

Should I study towards a MD/PhD in light of advances in AI/robotics/automation? - piggyback

I&#x27;m considering becoming a radiation oncologist. Specifically, I would like to do a BSc in Electrical Engineering plus pre-med, followed by a joint MD&#x2F;PhD (EE) degree. A BSc takes four years, and MD&#x2F;PhD programs take an average of 7-8 years. On top of that there is a one year internship and a residency requirement of at least five years. All in all, it would take me 18 years to get to my dream job; even if I did away with the PhD and only went for a regular MD, it would still take 14 years to become an oncologist.<p>My question is twofold:<p>(1) Will AI&#x2F;robotics&#x2F;automation have made most health care jobs redundant (or at least reduced their financial viability) by then, making such an investment (nearly two decades of opportunity cost) futile?<p>(2) Provided physicians are still needed in the future, is it at all possible to start a healthcare technology company on the side to make use of my technical knowledge while working as a doctor part-time? Would hospitals or private practices be prepared to accommodate me? Would it be financially feasible?<p>Thank you.
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amrosado
I'm an MD-PhD student with the type of background you are interested in
developing. Radiation oncology is going to be a dying field in the future, but
that is the subject of a different conversation.

I think you want to go into MD-PhD, but I would suggest against it if you are
more interested in the technology than what is best for patients. A lot of
technologists are having problems conceptualizing this because they don't
understand the limitations of current technology and what dealing with
patients entails. Instead of trying to be a leader in this type of field you
should focus more on potential problems technology can solve much better for
patients by improving outcomes and decreasing costs. The biggest problem in
medicine right now are the insurance companies and healthcare administration
practices which are quite costly and provide little patient benefit.

1.) Technology is only going to have as big of a impact on medicine as doctors
and patients allow. If you want to make an impact on healthcare focus on
developing technology where you can convince doctors that outcomes and costs
are better. If you look at past clinical research done, a lot of technology
did not produce the beneficial outcomes perceived by the inventors. Clinicians
are skeptical of technology without proper evidence suggesting its usefulness.
Your technology will have to navigate this system.

2) MD-PhD gives you a lot of flexibility with doing this type of thing, but I
would suggest that you focus more on helping patients than building a
business. Likewise, I would suggest trying to become more involved at an
academic hospital that could support your intellectual property pursuits, give
you access to the patients your technology can help, and help find the
resources you need for new developments. Neurosurgeons with engineering
backgrounds are probably the most successful in this respect.

You have a long ways to go and the journey is not easy by any means. Good
luck. Questions are welcomed.

~~~
piggyback
Thanks for your input. Regarding insurance companies and healthcare
administration, I don't think those are problems to be solved by MDs or even
PhDs but rather issues to be solved by already existing tech automation
companies in coordination with legal experts. You mentioned radiation oncology
is a dying field. Could you elaborate on the future of the various specialties
(maybe top/bottom 3) as far as you can tell?

~~~
amrosado
I think radiation oncology is going to be displaced by emerging disciplines in
medicine. I would pay close attention to what is happening in the field of
immunotherapy since there are a lot of recent success in difficult cancers,
autoimmune diseases, and infections. Recently several specialists have
supported immunotherapy's potential in cancer treatment
([http://www.nature.com/nature/outlook/cancer-
immunotherapy/](http://www.nature.com/nature/outlook/cancer-immunotherapy/)).
Unfortunately, training in radiation oncology will most likely be different
than the training required to perform this type of medicine. Likewise, the
potential for automation/technology/AI in this particular field is quite
limited.

