MD as an obsolete degree?

[banana k]

i'm about to give up my place in medical school for the sake of a phd position. after months of worrying about what i should do, i sort of talked myself into a conclusion last night almost by accident when explaining it to a friend. here it is, and it took me FOREVER to figure out, so read my explanation before you cast the stone:

doctors are becoming redundant and obsolete!

no really, think about it.

-research positions that formerly went to MD's now go to PhD's or MD/PhD's (so why get the MD to do research?)
-clinical primary care positions and procedures that were formerly exclusively MD now go to LPN's, and frankly i think they give just as good care. meaning that the number of MDs per patients can go down to the smaller number needed to supervise said LPN'S. (so why get an MD for the sake of patient care?)
-specialist LPN's are ubiquitous and competent--e.g. derm, anesthetics, womens' health, etc. (so why get an MD to be a specialist? although ok i'll grant that there are some specialties left, but not heaps)

i think i wanted to be a doctor for so long so that i could merge the science angle and the people angle. but then i realised that it's not about science because you're just memorising what scientists past have done in order to treat people, and it's not about people because if it was, you wouldn't have to kowtow to HMO's and could treat all patients exactly how they needed. and these days, memorising all that science to treat people has become redundant because of auxiliary staff and other sources of care. all that's left exclusively to being a doctor is the glow of being able to announce that you are one.

i think, eventually, once that glow wears off, the profession of Medical Doctor and the degree of MD will become obsolete in the face of PhD in Medical Science and RN/LPN and other clinical caregivers.

feel free to cast stones on this argument. i'm really not quite sure i believe it myself yet, but i wanted to throw it out there and let you all tell me i'm nuts and give me good reasons why before i make a huge life-changing decision. what are your thoughts? (please, no knee-jerk reactions... really think about it!)

~k

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[dr_keki]

i know someone who got accepted into Harvard medical school but decided to go for a PhD in engineering or computer (forgot exactly). Here's what I dont get - why did you apply for med school in the first place?

 

[KMG365]

I think you might want to reevaluate your argument. First of all, it obviously doesn't come from someone who knows anything about healthcare. An LPN is a licensed practical nurse, it's below an RN. Most hospitals are phasing out their use, they can't even push IV medications, among much else.

I think you were referring to either Physician's Assistants or Nurse Practitioners (both of whom would (rightfully) give you exceedingly dirty looks if you mistook them for an LPN). Either way, both positions rely on MD/DOs to do their jobs. I know people who do both jobs, both in primary care and specialty settings, and all of them freely admit that they need the docs to confer with on difficult cases. For this, and innumerable other reasons I think your argument is fatally flawed.

But hey, I've always said I like PhD programs. They take the smart kids out of the med school pool. So, go for it, get your PhD, that's one less person I'm competing against.

 

[Law2Doc]

i'm about to give up my place in medical school for the sake of a phd position. after months of worrying about what i should do, i sort of talked myself into a conclusion last night almost by accident when explaining it to a friend. here it is, and it took me FOREVER to figure out, so read my explanation before you cast the stone:

doctors are becoming redundant and obsolete!

no really, think about it.

-research positions that formerly went to MD's now go to PhD's or MD/PhD's (so why get the MD to do research?)
-clinical primary care positions and procedures that were formerly exclusively MD now go to LPN's, and frankly i think they give just as good care. meaning that the number of MDs per patients can go down to the smaller number needed to supervise said LPN'S. (so why get an MD for the sake of patient care?)
-specialist LPN's are ubiquitous and competent--e.g. derm, anesthetics, womens' health, etc. (so why get an MD to be a specialist? although ok i'll grant that there are some specialties left, but not heaps)

i think i wanted to be a doctor for so long so that i could merge the science angle and the people angle. but then i realised that it's not about science because you're just memorising what scientists past have done in order to treat people, and it's not about people because if it was, you wouldn't have to kowtow to HMO's and could treat all patients exactly how they needed. and these days, memorising all that science to treat people has become redundant because of auxiliary staff and other sources of care. all that's left exclusively to being a doctor is the glow of being able to announce that you are one.

i think, eventually, once that glow wears off, the profession of Medical Doctor and the degree of MD will become obsolete in the face of PhD in Medical Science and RN/LPN and other clinical caregivers.

feel free to cast stones on this argument. i'm really not quite sure i believe it myself yet, but i wanted to throw it out there and let you all tell me i'm nuts and give me good reasons why before i make a huge life-changing decision. what are your thoughts? (please, no knee-jerk reactions... really think about it!)

~k

I wouldn't worry much about the future of medicine. With the baby boomer generation aging and increasing their medical needs, there will be a shortage of physicians in the US for the next couple of decades. Various other personnel, like PAs and CNRAs are being given additional responsibilities to ease the crunch, but there is no expectation for them to take over and they will forever be in the supporting role (much in the way that paralegals have never supplanted lawyers, no matter how much of a role they handle). But it seems that you lack a lot of knowledge of what a doctor really does. You may want to increase your exposure to some before you make any life changing decisions -- it sure seems like you have none.

 

[DrBowtie]

Unless your PhD starts to earn the same salary as an MD, the pool of people going for the MD will be sustained.

