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AAMC Reporter: August 2008
Programs Target Physician-Scientists
Thanks to scientific advances, diseases like polio are a
thing of the past for many Americans. And with a much
better understanding of the human genome, scientists
may be much closer to developing new and better treatments
for the diseases we face today. But even in this exciting
time, research institutions are having problems recruiting
a crucial class of investigators: physician-scientists.
Physician-scientists are critical because of their understanding
of important medical issues and contemporary
research processes. Decline or stagnation among the
ranks of physician-scientists could hinder the development
of specific treatments, even in the wake of major
genetic and other important laboratory-based discoveries.
Stakeholders have warned of a physician-scientist shortage
since the 1970s. A 2002 New England Journal of
Medicine article reported that in 1983, there were 18,535
physician-scientists in the United States, about 4 percent
of 479,439 total physicians. Fifteen years later, physician-scientists
only accounted for about 2 percent, as they
comprised 14.479 of the nation's 707,032 doctors. More
recently, a 2007 AAMC analysis found that half of all
responding clinical departments at medical schools
could not fill their assistant professorships.
The trend is alarming to many in the scientific community.
However, like the problem itself, a potential turn-around
may take time to develop, and there are no
shortage of obstacles.
"Finding cures for these and
many other diseases will require
passionate individuals whose
goal is to become physician scientists.
Unfortunately, the
current funding climate has
made today’s young people
increasingly reluctant to embark
on such a research career."
—Eugene P. Orringer, M.D.
University of North Carolina at
Chapel Hill School of Medicine |
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"We know the mutations that cause genetic diseases such
as sickle cell anemia and cystic fibrosis, but we have
not yet come up with cures for them," said Eugene P.
Orringer, M.D., the MD-PhD program director at the
University of North Carolina at Chapel Hill School of
Medicine. "Finding cures for these and many other diseases
will require passionate individuals whose goal is to
become physician-scientists. Unfortunately, the current
funding climate has made today's young people increasingly
reluctant to embark on such a research career."
According to AAMC Lead Science Policy Analyst Stephen
J. Heinig, M.A., grants can be difficult to secure. Subcommittees
in both the House and Senate have recently
proposed budget increases for the National Institutes of
Health (NIH), which provides many investigator grants.
However, while the increases would match biomedical
inflation for the coming years, the agency's budget has
experienced limited growth for five years and, when
adjusting for inflation, has actually been in decline.
Training time is also daunting. Investigator training generally
includes four to five years of medical school plus
five years to seven years of residency. If researchers go
for a combined M.D./Ph.D. degree, the training component
alone could take eight years.
Even with physician-scientist training generally lasting
as long as or longer than that of private-sector clinicians,
their income can still be relatively low or unpredictable.
According to AAMC faculty compensation
data, neurology faculty with M.D. and Ph.D. degrees,
an example of physician-scientists, earned an average
of $159,000 in fiscal year 2007. However, private-practice
neurologist salaries ranged from $198,312 to
$309,380, according to a 2007 survey published in
Modern Healthcare magazine.
Lack of high-quality mentors and dedicated research
time, and the complex federal regulations governing
human subjects research can also act as deterrents to
physician-scientists, Heinig said.
To get more physicians into lab coats, some new initiatives
are offering financial support and resources, more
research time, and innovative training structures.
The Howard Hughes Medical Institute's (HHMI) Early
Career Physician-Scientist Program funds investigators just
beginning their careers. The program was started three
years ago to inspire young faculty who may be discouraged
by failed grant applicants or insufficient research time.
"This early time is critical, because it's usually before physician-scientists have established their scientific credentials,"
said William R. Galey Jr., Ph.D., HHMI's program
director for graduate education and medical research training
programs. "This program gives them enough funding
to collect the first data they will need for NIH funding."
Awardees receive $75,000 annually for five years and
have at least 70 percent of their professional schedules
set aside specifically for research. So far, the program
has funded 53 physician-scientists.
Another program is the NIH's Clinical and Translational
Science Awards (CTSA), which offers funding
and other services to research training centers to establish
multi-disciplinary "academic homes" for clinical
research. Thirty-eight institutions are now participating;
this number is expected to reach 60 by 2012.
With its CTSA funding, the University of Wisconsin-Madison created an Institute for Clinical and Translational
Research, an interdisciplinary resource center for
researchers in Wisconsin's health sciences schools and
engineering college. Morehouse School of Medicine
developed a clinical research master's program specifically
designed to cultivate physician-scientists who will focus
on minority health issues. The program includes coursework
in biostatistics, epidemiology, and outcomes
research. To date, 23 physician-scientists have completed
the program. Last year, through a CTSA, Morehouse
joined the newly formed Atlanta Clinical and Translational
Science Institute (ACTSI), with Emory University
School of Medicine, Georgia Institute of Technology, and
other medical institutions to collaborate on research.
The ACTSI can "expand the mentor pool for our
trainees, and increase access to core resources," said
Elizabeth Ofili, M.D., M.P.H., Morehouse's associate
dean for clinical research.
To establish consistency across these programs, a CTSA
committee is developing a set of core competencies that
can help guide physician-scientist training, said Carol
Merchant, M.D., M.P.H., medical officer in the NIH's
Division for Clinical Research Resources.
"Right now, the training can be completely different," Merchant said. "By defining the training experience,
scholars will know the expectations, and communication
between programs can be enhanced."
A long-standing NIH initiative is the Medical Scientist
Training Program (MSTP), where students earn the
combined M.D./Ph.D degree through biomedical science
and clinical training. This July, Indiana University
School of Medicine and Purdue University received a
five-year, $1.25 million MSTP award.
—By Elissa Fuchs
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