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From the Editor

Going Extraordinary Distances With Physician–Scientists

Roberts, Laura Weiss MD, MA

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doi: 10.1097/ACM.0000000000003923
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The only justification

for extraordinary lengths

is extraordinary distances.

—Kay Ryan1

Medicine is far from its goal of ensuring good health for all people. Getting there requires advancing our understanding of mechanisms of disease and the underpinnings of well-being, inventing novel therapeutics, and providing excellent and safe clinical care. Getting there is predicated on the development of health services and systems that are accessible, equitable, and affordable, and on health policy and population-based strategies that are informed by rigorously derived evidence and demonstrate the aspirational values of society and the profession of medicine.

Ensuring good health for all people tomorrow requires the preparation of the coming generations of scientists, clinicians, educators, partners, and leaders across the health professions. Tackling immense challenges to improve human health, now and in the future, comprises the work of academic medicine and requires the dedication of people from many backgrounds, disciplines, and walks of life. In this issue of the journal, we have assembled several articles that focus on one key group of people in medicine who are critical in attaining these aims: physician–scientists. Physician–scientists, as with clinician–scientists more broadly, play a special role in bridging the fields of science and medicine. Physician–scientists go to extraordinary lengths in their training and in their professional duties to make crucial contributions in academics, government, industry, and, more broadly, to society. Physician–scientists are increasingly important in our world, as revealed in the context of the current COVID-19 pandemic, and their successes, sacrifices, and sustenance are worthy of our attention.

The National MD–PhD Program Outcomes Study

Many physician–scientists are educated in formal MD–PhD and medical scientist training programs. The National MD–PhD Program Outcomes Study of the Association of American Medical Colleges (AAMC) surveyed more than 6,000 graduates of physician–scientist training programs and combined their responses with data about all MD–PhD program alumni from several AAMC databases. 2,3 The study documents that most physician–scientist alumni were engaged in basic, translational, patient-oriented, health services, and other kinds of medical research. Most alumni served as full-time medical school faculty, while a smaller subset worked at the National Institutes of Health (NIH), in other research institutes, or in industry. Internal medicine, pathology, pediatrics, and neurology were the most common postgraduate medical training fields chosen by alumni, although the study found an increasing trend toward dermatology, ophthalmology, and radiation oncology.

A number of physician–scientists in the outcomes study served in prominent leadership roles and were recognized for exceptional scientific contributions through awards from honorary societies and the Howard Hughes Medical Institute. The vast majority of physician–scientists expressed satisfaction with their career paths and would have opted to pursue MD–PhD training again.

This outcomes study of physician–scientists built on the NIH’s earlier in-depth work to advance the careers of clinician–investigators. 4,5 The study serves as a further reminder that there are not enough physician–scientists to meet projected need. 6 Furthermore, more physician–scientists are slated to retire than to enter the workforce in coming years. 2 As in the past, the pool of applicants to physician–scientist training programs is small, continues to decline, and is nonrepresentative of the general population in terms of gender, race, and ethnicity. 2,3,7 The pool is less diverse than the pool of applicants to medical school. 2 Sixty-seven percent of physician–scientist respondents from the 2005–2014 graduation cohort were White and 66% were men. 2 The study also found that the overall period of training for physician–scientists is protracted and the time from graduation to the first position in academia is longer than in the past. 2 These findings have many implications for physician–scientists related to personal well-being, family commitments, and career longevity. Extended training before entering the academic workforce, moreover, introduces disproportionate burdens and disparities for women physician–scientists and physician–scientists who identify as nonmajority.

Novel Data and Approaches

Articles in this issue of the journal affirm the vital role of physician–scientists and research-oriented academic faculty and offer novel data and approaches to help sustain the physician–scientist workforce. Analyses conducted by Andriole et al 3 using data from the National MD–PhD Program Outcomes Study provide insights into research engagement in different specialties of medicine and influences on research-focused academic careers. Fernandez et al 8 performed a qualitative study to identify factors that facilitate or hinder the career advancement of research-oriented women faculty members, elevating the importance of institutional norms, mentorship approaches, and policies to women’s academic progress.

In a remarkable and inspiring report, Holsti et al 9 describe an innovative summer research program with 10 years of experience in increasing the participation of American Indian/Alaska Native college students in medicine and biomedical sciences. A second report by Modrek et al 10 describes the initial experience of trainees engaged in a novel accelerated MD–PhD residency pathway at NYU–Langone Medical Center, a program that reduces time and cost associated with MD–PhD training and creates continuity in undergraduate and postgraduate clinical and research training.