It's important to think about why medicine might be moving away from
radiological therapies. They are poorly tolerated by patients and expensive
([http://www.cancer.gov/cancertopics/coping/radiation-
therapy-...](http://www.cancer.gov/cancertopics/coping/radiation-therapy-and-
you/page6)). It's difficult to say what will happen in the next couple of
years, but radiology in general is taking a hit since hospitals are trying to
limit the use of expensive and unnecessary imaging often at the expense of
radiology professionals
([http://www.auntminnie.com/index.aspx?sec=ser&sub=def&pag=dis...](http://www.auntminnie.com/index.aspx?sec=ser&sub=def&pag=dis&ItemID=100261)).
Choosing a career path in medicine should be more about how you like
interacting with patients.

~~~
piggyback
Can you expand on potential future medical disciplines and what specialties
you think are going to be replaced?

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kerberus
Hi! I'm an MD/PhD student, in my final PhD year (6+2, Netherlands). I'm
working on computer navigation in orthopedic oncology, basically objective
navigation in the OR. This, together with some small sidesteps into 3d
printing and computer supported diagnostic imaging. The combination of
medicine and technology is an awesome field to be in. There are so many
projects that you can work on.

As Xaa has written, most doctors are not focused on technology. They will use
it, understand it but especially the older ones do not embrace the
possibilities automation or innovation can offer. That coupled with slow
development and access to the market makes us lag behind other high-tech/high-
impact industries (for example aviation).

Do not underestimate how hard it is for automation to completely take over a
doctors job. In 50 years we will still need radiologist. The tools you will
develop will support your and others workflows, making healthcare better. And
if it replaces a certain task, others will arise, as for example radio
frequency ablation has a growing role in oncology. (and is often done by a
radiologist!)

Furthermore there are legal implications. Surgery will not be completely
automated (fire and forget)in the next decades, simply because of this. A
surgeon always has to be present. For example: the most chosen approach for
robotics in orthopedics is assisted surgery, where you move the tool and the
robot blocks you from making bad moves.

So, as an MD/PhD you will be a bridge between two completely different
cultures. I sometimes joke that the engineers we talk to have a solution for a
non-existing problem and doctors no technical solution for an existing
problem. It's actually really hard to understand each others fields. So in
this you are valuable!

You seem very motivated! I can only draw conclusions on my choice, but I can
recommend it! If you have any questions ask away.

~~~
kerberus
Forgot to answer the questions directly and editing does not work:

1) No, definitely not.

2) Yes, lot's of research minded doctors/phd's already do. From producing
transplant transfusion fluids to pedicle screw insertion simulators or
acetabular cup reconstruction prosthesis after hemipelvectomies. During
residency its almost impossible though.

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xaa
I'm a PhD in biomedical sciences (biochem/bioinformatics), so I don't know
directly about the MD side, although I work with MDs frequently.

From what I have seen, physicians are generally not tech-savvy and are fairly
behind-the-curve when it comes to automation. Even many of the things that are
currently possible to automate, like EMRs and some aspects of diagnosis,
aren't. Since any technology that replaces what a physician does has to be
approved by the FDA, it moves very slowly. I think it is a long time before
large numbers of physicians are put out of work by technology. Especially
since the quantity of MDs is artificially limited.

That said, radiology is probably one of the first specialties that will be
automated. Already, some image recognition algorithms have been shown to
outperform trained radiologists at recognizing, e.g., cancer. So, if you're
purely after job security, it might not be the best specialty to choose.

But with a tech-heavy background like an EE, you have plenty of options.
MD/PhD + tech background is a perfect preparation for research, if you're into
that. Or you can help develop systems to automate various aspects of medicine.
Although it will put people out of work, in my opinion automation in medicine
is a very good thing for society because algorithms don't make mistakes (other
than the inherent limitations of the algorithm), don't get tired, and you
don't have to pay them, so automation should lower soaring health care costs.
You can always go into a biotech firm as well.

To answer 2), yes, physicians (at many places) have good flexibility with
their hours. The only thing you might have to worry about is who owns IP,
especially if you work for a university health care system.

~~~
piggyback
Thank you for your reply. Would you be so kind to elaborate on what you do for
a living as well as in what capacity you work with MDs? Frey and Osborne
(2013) published a paper that indicates how likely certain professions are to
computerization. You can find it here:

[http://www.oxfordmartin.ox.ac.uk/downloads/academic/The_Futu...](http://www.oxfordmartin.ox.ac.uk/downloads/academic/The_Future_of_Employment.pdf).

However they didn't elaborate on the various medical specialties. Do you
happen to have any information on that?

From what I hear MD/PhDs do research about 10-20% of their time, while they
spend the remainder on treating patients. I'm afraid very few
hospitals/practices would be willing to let me work only 3 days a week so I
can work on a tech company on the side. I'd think maybe I could do some
consulting but that's it; I don't think there would be time to pursue outright
entrepreneurship.

~~~
xaa
I am a researcher at a nonprofit research institution that does both basic and
clinical research. When I work with MDs (or MD/PhDs), it is usually to analyze
clinical and/or genomic data that they have collected from patients. Sometimes
I am roped into building web applications either for data analysis or patient
questionnaires. Once in a while, I develop prototype algorithms to aid in
diagnosis from e.g., histology images.

