2014 NIH Physician Scientist Taskforce Report

[_drinkcoffee_]

http://report.nih.gov/Workforce/PSW/index.aspx

I'm only a first-year MSTP student. This was an interesting report. Some passages from the summary:

• "PSW-WG analyses indicate that there were approximately 9,000 physician-scientists in the NIH-funded workforce during 2008-2012, including 4,192 with an MD, 4,086 with an MD/PhD, 341 nurse-scientists, 253 veterinarian-scientists, and 161 dentist-scientists."

• "Though their percentage of the overall biomedical workforce has been steadily decreasing since the 1970s, the total number of physician-scientists with a medical degree has remained remarkably steady over the past few decades, with MDs and MD/PhDs each comprising about 50 percent of the physician-scientist workforce with a medical degree. At the same time the average age of entry into the independent workforce (marked by receipt of an NIH RPG) has increased steadily, as has the average age of the physician-scientist workforce."

• "The transition between finishing a clinical or post-doctoral fellowship and initiating an independent research position is a very vulnerable period in the career path of all physician investigators. Funding pressures have mounted with the decrease in NIH funding and physician-scientists are increasingly being asked to support a higher percentage of their income by seeing patients."

• "NIH’s investment in the training of physician-scientists has a significant return. The RPG award rates for first-time RPG applicants with a prior LRP or K award are much higher than for those without: For MDs: 44.1 percent vs 9.2 percent and for MD/PhDs: 60.0 percent vs 10.1 percent. Similarly, early career support for physician-scientists through the Medical Scientist Training Program (MSTP) has also been successful at bolstering the physician-scientist workforce. Close to 80 percent of a cohort of MD/PhDs with past MSTP Appointments (1980-1989) have applied for RPGs, and approximately 78 percent have been successful. Despite this track record, the number of new physician-scientists with a medical degree entering the workforce is now declining, as reflected in the reduced numbers of applicants for early career (K and LRP) awards over the last 5 years."

They give 9 recommendations, with more detail in the actual report:

1. NIH should sustain strong support for the training of MD/PhDs
   
2. NIH should shift the balance in National Research Service Award (NRSA) postdoctoral training for physicians so that a greater proportion are supported through individual fellowships, rather than institutional training grants.
   
3. NIH should continue to address the gap in RPG award rates between new and established investigators.
   
4. NIH should adopt rigorous and effective tools for assessing the strength of the biomedical workforce, including physician-scientists, and tracking their career development and progression.
5. NIH should establish a new physician-scientist-specific granting mechanism to facilitate the transition from training to independence.
6. NIH should expand Loan Repayment Programs and the amount of loans forgiven should be increased to more realistically reflect the debt burden of current trainees.
   
7. NIH should support pilot grant programs to rigorously test existing and novel approaches to improve and/or shorten research training for physician-scientists
8. NIH should intensify its efforts to increase diversity in the physician-scientist workforce.
   
9. NIH should leverage the existing resources of the Clinical and Translational Science Awards (CTSA) program to obtain maximum benefit for training and career development of early-career physician-scientists.

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[_drinkcoffee_]

No comment.

6.7 applications/successful grant.

From 46 to 52 in 13 years.

Well, there's some good news!

 

[Neuronix]

I can't see any objective reason to do MD/PhD from this data. I suspect the number of MD/PhD graduates has been increasing over this time period, while the number of grant applicants has been flat (less percentage even trying), and R01 funding rates continue to decline. Depressing.

 

[_drinkcoffee_]

I can't see any objective reason to do MD/PhD from this data. I suspect the number of MD/PhD graduates has been increasing over this time period, while the number of grant applicants has been flat (less percentage even trying), and R01 funding rates continue to decline. Depressing.

I think your conclusion is too strong. What objective reason is there to do anything? Even at the very beginning of this dataset, MD/PhDs only got their first grant an average of about 1.5 years earlier. However, it is interesting to consider the parity in age at first grant with the context of the time spent by MD/PhDs doing the PhD.

