MD Plus
By: Michael Tan
PINOY KASI, INQUIRER
Last updated 02:42am (Mla time) 12/14/2007
The title I really wanted for today’s column was “The Once and Future Doctor,” but because my column is horizontally challenged, space-wise, the title always has to be short.
I’m writing about a bold innovation at Ateneo de Manila University’s new medical school, formally known as the Ateneo School of Medicine and Public Health, or ASMPH. They took in its first batch of medical students last June, and in a few years, they will be the first medical students to graduate from a Filipino medical school with two degrees: an MD (Doctor of Medicine) and an MM (Master of Management).
People expect medical schools to produce graduates who will excel as clinicians, meaning graduates practicing medicine in a clinic or hospital setting. The ASMPH hopes to do that, and more. All this goes back to years of planning, starting with the dreams of Dr. Alfredo Bengzon, the ASMPH dean, who assembled a small think-tank to work on his vision. “I want a medical school,” he would keep reiterating, “that will produce graduates who excel as clinicians, as administrators and as public health experts.”
It’s not surprising that such a vision would come from Dr. Bengzon, given his own background and experiences. His specialization is neurology, one of the most complicated medical fields. Later, working with The Medical City, he went on to get a Master’s in Business Administration. Eventually, he became Ateneo’s vice president for Professional Schools, expanding the MBA program to include two postgraduate degrees specifically targeting health professionals.
Under the Aquino presidency, Dr. Bengzon served as health secretary, which exposed him to the country’s many daunting public health problems. His government service wasn’t limited to health; when the negotiations around the US bases in the country began, he was appointed head of the Philippine panel, not an easy task. Dr. Bengzon knows what he’s talking about when he says health is economic and social and political.
Stateside
The idea of medical schools offering two degrees is not new, at least in the United States. I checked the website of the Association of American Medical Schools and was overwhelmed by the varieties of joint degree programs.
A total of 73 American medical schools offer an MD/MPH (Master in Public Health) program. The University of Pennsylvania, with its famous Wharton School of Business, was the first to offer a joint MD and MBA program in the 1970s. Today, there are 49 American medical schools that offer such dual degrees.
I think it’s significant that Ateneo offers an MM instead of an MBA. An MBA tends to be associated with corporations and for-profit institutions while an MM degree has a broader scope, training people for a wider range of settings -- from the Department of Health to the many international health organizations. Ateneo’s MM should, hopefully, produce someone who is as comfortable in a corporate setting (which is what many hospitals are) dealing with executives, as well as a community, and with some small town’s mayor. The inputs here have come from Dr. Marife Yap, the ASMPH associate dean, who originally came in from community medicine practice. In a way then, Ateneo’s MM is an MBA and an MPH rolled into one. (Really now, working for three degrees simultaneously would have been too much.)
What are the other American joint degree programs? There are 22 medical schools offering an MD/JD program, meaning, graduates will be both physicians and lawyers. We actually have some of these doctor-lawyers (“dokattorneys,” TV host Korina Sanchez calls them) but they get there through a long route: a bachelor’s degree, followed by medical and law schools taken separately, at least over 12 years.
Many of the American medical schools offer an MD with a PhD in a specialized biomedical field (for example, immunology, neuroscience, toxicology). What surprised me though was that 103 of the medical schools now offer an MD with a postgraduate degree in an interdisciplinary field not directly related to biomedicine. Harvard, for example, offers an MD with a PhD to be chosen from three fields: Health Care Policy, History of Science or Medical Anthropology. Case Western University has an Anthropology and Medicine program where medical students can work toward an MA or PhD in urban health, cross-cultural aging, international health or psychological anthropology.
Staying home
The wave of the future in medical schools isn’t just around these dual-degree programs. What we’re seeing here is a distinct trend toward producing a “Doctor Plus,” a physician who goes beyond biomedicine. In many ways though, this is not new, representing a return to what doctors once were: people who could take time to better understand their patients. So, even without a dual-degree program, many American medical schools are emphasizing a more interdisciplinary curriculum even in their regular medical training. The University of California in San Francisco, for example, devotes its 4th year to advanced studies, where students get to pick from medical humanities, the science of medicine, or global and public health.
Disclosure time: Yes, I’ve been part of Dr. Bengzon’s think-tank from the beginning. We work without compensation, usually on weekends and in late evenings, the joy and fulfillment coming from being able to dream with Dr. Bengzon and other visionaries.
No, I have not left the University of the Philippines (yet). At UP’s College of Medicine, I’ve been working with the Department of Community and Family Medicine to find ways to equip our students to deal with the realities of medicine, outside of hospitals. We send students out for a reality check, in the streets, in the “Quiapo Medical Center” (yes, Plaza Miranda with its medicinal plants and amulets) and further afield. We remind them, too, of the importance of understanding why medicines are expensive, of looking into social and political issues from gender inequity to governance (or its lack thereof).
I think we’re doing a fairly good job at UP and ASMPH; in fact, my fear at times is that we might be doing too good a job. Our graduates won’t need to go to nursing school if they want to work overseas; instead, they’ll be very competitive as an “MD plus” when applying for the World Health Organization and other international agencies, as well as American and European hospitals that emphasize cultural competence or the ability to work with people of different ethnicities.
I can only hope that our alternative medical curricula are also strong enough to produce doctors who will be inspired to stay on and serve in the Philippines, partly because of patriotism but also, in a practical way, because they will be less prone to despair. These would be physicians confident in their ability to use the sophisticated technologies of the 21st century, but also mindful of the need to put down their stethoscopes and CT scan reports and return to the patient -- listening, observing and understanding.
