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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16 thoughts on “When is a doctor educated enough?

  1. John Burke MB., BS., FRACGP says:

    I can only agree.
    In my many years of working as a Rural Practitioner I was never asked about what letters I had. Patients seemed only interested in clinical competency which they learned about from friends and family.
    Letters don’t make you a better Clinician. Knowledge and experience does.
    May I ask why are you pursuing the letters?

  2. Venita Munir MBBS, FACEM, Assoc Deg PWE says:

    Well said, Malcolm. It’s not only post-nominals, but also ‘premed’. The number of hoops want-to-be doctors need to hurtle through in order to achieve graduate level entry into medicine has made it more and more difficult. Even when they get the highest ATARs, and may have completed 3-5-year degrees, it’s not guaranteed. By the time they finish medicine, graduates may already be in their 30s when they start the increasingly competitive game of specialisation. They’re made to believe the more academic qualifications they have, the better their chances.

  3. Anonymous says:

    Malcolm, your observations are so very true. I am a sub specialist cancer surgeon currently doing a PhD in my early 50’s.
    The main reason I am doing this is that I am interested in the topic of my PhD. However, there has also been a huge
    change in the way clinical jobs are allocated, and head of Department jobs in many city hospitals are now decided on by
    large Universities they are associated with. This is the case where I work. Being a good clinician/surgeon is not enough- in fact,
    it may even work against me, as I have dedicated my last 15 years gaining clinical and surgical skills looking after patients
    to the best of my ability, rather than doing high-end research. In the current era of bimolecular and genetics,
    University funding is based on these areas, and they are therefore pushing to get clinical academics with a research profile in these areas to take over
    Clinical Departments in hospitals. Surgical positions are particularly desired and lucrative. The hospital administration really
    don’t care too much- as long as the work gets done. Being a good surgeon/clinician is not necessarily what they want, but an association
    with a large university who can help pay for the doctor, and someone who won’t be pushing for better patient-focused services, is highly desirable
    to them.

  4. Anonymous says:

    Horses for courses. Some just like studying. For my money, apart from the professional one, rest are not relevant. Academics need doctorate.

  5. DrPhil says:

    A corollary regarding the city/rural unbalance is that “out in the bush” you need to be better trained and more experienced than most city folk as the back up is a long way off. I’ve been saying this to the city folk for over 30 years but of course they’re not interested. There’s a regular columnist in my craft group’s magazine who has eleven (!) postgrad qualifications. How he ever find time to gain clinical experience in a procedural specialty is beyond me. Shades of “those who can, do, those who can’t, teach”. Retirement looks very attractive after 33 years at the coalface.

  6. Max Kamien says:

    1. There is a difference between education and training.
    2. It is easy to get an post-nominal alphabet eg I have a DPM. I could write DPM (RCPL & RCSE) etc
    3. The Rural GPs split from the RACGP over post nominal letters. So it can be important to some doctors.
    4. In 58 years I have never been asked about post-nominals
    5. Patients and golf buddies are much more impressed with a professor title. They are now much easier to come by than are most post-nominals.
    6. D.Phil looks like a learned doctorate.
    7. I should not bite, but IME those who teach also do and do pretty well. Town-Gown prejudices die hard even when most of the town love their Adjunct professor titles and use them at every opportunity.

  7. Dr. Elliot Rubinstein says:

    You may be able to be overtrained but you can never be over educated.

  8. Andrew Jamieson says:

    You have nailed it Malcolm! Having retired recently recently my letters were the minimum necessary for a satisfying career. I have the enormous satisfaction of having made many patients happy, damaged very few and I have no regrets that my lack of academic cred. resulted in me not getting the coveted prestigious teaching hospital job and heading to the outer suburbs. Later I headed to the bush where my happiest clinical days were spent.

