MD/PhD in Health Services Research... waste of time?

[Giggles88]

Hi all,

I have a few questions about whether or not the MD/PhD program would be worth it for me.

1. Is a PhD in Health Services Research and Administration necessary for an academic career? Would a masters suffice?

2. What do you personally think of Health Service Research? The curriculum seems kind of lax for a PhD. Would you consider the program to be a joke?


Thanks for your help.


PhD program:
http://www.sph.umich.edu/hmp/pdf/Curriculum Guide 2011_12.pdf

Masters:
http://www.sph.umich.edu/hmp/programs/masters/ms.html

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[Ombret]

A friend of mine was interested in health policy and did his MD-PhD with PhD in that area. He is now in a very successful career publishing high-impact policy-related papers, doing work that is useful to the public interest and is rewarding to him.

I think this field (and the curriculum you linked to) could seem academically lax because on the face of it it's relatively approachable. Anyone can understand what you mean if you are working on figuring out whether Big Macs cause heart attacks, whereas if you are studying the conformational dynamics of beta-actin pleated sheets in high shear environments, you sound like a genius. However, that health policy coursework is probably pretty rigorous.

You would get a lot of the same coursework at the masters level. I don't know if you need a PhD to succeed in this area. I think, because of the success of MPH as a concept, and with the current proliferation of masters-level postprofessional degrees (masters in clinical epidemiology, etc.), that there are plenty of ways you could build a strong health services research program with a MD-masters; in fact this is more likely in health services than in basic science. Somewhat paradoxically, the PhD route would give you more time to develop your program earlier in your life--but you would not have the benefit of the clinical perspective that you will gain later in your MD and residency (and probably fellowship) years. Conclusion--if you are looking at a program with strong mentorship, and you have a good idea of what you want to do in health services, MD-PhD could work. Otherwise you are not limiting yourself by planning on a masters later.

 

[Neuronix]

1. Is a PhD in Health Services Research and Administration necessary for an academic career? Would a masters suffice?

An advanced degree beyond an MD is never required for an academic career.

2. What do you personally think of Health Service Research? The curriculum seems kind of lax for a PhD. Would you consider the program to be a joke?

It doesn't matter what I think. Most fully-funded MD/PhD programs are not going to fund your medical school so that you can do this sort of research. There are only a handful of programs that would consider it.

 

[Giggles88]

A friend of mine was interested in health policy and did his MD-PhD with PhD in that area. He is now in a very successful career publishing high-impact policy-related papers, doing work that is useful to the public interest and is rewarding to him.

I think this field (and the curriculum you linked to) could seem academically lax because on the face of it it's relatively approachable. Anyone can understand what you mean if you are working on figuring out whether Big Macs cause heart attacks, whereas if you are studying the conformational dynamics of beta-actin pleated sheets in high shear environments, you sound like a genius. However, that health policy coursework is probably pretty rigorous.

You would get a lot of the same coursework at the masters level. I don't know if you need a PhD to succeed in this area. I think, because of the success of MPH as a concept, and with the current proliferation of masters-level postprofessional degrees (masters in clinical epidemiology, etc.), that there are plenty of ways you could build a strong health services research program with a MD-masters; in fact this is more likely in health services than in basic science. Somewhat paradoxically, the PhD route would give you more time to develop your program earlier in your life--but you would not have the benefit of the clinical perspective that you will gain later in your MD and residency (and probably fellowship) years. Conclusion--if you are looking at a program with strong mentorship, and you have a good idea of what you want to do in health services, MD-PhD could work. Otherwise you are not limiting yourself by planning on a masters later.

Hmm... I guess I have more options than I originally thought. Thanks!

An advanced degree beyond an MD is never required for an academic career.



It doesn't matter what I think. Most fully-funded MD/PhD programs are not going to fund your medical school so that you can do this sort of research. There are only a handful of programs that would consider it.

Really? I would think that health outcomes research would be more of a priority considering the current state of things. That's unfortunate.

 

[K31]

Really? I would think that health outcomes research would be more of a priority considering the current state of things. That's unfortunate.

