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Physician-Scientist Workforce (PSW) Report 2014

Chapter 2: The Physician-Scientist Workforce: Past, Present, & Future

Historical Concerns about the Physician-Scientist Workforce

Despite the critical role that the physician-scientist plays in the biomedical workforce, concern regarding the health of this sector of the scientific enterprise began to grow in the latter decades of the 20th century. The physician-scientist with a medical degree was becoming “an endangered species,” according to James Wyngaarden, who later became an NIH Director, in a 1979 paper in the New England Journal of Medicine).2 He had observed that MD applicants for NIH project grants represented a progressively smaller fraction of all applicants than previously, while the corresponding fraction of PhD applicants increased dramatically. Subsequently, in 1984, Gordon Gill published an essay titled “The End of the Physician Scientist?” in American Scholar.3 He argued that physicians who were engaged in research were increasingly being drawn toward basic laboratory science, excited by the revolution in molecular biology. In 1987, Moody published a paper in the American Journal of Surgery that drew attention to the adverse impact of cost containment policies on research in clinical settings.4

In response, the Institute of Medicine (1994) undertook a study on overcoming barriers to career paths for clinical research. In 1996, NIH director Harold Varmus established a task force headed by David G. Nathan to make recommendations about how to address the perceived shortfall of clinical investigators. The Nathan Committee recommended creating new career development grants for patient-oriented research and loan repayment programs to help young physician-scientists pursue research careers despite an increasing load of educational debt.5

The Association of American Medical Colleges established two task forces on clinical research by physician-scientists. These task forces recommended that clinical research be introduced in undergraduate and graduate medical education curricula and training in clinical research be restructured to accelerate training. In addition, private foundations such as the Burroughs Wellcome Fund, the Doris Duke Charitable Foundation, the Howard Hughes Medical Institute, and the Robert Wood Johnson Foundation created initiatives aimed at revitalizing the physician-scientist workforce.6

Nonetheless, an analysis by Zemlo, Garrison, Partridge, and Ley, based on data through the mid-1990s, indicated that medical school students’ intentions to pursue a research career had declined; at the same time, the average debt levels of medical school graduates increased. Their study also found that the number of MDs with NIH training and fellowships declined during this period and that the number of first-time grant applications submitted by MDs remained stagnant.7

In 1999, Rosenberg emphasized that numerous forces, including the increasing debt burden of medical school graduates, the increasing length of postdoctoral training required, and the instability of NIH funding were responsible in large part for putting the future of the physician-scientist career path at significant risk.8

NIH funding increased greatly in the late 1990s from $13.675 billion (1998) to $27.167 billion (2003). During this period, institutions expanded their research capacity and training programs, and the number of physicians applying for NIH R01 grants increased. NIH’s budget growth came to a halt in 2004 and has since remained static. After adjusting for inflation using the Biomedical Research and Development Price Index, the 2013 NIH budget was 21.9 percent below its 2003 level.9 The 2008 recession also reduced research funding from other sources, including pharmaceutical companies.

Garrison & Deschamps’ analysis of data from multiple sources, including NIH, through 2011 indicated that physician-scientists’ role in biomedical research is more limited than in the past. Among their chief findings, however, was that the decline in the number of physicians entering research careers was temporarily mitigated during the 1998-2003 period of growth in the NIH budget.10

Although nurse-scientists, dentist-scientists and veterinarian-scientists face many of the same issues—debt, length of training, and funding instability—as physician-scientists with a medical degree, each segment of the workforce contends with other threats. Traditionally, these non-MD segments of the workforce have lacked a critical mass of individuals trained in science and research due to the heavy focus of these training programs on producing clinical practitioners; these professions have been viewed as entirely clinical entities by the public, which has impacted adversely on the number of trainees pursuing a research career in these profession. As a result, there is a shortage of faculty members with scientific research programs who can serve as role models and mentors to students in training.

2 Wyngaarden, J.B. (1979). The clinical investigator as an endangered species. New England Journal of Medicine, 301(23), 1254-59.

3 Gill, G.N. (1984). The end of the physician-scientist? American Scholar 53, 353—69.

4 Moody, F.G. (1987). Clinical research in an era of cost containment. American Journal of Surgery 153, 337-340.

5 Nathan, D.G. & Wilson, J.D. (2003). Clinical research and the NIH: A report card. New England Journal of Medicine, 349(19), 1860-65.

6 Schafer, A.I. (2009). The Vanishing Physician-Scientist? Ithaca, NY: Cornell University Press.

7 Zemlo, T.R., Garrison, H.H., Partridge, N.C. & Ley, T.J. (2000). The physician-scientist: Career issues and challenges at the year 2000. The FASEB Journal 14, 221-230.

8 Rosenberg, L.E. (1999). Physician-scientists—endangered and essential. Science 283, 331-332.

9 NIH/OEP Staff Calculations.

10 Garrison, H.H. & Deschamps, A. (2014.). NIH research funding and early career physician-scientists: continuing challenges in the 21st century. The FASEB Journal 28, 1-10.