field of medical practice, M.D.-Ph.D. graduates tend to find jobs in medical research and academia.

Pursuing a medical degree is challenging and requires great familiarity and comfort with biomedical science. For those inclined to delve deeper into biomedical research, dual M.D.-Ph.D. programs offer an intriguing and unique pathway and should be carefully considered.

How Are M.D. and M.D.-Ph.D. Programs Different?

M.D.-Ph.D. programs differ from M.D.-only programs in several ways, including time, expense and purpose.

Time Commitment

While M.D. programs typically take four years to complete, M.D.-Ph.D. programs integrate heavy research training and last an average of four years longer than traditional medical school . This significant time commitment allows you to complete the requirements for a Ph.D. in a biological science, typically doing lab rotations before and during the first and second years of med school, followed by full-time lab work between the second and third years and culminating in thesis defense and awarding of the Ph.D. degree.

These joint programs typically are accelerated. Some medical students complete the Ph.D. requirements in three years, but most need four to five years. With the Ph.D. work done, the M.D. is earned upon completion of the third and fourth years of med school.

Cost Considerations

The average cost of medical school alone in the U.S. is $230,296, according to the Education Data Initiative, although it can range depending on the school and the student's state of residency.

Generally, M.D.-Ph.D. programs cost more because of the additional degree. However, the National Institutes of Health's dual M.D.-Ph.D. programs are divided into those that receive NIH Medical Scientist Training Program funding via a T32 research training grant for their students, and programs that don't. All MSTPs and many non-MSTPs waive med school tuition and provide stipends for M.D.-Ph.D. students.

Thus, many M.D.-Ph.D. students don't need to take out additional loans, which can be a significant advantage.  

M.D. degree recipients tend to go into some field of medical practice, while M.D.-Ph.D. graduates veer more toward medical research and academia.

Typically for M.D.-Ph.D. studies, MSTP programs are better organized and more productive than their non-MSTP counterparts, and more effectively prepare students to compete for independent faculty positions at academic medical centers.

The career goal of becoming a physician scientist who practices medicine and runs an NIH-funded research laboratory drives M.D.-Ph.D. students through a long and difficult training period, which is the primary purpose of such programs.  

What Is the M.D.-Ph.D. Application Process?

Applying to M.D.-Ph.D. programs, similar to M.D.-only programs, can be done through the American Medical College Application Service, known as AMCAS . The same application materials are required, plus two additional essays: an M.D.-Ph.D. essay detailing your motivation to apply and an essay describing your individual research experiences and accomplishments. 

Throughout your application, your thoughtful consideration of the M.D.-Ph.D. pathway and a genuine passion for research must be evident. This is commonly the No. 1 component that admissions committees look for – does this applicant truly love biomedical research and demonstrate the commitment to science that will keep them motivated and on track during the arduous training process?

Passion and commitment can be communicated through the essays, work and activities section, personal statement , interviews and, critically, letters of recommendation – hopefully from accomplished faculty in biomedical sciences. 

Significant research background is expected for M.D.-Ph.D. applicants, and it is extremely important to demonstrate high familiarity with research throughout the application.

A minimum of two years in a lab is generally considered significant research experience, and many applicants take one or more gap years to expand their research background and acquire further recommendation letters from scientists or doctors who can speak to both clinical and research potential. These recommendations take on added importance in the smaller biomedical research community.  

What About an M.D. With Research  vs. an M.D.-Ph.D.?

So, you’ve joined a lab as a premed and are enjoying research – at least more than you expected to. That’s great! At the very least, clinical medicine needs physicians with a strong background in scientific research.

But how do you know whether you should pursue an M.D.-Ph.D. program, with the goal of a lifelong career in research after graduation? Many med students, residents and attending physicians without a Ph.D. lead successful research endeavors, so pursuing an M.D. with research is feasible. 

If you’re weighing such a choice, ask yourself if science brings out enough passion in you to sustain a lengthy training period. If the thought of watching your peers graduate and rise in their professions while you remain in training is outweighed by the thrill of scientific discovery, an M.D.-Ph.D. program may be a wise decision. 

The benefits of a Ph.D. through a combined M.D.-Ph.D. program, compared to pursuing research later in your career as an M.D., are:

• Elevated familiarity with the methodology of basic science.
• More in-depth experience in carrying out experiments, compiling data, writing and publishing high-impact papers.
• Networking opportunities and the valuable connections they can create.

The protected research time of a Ph.D. is a rare and valuable commodity. Never in your career as a doctor will you have an opportunity to delve as deeply into a scientific subject as you will during Ph.D. studies. Although exceptions abound, researchers without a Ph.D. are frequently limited to clinical or translational science, and often do not feel comfortable enough with basic science methodologies to run a laboratory built around such techniques. With fewer publications and experience, the transition to an independently funded scientific career is typically harder.

Traditionally, this transition is accompanied by a K08 clinical investigator award, which provides funding for supervised research development as a final step before full independence, for example running a NIH R01-funded laboratory . K08 grants and other early-career funding opportunities are competitive, so it's a great benefit to have more publications and research experience.  

Should I Apply to Traditional M.D. Programs as a Backup?

M.D.-Ph.D. programs are highly competitive, as you must demonstrate to a medical school that you are worth significant time and financial investment. Admissions committees must feel that you are a worthwhile investment and will contribute significantly to biomedical research as a future alumnus. 

After deciding to apply to M.D.-Ph.D. programs, should you apply to traditional M.D.-only programs as a backup option? If you feel you have enough clinical experience to be competitive for M.D.-only programs and don't want to take a gap year, this is a realistic backup pathway. You can still pursue a meaningful research direction as an M.D., particularly if you dedicate several years to a postdoctoral position to learn research techniques. 

A cautionary word of advice: Honestly self-reflect and try to understand and maintain focus on your primary interest.

If you are more excited to practice clinical medicine than research, you should heavily consider applying only to traditional M.D. programs. You can still pursue collaborations with basic science researchers and participate in clinical trials without a Ph.D., with a flexible level of involvement in basic science. 

To make the right decision, consider your personal aspirations, long-term career goals and genuine level of commitment to biomedical research. Carefully evaluate these factors, as well as your qualifications.

Seek out mentorship from M.D.s and M.D.-Ph.D.s who know you and your application, and ask them whether you will be competitive for such programs. It can help to ask M.D.-Ph.D.s how they knew they wanted to apply, if they would make the same decision again and whether they can see you being fulfilled in a career using that degree. 

Premed students commonly describe their affinity for medicine with a variation of the words, “I can’t imagine a fulfilling career outside of medicine.” The decision-making process for an M.D.-Ph.D. versus a traditional M.D. can often be broken down similarly: Can you imagine a fulfilling career without scientific research?

If the answer is yes, an M.D.-Ph.D. probably doesn’t align with your career goals. If the answer is no, this long but rewarding training path may indeed be for you.

As you embark on this application journey , know that regardless of the path you choose, you have likely already developed an appreciation for the importance of scientific discovery in furthering advancements in clinical care. Successful completion of either program will allow you to make valuable contributions to biomedical science, and it is a privilege to have the opportunity to advance understanding of medicine in such a unique and meaningful way. 

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About Medical School Admissions Doctor

Need a guide through the murky medical school admissions process? Medical School Admissions Doctor offers a roundup of expert and student voices in the field to guide prospective students in their pursuit of a medical education. The blog is currently authored by Dr. Ali Loftizadeh, Dr. Azadeh Salek and Zach Grimmett at Admissions Helpers , a provider of medical school application services; Dr. Renee Marinelli at MedSchoolCoach , a premed and med school admissions consultancy; Dr. Rachel Rizal, co-founder and CEO of the Cracking Med School Admissions consultancy; Dr. Cassie Kosarec at Varsity Tutors , an advertiser with U.S. News & World Report; Dr. Kathleen Franco, a med school emeritus professor and psychiatrist; and Liana Meffert, a fourth-year medical student at the University of Iowa's Carver College of Medicine and a writer for Admissions Helpers. Got a question? Email [email protected] .

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• Medical School Application

MD-PhD vs MD: Which Path is Best For You?

Featured Expert: Dr. Jacquelyn Paquet, MD, PhD

If you find yourself struggling between pursuing an MD-PhD vs MD degree, you've come to the right place. You may have really enjoyed research during your undergraduate degree, or you think a PhD will help you in your career goals. Either way, the decision to pursue an MD or a MD-PhD is an important one and should be considered carefully. In this blog, we'll explore the similarities and differences between medical doctors and physician-scientists to help you determine how to choose the pathway that is best suited for you.

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Article Contents 7 min read

Md-phd vs md.

An MD-PhD program is a dual-degree program that trains students to become both medical doctors (MD) and research scientists (PhD). It combines the clinical education of medical school with advanced research training in a specific scientific discipline.

Graduates are equipped to bridge the gap between medicine and research, often pursuing careers as physician-scientists who contribute to both patient care and medical innovation through scientific discovery. While MD graduates can and do participate in research, an MD-PhD is uniquely equipped to lead research programs and engage with academic medicine.

MD-PhD programs are more intensive than MD programs as they involve all of the normal program requirements of medical school combined with the rigor of a PhD program. While some MD programs involve research programs or theses, an MD-PhD involves independent research at the highest level.

Those with MD-PhD and MD degrees are both medical doctors and you may be wondering how long it takes to become a doctor . For MD-PhD programs, you will also complete a PhD which requires a different program structure and length compared to MD programs.

MD-PhD programs are generally 7-8 years in length and require attendance at both medical and graduate school concurrently. MD programs, on the other hand, will be completed in four years, half the time it will take MD-PhD students.

While both programs are classroom-based during the first two years, MD-PhD students will move on to graduate school to complete their PhD thesis for between 3-4 years. They will then return to medical school for a year or two to complete clinical rotations. There are many different program schedules depending on the school and the program so make sure you do your research into your desired program.

Following the completion of medical school, both MD-PhD and MD graduates will complete their residency training for between 3-7 years before being licensed to practice medicine.

Your medical school application preparation and timeline are not very different for MD-PhD vs MD programs, but you need to consider a few additional factors.

To apply for most MD-PhD programs, you’ll start by applying for the MD program and applying to the PhD program separately.

On the MD side, you'll apply to most programs through AMCAS , where you'll complete all sections of the application, including the AMCAS work and activities section and you'll upload your coursework, letters of evaluation, and medical school personal statement .