The ratio of research to clinical practice for MD(/PhD)s is basically whatever
you want it to be. At my institution, it seems more like 70% research / 30%
clinical on average, but that's because it's a research institution with a
clinic, not a clinic that does some research. Several of the MDs I work with
have dropped clinical practice altogether for full-time research as well.

Also at my institution there are researchers and/or clinicians who spend most
of their time on building a business. The administration very much encourages
this because they get a cut of the IP royalties. In academia, your value is
basically proportional to the money you bring in, so these people are actually
treated like gods.

Basically, there are a LOT of jobs out there; if you are qualified and
productive, you can easily find one that suits your preferences.

(I have no hard data on what specialties are more or less likely to automate.
I would expect GPs/family practitioners to be the least likely, but who
knows.)

~~~
piggyback
That sound pretty good to me! Can you tell me about the salary range of those
MD/PhDs doing research and about the cut such an institution gets? I'm asking
I'm guessing the hours that your institution are sane (read: 9-5ish)? Thanks a
bunch.

~~~
xaa
I live in an inexpensive part of the country, so salaries obviously vary based
on that. $80-150K is the normal range for a PI here, but the sky's the limit
if you can pull in a lot of grants/royalties.

There are no set hours. You work when and where you want. (I usually roll in
around 11-noon). They don't really care how you spend your time, as long as
you publish and get grants. Patents are just icing. Obviously clinical hours
are in the 9-5 timeframe though.

I don't really know the normal IP cut in detail. I believe it is roughly 50%
of the patent royalties, negotiable depending on how much pull you have. But
if you are the actual owner of the business as well as the patent creator,
then you get both the royalty cut and the business profit, whereas if you just
sell the patent you get only the royalties (but obviously that is a lot less
work).

EDIT: I feel compelled to point out that it's not all roses. The flip side of
the freedom is that you are judged solely on your results. If you can't
produce, for whatever reason, you're going to have a hard time. There's little
job security. And so forth.

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djokkataja
Do the BSc + premed and evaluate the medical thing more deeply in your third
year--or graduate, work for a couple years, and then decide. Work can provide
a lot of perspective that's difficult to get otherwise (assuming you're still
in high school). It's tough to plan your life that far in advance; you might
develop more specific interests as time goes on (plus expectations of what the
industry will look like may change over the next few years too). Even if your
plans change considerably, EE + premed is a solid background, so transitioning
to a different field wouldn't be a huge pain.

1\. Automation will have a big impact on medicine, but it will be an ongoing
process, not something that happens overnight. If you're doing a joint
MD/PhD(EE) program, then you'll presumably at least have some technical
qualifications that would make you more appealing to a company that is working
towards the automation of healthcare.

2\. You might be able to start a business on the side, but not as a resident
unless residencies become immensely less stressful and time-consuming. Part-
time work as an oncologist may be hard to negotiate early in your medical
career, but I am not a doctor (though I did investigate similar questions a
few years back, and this was the impression I got from speaking with doctors
and MD/PhDs). Financial feasibility... as an MD/PhD, you shouldn't have much
in the way of personal debt (since the PhD covers the MD tuition as well), and
I wouldn't expect you to be dipping too close to the poverty line.

Realistically, it depends a lot on whether you have a specific business idea
in mind and what your drive looks like. Those aren't things that you can plan
very well 20 years in advance.

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mulcher
Yes get the MD/Ph.D With an EE degree you can build the next generation
devices.

~~~
salaaaami
do NOT get an md degree. it is useless. in this era of corporate driven health
care that is mass produced, physicians are glorified trades workers. Real
impact in the tech of health care is done by engineers. Being a physician does
not allow you to implement anything in the current medicolegal climate. And
understanding the reality of health care delivery does not require an md
degree. Witness all the lawyers pursuing suits for many of the tech
advancements of yesteryear-artificial hips, slings, implants-not to mention
medications.

Future development of health tech will get hamstrung by the same sort of thing
except it will be driven by cyber failures and privacy violations. Physicians
will remain the fall guy for any product failure. Better to get a phd in a
product that has major health implications-for example, develop a sensor for
blood sugar that is non invasive, develop an algorithm and an app that
predicts MI and cardiac disease for an individual. etc.

We are currently importing our physicians because other countries produce them
so cheaply (just like software engineers). And we pay them a fraction of what
medical school tuition accumulates to.

