Is a PhD really worth it in the end?

The question of whether to do a PhD as a doctor is a long and nuanced one.

We're not going to make you read to the end before you reach our answer of "it depends". We'll be honest about that answer up front. But the key question is what it varies on so you can map those factors onto your career to make a decision.

The obvious place to start is with those who already have a burning academic desire. For these doctors, their curiosity about traumatic brain injury or chronic kidney disease keeps them up at night in the genuinely enthusiastic sense. They want to add to the literature, not just cite it. For this group, the decision is fairly straightforward, and we'd go as far as to say they don't need this article.

While we're here, it doesn't get said enough, especially with the decline of clinical academics in recent years, so kudos to you guys. It is not remotely dramatic to say that the guidelines, pathways and techniques every other doctor in the country works from depend on this shrinking group choosing to do what you're about to do.

But be very careful friends… in the corner of every academic department, you'll find the disenchanted PhD student. They set out wanting to understand a disease better, and instead found themselves managing one narrow research question, largely alone, at the mercy of a supervisor's priorities and a funding body's timelines. That mismatch catches a lot of genuinely curious people off guard.

Many say that your PhD lives or dies on supervisor quality far more than on your topic or the league table ranking of your university. And there's no reliable way to vet that in advance. You can ask around, meet current students, do all the due diligence in the world, and still end up in an unfavourable position. Is this a reason to avoid a PhD? Of course not. It's a reason to go in with your eyes open.

Then there are the transactional reasons for a PhD. The main one being the ST3 (or ST4, or consultant) application. There's a growing list of specialities where a postgraduate degree is close to a minimum requirement at registrar or consultant level. And it's not only the PhD itself doing the work, but it's also the publications, presentations and audits that tend to fall out of it along the way.

If you are going to do a PhD for, let’s say, these more “transactional” reasons, do your homework and really see what it is worth for your specific position before you extend your training for 3-4 years. In many specialities’ ST3 self-assessments, a PhD or MD scores the maximum mark available in the research domain, but that domain is only a small handful of points within a much wider total score.

Is extending your training by three to four years for a handful of points a good use of your time? For many, the answer is no.

How many times have you run into a registrar with a PhD that ends up being loosely related to the speciality or subspeciality they eventually practice in? That ENT registrar with a PhD in head and neck surgery, who ends up in otology. The Radiology Reg with a PhD in microsurgery from a previous life and so on.

Far from being a place where we turn our noses up at anyone who dares bring up money when we're discussing something as noble as academia, we know finances matter.

Your consultant years are the golden years for your finances. Not just because your salary increases, but the additional contributions that are made to your NHS pension. Every year a PhD delays your CCT is a year you’re earning registrar money instead of consultant money. Do that for three to four years, and you're looking at somewhere in the region of £150,000–£200,000 of foregone consultant-level earnings during the PhD years alone (once again without factoring in the higher pension accrual).

An Academic Clinical Fellowship (ACF) is usually a four-year clinical post with protected research time, aimed to help you develop a PhD application and acquire a PhD funding package. How much you get paid during your PhD comes down to your PhD funding package. If you can get your PhD funded through a separate award like an NIHR fellowship or Wellcome Trust grant, your salary is protected for the whole thing, at something close to registrar-level pay, and pension contributions keep building your NHS pension throughout. This is genuinely the route that makes a PhD financially sane.

If you’re not on one of those awards, you are taking a significant pay cut to undertake your PhD. Standard PhD stipends sit well below registrar pay.

The decision to do a PhD isn’t one decision; it’s a good three or four rolled into one: an academic decision, a career decision, a financial decision, and ultimately, a personal one. So, as we said, the answer varies. But it varies on some things that you can actually find out in advance before you make any decisions.

Medical "influencers" tend to get a bad rep online. They're usually at the end of the jokes about doctors who should stick to coffee-cup-and-stethoscope pictures for Instagram rather than train for the next arrest call.

And yet, in the depths of the evening, sofa-bound and scrolling, we stop for their content too, feeding the algorithm that keeps them there.

We can’t lump every medic-content-creator into one category and leave it at that. However noble we "regular" doctors working in hospitals, GP surgeries and community practices like to think we are, a doctor creating content online can reach hundreds of thousands of minds, one video at a time. That’s influence we could only dream of.

