MD or DO / PharmD Joint Program

[Aidan]

Is there such a thing as a program that awards an MD or DO degree as well as a PharmD? If not, wouldn't this be useful? To either have a pharmacist that has MD knowledge in medicine, or a physician that has PharmD knowledge in medication? I ask because I've seen a lot of our prescriptions (I work in a pharmacy) get sent back to the prescribing physician d/t them being a danger to the patient, either by drug interaction or a contraindication with their disease state.

Thanks~ also discussion would be cool, i.e. saying why this would be helpful or why it is unnecessary.

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[MattD]

MDs and DOs have plenty of knowledge of medications, and typically have access to just as much information as a pharmacist has via electronic tools. However, physicians are human and sometimes things are missed, which is why it's certainly important to have another layer of protection for the patient via the pharmacist. There is no need for a physician to learn all the things a pharmacist needs to know (which is not just pharmacology), and it's not going to be useful enough for their practice to spend the extra few years it would take.

I can see even less reason for a pharmacist to want the full medical school experience to 'enhance' his/her pharmacy practice.

If as a physician you want to have additional expertise in pharmacology there's nothing stopping you from studying the topic, and I do agree that knowledge of pharmacology is one of the most important things for a physician to possess. After all, carpenters use wood, saws, and nails, painters use canvas and paint, physicians use drugs. We need to know how to use our tools

 

[Aidan]

MDs and DOs have plenty of knowledge of medications, and typically have access to just as much information as a pharmacist has via electronic tools. However, physicians are human and sometimes things are missed, which is why it's certainly important to have another layer of protection for the patient via the pharmacist. There is no need for a physician to learn all the things a pharmacist needs to know (which is not just pharmacology), and it's not going to be useful enough for their practice to spend the extra few years it would take.

I can see even less reason for a pharmacist to want the full medical school experience to 'enhance' his/her pharmacy practice.

If as a physician you want to have additional expertise in pharmacology there's nothing stopping you from studying the topic, and I do agree that knowledge of pharmacology is one of the most important things for a physician to possess. After all, carpenters use wood, saws, and nails, painters use canvas and paint, physicians use drugs. We need to know how to use our tools

I didn't mean to imply that physicians' knowledge base of pharmacology was inadequate, or to imply that their mistakes are from incompetence and not just accidents. However, I meant that an MD/PharmD could render a more holistic physician, and that they might be able to see a correlation between some complex aspect of a drug's pharmacokinetics and a side effect or symptom the patient is having, which could lead the diagnosis in a different direction.

How often something like that is actually important or actually happens, I'm not sure...as a med student you're more in the light than I am, so your post clears things up quite a bit, thanks .

 

[cpants]

Career-wise it wouldn't help you, because (correct me if I'm wrong) I think MD's are allowed to dispense medication. I think you could technically run your own pharmacy out of your office without getting any additional schooling.

As far as the drug interactions thing goes, you are responsible to know about this stuff as an MD, and you will learn it. I don't think the extra time spent in PharmD school would necessarily help you in any way. When you prescribe medications, you will look at all the meds the patient is taking and check for interactions. When a patient presents with symptoms, you will check their meds to decide if a drug reaction should be part of your differential. Basically this would just be a lot more school, for little (if any) benefit.

 

[MattD]

I didn't mean to imply that physicians' knowledge base of pharmacology was inadequate, or to imply that their mistakes are from incompetence and not just accidents...

Yeah I knew what you meant, I was just pointing out the importance of having a pharmacist in the equation, and the relative lack of importance in a physician having the full training of a pharmacist. As tired noted, medicine's not really that complicated (well it still certainly can be for me, but I'm a noob

 

[dragonfly99]

I don't think getting both these degrees would be that helpful. It takes a whole health care team to take care of patients comprehensively. I am however, surprised that some med school and pharm. schools haven't dreamed up such a degree in order to make money (evidence the multiple MD/MBA, MD/MPH, etc. degrees that proliferated in recent years).

As far as what you have seen while working in the pharmacy, some of it is definitely just physicians making a mistake, but also there are times/situations when a physician prescribes meds in a way that isn't what the computer or pharmacy books say he/she should. That isn't always an error or mistake. There are time when off-label medication usage (i.e. using medicines for things the FDA hasn't approved them for) or different/weird doses are justified. Specialists like oncology, cardiology, etc. might do this more often.

 

[Isoprop]

I don't think getting both these degrees would be that helpful. It takes a whole health care team to take care of patients comprehensively. I am however, surprised that some med school and pharm. schools haven't dreamed up such a degree in order to make money (evidence the multiple MD/MBA, MD/MPH, etc. degrees that proliferated in recent years).

As far as what you have seen while working in the pharmacy, some of it is definitely just physicians making a mistake, but also there are times/situations when a physician prescribes meds in a way that isn't what the computer or pharmacy books say he/she should. That isn't always an error or mistake. There are time when off-label medication usage (i.e. using medicines for things the FDA hasn't approved them for) or different/weird doses are justified. Specialists like oncology, cardiology, etc. might do this more often.

well, i could see md/mba or md/mph degrees being useful. but md/pharmd? what purpose would that serve?

 

[deleted6669]

there are a handful of pa/pharmd programs( around 6) that can be done in 5 yrs after a bs( you save 1 yr as the pa2 yr counts as the pharmd senior yr).
here is 1:
http://www.washington.edu/medicine/som/depts/medex/applicants/degreeoptions_pharmd.htm

 

[Aidan]

Thank you all for posting your thoughts and opinions, it's really explained and cleared up a lot for me..esp. the person that brought up the idea of drugs being used as off label and thus raising a 'flag' in our system..I hadn't though of that. I love how easy it is to get a discussion going with allied health people of all backgrounds..this site is invaluable.

