The ‘physician-scientist’ refers to the subset of MDs who are actively involved in research with the goal of advancing medical knowledge and health. The definition includes all type of research: basic research (with or without animals), disease and patient oriented, epidemiology and prevention.
Sitting at the nexus between clinical practice and scientific research these individuals are an essential component of our medical research enterprise. They are uniquely positioned to bring insights from the clinic in combination with basic knowledge in order to formulate research hypotheses that might be most relevant to their patients’ health. The translation of basic scientific discoveries into the clinic depends importantly on them.
Unfortunately, the physician-scientist is an endangered species.
Analysis of NIH research grant awards shows that the rate of success for MDs and PhDs to obtain a grant are virtually the the same (1,2). The distribution of priority scores is nearly identical for research involving human and non-human animals, and the rate of funding of clinical research (independently of weather is carried out by MDs or PhDs) is only a slightly smaller than non-clinical research. Overall, MDs doing clinical research fair rather well in the grant review process.
These data reject the claim of animal right activists that the reason we don’t see more clinically oriented research with human subjects is that basic scientists using animals in their research are favored by the system.
Instead, the data show that the number of grant applications from MDs has been falling over time, while the number coming from PhDs have remained constant (1). The number of graduating medical students with research career intentions is evidently on a decline and the physician-scientists is truly endangered.
Experts have discussed the possible reasons for such a state of affairs. Some of the issues identified include, among others: soaring medical school debt that make medical students shy away from postdoctoral research positions in research which provide only a modest pay; a managed health-care system that has pushed clinical departments to demand their faculty members to spend time seeing as many patients possible, possibly in detriment of research activities; NIH-supported research careers are seen as increasingly unstable by students; the training they receive is not appropriate to follow a research career; and many more.
For example, within the field of anesthesiology, we hear a clear lament and wake-up call (3):
“It is our view that we, as a specialty, have reaped what we have sown. Students correctly see anesthesiology as a specialty that does not view research as essential. “After all,” students astutely tell us, “fellowships in anesthesiology are great because they aren’t so long and don’t even require research.” Without substantive research training in either basic or clinical research, anesthesiology does not produce individuals capable of or even interested in applying for NIH K award funding as junior faculty members.”
The good health of our medical research enterprise requires we work to restore the numbers of physicians actively involved in research. As we look for remedies one thing must be clear: opponents of animal research are unjustified in putting the blame on basic research with animals.
1) Rosenberg L. Physician-scientists: Endangered and essential. Science. 283:331–332, 1999.
2) Kotchen T, Lindquist T, Malik K, Ehrenfeld E. NIH peer review of grant applications for clinical research. J Am Med Assoc. 291:836–43, 2004.
3) Schwinn DA, Blasser R. Anesthesiology Physician Scientists in Academic Medicine: A wake-up call. Anesthesiology. 104(1):170-178, 2006.