Physician-scientist

A physician-scientist (in North American English) or clinician-scientist (in British English[1] and Australian English[2]) is a physician who divides their professional time between direct clinical practice with patients and scientific research.[1] Physician-scientists traditionally hold both a medical degree and a Doctor of Philosophy, also known as an MD-PhD or DO-PhD. Compared to other clinicians, physician-scientists invest significant time and professional effort in scientific research, with ratios of research to clinical time ranging from 50/50 to 80/20.{{citation needed|date=May 2024} Physician-scientists are often employed by academic or research institutions where they drive innovation across a wide range of medical specialties and may also use their extensive training to focus their clinical practices on specialized patient populations, such as those with rare genetic diseases or cancers. Although they are a minority of both practicing physicians and active research scientists, physician-scientists are often cited as playing a critical role in translational medicine and clinical research by adapting biomedical research findings to health care applications.[3][4] Over time, the term physician scientist has expanded to holders of other clinical degrees—such as nurses, dentists, and veterinarians—who are also included by the United States National Institutes of Health (NIH) in its studies of the physician-scientist workforce (PSW).[5]

## Contents

* 1 History
* 2 Education
* 3 Impact
* 4 Career and workforce
* 5 References
* 6 Further reading

## History

The concept of the physician-scientist is often attributed to Samuel Meltzer's work in the early 1900s.[3] Concern has often been displayed at declining interest or participation in the field, with James Wyngaarden—who would later go on to become the director of the NIH—describing physician-scientists as an "endangered species" in 1979.[6] Among U.S. biomedical researchers, physician-scientists have declined over time as a share of the total researcher population since the 1970s.[4]

## Education

Physician-scientists by definition hold terminal degrees in medicine and/or biomedical science. In the United States and Canada, some universities run specialized dual degree MD-PhD programs, and a small number of D.O.-granting institutions also offer dual degree options as D.O.-Ph.D.[7] In the United States the NIH supports competitive university programs called Medical Scientist Training Programs that aim to train physician-scientists, originally established in 1964 and present at 45 institutions as of 2015.[8] Similar programs were established in the United Kingdom in the 1980s, although with relatively less funding support.[1] There are 3000-5000 trainees in this early-career pool based on the number of MD/PhD trainees in the country and number of medical trainees intending research intense careers .[9][10] Although this dual-degree pathway is not necessary to establish a physician-scientist career, most do receive some form of explicit research training in addition to their clinical education.[11]

## Impact

Physician-scientists are a particularly productive research cohort contributing to biomedical innovation, discovering life-saving therapies, and developing disease prevention strategies.[12] Physician-scientists only make up 1.5% of the biomedical workforce, yet according to the PSW, they account for 37% of Nobel Laureates in Physiology or Medicine from 1990 to 2014, and over the last 30 years of the Lasker Awards, 41% of the Basic Awards and 65% of the Clinical Awards have gone to physician-scientists.[13][14]

## Career and workforce

Most physician-scientists are employed by universities and medical schools, or by research institutions such as the National Institutes of Health.[3][15] As of 2014, the NIH counted around 9,000 NIH-funded physician-scientists; this count does not include those whose work is funded by sources other than the NIH—typically meaning those who work in industry, such as at pharmaceutical companies or medical device companies.[5]

At many medical schools, physician-scientist faculty are expected to obtain significant fractions of their nominal salary in the form of competitive research grants, which are also requirements for the award of tenure. This "up or out" system has been described as developed for a primarily male workforce with homemaker wives, incompatible with the work-life balance needs of the current workforce.[6] Uncertainty about stable careers in academic medicine and the long initial training phase are often cited as concerns by aspiring entrants to the field.[16][17] Data from the NIH on physician-scientist grant awardees suggests that women and minorities are often underrepresented in the population, even in fields like veterinary science where the majority of students are women.[5]

The American Physician Scientists Association (APSA) is a professional association dedicated to physician-scientists, founded in 2003.[18] APSA has worked to identify and remove barriers thus improving the retention of physician-scientists in academic research.[19][10] Transitioning through the early career stages of a resident to fellow to junior faculty is the leakiest part of the physician-scientist pathway. The major reasons for leaving research include the inability to obtain research funding, disparities in salaries between research track physician-scientists and full-time clinicians, and increased financial obligations during this time. Therefore, early career awards are the best target for new funding opportunities.

During the COVID-19 pandemic, there has been an unprecedented delay and drop in research productivity due to halted studies, reduction of research time to prioritize COVID-19 related clinical duties, and diminished funding opportunities by private foundations as a result of revenue loss due to the pandemic.[20][21] These challenges have weakened the physician-scientist workforce further.