 

[OddNath]

I'm not sure if "doctors are becoming obselete" is the conclusion I'd come to with your arguments. If anything, I think the reason that RN's and PA's are doing so much of the clinical work these days is b/c there's a shortage of doctors. It's undeniable that there's places all over the country that don't have enough health providers.

"research positions that formerly went to MD's now go to PhD's or MD/PhD's"
Well of course-- who does MD-only for research training?

And I don't think specialists will be going out of business any time soon. I think you're underestimating what all is out there. Just b/c other health professionals are taking over some primary care responsibilities, that doesn't mean that surgery, neuro, emergency medicine, optho, or anything else you can think of is becoming "obselete."

I think your train of thought is exaggerating various roles of an MD which may/may not be declining for the sake of making your decision easier. Please don't let one pessimistic conversation with your friend make a big decision like this. At least talk to some doctors/current students for more opinions (and I mean in person, not necessarily here).

 

[pip00]

i think m.d. is better than any biological sciences ph.d. because all the skills that you really need to do research in bioscienses are introductory courses like orgchem,biochem,cell bio, etc. of course many ph.d's have an inherent interest in research, reading articles, doing experiments, etc. but it doesnt stop you to do the same as an m.d. on the other hand you can make a lot more money and also some may find it interesting to interact with patients(how different from a nurse you are depends on many circumstances including the type of illness that they have). but of course if you're interested in something like math/physics, then it's good if you stay away from m.d., though perhaps you may get a ugrad degree in math/physics and then find out that you're not really interested/competent in it, then m.d. is a great possibility.

 

[Flopotomist]

I think the OP meant mid-level provider (eg NP, PA) instead of LPN. There will not be any drop in the need for physicians any time soon though for a few reasons.

1. Mid-levels need to be supervised by a physician.
2. The sheer volume of patients exceeds the capacity of mid-levels.
3. Some specialties require a physician, and a mid-level just doesn't have the scope of practice to perform certain tasks (eg surgery)
4. To make new discoveries in medicine, the PhDs may do the bench research, but the physicians will actually move the research from theoretical to standard of practice.


I wish you luck in whatever path you take, but do a bit more homework before making this decision. It sounds like you are a bit uninformed currently.

 

[banana k]

ooh, sorry, i got my initials wrong. erk! proof that one should proofread posts... but seriously, don't jump down my throat just for that. i DID mean nurse practitioners--my bad. (cut me some slack, i'm not from where you are.)

as far as "conferring with doctors" goes... refer to my argument again, that you just need as many MD's as needed to supervise the NP's. i would posit that maybe the MD force would be downsized by HMO's who can pay NP caregivers less to do the same job, and eventually they'll have the experience as well as the skills to make up the difference. i'm not saying this is TRUE--i'm just asking what people think.

and i applied for med school in the first place because i had a naive idea that it was (as i said, if you read and did not just skim) a merging of science and people skills. having spent a deferred year in research and behind the scenes of both PhD researchers and clinical physicians, that bubble got burst. i haven't met a single physician who's told me to continue down the medical path, though every hoi polloi member seems to think it's a great idea because of money and respect.

as for you, valedictorian, i said i wasn't sure of this argument--i'm looking for facts and beliefs, not troll reactions.

lastly: this is not based on the single conversation. basically it was ME telling my friend this stuff and then realising the direction of my evidence. it's based, as i said, on a year of research and shadowing.

 

[Law2Doc]

ooh, sorry, i got my initials wrong. erk! proof that one should proofread posts... but seriously, don't jump down my throat just for that. i DID mean nurse practitioners--my bad. (cut me some slack, i'm not from where you are.)

as far as "conferring with doctors" goes... refer to my argument again, that you just need as many MD's as needed to supervise the NP's. i would posit that maybe the MD force would be downsized by HMO's who can pay NP caregivers less to do the same job, and eventually they'll have the experience as well as the skills to make up the difference. i'm not saying this is TRUE--i'm just asking what people think.

and i applied for med school in the first place because i had a naive idea that it was (as i said, if you read and did not just skim) a merging of science and people skills. having spent a deferred year in research and behind the scenes of both PhD researchers and clinical physicians, that bubble got burst.

as for you, valedictorian, i said i wasn't sure of this argument--i'm looking for facts and beliefs, not troll reactions.

NPs and the like are not currently licensed to do everything that doctors do, so its not a matter of experience. And HMOs are not exactly the kind of employer who can "downsize" MDs in favor of NPs, because to do so would put them into competition with MDs rather then exploiting them. The latter is a much better position for them. MDs and HMOs need the symbiotic relationship they are in, and are unlikely to rock the boat.

 

[DrMom]

Sounds like you were more interested in the research than clinical medicine. That's great because we need good medical researchers...and people need to have professions that they enjoy & find challenging/rewarding.

That said, your preference doesn't at all mean that medicine isn't going to remain the realm of physicians. There are more mid-levels taking care of the routine primary care cases, but there are still a ton of FM/IM docs out there doing very well (and taking care of more complex patients). You're not going to see the big flux into most other specialties b/c they really need more training. PAs may be assisting in surgery & surgical patient care, for example, but I don't forsee them taking over the realm of surgery.

