Andrew R. Marks
J Clin Invest.
A role for the vanishing physician-scientist?
University of Washington School of Medicine
Published January 20, 2005
To the editor:
Your editorial, entitled "How to support the basic sciences," cut to the heart of a troubling reality for academic medical research in the United States- -the problem of diminishing resources. However, the proposed solution, that a greater proportion of clinical revenues be used to support basic sciences programs, in exchange for increased efforts on the part of basic scientists to share their knowledge with clinical colleagues, fails to address the crux of the problem. As the editorial points out, there is much less clinical revenue available for the proposed purpose than there used to be.
Since academic clinicians in the US are certainly working at least as hard as in the past, what has happened to these clinical revenues? The reality is that while US healthcare expenditures have continued to increase at a startling pace, the proportion that goes directly to academic clinicians (i.e., per capitia reimbursement for physician services) has typically decreased. At the same time, new billing policies and privacy regulations have imposed added costs on many healthcare systems, costs that administrators in academic healthcare systems tend to offset using the very clinical revenues the editorialist would like to see used to support basic biomedical research. For the most part, the increased funds flowing into the healthcare system can be found in the pockets of private healthcare administrators, pharmaceutical companies, insurance companies, and others who have invested in and built "for- profit" healthcare systems over the past decade, not in academic healthcare systems. Considering who has become rich as a result of the current disposition of US healthcare dollars, it should not surprise anyone if the response from academic clinicians is, "Why us?"
The editorial fails to acknowledge the existence of an important segment of the academic medical community that, defying the assumed dichotomy, might most effectively address the funding of biomedical research at a national level: the physician-scientist. Having eyes, ears, and feet in both worlds, they are perhaps best-positioned to recognize that the problem will not be solved by shifting revenues from one side of the academic medical center to the other, and to advocate for federal legislation that would facilitate reallocation of a significant proportion of US healthcare dollars toward academic medical centers, where both the clinic research centers and the basic research laboratories merit increased support. They are also well- positioned to advocate for another critical activity in which academic medical centers (and, through them, the federal government) ought to be investing, namely, translational research. It is especially unrealistic to expect that this additional need, recently acknowledged in the creation of the NIH Roadmap, could be met through internal cost-sharing on the part of academic medical centers.