You should make sure even your general MD requirements like the personal statement still allude to your success in the PhD program. One of our experts, Dr. Jacquelyn Paquet, gives some valuable advice on crafting a personal statement for an MD-PhD:

“In your personal statement you want to highlight your breadth and skillset in research and areas of interest. You also want to highlight how completing a PhD will make you a stronger clinician and how you see yourself fulfilling the roles of researcher and clinician.” -  Dr. Jacquelyn Paquet, PhD, MD

Some components may matter more in an MD-PhD application than an MD. For example, it is unlikely you will get into an MD-PhD program with a low GPA , as GPA is a more important factor for your academic success. If you are also applying to a PhD program, make sure to emphasize your research experience in your medical school resume .

There may be additional application components in order to gain a place in an MD-PhD program. These can include an MD-PhD essay or a graduate school statement of purpose .

In general, for a joint program you need to apply to both an MD and a PhD program at the same time and gain admission to both. However, some schools, such as Stanford Medical School , allow you to apply for their PhD programs during your first year of medical school.

It's no secret that both MD-PhD and MD programs are extremely competitive, with medical school acceptance rates averaging under 5% and many schools having acceptance rates closer to 1%.

There are far fewer MD-PhD programs available compared with MD programs and the large benefit of reduced or waived tuition can make for stiff competition. However, generally there are far fewer applicants for an MD-PhD program, meaning it might not necessarily be as competitive to get in.

This is especially true if you have a stellar academic and research background .

Here are 5 quick tips on getting accepted to an MD-PhD Program!

MD-PhD vs MD: Tuition and Cost

Your medical school tuition and overall cost of medical school can be very expensive. For both MD and MD-PHD students, during their four years of medical school tuition can cost between $40-60,000 at public universities and $60-80,000 at private schools. In general, MD-PhD students will pay reduced tuition in years where they are primarily working on PhD program requirements. Depending on your program you may get tuition fee waivers or graduate school stipends as well.

As a PhD student you may also be eligible for graduate school scholarships which can help ease the load of tuition. For example, students in MD-PhD programs are eligible to apply for funding from the National Institute of General Medical Sciences (NIGMS) through the highly competitive Medical Scientist Training Program (MSTP).

Generally, MD graduates have a higher level of indebtedness upon graduation, ranging between $200-250,000. In contrast, MD-PhD graduates typically graduate with less than $100,000 in debt.

However, it is important to note that there is a big difference between programs here. Those in highly competitive programs at top schools might receive many scholarships and awards, whereas those in other programs may receive none and end up with more debt over a longer period than typical MD graduates.

MD-PhD vs MD: Career Outlook and Salary

As MD-PhD graduates possess two degrees there are many different potential career paths that they can take with many different outcomes.

MD-PhD graduates will also complete residency before they find a permanent career. The most common residency training programs for MD-PhDs are in internal medicine , pathology , pediatrics , and neurology , however, many other specialties are also represented. 

According to a study conducted by the AAMC, nearly all MD-PhD graduates enjoy careers as faculty members at medical schools or work for the National Institute of Health (NIH), other research institutions, industry, and federal agencies with many devoting a large portion of their time to research. While these positions may allow you to practice medicine in some way, most of them are much more based in theory or education rather than a clinical setting. The typical MD-PhD position is 70-80% research, with the rest being administrative or clinical work.

You can look up which medical specialties make the most money to help inform you on salary potential from an MD or MD-PhD program. Generally, MDs can expect to make $180,000 to above $280,000 when they finish residency. Average starting salaries of MD-PhD graduates are much lower, between $75,000 and $150,000.

However, the bottom line is that this is highly variable depending on your career path and MD-PhD career paths often have much more room for growth into positions of leadership. An academic administrator at a university with an MD-PhD will generally make much more than a family physician, while a specialized surgeon with just an MD could easily make more than both combined! 

Potential salaries are important, but you should also consider the impact on your work-life balance. Working in academia or research can be stressful, but usually the time demands will be less than that of a clinician or at least will be more predictable. Another recent study found that 86% of MD-PhD graduates were satisfied with their career path and 77% would choose the same career path if they could back. While career satisfaction differs across disciplines, on average 76% of MDs were satisfied with their career paths meaning MD-PhDs generally have a more positive career outlook.

So, what if you have a passion for both science and medicine? How can you choose whether to pursue an MD degree or a joint MD-PhD degree?

Find Out What Drives You

Start by thinking about what you're interested in and what motivates you to help you determine where your true passions lie. If you know that you are really interested in medicine and in helping others but only have a slight interest in research, then it's probably a good idea to pursue an MD or DO program on its own

If you are interested in those bigger questions and societal issues surrounding healthcare, maybe an MD-PhD is for you. 

You can find out what inspires you by participating in as many experiences as you can early on such as through early-stage high school internships . You can explore different research opportunities as an undergrad student.

Let Your Experiences Guide You

If you're struggling to decide between an MD and MD-PhD program, be sure to gain both clinical and research experience . This will be a great way for you to get hands-on experience in both fields to see which areas really spark your interest.

Learn how to ask to shadow a doctor , sign up for volunteering experiences that place you in the medical or research field, and partake in scientific experiments where you'll be testing hypotheses to gain research experience.

Not only will these experiences be essential when filling out your medical school applications, the key is that through a variety of different experiences, you'll be able to home in on your interests.

Consider the Cost

A major benefit of MD-PhD programs is the fact that most programs partially cover or completely waive tuition for enrolled students, and many also provide a stipend that can be used to cover the costs of living expenses. Now, this isn't to say that you should simply pick a program based on the cost but how to pay for medical school is an important factor to consider if you want to pursue either option.

This varies depending on the specific program and your research topic, but you can expect to take 7-8 years to complete the requirements of both an MD and PhD.

Yes! While not as intensive there are many other research opportunities for medical students such as master’s programs and internships.

Not necessarily. While PhDs can lead to different positions, including high-paying administrative roles, they are not a guarantee for more financial success.

Often you can actually save money during an MD-PhD program. This is because many programs offer stipends or tuition waivers to MD-PhD students.

Yes, an MD-PhD will take longer than a regular MD program. You should not undertake one if you are interested in practicing medicine as quickly as possible.

Generally, yes. While some programs may allow you to apply for a PhD once you’ve been admitted to medical school, most require concurrent applications.

Yes and no, as both programs can be highly competitive with low admissions rates. While there may be additional components and limited spots for MD-PhD programs, it is not necessarily harder to get into an MD-PhD program if you have a strong research background.

Yes. Most students entering regular MD programs have research experience and given the research-intensive nature of MD-PhD programs it is essential to gain research experience before you apply.

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• PhD vs MD: What You Need to Know Before Deciding
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• Medical School

Choosing between a PhD and an MD is crucial as it determines your future career. But before making a choice, it’s imperative to understand where the two degrees differ and what each has to offer. 

Have you ever wondered whether a career in research or patient care is the right fit for you? Choosing between a PhD and an MD can significantly shape your professional life. Understanding their differences is crucial for making an informed decision that aligns with your interests and career goals.

✅ Request information on AUA's MD program TODAY!

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So, if you’re stuck in choosing between PhD vs MD degrees, come along as we delve into the differences between these two degrees and what to consider before making your decision. This blog post includes everything you need to know!

What Is a PhD?

A PhD, or Doctor of Philosophy, is a degree awarded to professionals who conduct research in medicine. This title, however, can be awarded not only to medical professionals but also to anyone who conducts research in their chosen field. 

The process develops deep expertise, critical thinking, and advanced research skills, contributing further to enhanced career opportunities for the PhD title owner and new knowledge in the field the research has been conducted in. 

What Is an MD?

The MD, Doctor of Medicine degree, is awarded by medical schools to students seeking to become physicians and specialize in a chosen medical field. It is divided into two phases: theoretical and practical. 

The primary focus of an MD is patient care, emphasizing the practical application of medical knowledge to treat physical and mental health conditions. After earning an MD, graduates must complete residency training in a chosen specialty.

Difference Between PhD and MD

Making the difference between PhD and MD degrees requires a closer look at the educational pathways, training and skills acquired, and career opportunities each degree offers.

Educational Pathways

The educational path for obtaining a PhD degree is purely academic, mixed with research requirements:

• Bachelor’s Degree: Start with an undergraduate degree, typically in a related field.
• Master’s Degree (sometimes optional): Some programs require a master’s degree before entering a PhD program.
• Coursework and Exams: After applying and getting accepted into a PhD program, you begin with 1-2 years of advanced coursework to build specialized knowledge in your field. Passing exams that test your understanding of the field is vital. These are often required before moving on to research.
• Research: Develop a research question or project and get it approved by your advisor and committee. Then, conduct original research, which may often take several years, contributing new knowledge to the field.
• Dissertation: Write a detailed document presenting your research findings and defend your research before a committee of experts.
• Graduation: If successful, earn your PhD and become an expert in your field.

On the contrary, MD candidates go through an educational process that combines both the theoretical and the practical:

• Bachelor’s Degree : Start with an undergraduate degree, often with a focus on pre-medical courses like biology and chemistry.
• Medical College Admission Test (MCAT) : Take and pass the MCAT , a standardized exam required for medical school admission.
• Medical School (4 years):
• Years 1-2: Complete classroom-based courses covering medical sciences like anatomy, pharmacology, and pathology.
• Years 3-4: Engage in clinical rotations in hospitals, working in different specialties like surgery, pediatrics, and internal medicine.
• USMLE Exams : Pass the United States Medical Licensing Examination (USMLE) Step 1 and Step 2 during medical school.
• Graduation : Earn your MD degree upon completing medical school.

Following graduation, MD’s are required to begin residency training, where they work as doctors under supervision. After residency, they need to pass exams to become board-certified in a chosen specialty.