Take Dr Karan Rajan, a general surgeon turned medical content creator who spends his free time playing medical-myth ghostbuster and championing gut health. He's genuinely out there in the wild west of medical misinformation, stamping out nonsense.

Is there a selection bias in who ends up in this line of work? Could you argue that those less devoted to medicine are more drawn to it? It's certainly a case worth making, even if it doesn't hold in every instance. Take Ollie Burton, a neurosurgical registrar who has been creating medical content for years, all while putting himself through the self-inflicted masochism of neurosurgical training. Some of you may see the irony and accuse the On-Call team of the same charge. Whether we are the exception that proves the rule is a serious (and valid) debate for another day.

So, as ever, we don't land on a tidy blanket policy. We have to look at the individual and their content, and judge from there. Your F1 wielding a camera round the hospital, vlogging between ED bleeps? Probably not the one.

Navigate the minefield that is buying your first home as a medic

For decades, buying big expenses boxes made of bricks and mortar has been part of our national psyche. If the American dream consists of telling your countryman the (debatable) truth that anyone can achieve success, the British dream is all about owning your own place in Swindon.

For those doctors who are about to embark on this home-buying journey for the first time, On-Call is here to be your house-buying big brother and give you some crucial tips.

The job of a mortgage broker is to take your income, the deposit you have saved up and your credit to give you borrowing power and lending options.

Some ways they can be useful include telling you:

Starting the conversation can always feel like the hard part. Sometimes you just want to collect advice and numbers without formally embarking on the house buying process. Firstly, book an appointment and ask if they offer an initial consultation free of charge. If so, you could go on to say something like this:

Brokers love giving out an optimistic max value that you can borrow.

You want a safe and usable figure instead. If you were confident the home you were buying was going to be a forever home, then fine, perhaps stretch yourself a bit to avoid paying one-off charges like stamp duty over and over again. But as this first home is likely not going to be your forever home, then you don’t want to end up being property rich, cash poor by taking on a huge mortgage and sinking under repayments.

More questions to ask your broker:

Things to Hand Your Broker

So you now have an idea of budget. Time to meet the estate agent. Your opening line could go something like this:

Some Questions to Ask Your Agent:

“Sat with a Consultant for lunch and he joked about how social media has given a public forum for people to vent their frustrations to the eyes of millions, whilst they had to suffer in silence or head to the pub to drink away their sorrows.”

“Which speciality brings the most ‘interesting’ patients? Feel free to define interesting however you like, but surely it’s neuro.”

“Message to my consultant friends who have just taken up educational/clinical supervisor posts. Do things exactly by the book. There will come a day when you need to justify how and why you have made the decisions you made.”

“Speaking to my IMG colleagues who were talking about the medic climate back home, it very much seems like the PLAB route is dead. All this whilst predatory courses continue to mis-sell dreams to hopeful doctors in their home countries who haven’t done the necessary research.”

What’s on your mind? Email us!

Some things to review when you’re off the ward…

A UK-based study in fracture clinics reported that 12% of all their orthopaedic patients had experienced intimate partner violence in the preceding year.

Every doctor’s fear is being summoned to a disciplinary committee. How egregious is it then that the Guardian reports that our economy loses £28.5bn a year from “poorly executed” disciplinary investigations. Now, this figure applies across all employers, not just the NHS, but it is worth dwelling on, especially as the consequences for those concerned can be drastic.

Last week’s poll:

Have you ever delayed escalating a patient because you were worried your senior would think you should have managed it yourself?

…and whilst you’re here, can we please take a quick history from you?

Something you’d like to know in our next poll? Let us know!

Up and down the country, doctors are settling into departments and getting to know their colleagues. The doctors in the On-Call team are no different. One of us was getting to know a colleague that we will call Justin…

Justin was lamenting how much of his medical career he had wasted thus far. Having reached the end of GP training, he decided to retrain and enter surgical training. He spoke about how his former colleagues are now financially and geographically stable, whilst he finds himself at the beginning of training. With a despondent look in his eyes, he continued to contemplate his life decisions.

Doctors often fail to realise how unhealthy unfair comparisons can be. A healthy mind doesn’t allow the achievements and successes of others to constantly enter consciousness and reduce us to a feeling of inadequacy. When you look around work, everyone will have had different trajectories and upbringings. Some more fortunate, some drastically more unfortunate.

Your mind will thank you when you recognise the futility and cruelty of constantly finding faults in your own nature.