Newsgroups: bit.listserv.mdphd-l
Date:         Mon, 11 Jan 1993 10:51:55 PST
From:         Dean Lee <MBIDLE@LLUVM.BITNET>
Subject:      bias for/against MuD/PHuDs, some current problems

Aahhh, sweet success. I feel as though I have just passed an informal exam
for my degree- "basic cryptics of using bitnet via a University-based
mainframe."  An especially difficult course for a hardline Mac user.  God I
wish we would update things around here...

Anyway, concerning some recent postings:

Bioscience MD/PhDs are not all a rigid 7-year program, as some have suggested.
Here at LLU, only one person has finished the program in 7 years since its
inception 11 years ago, and based on current progress of senior students, we
won't be adding any more to that list for a few more years.  The range is from
7 to 11 years, with an average of about 8.5-9.
There are definately some wide variations between individual programs, not to
mention between individuals. This makes this issue of stereotypes even more of
a problem.  While stereotyping problems were mentioned regarding residencies,
I recently encountered a strong bias against me in interacting with a guest PhD
lecturer recently.  After some discussion, it came out that she resented
MD/PhDs for not having to work as hard as she did to get her PhD.  The program
at her university was a set 7 year program, and special considerations (and
probably concessions) were given to dual degree students in an effort to meet
the 7 year deadline.  I have also heard of programs in which MD/PhDs are
"released" from their senior year of medicine, having counted their research as
elective time.  So there is going to be a certain amount of negative bias
against MD/PhDs from both sides because of these programs, being viewed as
doctors who didn't do a "real" MD or a "real" PhD.  So can you count your
MD/PhD as a "credential?"  I try not to even mention it until I have some
indication about the kind of "stereotype" that a particular person has about
MD/PhDs.

Actually, it doesn't bother me that people use stereotypes instead of
impericism for purposes of early evaluations.  Categorization is a powerful
intellectual tool that, when used properly (the key here), allows us to make
quantum leaps with subsequent imperical tools.  If every factor within a given
situation had to be redefined emperically, science would have to be done by
accountants.

The real problem is that MD/PhDs are not a category of individuals, beyond the
fact that they have two degrees, any more than racial categories are anything
more than skin color (and possible disease susceptibilities).

Finally, regarding breaking these stereotypes, I'm not sure that "scholarly
deliberate impericism" will do anything for our status with MDs.  I'm enclosing
a file that I had tried to send earlier (below), discussing the fact that MDs
and PhDs use inherently different intellectual skills (for the most part).  I
think that many MDs find "scholarly deliberate impericism" to be a major
hindrance in the clinical setting, and would much rather see that you also have
strong abilities in pattern recognition and memorization.  Tell me what you
think.  By the way, a push for impericism in medicine was recently reviewed
with less-than-hoped-for success in a recent issue of JAMA (October?).

The following file was written in response to some earlier comments seen here
(before I figured out how to use this), but I am including it in an effort to
get caught up, and also because it still relates to the current topics.

Dean Lee, mbidle@lluvm
----------------------

     Several recent letters coming across this forum have focussed
on the problems and possibilities of dual careers for us who hold
(or will hold) dual degrees.  Several combined degree students here
spent an afternoon discussing this issue following a rather
disheartening forum on the subject during our weekly seminar.  We
had all recently participated in a testing pilot using the Hermann
brain-dominance profile, and found that a combination of our
personality and mental skills profiles were reasonably accurate in
predicting what we felt would be our ideal future career.
Following a review of these results was a panel discussion of some
of the most successful medical researchers in the school.  While
this in itself was not discouraging, it did expose several
problems: 1) most of the students had medicine as their primary
interest (based on their personality, not just from a financial
perspective), 2) the panel members severely discouraged those of us
who had a real interest in medicine and research from attempting to
do both, and 3) the panel contained no MD/PhDs.  This last problem
was not just a matter of poor selection.  After reviewing a list of
MD/PhDs in the school, none of them are primarily scientists.  All
are practicing physicians, most with administrative roles.  The
panel included one PhD and three MDs.
     While I started school here as a PhD student in the Micro
Department and added medicine later (I know that I am too much of
a people-person to be stuck in a lab for the rest of my life), most
students in the program at LLU have medicine as their primary
interest and included research as a secondary one.  At first, I was
a little self-righteous about this fact, feeling that I had a more
noble goal in utilizing my two degrees to their best advantage.
Following the discussion mentioned above, a few of us stayed after
to try and iron out some of these problems, resulting in some of
the following ideals:
1) if personality and mental skills play a major role in career
choice (no doubt that different skills are required in graduate
school vs. med school), then I can't be cocky or judgmental about
how I or anyone else chooses to utilize their knowledge base, as
long as they use it.
2) MD/PhDs can utilize this knowledge effectively in three ways:
   a) as a scientific physician-  a full-time physician with a
narrow specialty in a tertiary-care center can use an understanding
of concepts and mechanisms to solve difficult cases which would be
more difficult for someone with pattern-recognition skills alone,
even if highly developed.
   b) as a medical scientist-  a researcher with training in
medicine is sure to find more correlations and relevance to his
basic science research than one without this training.
   c) as a physician scientist-  a combination of the above.

     I would consider all of these professional models as noble
applications of a combined degree education.  Unfortunately, and
here is the point of this letter, this institution and science as
a whole considers it a terrible waste of education and resources to
practice medicine full time after investing in a combined degree.
This year, administration has implemented a new policy for the MSTP
here at LLU which would transform the medical school tuition wavers
into low-interest loans for anyone who does not show research as a
major interest by at least attempting to get into a research-
oriented residency.
     I understand the need to prevent the abuse of something like
free medical education (especially at a private school), and I also
understand the fact that this and similar programs were designed to
ease the financial burden of would-be medical scientists who, if
forced to pay for medical training on their own, would never make
enough at full-time research to pay off their loans.  Finally, I
also understand the frustration of paying for someone's education
towards an understood objective only to see them discard it for
high six-figure incomes.  However, while the name of the program
may justify this new policy (MSTP, see medical scientist above),
the comments seen in MDPHD-L recently suggest that even for those
who intend to do full-time basic research, a research residency may
not be preferred.
     Having kept on ongoing interest in this problem of dual
careers for dual degreeists, try reading the following for
different views:
  Pharos (Alpha Omega Alpha Honor Medical Society), Fall `92, p2-6
  Amer. Med. News, Oct 12 1992, p7-8
  The New Phys., Jan-Feb 1989, p31-32
  J. Clin. Inv., Sept 1986, 78:848-54.

Appreciative of comments and critique,

Dean Lee, 6/8or9
Department of Microbiology
Loma Linda University
MBIDLE@LLUVM
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