All that was a little beside the point. I think the recommendations are interesting, especially number five: "The NIH should establish a new physician-scientist-specific granting mechanism to facilitate the transition from training to independence."

 

[gutonc]

That sounds good, but will likely not happen. And if it does, it will be a token number to make it look like they're addressing the issue.

And nearly 7 applications in order to get one grant funded? Pardon my French, but f*&@ that. Practically speaking, you can do 2 grant cycles a year as a new investigator at the most. So you're looking at 3-4 years of scraping together funding (which, let's remember, requires more grant writing) in the hopes of getting a golden ticket. No way. I miss research, but I'm glad I bailed after only 2 years of writing non funded grants.

 

[ratherbefishing]

How long do you think it will take to realistically implement some of these changes? The loan thing would be huge for me.

 

[Elixir6]

.... being a researcher stinks

 

[gutonc]

How long do you think it will take to realistically implement some of these changes? The loan thing would be huge for me.

They already have a program. It funds at better than the R01 rate but still not automatic.

 

[gbwillner]

I think your conclusion is too strong. What objective reason is there to do anything? Even at the very beginning of this dataset, MD/PhDs only got their first grant an average of about 1.5 years earlier. However, it is interesting to consider the parity in age at first grant with the context of the time spent by MD/PhDs doing the PhD.

All that was a little beside the point. I think the recommendations are interesting, especially number five: "The NIH should establish a new physician-scientist-specific granting mechanism to facilitate the transition from training to independence."

Yes, I've been saying this for years. Despite the fact that the number of MD/PhD positions has been climbing higher and higher, the number who apply for grants is flat. That could mean there is a real core of individuals who are genuinely interested in pursuing this path, and adding more positions has not increased the number of such individuals. I think we should be more discriminating about who gets into the pathway, and then once there, do everything we can to help them succeed instead of throwing them to the wolves. I would totally support spending 1/2 of the MSTP budget on guaranteed transitional funds for those finishing training and entering their first academic appointment. Those well-entrenched currently are not having as hard a time right now, but for those just now entering the work force it's pretty brutal.

 

[solitude]

I would totally support spending 1/2 of the MSTP budget on guaranteed transitional funds for those finishing training and entering their first academic appointment. Those well-entrenched currently are not having as hard a time right now, but for those just now entering the work force it's pretty brutal.

Even better, just abolish MSTP, convert 100% of the money to transitional funds and loan repayment for those individuals hardy enough to pursue research after finishing their 10 years of clinical training. Make the loan repayment graded over say 7 years to avoid people exploiting the system.

 

[ratherbefishing]

They already have a program. It funds at better than the R01 rate but still not automatic.

I think you are talking about the Loan Repayment Program, but that only funds up to $35k per year for 5 years (total $175k).

 

[gutonc]

I think you are talking about the Loan Repayment Program, but that only funds up to $35k per year for 5 years (total $175k).

I am. And they basically say that they should just increase the amount of the current program. But, again, the current funding rate for new applicants is about 40%. So what's the right thing to do here? Increase the number of people who get the current amount of money? Or increase the amount of money that each successful applicant gets?

Band-Aid on a sucking chest wound either way.

 

[bd4727]

That sounds good, but will likely not happen. And if it does, it will be a token number to make it look like they're addressing the issue.

100% agree with this statement.

 

[bd4727]

I think you are talking about the Loan Repayment Program, but that only funds up to $35k per year for 5 years (total $175k).

It's more complicated than this too... basically its not like if you have 175k of loans you can get 175k repaid. I forget the details but basically you are eligible for a certain percentage of your total loan burden to be repaid per year and that percentage is like based on your current income or something? with some annual hard cap on that amount (want to say like 40?). So then each year your loans decrease because they are being repaid through LRP and then once. Anyway, its not like a true full repayment ever it actually ends up working out to not that much money for someone who was MSTP funded but say had undergrad loans.

