THE current controversy over the role of the PhD in the effectiveness and career progression of lecturers at Nigerian medical schools may be unnecessary and avoidable if we all agree to consider the facts, experiences and “best practices” from premier medical institutions all over the world.
While the National Universities Commission is statutorily given the authority to regulate all academic activities at all Nigerian universities, it does have the obligation to exercise that authority in line with worldwide best practices. Furthermore, with regards to medical education and training at undergraduate and postgraduate levels, the NUC shares some of these responsibilities with the National Postgraduate Medical College of Nigeria. The NUC appears to have erred in making an additional PhD degree a requirement, or at least something “desirable but not necessary” for academic career progression in Nigerian medical schools. The NUC Executive Secretary is even quoted as having said that “if you have a PhD, your promotion will be faster”. As if merely “having” the PhD is all you need whether or not you then use that PhD to advance medical knowledge and scholarship on a regular basis.
The MDCAN (Medical and Dental Consultants Association of Nigeria) disagrees. To them, a PhD “does not add any further value to our training’ and “it does not improve our ability to train medical students and it doesn’t improve our ability to take care of patients”.
They cannot both be right, but both sides may be able to find common ground on this important issue.
What is the role of the PhD in medical education and research?
We cannot resolve this debate without first agreeing on a few definitions of the terms of the debate. And since we are talking about best practices from some of the highest rated medical institutions from all over the world, some of the terms may be international. The arguments in this presentation are derived from experiences in the U.S., U.K., and Canada. These experiences may or may not be considered relevant to the Nigerian situation, but they represent some of the best practices at some of the top medical institutions in the world.
A PhD degree is a doctoral degree, the highest academic degree that can be earned. Most academic communities also consider other doctoral degrees to be equivalent to the PhD. In the U.S.A. these other equivalent degrees include the M.D. (Medical Doctor/Doctor of Medicine) awarded to graduates of all medical schools. This M.D. degree is equivalent to the MBBS. degree awarded by Nigerian medical schools, as indicated on the licensing certificates issued to holders of Nigerian MBBS degrees when they receive licenses to practice and/or teach medicine in the U.S. It is true that some medical faculty members all over the world hold PhD degrees in addition to their MD (MBBS) degrees. And that many of the top medical schools in the world even offer combined MD-PhD programs which they fund with generous scholarships and stipends. These programs are designed to attract the best and brightest of those students who have decided to pursue full time scientist-researcher careers where they will spend 80-100% of their time in their laboratories doing scholarly research. These full-time scientist-researchers run the research activities in the laboratories of premier universities and organizations like the US National Institutes of Health, pharmaceutical industry laboratories and other research-oriented institutions. They are not however, the core of the general medical faculty in any of those reputable medical schools and universities. For the core medical faculty, an added PhD is not usually considered to be of any added benefit and could in fact be considered wasteful of scare resources when you consider the cost of producing each MD-PhD scientist (in the US approx. $1M over 8-10 years).
Most medical school faculty members the world over, do not have PhDs in addition to their medical degrees. Data from the website of the AAMC (American Association of Medical Colleges) confirms that in 2019, fewer than 10% of all medical faculty in all medical schools in the U.S. held a PhD in addition to a medical degree. The actual number is 13,666 out of a total of 179,238 or 7.6%.
All top medical schools in the world recognize and require postgraduate fellowship training/board certification/Royal College/Nigerian College/West African College and other national/regional professional college memberships and fellowships as evidence of the training and scholarship required for its faculty members. Career progression is then determined by evidence of continued scholarship and excellence. These schools all allow their faculty members to demonstrate their career advancement and eligibility for promotion through several different optional career “tracks”. None of these tracks require anyone to “hold” a PhD for “rapid promotion”. For example, the Duke University School of Medicine has five tracks available to all its faculty members who can choose whichever one they like. The promotion criteria are spelled out for each distinct career track. All are equivalent. No one results in “more rapid promotion” than the other.
Track 1. Clinician-Practitioner-Educator-Administrator. For faculty who are primarily engaged in patient care, clinical service functions, teaching or administration.
Track2. Researcher/Clinician-Practitioner/Teacher. For Faculty who hold MDs, MD/PhDs, PhDs and who are either clinician-scientists or are scientists who perform basic or clinical research and are engaged in patient care or service functions.
Track 3. Researcher/Teacher. Faculty who hold MDs, MD/PhDs, PhDs and who typically spend 75% or more of their time in research
Track 4. Academic Clinician Non-tenured faculty who have some clinical component to their professional activity and are committed to a career on clinical medicine.
Track 5. Research – faculty who are engaged largely in research endeavors and instruction (usually >80% or more of their time) and who have little or no involvement in patient care.
It is in Track 5 that you see many of the PhD holders. This is where the added PhD is clearly an advantage. But this group is less than 10% of the entire faculty. And faculty who choose to enter this career track do not necessarily get promotions any faster than faculty in any other track. Harvard Medical School has its faculty website and faculty handbook documents open to the public (fa.hms.harvard.edu). There you can see all the criteria for appointments and promotions to the various academic positions. Holding a PhD, by itself, is not a criterion for appointment or promotion to any position. In fact, a quick perusal of online adverts for appointments to Full Professor at Harvard Medical School and other top medical schools shows that they say nothing about the desirability or superiority of PhDs. Even at the faculty entry level positions the requirements are always that candidates have:
“a doctoral degree (PhD, MD, or equivalent) with successful completion of a postgraduate training program (i.e. fellowship program), ABMS board certification or equivalent (e.g. Royal College fellowship) in a clinical discipline”. Note the phrase: “with successful completion….”. Even if you do have a PhD, if it’s a clinical position in a medical school, you MUST have that fellowship training and board certification. Absolutely necessary. Non-negotiable. If fewer than 10 per cent of all medical school faculty in the USA hold added PhD degrees, then what could be the basis of the current position of the NUC? And if the NUC were to prevail in the current debate, what are its answers to the questions that would necessarily follow. Questions like: Where are all the new PhDs going to come from? Who is going to pay for all this additional PhD training? Where will the research grants and research laboratories come from?
Who will pay to keep the new PhDs actively involved in the level of daily research activity that would justify the great expense of their additional PhD training?
Does Nigeria need more PhD scientist-researchers, or do we need more clinicians-educators for whom rigorous PG fellowship training is more relevant? Do we want our neurosurgeons to have additional PhDs or do we prefer that they be products of rigorous and recognized clinical fellowship training?
What are the medical education and training needs of our nation at this critical time in our national development? The NUC should engage in sincere dialogue with the MDCAN and other stakeholders to come to a fuller understanding of all relevant issues. Both sides can reach common ground if they spend their energies defining and developing thoughtful and well-planned career tracks for all faculty members at all our medical schools. All the information from all over the world are easily available for review by anyone with a smartphone and internet connection. The experiences of all the top medical institutions from all over the world are carefully detailed on all their public websites. The website of the American Association of Medical Colleges (aamc.org) is particularly useful as it contains all manner of very detailed data and information on all aspects of medical education in the USA.
This debate should not boil down to emotions and untenable ideological positions on either side. We should be driven by data and science and proven best practices from around the world. And that is one thing that any PhD holder and any fellowship trained doctor can both agree on: fact and data-based national policy development.
The NUC has erred and should reexamine its current position. And the MDCAN should get back to its very important daily work of training the next generation of our nation’s doctors. As they have done for generations. No PhD required.
Sokunbi (MD, FACP, FASN
Nacogdoches Nephrology, P.A.
Nacogdoches) writes in from Texas, United States