Rescuing the physician-scientist workforce: the time for action is now
Dianna M. Milewicz, … , Lawrence F. Brass, the National Association of MD-PhD Programs Executive Committee
Dianna M. Milewicz, … , Lawrence F. Brass, the National Association of MD-PhD Programs Executive Committee
Published October 1, 2015
Citation Information: J Clin Invest. 2015;125(10):3742-3747. https://doi.org/10.1172/JCI84170.
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Perspective

Rescuing the physician-scientist workforce: the time for action is now

Abstract

The 2014 NIH Physician-Scientist Workforce (PSW) Working Group report identified distressing trends among the small proportion of physicians who consider research to be their primary occupation. If unchecked, these trends will lead to a steep decline in the size of the workforce. They include high rates of attrition among young investigators, failure to maintain a robust and diverse pipeline, and a marked increase in the average age of physician-scientists, as older investigators have chosen to continue working and too few younger investigators have entered the workforce to replace them when they eventually retire. While the policy debates continue, here we propose four actions that can be implemented now. These include applying lessons from the MD-PhD training experience to postgraduate training, shortening the time to independence by at least 5 years, achieving greater diversity and numbers in training programs, and establishing Physician-Scientist Career Development offices at medical centers and universities. Rather than waiting for the federal government to solve our problems, we urge the academic community to address these goals by partnering with the NIH and national clinical specialty and medical organizations.

Authors

Dianna M. Milewicz, Robin G. Lorenz, Terence S. Dermody, Lawrence F. Brass, the National Association of MD-PhD Programs Executive Committee

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Figure 1

The physician-scientist pipeline: long and leaky.

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The physician-scientist pipeline: long and leaky. The figure highlights ...
The figure highlights a number of issues, including career attrition at every stage and the existence of a protracted period when well-trained physicians in their 30s are serving in subordinate positions awaiting the next step in their career progression. To draw attention to their plight, we call this period the holding zone. The illustration is based on the experience of MD-PhD program graduates, but many of the issues reflect the obstacles for any would-be physician-scientist. Attrition rates from MD-PhD programs are low, with most of those who withdraw completing medical school or graduate school. Very few MD-PhD program graduates (5% or fewer) choose to forego postgraduate clinical training as residents and fellows. In our experience, career attrition takes many forms and becomes cumulative at each stage, reflecting the proportion of individuals who either never return to research, opt for full-time clinical practice outside of academia, join academia as an assistant professor but spend their time caring for patients, or are appointed to the tenure track but end up devoting minimal time to research (1). A declaration of success depends in part on the definition of success. Outcome data show that approximately 80% of MD-PhD program graduates are working in academia, industry, or research institutes — including the NIH — but not all are doing research (3). Data on NIH award rates, conversions from K grants to R grants, and the proportion of individuals appointed to MSTP T32 grants can be found in the PSW report (1). The NIH continues to track principal investigators on grants but is just starting to track physician-scientists who play essential roles as other key personnel.