I think that the mid-levels have an important (and legitimate) role in medicine, but overall they're not going to replace physicians.

 

[moinmoin]

.

 

[jbone]

Ok, you love the PHD so much, you give up your MD spot and give it to me . Sounds like a plan. Everybody goes home happy.
Good luck!!

 

[nimotsu]

I think you're correct... we're all just crazy studying for the MCAT, taking classes, and doing ECs to get into these obsolete institutions.

 

[deuist]

I tried the grad school route before going to medical school. PhD's will always play second fiddle to the MD's. Physicians can prescribe meds and test biomedical products on patients---something that PhD's can't. If you are interested in doing research, hold out for your medical degree---what, another two years---and then do a research residency. You'll be a strong contender for a lab or a university.

 

[banana k]

moinmoin, i have already chosen--and it's phd unless something happens to crash and burn my scholarship. i've gotten a fair bit of well-considered advice from friends family and professionals in both fields so it's not really a personal decision question, much.

momMD--very helpful answer, so let me rephrase a bit and see what you think. i know there are still FP/IM's and others out there doing just fine; i guess my point is simply that what they do is no longer... as interesting? that the field of interesting and diverse tasks is becoming narrower, maybe? practicing physicians all sound like they have less time to interact with patients, and the patient interaction is given over to the mid-levels, so that kills my hope for that. and the intellectual research/clinical trial side of things is being given over to researchers, so that kills my hope for that. and one more thing to add: there's much more BUSINESS involved than there used to be.

 

[Will Ferrell]

shuttup you gunner. i bet you made this post to weed out competition. how the heck is an md going to end up obsolete?

 

[banana k]

gunner? i got in by the skin of my teeth! besides, if you read my post you'll see my answer to your question. (at least, a possible answer, take it or leave it.)

i think maybe my view is also a little skewed by the gunner phenomenon. once the goal was not so lofty (i.e. i'd gotten in), i started to look at it from a different perspective. i'd competed so hard to get there, and then was ready to settle down and be friendly and happy with where i was and not always rise to the top of the heap, but everyone else still wanted to be "better than the joneses"... i had to wonder how many were there for the glitter of being a doctor over actually studying medicine.

and finally, a rephrasing of my original conclusion... MD is becoming obsolete in the areas which originally drew me to it. yes?

 

[guv_garfunkel]

Banana, I've worked in a hospital setting for almost three years and shadowed a bunch of docs. Sounds like you don't have much experience in how health care really works. I don't say that to be rude, but if you did have the experience you would know that MDs are not nor will ever become obsolete.

 

[masterMood]

doctors haven't been obsolete for the past 4000 years, what makes you think they will be obsolete now? The Apocalypse?

 

[docbill]

gunner? i got in by the skin of my teeth! besides, if you read my post you'll see my answer to your question. (at least, a possible answer, ....

Banana,, you are slipppppinggggggggg

I would not give up your MD or DO position. Are you drunk, drugged or what??? If you are interested in doing PhD in life sciences that means you have some interest in medicine. Initially you had interest in medicine now you may be loosing focus. Don't give it up, you should wait till start of classes if you are to give it up. This is one chance you will not get again.

How do I know what is worth more.. medical degree or PhD. I have (almost) a PhD in Cardiology research, and I KNOW, that the best way to make it in medical research, is to have an MD or MD/PhD. Did you consider starting first year med and applying to MD/PhD program at that time. Think carefuly.

BUT------ IF YOU LOVEEEEE RESEARCH AND ARE SURE THAT IS THE ONLY THING YOU WILL BE DOING.... then that is okay.

 

[banana k]

okay guv, i'm listening--that's the point--to tell me. with facts and personal observations instead of insults, if you don't mind. maybe all of you could give some good examples and prove me wrong, instead of just telling me i'm wrong and a *****? i really tried to make this an ad rem arguable topic but some of you are just wayyyyyyy too used to the ad hominem bandwagon on this forum.

and by the way, 4000 years ago, people went to religious and spiritual healers. and as recently as 200 years ago, medical school had the least stringent standards of any profession and doctors hadn't the first clue as to what organ systems were. the medical field and its practitioners is not exactly a constant.

 

[BKN]

okay guv, i'm listening--that's the point--to tell me. with facts and personal observations .

OK personal obs and a few facts. Here's my take. I'm a EM doc, entered medical school in 1972, 26 years of practice, mostly in academics, program director, MS in clinical research design and stats, and a fair number of pubs.

You are correct, MDs knew little until the end of the 19th century. The twentieth century was the century of pathophys and organ based medicine. It was wonderful and wonderful to live through. The nature of my practice has changed amazingly over my life, just as my professors said it would, even though they didn't know how. The last 30 years have been the golden age of molecular biology and we have just entered the age of molecular medicine. The time of your career (say the next 40 years) will be filled with ever more knowledge of disease at the cellular and molecular level. We will begin to tailor therapy to the particular genome of our patients. Rather than medicine becoming "obsolete", it will be more exciting then ever. Get on board as a physician,scientist or both; you'll have a great life and career. And if you're going to research: We've got a handle on trauma and CAD, aim at Sepsis/Multiple Organ Failure or Cancer.