 

[_drinkcoffee_]

@gutonc et al.

NIH should establish a new physician-scientist-specific granting mechanism to facilitate the transition from training to independence.

I do not think this was referring to a loan repayment system, but instead a type of research grant which only MD/PhDs (or perhaps even only MSTP graduates) will be allowed to apply. Similar to an F30, but for the residency/fellowship years, instead of during the PhD. Getting one of these would thus provide you with funding and time to work successfully toward getting an R grant.

Perhaps this is an optimistic interpretation.

 

[gutonc]

@gutonc et al.

NIH should establish a new physician-scientist-specific granting mechanism to facilitate the transition from training to independence.

I do not think this was referring to a loan repayment system, but instead a type of research grant which only MD/PhDs (or perhaps even only MSTP graduates) will be allowed to apply. Similar to an F30, but for the residency/fellowship years, instead of during the PhD. Getting one of these would thus provide you with funding and time to work successfully toward getting an R grant.

Perhaps this is an optimistic interpretation.

Did you not actually read what you posted up at the top? Because immediately after the bolded above, is this:

NIH should expand Loan Repayment Programs and the amount of loans forgiven should be increased to more realistically reflect the debt burden of current trainees.

This is what we're talking about.

 

[Fencer]

MD/PhD directors gave responses to NIH about the recommendations, this past July. We discussed additional slides not included in the report, such the leveling and small decline of new MD/PhD tenure-track appointments. In my view, the key recommendations will be about strengthening the residency research pathways with funding mechanisms (PSTPs) and enhance the transition to independence for early junior faculty (KL-2, R99, and other mechanisms) to lead to career development grants (K08, K23).

 

[Neuronix]

I think your conclusion is too strong. What objective reason is there to do anything?

The objective reason to go through 8 +/- 1 years of MD and PhD training followed by lengthy residency is to become a primary researcher in an academic medical center. If this objective is unrealistic, there is no objective reason to amass all of that training when an MD will suffice for a clinical or physician-scientist career (with additional training later).

Despite the fact that the number of MD/PhD positions has been climbing higher and higher, the number who apply for grants is flat. That could mean there is a real core of individuals who are genuinely interested in pursuing this path, and adding more positions has not increased the number of such individuals.

Following your logic, should every MD/PhD be fighting for big grants? Should we drive down the funding rates even further?

I think we should be more discriminating about who gets into the pathway, and then once there, do everything we can to help them succeed instead of throwing them to the wolves. I would totally support spending 1/2 of the MSTP budget on guaranteed transitional funds for those finishing training and entering their first academic appointment. Those well-entrenched currently are not having as hard a time right now, but for those just now entering the work force it's pretty brutal.

I don't believe that there is some large group of MD/PhDs who are there to exploit the system to become clinicians. I think the barriers to becoming a physician-scientist are incredibly high, and MD/PhD applicants and junior students like drinkcoffee aren't realistically exposed to these barriers. The lower these barriers become (within reason), the more MD/PhDs will be recruited by further training pathways (residencies, fellowships, and junior faculty positions) and then have a reasonable chance at success as an investigator. I'm of the belief that with current funding levels it wouldn't even be possible for all current MD/PhD graduates to become majority researchers, even if they were diehard about becoming physician-scientists. For different people, there are different levels of tolerable barriers. But I see further training (i.e. post-doc), for 1/2 - 1/3 the salary, for more hard work (1.5x - 2x), for no location stability and minimal choice, for a low chance at a real startup position anyway, and for a low chance of obtaining large grants in my career. So why should I even try? What sane person would?

MD/PhD directors gave responses to NIH about the recommendations, this past July. We discussed additional slides not included in the report, such the leveling and small decline of new MD/PhD tenure-track appointments. In my view, the key recommendations will be about strengthening the residency research pathways with funding mechanisms (PSTPs) and enhance the transition to independence for early junior faculty (KL-2, R99, and other mechanisms) to lead to career development grants (K08, K23).

