Fifty years ago, the first small MD-PhD programs were established with the goal of expanding the physician–scientist workforce by combining the best parts of medical and graduate education. As MD-PhD programs have grown, so has the tradition of granting students full fellowships that pay for both graduate school and medical school and provide a stipend. Mr. Samarasinghe expresses his concerns about the recent decision by the National Institutes of Neurological Disorders and Stroke (NINDS) to discontinue a program that helps defray medical school costs for MD-PhD students. He also voices his concern about the adverse impact of this and other recent federal funding decisions on the career choices made by students planning to become physician–scientists.
As program directors, we share these concerns. Intentionally or not, the NINDS decision raises an important question, which is how best to cover the costs of training the next generation of physician–investigators. There is broad agreement that future physician–scientists should be relieved of as much of their training costs as possible so that large debts incurred during medical school do not push them into private practice. The NIH loan repayment program was established with this in mind, but since it kicks in years after the debts are incurred, it may not have the same impact on career planning as would avoiding debt to begin with. Although not the only way to train physician–scientists, recent data show that most MD-PhD program alumni are engaged in academic medicine and biomedical research.1 MD-PhD training takes about eight years and is expensive.1 Institutional Medical Scientist Training Program (MSTP) grants from the National Institute of General Medical Sciences cover some of the costs and provide a strong incentive to create high-quality, integrated MD-PhD training programs. However, MSTP grants typically cover less than 25% of total program costs. The remainder comes from a combination of university funds, research grants, private foundations, and individual fellowships that students compete for nationally. Each of these has a role, and any future expansion of the physician–scientist workforce will require all of them.
In 2005 the National Academy called for a 20% increase in support for physician–scientist training programs.2 Individual fellowships offered by NIH institutes are one way to do this and, when combined with other outreach efforts, can help institutes achieve their goal of attracting promising physician–scientists into research and clinical fields aligned with the institute's mission.
Physician–scientists play a vital role across the entire spectrum of biomedical investigation that includes basic, translational, patient-oriented, and effectiveness research. We applaud Mr. Samarasinghe's efforts to bring his important concerns to greater public notice.
Lawrence F. Brass, MD, PhD
Professor of medicine and director, Medical Scientist Training Program, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; firstname.lastname@example.org.
Olaf S. Andersen, MD
Professor of physiology and biophysics and director, Weill Cornell/Rockefeller/Sloan-Kettering Tri-Institutional MD-PhD Program, Weill Cornell Medical College, New York, New York.
Myles H. Akabas, MD, PhD
Professor of physiology and biophysics and director, Medical Scientist Training Program, Albert Einstein College of Medicine, Bronx, New York.
2 Committee for Monitoring the Nation's Changing Needs for Biomedical, Behavioral, and Clinical Personnel, Board on Higher Education and Workforce, National Research Council. Advancing the Nation's Health Needs: NIH Research Training Programs. http://www.nap.edu/catalog/11275.html
. Accessed November 12, 2010.