Training and Skills

The PhD degree equips candidates with a diverse range of skills that stem from years of knowledge acquisition, research, and writing experience. The most critical skills PhD owners have include:

Research Skills

• Learn how to design, conduct, and analyze research projects
• Develop expertise in research methods and tools specific to your field

Critical Thinking

• Sharpen the ability to evaluate theories, data, and research findings
• Learn to identify gaps in existing knowledge and formulate new questions

Problem-Solving

• Tackle complex problems through independent research
• Develop innovative solutions and contribute new insights to your field

Writing and Communication

• Improve academic writing skills, especially for writing research papers and your dissertation
• Learn to present complex ideas clearly, both in writing and orally

Teaching and Mentoring

• Gain experience teaching undergraduate students and mentoring junior researchers

The MD degree, on the other hand, provides a wide range of strengths that extend beyond soft skills, equipping candidates with advanced medical prowess that aids in effective patient care. The list includes: 

Medical Knowledge

• Learn in-depth about human anatomy, physiology, diseases, and treatments
• Understand the science behind various medical conditions and how to treat them

Clinical Skills

• Develop hands-on skills like taking patient histories, performing physical exams, and conducting medical procedures
• Learn how to diagnose illnesses, interpret lab results, and create treatment plans

Patient Care

• Enhance communication skills for interacting with patients and their families
• Learn how to provide compassionate, patient-centered care
• Work closely with other healthcare professionals, like nurses and specialists, to provide coordinated care

Professionalism and Ethics

• Understand the ethical principles of medicine, including patient confidentiality and informed consent
• Develop a strong sense of responsibility and professionalism in all interactions

Career Opportunities

The career outlook for PhD individuals is vast. From academic settings to research, here are some potential careers for PhD graduates:

• Academic Professor: Teach and conduct research at universities, mentoring students and contributing to academic knowledge.
• Research Scientist: Work in laboratories (universities, government, or private companies) conducting experiments and studies to advance knowledge in your field
• Consultant: Provide expert advice to businesses, government agencies, or non-profits, using your deep knowledge to solve complex problems
• Data Scientist: Analyze large data sets to identify trends and insights, often working in tech, finance, or healthcare
• Science Communicator: Write, speak, or create content to explain complex scientific concepts to the public, working in media, museums, or education

Potential careers for MD graduates include:

• Primary Care Physician: Provide general medical care, including diagnosing and treating common illnesses, and managing overall patient health
• Surgeon : Perform operations to treat injuries, diseases, or deformities, specializing in areas like orthopedics, neurosurgery, or cardiac surgery
• Medical Researcher: Conduct research to develop new treatments, medications, or medical technologies, often working in hospitals, universities, or pharmaceutical companies
• Hospital Administrator: Manage hospital operations, overseeing staff, budgets, and policies to ensure efficient and effective patient care
• Public Health Official: Work to improve community health through policy, education, and disease prevention programs, often within government or non-profits

The salary expectations for both PhD and MD graduates are relatively high, with some careers offering better salaries than others. 

Academic professors, for example, can expect an annual salary of $84,340 by working in public and private universities and colleges or professional schools. Medical scientists, currently in demand and with an expected growth in employment by 10%, gain $100,890 yearly income. 

The demand for data scientists, on the other hand, is significantly higher than most careers, with 35% estimated growth , and with a salary that reaches $108,000 every year. 

MD graduates typically have higher salaries, resulting from the high-risk critical nature of their work in dealing with patients. The salary for surgeons of any specialty is up to $343,900 annually, which surpasses many other careers. Hospital administrators’ salaries are also high, with a $272,355 median salary per year.

In general, the demand for physicians and surgeons is anticipated to grow by 3% in the following decade. 

Considerations for Choosing Between a PhD and MD

Aside from the differences between PhD vs. MD degrees, one must consider their personal interests and goals before taking the next step. Career aspirations and lifestyle choices also should factor in when making the ultimate decision. 

Personal Interests and Goals

Choosing between a PhD and an MD depends on your personal interests and career goals. If you’re passionate about research, discovery, and contributing new knowledge, a PhD may be the right path. 

If you’re driven by a desire to directly help patients, diagnose, and treat illnesses, an MD aligns better. Both require dedication, but the choice hinges on whether you prefer research or clinical practice.

Career Aspirations

Career aspirations significantly influence whether a PhD or MD is the better fit. A PhD is ideal for those aiming for careers in academia, research, or specialized industry roles, where deep expertise and innovation are key. 

An MD suits those aspiring to practice medicine, provide patient care, or work in clinical settings. Each degree supports distinct professional paths—research for PhDs, and patient care for MDs.

Work-Life Balance and Lifestyle

Work-life balance and lifestyle differ between a PhD and an MD. PhD careers, especially in academia or research, often offer more flexible hours, allowing for better work-life balance. MDs, particularly in clinical roles, may face long, irregular hours, especially during residency and early practice, leading to more demanding lifestyles. 

However, MDs often experience high job satisfaction from direct patient care, despite the rigorous schedule.

Understanding the differences between a PhD vs. MD proves to be vital for any student. From the educational path each degree requires to the skills acquired and the careers offered, exploring their differences can aid in making the right choice for your future.

Reflect on your personal interests and career goals to determine which path aligns best with your aspirations. Whether you want to contribute to academic knowledge or provide patient care, each degree has its importance and can prepare you for success!

Frequently Asked Questions (FAQs):

Is it possible to combine a phd with an md, and if so, how.

Yes, combining a PhD with an MD is possible through MD/PhD programs, which integrate medical training with research-focused PhD studies. This path allows for a career that blends clinical practice with advanced research.

Can you pursue a PhD after earning an MD?

Yes, you can pursue a PhD after earning an MD. Many MDs choose to return to academia to conduct research, often focusing on areas where their clinical experience enhances their scientific work.

Why I Chose AUA:

“I was confident going into AUA because of their leadership. It was clear to me from the beginning that the staff and administration from top to bottom were pioneers and leaders in medical education. They showed a great deal of commitment by investing in constructing a brand new state of the art campus while I was there. Although the new campus opened shortly after I left the island, it was encouraging to watch its construction. It let us know that AUA was committed to investing back into its students, and are here to stay for years to come.”

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Comparing the differences between MD vs. PhD vs. professional doctorate

Written by Michael Feder

Reviewed by Marc Booker , PhD,  Vice Provost, Strategy

What is a doctorate? Breaking down the three types

Some people might confuse an MD (Doctor of Medicine) with a PhD (Doctor of Philosophy), and vice versa. While both an MD and a PhD are prestigious degrees near the top of the  academic ladder , they each have a different meaning and come with very different requirements.

Different still from both of those degrees are professional doctorates, which allow industry professionals to translate their education and experience into credibility and leadership through research. Professional doctorates have similar requirements to PhDs, such as a dissertation and residency, but focus on the application of research and professional growth over original research.

Upon graduation, those who have earned any of these three degrees can call themselves a “doctor,” but the path to a degree, the purpose behind it and its applications vary based on the choice. MD graduates want to work in medicine and healthcare. PhDs want to bring new knowledge and research to the world. A practice-based doctoral graduate wants to grow in their professional expertise. (If the last one sounds like you, University of Phoenix can help!)

Keep reading to learn more about these doctoral programs and which is right for you.

What does MD stand for?

MD is an abbreviation for Doctor of Medicine and identifies a medical practitioner who has completed undergraduate studies and four years of medical school. An MD program teaches medical students about the human body and diseases through a combination of classroom instruction and hands-on clinical labs.

Several  types of physicians  might have this degree, depending on their area of study. For example, medical practitioners with an MD degree might become a medical doctor and potentially specialize in dermatology, cardiovascular disease, family medicine, oncology, pediatrics, neurology or preventive medicine. As you can see, this degree can lead to a variety of career paths, depending on which specialty interests you and what your medical education is.

How to earn an MD

Becoming a Doctor of Medicine  requires a significant investment of time and money, but the reward can be well worth it. Before medical school, you’ll need to  take the Medical College Admission Test  (MCAT®) and earn a passing score. You’ll also need to build a portfolio of coursework and experience to help you gain admittance to medical school.

Medical school typically takes students four years to complete. You’ll learn the latest techniques and approaches for patient assessment, diagnosis and treatment. Medical schools commonly provide a combination of classroom, research and clinical experience. You’ll work alongside peers and healthcare professionals as you develop skills in general medicine.

You’ll choose a field to specialize in during your final year of medical school. Students have more than 120 options to choose from when specializing, including primary care, pediatrics, geriatrics, emergency medicine and family medicine.

After graduating, you’ll complete residency training to further develop skills in your specialty. Residency typically lasts three to seven years, depending on the field you’ve selected. During the residency portion of your education, you’ll treat patients under the supervision of more experienced physicians.

Even after you begin to practice as an MD, the educational portion of your career never stops. As practices change, patient needs evolve and research continues, MDs benefit from ongoing education to stay current.

What does PhD stand for?

A PhD, or Doctor of Philosophy, is a doctoral degree that recognizes graduates who have completed a full postsecondary program. Students can earn a PhD in more fields than philosophy. After completing the necessary coursework, original research and hands-on experience, you can earn a PhD in fields like science, the humanities and engineering.

Earning a PhD can help unlock a wide range of potential career opportunities. Computer engineers, research scientists, statisticians, healthcare administrators, professors, chemists and other careers commonly require a PhD degree, in addition to appropriate undergraduate study.

How to earn a PhD

Becoming a PhD is also a serious commitment that requires an investment of time, money and energy.

Here is what’s typically required to become a PhD:

• Complete a bachelor’s degree in your field
• Complete a master’s degree in an appropriate field
• Pass any program entrance exams
• Fulfill coursework, research and hands-on lab requirements in your program
• Finalize and defend your dissertation as a  doctoral candidate  (unless your program specifies otherwise)

It’s important to note that many PhD programs have different requirements, prerequisites and parameters for students. Check with your preferred institution for a more detailed explanation of these requirements.

What is a professional doctorate?

While some professional or practice-based doctorate programs are medical,  others are designed for professionals in other fields . These programs are meant for scholar-practitioners in disciplines like education, business or psychology. One of the key differences between this degree and a PhD is the focus on applying research to a professional setting rather than conducting theoretical and research-focused studies. Often, programs are differentiated as academic versus professional.

Examples of doctoral degrees are Doctor of Education, Doctor of Nursing Practice and Doctor of Business Administration. Each of these programs focuses on a specific discipline and applying research in those areas to a professional setting.

How to earn a doctorate

While  practitioner doctoral programs  teach different skills, they all share common requirements. You’ll need to complete a bachelor’s degree in your field and sometimes a master’s degree, depending on program requirements.

After completing the necessary coursework and research, students also typically need to finish a supervised thesis and defend their dissertation or capstone project-specific coursework, research and hands-on labs alongside other students in the same field. However, this will depend on the specific program and its requirements.

What does the title “Dr.” really mean?

The term “doctor” or “Dr.” is commonly used today to describe a wide variety of occupations. Students who complete a doctoral degree can earn the title of “Dr.” even though they earned their credentials in a non-medical field like education or business management.

While a variety of professionals can earn a doctorate, the term is often still  reserved for medical practitioners . In conventional use,   doctors typically refer to medical physicians. However, it is appropriate to use “Dr.” if you graduated from any of the three programs discussed above.  

