Physician-Scientist Development
Abstract
Physician-scientists represent one of the most impactful, yet underrecognized, innovations of 20th century academic medicine. Defined by a commitment to full-time careers in investigative work, physician-scientists have repeatedly demonstrated a unique ability to identify and solve problems of unmet medical need in a focused and intentional manner using their dual training in clinical medicine and the scientific method as both stethoscope and scalpel. Unfortunately, mounting financial pressures from both the clinical and research marketplaces have placed this storied workforce in jeopardy due to the absence of a dedicated and explicitly defined vocational structure and business model. This white paper reports the output of a consortium of academic medical centers, foundations and professional societies seeking to remedy this deficiency. This consortium specifically developed a framework to formalize the career path of physician-scientist faculty into a professionally unified and financially sustainable structure in a way that could be adopted to different U.S. academic medical centers and health systems. Key components of this framework included an administratively operational definition of physician-scientists, and three central and interconnected pillars (academic, financial, and organizational) that are rooted in this foundational definition. Herein, we detail core concepts and concrete recommendations.
Authors
Christopher S. Williams, Megan Allen, Paige Cooper Byas, John B. Hawley, Louis J. Muglia, E. Dale Abel, Julie A. Bastarache, Carolyn S. Calfee, John M. Carethers, David N. Cornfield, Oliver Eickelberg, Emily J. Gallagher, Anna Greka, Peter J. Gruber, Anthony N. Hollenberg, Heidi H. Kong, Barbara I. Kazmierczak, Gary A. Koretzky, Mark Lachs, Deborah J. Lenschow, Geoffrey S. Pitt, Don C. Rockey, Lisa M. Satlin, Barry P. Sleckman, David A. Stoltz, Jatin M. Vyas, Thomas J. Wang, Kyu Y. Rhee
Abstract
The physician-scientist career has historically progressed through individual persistence and improvisation, as physician-scientists have navigated the demands of clinical practice combined with biomedical research without a clearly structured path. While this approach has sustained the field for several decades, individual determination is increasingly insufficient in the current climate, given the growing complexity within both clinical and research training, as well as potential disruptions to research funding and health care reimbursement. The 2025 ASCI / AAIM / Burroughs Wellcome Fund Physician-Scientist Pathways Workshop convened national leaders and faculty at all career stages to assess existing structures and envision new and more deliberate approaches. Discussions highlighted the impact of NIH initiatives in supporting early careers, institutional vulnerabilities, and need for intentional investments in physician-scientist careers. Breakout sessions emphasized the importance of dedicated funding for physician-scientist pathways, mentorship, social supports, and national benchmarks for compensation and promotion for this unique career pathway. The physician-scientist career path now stands at a crossroads. Going forward, sustained investment, longer and more flexible funding mechanisms such as the R37 and R35 Maximizing Investigators’ Research Award (MIRA) programs, and transparent standards are required. Federal funding alone cannot ensure the stability of a physician-scientist’s career; therefore, new approaches and commitments from academic health centers, philanthropy, and industry will be essential to ensure the viability of this career. With coordinated, intentional strategic planning, the physician-scientist workforce can thrive and remain a driver of America’s biomedical research future.
Authors
Christopher S. Williams, Emily J. Gallagher, Daniel P. Cook, David Mankoff, Rebecca M. Baron, Christopher Pittenger, Jatin M. Vyas, Don C. Rockey, Patrick J. Hu, Ashley L. Steed, W. Kimryn Rathmell, Jeffrey R. Balser, Nancy J. Brown, John M. Carethers, Jonathan A. Epstein, Keith A. Choate, Peter J. Gruber, Tiffany C. Scharschmidt, Kyu Rhee
Abstract
MD-PhD trainees increasingly pursue PhDs in humanities, social sciences, and public health (SSHPH). We characterized SSHPH trainee experiences and compared them to peers in traditional biomedical disciplines. From March-July 2023, a nationwide survey was sent to United States MD-PhD programs that accept SSHPH trainees. Both SSHPH and non-SSHPH trainees participated in a survey focused on belonging, challenges and barriers, funding, and leadership recommendations. Quantitative data were analyzed using Fisher’s exact tests, Student’s t-tests, and Wilcoxon rank sum tests. Qualitative comments were analyzed using a hybrid deductive-inductive approach. 234 MD-PhD trainees across the U.S. participated, with 111 (47.4%) in SSHPH and 123 (52.6%) in non-SSHPH disciplines. Overall, there were many similarities between trainees across disciplinary groups, but small and consistent differences were noted among SSHPH trainees, including decreased belonging, difficulty identifying role models, and increased work requirements during graduate school. Respondents had 5 recommendations for MD-PhD leaders and 3 recommendations for the National Institutes of Health, such as integrating SSHPH scholars into speaker series and incentivizing funding parity. Limitations include high percentages of missing responses. This exploratory study provides insights into SSHPH MD-PhD trainee experiences, highlighting similarities and unique needs that can be addressed within and across MD-PhD programs.
