Letter to the Editor
By: Sagar Dugani
I read with great interest your article titled “Double Doctors, Double Trouble” in the Spring 2012 issue of the IMS Magazine. In this commentary, I would like to clarify few issues raised in the article.
Being a physician scientist is a privilege that allows one to be involved in both compassionate care and cutting edge research. Commitment to a dual career is made early on when students enroll in a combined MD/PhD program or when they obtain their PhD during residency. As described in your article, a physician scientist commits to both pursuits; however, the dynamic framework underlying this balance is not captured in your article. The majority of physician scientists operate under different work models. For example, some opt for a 50-50 split, i.e., 50% of their time is protected for clinical duties and the other 50% for research activities. Others may opt for an 80-20 split, or slightly different breakdowns. While physician scientists commit to both endeavours, your article paints a picture of an individual who is “spread too thin,” and struggles to spend every work day conducting experiments, teaching students, and operating on patients. This picture is inaccurate, as physician scientists have protected time, and they have research/clinical colleagues to help them prioritize particular activities while not compromising the quality of any particular endeavour.
The University of Toronto has Canada’s oldest and largest MD/PhD program and it takes the responsibility of educating and mentoring future physician scientists quite seriously. Leadership from the Faculty of Medicine and MD/PhD program raise significant funds to provide financial support, offer formal and informal mentorship, and ensure that their trainees receive the finest medical education and research experience. Their success is evinced by the excellent publication record of MD/PhD trainees in top tier journals such as Cancer Cell, Cell Stem Cell, Science, etc. MD/PhD students have received top awards for outstanding research, leadership, community service, and publishing that have garnered them national and international recognition. Thus, I am not convinced that, as stated by the article, MD/PhD trainees or graduates spend their time dispelling rumors of being inadequate clinicians and researchers.
I read with curiosity about the characterization of MD/PhD graduates and the world they inhabit. The labeling of scientists as “skeptical” or of patients as “submissive” is intriguing and inaccurate. Scientists have developed a rigorous method of hypothesis-driven research and this drives their curiosity and the high standards to which they hold all scientific findings, and this is not due to any underlying skepticism. Furthermore, patients are empowered to be active participants in the care they receive. While this empowerment is embodied in the guiding principle of “autonomy,” physicians encounter situations in which patients may not have all the information required to make an informed decision. In such cases, physicians (including MD/PhD graduates) are guided by principles of beneficence and non-malfeasance, and always provide patients with all required information and include them in every healthcare decision. They provide patients with material to make an informed decision. To characterize patients as “submissive” suggests a power imbalance that works in favour of a physician’s hidden agenda. Research and clinical work have their own timelines and moments of urgency, and it would be unfair to characterize research as lacking “hard deadlines” and clinical work as “fast-paced…reacting to emergency situations.” Finally, MD/PhD trainees and graduates, to my knowledge, are not living in a conflicting world ranging from “nerdiness” to “level-headedness” as you suggest is portrayed in popular television series.
While the article points to a recent survey done at the University of Toronto, I would like to refer you to data stating that >60% of MD/PhD graduates from the University of Toronto have gone on to have academic careers, which is similar in number to recent statistics from US programs. It is improper to extrapolate one student’s comments (without the appropriate context) as being reflective of all students’ experience. While the article raises questions about the level of preparedness for clinical contexts or ability to carry out research, it is important to point out that trainees and graduates take their responsibilities as researchers and physicians very seriously. All MD/PhD students receive a PhD that is approved by the School of Graduate Studies, and they all complete their medical education (including residency) with a license to practice from their relevant national residency/fellowship organization. This means that all MD/PhD graduates fulfill all the requirements as determined by relevant research and clinical organizations. All physicians, whether they are involved in research or not, commit to being life-long learners. This philosophy stems from the fact that 1) it is impossible to have an encyclopedic medical knowledge, 2) medical knowledge and research are constantly evolving towards approaches that ensure superior patient centered care, and 3) physician scientists operate in a broader context (i.e., an interprofessional healthcare team) and, hence, they can always consult with their colleagues.
We are at a crucial time in building clinical knowledge and in developing therapeutic interventions for our patients. Being a physician scientist is a privilege and we recognize the impact of a short-term encounter while supporting a patient through a difficult medical diagnosis or a death of a family member. We also recognize the long-term impact of a scientific discovery on individuals we may never meet. If I had written the article, I would have entitled it “Double Doctors, Double Responsibility.”
Sagar Dugani MD PhD
University of Toronto 2012
Resident, Internal Medicine
Brigham and Women’s Hospital-Affiliated with Harvard Medical School