Practitioner doctoral degree programs at University of Phoenix

While University of Phoenix (UOPX) does not have MD or PhD programs, it does offer several professional doctoral degrees that can be earned completely online. Students might choose the UOPX programs because classes are flexible and offered online, and because of the University’s unique “ Scholar-Practitioner-Leader model .”

If you are curious about a doctoral degree, the following programs are available at UOPX:

• Doctor of Business Administration : This doctorate can help you gain strategic vision and skills to position yourself as a business leader. It explores how to solve organizational problems, how to design and conduct research studies, how to introduce innovative business ideas to the industry and more.
• Doctor of Management :  This doctorate equips you with critical thinking skills to find creative solutions to complex problems.
• Doctor of Education : This doctoral program prepares you to use analytical, critical and innovative thinking to improve performance and solve complex problems in education.
• Doctor of Health Administration : If you’re a health professional who is seeking greater responsibility in shaping the future of the health sector, this doctorate can help you meet the challenges inherent to today’s healthcare landscape, including economic fluctuations, burgeoning patient needs and industry-changing legislation.
• Doctor of Nursing Practice : This doctorate is designed for working nurses who require a doctorate for advanced practice or nurses who desire their terminal degree. It does not prepare students for professional certification or state licensure as a nurse or as an advanced practice nurse.

These doctoral studies are only some of the many options for professionals who want to gain the highest academic credentials in their fields. Doctoral programs offer significant benefits to program graduates, including newly developed skills, insight into field trends, hands-on research opportunities and leadership capabilities.

Completing a doctoral program is also a strong indication to employers that you’re serious about your career and your field. With so many options for advanced study, these programs are available for most major fields. Even if you have already completed a bachelor’s or master’s degree in your discipline, a doctorate lends further credibility to your reputation and can help prepare you for a leadership position.

ABOUT THE AUTHOR

A graduate of Johns Hopkins University and its Writing Seminars program and winner of the Stephen A. Dixon Literary Prize, Michael Feder brings an eye for detail and a passion for research to every article he writes. His academic and professional background includes experience in marketing, content development, script writing and SEO. Today, he works as a multimedia specialist at University of Phoenix where he covers a variety of topics ranging from healthcare to IT.

ABOUT THE REVIEWER

Dr. Marc Booker, University of Phoenix Vice Provost for Strategy, has more than two decades of experience working with online and distance education students at the post-secondary level. He currently oversees critical path academic initiatives to improve the student experience. Dr. Booker is a regular speaker, author and contributor to national higher education associations.

This article has been vetted by University of Phoenix's editorial advisory committee.  Read more about our editorial process.

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MD vs. MD/PhD: Key Differences and Choosing the Best Path

by internationalmedicalaid

MD/PhD vs. MD: Education

Both MDs and MD/PhDs are medical doctors, but MD/PhDs also hold a PhD and therefore are known as physician-scientists or medical scientists. If you want to obtain this additional title, you will need to take part in a program with a different structure and length than standard MD programs. MD/PhD programs are typically between seven to eight years in length and require one to attend both medical and graduate school. MD programs can be completed in four years (half the time of an MD/PhD program). During the first two years, both programs are classroom-based, but MD/PhD students will move on to grad school to complete their PhD thesis during years three and four. Afterward, they will return to medical school for one to two years to focus on completing clinical rotations. Both MD and MD/PhD students will take part in and spend around three to seven years in a residency program before obtaining their license to practice medicine.

MD/PhD vs. MD: Application and Tuition

The application for both programs is similar no matter which you decide to pursue. You will apply to the majority of these programs through the AMCAS , completing all sections of the application, including the AMCAS work and activities section , and uploading your coursework, letters of evaluation, and personal statement . Before submitting your application, it is important to check the requirements of each medical school, as some will require you to take the CASPer exam . If the program you want to apply to requires this exam, begin practicing for the exam by utilizing practice questions as soon as you can to best prepare yourself. In addition to the standard components of an MD program application, MD/PhD applicants will need to complete two additional essays. These essays will describe their reasons for pursuing an MD/PhD program and their previous research experience. Review each college’s application process and timeline to ensure you are aware of the process and any deadlines.

On average, the yearly medical school tuition for students enrolled in an MD program is around $37,000 in-state and $62,000 out-of-state or for those attending a private college. Students who are enrolled in MD/PhD programs often have the benefit of a largely reduced tuition or free tuition as some programs provide waivers and offer stipends to help students afford the cost of living expenses. Currently, forty-nine MD/PhD programs receive funding from the National Institute of General Medical Sciences (NIGMS) through the Medical Scientist Training Program (MSTP).

MD/PhD vs. MD: Competition

It’s no surprise that both MD/PhD and MD programs are highly competitive. The average acceptance rate of these programs is between 1-4%. Compared to MD programs, there are considerably fewer MD/PhD programs available. The added benefit of tuition waivers makes the competition for these programs even higher. With such high levels of competition, it is a good idea to see how your grades and test scores compare to the average scores of students accepted into the program. Last year, matriculants of MD/PhD programs had an MCAT score of 516 and an average GPA of 3.8. The average MCAT and GPA of MD program students was 511.5 and 3.73, respectively. From this data, we can determine that to be a competitive applicant get into an MD/PhD program, one will need to possess a higher GPA and MCAT score than what is typically required for an MD program. Of course, each college will also have varying levels of competition as some receive a higher volume of applications each year than others. 

If you are considering applying for an MD/PhD program and have already taken the MCAT but did not receive a score of 516 or higher, you may want to consider retaking the MCAT . Retaking the MCAT is not right for all students, but it may help boost your test score and give you an edge when applying to competitive programs. For further personalized help, consider seeking the guidance of medical school admissions consulting .

MD/PhD vs. MD: Salary and Career Outlook

While it may be obvious that those who graduate from an MD program go on to practice medicine as medical doctors within a hospital or clinic environment, some individuals are unsure of what post-grad life would look like for a physician-scientist. The majority of MD/PhD graduates choose to complete their residency in pediatrics, internal medicine, pathology, or neurology. However, many specialties are represented, from emergency medicine to surgery and radiology. Among MD graduates, internal medicine, pediatrics, family medicine, and emergency medicine are the most common specialties. According to AAMC’s study, almost 80% of MD/PhD graduates hold positions at federal agencies, research institutes, medical schools, or the National Institute of Health. Of the 7,000 MD/PhD grads who took part in the study, 82% said they would take part in an MD/PhD program again. 

Physician-scientist possess both in-depth knowledge of the medical field and knowledge of population health and disease. They are also trained to conduct thorough independent research and analysis. Physician-scientists with this dual degree are highly valued for their ability to treat patients, develop new treatments, and detect potential health threats. Those who choose to work in academia often teach and provide clinical services while also conducting their own research. The average annual MD/PhD salary is between $60k and $115k, depending on location and type of employment. 

Physicians manage the health and well-being of patients in their care. This is done through physical exams, treatment, diagnostic testing, and communication. Depending on the type of physician, they may treat specific or general illnesses and diseases and perform surgical procedures. The annual salaries of physicians correspond to their level of training and specialization, but on average, a non MD/PhD salary for physicians ranges from $180k to $280k.

MD/PhD vs. MD: Which is a for You?

For some people, they knew what they wanted to be from the moment they first put on safety glasses in science class or gave their teddy bear an exam with a toy stethoscope. However, not everyone has the “aha” moment or an immediate passion for a field of work. Sometimes, one’s drive and passion for medicine and research develop later in their life. This passion may be formed by experiences, education, or overcoming hardships. What if you have a passion for both medicine and science? How does one choose whether to pursue a joint MD/PhD or an MD degree? You should only choose after you’ve taken the time to consider the variety of factors involved and are 100% confident in your decision. The reality is that neither choice will be easy, and both will require you to invest a lot of time, effort, and money.

Discover What Drives You

Begin by thinking about what you’re interested in and what motivates you—this will help you determine what your true passion is. If you discover that you are highly interested in medicine and want to help others, but you only have a small interest in the field of research, it may be best to pursue a career solely in medicine. With it being twice the length of an MD program, an MD/PhD program is no cakewalk. Students should only pursue this program if they have deep passions for both medicine and research. If you feel passionate about helping and treating patients and are interested in discovering more about the mechanisms behind diseases or can’t imagine a career that doesn’t involve some form of research, then the joint program may be right for you. 

When deciding between these two career pathways, the first decision you will have to make is determining whether you are interested in becoming a physician-scientist or medical doctor. Those who are motivated by their passions are more likely to enjoy their career because they are doing something that they want to do. If you struggle to determine where your passions lie, consider participating in a pre-med shadowing study abroad program . 

Let Your Experiences Guide You

What’s the best way to know which path is right for you? Gain experience in the field you are interested in before filling out your medical school applications. If you are struggling to choose between the two program options, be sure to gain experience in both fields before making your final decision. Getting hands-on experience in both fields is a great way to discover which career path truly sparks your interest. Some ways to gain this hands-on experience are by shadowing a doctor or participating in a healthcare internship. These experiences will be essential when it’s time to fill out your med school application, and through these unique experiences, you will discover your passion.

Consider Each Program’s Affordability

According to data from AAMC, approximately 76% of med school students graduate with some form of college-related debt. For students who take out student loans, the median debt is around $200k. Of course, physicians often earn a high salary, so this debt can be repaid after entering the workforce, but many students experience a rocky start as they begin their careers. One of the biggest benefits of an MD/PhD program is that most of these programs partially cover or waive tuition for students. Students may also receive a stipend to cover the cost of their living expenses. This allows some students to complete their training and graduate debt free. While you shouldn’t choose a program only based on the cost associated with the program, it is an important factor to consider. You should make a decision that best aligns with your passions, motivations, interests, and career goals. 

International Medical Aid provides  global internship opportunities  for students and clinicians who are looking to broaden their horizons and experience healthcare on an international level. These program participants have the unique opportunity to shadow healthcare providers as they treat individuals who live in remote and underserved areas and who don’t have easy access to medical attention. International Medical Aid also provides  medical school admissions consulting  to individuals applying to medical school and PA school programs. We review primary and secondary applications, offer guidance for personal statements and essays, and conduct mock interviews to prepare you for the admissions committees that will interview you before accepting you into their programs. IMA is here to provide the tools you need to help further your career and expand your opportunities in healthcare.

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MD vs PhD - Which should You study?