  9. Anonymous says:

    There is also the relentless marketing by universities. For example, Sydney University offers a Master of Critical Care Medicine for about $30,000, and spruiks it as a chance to stand out from the crowd seeking training jobs in anaesthetics or critical care medicine. Those achieving this degree still have to study for, pay for and pass the relevant primary exam, but will have learnt some basic science they would once have learnt as an undergraduate.

    Such a masters degrees is nothing more than a second bite at the financial cherry for universities which are producing too many underdone medical graduates.

  10. Anonymous says:

    I had a basic medical degree and a post graduate qualification, I saw in excess of 150,000 patients in my life and stopped counting, Only one patient ever enquired why my qualifications were not on the wall so I told her I thought that they were in a drawer at home. I suggested she check with the medical board but I saw her for years .
    The oddest thing is I love doing exams and always do self assessment courses which is my way of continuing to learn.
    I only work part time now as I am old.
    Unfortunately the situation may have changed now so this is just what used to happen.
    PS. Nobody ever enquired about my Leaving Certificate or University results at all.
    Perhaps you just need to be available, affable and able.

  11. Maxine says:

    Thank you for raising this. When will it end? Post graduate qualifications are ridiculously expensive $30k per year for a masters degree. They take a lot of time, and what are they used for? Does doing a PhD add value to your clinical practice? it certainly takes away time from clinical practice….as well as our families as you correctly raise. Why do we weight ‘qualifications’ so highly? What our patients care about is how much we care for them. Extra qualifications don’t mean we care more or know more. I’ve often wondered why we have this ceaseless need to prove ourselves through ‘qualifications’ and why are qualifications valued more than years of clinical experience? Something has to end. This is part of our daily professional stress and distress and contributes to our ill-health. No other profession has people ongoing eternally getting and seeking qualifications and ‘publications’ in order to prove their daily worth as our profession does. And how it adds value to our patient care is entirely questionable.

  12. Anonymous says:

    I was one of the junior doctors who started a higher degree with the ultimate goal of getting training position in a super competitive specialty. However, as I reach the end of my PhD I have noticed a huge shift in my own values and priorities. The opportunities I have had whilst taking a break from full-time clinical and work have afforded me a chance to see what else is out there and what my ideal career could be. And it isn’t slaving away in the hospital system. Whilst I enjoy being a doctor (and consider myself a decent one with good technical skills, good knowledge and good patient interactions) to do only that day in/out for 60+ hours/week for the rest of my life doesn’t excite me anymore. Perhaps the pursuit of further knowledge has other intangible benefits such as a chance for self-discovery, reflection and a desire to see a road less traveled within medicine…

  13. Xavier Yu says:

    I think that doctors are not sufficiently educated on the business of medicine (what I call the “Part 3 exam”): how to get a sustainable job post fellowship, and how to navigate the bureaucracy. The Colleges and AMA can do more in these regards to supports their members

  14. Anonymous says:

    I think that is all that one needs – medical degree & the fellowship.
    Yet it is still up to the individual if they want more letters after their name.
    However, a doctor should not say I am educated enough.
    We all should always be updating ourselves. We shouldn’t stop learning , training or educating. There is always room for improvement. We can’t know everything.

  15. Anon Y Mouse says:

    The fact is that there is money in offering education and higher learning degrees. It justifies the position of senior academics. You probably won’t make Prof unless you supervise a few PhDs and Masters students.

    I find it inordinately frustrating that despite building a growing surgical research unit and holding an MPH (which I did for my own interest) that you aren’t taken seriously or considered for competitive grant funding unless you have a PhD. I don’t want to do a useless degree just to get funding for surgical research!

  16. Anonymous says:

    I would like to suggest six full-time years of basic since research and laboratory work does not culminate in a ‘useless degree’. The decision to complete additional training, as for most of life, is/should be an individual quest for further development. I agree with ‘anonymous’ that seeing patients back-back 8-10 hours a day 5-6 days a week for 30 years is not my idea of the career I would like. But, again, that is my view. Perhaps we should allow others the respect to make their own decision without the need to comment on it.

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