The quest for my PhD

I sat through two interviews the other day. I am writing in this blog post to chronicle my interview process and provide a perspective to the readers. These interviews were given to people from two business schools. One of them is an international collaboration, and the other is a public funded organisation. Incidentally, both of my interview panellists were PhD’s from the US. The names don’t matter here.

The first one was given to a behavioural economist specialising in quantitative methodologies applied to healthcare. These are the obvious gaps in my knowledge (and statistical skills) to explain complex phenomena. The interview process was actually a masterclass in assessing the interviewee and applying a cogent (and a rather covert real-time) psychological assessment. It was perhaps one of the best interviews I had ever appeared for. We did overshoot the time requirement and the conversation flowed freely; almost feeling like a brainstorming session to define my career transition, if I agreed. It was an ample mix of empathy, leadership, team work and a genuine reflection of the role that I would be expected to fill with enough leeway to make me understand the career loops in the organisation. The reality checks were given with enough forewarning around my anticipated knowledge gaps and expectations from the employer. I will cherish the interaction, and I hope to incorporate that in my future endeavours. This blog post also documents my positive experience, and I hope there were more interactions like these to speak about as case studies. I had also specifically mentioned that this wasn’t the only opportunity I was trying for, and I had other interviews lined up. I am definitely not facing the paradox of choices here. Instead, I am trying to get out of the core clinics to explore specific ideas in allied healthcare.

The other interview was lined up with one of the directors of a major publicly funded institution. I had sent the specific requirements to explore “research opportunities”; especially in healthcare. The experience was in stark contrast to the earlier one in the day, and was oriented towards “one-upmanship” on his part. I will refrain further from making a public comment about it.

This begs the question – why is there a difference in the approach? I assume it has to do with an individual level curiosity. The reasons for a cold shouldered approach, especially by the latter, could be many; possibly an ossification of ideas (and thought processes), possible looming retirement, and a bit of cynicism around an upstart of ideas. This also merits a closer look at the larger picture around meritocracy, institutional and state capacity, and how the state can encourage a better application of concepts around improving efficiency for deliveries. Incidentally, I am working two long forms around institutional and state capacity, and I’ll share the observations here later.

The “market” values “signalling”. A degree from an Ivy League university will fetch interpersonal networking and signals the “aptitude” of the individual. It is a “marker” for success. However, the long-term personal success depends on innate curiosity and ability to add value to others as an essential contribution. It explains my desire to form idea matrices, gain a holistic view of the problems, and zoom into specifics to teach and add value to those learning. Academia has that pull. I am sure those who have ventured into this understand this. Publications and citation indices (possibly patents) and contribution to a knowledge economy are a more valuable goal for me personally.

There has been an interesting influx of ideas around funding people (and ideas) instead of projects. We don’t know if these “radical ideas” will work. For example, Howard Huges Institute of Medicine has produced more impactful research than the National Institute of Health (NIH), for which the data is publicly available. The funding mechanisms are for long-term horizons, providing a predictable pattern of recurrent funds to allow the “research” to proceed. My favourite example is the presidential directive (in the US) around Manhattan projects and the DARPA model, which funds several “moonshots” technological ideas; many of which are destined to fail. There are similar calls for healthcare, but the stodgy and bureaucratic processes impede new ideas. The purpose of the research in healthcare is to incorporate ideas to make processes seamless, address uncertainty and financial commitments, and define goals for public policies for the greater common good. Sadly, most of the interventions in the “global south” are replicas of the West, especially around the “digital medicine” and replication crisis in biomedicine. The western ideals around data retention and “privacy” while having an universal appeal are simply not extendible (or fungible) with the prevailing socio-cultural contexts elsewhere.

The next obvious question – if we fund ideas (and not “projects”), how do we have an impact assessment – is it just a publication or actionable policy? Can we scale them? Can a single business school herald a swan song about thinking differently? I guess, the big impediment in the current academic approach is that we have stopped thinking about the question- “what if”. It means we are no longer constraining ourselves to think about the alternatives, but find comfort in the “conventional”. These ideas with their outcomes are varied. Do they translate into an increased knowledge stock? If yes, how does it benefit people? My reasoning is to define the problem with the solution backwards. The desired outcome will determine the course the problem must take (excluding any specific random variables which could derail the process). Besides, there is no effective methodology to compare “different policies”, leading to more claims for squeezing out causal data (or complex statistical approaches) to explain them. The relative lack of clarity around the research on “research funding” (or any specific approach set in stone) defaults to having a committee instead with “shared responsibilities” and minimal risk appetite. The science (and ideas) suffer.

Besides societal benefit (in the long term) and intermediate metrics (in the medium term) to assess inputs for policy frameworks, is a better marker for individual assessment. The pandied soft-skills assessments (team work/individual approach/motivation and persuasion) are other markers in the immediate term, which become apparent in the regular interaction. For example, a letter of intent for a PhD may just be a scrap of paper (a few individuals leave the PhD and the academia) and does nothing to determine the individual motivation. Instead, the better signal for tenured academics (in some universities) is a candidate getting their own funding resources. I lacked these means absolutely, and the pandemic was a higher call to see through for my patients under my care that I had to put the PhD plans on hold.

There are issues around operational freedom in specific institutions that make it difficult to operate in a specific direction, especially as healthcare facilities routinely transition to transactional marketplaces. There is a huge chasm of opportunity in public health (as optimal health goals are still not politically expedient) and lack of efficiency scaling in the private delivery modes that beg for attention (and hence my abiding interest in creating effective policy around standardisation of delivery). Healthcare requires an incentivising approach within the confines of academic rigour to realise its eventual benefits. More funding towards the same wasteful processes defies logic.

A career transition may not be immediately expedient in terms of benefits, but helps learn contours of multi-disciplinary tracks with unique perspectives. I, however, feel that clinicians with a core clinical approach require fresh insight into allied health, which has a better chance to see our patients thrive. It is heartbreaking to expend energies in treating patients with cancer, and then pushing them back in the same system lacking the institutional/state capacities to nurture them back to health.

Someone has to do it.