Regenerating physician-scientists

Abstract

nature medicine volume 16 | number 5 | may 2010 511 The academic niche for physician-scientists has been degenerating for over three decades. In 1979, the director of the US National Institutes of Health (NIH), James Wyngaarden, initially highlighted an alarming drop-off in the number of physician-scientists and their success rates in NIH funding. Since then, the combined burdens of an increasingly stringent overall NIH budget, educational loans on young physicians (often in the six figures), the procedure-driven nature of modern clinical medicine, and the financial vise of managed care and its follow-on effects on the academic environment have created an increasingly ablative force on the necessary environment to maintain a proper balance in the numbers of physician-scientists. In The Vanishing Physician-Scientist?, edited by Andrew I. Schafer, currently chairman of the Department of Medicine at Weill Cornell Medical College, the fate of the physician-scientist is revisited from multiple angles: renewal versus extinction, the evolution of diverse lineages (MD-PhD, late bloomers with MD degrees alone, PhDs in clinical departments), implications for biotechnology and drug discovery, gender imbalance, pipeline versus attrition effects, role models, financial and modern lifestyle concerns and the fragile microenvironmental niche of academic medicine in general. The result is a fascinating must-read for those of us with a deep interest in the subject that goes beyond conjecture and anecdotal personal experience to recent academic survey data, population analyses, current NIH funding trends, outcome analyses of MD-PhD trainees and, most importantly, onward toward a series of cogent, specific and implementable suggestions for regeneration. As the last page is turned, a more sanguine view of the problem emerges, along with a few surprises. The book is comprised of 15 chapters written by over twenty leading physician-scientists who offer a number of penetrating insights into the crux of the problem of regenerating a new cadre of leaders in academic medicine. For example, as noted in the book by Tim Ley, a former president of the American Society of Clinical Investigation, the demographics of physician-scientists have been relatively stable since 1990. The bulk of these researchers hold an MD degree alone, and their success rates for NIH funding are similar to others with PhD or MD-PhD joint degrees. Regenerating physician-scientists