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.
Dianna M. Milewicz, Robin G. Lorenz, Terence S. Dermody, Lawrence F. Brass, the National Association of MD-PhD Programs Executive Committee
Submitter: Peter Mittwede | firstname.lastname@example.org
University of Mississippi Medical Center
Published February 19, 2016
As an MD-PhD student approaching graduation in a few months, I appreciate the commitment of Dr. Milewicz and her co-authors to the support of physician-scientist trainees. I can honestly say that, if I had to start over, I would go through this process again. Of course, there have been challenges, frustrations, and discouraging times along the way, but I have grown personally and professionally in ways I never could have imagined. I remain absolutely committed to pursuing a career as a physician-scientist, which is a testament to the many wonderful people who have supported me over the course of my life, but particularly during the past seven years.
I would argue that the research (and related) experiences—both in terms of personal fulfillment and relative success/productivity—that a trainee has during the student and resident/fellow stages are of utmost importance in determining whether that individual will end up in the “attrition” group or in the “funded physician-scientist” group. It is for this reason that we must take ownership of our careers and not assume that everything will fall into place without meticulous planning and inexorable effort.
In addition to taking steps to ensure that we will not be the ones leaking out of the pipeline, there is much that we can do to directly and indirectly support future physician-scientists. Advocacy is undoubtedly an important component of this, and it need not be on the national stage. We have the potential to assist our institutions in following the recommendations set forth by Dr. Milewicz and colleagues, whether it relates to initiatives focused on the integration of medical and research training, the collection and sharing of program outcome data, the achievement of increased diversity within our programs, or the creation of physician-scientist mentoring networks. To assist residents who are pursuing careers as physician-scientists but who may not have time to lead their own studies, we (students) can involve them in our projects so that they do not go years without being involved with research. This would likely lead to mutually beneficial relationships. Finally, we can serve as mentors to those younger than we are. I have benefitted greatly from my mentors, and thus have a passion for the mentorship of younger, aspiring physician-scientist trainees. Enthusiasm and optimism are infectious, and if we exhibit these traits, we can be of great service to more junior individuals who may be in need of guidance.