Physician-Scientist Workforce (PSW) Report 2014
The Physician-Scientist Workforce Working Group
Presentation of Findings
Chapter 2: The Physician-Scientist Workforce: Past, Present, & Future
Historical Concerns about the Physician-Scientist Workforce
The Physician-Scientist Workforce
NIH Support for the Development of the Physician-Scientist Workforce
Future Trends Affecting the Physician-Scientist Workforce
Chapter 3: Physician-Scientists with a Medical Degree
Training of Physician-Scientists with Medical Degrees
Research about Medical Students' Decision to Pursue a Research Career
Size and Composition of the Physician-Scientist Workforce in 2012
Physician-Scientists with a Medical Degree in the NIH-Funded Workforce
NIH RPG Award Rates by Degree Type and Experience
Persistence Quality by Degree and Gender
Effects of Early Career NIH Programs on Physician-Scientists with a Medical Degree
Challenges Facing the Physician-Scientist Workforce
Chapter 4: Nurse-Scientists
Training of Nurse-Scientists
The Nurse-Scientist Workforce
Qualitative Research Findings Related to Nurse-Scientists
Nurse-Scientists as Participants in the NIH-funded Workforce
Summary of Challenges Facing the Nurse-Scientist Workforce
Specific Recommendations Related to the Nurse-Scientist Workforce
Chapter 5: Veterinarian-Scientists
Training in Veterinary Medicine
Qualitative Research Findings Related to Veterinary Students
Veterinary-Scientists as Participants in the NIH-Funded Workforce
Summary of Challenges Facing the Veterinary-Scientist Workforce
Specific Recommendations for the Veterinarian-Scientist Workforce
Chapter 6: Dentist-Scientists
Training of Dentist-Scientists
Qualitative Research Findings Related to Dentist-Scientists
Dentist-Scientists in the NIH-funded Workforce
Summary of Challenges Facing the Dentist-Scientist Workforce
Specific Recommendations for the Dentist-Scientist Workforce
Chapter 7: Recommendations
Appendix I: Physician-Scientist Workforce Working Group Subcommittees
Appendix II: Quantitative Analysis Methodology
Appendix III: Data Definitions
Appendix IV: Physician-Scientists Workforce Data
PSW Report - Main Data
Chapter 2: The Physician-Scientist Workforce Data
Chapter 3: Physician-Scientists with a Medical Degree Data
Chapter 4: Nurse-Scientists Data
Chapter 5: Veterinarian-Scientists Data
Chapter 6: Dentist-Scientists Data
PSW Report - Appendix IV Supplementary Data
K Data
LRP data
MSTP Data
RPG Data
R01 Data
AAMC Faculty
Appendix V: Qualitative Research Findings
Medical Students and Deans
K Awardees
Home > Workforce > ACD PSW Report 2014 > Chapter 2: Historical Concerns about the Physician-Scientist Workforce
Despite the critical role that the physician-scientist plays in the biomedical workforce, concern regarding the health of this sector of the scientific enterprise began to grow in the latter decades of the 20th century. The physician-scientist with a medical degree was becoming "an endangered species," according to James Wyngaarden, who later became an NIH Director, in a 1979 paper in the New England Journal of Medicine ).2 He had observed that MD applicants for NIH project grants represented a progressively smaller fraction of all applicants than previously, while the corresponding fraction of PhD applicants increased dramatically. Subsequently, in 1984, Gordon Gill published an essay titled "The End of the Physician Scientist?" in American Scholar .3 He argued that physicians who were engaged in research were increasingly being drawn toward basic laboratory science, excited by the revolution in molecular biology. In 1987, Moody published a paper in the American Journal of Surgery that drew attention to the adverse impact of cost containment policies on research in clinical settings.4
In response, the Institute of Medicine (1994) undertook a study on overcoming barriers to career paths for clinical research. In 1996, NIH director Harold Varmus established a task force headed by David G. Nathan to make recommendations about how to address the perceived shortfall of clinical investigators. The Nathan Committee recommended creating new career development grants for patient-oriented research and loan repayment programs to help young physician-scientists pursue research careers despite an increasing load of educational debt.5
The Association of American Medical Colleges established two task forces on clinical research by physician-scientists. These task forces recommended that clinical research be introduced in undergraduate and graduate medical education curricula and training in clinical research be restructured to accelerate training. In addition, private foundations such as the Burroughs Wellcome Fund, the Doris Duke Charitable Foundation, the Howard Hughes Medical Institute, and the Robert Wood Johnson Foundation created initiatives aimed at revitalizing the physician-scientist workforce.6
Nonetheless, an analysis by Zemlo, Garrison, Partridge, and Ley, based on data through the mid-1990s, indicated that medical school students' intentions to pursue a research career had declined; at the same time, the average debt levels of medical school graduates increased. Their study also found that the number of MDs with NIH training and fellowships declined during this period and that the number of first-time grant applications submitted by MDs remained stagnant.7
In 1999, Rosenberg emphasized that numerous forces, including the increasing debt burden of medical school graduates, the increasing length of postdoctoral training required, and the instability of NIH funding were responsible in large part for putting the future of the physician-scientist career path at significant risk.8
NIH funding increased greatly in the late 1990s from $13.675 billion (1998) to $27.167 billion (2003). During this period, institutions expanded their research capacity and training programs, and the number of physicians applying for NIH R01 grants increased. NIH's budget growth came to a halt in 2004 and has since remained static. After adjusting for inflation using the Biomedical Research and Development Price Index, the 2013 NIH budget was 21.9 percent below its 2003 level.9 The 2008 recession also reduced research funding from other sources, including pharmaceutical companies.
Garrison & Deschamps' analysis of data from multiple sources, including NIH, through 2011 indicated that physician-scientists' role in biomedical research is more limited than in the past. Among their chief findings, however, was that the decline in the number of physicians entering research careers was temporarily mitigated during the 1998-2003 period of growth in the NIH budget.10
Although nurse-scientists, dentist-scientists and veterinarian-scientists face many of the same issues—debt, length of training, and funding instability—as physician-scientists with a medical degree, each segment of the workforce contends with other threats. Traditionally, these non-MD segments of the workforce have lacked a critical mass of individuals trained in science and research due to the heavy focus of these training programs on producing clinical practitioners; these professions have been viewed as entirely clinical entities by the public, which has impacted adversely on the number of trainees pursuing a research career in these profession. As a result, there is a shortage of faculty members with scientific research programs who can serve as role models and mentors to students in training.
2 Wyngaarden, J.B. (1979). The clinical investigator as an endangered species. New England Journal of Medicine, 301(23), 1254-59.
3 Gill, G.N. (1984). The end of the physician-scientist? American Scholar 53, 353—69.
4 Moody, F.G. (1987). Clinical research in an era of cost containment. American Journal of Surgery 153, 337-340.
5 Nathan, D.G. & Wilson, J.D. (2003). Clinical research and the NIH: A report card. New England Journal of Medicine, 349(19), 1860-65.
6 Schafer, A.I. (2009). The Vanishing Physician-Scientist? Ithaca, NY: Cornell University Press.
7 Zemlo, T.R., Garrison, H.H., Partridge, N.C. & Ley, T.J. (2000). The physician-scientist: Career issues and challenges at the year 2000. The FASEB Journal 14, 221-230.
8 Rosenberg, L.E. (1999). Physician-scientists—endangered and essential. Science 283, 331-332.
9 NIH/OEP Staff Calculations.
10 Garrison, H.H. & Deschamps, A. (2014.). NIH research funding and early career physician-scientists: continuing challenges in the 21st century. The FASEB Journal 28, 1-10.
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