Stuck between graduate paths... GRF or MD?

[lazypurine]

Hi Everyone! 

I have always been conflicted about whether to pursue an MD or PhD. I planned to apply for MD programs this year and potentially return to industry (I currently work full time in pharma). Based on my  strong research interest and background, I also considered applying for PhD and MD/Phd programs

Last month, I was fortunate to be offered the NSF GRF, however, the opportunity is really forcing a decision about my future.

(For unknown reasons, the NSF approved my graduate research plan, even though it is essentially drug development. This was unexpected, because the fellowship suggests therapeutically focused research is not favored (and potentially not eligible for funding) by the NSF. The fellowship explicitly does not fund MD/PhD and cannot be deferred in 2019.)

I am a bit concerned about the 'publish or else' mentality and the importance of grant funding in the PhD space, which is not present for MDs in research. I think this mentality has caused several of my mentors (with PhDs) to insinuate I'd be (a fool?) making a mistake to decline the fellowship. 

Ideally, I would like some flexibility in whatever path I choose with opportunity to continue pursuing research or potentially business in the future. I know that as my career progresses my goals might change. 

I am at a bit of a crossroads and would appreciate some advice!