At what point did you decide to study neurology and why?
I have always been interested in neurology and psychiatry - how the mind works and why we experience what we experience. However, a short stint in psychiatry shortly after graduation was enough to show me that psychiatry was not for me.
Neurology is respected but, within medicine, sometimes seen as overly academic, esoteric, difficult, and unsuccessful in treating patients. I think this is an outdated view and neurology is changing for the better, but I try to see those perceived negative aspects as challenges. In the end, I think you have to do what you want to do in medicine, which involves deciding what is important to you. That may be finding out more about disease and its treatments, changing what many be believe to be unchangeable, or simply finding a way to balance medicine with a normal life.
What are you working on at the moment?
I am working on a research trial looking into the effectiveness of a particular treatment for a set of diseases, which fall into the remit of my chosen specialty. The trials are very complex and involve a lot of paper work.
The advantage to doing this sort of work is that it’s well organised and the funding is usually in place so that you can apply as you would for any job, usually to an advert in the medical press, on the understanding that if they like you and you like them that they will pay you regularly to do the work described.
The disadvantage is that you have to be ready to make your own educational needs (studying for an MD/ PhD) your own business and have to meet the needs of the trial work with your own aims. This is the case with me, and the trade off is that I have to spend some time doing work which will not directly count towards my higher degree.
What other options for research did you consider?
I considered applying to an already funded research scheme that may have been closer to what I am doing my PhD in. This would have meant I could have worked all day on the exact project that leads to my higher degree. However, this will usually be more basic science based (laboratory work, or medical imaging work) and not be directly involved with trialling medicines/ treating patients, which particularly interested me.
I spent some time investigating the possibility of coming up with my own project and trying to get funding for it. This would have involved applying for grants from medical charities which is very time consuming, competitive, difficult and offers no way of knowing whether or not you might be successful at the end of it. Also you need grants for two separate and expensive things: one is the money to actually do what you are proposing (e.g. for laboratory time and facilities, and research materials) and the second is your own salary.
Most of these salaries are calculated at the basic rate of the equivalent NHS job based on a standard working week which means that they can be nearly half what doctors are used to prior to going into research.
I decided in the end that the uncertainty and the difficulty of doing it that way were too high prices to pay.
What are the pros of combining academic study with medical practice so far?
The opportunity to use your brain, which is not something you always have the luxury of doing in ‘everyday medicine’ and getting to see the bigger picture of medicine from outside the world you’ve been in, before going back in, or not.
More flexible and hopefully (although not necessarily) shorter working hours.
An opportunity to escape the less attractive bits of everday hospital medicine: the night shifts, the constant stresses, death, hospitals, abusive patients and bodily fluids (depending on what sort of research you do).
Advancing your career and making you a more attractive candidate for most jobs that you will apply for.
The opportunity to expand human knowledge, possibly even make a difference to someone. Not to mention win a Nobel prize, appear in your own Sunday evening BBC 1 documentary and be a regular guest on Radio 4 discussion programmes.
And the cons?
There’s a lot less money and a relative loss of job security. One of the few benefits of NHS medicine is that being such an in-short-supply commodity we are used to the idea that there will always be a job for us doing roughly what we want (somewhere). However in academic medicine this security is significantly less. This appears to be true even higher up. Professors need to justify their budgets and chairs to the faculty regularly and their positions are not entirely secure. More junior members of research teams need to ensure that their funding is renewed and that fruitful things are in the pipeline within their groups. The old maxim; ‘PUBLISH or PERISH’ has not come about by accident.
There are stresses involved in academic medicine, which, while probably familiar enough to those used to working outside medicine are often a surprise to doctors: ‘Will I finish before my deadline? Will my funding be renewed? Will my project work out? Will it come to anything? What’s it all about? Why are we here?’
What advice would you give to someone at medical school starting to think about academic medicine?
Most medical students find studying medicine more than enough to be getting along with. However, if you are especially keen/ unhappy/ brilliant and you are looking into a career in academic medicine it is a good idea to plan an intercalated degree in a subject close to what you envisage doing. This will benefit your CV, gain you contacts and probably more importantly than anything else allow you to get an idea if it is something that you really can envisage doing.
There are some joint MBBS/ PhD courses available at some institutions. These are very intensive and competitive but would certainly give someone convinced that they want to pursue an academic career a head start.