And as for us EM docs, far from the cutting edge. We'll always have a job because people will always do stupid things and we stay up all night allowing the physician/scientists to sleep.

 

[QuikClot]

okay guv, i'm listening--that's the point--to tell me. with facts and personal observations instead of insults, if you don't mind. maybe all of you could give some good examples and prove me wrong, instead of just telling me i'm wrong and a *****?

If you want facts and personal experience used in refuting you, you should use them to make your case, rather than sweeping generalizations and unsupported speculation about the future of the medical profession. No one is going to spend hours in painstaking research to refute such a sloppy argument. Garbage in, garbage out.

Now, why are people upset with you? Because you have taken a personal choice you made about your career and generalized it into a death sentence for the entire profession. You then logged on to a website for would-be doctors and expounded this thesis, implying that you were quitting because you had wised up, and the rest of us were still laboring under the delusion that we had a bright future. Can you see how that would piss some people off?

You also changed your story. You began by saying the profession was doomed and are now saying that it's not going to be as much fun as it used to be. Those are very different claims.

Personally, I am not afraid of HMOs or NPs. Perhaps its a function of having had a real job, in which my clout was truly zero and I could be replaced at any time; I recognise that doctors have a vast amount of leverage compared to most employees, and better pay and conditions than all but a handful of hourly employees.

The role of physician is not in any sense inevitable. You could organize healthcare in another way; specialists only, perhaps, with an RN co-ordinator acting as PCP. They same could be said of many professions; you could organize society in a different way, and assign their functions elsewhere.But that is not the healthcare system we have, or are likely to have in the future.

 

[drmota]

i can feel myself losing brain cells.
-mota

 

[QuikClot]

And as for us EM docs, far from the cutting edge. We'll always have a job because people will always do stupid things and we stay up all night allowing the physician/scientists to sleep.

I'm a paramedic and would-be EM doc. High five for stupidity, the ultimate renewable resource!

 

[RunnerMD]

oops--submitted msg 2x. sorry!

 

[RunnerMD]

Although it sounds like you have already made up your mind, I'd ask you to listen to an experience I had with a practicing physician. Like you, this career path interests me because I can merge my love for the sciences with interpersonal contact.

I think its very important to remember that the role of a physician is up to YOU. I shadowed a doctor who DOES take time to establish strong physician/patient relationships. He spends time talking with each patient--in fact, he's even written a number of books about the unique lives/experiences of his patients (with their permission of course). In my conversations with him, its evident that these interpersonal relationships are his motivation to practice medicine.

Anyhow, I'm not sure if I expressed that point clearly (I've had a looong day), but my point is that its up to YOU. If you want to be a patient-centered physician, you just have to make the effort. Don't just fall back on the PhD b/c you're dissatisfied with the current health care system. But if you truly are motivated to do research and want to spend your life devoted to writing grants to fund projects, writing articles, etc., then follow that path. Do what you feel is right in your heart.

 

[lattimer13]

i'm about to give up my place in medical school for the sake of a phd position. after months of worrying about what i should do, i sort of talked myself into a conclusion last night almost by accident when explaining it to a friend. here it is, and it took me FOREVER to figure out, so read my explanation before you cast the stone:

doctors are becoming redundant and obsolete!

no really, think about it.

-research positions that formerly went to MD's now go to PhD's or MD/PhD's (so why get the MD to do research?)
-clinical primary care positions and procedures that were formerly exclusively MD now go to LPN's, and frankly i think they give just as good care. meaning that the number of MDs per patients can go down to the smaller number needed to supervise said LPN'S. (so why get an MD for the sake of patient care?)
-specialist LPN's are ubiquitous and competent--e.g. derm, anesthetics, womens' health, etc. (so why get an MD to be a specialist? although ok i'll grant that there are some specialties left, but not heaps)

i think i wanted to be a doctor for so long so that i could merge the science angle and the people angle. but then i realised that it's not about science because you're just memorising what scientists past have done in order to treat people, and it's not about people because if it was, you wouldn't have to kowtow to HMO's and could treat all patients exactly how they needed. and these days, memorising all that science to treat people has become redundant because of auxiliary staff and other sources of care. all that's left exclusively to being a doctor is the glow of being able to announce that you are one.

i think, eventually, once that glow wears off, the profession of Medical Doctor and the degree of MD will become obsolete in the face of PhD in Medical Science and RN/LPN and other clinical caregivers.

feel free to cast stones on this argument. i'm really not quite sure i believe it myself yet, but i wanted to throw it out there and let you all tell me i'm nuts and give me good reasons why before i make a huge life-changing decision. what are your thoughts? (please, no knee-jerk reactions... really think about it!)

~k

i find it impossible to believe that you were actually accepted to medical school after reading such an ignorant post.

 

[TX515]

MD/DOs will never become obsolete. They will be in more demand. The increase in mid level health care providers will also increase due to the lack of health care provided by doctors.
If you want to go into research, good for you.