Indeed, tenure-track is virtually non-existent as we've discussed in other threads. Departments do not expect a return on their start-up investments, so start-up packages and research appointments for physician-scientists barely exist anymore. Even research fellowships and research protected time is on the decline. The jobs just don't exist anymore in the real world. It's really sad to me.

Even better, just abolish MSTP, convert 100% of the money to transitional funds and loan repayment for those individuals hardy enough to pursue research after finishing their 10 years of clinical training. Make the loan repayment graded over say 7 years to avoid people exploiting the system.

Hardy enough? More like, clinical disasters or unable to pursue clinical careers due to incompetence or criminal records. Once you have that guaranteed salary and reasonable lifestyle in your grasp in your 30s, sane people aren't going to run back to the lab in this environment.

 

[SynBio]

Therefore, let's pursue insanity.

 

[solitude]

Hardy enough? More like, clinical disasters or unable to pursue clinical careers due to incompetence or criminal records. Once you have that guaranteed salary and reasonable lifestyle in your grasp in your 30s, sane people aren't going to run back to the lab in this environment.

They would be younger (straight MD + 4-5y clinical training including fellow), and since fewer of them would do it, there would be more money available, so funding odds would increase, until you reached a new steady state that was more sane. I agree with you that in the current environment, you have to be borderline insane, which is why I advocate such radical changes in the environment i.e. abolish MSTP.

 

[_drinkcoffee_]

Did you not actually read what you posted up at the top? Because immediately after the bolded above, is this:

This is what we're talking about.

That was point 6, not point 5. To quote from the report, which I also read:

"NIH should establish a new physician-scientist-specific granting mechanism to facilitate the transition from training to independence.
This program should be similar to the K99/R00 program whose funding currently goes almost exclusively to individuals holding a PhD degree. This new grant program could serve either as a replacement or transition from existing K Awards for physician scientists, and should provide a longer period of support, potentially lengthening the R00 phase to 5 years (with an interim staff review at year 3). This new grant series, as well as K and all other training awards, should rigorously enforce protected time of at least 75 percent effort and provide sufficient salary support to make that possible."

 

[solitude]

That was point 6, not point 5. To quote from the report, which I also read:

"NIH should establish a new physician-scientist-specific granting mechanism to facilitate the transition from training to independence.
This program should be similar to the K99/R00 program whose funding currently goes almost exclusively to individuals holding a PhD degree. This new grant program could serve either as a replacement or transition from existing K Awards for physician scientists, and should provide a longer period of support, potentially lengthening the R00 phase to 5 years (with an interim staff review at year 3). This new grant series, as well as K and all other training awards, should rigorously enforce protected time of at least 75 percent effort and provide sufficient salary support to make that possible."

Yes, but as a wise man once said, show me the money. Until they do, this is just window dressing.

 

[gutonc]

That was point 6, not point 5. To quote from the report, which I also read:

I'm not sure what you're arguing about here.

You're all up on the "new granting mechanism for MSTPs", which is a total pipedream and will never come about...at least not in a timeline that is relevant to anyone currently posting on SDN (although my 7yo daughter might be able to avail herself of it, assuming the Ebolocalypse doesn't get us all first).

There is a completely separate discussion going on about loan repayment (another point in the original article)...which is still unlikely to happen but at least has a precedent.

You're trying to have a fight about two almost unrelated topics. Knock it off.

 

[mercaptovizadeh]

This task force is another bureaucratic sinkhole. Folks, we have to be realistic. It's back to apprenticeships and patronage. Go work for 5+ years in the lab of a Nobel Laureate or NAS member, get those big journal papers, develop your scientific vision as a side project in the lab - using that mentor's clout and resources to push things through - and lobby the rich guys with you new "cure for cancer" research. Seems way more promising at this point than a random research fellowship and applying for funding from the NIH.