Most MD/PhD directors are biomedical scientists, so they tend to see the goal of the program as training the same. They also likely don't see the point paying for someone's medical school when (at least in their view) an MD/MPH could do the same work.

 

[Giggles88]

Most MD/PhD directors are biomedical scientists, so they tend to see the goal of the program as training the same. They also likely don't see the point paying for someone's medical school when (at least in their view) an MD/MPH could do the same work.

There are some aspects of the PhD training that I can't get from a masters alone, so I guess it would be wise to figure out if my research interests would without a doubt require those aspects, and if so, I should emphasize that in the interview or my PS.

I have a quick question about funding. If a school has historically not funded certain programs, is it possible for them to change that position if they like where a student is headed with their research? Or is the budget set in stone?

Sorry if these questions seem stupid. Clearly, I'm new to this process.

 

[Ombret]

Much of the funding for MD-PhD (specifically the MSTP piece) comes from NIGMS, the National Institute of General Medical Sciences. Each MSTP site has to apply for the funding; it's a competitive grant; the desired outcome is the training of physician-scientists. Training policy types just does not mesh with the goals of that program, even though health policy is a worthy pursuit. Just imagine, you are a program director, you got millions of dollars from the NIH, now it's renewal time and you have to explain why some of the funding went to pay to train someone to be something other than a physician-scientist. (In addition to explaining the person who did their PhD in health policy, you might also have to explain your graduates who are now doing Botox in private practice; both have their place in the health ecosystem; neither was precisely the desired outcome of MSTP training.)

That doesn't mean there is no program that would be able to work it in. Non-MSTPs are spending the university's own money and can do whatever they want with it. Some larger MSTP somewhere might be willing to make a liberal interpretation of what "medical science" encompasses. You just have to ask. If the program has not funded trainees to do non-bench science in the past then they are probably not going to change their practices for you now. The health policy program may also just not "play nice" with the med school curriculum. (Seems trivial, but MD-PhDs usually take a grad course or two in their first year; now imagine that all the policy courses are at precisely the same time as the anatomy sections, or that the calendars are out of sync with each other).

 

[Giggles88]

Much of the funding for MD-PhD (specifically the MSTP piece) comes from NIGMS, the National Institute of General Medical Sciences. Each MSTP site has to apply for the funding; it's a competitive grant; the desired outcome is the training of physician-scientists. Training policy types just does not mesh with the goals of that program, even though health policy is a worthy pursuit. Just imagine, you are a program director, you got millions of dollars from the NIH, now it's renewal time and you have to explain why some of the funding went to pay to train someone to be something other than a physician-scientist. (In addition to explaining the person who did their PhD in health policy, you might also have to explain your graduates who are now doing Botox in private practice; both have their place in the health ecosystem; neither was precisely the desired outcome of MSTP training.)

That doesn't mean there is no program that would be able to work it in. Non-MSTPs are spending the university's own money and can do whatever they want with it. Some larger MSTP somewhere might be willing to make a liberal interpretation of what "medical science" encompasses. You just have to ask. If the program has not funded trainees to do non-bench science in the past then they are probably not going to change their practices for you now. The health policy program may also just not "play nice" with the med school curriculum. (Seems trivial, but MD-PhDs usually take a grad course or two in their first year; now imagine that all the policy courses are at precisely the same time as the anatomy sections, or that the calendars are out of sync with each other).

Thanks for providing a bit of clarity on this issue. I definitely have a lot to consider now.

 

[mrsanator]

I'm a 6th year MD-PhD student (MD 1-2, PhD 1-4) finishing a PhD in Health Policy and Management.

A couple of thoughts:

1. Contrary to what's been posted above, I've found NIH receptive to funding the work I do, as have many of my fellow public health MD-PhD students. I was carried by our program's MSTP grant in my first year of medical school, and received an F30 on my initial submission to NHLBI. During my first two years of graduate school, I was also carried on my advisor's R01 from NIA. The key is career goal. If your stated goal is to be a policymaker (e.g., to run a state Medicaid program) then no, NIH isn't going to fund that. If you're interested in doing a mix of applied research and methodology development, NIH is happy to fund. AHRQ and now PCORI are other sources of funding.

