I continue to struggle with the concept behind the combined MD/PhD degree. For that matter, I continue to struggle with the concept of physicians doing research in the first place - even though it's considered pretty standard practice in academic medicine. If you want to keep your faculty position at Big University Hospital, you had better be writing grants and publishing. Why?

With the persistent, pervasive culture of publish, publish, publish pressing down upon me, I can't help but feel that I've been the victim of a 'bait and switch' somewhere along the line. I went to medical school specifically because I did not want to do research, write grants or publish. If I had wanted to do any of these things, I would have gone for a PhD rather than the MD which I very specifically remember checking on my med school application. The skills and knowledge required to do medicine versus the skills and knowledge required to do academics are not the same. Yet somehow, the medical community finds it natural that doctors should do research and, if you're already doing the research, hell, why not follow that to its logical conclusion - a PhD?

The way I see it, physicians and researchers are charged with very different tasks. Physicians are in the business of helping you. Physicians are interested in mastering as large body of knowledge as they can in the shortest amount of time possible and in applying that knowledge in such a way as to cure or help manage your medical condition. Researchers aren't interested in you. Researchers are interested in furthering scientific knowledge. People who do research and get PhD's spend huge quantities of time investigating an extremely narrow question, the answer to which is probably completely irrelevant to any medical condition that you have or ever will have. The whole point of being a physician is that we get to enjoy the fruits of this labor. Thousands of hours spent writing grants, controlling variables, running PCR reactions, taking x-rays and whatever else eventually does result in real and useful knowledge that we physicians have the pleasure of using in the course of patient care.

To me, a physician who studies, say chemotherapy drugs, is like an auto mechanic who studies structural engineering. And, I have nothing at all against structural engineers or cancer researchers. Quite the contrary. Only, it's not what I signed up for.