What life is life should I have not a PhD?
Faculty of Medicine and Dentistry, Palack? University, Olomouc, Czech Republic
Patient admitted to a hospital shows little interest in the scientific abilities of his doctor, situation that changes very much once the doctor gets into the nitty gritty details of explaining the treatment. The patient senses a quality if the doctor is a PhD, a sign of post-graduate training. However, doctoral degree in any field of clinical medicine is intended to be a starting point of a scientific career. A career that involves writing and managing projects, designing experiments, writing papers, and everything else that is part of a scientist¥s life. But that part of science is not what the patient cares about. He desires a well-trained, experienced and empathic physician who will provide the best treatment available to remedy his medical problem.
Studying to become a medical doctor is the toughest and most demanding task for anyone who chooses to do so. It is a vocation with compulsory lifelong learning, primary aim of which is to establish exactly the well-trained physician desired by patients. Many doctors aim to be just that. Nevertheless, in order to transfer their experiences to the next generation of physicians, the educational system demands that the MD ñ teacher is involved in science. Quite a number of doctors then face a decision, at some point of their career, whether to remain just a physician or jump the wagon with a view of advancing their career, perhaps leaving medical practice for good. Educational system of the Czech Republic requires that undergraduate students are taught by professors, associate professors, and assistant professors. The basic prerequisite to hold one of these positions is a completed PhD program in the corresponding field.
PhD program is designed to last three years, it can be a full-time or a part-time type of program. Regardless of program type, the student has to meet certain criteria that include: publication of two original articles in a peer-reviewed journal, passing a minimum of three exams related to the field of study, writing a grant proposal, and doing a congress presentation. There are very few students who fulfill the criteria within the time alloted, in case of clinical specializations PhD program is usually completed in 6.5 years on average. Often it is due to delayed publication of results as clinical research requires statistically significant number of patients included in the study, and these may become difficult to find. Case in point is a PhD thesis focused on traumatic head injuries in children after car accidents. That PhD started the year prior to a new law, which demands the use of child seat in vehicles at all times under stiff penalty. Public applauded the drop in child injuries, the student faces threat of an incomplete PhD.
††††††††††† Type of a PhD program is also a very much of interest. A full-time PhD student receives a government-paid stipend (approx. 250Š per month) for three years. Social security and health insurance payments being covered by government as well, but only until the age of 26 taking a bite out of the already low income. On the other hand, student enrolled in a clinical PhD must have a part-time employment in the hospital of his residency in order to be allowed access to patients and their data. Possibility of night shift and on-duty physician service is associated with the required hospital part-time employment meaning some extra income for the student. Part-time PhD student always holds a full-time job in a hospital and receives no government-sponsored payments. In both cases clinical PhDs are burdened with physician duties ñ treating patients, doing the paperwork and all the rest of hospital work.
††††††††††† Concealed in the ìrest of hospital workî is the obligatory residency training for Medical Board Certification. Scheduled to last a minimum of five years, residency training is a must for any future specialist. But can one receive a credit for a PhD program as part of the residency? The general answer is yes. Although the Ministry of Health provides an application form to be filled and approved by a hospital representative (often thesis advisor), the form gives the Ministry a final decision whether the completed PhD program counts as a part of residency training.
††††††††††† Can a Board Certified specialist willing to teach undergraduates become an associate professor or even a professor? Not without a PhD. And the same applies vice versa. Hence a doctor aiming for a professorial position, a position of high social status and with open career options, must have a complete PhD and have the highest Board Certificate in the corresponding field at the same time. Along with certain number of original articles with a proven citation record and a teaching record as an assistant professor. Many doctors perceive this as doing the same thing twice. Not without a merit: some Board Certification exams overlap very much with the exams required as part of the PhD program. On the other hand, primary goal of PhD training is creative research leading to publications and innovations in medical treatments.
††††††††††† Despite the cons we see an increasing number of doctors starting PhD studies in a clinical subject. Approximately one half of students enrolled are in the age group of 25 to 34 years, the other half is older than 35 with isolated cases of 55 years or more. The fresh graduates hope for an advantage when seeking a job, the seasoned doctors aim to hold or advance their careers in an increasingly crowded employee market of MDs. It is also a result of the push from universities as well as from employers, especially university hospitals, for a medical doctor to do post-graduate training in the form of PhD besides the obligatory clinical specialization training. The downside is that the important part of scientific training vanished from the discussion along with the quality of PhD theses.
††††††††††† The last point to discuss is the compatibility of PhD as well as Medical Board Certification process among European Union countries. Although internalization of research and PhD programs is supported by universities across the continent, the details may pose a problem. Differences in credit systems or numbers of publications are easily overcome, financing of the student is much more sizeable obstacle. For example the French ìdoctorate en co-tutelleî requires the student to do three six months long study programs at the french institution while offering very few options of financing. Hence the student is forced to compete for grant money from agencies where the success rate is below 25%. For a clinical PhD there lies a little chance.
††††††††††† In conclusion, it is still important for an MD to do a PhD program. Not just to impress his patients but to have research as a part of the lifelong learning process. There are still many problems to be solved, such as compatibility of programs across EU and removal of duplicities with Board Certification process, and this is where ORPHEUS can step in and offer assistance.
PhD program of the Faculty of Medicine and Dentistry, Palack? University,
is currently receiving financial support from the European Social Fund
project No. CZ.04.1.03/126.96.36.199/0033.