31 st October 2019

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If you want to further your position on the career ladder within the medical profession, then a course of postgraduate study may be your best choice. However, there are two options available for those wishing to pursue further qualifications in medicine - a  PhD  (Doctor of Philosophy) or an MD   (Doctor of Medicine).

Which one should you go for? We take a look at the differences between the two to help you decide...

PhD vs. MD: Course Structure

One of the key differences between a PhD and an MD is the structure of the course. While a PhD is generally lab-based and lasts a minimum of 3 years, the MD lasts 2-3 years and combines a student’s research findings with clinical practice.

Both qualifications require a student to submit a thesis or a portfolio of published work at the end of their course.

PhD vs. MD: Career Ambitions

Whether you decide to study for a PhD in Medicine or for an MD qualification, this will have a significant impact upon your career. For the most part, those with an MD are more suited to clinical roles, using their specialist knowledge to diagnose and interact with patients. For those wishing to be working doctors, this may be the ideal option for you.

However, if you’re looking to take your career in a research-based direction, then you may wish to study a PhD.

PhD vs. MD: Academic Prestige

While both the MD and the PhD are highly regarded qualifications, it could be argued that there is (in general) slightly more prestige attached to having a PhD, as the course is longer and the research more thorough.

Having said this, if you want to pursue a career in clinical practice but academic reputation of your qualification isn't that important to you, it isn’t essential to study on a PhD course. There are a number of prestigious institutions (including University of Cambridge) that offer a wide range of renowned MD qualifications. 

PhD vs. MD: Financial restrictions

One of the key things to take into consideration when studying any postgraduate course is the cost. While all courses are going to cost money, it is important that you consider whether or not you can afford the course before making your application. In order to study on an MD or a PhD the majority of students will finance the course through a combination of loans and external funding.

Despite this, studying on an MD or a PhD may become a financial struggle as both courses are very time demanding. However, with an MD, there are some opportunities to find medical paid work during your clinical learning, whereas this is much harder for those studying on a PhD.

Both MD and PhDs typically costs between £4,000 and £6,000 per year, but as the MD course only lasts 2 years (full-time), the cost of fees is a lot lower. 

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Is an MD-PhD Right for Me?

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Do you want the opportunity to train in both medicine and research? An MD-PhD allows you to do just that. But what does it mean to become a physician scientist? We asked AAMC experts to explain why you might want to consider this type of training.

As you prepare to apply to medical school, it’s valuable to explore other potential career paths beyond a traditional MD degree. One path to consider is an MD-PhD degree, which provides training in both medicine and research.

But how do you know if it’s the right career path for you? We asked AAMC experts to explain the advantages of training to be a physician scientist through an MD-PhD program.  

Who are physician scientists? Physician scientists are focused on scientific discovery and patient care at the intersection of science and medicine, understanding human health and disease from a scientific and clinical perspective. Physician scientists have the unique ability to identify and study important questions in health care. There are four pathways to become a physician scientist:

• Complete MD training and then conduct extended research through fellowship training.
• Complete MD training and then return to graduate school to earn a PhD degree.
• Complete PhD training and then enter medical school to earn an MD degree.
• Work towards both degrees simultaneously in a dual MD-PhD degree program.

In each pathway, students are exposed to a career in scientific research while also treating patients in a clinical setting.

What are MD-PhD Programs? MD-PhD programs provide training for the dual degree by integrating research and clinical training experiences where students learn to conduct hypothesis driven research in a mentored environment. There are over 100 MD-PhD programs affiliated with U.S. medical schools, and the National Institute of General Medical Sciences partially supports approximately 45 programs, known as Medical Scientist Training Programs (MSTPs). 

These programs provide unique training experiences, including MD-PhD specific courses and professional development workshops, visiting scholar seminars, retreats, opportunities to attend national conferences and join organizations, and mentoring for graduate and residency training. The students and mentors in these programs are a vibrant community, working to advance the trainees’ development as a scientist and physician. 

How long does training take?

The MD-PhD career path is a commitment, as training to complete both MD and PhD degrees takes about 7 or 8 years.

How do I pay for a MD-PhD program?

Most programs offer financial support, including stipends, tuition waivers, and health insurance to help students cover the cost of their scientific and medical training.

Who are MD-PhD students?

Annually, an estimated 600 students matriculate into MD-PhD programs. This is only about 3% of all students who matriculate into medical school. PhD training for MD-PhD students is typically in biomedical sciences, such as molecular, cellular, or human or animal studies in biochemistry, cell biology and microbiology, immunology and genetics, neuroscience, pharmacology, and physiology. However, PhD training may also be in fields outside of the classical biomedical sciences, such as bioengineering, chemical biology, bioinformatics, public health, anthropology, and bioethics. 

What do MD-PhDs do after graduation?

Most MD-PhD graduates train in a residency program and become licensed to practice in a specific field of medicine. From there, they typically go on to careers that blend research and clinical medicine, though their research topic may or may not be closely related to their field of medical practice. Most MD-PhDs work in academic medical centers, such as medical schools or teaching hospitals. MD-PhDs also conduct research in institutes such as the National Institutes of Health or other government or private agencies, or work for pharma or biotech companies.

MD-PhD careers provide unique perspectives on questions about basic scientific discovery, medical intervention, or translational research. During their career, MD-PhDs may remain focused as a basic or clinical scientist, or become an administrative leader within their academic medical center. Their training provides opportunities to be successful in either environment. 

Is an MD-PhD path right for you? To find out more, visit the AAMC website for information on MD-PhD dual degree training . 

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Information about applying to MD-PhD programs, emphasizing the application process during COVID-19.

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Learn about MD-PhD Programs from program leaders.

Upcoming short presentations will describe features of MD-PhD training, alumni careers, and detailed logistics of the application process.

Emily battled viral encephalitis for years during college, and now as a MD/PhD student, she reminds premeds that it's okay to ask for help.

Cesar couldn't apply to medical school when he first graduated from college due to his undocumented status. Now he's in a MD-PhD program and hopes to practice in the Southwest where there's a high need for Spanish-speaking physicians.

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What does it mean to have an MD/PhD? MD/PhD programs provide training in both medicine and research for students who want to become a physician-scientist. MD/PhD graduates often go on to become faculty members at medical schools, universities and research institutes such as the NIH. MD/PhD trainees are prepared for careers in which they will spend most of their time doing research, not just taking care of patients. It is a challenging career that offers opportunities to benefit many people by advancing knowledge or health and illness, developing new diagnostics and treatments for diseases, and inventing new technologies for clinical application.  What is the difference between MD/PhD and MSTP? Medical Scientist Training Program (MSTP) indicates that an MD/PhD program has been awarded a training grant (T32) from the National Institute of General Medical Sciences that financially supports trainees in the program. There are currently about 46 MSTPs.  Non-MSTP MD/PhD programs also provide environments where students receive outstanding dual-degree training.       What is MSTP funding? MSTP funding comes from the National Institute of General Medical Science T32 training grant.  This grant is used to financially support trainees in MSTPs. How do I know if my school accepts MSTP funding? A list of schools that have MSTPs can be found  here . How do I know if I qualify for MSTP funding? The only requirement to qualify for MSTP funding is that trainees must be citizens or noncitizen nationals of the United States or have been lawfully admitted for permanent residence (i.e., possess an alien registration receipt card I-151 or I-551).  Your individual medical school’s MSTP determines any other requirements.  Are there opportunities for international students? There are MD/PhD opportunities available around the country for international students, but at this time, the NIH MD/PhD Partnership Training Program funding is only available if you are a US citizen or permanent resident and admitted to a U.S. medical school or MSTP.

What’s the benefit of getting my PhD with the NIH? The National Institutes of Health is the largest biomedical research facility in the world. Scholars who are accepted to one of the graduate programs at the NIH are able to take advantage of its amazing facilities and technologies. The NIH is comprised of 27 different Institutes and Centers, each with its own specific research agenda; this promotes an engaging and diverse research environment with lots of room for interdisciplinary collaboration. To learn about the NIH and its many resources, please visit  www.nih.gov/about/  or contact the administration with any specific questions. Do I select which track I am on? No. Your track is based on your current educational status. Please visit the “How to Apply” page to determine your track. Do I have to do my PhD with the NIH Oxford-Cambridge Scholars Program? It is not a requirement of the NIH MD/PhD Partnership Training that you participate in the NIH Oxford-Cambridge Scholars Program; however, Track 1 candidates are automatically granted a place in the OxCam Program when they are awarded a slot in the MD/PhD Partnership Training Program. The OxCam Program is also the only program within the NIH GPP that has a deferral process in place to enable students to complete the first years of medical school. Visit our page on the  GPP  to learn more about other Institutional or Individual Partnerships. What’s an Individual Partnership? An Individual Partnership is a partnership with a program or university that does not already have an existing agreement with the NIH through the GPP. These partnerships are arranged through the GPP and are based on the specific needs of an individual student. For more information, contact the GPP. Will I be getting clinical experience during my PhD? There is no formal requirement that you get clinical experience during the PhD phase of your training. However, you may get involved with Clinical Grand Rounds and other didactic sessions, bedside teaching rounds and other clinical training opportunities, and clinical research protocol activities at the NIH and partnering institutions. How much time will I spend away from medical school? The time it takes to complete the PhD portion of your training depends on the graduate program in which you participate. NIH OxCam Scholars are expected to complete their PhD in about four years. How much time will I spend at the NIH? Approximately half of your PhD thesis research must be completed at the NIH. NIH OxCam Scholars will spend approximately two years at the NIH and two years at either the University of Oxford or the University of Cambridge. When do I select my PhD mentor? You select you mentor after you are officially admitted to the program. If you are a Track 1 student, you will select a mentor at the NIH before beginning medical school; Track 2 students select their mentors during the time frame determined by their graduate program.

Are there GPA/MCAT cut-offs? The NIH MD/PhD Partnership Training Program is highly competitive, but there are no hard and fast cut-offs for grades or test scores; however, acceptance into the NIH MD/PhD Partnership Training Program and receipt of extramural MSTP funding is pending acceptance to a qualifying MSTP program at a participating medical school.  This means that applicants to the NIH MD/PhD Partnership Training Program must meet the minimum acceptance requirements of the programs to which they are applying.

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Family Relationships and Well-Being

Patricia a thomas , phd, hui liu , phd, debra umberson , phd.

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Address correspondence to: Patricia A. Thomas, PhD, Department of Sociology, Purdue University, 700 W. State Street, West Lafayette, IN 47907. E-mail: [email protected]

Collection date 2017 Nov.

