Results of the study were presented today at a JAMA media briefing on medical research.
Physician-scientists, defined as individuals with a medical degree who perform medical research as their primary professional activity, have contributed much to the preeminent position of the U.S. in medical science, according to background information in the article. The unique perspective that physician-scientists bring to the medical research workforce is that their scientific questions arise at the bedside and in the clinic. Despite this perspective, the pipeline of physician-scientists has had a serious problem, first described more than a generation ago: the physician-scientist population in the U.S. is smaller and older than it was 25 years ago. These and other trends have led some observers to conclude that the physician-scientist is a threatened species. A variety of factors were thought to contribute to this problem, including increasing indebtedness of medical school graduates caused by rapidly rising medical school tuition costs.
Several National Institutes of Health (NIH)–sponsored groups, private foundations, and national organizations called for new initiatives and award programs aimed at revitalizing the physician-scientist career path. These initiatives were begun between 1998 and 2002.
These initiatives included NIH career development awards for young physicians being trained to carry out clinical research, awards for established clinical investigators, awards for academic institutions with programs supporting clinical research training and infrastructure, and a series of competitive loan repayment programs (LRPs) for young physician-scientists with significant debt.
The private not-for-profit sector created new awards for young and established physician-scientists and an increasing number of research-intensive medical schools and hospitals (where most physician-scientists work) have constructed multifaceted programs aimed at encouraging medical students to become involved with research before and after receiving their M.D. degree and at protecting the research time of young physician-scientists during their junior faculty appointments.
Timothy J. Ley, M.D., of the Washington University School of Medicine, St Louis, and Leon E. Rosenberg, M.D., of Princeton University, Princeton, N.J., conducted a study to attempt to define the effects that these budgetary and institutional initiatives have had on the physician-scientist career path. The authors determined trends using data obtained from the NIH, the American Medical Association, the Association of American Medical Colleges, and other sources.
The researchers found that the number of physician-scientists in the United States has been in a steady state for the past decade, but funded physician-scientists are significantly older than they were 2 decades ago. "However, the study of early career markers over the past 7 to 10 years has demonstrated increasing interest in research careers by medical students, steady growth of the M.D.-Ph.D. pool, and a new burst of activity in the 'late bloomer' pool of M.D.s (individuals who choose research careers in medical school or in residency training), fueled by loan repayment programs that were created by the NIH in 2002. Several recent trends for more established physician-scientists have also suggested improvement."
Concerning applications for NIH research project grants (RPGs), first-time M.D. applicants, whose numbers hovered at 750 to 800 between 1995 and 1999, have slowly increased recently, reaching a total of 995 in 2003. First-time RPG applicants with M.D.-Ph.D. degrees have steadily increased, from 133 in 1970 to 600 in 2003.
"New programs recently initiated by the NIH and private foundations are beginning to have a positive impact on the decisions of young physicians to pursue research careers. To maintain this trend, strong funding commitments will be required beyond the entry level. If these commitments are sustained, we are cautiously optimistic that they will result in an increase in the population of physician-scientists in the United States in the near future," the authors conclude.
(JAMA. 2005; 294:1343 - 1351. Available pre-embargo to the media at www.jamamedia.org.)
Editor's Note: The Alan and Edith Wolff Chair provided support for Dr. Ley.
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