The 2014 NIH Physician-Scientist Workforce (PSW) Working Group report identified distressing trends among the small proportion of physicians who consider research to be their primary occupation. If unchecked, these trends will lead to a steep decline in the size of the workforce. They include high rates of attrition among young investigators, failure to maintain a robust and diverse pipeline, and a marked increase in the average age of physician-scientists, as older investigators have chosen to continue working and too few younger investigators have entered the workforce to replace them when they eventually retire. While the policy debates continue, here we propose four actions that can be implemented now. These include applying lessons from the MD-PhD training experience to postgraduate training, shortening the time to independence by at least 5 years, achieving greater diversity and numbers in training programs, and establishing Physician-Scientist Career Development offices at medical centers and universities. Rather than waiting for the federal government to solve our problems, we urge the academic community to address these goals by partnering with the NIH and national clinical specialty and medical organizations.
Dianna M. Milewicz, Robin G. Lorenz, Terence S. Dermody, Lawrence F. Brass, the National Association of MD-PhD Programs Executive Committee
The physician-scientist pipeline: long and leaky.
The figure highlights a number of issues, including career attrition at every stage and the existence of a protracted period when well-trained physicians in their 30s are serving in subordinate positions awaiting the next step in their career progression. To draw attention to their plight, we call this period the holding zone. The illustration is based on the experience of MD-PhD program graduates, but many of the issues reflect the obstacles for any would-be physician-scientist. Attrition rates from MD-PhD programs are low, with most of those who withdraw completing medical school or graduate school. Very few MD-PhD program graduates (5% or fewer) choose to forego postgraduate clinical training as residents and fellows. In our experience, career attrition takes many forms and becomes cumulative at each stage, reflecting the proportion of individuals who either never return to research, opt for full-time clinical practice outside of academia, join academia as an assistant professor but spend their time caring for patients, or are appointed to the tenure track but end up devoting minimal time to research (