This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact [email protected]

Family relationships are enduring and consequential for well-being across the life course. We discuss several types of family relationships—marital, intergenerational, and sibling ties—that have an important influence on well-being. We highlight the quality of family relationships as well as diversity of family relationships in explaining their impact on well-being across the adult life course. We discuss directions for future research, such as better understanding the complexities of these relationships with greater attention to diverse family structures, unexpected benefits of relationship strain, and unique intersections of social statuses.

Keywords: Caregiver stress, Gender issues, Intergenerational, Social support, Well-being

Translational Significance

It is important for future research and health promotion policies to take into account complexities in family relationships, paying attention to family context, diversity of family structures, relationship quality, and intersections of social statuses in an aging society to provide resources to families to reduce caregiving burdens and benefit health and well-being.

For better and for worse, family relationships play a central role in shaping an individual’s well-being across the life course ( Merz, Consedine, Schulze, & Schuengel, 2009 ). An aging population and concomitant age-related disease underlies an emergent need to better understand factors that contribute to health and well-being among the increasing numbers of older adults in the United States. Family relationships may become even more important to well-being as individuals age, needs for caregiving increase, and social ties in other domains such as the workplace become less central in their lives ( Milkie, Bierman, & Schieman, 2008 ). In this review, we consider key family relationships in adulthood—marital, parent–child, grandparent, and sibling relationships—and their impact on well-being across the adult life course.

We begin with an overview of theoretical explanations that point to the primary pathways and mechanisms through which family relationships influence well-being, and then we describe how each type of family relationship is associated with well-being, and how these patterns unfold over the adult life course. In this article, we use a broad definition of well-being, including multiple dimensions such as general happiness, life satisfaction, and good mental and physical health, to reflect the breadth of this concept’s use in the literature. We explore important directions for future research, emphasizing the need for research that takes into account the complexity of relationships, diverse family structures, and intersections of structural locations.

Pathways Linking Family Relationships to Well-Being

A life course perspective draws attention to the importance of linked lives, or interdependence within relationships, across the life course ( Elder, Johnson, & Crosnoe, 2003 ). Family members are linked in important ways through each stage of life, and these relationships are an important source of social connection and social influence for individuals throughout their lives ( Umberson, Crosnoe, & Reczek, 2010 ). Substantial evidence consistently shows that social relationships can profoundly influence well-being across the life course ( Umberson & Montez, 2010 ). Family connections can provide a greater sense of meaning and purpose as well as social and tangible resources that benefit well-being ( Hartwell & Benson, 2007 ; Kawachi & Berkman, 2001 ).

The quality of family relationships, including social support (e.g., providing love, advice, and care) and strain (e.g., arguments, being critical, making too many demands), can influence well-being through psychosocial, behavioral, and physiological pathways. Stressors and social support are core components of stress process theory ( Pearlin, 1999 ), which argues that stress can undermine mental health while social support may serve as a protective resource. Prior studies clearly show that stress undermines health and well-being ( Thoits, 2010 ), and strains in relationships with family members are an especially salient type of stress. Social support may provide a resource for coping that dulls the detrimental impact of stressors on well-being ( Thoits, 2010 ), and support may also promote well-being through increased self-esteem, which involves more positive views of oneself ( Fukukawa et al., 2000 ). Those receiving support from their family members may feel a greater sense of self-worth, and this enhanced self-esteem may be a psychological resource, encouraging optimism, positive affect, and better mental health ( Symister & Friend, 2003 ). Family members may also regulate each other’s behaviors (i.e., social control) and provide information and encouragement to behave in healthier ways and to more effectively utilize health care services ( Cohen, 2004 ; Reczek, Thomeer, Lodge, Umberson, & Underhill, 2014 ), but stress in relationships may also lead to health-compromising behaviors as coping mechanisms to deal with stress ( Ng & Jeffery, 2003 ). The stress of relationship strain can result in physiological processes that impair immune function, affect the cardiovascular system, and increase risk for depression ( Graham, Christian, & Kiecolt-Glaser, 2006 ; Kiecolt-Glaser & Newton, 2001 ), whereas positive relationships are associated with lower allostatic load (i.e., “wear and tear” on the body accumulating from stress) ( Seeman, Singer, Ryff, Love, & Levy-Storms, 2002 ). Clearly, the quality of family relationships can have considerable consequences for well-being.

Marital Relationships

A life course perspective has posited marital relationships as one of the most important relationships that define life context and in turn affect individuals’ well-being throughout adulthood ( Umberson & Montez, 2010 ). Being married, especially happily married, is associated with better mental and physical health ( Carr & Springer, 2010 ; Umberson, Williams, & Thomeer, 2013 ), and the strength of the marital effect on health is comparable to that of other traditional risk factors such as smoking and obesity ( Sbarra, 2009 ). Although some studies emphasize the possibility of selection effects, suggesting that individuals in better health are more likely to be married ( Lipowicz, 2014 ), most researchers emphasize two theoretical models to explain why marital relationships shape well-being: the marital resource model and the stress model ( Waite & Gallager, 2000 ; Williams & Umberson, 2004 ). The marital resource model suggests that marriage promotes well-being through increased access to economic, social, and health-promoting resources ( Rendall, Weden, Favreault, & Waldron, 2011 ; Umberson et al., 2013 ). The stress model suggests that negative aspects of marital relationships such as marital strain and marital dissolutions create stress and undermine well-being ( Williams & Umberson, 2004 ), whereas positive aspects of marital relationships may prompt social support, enhance self-esteem, and promote healthier behaviors in general and in coping with stress ( Reczek, Thomeer, et al., 2014 ; Symister & Friend, 2003 ; Waite & Gallager, 2000 ). Marital relationships also tend to become more salient with advancing age, as other social relationships such as those with family members, friends, and neighbors are often lost due to geographic relocation and death in the later part of the life course ( Liu & Waite, 2014 ).

Married people, on average, enjoy better mental health, physical health, and longer life expectancy than divorced/separated, widowed, and never-married people ( Hughes & Waite, 2009 ; Simon, 2002 ), although the health gap between the married and never married has decreased in the past few decades ( Liu & Umberson, 2008 ). Moreover, marital links to well-being depend on the quality of the relationship; those in distressed marriages are more likely to report depressive symptoms and poorer health than those in happy marriages ( Donoho, Crimmins, & Seeman, 2013 ; Liu & Waite, 2014 ; Umberson, Williams, Powers, Liu, & Needham, 2006 ), whereas a happy marriage may buffer the effects of stress via greater access to emotional support ( Williams, 2003 ). A number of studies suggest that the negative aspects of close relationships have a stronger impact on well-being than the positive aspects of relationships (e.g., Rook, 2014 ), and past research shows that the impact of marital strain on health increases with advancing age ( Liu & Waite, 2014 ; Umberson et al., 2006 ).

Prior studies suggest that marital transitions, either into or out of marriage, shape life context and affect well-being ( Williams & Umberson, 2004 ). National longitudinal studies provide evidence that past experiences of divorce and widowhood are associated with increased risk of heart disease in later life especially among women, irrespective of current marital status ( Zhang & Hayward, 2006 ), and longer duration of divorce or widowhood is associated with a greater number of chronic conditions and mobility limitations ( Hughes & Waite, 2009 ; Lorenz, Wickrama, Conger, & Elder, 2006 ) but only short-term declines in mental health ( Lee & Demaris, 2007 ). On the other hand, entry into marriages, especially first marriages, improves psychological well-being and decreases depression ( Frech & Williams, 2007 ; Musick & Bumpass, 2012 ), although the benefits of remarriage may not be as large as those that accompany a first marriage ( Hughes & Waite, 2009 ). Taken together, these studies show the importance of understanding the lifelong cumulative impact of marital status and marital transitions.

Gender Differences

Gender is a central focus of research on marital relationships and well-being and an important determinant of life course experiences ( Bernard, 1972 ; Liu & Waite, 2014 ; Zhang & Hayward, 2006 ). A long-observed pattern is that men receive more physical health benefits from marriage than women, and women are more psychologically and physiologically vulnerable to marital stress than men ( Kiecolt-Glaser & Newton, 2001 ; Revenson et al., 2016 ; Simon, 2002 ; Williams, 2004 ). Women tend to receive more financial benefits from their typically higher-earning male spouse than do men, but men generally receive more health promotion benefits such as emotional support and regulation of health behaviors from marriage than do women ( Liu & Umberson, 2008 ; Liu & Waite, 2014 ). This is because within a traditional marriage, women tend to take more responsibility for maintaining social connections to family and friends, and are more likely to provide emotional support to their husband, whereas men are more likely to receive emotional support and enjoy the benefit of expanded social networks—all factors that may promote husbands’ health and well-being ( Revenson et al., 2016 ).

However, there is mixed evidence regarding whether men’s or women’s well-being is more affected by marriage. On the one hand, a number of studies have documented that marital status differences in both mental and physical health are greater for men than women ( Liu & Umberson, 2008 ; Sbarra, 2009 ). For example, Williams and Umberson (2004) found that men’s health improves more than women’s from entering marriage. On the other hand, a number of studies reveal stronger effects of marital strain on women’s health than men’s including more depressive symptoms, increases in cardiovascular health risk, and changes in hormones ( Kiecolt-Glaser & Newton, 2001 ; Liu & Waite, 2014 ; Liu, Waite, & Shen, 2016 ). Yet, other studies found no gender differences in marriage and health links (e.g., Umberson et al., 2006 ). The mixed evidence regarding gender differences in the impact of marital relationships on well-being may be attributed to different study samples (e.g., with different age groups) and variations in measurements and methodologies. More research based on representative longitudinal samples is clearly warranted to contribute to this line of investigation.

Race-Ethnicity and SES Heterogeneity

Family scholars argue that marriage has different meanings and dynamics across socioeconomic status (SES) and racial-ethnic groups due to varying social, economic, historical, and cultural contexts. Therefore, marriage may be associated with well-being in different ways across these groups. For example, women who are black or lower SES may be less likely than their white, higher SES counterparts to increase their financial capital from relationship unions because eligible men in their social networks are more socioeconomically challenged ( Edin & Kefalas, 2005 ). Some studies also find that marital quality is lower among low SES and black couples than white couples with higher SES ( Broman, 2005 ). This may occur because the former groups face more stress in their daily lives throughout the life course and these higher levels of stress undermine marital quality ( Umberson, Williams, Thomas, Liu, & Thomeer, 2014 ). Other studies, however, suggest stronger effects of marriage on the well-being of black adults than white adults. For example, black older adults seem to benefit more from marriage than older whites in terms of chronic conditions and disability ( Pienta, Hayward, & Jenkins, 2000 ).

