Alphabet Soup: PhD, MBA, JD, MS

All retina specialists have an MD; not all retina specialists have another postgraduate degree. In this episode of New Retina Radio, we examine how and why those degrees were obtained by retina specialists-and if they were even worth the time. Featuring Derek Kunimoto, MD, JD; Paul Hahn, MD, PhD; David Almeida, MD, PhD, MBA; and Scott Walter, MD, MS.

Jaraha: It’s undeniable, and hey, I’m stating the obvious here, it’s, it’s extra work.

Krzywonos: I know, but it’s their passion. They love it.

Jaraha: Yeah, and no matter how you look at it, they’re coming out with something valuable.

Krzywonos: Alright. Are you ready?

Jaraha: Yeah, let’s do it.

Krzywonos: I’m Scott

Jaraha: I’m Ranna.

Krzywonos: This is New Retina Radio. Today, we’re covering those extra letters after MD in someone’s name.

Jaraha: You’ve got PhD, JD, MBA, MS.

Krzywonos: Some doctors have so many letters after their names that it looks like alphabet soup. We all know what those letters mean, but we don’t know how—or if—they affect the careers of retina doctors. We’ll start with the PhD.

Hahn: Hi. My name is Paul Hahn. I'm an associate at NJ Retina.

Krzywonos: We’re starting with the PhD because it takes so long to get if you earn it in an MD/PhD program.

Hahn: 12 years in total.

Krzywonos: Which is a significant amount of time.

Hahn: So normally, uh, it would be four years of medical school and then for ophthalmology, it's one year of internship and three years of residency, so eight years total.

Krzywonos: And to get us to 12?

Hahn: So on top of that, I added another four years for the PhD

Jaraha: You can earn an MD/PhD in a combined program, like Paul did, or you can earn the MD and the PhD separately, but we’ll get to that one later.

Hahn: You apply for an MD-PhD, um, program out of college and I didn't know much about it but similar to the reason that I chose biochemistry. It was just kind of the most challenging of the, of the majors at Harvard.

Krzywonos: For a young applicant, that might be an attractive competition.

Hahn: It's, um, a challenging thing to get into it

Krzywonos: In Paul’s case, he knew of no one who had done it.

Hahn: I didn't really know anyone who had done it. Also, no one, there was not much precedent, at least back then. I think it was a relativity uncommon thing to do.

Krzywonos: If you enroll in an MD/PhD program, you take circuitous route toward the termination of your formal education.

Hahn: Most MD/PhD programs are structured relatively similarly, which is that you do a couple years of med school, usually two years of med school first, and then you finish up the PhD, and then you finish up your medical training at the end.

Krzywonos: Some course work in an MD/PhD overlaps, so it’s not like it’s wasted time. Paul detailed the coursework required for his PhD.

Hahn: The first two years of medical school are generally coursework, as well, um, and that coursework includes things like basic pharmacology and microbiology, and those are the types of, uh, of similar courses that you would be taking for a PhD degree also. So, generally, you're exempt from that coursework when you're doing the combined degree the second time.

Krzywonos: A combined MD/PhD saves you time compared with and MD acquired separately from a PhD.

Hahn: They definitely overlap and because of that, you can shave off a little bit of time.

Krzywonos: So, that covers the MD/PhD combo.

Jaraha: Mm-hmm. And you can take another route. It’s not as fluid. You can start with a PhD, then get the MD. So, let’s meet David.

Almeida: Hi, David Almeida from VRS, VitreoRetinal Surgery, in Minneapolis, Minnesota.

Jaraha: David did 4 years of undergrad at the University of Toronto.

Almeida: I have an Honours Bachelor of Science, and, uh, my thesis was on toxicology.

Jaraha: And then pursued a PhD in pharmacologic sciences, which took him overseas.

Almeida: That brought me to Europe, to the University of Szeged in Hungary, uh, out of all places, and that's because my supervisor at that time was in the Department of Chemistry at the University of Toronto, but he was going away for a year in sabbatical. So, um, you know, he said, "Well, why don't you just come over and do it, uh, there with me?" and so, you know, that took me to Europe and I lived there for a while.

Krzywonos: Is that the same as a PharmD?

Jaraha: Nope, totally different. It’s more on the development end of things. A PhD in pharmaceutical sciences is certainly related to medicine, but the content doesn’t exactly prepare you for medical school like Paul’s training did. Still, like Paul, David finished quickly.

Almeida: And so, I did the PhD in, uh, about three years.