Authors
Cambray Smith, Evans K. Lodge, C. Ray Cheever, Seth M. Holmes, Anna R. Kahkoska
Abstract
Dual-degree medical students pursue additional training to prepare for careers in research, public health, and administration, but how these experiences influence residency application behaviors and outcomes are poorly understood. We analyzed 36,298 residency applicants from the TexasSTAR database spanning 2017-2023 to compare application, interview, and match patterns among single-degree MD applicants and those with MD-PhD, MD-MPH, MD-MBA, or MD-MSc degrees. Despite differences in academic metrics, application strategies, and interview rates, match rates were similar across degree groups. MD-PhD students applied to fewer programs but had the highest interview offer-to-application rate and matched at more prestigious programs based on Doximity rankings. Beyond traditional application metrics such as board scores, research productivity, grades, and honor society membership, strategies including away rotations, geographic preferencing, and program signaling were associated with increased interview offers and match success among all applicants but were less influential for dual-degree applicants. These findings suggest dual-degree applicants require specialized advising and evaluation.
Authors
Daniel C. Brock, Deborah D. Rupert, Toni Darville, Caroline S. Jansen, Elias M. Wisdom, Cynthia Y. Tang
Abstract
Physician-scientists in academic medical centers require extramural grant support to launch and maintain their research careers. In order to cultivate the next generation of biomedical researchers, including physician-scientists, the NIH supports multiple career development (K series) awards. For many, their first experience in grant writing is composing a career development award (CDA) application. From the applicant’s perspective, this process can be difficult. For one, NIH institute–specific differences between the same K mechanism can be confusing. Additionally, the importance of the various elements that make up the K application are frequently misunderstood. Furthermore, many K applications will not be funded on the initial submission; therefore, the need to resubmit an application should not be viewed as a sign of failure, but rather can be viewed as an element of resilience in biomedical research. In this piece, we aim to provide guidance for aspiring K applicants — in particular, from the reviewer perspective — with the intent of making the application process more understandable. We offer dos and don’ts on different components of the K application, advice on when to reach out to a program officer, and tips on resubmission. Our overarching goal is to provide support for prospective K applicants in their effort to obtain a K award. While targeted to K applications, most of the contents of this summary apply to any CDA.
Authors
Don C. Rockey, Kyu Y. Rhee, Christopher S. Williams, Jatin M. Vyas, Charles W. Emala, Emily J. Gallagher
Abstract
High rates of physician-scientist attrition from the investigative workforce remains a significant problem despite the development of dedicated programs and initiatives designed to address the unique challenges faced by physician-scientists. However, many of these efforts are restricted to single career stages of physician-scientist training or to a single medical specialty, which may limit opportunities for beneficial vertical and horizontal mentorship regarding overcoming common career obstacles. Here, we outline the development of a physician-scientist symposium to break down silos and enable productive interactions between physician-scientists across career/training stages, academic and scientific disciplines, and medical specialties. Participants were mixed in (1) small-group problem-based discussions, (2) a cross-specialty keynote panel on overcoming barriers in a physician-scientist career, and (3) skill-building workshops. Attendees indicated that they fostered new connections, developed new skills to overcome career challenges, and increased their commitment to persevering in a career as a physician-scientist. Positive evaluations were not dependent on attendee career/training stage or gender. We suggest these elements of the symposium curriculum may be easily adapted for inclusion in a wide variety of physician-scientist training formats.