Directions for Future Research

The rapid aging of the U.S. population along with significant changes in marriage and families indicate that a growing number of older adults enter late life with both complex marital histories and great heterogeneity in their relationships. While most research to date focuses on different-sex marriages, a growing body of research has started to examine whether the marital advantage in health and well-being is extended to same-sex couples, which represents a growing segment of relationship types among older couples ( Denney, Gorman, & Barrera, 2013 ; Goldsen et al., 2017 ; Liu, Reczek, & Brown, 2013 ; Reczek, Liu, & Spiker, 2014 ). Evidence shows that same-sex cohabiting couples report worse health than different-sex married couples ( Denney et al., 2013 ; Liu et al., 2013 ), but same-sex married couples are often not significantly different from or are even better off than different-sex married couples in other outcomes such as alcohol use ( Reczek, Liu, et al., 2014 ) and care from their partner during periods of illness ( Umberson, Thomeer, Reczek, & Donnelly, 2016 ). These results suggest that marriage may promote the well-being of same-sex couples, perhaps even more so than for different-sex couples ( Umberson et al., 2016 ). Including same-sex couples in future work on marriage and well-being will garner unique insights into gender differences in marital dynamics that have long been taken for granted based on studies of different-sex couples ( Umberson, Thomeer, Kroeger, Lodge, & Xu, 2015 ). Moreover, future work on same-sex and different-sex couples should take into account the intersection of other statuses such as race-ethnicity and SES to better understand the impact of marital relationships on well-being.

Another avenue for future research involves investigating complexities of marital strain effects on well-being. Some recent studies among older adults suggest that relationship strain may actually benefit certain dimensions of well-being. These studies suggest that strain with a spouse may be protective for certain health outcomes including cognitive decline ( Xu, Thomas, & Umberson, 2016 ) and diabetes control ( Liu et al., 2016 ), while support may not be, especially for men ( Carr, Cornman, & Freedman, 2016 ). Explanations for these unexpected findings among older adults are not fully understood. Family and health scholars suggest that spouses may prod their significant others to engage in more health-promoting behaviors ( Umberson, Crosnoe, et al., 2010 ). These attempts may be a source of friction, creating strain in the relationship; however, this dynamic may still contribute to better health outcomes for older adults. Future research should explore the processes by which strain may have a positive influence on health and well-being, perhaps differently by gender.

Intergenerational Relationships

Children and parents tend to remain closely connected to each other across the life course, and it is well-established that the quality of intergenerational relationships is central to the well-being of both generations ( Merz, Schuengel, & Schulze, 2009 ; Polenick, DePasquale, Eggebeen, Zarit, & Fingerman, 2016 ). Recent research also points to the importance of relationships with grandchildren for aging adults ( Mahne & Huxhold, 2015 ). We focus here on the well-being of parents, adult children, and grandparents. Parents, grandparents, and children often provide care for each other at different points in the life course, which can contribute to social support, stress, and social control mechanisms that influence the health and well-being of each in important ways over the life course ( Nomaguchi & Milkie, 2003 ; Pinquart & Soerensen, 2007 ; Reczek, Thomeer, et al., 2014 ).

Family scholarship highlights the complexities of parent–child relationships, finding that parenthood generates both rewards and stressors, with important implications for well-being ( Nomaguchi & Milkie, 2003 ; Umberson, Pudrovska, & Reczek, 2010 ). Parenthood increases time constraints, producing stress and diminishing well-being, especially when children are younger ( Nomaguchi, Milkie, & Bianchi, 2005 ), but parenthood can also increase social integration, leading to greater emotional support and a sense of belonging and meaning ( Berkman, Glass, Brissette, & Seeman, 2000 ), with positive consequences for well-being. Studies show that adult children play a pivotal role in the social networks of their parents across the life course ( Umberson, Pudrovska, et al., 2010 ), and the effects of parenthood on health and well-being become increasingly important at older ages as adult children provide one of the major sources of care for aging adults ( Seltzer & Bianchi, 2013 ). Norms of filial obligation of adult children to care for parents may be a form of social capital to be accessed by parents when their needs arise ( Silverstein, Gans, & Yang, 2006 ).

Although the general pattern is that receiving support from adult children is beneficial for parents’ well-being ( Merz, Schulze, & Schuengel, 2010 ), there is also evidence showing that receiving social support from adult children is related to lower well-being among older adults, suggesting that challenges to an identity of independence and usefulness may offset some of the benefits of receiving support ( Merz et al., 2010 ; Thomas, 2010 ). Contrary to popular thought, older parents are also very likely to provide instrumental/financial support to their adult children, typically contributing more than they receive ( Grundy, 2005 ), and providing emotional support to their adult children is related to higher well-being for older adults ( Thomas, 2010 ). In addition, consistent with the tenets of stress process theory, most evidence points to poor quality relationships with adult children as detrimental to parents’ well-being ( Koropeckyj-Cox, 2002 ; Polenick et al., 2016 ); however, a recent study found that strain with adult children is related to better cognitive health among older parents, especially fathers ( Thomas & Umberson, 2017 ).

Adult Children

As children and parents age, the nature of the parent–child relationship often changes such that adult children may take on a caregiving role for their older parents ( Pinquart & Soerensen, 2007 ). Adult children often experience competing pressures of employment, taking care of their own children, and providing care for older parents ( Evans et al., 2016 ). Support and strain from intergenerational ties during this stressful time of balancing family roles and work obligations may be particularly important for the mental health of adults in midlife ( Thomas, 2016 ). Most evidence suggests that caregiving for parents is related to lower well-being for adult children, including more negative affect and greater stress response in terms of overall output of daily cortisol ( Bangerter et al., 2017 ); however, some studies suggest that caregiving may be beneficial or neutral for well-being ( Merz et al., 2010 ). Family scholars suggest that this discrepancy may be due to varying types of caregiving and relationship quality. For example, providing emotional support to parents can increase well-being, but providing instrumental support does not unless the caregiver is emotionally engaged ( Morelli, Lee, Arnn, & Zaki, 2015 ). Moreover, the quality of the adult child-parent relationship may matter more for the well-being of adult children than does the caregiving they provide ( Merz, Schuengel, et al., 2009 ).

Although caregiving is a critical issue, adult children generally experience many years with parents in good health ( Settersten, 2007 ), and relationship quality and support exchanges have important implications for well-being beyond caregiving roles. The preponderance of research suggests that most adults feel emotionally close to their parents, and emotional support such as encouragement, companionship, and serving as a confidant is commonly exchanged in both directions ( Swartz, 2009 ). Intergenerational support exchanges often flow across generations or towards adult children rather than towards parents. For example, adult children are more likely to receive financial support from parents than vice versa until parents are very old ( Grundy, 2005 ). Intergenerational support exchanges are integral to the lives of both parents and adult children, both in times of need and in daily life.

Grandparents

Over 65 million Americans are grandparents ( Ellis & Simmons, 2014 ), 10% of children lived with at least one grandparent in 2012 ( Dunifon, Ziol-Guest, & Kopko, 2014 ), and a growing number of American families rely on grandparents as a source of support ( Settersten, 2007 ), suggesting the importance of studying grandparenting. Grandparents’ relationships with their grandchildren are generally related to higher well-being for both grandparents and grandchildren, with some important exceptions such as when they involve more extensive childcare responsibilities ( Kim, Kang, & Johnson-Motoyama, 2017 ; Lee, Clarkson-Hendrix, & Lee, 2016 ). Most grandparents engage in activities with their grandchildren that they find meaningful, feel close to their grandchildren, consider the grandparent role important ( Swartz, 2009 ), and experience lower well-being if they lose contact with their grandchildren ( Drew & Silverstein, 2007 ). However, a growing proportion of children live in households maintained by grandparents ( Settersten, 2007 ), and grandparents who care for their grandchildren without the support of the children’s parents usually experience greater stress ( Lee et al., 2016 ) and more depressive symptoms ( Blustein, Chan, & Guanais, 2004 ), sometimes juggling grandparenting responsibilities with their own employment ( Harrington Meyer, 2014 ). Using professional help and community services reduced the detrimental effects of grandparent caregiving on well-being ( Gerard, Landry-Meyer, & Roe, 2006 ), suggesting that future policy could help mitigate the stress of grandparent parenting and enhance the rewarding aspects of grandparenting instead.

Substantial evidence suggests that the experience of intergenerational relationships varies for men and women. Women tend to be more involved with and affected by intergenerational relationships, with adult children feeling closer to mothers than fathers ( Swartz, 2009 ). Moreover, relationship quality with children is more strongly associated with mothers’ well-being than with fathers’ well-being ( Milkie et al., 2008 ). Motherhood may be particularly salient to women ( McQuillan, Greil, Shreffler, & Tichenor, 2008 ), and women carry a disproportionate share of the burden of parenting, including greater caregiving for young children and aging parents as well as time deficits from these obligations that lead to lower well-being ( Nomaguchi et al., 2005 ; Pinquart & Sorensen, 2006 ). Mothers often report greater parental pressures than fathers, such as more obligation to be there for their children ( Reczek, Thomeer, et al., 2014 ; Stone, 2007 ), and to actively work on family relationships ( Erickson, 2005 ). Mothers are also more likely to blame themselves for poor parent–child relationship quality ( Elliott, Powell, & Brenton, 2015 ), contributing to greater distress for women. It is important to take into account the different pressures and meanings surrounding intergenerational relationships for men and for women in future research.

Family scholars have noted important variations in family dynamics and constraints by race-ethnicity and socioeconomic status. Lower SES can produce and exacerbate family strains ( Conger, Conger, & Martin, 2010 ). Socioeconomically disadvantaged adult children may need more assistance from parents and grandparents who in turn have fewer resources to provide ( Seltzer & Bianchi, 2013 ). Higher SES and white families tend to provide more financial and emotional support, whereas lower SES, black, and Latino families are more likely to coreside and provide practical help, and these differences in support exchanges contribute to the intergenerational transmission of inequality through families ( Swartz, 2009 ). Moreover, scholars have found that a happiness penalty exists such that parents of young children have lower levels of well-being than nonparents; however, policies such as childcare subsidies and paid time off that help parents negotiate work and family responsibilities explain this disparity ( Glass, Simon, & Andersson, 2016 ). Fewer resources can also place strain on grandparent–grandchild relationships. For example, well-being derived from these relationships may be unequally distributed across grandparents’ education level such that those with less education bear the brunt of more stressful grandparenting experiences and lower well-being ( Mahne & Huxhold, 2015 ). Both the burden of parenting grandchildren and its effects on depressive symptoms disproportionately fall upon single grandmothers of color ( Blustein et al., 2004 ). These studies demonstrate the importance of understanding structural constraints that produce greater stress for less advantaged groups and their impact on family relationships and well-being.

