DOCTORS today seem to have more letters behind their names than ever before. Most of my colleagues have diplomas or master’s degrees in public health, health policy, business or law, and a number of friends are “double doctors” with a medical degree and a PhD. Many of the interns I speak with have started or are planning further university study.
What is our newfound obsession with this post-nominal alphabet soup?
I believe it relates to two key factors.
First, there is an oversupply of metropolitan-based doctors in Australia. As growing numbers of doctors compete for the same number of positions, there is a necessity to differentiate oneself from the pack. Hospitals and colleges reinforce this by their points-based systems of selecting doctors with a heavy focus on qualifications and research. No longer is it considered good enough to be a fine clinician. Now you also need to be a leader, a scholar or an Olympic medallist.
The default option to enhance one’s employability is to pursue further education. While some doctors go back to university to diversify their career, the majority of my colleagues are accruing additional certificates, diplomas and master’s degrees to secure a prized training position or a future consultant job. The same applies to research – it’s no longer an optional extra for those passionate about scientific inquiry but an obligatory task to stay in the game, which results in research output focused on quantity over quality.
Second, imposter syndrome is endemic in our profession. Many doctors have a sense of insecurity about their knowledge and place in the medical hierarchy. This can manifest as reluctance in doctors to speak about an issue unless they hold a specific qualification that they believe affords them the right to have a strong opinion. This state of affairs reflects the adage by Bertrand Russell in his 1933 essay, The triumph of stupidity, that:
“… in the modern world the stupid are cocksure while the intelligent are full of doubt”.
In lieu of clinical experience, which can’t be fast-tracked, some doctors acquire additional qualifications to ameliorate this uncomfortable self-doubt.
Perhaps these two factors have nothing to do with it. Whatever the cause, I believe the relentless focus on accruing more and more post-nominals is misguided. It takes time away from one’s clinical work, personal pursuits and precious leisure activities. It leads to financial debt and, in some cases, emotional debt.
At the end of my training, I will have 22 letters behind my name, 11 of which are unnecessary for my career goal to work as a regionally based psychiatrist. I rue the tens of thousands of dollars spent and the time sacrificed with family and friends for those letters.
At the beginning of the university year and as my colleagues are preparing themselves for a busy year of “work, study, sleep, repeat” – long hours juggling post-graduate study with hectic clinical jobs, research, college exams, continuing professional development, extracurricular activities, and family and social commitments – I encourage them to reflect on what is most important to them. Is the extra university qualification an added value or a distraction? Some post-graduate qualifications are now so ubiquitous they’ve lost the quality signal they once provided.
When is a doctor educated enough? Does one need a plethora of post-nominals to be educated enough, or is this just a sign of the inexorable pace of the rat race in medicine? My view is that a medical degree and a college fellowship are probably enough education for most of us.
Dr Malcolm Forbes is a psychiatry registrar at Royal Children’s Hospital in Melbourne and holds an honorary position as Clinical Senior Lecturer at the University of Melbourne.
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