Physician-scientists: staying alive.

Abstract

With reference to the Policy Forum “Physician-scientists—Endangered and essential” by Leon E. Rosenberg ( Science 's Compass, 15 Jan. p. [331][1]), I would like to comment on his proposals and to clarify the record regarding applicants to the Howard Hughes Medical Institute (HHMI) physician postdoctoral program. Rosenberg suggests several initiatives for the U.S. National Institutes of Health (NIH) and private funders, including a year out for research by medical students, more postdoctoral fellowships, and a national database of physician-scientists and their research careers. All of these programs are in place at HHMI. Through two programs, the Research Scholars at NIH and the Research Training Fellowships for Medical Schools, we have supported more than 100 medical students each year since 1989 in a full-time research year at NIH, at their own medical school, or at another institution. Since 1990, through the Postdoctoral Research Fellowships for Physicians program, we have awarded 3 years of support to more than 300 M.D.'s and M.D./Ph.D.'s and supported hundreds of postdoctoral associates in the laboratories of Hughes investigators. Through a collaboration with the Association of American Medical Colleges, we continue to support a project that uses national databases to track the research involvement of all M.D. graduates from U.S. medical schools since 1980. Outcome measures include NIH support of postdoctoral training, NIH research grants, and appointment to the clinical or basic science faculty of U.S. medical schools. (Early data suggest that the Research Training Fellowships for Medical Schools program is indeed successful in reinforcing interest in research, at least to the point of seeking postdoctoral training.) Another relevant initiative is the HHMI Biomedical Research Support for Medical Schools program, which awarded $80 million to 30 medical schools in 1995. Those 4-year grants have provided start-up funding for more than 150 faculty, of whom 33 are M.D.'s or M.D./Ph.D.'s. In addition, 46 M.D.'s and M.D./Ph.D.'s have received funding for pilot projects. A second competition in the year ahead will award $90 million. Rosenberg presents compelling data on the relative decline of physician applications to NIH for research grant support, and notes that our physician postdoctoral program data support his concern for the future pool of physician-scientists. While the HHMI data cited show a 57% decline (from 174 to 74 applicants), the actual decline was 45%. The latter figure includes not only M.D. but also M.D./Ph.D. applicants. The actual decline was from 276 (a 5-year high) to 152. Although of definite concern in the context of future trends in the pool of physician-scientists, the numbers are confounded by the increase in K awards by NIH. We see application withdrawals and fellowship declines because of these awards, and will follow closely their future impact on the HHMI program. [1]: /lookup/doi/10.1126/science.283.5400.331