Jaraha: Sounds fast, but David credits the nature of the work, which relies on computer models and calculations, with that speed.

Almeida: You know, everything is basically at the quantum level with those types of calculations, so it's either you, you and the computer. It's almost more, more computer science than, uh, than chemistry in terms of the, the bench work, like I never did any bench work. Everything was on the computer.

Jaraha: He compared it with a math PhD, which also takes about 3 years to compete.

Almeida: For example, the kind of experiments I was running would be, well, I'll put the structure together and then I would hit enter, and I would run, uh, basically, quantum chemical calculations and they would run all night.

Jaraha: He’d go home, grab some sleep…

Almeida: Then, I'd wake up in the morning, it'll be done. I'd say, "Okay, that didn't work. Let's try this." And so, there's always this involvement, so you're almost working 24 hours a day, but not really because the computer's always working when you're not.

Jaraha: Anyway, David finished and knew that if he wanted to create drugs, he needed to go to medical school. It came down to the human dynamics of collaborative pharmaceutical creation.

Almeida: Whenever there will be like, you know, multidisciplinary cross-sectional teams, you know, it ... You'd always have to yield to the medical people. Not, not that there's anything wrong with that, it's just that they knew all the processes, right? And I never knew any of those. So, I thought, "Hey, man. If I want to actually design some good drugs or I have to understand so there's side of it that, uh, I have to, I have to, you know, build my skill set around that, and so, that's what brought me to med school.

Jaraha: He does the med school thing, enrolls at Queens University…

Almeida: in, uh, Kingston, Ontario, Canada

Jaraha: …and the rest is history.

Krzywonos: So there we have it: two doctors with MDs and PhDs, who arrived there two very different ways, with two very different areas of study.

Hahn: Age-related macular degeneration and looking at iron as a potential co-factor for the pathogenesis of dry AMD.

Almeida: I developed a method called rational molecular fragmentation.

Krzywonos: But they both agreed that their PhDs came in handy.

Jaraha: For David, his background in pharmacologic sciences gives him a deeper understanding of the drugs his patients use.

Almeida: My understanding of, you know, the drugs and mechanisms of pharmacodynamics, pharmacokinetics and stuff, you know, comes really easy.

Jaraha: That training comes in handy when working alongside industry, too. He and industry reps speak the same language.

Almeida: I really enjoy research and I'm still really active, still doing a lot of it, uh, and I'm building really strong relationships with pharma and the industry and I think, that said, we, we can connect really quickly because in…I, I understand what their point of what they're trying to do and, uh, I can see it from the delivery point as well.

Krzywonos: Paul has different reasons for finding the PhD useful.

Hahn: I think what the PhD really trains you to do are things that are, that are studied in medical school but not as strongly reinforced. And that is to have a scientific mind and a very rigorous, uh, way to approach and think about things.

Krzywonos: He pointed to the words of a former mentor…

Hahn: David Epstein.

Krzywonos: David passed away in 2014, but Paul says his words still resonate.

Hahn: For a long time and he really recommended that you use your patients as what he called a clinical laboratory. Um, not to mean that you should experiment on patients, but really use patients to form hypothesis, test those hypothesis and then reformulate those hypothesis based on those results, um, and I think that's been a fantastic way to look at things.

Krzywonos: Paul said that the PhD’s tendency to strengthen the muscles in your scientific mind leads to thorough analysis of results. Building on David Epstein’s advice that you carefully follow patient’s response to therapy, Paul said:

Hahn: I think it's very important to try to improve yourself, improve your clinical care, and I think if you have that rigorous and standardized way of approaching things, it really helps you to, to, to do better for everybody.

Krzywonos: Another doctor we spoke with said his extra degree—in this case, a Master of Science degree—reflected the way he viewed medicine.

Walter: Hi, I'm Scott Walter. I'm a first year, vitreoretinal surgery fellow at The Duke Eye Center.

Krzywonos: He’s in year 2 of fellowship now. Anyway, he used a particularly eloquent phrasing to describe how he viewed science from a young age.

Walter: Science was, um, was sort of the most powerful epistemological tool, um, or intellectual framework which to understand the world.

Krzywonos: He realized this in his first year of undergrad at Reed College.

Walter: A small, liberal arts college in Portland, Oregon.

Krzywonos: He transferred.

Walter: I ended up, uh, transferring to Stanford. Uh, which, uh, was another wonderful place to study. Totally different, um, intellectual climate than, uh, Reed.

Krzywonos: His major at Stanford wasn’t exactly pre-med.

