Medicine after a PhD? Not working in the NHS?

[GoPlayer]

Hi, I'm currently doing a physics PhD and considering GEM (2011 entry). I'm trying to figure out whether medicine is a sensible path.

Backstory:
My PhD is pretty solid in terms of publications; it is also both fundamental physics and interdisciplinary at the same time. The group I work in has a pedigree of producing ground breaking biomedical instruments, typically radiography/nuclear medicine related. My research has direct applications in medicine (as well as space, transport, defense, materials, etc, etc).

FWIW, I also have an MSc (astronautical engineering) and a physics BSc (hons) (a 2ii, but I was only 19 when I graduated). In between degrees, I worked in industry and then ran my own business for a few years.
/backstory

I have reservations about moving to medicine though: Primarily, I don't want to work in the NHS because I fear the bureaucracy and lack of freedom. I want to do medicine but I'm not really interested in being a GP or regular hospital-based physician. I feel a bit stuck because of this.

If it was still running, the University of Miami's PhD to MD program would be my clear choice.

If I went for medicine, long term I'd like to split my time between private practice and academic medicine/research. I'd want to be doing something new and interesting in a fast evolving field, where I can publish extensively. If I had steadier hands I'd be thinking surgery, but radiology/nuclear medicine/oncology would be the obvious choice given my PhD. Aviation/space medicine may be an option and would play to my previous skills/education. Emergency med and trauma is also interesting. As a wildcard, possibly endocrinology/transgender medicine - the field is so under-researched and the positive benefit to patients so immense.

In short, I'm a bit stuck as to how to explore what I want to do and whether GEM is right for me. Please does anyone have any suggestions how I can explore the options? Are there general pre-application university open days you can go on for GEM courses?

Additionally, I'm a bit perturbed about the fitness to practice question of "Have you ever deliberately harmed yourself?" Are generally non-visible SH scars from when I was 18/19 really going to make me unfit to practice? I don't see any contemporary relevance from such old scars on my current fitness to practice.

[yazoo]

You express your interest in research in medical fields, but not why you want to be a Dr. What does the Dr part offer that you seek? Have you thought about getting some work/voluntary experience to see if you actually like caring for patients?

You will never have a great deal of freedom in medicine in relation to treating patients. The approach should be evidence-based, so most Drs use similar approaches to diagnosing and then treating different types of problem.

You cannot get post-graduate training in private healthcare in the UK. You would have to work in the NHS for 5-9 years after graduating if you chose to stay in the UK.

[GoPlayer]

Well, being medically qualified as well as having a good research background is pretty much required if you're going to do research on, say, the prolonged effects of microgravity on the human body, or other aspects of human space flight involving real people. More mundanely, I've seen that having both sets of skills is to be highly prized if you're developing new nuclear medicine instrumentation too. Especially when it comes to clinical trials.

Really, what I'm considering, is whether I want to be in a similar position to the physician-scientist (MD/PhD) crowd in North America. It would allow me to straddle both camps and act as a bridge between the two. I realise that it's not as frequently encountered in the UK as it is in North America though, so it's a tricky situation to be in.

The freedom I'm interested in is academic freedom, and as much freedom from red tape and bureaucracy as I have in academia.

[yazoo]

Hmmm. I would encourage you to think more about what being a Dr involves. You won't be useful in straddling both academic and clinical camps if you don't actually want to do both roles.

[GoPlayer]

Thanks for the replies. I'm surprised you're not more encouraging though, or can't see how the two roles would coexist happily. Physician-scientists (MD/PhD and PhD-to-MD) have an excellent reputation in Canada/US and are highly desirable. I know of a couple of people doing physician-scientist type roles in the UK, but granted, they are unusual. (I suspect there are quite a few more working in drug discovery/biotech though.)

By the way, no where have I said I'm not prepared to get my hands dirty, just that I'm more interested in the unusual than the common.

[yazoo]

Thanks for the replies. I'm surprised you're not more encouraging though, or can't see how the two roles would coexist happily.

They can. But most Drs would not be happy being scientists** and most inspired scientists would be unhappy (and bad) Drs. I say this having experience of both worlds.

