I wasn’t sure where to get clarification, so I thought I’d ask our knowledgable OPM’ers! 
What exactly is an academic position? What kind of training do academic docs have? Are these all MD/PhDs? Does it include research and clinics?
Let me explain why I’m asking. I want to practice medicine, but I also have an interest in teaching and training other people. Can I do both and what kind of training is involved? (I’m not interested in the PhD)
Straight MD’s do research, right? So what’s the difference between MD research and PhD/MD research? (no insult intended by my ignorance!)
Thanks for the info!
Theresa
| QUOTE (TheresaW @ Jun 9 2003, 09:28 AM) |
| I wasn't sure where to get clarification, so I thought I'd ask our knowledgable OPM'ers! What exactly is an academic position? What kind of training do academic docs have? Are these all MD/PhDs? Does it include research and clinics? Let me explain why I'm asking. I want to practice medicine, but I also have an interest in teaching and training other people. Can I do both and what kind of training is involved? (I'm not interested in the PhD) Straight MD's do research, right? So what's the difference between MD research and PhD/MD research? (no insult intended by my ignorance!) Thanks for the info! Theresa |
Hi there,
Not all academic physicians do research but all do have teaching responsibilities. The MD-Ph.D combination is best if you anticipate having a research lab but is not manditory. Some academic MDs have labs but they are closely affiliated with Ph.Ds who do their research. You must have an MD to do clinical research.
The academic physicians at UVa do not have private practices or patients. All patients admitted by attending physicians must be covered by housestaff (us). The housestaff are under the direction of a chief resident who directs the day-to-day care of each patient in consultation with the attending physicians. Academic physicians at UVa are required to publish and participate in research or teaching. All of the authors of the "Recall" series are UVa faculty or former residents. Travis Crabtree, MD, the current author of BRS Surgery is a former UVa surgery resident. We also boast two former chairmen of the American College of Surgerons and the past president of SAGES (Society of American Gastric and Endoscopic Surgeons). The academic environment here is extremely competitive and we all do a book chapter or two in addition to several papers as we move toward the chief resident positions.
Academic physicians generally are paid less than physicians in private practice. The exception would be physicians who hold "endowed" chairs or those who hold patents on inventions. Three or our cardiothoracic surgeons hold patents on patient care devices and the chairman of our department holds an endowed chair as do the chiefs of the various divisions. In your practice, you will generally be required to see enough patients to make your salary or you may find that you will not obtain tenure. You are required to see patients in clinic, maintain or exceed your salary and put out some meaningful research with publications. You do all of this (with help from your house staff) on less salary than your private practice counterparts.
To do an academic practice in a strong university setting, you generally have to train in a strong academic (read university) environment. All of our physicians at UVa are university-trained and most have MD-Ph.D degrees. If you opt for training in a community setting, it is generally going to be very difficult to break into an academic post unless you invent something extraordinary. There is something to the phase "Ivory tower" when folks are talking about university-based practices.
University-based residencies are generally more competitive than community residencies so you need to do pretty well in medical school and have some research and publications for consideration. There is much of an "old boys" club in academia as the number of females and URM in academic medicine is very low. I can count the number of female clinical professors on two hands at UVa and the number of URMs on one hand! UVa has been a very difficult place for women and URMs to practice though the chairman of Emergency Medicine is an URM. There are no women division chiefs or department chairs even in Pediatrics or OB-Gyn.
Still, you can't beat the tough and competitive academics of a university-based residency. I have been able to thrive in this environment even though I tend to read myself and study myself to death. I had Greenfields tucked under my arm as I headed into the hotel for this years OPM convention. No doubt, I will do the same next year.
Natalie
Thanks Natalie, that was a fantastic reply!
Theresa
MD/PhD is the best way to train if you want to be a physician-scientist. Its not the ONLY way to do it, but I believe it offers the best of both worlds. MD doesnt train you to be a scientist, whereas that is precisely the goal of a PhD.
Most MD/PhDs spend the majority of their time in research and the rest in clinical practice (maybe 80/20 or 60/40 split). If you are interested in administration, you dont need a PhD for that.
For research purposes, I compare MD vs MD/PhD with the following analogy:
Suppose you are competing in a cross-country trek and are given the choice of 2 vehicles: a souped up Land Rover or a smaller less versatile sport utility vehicle thats not really designed for off road work.
Now, you can finish the race with either vehicle and there are people who choose both cars who finish; however having the Land Rover gives you an advantage and improves your odds in getting to the finish line first.
To extend the metaphor, with which I basically agree:
basic science is off-road driving…
and a lot of clinical research is probably reasonably well-paved.
So if you want to develop an AIDS drug, you’re driving off-road; if you want to run a clinical trial of an AIDS drug, you’re on better paved road. Either way you can be an academic physician. If you want to figure out the mechanism of how HIV induces apoptosis, you’re definitely off-road; if you want to track patients to see what strategy leads to better immune cell survival over time, you’re probably usually on pavement. (And then you’re sending blood samples to some off-road drivers who try to figure out more about why the winning strategy works better.)
As I’ve seen it, anyway, clinical research is mainly close observation, adherence to protocol, good data-gathering and epidemiology; the hypotheses are usually fairly straightforward; and the challenge is often in the implementation of the study, and usually (though not always) not as much the study design. In bench science, you not only have to come up with the question, you often have to design and test the ways you will answer it, including new ways of using assays, etc.–often, each part of the project is new and untested and you’re not sure where you’re headed. There’s often not a clear answer at the end of the path, and you have to follow experiments with more experiments, etc. This unpredictability and difficulty is what the PhD trains you to face. Hence the more frequently “off-road” nature of the work.
Academic physicians also include docs who teach doctors how to be doctors–for instance, people who do research on palliative care, run a hospice, and teach medical students about death and dying issues might be academic physicians as well. Or, a doc who is just good at teaching can sometimes teach a class on medical interviewing, for instance. Another example is someone like Atul Gawande who wrote Complications and does analysis of errors in medicine in his academic career. He just published a paper on sponges left in surgical patients, and the situations that more often lead to sponges getting left in patients during surgery. He’ll complete his surgical residency and then become clinical faculty at Harvard Med School and a prof at the Harvard School of Public Health, starting a new center on public health and surgery I think. This involves scientific method but not basic science–i.e., he is not looking for a sponge-leaving gene. Another option–which often does require a PhD + an MD because social scientists are often even clubbier than basic scientists–is something like medical anthropology or medical sociology.
Take-home: there is a big range of things to do as an academic physician; and so you can probably find a field you’re interested in working in even as simply an MD if you like research and teaching generally. (One way to look: look at med school web pages and see what the faculty are doing.) I think an MD/PhD is a very reasonable choice but not a necessary one for the more clinical paths, and not completely necessary even for bench science–but MD/PhD’s off-road analogy is pretty fair for bench science. Medical school is not science school–it teaches you known answers, but doesn’t do as well at teaching you how to ask questions. So, you have to learn that outside of your course work if you want to do it.
–joe