2. It's definitely true that a portion of the work I do could be done by somebody with an MPH or similar degree (as is true about the workload of most physician and PhD scientists), but there are other aspects of my work that could not be done without study beyond the MPH, whether via independent study, PhD, post-doc, etc. Again, it depends on career goal.

3. I'm curious what PhD program you have in mind as a comparator when you deem the Michigan HPM curriculum as being "kind of lax". Michigan is a highly respected program. At least at my institution, the coursework requirements of Public Health PhD programs are much more extensive than those of biomedical PhD programs. The tradeoff is that completion of the dissertation project generally goes much more quickly in public health than biomedical; in general, these tend to balance out to roughly equal time to graduation.

4. "Anyone can understand what you mean if you are working on figuring out whether Big Macs cause heart attacks, whereas if you are studying the conformational dynamics of beta-actin pleated sheets in high shear environments, you sound like a genius."

Economists, sociologists, political scientists, operations researchers, etc. (all of whom are under the HPM umbrella) are quite capable of producing impressive-sounding jargon.

5. Yes, you should ask programs whether they're willing to consider such a degree before applying. However, they're not as rare as other commenters who applied 10+ years ago think they are. I'm on adcom at my school, and we are almost always competing for the public health students we want with other institutions. Search other posts for lists.

 

[Soulstice]

I'm a 6th year MD-PhD student (MD 1-2, PhD 1-4) finishing a PhD in Health Policy and Management.

A couple of thoughts:

1. Contrary to what's been posted above, I've found NIH receptive to funding the work I do, as have many of my fellow public health MD-PhD students. I was carried by our program's MSTP grant in my first year of medical school, and received an F30 on my initial submission to NHLBI. During my first two years of graduate school, I was also carried on my advisor's R01 from NIA. The key is career goal. If your stated goal is to be a policymaker (e.g., to run a state Medicaid program) then no, NIH isn't going to fund that. If you're interested in doing a mix of applied research and methodology development, NIH is happy to fund. AHRQ and now PCORI are other sources of funding.

2. It's definitely true that a portion of the work I do could be done by somebody with an MPH or similar degree (as is true about the workload of most physician and PhD scientists), but there are other aspects of my work that could not be done without study beyond the MPH, whether via independent study, PhD, post-doc, etc. Again, it depends on career goal.

3. I'm curious what PhD program you have in mind as a comparator when you deem the Michigan HPM curriculum as being "kind of lax". Michigan is a highly respected program. At least at my institution, the coursework requirements of Public Health PhD programs are much more extensive than those of biomedical PhD programs. The tradeoff is that completion of the dissertation project generally goes much more quickly in public health than biomedical; in general, these tend to balance out to roughly equal time to graduation.

4. "Anyone can understand what you mean if you are working on figuring out whether Big Macs cause heart attacks, whereas if you are studying the conformational dynamics of beta-actin pleated sheets in high shear environments, you sound like a genius."

Economists, sociologists, political scientists, operations researchers, etc. (all of whom are under the HPM umbrella) are quite capable of producing impressive-sounding jargon.

5. Yes, you should ask programs whether they're willing to consider such a degree before applying. However, they're not as rare as other commenters who applied 10+ years ago think they are. I'm on adcom at my school, and we are almost always competing for the public health students we want with other institutions. Search other posts for lists.

What other programs are out there which are similar to this? I'm trying to find MD/PhD programs that are funded for the social sciences, and they seem to be very very scarce ..

 

[twright]

What other programs are out there which are similar to this? I'm trying to find MD/PhD programs that are funded for the social sciences, and they seem to be very very scarce ..

They are fairly scarce. For programs that are not completely integrated you would probably get funding for some or part of your PhD studies but not for your MD studies. For example, Harvard has a PhD program in health policy that can be combined with an MD, but (a) you don't necessarily save any time, and (b) you would receive funding for your PhD studies (not guaranteed-- for example, you might receive 2 years of support and then be required to go on a T32 or F30) but not your MD studies.

Case Western Reserve University has an integrated MD/PhD in health services research, with 5 years of guaranteed funding.
http://epbiwww.case.edu/index.php/academics/md-phd