America is facing a major roadblock to medical progress. For the speedy translation of promising scientific discoveries into patient treatment, we need a special breed of medical researchers who are trained to ask clinically relevant questions in a health research environment. It’s these individuals who transform clinical observations into research studies and eventual medical advances.From the University of California – San Diego :The physician-scientist: A catalyst for translational medicine
Presentation at American Association for the Advancement of Science Annual Meeting
America is facing a major roadblock to medical progress. For the speedy translation of promising scientific discoveries into patient treatment, we need a special breed of medical researchers who are trained to ask clinically relevant questions in a health research environment. It’s these individuals who transform clinical observations into research studies and eventual medical advances.
Sadly, there is a critical shortage of these physician-scientists ? those MDs who devote a majority of their professional effort to research, and investigators with joint MD/PhD degrees who work at this important interface between science and medicine.
In a speech at the American Heart Association Scientific Sessions 2001, David P. Faxon, MD, University of Chicago, noted that “we are in danger of squandering some of the greatest advances in science, of losing lives because we cannot move new technologies, medications, and knowledge through the chain to where it belongs: at the bedside.”
Why are physician-scientists important? What has caused this decline? And, what can we do about it?
In this symposium, we will cover the scope of the problem, current attempts to alleviate the training shortage, and the practicality of help from funding agencies such as the National Institutes of Health (NIH). Additional topics include ways in which medical schools can better emphasize biomedical research, the importance of scientific training for the practicing physician, and the role of the physician-scientist in drug discovery and biotechnology. We’ll also provide a current example of bench to bedside research by a team of physician-scientists.
The Critical Shortage
In the New England Journal of Medicine, Leon Rosenberg, M.D., Princeton University, and Timothy J. Ley, M.D., Washington University School of Medicine, St. Louis, noted that the pool of physicians-scientists has been dwindling for more than two decades. In 1983, 3.9 percent of all physicians were scientists; in 1998, that percentage had decreased to 2 percent.
A February 2000 study by the Federation of American Societies for Experimental Biology (FASEB) noted that while research activity in the biomedical sciences has increased, the level of physician-scientist participation has declined. For example, the number of U.S. physicians reporting research as their primary activity had dropped 6 percent in the previous 17 years. The number of MD faculty members in basic science departments of medical schools also declined.
An April 16, 2002 article in the American Heart Association’s journal Circulation, noted that the number of first-time MD applicants for NIH research project grants has plummeted in the past few years, with a 31 percent drop from 1994 to 1997. And, the September 2002 issue of the Howard Hughes Medical Institute Bulletin commented on the critical shortage of physician-scientists, noting that only 11 percent of medical school graduates plan careers exclusively or significantly devoted to research.
The Vital Role of the Physician-Scientist
While some argue that only a PhD is needed for scientific investigation, there is a unique clinical, hands-on patient perspective that an MD brings to medical research. Physician-scientists are trained to ask clinically relevant questions that lead to faster development and translation of scientific findings into clinical treatment. Among examples of physician-scientist contributions have been the development of new or improved surgical techniques, an increased understanding of the causes and effects of adverse drug reactions, detailed descriptions of hereditary diseases and insight into their genetic components, and the identification and treatment of new or emerging infectious diseases.
The FASEB study commented on the importance of physician-scientists in medical schools, noting they “are a critical resource for assuring excellence in medical education, since they teach students that the basis of medicine is science and that scientific rigor should apply to patient care as well as research.”
Drug development is another critical area where physician-scientists provide their clinical knowledge to recognize early on the potential for new therapies. Pharmaceutical companies which capitalize on understanding new medical discoveries and translating them to usable medicine for patients will capture future success as the industry faces enormous pressure to deliver novel drugs faster.
Why the Decline?
The problem often starts with the physician’s initial decision whether to pursue a clinical or research career. Many doctors are turned away from research by fear of long training periods, accumulated debt coupled with lower salaries, and the uncertainty of research success.
