This is a continuation of my series on joint degrees in medicine and social sciences, in response to frequently asked questions from undergraduates.
Health economics can be studied in numerous types of PhD departments, with a range of flavors. Here I have listed some of the key considerations when deciding where to pursue a PhD. I then discuss how these vary between Economics Department, Public Policy Schools, and Public Health Schools
- Coursework: Coursework will consume a substantial amount of your time as an early PhD student. Those courses should teach skills and subject matter you want to learn.
- Peer and Faculty Research Interests: Your peers and faculty will shape your research topics and provide critical feedback on your work. Your will have to convince them your research is interesting and robust. Their perspective and research background will profoundly shape your research questions and taste.
- General Pros and Cons: Some additional considerations to have in mind.
Economics Departments and Business Schools
- Coursework: Macroeconomics, microeconomics, theory-oriented econometrics (first year); Economics field courses in topics such as labor economics, public economics, industrial organization, etc. (second year).
- Peer and Faculty Research Interests: Similar to field course topics. Industrial organization, trade, behavioral economics, macroeconomics, labor economics, etc.
- Pros: Arguably the most prestigious. Most robust training in economic and statistical theory. Broad training lets you easily bring new methods and concepts to health economics. Easier to get jobs in a range of departments across the spectrum.
- Cons: Very little of the material covered in courses will explicitly health focused (<10%). Vast majority of your audience be economists who don’t know or care that much about healthcare. You will need to convince them why your research topic is interesting and applicable outside of healthcare (They will not be satisfied if your research question *only* addresses an important problem in healthcare; the problem must also be broadly “economically interesting”). Most of your audience will think JAMA (and other top medical journals) are second rate journals.
Public Policy Departments
- Coursework: Microeconomics and causal inference oriented econometrics (first year); Economics field courses and various elective courses as desired (e.g. methods courses in CS or stats; Subject matter courses on energy, environment, education, etc).
- Peer and Faculty Research Interests: Applied microeconomics on topics such as crime, international development, social programs, educations, healthcare, etc.
- Pros: Robust training in economic and statistical methods. Training is more applied and less theoretical, with more direct applicability to health. Broad training lets you port new methods and concepts from subjects to health. For example, the techniques used to study judicial sentencing and teacher performance can be adapted to study physicians. More respect for applied problems. One can generally move to a healthcare policy or management department afterwards (transitions to economics department seem to be more challenging).
- Cons: A minority of material covered in courses will be health focused (<20%). Again, most of your classmates will not study healthcare, so there will still be some pressure to make you research “economically interesting” outside of healthcare. Finally, nobody understands what a “Public Policy” degree is (I just tell people I study health economics to avoid confusion over the term “Public Policy”).
Healthcare Policy and Management Departments
- Coursework: Statistics and Econometrics; Microeconomics; Introduction to the US Healthcare system.
- Peer and Faculty Research Interests: Healthcare policy, healthcare management, healthcare administration, etc.
- Pros: The training is more focused on healthcare. People will respect if you work on big problems healthcare, even if they are “only” relevant in the context of healthcare. Peers and faculty will have a much higher baseline level of knowledge about the healthcare system. You may have more support and resources to draw on for navigating complex healthcare datasets and institutional details.
- Cons: Overall, the training is more narrowly focused on health economics and domain specific healthcare knowledge. You may not get as broad a perspective on methods, theories, and issues in other areas of economics (e.g. labor, IO, etc). On the one hand this saves a lot of time that would be spent learning irrelevant material. On the other hand, it may limit your ability to arbitrage across fields, by bringing new developments in, say, public economics, to health economics.
Public Health Schools (Health Services/Health Economics Track)
- Coursework: Biostatistics, Health Services Research methods (very applied, relatively non-theoretical causal inference methods), Introduction to the US Healthcare System, Epidemiology, Introduction to Grant Writing
- Peer and Faculty Research Interests: Health services research in various areas, biostatistics, epidemiology.
- Pros: Research is often more clinically relevant. Formal curriculum includes grant writing (nearly 100% of MD-PhDs researchers are in grant funded departments, even if they study social sciences) and faculty are also expert advisors in grant writing. People have more respect for domain specific knowledge, which is a strength/interest of MD-PhD students.
- Cons: Researchers from public health schools often end up more narrowly focused on a very specific domain of health or healthcare (similar to healthcare management schools). They become experts in the payment systems for exactly one type of healthcare, such as nursing homes, or the costs of various drugs for specific type of cancer. Domain specific knowledge is highly useful, but it can come at the cost of more rigorous economics training. The research is often deeper in the weeds and contextually rich but sometimes lacks a connection to the fundamental economic forces at work. Research agendas tends to focus around a domain topic (e.g. cancer drug costs), rather than a particular method or theoretical approach. Also, it may be challenging to move to the other types of departments discussed previously from a public health department.
- The best training path is the one that fits your interests. If you don’t know what that is, look where researchers you admire did their training (Important Note: This often fairly different from where they work now. Most economists in public health schools did their PhD in healthcare policy departments and most economists at health policy departments did their PhDs at Economics/Business schools).
- In my observation, people tend to move in the direction of studying more applied problems over the course of their research career. One’s PhD is often the high-water mark of theoretical and, for many, cutting edge methodological knowledge.
- Transitions seem to be easier in the direction of: Economics (most theoretical, least applied) à public policy à healthcare management à public health (least theoretical, most applied).
- A reasonable strategy is to aim for a program which is slightly more theoretical and less applied than the work you ultimately aspire to do. One advisor told me that you need to overtrain a bit for the research that you want to do. You should always aim to use research methods that you understand more than strictly necessary, theories which you know forwards and backwards, etc. This strategy helps you avoid mistakes and do robust research.
- All that said, when picking a PhD department, there’s no wrong choice of discipline! People do creative and impactful work in all varieties of methods, subject areas, and disciplines.