Authors
Kevin F. Dowling, Shohini K. Ghosh-Choudhary, Neil Carleton, Kathleen Prigg, Richard A. Steinman
Abstract
MD-PhD programs provide interdisciplinary training in medicine and research. Undergraduate pre-health advisors (PHAs) play a critical role in counseling prospective applicants, yet there have been no studies to our knowledge of MD-PhD pre-health advising. Here we surveyed 280 PHAs from US colleges and universities using both qualitative and quantitative measures that assessed their real-world advising behaviors as well as standardized evaluation of 1 of 2 fictional MD-PhD applicants, identical except for gender. We identified 3 factors that influenced advising behaviors: experience advising MD-PhD applicants, attitudes toward MD-PhD programs, and gender bias. Those PHAs with less experience and who held negative attitudes toward MD-PhD programs were less likely to initiate discussions about MD-PhD programs with qualified applicants and less likely to recommend the fictional applicants apply to MD-PhD programs. Finally, there was subtle gender bias that favored the male applicant. PHAs face challenges in advising MD-PhD applicants because there are relatively few MD-PHD applicants overall and there is a lack of resources to guide them. Addressing these challenges by strengthening collaborations with PHAs and providing comprehensive information about the value of and applicant qualifications for MD-PhD programs is crucial to enhancing MD-PhD advising, mitigating effects of bias, and expanding the pool of qualified applicants.
Authors
Amara L. Plaza-Jennings, Christie B. Ryba, Jessica Tan, Jennifer E.L. Diaz, Grace E. Mosley, Talia H. Swartz, Margaret H. Baron, Robert Fallar, Valerie Parkas
Abstract
Efforts dating back to the 1950s have sought to formalize educating physician-scientists, individuals trained in both science and medicine and who devote the bulk of their professional time to investigative work. The return on investment has been huge, because, as a group, these individuals have made outsized contributions to advancing human health. However, efforts at supporting the physician-scientist career path have been accompanied by repeated concerns regarding the lack of intentional support needed to sustain trainees and faculty. This Perspective reviews the history of the career path, highlighting both opportunities and challenges, and offers seven recommendations with the potential to both promote its vitally and reinvigorate its future at all its stages.
Authors
Gary Koretzky
Abstract
The Alliance for Academic Internal Medicine (AAIM) first convened a workshop in 2015 that brought a small group of internal medicine program directors together who recognized the growing success of early-phase physician-scientist training programs but the unclear path afterward for these trainees. The meeting subsequently evolved into what is now the annual American Society for Clinical Investigation/AAIM/Burroughs Wellcome Fund (ASCI/AAIM/BWF) Physician-Scientist Pathways Workshop, which continues to bring stakeholders together to discuss the obstacles to success that physician-scientists face at all stages of their careers. This perspective presents the history and goals of the workshop, with an emphasis on the most recent meeting in 2024, and looks ahead to the work that still needs to be done to ensure a robust physician-scientist workforce.
Authors
Kyu Y. Rhee, Charles W. Emala, Emily Jane Gallagher, Don C. Rockey, Patrick J. Hu, Jatin M. Vyas, Daniel P. Cook, Tiffany C. Scharschmidt, Olujimi A. Ajijola, ASCI Research Pathways Working Group, Christopher S. Williams
Abstract
MD-PhD programs prepare physicians for research-focused careers. The challenge for admissions committees is to select from among their applicants those who will achieve this goal, becoming leaders in academic medicine and biomedical research. Although holistic practices are encouraged, the temptation remains to use metrics such as grade point average, MCAT scores, and postbaccalaureate gap length, combined with race/ethnicity, age at college graduation, and sex to select whom to interview and admit. Here we asked whether any of these metrics predict performance in training or career paths after graduation. Data were drawn from the National MD-PhD Program Outcomes Study with information on 4,659 alumni, and 593 MD-PhD graduates of the Albert Einstein College of Medicine and the University of Pennsylvania. The Penn-Einstein dataset included admissions committee summative scores, attrition, and the number and impact of PhD publications. Output metrics included time to degree, eventual employment in workplaces consistent with MD-PhD training goals, and self-reported research effort. Data were analyzed using machine learning and multivariate linear regression. The results show that none of the applicant metrics, individually or collectively, predict in-program performance, future research effort, or eventual workplace choices even when comparisons were limited to those in the top and bottom quintiles.
Authors
Lawrence F. Brass, Maurizio Tomaiuolo, Aislinn Wallace, Myles H. Akabas
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