 

[Pose]

I was actually worried for a while...I'd be really really disappointed to make it through medical school and residency to let someone that hadn't made it take over. I gave up on that, and figured I'll practice medicine regardless of who lobbies for what.

If medicine allows 'mid-levels' to take such drastic steps into authority, medicine must be evolving in several ways and I see no possible way for the physician to be eliminated because of that. If NP's and PA's and CRNA's and *whatever* are given the same scope of practice tomorrow, it's beyond a compromise to patient care, however, is that reality?

And if science creates a "cure" for all disease? And people start wearing seatbelts, and stop taking drugs? I doubt the physician will ever be phased out, because people aren't going to stop getting sick, regardless of science and
the nursing model.

However, this was still reassuring!

 

[Overeducated]

I don't understand how anyone could work so hard and get that far only to come to this shallow a conclusion

 

[neovenom]

i'm sorry for you that you have spent so much effort to get into med school but now are deciding against it. however, that is good news for another applicant who is more passionate about a career as a physician.

as for your initial point, i don't believe that an MD will be obsolete anytime soon. and here's an argument that i can think of. there's a shortage of doctors in the country, esp rural areas. those areas cannot afford to have various health professionals (due to competition from cities for the same positions); they need a doctor who has the authority and training to carry out a broad range of procedures by himself.

along the same lines, my father is a physician. a much needed psychiatrist in a small town actually. he's told me that his hospital keeps getting budget cuts, and certain positions get laid off, but never a doctor because they are needed for their authoritive power and scope of medical knowledge. so this makes me think that the MD degree has a lot of value in the world, and won't be going anywhere.

 

[Centinel]

as for you, valedictorian, i said i wasn't sure of this argument--i'm looking for facts and beliefs, not troll reactions.

While you may not have been looking for an onslaught of ad hominem attacks, the very title of your thread is little more than an ad hominem against the majority of the users on SDN. Consider yourself lucky for getting as many rational responses as you have.

 

[gary5]

Yes, you should definitely become a PhD. Skip both MD and MD/PhD.

 

[tacrum43]

MDs do many things that other healthcare providers (except DOs of course) can't do. A PA or an LVN isn't going to do open heart surgery anytime soon.

To the OP, it's fine if you don't want to go to medical school afterall, but it shouldn't be because you think there won't be medical doctors in 20 years or something. Stop trying to convince yourself that it's for this ridiculous reason, because if that's really why, you're just going to be miserable with your decision later.

There is a real and growing need for doctors (as well as other healthcare providers) and being a physician is one of the most secure jobs out there.

 

[Overeducated]

There is a real and growing need for doctors (as well as other healthcare providers) and being a physician is one of the most secure jobs out there.

Quite true.

This entire thread sounds troll-ish to me... if it were legitimate wouldn't it be posted in the allopathic forum rather than the pre-allo forum?

 

[Stroganoff]

doctors haven't been obsolete for the past 4000 years, what makes you think they will be obsolete now? The Apocalypse?

That damn apocalypse, always ruining my golf game.

I agree that it's pretty ignorant to say that the medical degree (MD or DO) will be obsolete. It's always evolving in scope and daily practice, but it's the pinnacle of responsibility and knowledge. It's like saying CEOs and presidents are obsolete.

The only thing that may be rendered "obsolete" is some of the primary care procedures. These don't require advanced skill, so it's smarter time-wise, money-wise, and management-wise to allocate these procedures to qualified mid-level peeps to do. This will give us physicians more free time to do the stuff that we really want.

BKN made some awesome points about genomic/molecular medicine. I'm totally stoked about that. I also think the 21st Century will herald the transition of nanomedicine from theory to reality.

Physicians are trained to be experts, so it's only wise to match them with expert responsibilities and procedures and leave the basic and intermediate tasks to the people who have not had the training of a physician.

 

[banana k]

okay, thank you for the well-thought-out posts, i appreciate them. for those of you with ad hominem attacks, i DID say that i wasn't sure of this argument, that it was based on impressions not facts, and that i was looking for facts. and then i changed it because someone refuted me effectively! (christ, if only the government would do that.) i don't want to be a doctor anymore because the former attractions it held no longer apply. not obsolete ENTIRELY, but the role has had a paradigm change which i didn't discover until i'd stuck my fingers in more pies. admittedly, i should have tried those pies before i applied and got in. OOPS. i think a career mistake or two is permissible when yours is the only fate at risk.

a lot of you have good ideas... but a lot of you are looking at the field as a whole, not at your individual roles as doctors. please, i was looking for thoughtful science v. practice experiences, not "you're dumb" reactions. would you do that in a face to face forum? i think not.

 

[BooMed]

i can feel myself losing brain cells.
-mota

mota, you are my favorite!

 

[Its_MurDAH]

okay, thank you for the well-thought-out posts, i appreciate them. for those of you with ad hominem attacks, i DID say that i wasn't sure of this argument, that it was based on impressions not facts, and that i was looking for facts. and then i changed it because someone refuted me effectively! (christ, if only the government would do that.) i don't want to be a doctor anymore because the former attractions it held no longer apply. not obsolete ENTIRELY, but the role has had a paradigm change which i didn't discover until i'd stuck my fingers in more pies. admittedly, i should have tried those pies before i applied and got in. OOPS. i think a career mistake or two is permissible when yours is the only fate at risk.

a lot of you have good ideas... but a lot of you are looking at the field as a whole, not at your individual roles as doctors. please, i was looking for thoughtful science v. practice experiences, not "you're dumb" reactions. would you do that in a face to face forum? i think not.

