Chapter 7: Recommendations
A number of forces outside the NIH pose great challenges to the future PSW including:
- changes in the funding and practices of academic medical centers
- dramatic shifts in the economics of medicine and healthcare
- rising educational debt
- increasing length of training
- growth in the regulatory burdens required to maintain clinical practice
- challenges to the overall quality of Science, Technology, and Mathematics (STEM) education in the United States, and
- changing immigration policy affecting a significant component of the physician-scientist workforce.
Wherever possible, NIH should engage with appropriate other private and public agencies to address these larger societal issues. Here, we will provide our specific recommendations regarding what NIH can directly do to enhance and maintain the physician-scientist pipeline and workforce.
Although the absolute number of physician-scientists has declined only slightly over the past decade, the workforce is progressively aging. The number of new physician-scientists entering the workforce is falling, as reflected in the reduced numbers of applicants for early career (K and LRP) awards over the last 5 years. These data presage a decline in the physician-scientist workforce as the current cohort of senior physician-scientists retires. Our key recommendations thus focus on the early stages of the pipeline, on enhancing the ability of the NIH to evaluate the relative effectiveness of its programs to build and maintain the pipeline, and on systematically collecting and reviewing data so the biomedical workforce can more easily and readily be assessed.
The recommendations outlined below should be extended to all clinically-trained scientists, including veterinarian-scientists, dentist-scientists, and nurse-scientists. Recommendations that are specific to a given segment of the workforce may be found in the previous chapters.
The following recommendations apply to all clinically-trained investigators, including veterinarian-scientists, dentist-scientists, and nurse-scientists.
- NIH should sustain strong support for the training of MD/PhDs. MD/PhD programs (including the Medical Scientist Training Program [MSTP] program funded by NIH) have been successful in promoting the development of physician-scientists and should be continued.
- NIH should shift the balance in National Research Service Award (NRSA) postdoctoral training for physicians so that a greater proportion are supported through individual fellowships, rather than institutional training grants. The number of individual fellowship awards for MD-PhD students (F30/F31 grants) should also be increased. The PSW-WG endorses the similar recommendation from the Biomedical Workforce Working Group that support for both pre- and post-doctoral PhD trainees and individual fellowship for MD/PhD trainees should be expanded. It is critical to obtain accurate long-term follow-up on trainees through all of these programs to assess comparative effectiveness. These results should guide future allocation of NIH funds to these various mechanisms.
- NIH should continue to address the gap in RPG award rates between new and established investigators. Although NIH policies have narrowed the gap for new RO1 applicants, this problem remains significant and needs continued attention. A number of pilot approaches should be explored, and rigorously assessed, with the most successful given expanded support (also see #7 below).
- NIH should adopt rigorous and effective tools for assessing the strength of the biomedical workforce, including physician-scientists, and tracking their career development and progression. NIH should collaborate with external organizations that also have a strong investment in workforce development to collect, monitor, and report on key indices related to workforce issues. Specifically, NIH should establish an ongoing workgroup of NIH employees and external partners to support the development of a Biomedical Workforce Dashboard application that provides real-time tracking of the career development and progression of the workforce. The Dashboard would be a tool that both NIH employees and the public could use to instantly answer questions related to important workforce issues at the agency or I/C level.
- NIH should establish a new physician-scientist-specific granting mechanism to facilitate the transition from training to independence. This program should be similar to the K99/R00 program whose funding currently goes almost exclusively to individuals holding a PhD degree. This new grant program could serve either as a replacement or transition from existing K Awards for physician scientists, and should provide a longer period of support, potentially lengthening the R00 phase to 5 years (with an interim staff review at year 3). This new grant series, as well as K and all other training awards, should rigorously enforce protected time of at least 75 percent effort and provide sufficient salary support to make that possible.
- NIH should expand Loan Repayment Programs and the amount of loans forgiven should be increased to more realistically reflect the debt burden of current trainees. This program should also be made available to all students pursuing biomedical physician-scientist researcher careers, regardless of particular research area or clinical specialty.
- NIH should support pilot grant programs to rigorously test existing and novel approaches to improve and/or shorten research training for physician-scientists. These programs should include (but not be limited to) mechanisms to shorten medical and/or laboratory training, explore timing and spacing of the research and clinical components of post-graduate training, and other alternatives. New opportunities for training in informatics and social science research that address emerging needs of the health care system should also be evaluated. Those programs exhibiting the most promising results should receive expanded support.
- NIH should intensify its efforts to increase diversity in the physician-scientist workforce. This Working Group recognized major deficiencies of the physician-scientist workforce with regard to diversity. The PSW-WG strongly endorses the previous recommendations of the preceding biomedical workforce Working Group and the Working Group on diversity, all of which should be extended to the physician-scientist workforce.
- NIH should leverage the existing resources of the Clinical and Translational Science Awards (CTSA) program to obtain maximum benefit for training and career development of early-career physician-scientists. This process should include critical review and analysis of rigorous outcome data, as outlined in #7 above.
Recommendations specific to each segment of the non-MD workforce (nurse-scientists, veterinarian-scientists, and dentist-scientists) may be found in Chapters 4 through 6.
Back to top