 

[cbrons]

Career-wise it wouldn't help you, because (correct me if I'm wrong) I think MD's are allowed to dispense medication. I think you could technically run your own pharmacy out of your office without getting any additional schooling.

Its up to the individual state. In most cases, doctors can dispense medication from their office... which is why drug reps are able to give them samples. Certain states restrict the type of substance doctors can issue through their office (i.e. certain states allow CII (Ritalin, Oxycontin, Fentanyl, etc.) through CV (and OTC) stuff). In IL, this is the case but requires a separate license from the state. There are further restrictions that disallow physicians from dispensing (or counseling patients on) drugs that are outside their scope of practice... so a psychiatrist is technically not allowed to dispense, counsel, or even write a prescription for (I dont know? whats an example?)... Januvia?/something diabetes-related?

mind you this is all in my preparation literature for the silly little cpht exam

 

[MattD]

Well, I mean, nobody ever "has it down". It's a constant process of learning and incorporating your experience into new situations.

But that's more a matter of pattern-recognition and remembering facts you learned long ago.

It's certainly not House. That's all I was trying to say.

House isn't real?

Maybe that explains some of my eval comments.....

:-D

 

[Samoa]

Speaking as someone with both degrees, their value on a medical team lies mostly in the fact that they are separate pairs of eyes, and perhaps 20-30% in their respective knowledge bases (and yes, they are significantly different).

I find that I am only slightly less error-prone with respect to prescription writing than the average physician. I'm a bit more sophisticated about drug therapy than your average surgeon, and perhaps have a wider range of familiar drugs to use and can address some problems that another might punt to a consultant. But the value of the training to my medical practice is not worth the time I spent getting the degree.

Conversely, in my role as a pharmacist, I don't have time to satisfy my curiosity about whether the medication that the physician has prescribed is REALLY what I would have chosen. However, my recommendations are somewhat better tailored than those of most clinical pharmacists. But again, if I intended to practice as a pharmacist, the extra knowledge gained from medical school and internship is not helpful enough to justify the time and expense of gaining it.

 

[J ROD]

I am sort of doing a joint MD/PharmD. There is not one established but I let my instate med school know what I was doing before I started pharm school.

I had a hard time deciding between the two so I just decided I would do them both. I got accepted into pharm school rather quickly and easily and I know med school would be harder so I just went pharm school. I wanted to make sure I at least got one decent career.

After being in for several years, I would say it is not worth it overall. Time and money wise. I think it will give me some advantage but not much.

For me, I just knew it was going to take several years to be competitive for med school and I already had a pharm acceptance so I figured I could almost have my PharmD by the time I was prepared for med school.

Plus, I like putting more initials after my name, I am such an initials *****!!

 

[Sarapary]

why do you think it is not worth it?

 

[J ROD]

why do you think it is not worth it?

Time, money, effort, and opportunity costs.

I will be very happy with my two doctorates though.

I always wanted two. I hate research so PhD was not for me.

So, a MD/PharmD made the most sense.

I do not regret it for myself but I would not recommend it either.

 

[swamprat]

Time, money, effort, and opportunity costs.

I will be very happy with my two doctorates though.

I always wanted two. I hate research so PhD was not for me.

So, a MD/PharmD made the most sense.

I do not regret it for myself but I would not recommend it either.

When will you be done with your PharmD if you don't mind me asking?

 

[Samoa]

Time, money, effort, and opportunity costs.

Agreed. All of those outweigh its utility substantially. Having a PharmD is a nifty conversation piece, but I can think of far better ways to have spent the years it took me to get it.

I don't know--maybe it would be more useful if I were an internal med doc. But I have no interest in anything that doesn't involve surgery. And in surgery, it's nearly a total waste.

 

[J ROD]

When will you be done with your PharmD if you don't mind me asking?

Next May! I'm a 3rd year.

 

[J ROD]

I don't know--maybe it would be more useful if I were an internal med doc. But I have no interest in anything that doesn't involve surgery. And in surgery, it's nearly a total waste.

yeah, for surgery, it is almost a waste.

I really like EM and Anes. I know it will help me with Anes.

Surgery, Peds, and OB/GYN are my least favs as of now.

 

[vraypharmd2md]

Agree with Samoa,

As one who has a PharmD and is a couple of months from having the MD, I do not think both degrees will make me a "superstar" or will be the key to practicing good medicine or good pharmacy. Both fields require continual learning and improvement

Important benefits:

1. A deeper appreciation for fellow healthcare professionals; friends that are able to keep you uptodate on new advances in either profession

2. Potential high-paying part-time job during medical school (will be impossible for me to practice pharmacy during residency)

3. Also agree, that I am a little more careful with prescribing, but by no means infallible.


The drawbacks

1. Time. If I could do it all over again, I would go straight to medical school. You can't get years of your life back. More important as you get older. (I have had a great experience, but could be well into my residency if I came straight to medical school)

2. Money. This is not a cheap choice b/c you pay for the education and you miss out on years of potential earning. After 4 years of medical school and about 4 years of residency(med-peds), I will miss out on about $800K of earning as a pharmacist ( about $100k a year) to make about $150K a year in general practice, if I'm lucky. Don't forget the loans for college, pharmacy school and medical school. Bottom line: I won't be poor, but the decision definitely has large financial implications.


But I have enjoyed my training and love both medicine and pharmacy. I am willing to answer any questions as well.