The American Society for Clinical Investigation introduced Young Physician-Scientist Awards in 2013 to support productive early-career researchers.[22][5]

## References

1. ↑ 1.0 1.1 1.2 "The clinician-scientist: a rare breed under threat in a hostile environment". Disease Models & Mechanisms 1 (1): 12–4. July–August 2008. doi:10.1242/dmm.000752. PMID 19048043.
2. ↑ "Life as a Clinician-Scientist - AAHMS". 23 March 2022. https://aahms.org/programs/lacs/.
3. ↑ 3.0 3.1 3.2 "Challenges and opportunities for reinvigorating the physician-scientist pipeline". The Journal of Clinical Investigation 125 (3): 883–7. March 2015. doi:10.1172/JCI80933. PMID 25689260.
4. ↑ 4.0 4.1 "The physician-scientist career pipeline in 2005: build it, and they will come". JAMA 294 (11): 1343–51. September 2005. doi:10.1001/jama.294.11.1343. PMID 16174692.
5. ↑ 5.0 5.1 5.2 5.3 "Physician-Scientist Workforce (PSW) Report 2014". National Institutes of Health. http://report.nih.gov/workforce/psw/index.aspx.
6. ↑ 6.0 6.1 "The vanishing physician-scientist?". Translational Research 155 (1): 1–2. January 2010. doi:10.1016/j.trsl.2009.09.006. PMID 20004354.
7. ↑ "Do/PhD Programs". http://www.physicianscientists.org/?page=DOPhDProgramsList.
8. ↑ "Medical Scientist Training Program". National Institutes of Health. http://www.nigms.nih.gov/Training/InstPredoc/Pages/PredocOverview-MSTP.aspx.
9. ↑ "2020 FACTS: Enrollment, Graduates, and MD-PhD Data" (in en). https://www.aamc.org/data-reports/students-residents/interactive-data/2020-facts-enrollment-graduates-and-md-phd-data.
10. ↑ 10.0 10.1 "A nationwide assessment of perceptions of research-intense academic careers among predoctoral MD and MD-PhD trainees". Journal of Clinical and Translational Science 4 (4): 307–316. March 2020. doi:10.1017/cts.2020.18. PMID 33244411.
11. ↑ "Is a Physician-Scientist Career Right for You?". The physician scientist's career guide. New York: Springer. 2011. ISBN 9781603279079.
12. ↑ "Re-examining physician-scientist training through the prism of the discovery-invention cycle". F1000Research 8: 2123. 2019. doi:10.12688/f1000research.21448.1. PMID 32089830.
13. ↑ "Saving the Endangered Physician-Scientist - A Plan for Accelerating Medical Breakthroughs". The New England Journal of Medicine 381 (5): 399–402. August 2019. doi:10.1056/NEJMp1904482. PMID 31365796.
14. ↑ "NIH RePORT - Physician Scientist-Workforce Report 2014". https://report.nih.gov/Workforce/PSW/index.aspx.
15. ↑ "Finding Nirvana: Paths to Becoming a Physician-Scientist". Science. 16 October 2013. doi:10.1126/science.caredit.a1300227.
16. ↑ "Challenges facing physician scientist trainees: a survey of trainees in Canada's largest undergraduate and postgraduate programs in a single centre". Clinical and Investigative Medicine 37 (5): E268-83. October 2014. doi:10.25011/cim.v37i5.22008. PMID 25282134.
17. ↑ "The physician scientist: balancing clinical and research duties". Nature Immunology 15 (12): 1092–4. December 2014. doi:10.1038/ni.3010. PMID 25396341.
18. ↑ "About APSA". http://www.physicianscientists.org/?page=about.
19. ↑ "Exploring intentions of physician-scientist trainees: factors influencing MD and MD/PhD interest in research careers". BMC Medical Education 17 (1): 115. July 2017. doi:10.1186/s12909-017-0954-8. PMID 28697782.
20. ↑ "Physician-Scientists in the Era of COVID-19: Gone but Not Forgotten". Academic Medicine 96 (1): e5–e6. January 2021. doi:10.1097/ACM.0000000000003771. PMID 32991352.
21. ↑ "COVID-19 impact on early career investigators: a call for action". Nature Reviews. Cancer 20 (7): 357–358. July 2020. doi:10.1038/s41568-020-0279-5. PMID 32503987.
22. ↑ "Young Physician-Scientist Awards". https://www.the-asci.org/ypsa/.

## Further reading

* "My life as a clinician-scientist: trying to bridge the perceived gap between medicine and science". DNA and Cell Biology 34 (6): 383–90. June 2015. doi:10.1089/dna.2015.2860. PMID 25825921.

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