From PhD to MD

Joana Desterro September 21, 2013

“Go confidently in the direction

of your dreams.

Live the life you have

imagined.”

Henry David Thoreau

How did I become a PhD MD?

Chemical Engineer/Biotechnology

Portugal 5 years

(1989-1994) PhD Biochemistry

Scotland 3 years

(1996-1999)

Post-doc Molecular Biology

Portugal 3 years

(2000-2003) Molecular Biology and Oncobioly Lecturer

Portugal FML (since 2003 )

Graduate/ Medical Doctor

Portugal FML (2006-2012)

Researcher Lecturer Medical Resident CHLN 2013

MD

PhD

Rewards

Costs Lack of Time – Training time and hard to keep two jobs;

Decrease in scientific produtivity;

Difficult to compete with full time scientists;

Clinicians and basic scientists think in different ways and have different skills.

Career satisfaction;

Maturity;

Improvement in my teaching performance in classes;

Better prepared for the rapid advances in clinical medicine;

Clinicians and basic scientists think in different ways and have different skills.

Clinical medicine Basic science

Need for immediate action Avoiding a rush to judgment

Adherence to standards of practice Encouragement to challenge existing paradigms

Respect for hierarchy and expert authority Encouragement to critique accepted wisdom

Errors as mortal threats Errors as part of the creative process

Application of scientific knowledge Discovery of scientific knowledge

Schedule tied to patient care Greater control of working hours

Commitment to the physician’s oath Commitment to search for the truth

Direct access to patients Access to patients only via clinicians

Long-term mentoring Mentoring ends with PhD or postdoc

Adapted from Richard Gordon “The Vanishing Physician Scientist: A Critical Review and Analysis. “Accountability in Research, 19:89–113, 2012

Medical Degree

Medical Degree

PhD

PhD

Patient care

Discovery of the unknown

Improve quality of life

Have a good reason to do it. Have high tolerance for frustration. Balance multiple projects at once. Have passion for helping people. Enjoy studying hard. Have support from your boss. Don’t forget yourself – family, friends and hobbies. Be well organized. Do not stop doing research. Be persistent. Expect to run between lab and hospital. Enjoy team work. Be prepared to memorise. Love people. General Advice

21st Century Medicine

Molecular and cellular events that underlie many

diseases are being unveiled

Preventive medicine

Need to understand the preclinical molecular events, and detect patients at risk

Cancer and CV diseases are the mains cause of death

Extended life-time

Over specialized, precision medicine

Personalized medicine

Clinical Practice

Basic Science

Increased development In biomedical research

Modern clinical practice very demanding

Clinician-Scientist

Clinical Translational or Academic Centres

Conditions for the practice of research in hospitals

Multidisciplinary teams

Multidisciplinary meetings

Creation of clinical databases and biobanks

Clinician-Scientist career

Different metrics for professional success

Science as part of the academic life

New subjects in the Medical School

Clinical subjects in basic science PhD’s

Continuous update of clinicians with new biomedical research

MD PhD programmes

How to decrease this gap

Clinical Practice

Basic Science

The way we address this gap will dramatically affect the medicine we will have in the near future.

Jan 1999 Dec 2012 In 20 years time...

Go over, go under, go around or go through,

but never give up your dreams!