To the Editor:
There has been growing concern that the number of physician–scientists is decreasing.1,2 While this problem is multifactorial, we are most troubled by the belief that it is too difficult to do both medicine and science. Young trainees are faced with a choice: either pursue research (and rarely see patients) or practice medicine (and have nominal research activity). The consequence is growing disillusionment with a career path that, in theory, unifies the two. In contrast, we believe in an integrated concept of the physician–scientist: actively practicing physicians who transform their own clinical observations into research hypotheses and who, in turn, use that research to drive improvement in patient care they themselves deliver.
We argue that the above concept of the physician–scientist needs to be reclaimed by the medical community: training programs, funding organizations, and academic centers should restore that ideal by developing infrastructure to train, support, and retain individuals committed to this path. The educational experience should be multidisciplinary, incorporating leadership training, contract negotiation, clinical trial design, and statistics in addition to the traditional medical and scientific education. This requires new educational pathways that incorporate coursework from schools of health research, policy, business, and law. Second, the educational career should exist as a continuum, in contrast to the current system, where MD and PhD training are separated into blocks. Many cite the need for “immersion” to fully gain understanding of either medicine or research. Perhaps this is true, but the fact remains that our current training system fails to prepare individuals for integrating clinical practice and research.
Zemlo et al3 wrote, “Physician–scientists are a vital force in transforming clinical observations into testable research hypotheses and translating research findings into medical advances.” We agree, and maintain that MD/PhD applicants and trainees should be the vital force at the interface between science and medicine. Unfortunately, the reality encountered is far from this ideal. To cultivate today's trainees as leaders and drivers of change, we must equip them with appropriate skills. Academic medicine needs to rethink the paradigm of how we perceive and train physician–scientists.
Matthew J. Goldstein, PhD
MD/PhD candidate, Medical Scientist Training Program,
Division of Oncology, Department of Medicine,
Stanford University School of Medicine, Stanford,
Holbrook E. Kohrt, MD
MD/PhD candidate and Advanced Residency Training
Scholar, Division of Oncology, Department of
Medicine, Stanford University School of Medicine,
1. Wyngaarden JB. The clinical investigator as an endangered species. N Engl J Med. 1979;301:1254–1259.
2. Schafer AI. The vanishing physician–scientist? Transl Res. 2010;155:1–2.
3. Zemlo TR, Garrison HH, Partridge NC, Ley TJ. The physician–scientist: Career issues and challenges at the year 2000. FASEB J. 2000;14:221–230.