Walter: I ended up, um, gravitating towards this very unusual department called The Department of Anthropological Sciences.

Jaraha: Department of Anthropological Sciences.

Krzywonos: Yeah, I know. He described it as anthropology meets genetics.

Walter: It was, um, a sort of comprehensive scientific approach to all sorts of anthropological questions.

Krzywonos: There’s that concept again: the scientific approach.

Walter: They wanted to see maybe there are scientific ways of understanding human behavior, of understanding human ecological, um, you know, constraints that, uh, effect human behavior. Um, at looking at medical anthropology and all sort of, um, you know, new kinds of questions that might be answered using a scientific framework.

Krzywonos: Like Paul’s and David’s training, Scott’s training focused on reinforcing the scientific method, especially in scenarios where using the scientific method was unusual.

Walter: I think it was, you know, a really wonderful place to be as pre-medical student, because you were constantly, you know, forced to, uh, think about how might we apply the scientific method to questions that most people thought, you know, were not really scientific kinds of questions.

Krzywonos: If anything, the combination of an undergrad career that kicked off in the liberal arts and then drew him toward anthropological sciences—and then eventually retina—taught Scott a concept that underpins his perspective of the intersection of science and philosophy.

Walter: For me, science is a philosophy of knowing. You know, science is a, a way in which, you know, we, um, we evaluate our own thoughts. It’s just such a, such a powerful, um, framework to understand the world.

Krzywonos: We’ll be back after a short break. But when we do, we’ve got more alphabet soup talk: MBAs and law degrees. Hang tight, we’ll be right back.

[Commercial break]

Krzywonos: Scott

Jaraha: Ranna.

Krzywonos: Before the break, we spoke with 3 retina doctors. One pursued a combined MD/PhD, and the other two received other degrees before grabbing an MD.

Jaraha: One picked up a Master of Science, the other a PhD, which means that all three of the doctors we interviewed earned degrees that were related to science in some way.

Krzywonos: Even if those degrees were only tangentially related to medicine, like Scott’s degree in anthropological sciences, they still strengthened the scientific instincts of a future retina specialist.

Jaraha: Now, for the second half of this episode, we’re moving from science degrees to degrees that have nothing to do with science or medicine: the JD and the MBA.

Krzywonos: Let’s meet Derek.

Kunimoto: Hi, I'm Derek Kunimoto. I am a co-managing partner at Retinal Consultants of Arizona.

Krzywonos: Derek has a law degree, also known as a juris doctorate, or a JD. His educational career started off normal enough.

Kunimoto: I went to Harvard, graduated, uh, with a major in biology and, uh, did a lot of things that all premed majors do.

Krzywonos: He was accepted to medical school. And then things took a different turn.

Kunimoto: I received the Rhodes Scholarship.

Krzywonos: I’m sure you’ve heard of it, but as a reminder, it’s a postgraduate scholarship awarded by the University of Oxford. Med school said they’d save him a space.

Kunimoto: I had a spot at Harvard Medical School.

Krzywonos: Derek thought about getting a PhD at Oxford, but decided against it.

Kunimoto: On that scholarship, uh, I was able to choose whatever field of study I wanted.

Krzywonos: Here was an opportunity: a chance to take a mental vacation from medicine while still exercising his mind.

Kunimoto: And at that point I thought should I study what I've already studied and what I'm going to continue to do in my profession, professional life? Or should I do something completely different that simply holds intellectual interest to me?

Krzywonos: The decision was easy.

Kunimoto: It was a no-brainer

Krzywonos: He went toward another interest he had.

Kunimoto: So I, I studied law there. I, I got a law degree, a completely different way of viewing the world but, but I'm very happy that I did it.

Krzywonos: To be clear, this is a British law degree, not an American one. But Derek said those details don’t really matter for the profession he’s in.

Kunimoto: American law is based on English common law.

Krzywonos: A law practice was never what he wanted anyway. Remember: Harvard Medical School had a spot with his name on it.

Kunimoto: I, I knew this going into it, that I wasn't planning on practicing.

Krzywonos: Derek finishes medical school, and even adds a fifth year so he can do some work abroad.

Kunimoto: I did research at an Eye Institute in India for three months. I spent time in Japan, uh, with the department of ophthalmology, uh, for nine months.

Krzywonos: And then a twist! He gets recruited to McKinzie and Company, a corporate consulting firm, while he’s medical intern.

Kunimoto: A lot of consulting companies recruited very strongly, um, out of, out of both, um, our Rhodes class as well as out of Oxford.

