Newsgroups: bit.listserv.mdphd-l
Date:         Tue, 22 Dec 1992 05:19:15 CST
From:         John Grant Moen <jgm1@MIDWAY.UCHICAGO.EDU>
Subject:      Clinical MD/PhD's ?!?

Attn: Pietro Mazzoni, Scott Selco, et alia....

Pietro -- a couple of comments on your message:

>One problem I have is with one logical step you make, Scott.  You have
>heard many people say that MDPhDs don't pratcise medicine and research
>and one person who says he does, and you conclude that MDPhDs practise
>medicine and research.  I think a couple of  steps are missing.  Based on
>the opinions you mention I would conclude that few MDPhDs practise
>medicine and research.  You do say later that your sample of opinions
>is biased in favor of "nondualists." This does not make your conclusion
>more likely, though; just more uncertain.

As a 6th yr (of 9) MD/PhD in the philosophy of science, I quite honestly
have trouble following *your* logic in the above paragraph.  If the point
you intended to make was a statistical one, then you might want to say
that no "conclusion" is really appropriate at all here (based on a small
"N", using anecdotal evidence).  I cannot say with any confidence what the
outcome of a rigorous survey of working MD/PhD's would be, but I do think
it *would* contradict the notion that "few MD/PhD's practise medicine and
[do] research."  My own experience is even more constricted than usual,
i.e. MD/PhD's doing research outside the biological sciences, and it has
been difficult for me to find more than a handful of role models who are
truly "physician-scholars."  By that last term, I mean persons who didn't
just get both degrees but fully utilize them both, too.  I *have* found a
few, though, and some generalizations that I can make about them are:
(1) They are great at time-management and setting priorities day-by-day
and sometimes even hour-by-hour.  (2) They are very conscientious about
keeping up with the clinical literature, and often take explicit steps to
"sharpen up" clinically before they start their one month (typically) of
attending on the wards.  (3) They are not weak at heart (no pushovers)...
they are able to successfully redirect, attenuate, or modulate pressures
which bear on them from any number of different sources (don't forget
home life, too!).

>                ........My own impression is that besides the rare
>brilliant/efficient/lucky-in-their-choice-of-favorite-field MDPhDs
>who carry out good basic research, practise good medicine and teach
>well, most MDPhDs who do combine research and medicine practise
>clinical research and specialize in a hospital that surrounds such
>researchers with enough other clinicians to maintain a proper level of
>patient care.

If you've seen this type of setup in your personal experience, it's fine
to mention it BUT please don't impugn the clinical integrity most
clinically active MD/PhD's (or their research, for that matter).  My
opinion is that if you need to be "surrounded by enough other clinicians
to maintain a proper level of patient care", THEN YOU REALLY DON'T HAVE
ANY BUSINESS BEING IN THE HOSPITAL TAKING CARE OF PATIENTS.  Don't get
me wrong, I think it's great to be especially resourceful in seeking out
the people who really know their stuff on a certain subject in order to
fill in the gaps in one's own knowledge and experience.  However, this also
applies to "regular" academic MD's who do research and practice, of which
there are thousands of successful examples.  (Aside: I've known academic
MD's whose research was actually MORE "basic" and MORE rigorous than that
of their MD/PhD colleagues!)  Interestingly, both MD/PhD and MD physician-
researchers often mention specifically seeking out clinical adjunct faculty
in their fields to really get the state-of-the-art info on the management
and treatment of patients.

>........................ Therefore my attitude is to
>continue trying to be a good researcher and a good doctor, but to be
>ready to give up being one of the two if the adjective "good" drops
>out, e.g. if I decide to set up a lab whose proper direction requires
>90% of my time.

I applaud your ethical vigilance with regard to your own career.  Let's
hope more people take the same attitude towards their development, so that
we won't have to "surround" or "prop up" clinically incompetent researchers
on the wards.  If one doesn't enjoy clinical work and isn't especially good
at it, why do it?  Unfortunately, the financial incentives work in the wrong
direction here (as they often do in many parts of our contemporary society).

I invite any further comments either in the forum or directly to my e-mailbox
(j-moen@uchicago.edu).  Peace be with you all!

--John G. Moen
  Philosophy of Science (Neurosci & Cognitive Sci)
Comments: Gated by NETNEWS@AUVM.AMERICAN.EDU