Research on intergenerational relationships suggests the importance of understanding greater complexity in these relationships in future work. For example, future research should pay greater attention to diverse family structures and perspectives of multiple family members. There is an increasing trend of individuals delaying childbearing or choosing not to bear children ( Umberson, Pudrovska, et al., 2010 ). How might this influence marital quality and general well-being over the life course and across different social groups? Greater attention to the quality and context of intergenerational relationships from each family member’s perspective over time may prove fruitful by gaining both parents’ and each child’s perceptions. This work has already yielded important insights, such as the ways in which intergenerational ambivalence (simultaneous positive and negative feelings about intergenerational relationships) from the perspectives of parents and adult children may be detrimental to well-being for both parties ( Fingerman, Pitzer, Lefkowitz, Birditt, & Mroczek, 2008 ; Gilligan, Suitor, Feld, & Pillemer, 2015 ). Future work understanding the perspectives of each family member could also provide leverage in understanding the mixed findings regarding whether living in blended families with stepchildren influences well-being ( Gennetian, 2005 ; Harcourt, Adler-Baeder, Erath, & Pettit, 2013 ) and the long-term implications of these family structures when older adults need care ( Seltzer & Bianchi, 2013 ). Longitudinal data linking generations, paying greater attention to the context of these relationships, and collected from multiple family members can help untangle the ways in which family members influence each other across the life course and how multiple family members’ well-being may be intertwined in important ways.

Future studies should also consider the impact of intersecting structural locations that place unique constraints on family relationships, producing greater stress at some intersections while providing greater resources at other intersections. For example, same-sex couples are less likely to have children ( Carpenter & Gates, 2008 ) and are more likely to provide parental caregiving regardless of gender ( Reczek & Umberson, 2016 ), suggesting important implications for stress and burden in intergenerational caregiving for this group. Much of the work on gender, sexuality, race, and socioeconomic status differences in intergenerational relationships and well-being examine one or two of these statuses, but there may be unique effects at the intersection of these and other statuses such as disability, age, and nativity. Moreover, these effects may vary at different stages of the life course.

Sibling Relationships

Sibling relationships are understudied, and the research on adult siblings is more limited than for other family relationships. Yet, sibling relationships are often the longest lasting family relationship in an individual’s life due to concurrent life spans, and indeed, around 75% of 70-year olds have a living sibling ( Settersten, 2007 ). Some suggest that sibling relationships play a more meaningful role in well-being than is often recognized ( Cicirelli, 2004 ). The available evidence suggests that high quality relationships characterized by closeness with siblings are related to higher levels of well-being ( Bedford & Avioli, 2001 ), whereas sibling relationships characterized by conflict and lack of closeness have been linked to lower well-being in terms of major depression and greater drug use in adulthood ( Waldinger, Vaillant, & Orav, 2007 ). Parental favoritism and disfavoritism of children affects the closeness of siblings ( Gilligan, Suitor, & Nam, 2015 ) and depression ( Jensen, Whiteman, Fingerman, & Birditt, 2013 ). Similar to other family relationships, sibling relationships can be characterized by both positive and negative aspects that may affect elements of the stress process, providing both resources and stressors that influence well-being.

Siblings play important roles in support exchanges and caregiving, especially if their sibling experiences physical impairment and other close ties, such as a spouse or adult children, are not available ( Degeneffe & Burcham, 2008 ; Namkung, Greenberg, & Mailick, 2017 ). Although sibling caregivers report lower well-being than noncaregivers, sibling caregivers experience this lower well-being to a lesser extent than spousal caregivers ( Namkung et al., 2017 ). Most people believe that their siblings would be available to help them in a crisis ( Connidis, 1994 ; Van Volkom, 2006 ), and in general support exchanges, receiving emotional support from a sibling is related to higher levels of well-being among older adults ( Thomas, 2010 ). Relationship quality affects the experience of caregiving, with higher quality sibling relationships linked to greater provision of care ( Eriksen & Gerstel, 2002 ) and a lower likelihood of emotional strain from caregiving ( Mui & Morrow-Howell, 1993 ; Quinn, Clare, & Woods, 2009 ). Taken together, these studies suggest the importance of sibling relationships for well-being across the adult life course.

The gender of the sibling dyad may play a role in the relationship’s effect on well-being, with relationships with sisters perceived as higher quality and linked to higher well-being ( Van Volkom, 2006 ), though some argue that brothers do not show their affection in the same way but nevertheless have similar sentiments towards their siblings ( Bedford & Avioli, 2001 ). General social support exchanges with siblings may be influenced by gender and larger family context; sisters exchanged more support with their siblings when they had higher quality relationships with their parents, but brothers exhibited a more compensatory role, exchanging more emotional support with siblings when they had lower quality relationships with their parents ( Voorpostel & Blieszner, 2008 ). Caregiving for aging parents is also distributed differently by gender, falling disproportionately on female siblings ( Pinquart & Sorensen, 2006 ), and sons provide less care to their parents if they have a sister ( Grigoryeva, 2017 ). However, men in same-sex marriages were more likely than men in different-sex marriages to provide caregiving to parents and parents-in-law ( Reczek & Umberson, 2016 ), which may ease the stress and burden on their female siblings.

Although there is less research in this area, family scholars have noted variations in sibling relationships and their effects by race-ethnicity and socioeconomic status. Lower socioeconomic status has been associated with reports of feeling less attached to siblings and this influences several outcomes such as obesity, depression, and substance use ( Van Gundy et al., 2015 ). Fewer socioeconomic resources can also limit the amount of care siblings provide ( Eriksen & Gerstel, 2002 ). These studies suggest sibling relationship quality as an axis of further disadvantage for already disadvantaged individuals. Sibling relationships may influence caregiving experiences by race as well, with black caregivers more likely to have siblings who also provide care to their parents than white caregivers ( White-Means & Rubin, 2008 ) and sibling caregiving leading to lower well-being among white caregivers than minority caregivers ( Namkung et al., 2017 ).

Research on within-family differences has made great strides in our understanding of family relationships and remains a fruitful area of growth for future research (e.g., Suitor et al., 2017 ). Data gathered on multiple members within the same family can help researchers better investigate how families influence well-being in complex ways, including reciprocal influences between siblings. Siblings may have different perceptions of their relationships with each other, and this may vary by gender and other social statuses. This type of data might be especially useful in understanding family effects in diverse family structures, such as differences in treatment and outcomes of biological versus stepchildren, how characteristics of their relationships such as age differences may play a role, and the implications for caregiving for aging parents and for each other. Moreover, it is important to use longitudinal data to understand the consequences of these within-family differences over time as the life course unfolds. In addition, a greater focus on heterogeneity in sibling relationships and their consequences at the intersection of gender, race-ethnicity, SES, and other social statuses merit further investigation.

Relationships with family members are significant for well-being across the life course ( Merz, Consedine, et al., 2009 ; Umberson, Pudrovska, et al., 2010 ). As individuals age, family relationships often become more complex, with sometimes complicated marital histories, varying relationships with children, competing time pressures, and obligations for care. At the same time, family relationships become more important for well-being as individuals age and social networks diminish even as family caregiving needs increase. Stress process theory suggests that the positive and negative aspects of relationships can have a large impact on the well-being of individuals. Family relationships provide resources that can help an individual cope with stress, engage in healthier behaviors, and enhance self-esteem, leading to higher well-being. However, poor relationship quality, intense caregiving for family members, and marital dissolution are all stressors that can take a toll on an individual’s well-being. Moreover, family relationships also change over the life course, with the potential to share different levels of emotional support and closeness, to take care of us when needed, to add varying levels of stress to our lives, and to need caregiving at different points in the life course. The potential risks and rewards of these relationships have a cumulative impact on health and well-being over the life course. Additionally, structural constraints and disadvantage place greater pressures on some families than others based on structural location such as gender, race, and SES, producing further disadvantage and intergenerational transmission of inequality.

Future research should take into account greater complexity in family relationships, diverse family structures, and intersections of social statuses. The rapid aging of the U.S. population along with significant changes in marriage and families suggest more complex marital and family histories as adults enter late life, which will have a large impact on family dynamics and caregiving. Growing segments of family relationships among older adults include same-sex couples, those without children, and those experiencing marital transitions leading to diverse family structures, which all merit greater attention in future research. Moreover, there is some evidence that strain in relationships can be beneficial for certain health outcomes, and the processes by which this occurs merit further investigation. A greater use of longitudinal data that link generations and obtain information from multiple family members will help researchers better understand the ways in which these complex family relationships unfold across the life course and shape well-being. We also highlighted gender, race-ethnicity, and socioeconomic status differences in each of these family relationships and their impact on well-being; however, many studies only consider one status at a time. Future research should consider the impact of intersecting structural locations that place unique constraints on family relationships, producing greater stress or providing greater resources at the intersections of different statuses.

The changing landscape of families combined with population aging present unique challenges and pressures for families and health care systems. With more experiences of age-related disease in a growing population of older adults as well as more complex family histories as these adults enter late life, such as a growing proportion of diverse family structures without children or with stepchildren, caregiving obligations and availability may be less clear. It is important to address ways to ease caregiving or shift the burden away from families through a variety of policies, such as greater resources for in-home aid, creation of older adult residential communities that facilitate social interactions and social support structures, and patient advocates to help older adults navigate health care systems. Adults in midlife may experience competing family pressures from their young children and aging parents, and policies such as childcare subsidies and paid leave to care for family members could reduce burden during this often stressful time ( Glass et al., 2016 ). Professional help and community services can also reduce the burden for grandparents involved in childcare, enabling grandparents to focus on the more positive aspects of grandparent–grandchild relationships. It is important for future research and health promotion policies to take into account the contexts and complexities of family relationships as part of a multipronged approach to benefit health and well-being, especially as a growing proportion of older adults reach late life.

This work was supported in part by grant, 5 R24 HD042849, Population Research Center, awarded to the Population Research Center at The University of Texas at Austin by the Eunice Kennedy Shriver National Institute of Child Health and Human Development.

Conflict of Interest

None reported.

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