Plight of the MD Investigator

Does the U.S. Have Enough Physician-Scientists to Maintain Scientific Leadership?

In the past century, physician-scientists produced many scientific breakthroughs that have translated to advancements in clinical practice. However, the number of physicians pursuing careers as scientists/researchers is not keeping pace with the national need for this research, while, at the same time, the average age of physician-scientists is rising. Recent data has shown that the negatives outweigh the positives for physician-scientists to undertake a scientific career.

The American Gastroenterological Association (AGA) believes it is essential for a highly respected academic research organization, such as the Institute ofMedicine, to conduct a thorough analysis of the current problems and issues surrounding the recruitment and retention of physician-scientists and to recommend long-term solutions.

The Number of Physician-Researchers Is Decreasing Despite Increased Funding

The total number of physician-scientists involved in NIH research has not increased from 1980-2004 despite the doubling of the NIH budget. There is ample anecdotal evidence to explain this phenomenon but the lack of comprehensive data on this important topic warrants future investigation.

In addition to the fact thatmany physicians are reluctant to go into investigative careers, many who begin this career path drop out, whichwastes our national investment in the development of these scientists. It is essential to retain physicians’ scientific and research expertise, especially at career transition pointswhere they aremost likely to leave a scientific career.

Why Are Physician-Scientists Leaving the Field?

Solutions should be explored and implemented at both the NIH and academic institution levels, both for K and R01 funding. K awards are designed specifically for post-doctorate and early career scientists who may be new to the grant writing process. The Research Project Grant (R01) awards provide support for health-related research and development based on the mission of the NIH.

The greatest attrition rate for physicianscientists occurs during the transition from K to R01 funding and when attempting to renew the first R01 grant or obtain a second R01 grant. There is also no clear national policy to determine how limited research funds should be distributed between young investigators who represent the future, and established investigators who are currently conducting clinically important studies.

Many reasons contribute to the attrition of physician-scientists including:

  • The large and increasing salary differential between physicianinvestigators and full-time practitioners.
  • High levels of debt after completion of formal education.
  • The high business costs of running individual laboratories and the uncertainty of continued NIH grant money or foundation funds where the scientist may not be able to accomplish their studies.
  • Competition among investigators for a limited number of NIH or other type of funds.
  • Difficulty in the retention of clinical investigators since those with either the MD degree alone or those proposing clinical research have the lowest success rates for receiving R01 funding.
  • The time horizon necessary to demonstrate tangible progress in clinical research often stretches beyond the funding period. Simultaneously, it is challenging to generate meaningful preliminary data without funding.
  • Physicians may not be exposed to the possibilities of a scientific path early enough in their careers and inmedical schools. Established faculty membersmay not present a scientific career in an attractive light.
  • Mentoring and institutional salary support may not be adequate.
  • Lifestyle issues relating to time for family and other activities.

Research is Needed to Understand This Issue

The AGA recommends that the Institute of Medicine conduct a thorough analysis of the problems and issues involved in the recruitment and retention of physician-scientists and make recommendations on how to address these issues.

Specific areas of study for the Institute of Medicine may include:

1. What are the factors, both for success and failure, which attract and sustain a researcher in their research career?
2. What are the factors, aside fromdebt, which adversely affect the retention of young physician scientists in the field of biomedical research?
3. Is the selection process for fellows adequate for the current environ-ment? Will codified training improve success, i.e. formal MS, MPH or PhD training programs that can be offered as an option during the fellowship training period?
4. Has the NIH established a national target for the number of trainees and researchers?
5. What actions have been taken to retain and support translational/ clinical researchers, despite the current funding environment?
6. If biomedical research is perceived as a potentially undesirable career, are there public relations strategies that can be developed to reverse this opinion?
7. How are established investigators presenting the profession to future researchers?
8. MD-PhD training programs have little focus on clinical or epidemiological research training; Are there future plans to expand training opportunities into non-basic areas?
9. Is there an advantage to conducting a research manpower analysis?

The Institute of Medicine should also collect data on the following:

1. Cultural barriers to research careers.
2. Aspirations of fellows.
3. Characteristics needed for a successful career in biomedical research.
4. Grassroots efforts at the state and local level that are affecting change under the current conditions.

09/08/2008