Physician-scientist

A physician-scientist is traditionally a holder of a medical degree and a doctor of philosophy also known as an MD-PhD. Compared to other clinicians, physician-scientists invest significant time and professional effort in scientific research and spend correspondingly less time in direct clinical practice with ratios of research to clinical time ranging from 50/50 to 80/20. Physician-scientists are often employed by academic or research institutions where they drive innovation across a wide range of medical specialties and may also use their extensive training to focus their clinical practices on specialized patient populations, such as those with rare genetic diseases or cancers. Although they are a minority of both practicing physicians and active research scientists, physician-scientists are often cited as playing a critical roles in translational medicine and clinical research by adapting biomedical research findings to health care applications.[1][2] Over time, the term physician scientist has expanded to holders of other clinical degrees—such as nurses, dentists, and veterinarians— who are also included by the United States National Institutes of Health in its studies of the physician-scientist workforce (PSW).[3]

History

The concept of the physician-scientist is often attributed to Samuel Meltzer's work in the early 1900s.[1] Concern has often been displayed at declining interest or participation in the field, with James Wyngaarden—who would later go on to become the director of the NIH—describing physician-scientists as an "endangered species" in 1979.[4] Among U.S. biomedical researchers, physician-scientists have declined over time as a share of the total researcher population since the 1970s.[2]

Education

Physician-scientists by definition hold terminal degrees in medicine and/or biomedical science. In the United States and Canada, some universities run specialized dual degree MD-PhD programs, and a small number of D.O.-granting institutions also offer dual degree options as D.O.-Ph.D.[5] In the United States the NIH supports competitive university programs called Medical Scientist Training Programs that aim to train physician-scientists, originally established in 1964 and present at 45 institutions as of 2015.[6] Similar programs were established in the United Kingdom in the 1980s, although with relatively less funding support.[7] There are 3000-5000 trainees in this early-career pool based on the number of MD/PhD trainees in the country and number of medical trainees intending research intense careers .[8][9] Although this dual-degree pathway is not necessary to establish a physician-scientist career, most do receive some form of explicit research training in addition to their clinical education.[10]

Impact

Physician-scientists are a particularly productive research cohort contributing to biomedical innovation, discovering life saving therapies, and developing disease prevention strategies.[11] Physician-scientists only make up 1.5% of the biomedical workforce, yet according to the PSW, they account for 37% of Nobel Laureates in Physiology or Medicine from 1990 to 2014, and over the last 30 years of the Lasker Awards, 41% of the Basic Awards and 65% of the Clinical Awards have gone to physician-scientists.[12][13]

Career and Workforce

Most physician-scientists are employed by universities and medical schools, or by research institutions such as the National Institutes of Health.[1][14] As of 2014, the NIH counted around 9,000 NIH-funded physician-scientists; this count does not include those whose work is funded by sources other than the NIH—typically meaning those who work in industry, such as at pharmaceutical companies or medical device companies.[3]

At many medical schools, physician-scientist faculty are expected to obtain significant fractions of their nominal salary in the form of competitive research grants, which are also requirements for the award of tenure. This "up or out" system has been described as developed for a primarily male workforce with homemaker wives, incompatible with the work-life balance needs of the current workforce.[4] Uncertainty about stable careers in academic medicine and the long initial training phase are often cited as concerns by aspiring entrants to the field.[15][16] Data from the NIH on physician-scientist grant awardees suggests that women and minorities are often underrepresented in the population, even in fields like veterinary science where the majority of students are women.[3]

The American Physician Scientists Association (APSA) is a professional association dedicated to physician-scientists, founded in 2003.[17] APSA has worked to identify and remove barriers thus improving the retention of physician-scientists in academic research.[18][19] Transitioning through early career stages of resident to fellow to junior faculty is the leakiest part of the physician-scientist pathway. The major reasons for leaving research include the inability to obtain research funding, disparities in salaries between research track physician-scientists and full-time clinicians, and increased financial obligations during this time of life. Therefore, early career awards are the best target for new funding opportunities.

During the COVID-19 pandemic, there has been an unprecedented delay and drop in research productivity due to halted studies, reduction of research time to prioritize COVID-19 related clinical duties and diminished funding opportunities by private foundations as a result of revenue loss due to the pandemic.[20][21] These challenges have weakened the physician-scientist workforce further.

