Physician Scientists: Recruitment and Sustainability
Physician scientists are the group of doctors who have a major role in medical research. Almost 40% of Nobel Prize winners in physiology or medicine have a medical degree. In the NIH, 70% of Institute Directors have an MD. Despite its productivity and contribution to medicine the role of the physician scientist has diminished over the last few decades1. This place has been taken by PhD scientists. One of the problems is the adverse effect of cost containment on clinical based research. Another issue is the debt accumulated by medical students during their undergraduate training. Research based posts don’t pay as well as clinical jobs.
Physician scientists engage in both clinical care and clinical research but not necessarily at the same point in their careers. The hybrid nature of the position allows the individual to engage in ‘bedside to bench’ and ‘bench to bedside’ research. They are able to highlight the clinical mechanisms of disease and on the other hand apply basic science to patient care. The two categories that have emerged are those undertake research directly with patients and those and those who conduct laboratory-based research. The increasing complexity of molecular and cellular biology has proven challenging for physicians.
Another concern is how to harness the full value of older research scientists. A mandatory retirement age has been common in Europe but was abandoned in the US in 1994. Some investigators retire from their position as chief investigator and take the role of co-investigator. It is important to achieve the correct balance between older and younger scientists. If a senior investigator is being productive and innovative, he has a right to be considered for work on merit. To phase out an individual’s participation in research simply because of age represents a wasted opportunity. In addition past performance is good predictor of future success2.
On the other hand the career path for younger physician scientists needs to be attractive and welcoming. The best solution would be to build on the experience of the senior investigators. In the latter stages of their career they should be encouraged to take up an active mentorship roles. They should participate in fostering the careers of their younger colleagues. There is a common complaint about the excessive amount of time required to prepare a grant application. The process can be stultifying, where the process becomes more important than the content. There is a tendency to undertake projects that will quickly deliver preliminary results suitable for a grant application3. The struggles and uncertainty associated with a career in research also deters many young aspiring scientists. Young physician scientists have to wait much longer to get their first grant. The average age that individuals receive the first NIH grant has risen from 38 years in 1980 to 45 years in 2013. This is a concern that this represents a lost opportunity. One of the possible explanations is the longer period of training. The linkage between youth and scientific discovery has been frequently reported. Without their own funding researchers can’t start their own laboratory or pursue their research ambitions.
The attitude towards research in Ireland is positive. Successive governments have been supportive. In Ireland, the Health Research Board (HRB) Strategy 2016 – 2020 commits the HRB to support exceptional researchers and leaders in health care research. It is the leading funding agency in Ireland for medical research. A structured system has been developed. It will fund early stage researchers through PhD programmes. It will support new investigators who are ready to work independently. Mid stage researchers will be helped to develop a team-based approach. The long-term goal is to train and support individuals as collaborative experts. The HRB supports the need to drive the integration of research and evidence into policy and practice.
The Irish Research Council was established in 2012. Its remit is to fund excellent research within and between all disciplines across the entire academic spectrum. The vision is to provide support and opportunities which will enable the country to reap benefits of scientific endeavor. The IRC has a primary interest in doctorates and masters level funding. It places an emphasis on explorative research that leads to new concepts.
Science Foundation Ireland (SFI) funds basic and applied research in the areas of science, technology and engineering and maths (STEM). It was established in 2003. It invests in academic researchers and academic teams that are likely to produce knowledge. Agenda 2020 is a strategic plan to position Ireland as a global leader, a society with science as its core. SFI funds early and mid-career researchers to become fully independent leaders with collaboration with UK funding bodies. SFI is currently funding INFANT- Irish centre for fetal and neonatal translational research at UCC. Also in the SFI portfolio is CURAM the centre for research in medical devices. Its vision is device- based solutions to treat chronic diseases globally.
SFI supports researchers when applying to the European Research Council (ERC) for funding. The ERC has a budget of €7.5 million. A survey of 1,008 Irish adults found that they highly valued science and appreciated its value for advancement of medical care and economic growth.
One of the challenges facing the young researcher is how to navigate the funding process and the various funding bodies. Senior physician science researchers can play an extremely valuable role in encouraging younger colleagues. A key role is protecting and shielding applicants from the disappointment of a grant application rejection. Disillusionment can quickly set in and the applicant abandons his scientific aspirations. These challenges must be confronted in order to increase the attraction of a career as a physician scientist.
Clinical medicine, on the other hand, is a safe and welcoming option. It becomes increasingly attractive when funding in a research post becomes insecure. Endeavour is rewarded and appreciated. The career path has clarity. The sense of security is greater. The remuneration is better.
Science is fundamentally important to the progress of medicine. The scientific community must continue to be welcoming and supportive. The ‘curiosity driven’ medical student should be provided with the opportunity to undertake a research module. The summer student scholarships are an ideal way to promote the scientific principle. Physician scientists play an important role in medical research. All health care systems should actively support their recruitment and retention.
- Orwoll E. Passing the baton- harnessing the full value of older scientists. N Engl J Med 2016;374:2514-7.
- National institutes of health. Physician scientist workforce working group report. June 2014. http://acd.od.nih.gov/reports/pswreport_acd06042014.pfd
- Daniels RJ. A generation at risk: young investigators and the future of the biomedical workforce. PNAS 2015;112:313-18