What do you REALLY want op? Did you not say earlier that you had essentially made your "decision" already to get a PhD instead of MD. Why, then, do you keep insisting on asking people to defend their life choices when you have already made yours? What are you going to gain now from reading people's posts about how your argument is flawed and just plain ridiculous (personal opinion)? You made your decision, just move the f*ck on. You can't come to SDN and then make some stupid as$ post like yours and expect lucid and well thought-out responses as to why you shouldn't stray from your path or whatever. If you are looking for some person to read your argument and have some sort of epiphany then I am sorry to say mate - it ain't happening.

Stop wasting everyone's time.

k thanx.

 

[TracksuitsRock]

and by the way, 4000 years ago, people went to religious and spiritual healers. and as recently as 200 years ago, medical school had the least stringent standards of any profession and doctors hadn't the first clue as to what organ systems were. the medical field and its practitioners is not exactly a constant.

I like what you say here. It's so true that medicine is ever-changing and will continue to be. That's one thing I love about it and it makes me feel as though there is so much opportunity for me to help to improve medicine. If you want to be an MD then be an MD. If your fear of becoming obsolete is going to hinder you from making a place for yourself in medicine, then by all means choose a route that will better serve your specific chosen path. I guess it depends on what you envision yourself doing and what your initial reasons were for applying.

Good luck!

 

[Stroganoff]

and i applied for med school in the first place because i had a naive idea that it was (as i said, if you read and did not just skim) a merging of science and people skills. having spent a deferred year in research and behind the scenes of both PhD researchers and clinical physicians, that bubble got burst.

......

it's based, as i said, on a year of research and shadowing.

Did you honestly think research would involve a ton of people skills? Clinical research, maybe. But bench research stuff? A big fat "duh" is in order. There's still plenty of pt. contact and co-worker interaction in medicine (another duh). It's up to you to do what you want to do.

I don't quite understand what you mean by "merging science and people skills." Medicine is an art based on science. Of course we'll have to deal with people. Everyday. Unless you explicitly choose diagnostic rads or bench research, you'll have to deal with people (duhhhh).

Be a professor if you wanna talk, talk, talk.

 

[unfrozencaveman]

a lot of you have good ideas... but a lot of you are looking at the field as a whole, not at your individual roles as doctors. please, i was looking for thoughtful science v. practice experiences, not "you're dumb" reactions. would you do that in a face to face forum? i think not.

Hey, I would take a look at the NIH's changing approach to funding- a very heavy emphasis on translational research, with the holy grail of it all being a kind of "bench to bedside" approach to research. The feeling is that research has lost an important clinical component, and is ignoring the real research force they have in MDs.

I actually also went to a talk the other day by the president of Novartis (this is all for work, I'm really not this lame), who basically went as far to say that pharma had really lost their way, in a way, to alienating doctors, and not using them as a value added measure in their orgs (the president of Novartis is an MD, so..)

So, anyway, I think you hit on some real points in your original post (a little extreme perhaps), but I would guess that the trend you suggest is actually not happening, and if anything, the pendulum is swinging back the other way.

 

[italicsquirel99]

Well, outside of the fact that this post is a little silly to begin with, something that has been glossed over is that, with a PhD instead of an MD, there is a lot of research doors that become closed to you. There are a lot of clinical things that you may be interested in doing that an IRB is going to let an MD do but not a PhD. Anything that has direct clinical contact with patients (doing so much as drawing a blood sample) is probably going to have to have an MD as PI to fly. If you're doing hard core bench research, or psychology research, that world belongs to the PhDs.

So I guess as you consider a career in research, you should also have a clear picture of what kind of research you see yourself doing, and which between an MD or PhD is going to be the better degree for you.

(Note: I have tried to be careful here...at no point am I saying that either degree is better or worse than the other. They simply put you on the path to different kinds of research).

 

[Tallulah]

Banana,, you are slipppppinggggggggg

I would not give up your MD or DO position. Are you drunk, drugged or what??? If you are interested in doing PhD in life sciences that means you have some interest in medicine. Initially you had interest in medicine now you may be loosing focus. Don't give it up, you should wait till start of classes if you are to give it up. This is one chance you will not get again.

How do I know what is worth more.. medical degree or PhD. I have (almost) a PhD in Cardiology research, and I KNOW, that the best way to make it in medical research, is to have an MD or MD/PhD. Did you consider starting first year med and applying to MD/PhD program at that time. Think carefuly.

BUT------ IF YOU LOVEEEEE RESEARCH AND ARE SURE THAT IS THE ONLY THING YOU WILL BE DOING.... then that is okay.