Krzywonos: McKinzie and Company consults for various corporate clients. They needed to find new talent, so they looked outside the traditional MBA pool.

Kunimoto: They looked for PhD candidates, um, JDs, um, MDs, so people that were pursuing, um, higher degrees that excelled in their, in their respective graduate schools and, and were open to learn ways of consulting.

Krzywonos: Derek used his elective time and vacation time to allow McKinzie to fly him to Spain for a few months for a crash course in business school.

Kunimoto: What's called a mini MBA.

Krzywonos: He after medical internship, the road to becoming a practicing retina surgeon took yet another turn.

Kunimoto: I applied for and took a job with McKenzie and Company.

Krzywonos: He worked as a corporate consultant for two years. Then he finished his ophthalmology and retina training. It’s a long road. Remember how we talked about how Paul’s combined MD/PhD, which saved him about 2 years by combining some common coursework?

Hahn: They definitely overlap and because of that, you can shave off a little bit of time.

Krzywonos: Derek’s path didn’t allow him to save any time.

Kunimoto: And so by the time all was said and done, I think while most people finish up at age 32 after fellowship, I was 37 or 38 at that time.

Krzywonos: Some time lost, then, but for good reason. Earning a JD requires a logical mindset that is not the scientific method. In that sense, his background in law—and even his work in consulting—does not affect his day-to-day medical judgment.

Kunimoto: I don't know that I approach diabetic tractional retinal detachment any differently than someone who's gone straight through.

Krzywonos: A hemorrhage is a hemorrhage is a hemorrhage, in other words. But a background in business, both from a legal standpoint and a career standpoint, give Derek perspective others may not have.

Kunimoto: The structure of our, of our business and, um, the legal framework of our business, the medical malpractice issues, the liability issues.

Krzywonos: His understanding of nonclinical issues is grounded in the work of academics and practical experience.

Kunimoto: I think that I have a different framework to come from. And it's only by, you know, spending hundreds and hundreds of hours reading arcane cases and, and reading about outcomes and, and the legal justification and rationale for these that, that I would even have that.

Krzywonos: Derek said he enjoyed being a medical student, but that it was largely a means to an end.

Kunimoto: While I enjoyed studies and I enjoyed being a student, um, that was more the path to get to where I was in medicine.

Krzywonos: The JD and the experiences abroad, however, were different. It’s fair to call Derek’s law degree and nonmedical professional experiences manifestations of his interests rather than experience cultivated to gain direct knowledge in his field.

Kunimoto: The other stuff, all the other things we talked about, doing the law degree, studying abroad—that is the life experiences which help broaden, um, my experience and, um, just, I think, give, it has given me a, a different, uh, different outlook.

Krzywonos: Indeed, in Derek’s estimation, having a JD or corporate experience gives you few advantages when looking for a job.

Kunimoto: Everybody out there has something unique about them. I think those unique things help get you noticed, and get you in the door. But after that everyone's on, on, you know, a level playing field because in the end it's not just about qualifications. It's not just about experiences that one's had. It's, it's about how you interact with people, how, how you respect others around you.

Krzywonos: Derek’s holistic understanding of his JD and his corporate consulting experience are refreshing and humble. Still, we can’t discount the very practical effect that they have: Derek Kunimoto, managing partner at Retina Consultants of Arizona, also happens to have a JD from Oxford. It’s a two-for-one deal.

Jaraha: And the corporate consultant experience. It’s more like a three-for-one deal.

Krzywonos: Good point. You know, and corporate consulting concerns are usually reserved for people with MBAs.

Jaraha: Mm-hmm. Luckily, one of our interview subjects has one of them, too. So, so we go back to David. He already had his PhD in pharmacologic sciences, and then he was working on the MD, knowing that he needed an MD if he was going to design drugs, because the MDs are the experts in panel discussions. But it didn’t take long for him to grow frustrated with hospital systems.

Almeida: The degree of, uh, how, how hospitals and how healthcare was being administered in terms of resource utilization, started to really bother me.

It, it ... I found that the administrative process, the decision-making analysis, how things are being, uh, allocated, and how decisions were made to what was covered and what was not was absolutely insane

Jaraha: Like any good medical student, he turned to his mentors for advice.

Almeida: I had good mentors at the time that said, "Well, you know what? Here, here's the problem. To speak to that administrative side of medicine, you really need a, uh, an MBA. You need to have some sort of a skill set that can help you communicate that.”

