Behind the sharp decline in physician-scientists—and how to address it

If you’re vaccinated against COVID-19, thank physician-scientists for providing safe, effective protection against the pandemic. However, despite the instrumental role they play in global healthcare management, there’s an unfortunate reduction in the size of this unique workforce of physician-scientists.

This shortage may lead to greater complications for healthcare in the event of future public health crises. The physician-scientist workforce can therefore benefit from mentorship, protected research time, and secured funding strategies.

Reasons for the reduction

According to an article published by Science Translational Medicine, some medical school programs previously rooted in 2-year basic sciences are now considered frivolous, leading some schools to abbreviate this chapter of their basic curriculum.^[]Although 3-year programs may save physicians time and money, these clinicians may pay down the line for a lack of foundational scientific knowledge and problem-solving skills.

Interactions between students and physician-scientists—which, for some students, is the reason they were inspired to pursue the physician-scientist path—are also increasingly rare. Some clinician-scientists may set their clinical practice aside to pursue research full time for funding purposes, resulting in a lack of role models for trainees longing to merge clinical practice with research.

Costs of medical school and postgraduate expenses alone are enough to drive away physician-scientists. Where their non-scientist counterparts often receive post-training salary support, physician-scientists rely heavily on grants, and attaining them can eat up precious time.

Additionally, the rate at which scientific information evolves—and accompanying shifts toward a more corporate ethos—may prove difficult for students maintaining clinical and research-based practices. Completing clinical training may require some physician-scientists to abandon their research for up to 7 years, which separates them from keeping up with technology advancements and increasingly complex datasets.

It’s also impossible to not mention COVID when referencing the dwindling population of physician-scientists. An article published by Cell Reports Medicine states that the weight of a global pandemic—in addition to the above challenges—has only further thwarted physician-scientists due to increased lab closures and hiring freezes.^[]

Strategies to bolster the physician-scientist workforce

While physician-scientists face their share of challenges, they aren’t without support. An article published by the Journal of Clinical Investigation offers a few tangible ways to uplift physician-scientists in achieving their academic and professional goals:^[]

• Mentorship. Access to mentors during residency and throughout fellowship is central to a trainee’s successful transition from student to faculty. Programs that center on the physician-scientist track can offer mentorship with participation of program supervisors who have established practices. Seminar series, social events, and career development workshops can also facilitate peer mentoring opportunities.

• Protected research time. Another way to ensure success of physician-scientists: securing protected research time for those navigating demanding clinical obligations. It’s crucial for trainees to get an immersive research experience, as this time will allow them to sow the seeds for their line of research. Trainees who have protected research time and receive feedback from seasoned physician-scientist mentors are more likely to stay on the physician-scientist track.

• Funding opportunities. The final strategy for academic institutions is increased financial access for aspiring physician-scientists. Funding strategies must account for protected research time and professional training, research for students at several junctures of their journey, and administrative support. Specific NIH and VA funding opportunities support premedical, medical, and graduate students; residents and fellows; and early-career faculty physician-scientists who spend at least 50% of their time on research may also to the NIH’s Loan Repayment Program for help with reducing educational debt. Residency is a good time to apply, as noted by the Journal of Clinical Investigation.

Away from the pipeline, toward Medicus physicus 

According to an article published by the Journal of Clinical and Translational Science, physician-scientists have long achieved their title by inching through a prescribed “pipeline.”^[]Trainees pursuing an MD-PhD track travel slowly through the pipe, finally reaching the ultimate goal of an R01 grant.

However, the pipeline is leaky: By attrition, only 12% of trainees complete this linear journey to success. Rather than calling a plumber, the article’s authors propose a different solution, namely, letting go of the traditional pipeline infrastructure and embracing a tree-like approach. The authors aptly named this tree Medicus physicus.

M. physicus, unlike a leaky pipeline, leaves room for physicians from various backgrounds to build careers in biomedicine and healthcare. Instead of forcing students to adhere to a strict, linear path, M. physicus has roots in various entry pathways. The trunk, representing the commonality of clinical and scientific training, permits trainees to branch out into their own niche and enrich the tree with their unique contributions (leaves).

M. physicus offers a much-needed fresh perspective on the physician-scientist path. Explaining this model, the authors wrote, “There is no predetermined destination but rather an endpoint of varied and rich contributions of the physician-scientist community.”