I have to wonder who you have been talking to OP. Several people in my family are research scientists with PhDs, including my father. He has always maintained that to be able to get grants and do a lot of the research you have to have an MD. MDs are able to do a lot of stuff that PhDs cannot. He has so far worked in 2 MD labs at a prestigious medical center and they got wayyyy more funding than the labs run by PhDs, so I would also suggest you rethink your decision and maybe talk to a few more people because the reality exists that if you want to run a lab and do your own research, then having an MD would NOT hold you back and actually help you.

 

[Orthodoc40]

-research positions that formerly went to MD's now go to PhD's or MD/PhD's (so why get the MD to do research?)

I don't know enough about this to say anything one way or the other. But I do work in a large academic hospital and the MD in our department DOES have a harder time getting grants for research than our PhD does. Those are only 2 people, however - hardly a trend that I can report.

-clinical primary care positions and procedures that were formerly exclusively MD now go to LPN's, and frankly i think they give just as good care. meaning that the number of MDs per patients can go down to the smaller number needed to supervise said LPN'S. (so why get an MD for the sake of patient care?)

You probably meant PAs and NPs, but yes, this is DEFINITELY TRUE. Once an NP has earned the respect of the MD's they work with, they operate almost independently of the MD's in their practice. The more they trust that you can do, the more they let you do. They just don't have time...

-specialist LPN's are ubiquitous and competent--e.g. derm, anesthetics, womens' health, etc. (so why get an MD to be a specialist? although ok i'll grant that there are some specialties left, but not heaps).

Probably true that they are competent, but most can not operate independently. And in this regard, they will NEVER make an MD specialist obsolete. There is way too much intensive training the MD receives that the NP or PA specialist will never, ever get. Period.

i think i wanted to be a doctor for so long so that i could merge the science angle and the people angle. but then i realised that it's not about science because you're just memorising what scientists past have done in order to treat people,

Interesting perception - makes sense.

and it's not about people because if it was, you wouldn't have to kowtow to HMO's and could treat all patients exactly how they needed.

Well, all insurance issues basically interfere, and in a big way, but I don't think it goes so far as to conclude it therefore isn't about people either. It just makes it a pain in the BLEEP!

and these days, memorising all that science to treat people has become redundant because of auxiliary staff and other sources of care.

Didn't follow that.

all that's left exclusively to being a doctor is the glow of being able to announce that you are one.

I don't think that is left at all, frankly!!! I think what is left is that in spite of all these challenges you've listed above, a person finds a way to serve others with compassion, and with their best knowledge, skill and experience.

i think, eventually, once that glow wears off, the profession of Medical Doctor and the degree of MD will become obsolete in the face of PhD in Medical Science and RN/LPN and other clinical caregivers.

While you have listed some reasonable observations, I don't think the conclusions are that dramatic or that black & white. While there IS evidence that in some specialties, for example orthopedics, there is an excess of MD's, and at the current rate of training there will be even a larger excess in 10 years time, (this is from the AAMC) but in other areas of medicine (obviously like family practice), there are shortages.

give me good reasons why before i make a huge life-changing decision. what are your thoughts?

I think you have to decide what is right for you, and that maybe you could benefit from more variety in your shadowing experience? (I don't know, since I don't know what you have or haven't done, just a thought). I say that only because I have tried to shadow a variety of MDs and PAs, NPs, PTs, Podiatrists, etc, to find out as much as I can with this decision, and you get so many viewpoints that way. There are plenty of MDs I've met that are happy, but there are some who would NEVER make the same choice if starting over.

 

[Hoberto]

Banana,

What I say is based on my experience at The Cleveland Clinic, University Hospitals (of Cleveland) and from anecdotal evidence from friends and colleagues. It in no way reflects the experiences of people who hang a shingle and are running their own practices.

Physicians who are interested in research often have money thrown at them to start up a lab and keep it running. This initial funding often comes from the hospital and in many cases keeps on coming if the grant writing is not successful. This means that a licensed physician can be in the lab 3 or 4 days a week and spend 1 day week in the clinic, doing surgery or whatever, WITHOUT the constant worrying about whether his job will be gone tomorrow or next week. A physician will not lose his job. His pay will not be cut.

A PhD who wants to start a lab must first secure funding and find a place to work. Now, even with funding, this PhD's job can be eliminated at any time without reason. A person with a PhD and many years of experience is competing against hundreds of other applicants with similar qualifications. This makes the job market for PhDs extremely poor. So, when that PhD's position is eliminated in favor of a new stem cell building, or breast cancer wing he is going to have real trouble finding another job. This becomes even more complicated if the researcher is tied to a single city of region.

Another thing to consider is the source of funding. Many grants are available to both PhDs and MD/DOs. This means that these people are frequently competing for the same money. A grant with a physician on it tends to be more successful than the all PhD grant. (Anecdotal, I have no data.) There are also more funding opportunities for physicians. So, it is far more likely that a physician will successfully find funding, whether it be from his own institution or from NIH, NSF, etc. The PhD grant writer is fighting an uphill battle and must constantly be writing grants if she expects to have some hope of keeping her job.

Physicians also have a higher pay scale. A PhD will almost always be paid less for the same (lab) work than a MD/DO. Many institutions have a pay grade scale that is based on years of experience and degree earned. Those MD/DO start at a higher pay grade and will most likely stay there. So, even if you choose to do research only, as a physician you will make more money than a PhD with the same job title and responsibilities.