Jaraha: You see, h was juggling two passions—medicine and complex business systems—but he still wanted to design drugs. He decided that earning an MBA must be done while getting the MD.

Almeida: So I, I did, uh, MBA with George Washington University in Washington, DC that allowed a part time, so, I did over two years during my last two years of meds, of med school, during my clerkship years.

Krzywonos: So he ended up using this MBA to address systemic failures in distribution of care and, like, administrative issues in hospital systems?

Jaraha: Not at all, actually.

Almeida: No. You see, then, then, things changed again.

Jaraha: For someone with interests as varied as his, David was in the right place at the right time: ophthalmology, early 2010s.

Almeida: I do an ophthalmology elective.

Jaraha: This is still at Queen’s University.

Almeida: I'm like, "Oh, man. This is amazing, like this is really fun.”

Jaraha: He loves it.

Almeida: They are doing wonderful surgery. They’ve got these fun clinics

Jaraha: This was 2012

Almeida: The anti-VEGF boom is in full effect, so innovation is just like going crazy in ophthalmology and retina in particular.

Jaraha: Seemed like the perfect match.

Almeida: I'm like, "Whoa, you know, this actually has everything here that I was kind of looking for.”

Krzywonos: Does he use the MBA?

Jaraha: Sort of. Not as much as he uses the PhD, and certainly not as much as our other interview subjects use the knowledge they gained from their degrees. David thinks that’s because the degree offers a survey in a number of business specialties, but no concentration in a particular one.

Almeida: I always find that the MBA is kind of like a funny degree because it's a basic skill set, but it's very generalized, right? Because you take courses in accounting, and human resources, and logistics, in operations management, supply chain…

Jaraha: The courses are short—too short, really, to delve into topics in a meaningful way, he said.

Almeida: I'm not an expert in any part of it, and so, I don't think I use it the way it was intended, perhaps.

Jaraha: It did come in handy once, though: on the interview trail. There was one other person with an MBA at VRS in Minneapolis, where he now practices, and they could talk shop right from the get go.

Almeida: When I interviewed, we hit it off exactly from that point of view because you can contribute, uh, significantly along those, uh, those lines of thought.

Jaraha: So, it’s not that the MBA was a waste of time, it’s just that David didn’t use it how he thought he would.

Krzywonos: There seems to be a pattern here: despite the fact that some of our interview subjects did not use their degrees as they intended, they’re still happy they earned them. Derek said that, if nothing else, it’s life experience.

Kunimoto: I would put both law and the time I was abroad in a similar category.

Krzywonos: Which is to say that they aren’t the usual experiences one earns in medical school.

Kunimoto: I mean, much like the way a junior year abroad would be except, you know, I did that a little later in life so I, I think, you know, in some ways it's a little more valuable. I could do more things and, and experience other things.

Jaraha: David thinks there are pros and cons to earning an extra degree—or in his case, two.

Almeida: I think on the idealistic sign on a humanitarian or a humanistic side, there's, you know, investing in your knowledge or your education is always, you know, is a worthwhile goal.

Jaraha: But it comes at a price.

Almeida: You lose time and there's an opportunity cost, there's a debt cost.

Jaraha: He thinks that degrees should be driven by questions, not by desires to rack up more letters behind your name.

Almeida: if it can happen organically like, uh, I always told me like you know, there are a bigger question I needed to get answered with a certain skill set and then, education provided at a steadfast route to that answer, so if you have something similar, then I, then I think that's a viable way to approach it.

Krzywonos: Certainly some impressive work, and we look forward to seeing what some of the young docs in this episode do with their unique educations.

Jaraha: Absolutely. Special thanks to Derek Kunimoto, Paul Hahn, David Almeida, and Scott Walter for this episode.

Krzywonos: I’m Scott Krzywonos.

Jaraha: I’m Ranna Jaraha.

Krzywonos: See you next time.

Jaraha: Bye.

Hahn: Hello, Scott. Paul Hahn here to read the credits. Here is goes. New Retina Radio is a production of Bryn Mawr Communications and New Retina MD. The show is produced by Scott Krzywonos with help from Ranna Jaraha and Rachel Kagan. The show was recorded, mixed, and edited by Greg Nothstein. Our staff includes Dave Levine, Megan Beisser, Elisa D’Amato, Laura Geise, Julie Kassab, Kyra Mazurek, Meredith Pollack, and MJ Stewart. Our publisher is Janet Burk. For advertising questions, contact us at NewRetinaRadio@bmctoday.com. That’s all. Chat later.