Physician-scientist

A physician-scientist (also referred to as a clinician-scientist or medical scientist) is a holder of a degree in medicine who invests significant time and professional effort in scientific research and spends correspondingly less time in direct clinical practice compared to other physicians. Physician-scientists are often employed by academic or research institutions and may focus their clinical practices on very specialized patient populations, such as those with rare genetic diseases or rare 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, connecting biomedical research findings to health care applications.^[1][2] The United States National Institutes of Health includes holders of other clinical degrees - such as nurses, dentists, and veterinarians - in its studies of the physician-scientist workforce (PSW).^[3]

Education

Physician-scientists by definition hold degrees in medicine; they may also hold additional graduate degrees such as a Ph.D. 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.^[4] 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.^[5] Similar programs were established in the United Kingdom in the 1980s, although with relatively less funding support.^[6] 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.^[7]

Career and workforce

Most physician-scientists are employed by universities and medical schools, or by research institutions such as the National Institutes of Health.^[1][8] 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.^[3]

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.^[9] Uncertainty about stable careers in academic medicine and the long initial training phase are often cited as concerns by aspiring entrants to the field.^[10][11] 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.^[3]

The American Physician Scientists Association (APSA) is a professional association dedicated to physician-scientists, founded in 2003.^[12] The American Society for Clinical Investigation introduced Young Physician-Scientist Awards in 2013 to support productive early-career researchers.^[13]

History

The concept of the physician-scientist is often attributed to Samuel Meltzer's work in the early 1900s.^[1] 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.^[9] Among U.S. biomedical researchers, physician-scientists have declined over time as a share of the total researcher population, although their absolute numbers have been stable since the 1970s.^[3][2]

References