Physicians often have better benefit packages. At CCF, for example, physicians have 100% coverage as part of their health insurance package. PhDs get this benefit only after several promotions and title changes. Until the PhD reaches 'Staff', he has the same benefits as the janitors and student workers. Can you imagine 100% coverage simply for having the MD/DO degree? You can be running the same gels, reading the same articles and going tot he same conferences as the guy next to you but your degree puts you in a while different category in regards to retirement, health and other benefits. If the physician finds a lump somewhere and want some diagnostic test run she can simply walk over to the hospital or clinic and see her doctor and get it checked out. She will pay no money. That guy without the PhD, has to call and make an appt, see the doc, then make another appt to get the tests run...and so on. I'm sure you have experienced this.

Personally, I would definitely go the physician route over the doctor route. As a physician you have far more opportunities and much better job security. You can choose to work with people a lot, a little or not at all. You can try 100% research for a while and if you hate it there are other things you can do.

Okay, I'm sure no one read this whole thing, but at least I got it all off my chest.

Good luck!

 

[LJDHC05]

Ok...I'm going to shoot the OP down on a couple of points and then go on my own rant...here it goes.

- There are plenty of MD's in research. I work with one, there are about 6 on my hall, and probably dozens on the floor. Research is becoming an integrative meeting place of biology, medicine, engineering, mathematics, physics, chemistry and anything else that you can think to stick in there. Each field brings a different prospective in solving a biomedical problem: MD's bring their knowledge of human anatomy, physiology, and clinical clinical practice to the floor, making the transition form the bench to bedside quicker. In theory atleast. MD/PhD's get crap from both MD's and PhD's because they straddle the two realms and get minimal respect from both.

-In line with what hoberto said...PhD isnt an easy life either. You have to battle through grad school on the poverty line working way more than 40 hours a week, then try to secure a post-doc position at the going rate of 35k a year for 60+ hours a week of work, then you have to apply for grant support (RO3/NRSA) through the NIH/NSF, both of which are fiscally growing at a rate of 7%/year and only receiving funding increases of 1-2% from congress and Bush...therefore the 70% of grants that were previously funded has been cut to about 10%. Then after establishing yourself as a PhD, you have to secure a full time faculty position to apply for the bigger grants (RO1) and teach in addition to keep your research running in the lab. And then you are gradually having less and less time in the lab, and more and more time behind a desk applying for funding and going to meetings and teaching and heading committees as a PI.

-

Now for my rant:

I went through the whole MD/PhD decision drama that you're going through right now. I'm a pretty competent scientist, and have the tools and connections to do pretty well in that field. But what nags at me with the PhD option is that it completely draws a line between me and the clinic that would be nearly impossible to cross. MD's work in research all the time. Most MD/PhD programs sell the prospect of combining science and medicine in your future. The only way to accomplish that goal is by being an MD who works in a lab 4-5 days a week and sees patients 1 or 2 days. There is no middle ground where the two realms meet evenly, research inevitably wins in my experience.

So, before you go jumping headlong into any decision, think about where you want to be 15-20 years from now, ask people who have been in both fields what keeps them in their field after all those years...ask them what it's like to be a 50 year old PI or a 50 year old physician. I guarantee that they'll tell you that it's not what they thought it would be when they started, or what some medschool pamphlet sold them. Honestly, it comes down to where your heart lies: clinic or lab bench. You help people with your work either way, you wont starve to death with either degree. But to call MD obselete, is off track if not dead wrong. Funding is tight for the forseeable future (2006 fiscal year, and as long as Bush runs a war in Iraq, cuts taxes and increases spending, and the greenspan clone continues to increase interest rates) regardless of the letters after your name.

 

[banana k]

hey everyone, thanks for your posts... i've been keeping my head down and out for a little while cos i've been waiting to hear from the scholarship committee to tell me whether they'd actually FUND my phd. word came back as yes, thank god. anyway, you know what, a lot of you are absolutely right, i did make that a black and white post which i didn't entirely agree with, and you've definitely convinced me that it's not so black and white. i guess it's a little different down in australia where it's a bit more black and white, since the emphasis is really on patient care rather than the science angle so physician scientists are hard to come by until they take a D.Sc. degree in medicine or some such. very few md/phd's. i'm sorry i assumed it was the same in the states--i shouldn't have done that; i just picked this forum cos it's more active than the Oz forum. anyway, like i said, i REALLY appreciate some of the insights that have come out--they give me some hope. phd's down here are 3 years rather than like 7 or 8 up north (they're sort of condensed and compressed into a three year slice of hell--bring it on) so it's not a huge unreasonable chunk of my life to do it, and it really doesn't rule out re-applying to med school later on if preclinical research starts to take a dive in funding and employment possibilities. med was the right decision for me a year and a half ago, and i think i would have been happy with it had i not in the meantime been exposed to basic research... now that i have, i know my heart's not in clinical practice and i'm REALLY glad that someone who wants it desperately will get my spot in the school.

so cheers guys, good luck, all the best!