The Decline of the Clinician-Scientist: How Medicine and Academia Thrive Together

MARIAM KALATHIL – In recent years, the clinician-scientist, a profession that lies at the intersection of patient care and scientific research, has significantly declined. The role is a backbone of translational research, turning lab discoveries into clinical tools for diagnosing, treating, or preventing human diseases. Indifferent to its importance, economic and professional barriers, and funding inefficiencies have been increasing, discouraging young physicians from choosing the clinician-scientist career path.

Beyond the scope of a normal scientist, clinician–scientists can bring their research from bench to bedside, and they are also uniquely capable of doing the reverse—incorporating the results of clinical studies into new research and treatment approaches. In this way, they are often more invested in patient well-being and more knowledgeable about clinical trials, and thus, they are more likely to follow up on perceived failures.

Between basic and clinical scientists, one of the major problems is that research discovery is viewed as an end rather than a means towards attaining treatments for patients. Clinician-scientist and cancer researcher Raymond Hohl says, “Colleagues tell me they’re very successful getting NIH grants because their experiments are elegant and likely to yield fundamental discoveries, even if they have no prospect of producing something that helps human diseases.” According to Hohl, research, then, truly is often the high-class, substance-less, and superficial career path taken for bragging rights and a name. To close this divide, the foundation of translational research must be reexamined—to be one built on addressing the real-world problems that patients face. Of further concern, despite the rising number of MDs in the U.S., clinician-scientists now only comprise 1.5% of the physician workforce, with only around 10% of medical students expressing serious interest in pursuing research careers. The field is also aging as around 50% of NIH-funded clinician-scientists are over 50 years old.

Funding inefficiencies in research amplify the barriers for clinician-scientists. An estimated 85% of biomedical research spending, equivalent to hundreds of billions of dollars globally, is thought to be wasted due to flawed design, lack of reproducibility, and limited clinical applicability. A 2009 study in The Lancet estimated that up to $200 billion of the $240 billion in global biomedical research spending each year does not yield useful or reproducible findings—a glaring inefficiency by over 80%  for a field that faces increasing financial pressures. For clinician-scientists, who are already required to overcome extensive debt and rigorous training, this misuse of resources can be demoralizing, further discouraging new entrants to the field.

Beyond personal and professional challenges, the financial aspect is another deterrent. MD/PhD training programs can extend beyond a decade, often at great personal cost. Furthermore, clinician-scientists are compensated at significantly lower rates than their MD-only peers in private practice, creating a stark financial disincentive for those interested in pursuing research. As the average medical school debt exceeds $200,000, fewer young doctors are willing to accept the lower salary and extended training time required to become clinician-scientists.

Despite efforts on behalf of the NIH to establish awards and programs to encourage physicians to enter or remain in the research world,  the clinician-scientist population has only continued to shrink. MD-pHD matriculants account for only 3% of all U.S. medical students. Evidently, greater debt relief and funding programs for prospective clinician-scientists are necessary to ameliorate the issue. 

Bettering the clinician-scientist decline requires restructuring training programs and funding models to make research careers more accessible and appealing. For instance, medical schools and the NIH are beginning to expand loan repayment options and create more MD/PhD scholarships to alleviate the financial burden on clinician-scientists. Additionally, federal funding bodies are increasingly offering special grants and fellowships to clinician-scientists under the age of 45, aiming to incentivize early-career researchers. A cultural shift is also needed. Both academia and healthcare institutions must emphasize the value of clinician-scientists by offering clearer career pathways, flexible work arrangements, and competitive compensation. In Europe, some countries have integrated research training into residency programs, giving trainees early exposure to translational science, which could be a model for other nations to adopt. 

Without clinician-scientists, a risk of leaving billions of American research dollars untapped is posed and potential discoveries would gather dust in laboratories rather than improving patients’ lives. But the workforce can be rebuilt.  By seeking to attract talent, drive, and compassion while streamlining training, reducing debt, and path promotion, a future with more clinician scientists looks bright alongside a more effective American healthcare system.

Copy Editor – Anaghah Sanikapally

Photography Source – https://thedo.osteopathic.org/2018/09/the-academic-medicine-life-why-its-a-calling-for-some-dos/