Medical PhDs are a crucial investment
By allowing doctors in Denmark to spend three years writing a PhD, we are advancing science and enhancing the healthcare system.
Should fewer doctors be doing research training, so that they can start treating patients sooner?
This is the view of the think tank Sund Fornuft, which, in a discussion article in Altinget proposes solutions to the shortage of resources in healthcare.
In Denmark, we have had a strategy of increasing the number of PhD students in lab coats, and new figures show that the efforts have borne fruit: The proportion of doctors starting a PhD has risen from 12% to 27% in less than 10 years (see table). But for just as long, we have been arguing about whether the prioritisation is correct: Are we getting enough out of our investment if we allow doctors with an already long study programme behind them to spend an additional three years in research training?
It's about creating the best team
Increasing the number of medical doctors who hold a PhD has been part of the efforts to improve patient treatment, which has proven a great success in major areas such as diabetes, cardiovascular diseases and cancer. Treatment has improved, and mortality has fallen – because both diagnostics and treatment are research-based. If we are to create similar improvements in other areas, such as psychiatry, there will be a need for continuous improvement and development through both basic and clinical research.
If you possess training in scientific methodology and an analytical mindset, and have learned to critically follow the latest research, you will take a scientific approach to your clinical work – even if you do not have the opportunity to conduct your own research projects in a busy working day.
It is not, therefore, a future-proof option to reduce the number of medical PhDs in order to move more doctors faster into clinical work. It's about creating the best team, and a research-trained approach strengthens the team – just as PhD-trained doctors help to give the training of new employees in the healthcare system a research foundation, allowing us to constantly develop and improve diagnostics and treatment. It all gives us more health for our money.
Only benefits the CV?
It is often argued that doctors take PhDs mainly because it boosts their careers and provides an advantage in the fight for the coveted specialist training programmes. There is no doubt that a PhD looks good on a CV, but it is important to remember that PhD graduates, whatever their specialty, acquire lifelong skills in research-based prevention, diagnosis, treatment and rehabilitation.
A study from the Ministry of Higher Education and Science (2016) shows a significant difference between doctors with and without a PhD when it comes to applying research skills in their daily work. Specialists with a PhD are better equipped to conduct research and apply the latest knowledge in clinical practice. Even if they do not become full-time researchers, they have acquired skills that are crucial in an increasingly complex world, where the drive for innovation in life sciences and healthcare depends on the ability to combine research and clinical practice and create new treatments.
Vital to continue to emphasise the PhD programme
It is also important to remember that PhD students make a significant contribution to clinical research in Denmark.
A study from the University of Copenhagen analysed 841 clinical PhD dissertations from the Department of Clinical Medicine in the period 2013-2017. The theses contained an average of 3.4 manuscripts each, and two years after the PhD defence, 92% of the manuscripts had been published – 82% of them in the highest-ranking journals in the field.
PhD students represent a very large part of our research capacity and are an important component in creating strong clinical environments that will deliver world-class research, education and patient care.
We should of course regularly discuss how many doctors should have a formalised research training if we are to run the health care system optimally. In the absence of any immediate increase in healthcare resources, we must constantly focus on cutting out what is unnecessary, or reprioritising. Today, just over a quarter of doctors take a PhD. Cutting down on this number – and thus on a large part of the basis for research and research-based development in the healthcare sector – would be the wrong thing to do.
PhD-trained doctors
The table shows the number of medical doctors (MD) who will be starting a medical PhD in their next degree programme.
Time between Master’s degree and commenced PhD | |||||
Year of Master (MD) | 0 to 1 year | 1 to 2 years | 2 to 3 years | 3 to 4 years | 4 years or more |
2008 | 1% | 2% | 4% | 5% | 12% |
2009 | 1% | 3% | 5% | 8% | 14% |
2010 | 1% | 3% | 6% | 10% | 15% |
2011 | 2% | 3% | 7% | 11% | 17% |
2012 | 2% | 5% | 9% | 14% | 23% |
2013 | 3% | 6% | 12% | 17% | 27% |
2014 | 5% | 8% | 13% | 17% | 25% |
2015 | 6% | 10% | 14% | 20% | 27% |
2016 | 4% | 7% | 10% | 16% | 19% |
2017 | 3% | 7% | 11% | 15% | |
2018 | 3% | 7% | 11% | ||
2019 | 4% | 7% | |||
2020 | 3% |
Please note that the category "4 years or more" is not comparable between years, as the most recent cohorts have not had as long as the older cohorts to start a PhD.
Source: Analysis and Data, Danish Agency for Higher Education and Science (new figures)