The physician-scientist workforce in the United States.

Abstract

Drs. Agren and Wetterberg conclude in their Letter to the Editor that “the declining proportion of research trained medical doctors in psychiatry is an increasing problem in Sweden.” This is concerning since physicians bring to their research the vital experience of caring for patients. This clinical “lens” enormously impacts how physician-scientists make hypotheses and design clinical research either on their own or, increasingly, in collaboration with PhD scientists. The focus of their clinical and translational research is for the benefit of the patient. Unfortunately, over the past 30 years, the number of physicians primarily engaged in research in the United States (US) has declined as the number of physicians engaged in patient care has steadily increased (1). As early as 1979, eminent physician scientists (2) and more recently in the 1990s, national organizations including the Institute of Medicine (3), the Association of American Medical Colleges (AAMC) (4) and the National Institutes of Health (NIH)(5) described challenges for the physician-scientist workforce, including barriers to attracting and retaining clinical investigators in research. Recommendations from these organizations to increase clinical research training in the US were enacted in the late 1990s at a time when the NIH annual budget doubled from $13.675 billion (1998) to $27.167 billion (2003). That period saw substantial growth in the number and types of clinical research training programs(6), many pioneered and heavily supported by the NIH itself alongside initiatives by foundations and other non-profit organizations which vitally support medical research.