Flores et al 11 describe a systematic effort undertaken by the Academic Pediatric Association, with support from the National Institute of Diabetes and Digestive and Kidney Disorders, to foster research skills and provide mentorship to research-engaged faculty members who identify as belonging to underrepresented groups, with the goal of career acceleration. Huang et al 12 outline institutional efforts to provide a nurturing environment for early-stage physician investigators. The authors underscore the physician–scientist shortage and their commitment to a “novel integrated strategy for continuous, comprehensive, and sustainable development and support of physician–investigators, whom we see as critical to our long-term success as an academic health system.”

With palpable commitment to the importance of physician–scientist training, Simpson et al 13 of the Burroughs Wellcome Fund describe a new institutional award program investing a total of $25 million into resources to advance physician–scientist training at 10 institutions in the United States. The authors articulate the barriers to physician–scientist training as the absence of effective mentorship, lack of research experience, financial challenges, institutional obstacles, cultural pressures, and work–life balance issues. The 10 institutional programs were chosen through highly competitive processes and individually focus on unique sets of issues, challenges, or threats associated with physician–scientist training, such as underrepresentation of backgrounds and disciplines among physician–scientists, work–life balance, debt, well-being, and the emergence of novel scientific areas and interdisciplinary training.

The Distances

Physician–scientists train longer, defer career milestones, and juggle professional and personal goals. Physician–scientists serve in consequential roles in academia, government, industry, and society at large, advancing discovery and building new knowledge that may be translated and applied for the good health of all. Too few in number and still limited in diversity and representativeness, physician–scientists work alongside other clinician–scientists, physician–scholars, and clinician–educators to carry tremendous responsibilities in science, clinical medicine, services and systems, and health policy.

Going to extraordinary lengths to inspire, prepare, and sustain physician–scientists, Dear Reader, is justified by the extraordinary distances that they have traveled professionally and personally, as well as the extraordinary distances that all of us in medicine must still go, together, to improve human health.

References

1. Ryan K. Extraordinary lengths. In: The Best of It: New and Selected Poems. 2010, New York, NY: Grove Press; 35.
2. Association of American Medical Colleges. National MD–PhD Program Outcomes Study. 2018, Washington, DC: Association of American Medical Colleges; https://store.aamc.org/national-md-phd-program-outcomes-study.html. Accessed January 6, 2021.
3. Andriole DA, Grbic D, Yellin J, McKinney R. MD–PhD program graduates’ engagement in research: Results of a national study. Acad Med. 2021; 96:540–548.
4. National Institute of General Medical Sciences. The Careers and Professional Activities of Graduates of the NIGMS Medical Scientist Training Program. NIH Publication Number 98-4363. 1998, Bethesda, MD: National Institutes of Health;
5. Schafer AI. The Vanishing Physician-Scientist?. 2009, Ithaca, NY: Cornell University Press;
6. Salata RA, Geraci MW, Rockey DC, et al. U.S. Physician-scientist workforce in the 21st century: Recommendations to attract and sustain the pipeline. Acad Med. 2018; 93:565–573.
7. Andriole DA, Wolfson RK. The physician–investigator workforce: Looking ahead. Acad Med. 2021; 96:486–489.
8. Fernandez SB, Clarke RD, Sheehan DM, Trepka MJ, Rose SM. Perceptual facilitators for and barriers to career progression: A qualitative study with female early stage investigators in health sciences. Acad Med. 2021; 96:576–584.
9. Holsti M, Clark EB, Fisher S, et al. Lessons from the first decade of the Native American Summer Research Internship at the University of Utah. Acad Med. 2021; 96:522–528.
10. Modrek AS, Tanese N, Placantonakis DG, et al. Breaking tradition to bridge bench and bedside: Accelerating the MD–PhD-residency pathway. Acad Med. 2021; 96:518–521.
11. Flores G, Mendoza F, Brimacombe MB, Frazier W III. Program evaluation of the Research in Academic Pediatrics Initiative on Diversity (RAPID): Impact on career development and professional society diversity. Acad Med. 2021; 96:549–556.
12. Huang X, Dovat S, Mailman RB, Thiboutot DM, Berini D, Parent LJ. Building a system to engage and sustain research careers for physicians. Acad Med. 2021; 96:490–494.
13. Simpson RL, Cornfield DN, Burris JE. Novel prescriptions from medical schools for physician–scientist training and engagement in the twenty-first century. Acad Med. 2021; 96:512–515.
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