Friday, April 4, 2014

Revisiting the PhD vs. the MD debate

So by far, the most 'popular' post that I've written is the below:

It has garnered a lot of reads, and many comments. Some agree with me, and some more, decidedly not. I have approved the majority of them, but if they were overly rude, I did not. My blog, my prerogative.  Yes, I did spell a word wrong. Shoot me.

So that was written over seven years ago. Have my opinions changed? In a way, they have changed dramatically. I have had the opportunity to work with many people in that time. Many were PhDs and many were MDs. I also have much less of the 'inferiority complex' that I did as a new postdoc. I'm in a stable, well paying job that I really love. The uncertainty that plagued that part of my life is over.  It changes your perspective.

I've also learned a couple of key points:

1. Elitism is alive and well in academia: I have had the pleasure to work with many high profile scientists, including amazing mentors - and they have been wonderful people as well as highly intelligent and innovative scientists. But I have also encountered many PhDs, at varying levels  of their career path, who are arrogant, self-centered and project a strong scent of self superiority. What I've learned is that those people are trying very hard to convince you how smart and important they are, when in reality their work should speak for itself. If the mouthpiece speaks louder than the science - it may just be because the science doesn't have much to say.  On the flip side, I've worked with many MDs who I may have previously projected the above traits on based on my own bias, but found the exact opposite. And I've also met some who are also smug and look down on me. In the end, people are people and your education doesn't necessarily determine if you'll treat people well.

2. More and more med students face similar challenges to graduate students: A degree in medicine, especially if you are highly specialized, is no longer a free ride to a high paying job in the city of your choice. See the attached story from October 2013 about such issues in Canada. Although the extent of the problem is not the same, it is headed in the same direction.  Potentially compounding this problem is that more and more med school students have advanced graduate degrees (masters and PhDs) prior to going into medicine. Many of these highly trained scientists will be looking to going into highly specialized medical practices, that may or may not be there for them when they complete their training. They are also older, with considerable student debt and they have been training FOREVER. No wonder they want that dream job.  This is at a time when many people are crying out for a family doctor, there are fewer to be found.  Could this be because being a 'specialist' is considered better than being a 'general practitioner'?  I'm no expert here. I have a family doctor that I respect immensely, and I would not for a second want her job. 

Which leads me to my third and final point:

3. Width vs. depth: I have learned that the biggest difference between an MD and a PhD is the type of knowledge gained. An MD in itself is about learning a wide width of knowledge across the medical discipline. This is refined during a residency to potential specialties.  In specialized fields (such as cardiac transplant surgery, pediatric infectious disease, etc.),  I would argue that the extra training years give you equivalent training in depth to virtually any PhD.  In contrast, the PhD is the depth in a very specific area (i.e. learning more and more about less and less), but in today's interdisciplinary world where to be successful you need to understand complex ideas from many different fields, such as bioinformatics, statistics, clinical trial design, ethics, epidemiology, genetics, molecular biology etc, etc, etc. The PhD is starting off with depth but expects the ability to acquire width. And therein is the essential difference.

Society does not appreciate the knowledge base of the average PhD, mostly because PhDs generally make themselves inaccessible to the general public. I do however, think its better than it was when I wrote my original post. People rarely ask me if I'm a 'real doctor' anymore, especially when they hear what I do. In turn, it's my responsibility to do that outreach, and to explain how my years of training does to benefit society.  In turn, it will be understood that there areas (in medicine, in my case) where I understand things very well, down to the cellular level. That being said, I would never, ever give anyone medical advice - I always say to talk to their MD.  I say this even though I have had about 16 years of experience understanding the complexities of the immune system, whereas their family doctor may have had a couple of modules in med school (or may have a PhD themselves, its very variable).  But our knowledge bases are different - I've not dealt with patients. My 'job' is to help enlighten how science and research (often done by PhDs) has lead to inform and direct medical practice (often done by MDs).

In the end we all have our place.

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