I know of a couple of people doing physician-scientist type roles in the UK, but granted, they are unusual.

They really are not at all unusual. There are ton of Drs who do PhDs/MDs and a ton of PhDs who do GEM. A reasonable proportion continue to do both clinical and research work in varying degrees. Less common are the group who actually find they really enjoy both roles... see above and below.

By the way, no where have I said I'm not prepared to get my hands dirty, just that I'm more interested in the unusual than the common.

Everybody is interested in the unusual. But medics need to be team players who get the crap boring jobs done as well as the interesting tasks. They also need to want to care for patients - for the patients' sakes. You've actually not mentioned any interest in patients - a major issue, IMO. As I said before, you need to want to do both jobs to straddle the research/physician interface effectively.

If you want to care for patients too - then great! But if not, think hard and long as you may just make yourself very unhappy and be a poor Dr.

**I differ from bigjim in my opinion of this - I think scientists must practice science, not just study it. And I don't think most medics practice science much of the time.

[Chwirkytheappleboy]

I'm not sure why you feel the need to study Medicine if you don't want to be a Doctor... there are other courses that are more suited to pure medical research, such as biomedical sciences. Medicine courses have a a primary focus of training Doctors - that's why 3/5 of the course is dedicated to clinical training... and in fact even during the first two years there's a lot of clinical contact and focus on the qualities that make someone a good doctor. If I'm honest, if I were the admissions tutor for a medical school, I wouldn't want to offer a place on a Medicine course to someone who didn't want to be a doctor, when there are so many other applicants who will actually want to use their training for its intended purpose.

I also don't think any medical schools will take very kindly to your lack of interest in the NHS. Firstly, all of your training (including that after you graduate) will take place in NHS establishments. Secondly, providing care based on clinical need rather than ability to pay is the central tenet of the NHS and an attitude that all medical schools try to instill in their students. A prospective student who states categorically that they do not hold this belief and would rather work in private health (and thus have no commitment to the NHS) will not seem like an attractive candidate at all. Remember that the NHS features quite highly in a lot of interview questions!

[GoPlayer]

Physician-scientist has a very specific meaning (i.e. those who did combined MD/PhD or DO/PhD programmes). They generally follow a different career path; typically research oriented but with a clinical aspect. Look them up, it's an interesting way of doing things. The training is less formal in the UK, but they still must be around. But praps it's another area where the UK is loosing out.

By the way, I'd prefer it if you'd not call me "Pal", honey, since I'm a girl (shocking!). When you've got three degrees and set up, run and sold your own company, then you can suggest that I might not be expecting to work hard. ;-) (I'm up at 5:20am each day and have worked 80+ hour weeks for years - since I was a teenager in fact. Today is the first free day I've had since New Year.)

[GoPlayer]

Thanks for your additional replies yazoo and Chwirkytheappleboy. I certainly am interested in patients, in fact, in my original post, I mentioned, albeit briefly since I thought it was a given, the benefit people derive from treatment as a prime motivating factor for my interest. I'd like to think I'm certainly a lot more empathetic and caring than some of the physicians I've met over the years.

I feel the big benefit I could bring is as an interface bridging research and practice, and by being well trained in a scientific discipline. Any open minded person can put themselves in another person's shoes and sympathise, but fewer can understand exactly how the science is working in order to fix them, or provide the tools to fix them.

[yazoo]

Physician-scientist has a very specific meaning (i.e. those who did combined MD/PhD or DO/PhD programmes). They generally follow a different career path; typically research oriented but with a clinical aspect. Look them up, it's an interesting way of doing things. The training is less formal in the UK, but they still must be around. But praps it's another area where the UK is loosing out.

Then go to the US. If you are good enough, the tranistion will be quite easy.

By the way, I'd prefer it if you'd not call me "Pal", honey, since I'm a girl (shocking!). When you've got three degrees and set up, run and sold your own company, then you can suggest that I might not be expecting to work hard. ;-) (I'm up at 5:20am each day and have worked 80+ hour weeks for years - since I was a teenager in fact. Today is the first free day I've had since New Year.)

Get over yourself. Lots of people have it way harder than you.