The American Society for Clinical Investigation introduced Young Physician-Scientist Awards in 2013 to support productive early-career researchers.[22][3]

References
  1. Daye D, Patel CB, Ahn J, Nguyen FT (March 2015). "Challenges and opportunities for reinvigorating the physician-scientist pipeline". The Journal of Clinical Investigation. 125 (3): 883–7. doi:10.1172/JCI80933. PMC 4362227. PMID 25689260.
  2. Ley TJ, Rosenberg LE (September 2005). "The physician-scientist career pipeline in 2005: build it, and they will come". JAMA. 294 (11): 1343–51. doi:10.1001/jama.294.11.1343. PMID 16174692.
  3. "Physician-Scientist Workforce (PSW) Report 2014". NIH RePORT. National Institutes of Health. Retrieved 12 October 2015.
  4. Schafer AI (January 2010). "The vanishing physician-scientist?". Translational Research. 155 (1): 1–2. doi:10.1016/j.trsl.2009.09.006. PMC 2796254. PMID 20004354.
  5. "Do/PhD Programs". American Physician Scientists Association. Retrieved 13 October 2015.
  6. "Medical Scientist Training Program". National Institute of General Medical Sciences. National Institutes of Health. Retrieved 13 October 2015.
  7. Lemoine NR (July–August 2008). "The clinician-scientist: a rare breed under threat in a hostile environment". Disease Models & Mechanisms. 1 (1): 12–4. doi:10.1242/dmm.000752. PMC 2561982. PMID 19048043.
  8. "2020 FACTS: Enrollment, Graduates, and MD-PhD Data". AAMC. Retrieved 2021-07-20.
  9. Kwan JM, Toubat O, Harrison AM, Riddle M, Wu B, Kim H, et al. (March 2020). "A nationwide assessment of perceptions of research-intense academic careers among predoctoral MD and MD-PhD trainees". Journal of Clinical and Translational Science. 4 (4): 307–316. doi:10.1017/cts.2020.18. PMC 7681110. PMID 33244411.
  10. Eisenberg MJ (2011). "Is a Physician-Scientist Career Right for You?". The physician scientist's career guide. New York: Springer. ISBN 9781603279079.
  11. Sarma GP, Levey A, Faundez V (2019). "Re-examining physician-scientist training through the prism of the discovery-invention cycle". F1000Research. 8: 2123. doi:10.12688/f1000research.21448.1. PMC 7014578. PMID 32089830.
  12. Jain MK, Cheung VG, Utz PJ, Kobilka BK, Yamada T, Lefkowitz R (August 2019). "Saving the Endangered Physician-Scientist - A Plan for Accelerating Medical Breakthroughs". The New England Journal of Medicine. 381 (5): 399–402. doi:10.1056/NEJMp1904482. PMID 31365796.
  13. "NIH RePORT - Physician Scientist-Workforce Report 2014". report.nih.gov. Retrieved 2021-07-20.
  14. Payne AS, Brass S (16 October 2013). "Finding Nirvana: Paths to Becoming a Physician-Scientist". Science. doi:10.1126/science.caredit.a1300227.
  15. Ballios BG, Rosenblum ND (October 2014). "Challenges facing physician scientist trainees: a survey of trainees in Canada's largest undergraduate and postgraduate programs in a single centre". Clinical and Investigative Medicine. 37 (5): E268-83. doi:10.25011/cim.v37i5.22008. PMID 25282134.
  16. Morel PA, Ross G (December 2014). "The physician scientist: balancing clinical and research duties". Nature Immunology. 15 (12): 1092–4. doi:10.1038/ni.3010. PMID 25396341. S2CID 29132886.
  17. "About APSA". American Physician Scientists Association. Retrieved 12 October 2015.
  18. Kwan JM, Daye D, Schmidt ML, Conlon CM, Kim H, Gaonkar B, et al. (July 2017). "Exploring intentions of physician-scientist trainees: factors influencing MD and MD/PhD interest in research careers". BMC Medical Education. 17 (1): 115. doi:10.1186/s12909-017-0954-8. PMC 5505137. PMID 28697782.
  19. Kwan JM, Toubat O, Harrison AM, Riddle M, Wu B, Kim H, et al. (March 2020). "A nationwide assessment of perceptions of research-intense academic careers among predoctoral MD and MD-PhD trainees". Journal of Clinical and Translational Science. 4 (4): 307–316. doi:10.1017/cts.2020.18. PMC 7681110. PMID 33244411.
  20. Wade C (January 2021). "Physician-Scientists in the Era of COVID-19: Gone but Not Forgotten". Academic Medicine. 96 (1): e5–e6. doi:10.1097/ACM.0000000000003771. PMC 7543910. PMID 32991352.
  21. Levine RL, Rathmell WK (July 2020). "COVID-19 impact on early career investigators: a call for action". Nature Reviews. Cancer. 20 (7): 357–358. doi:10.1038/s41568-020-0279-5. PMC 7273376. PMID 32503987.
  22. "Young Physician-Scientist Awards". The American Society for Clinical Investigation. Retrieved 13 October 2015.

Further reading
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