The FASEB study indicated that 3 percent of medical school graduates in 1985 had debt greater than $75,000, compared to nearly 50 percent in 1998 (with the number of graduates about the same in ’85 and ’98). In a New England Journal of Medicine article, Rosenberg noted that while individuals in the limited number of combined MD/PhD programs receive financial support, MDs who decide on a research career after completing medical training are usually saddled with an average debt of $119,000. The starting salary in a research-training program is about $41,000 a year; it’s two or three times that amount if the doctor enters clinical practice.
Another factor in the decline of physician-scientists is the financial crunch experienced by academic medical centers, as a result of managed care. More academic physicians have been forced into increased clinical practice, at the expense of research.
What can we do?
Revitalizing the physician-scientist career path will take a long time ? possibly as long (20 years) as it has taken for the problem to be recognized. Progress will be slow and will require participation by each of the major players in the medical research enterprise.
NIH has already responded with several new career development awards, a loan repayment program for trainees engaged in clinical research, an increase in the size of the Medical Scientist Training Program, and a broadening of disciplines in which the PhD degree would be encouraged. A growing number of foundations, for-profit and not-for-profit agencies have established training programs, grants and career awards.
The most critical players, however, are the medical schools and academic health centers where the seed of a physician-scientist is planted and cultivated as aspiring physicians are first exposed to the excitement of medical research. Truly effective programs must recruit a portion of each medical school class with research interests and then nurture such interests with research opportunities and mentoring throughout medical school. And, an educational program that allows a first-year medical student access to interesting patients will provide a more meaningful stimulus to get hooked on the molecular basis of disease and its treatment. Further, the physician-scientist faculty member must be a visible, respected, positive role model to students, house officers, and fellows alike.
In addition to their role in academia, physician-scientists are critical to the pharmaceutical industry where an in-depth, first-hand understanding of the complexity of specific human diseases is required to tailor biologically targeted therapy to unmet clinical needs and problems. Leaders in the pharmaceutical industry have suggested that internships and/or residencies that cross pharmaceutical discovery and development might be made available to encourage physician-scientists to enter the pharmaceutical field.
This 20-year-old problem can be solved if our attempts toward resolution are commensurate with the importance that physician-scientists represent to the medical research community and, through it, to the health of the public
Symposium Speakers and their topics:
Leon E. Rosenberg, MD, Princeton University
“Physician-Scientists: Endangered and Essential Species”
Dr. Rosenberg has written and lectured extensively on the physician-scientist as an “endangered species” in medical research. He will present the scope of the problem, how we got here and what we need to do.
Jeffrey M. Leiden, MD, PhD, Abbott Laboratories
“Why the Pharmaceutical Industry Needs More Physician-Scientists”
Dr. Leiden will discuss the physician-scientist’s role as the pharmaceutical industry faces enormous pressure to deliver novel drugs faster.
Kenneth Kaushansky, MD, University of California, San Diego
“The Importance of Scientific Training in the Medical School Environment”
Dr. Kaushansky, chair of UCSD’s Department of Medicine and 2003-2004 president of the American Society of Clinical Investigation, will cover the increasing need for medical school students and practicing physicians to understand new scientific findings and their application to patients.
Kenneth R. Chien, MD, PhD, University of California, San Diego
Symposium Organizer and speaker
“Physician-Scientists: Unraveling the Genomic Circuits of Human Cardiac Diseases”
Dr. Chien will illustrate the value of translational medicine, by highlighting recent research by a team of physician-scientists who discovered the molecular mechanisms involved in a genetically based form of human heart failure (Knoll et al, Cell, 12/27/2002), and who developed a therapeutic gene and molecular delivery system that provides successful long-term gene therapy in experimental model systems (Hoshijima et al, Nature Medicine, 8/2002) ? paving the way for clinical studies in heart failure patients. An overview of the area can be found in the September 2000 issue of Nature, v.407, pgs 227-232.
For examples of physician-scientist, translational research in the area of heart failure, see the following: