Neuronix said:
I wrote a nice long response to obp and SDN ate it. Ah well, here's the concise version:
I agree with malchik's summary. Med schools, and especially clinical departments, just don't invest in people anymore. I think this has to do with the declining profitability of hospitals and tightening funding from the NIH. I'm now seeing all the MD/PhDs who have left my lab and neighboring labs going into private practice because they couldn't get any money for career development. When they're just out of fellowship, they're not given enough protected time, not given any startup money, and instead are given alot of incentives for doing more and move clinical work. This is supposedly one of the best places for a physician-scientist (at least that's what my PDs like to have us think), but yet it doesn't seem like they're getting the support they need. I guess med schools just simply don't care about supporting physician-scientists.
What can the NIH do? More career development money. I'm not really sure what already exists, but it doesn't seem to be enough after watching several MD/PhDs try and fail. I mean heck, only a small minority of institutes will potentially fund that F30 I submitted. The NIH will have to pick up the slack that clinical departments won't give to their investigators so that physician-scientist careers can get started. What ever happened to things like startup packages?
Supporting training grants is a key aspect to developing physician scientists and a wide range of these grant programs already exist. Training grants, especially individual ones, such as K08s, primarily fund the individual, not the research laboratory. This can be great for the institution, but doesnt work to really develop a long-term career in and of itself. Ultimately, in my experience, the real point at which we lose physician-scientists is at the point of transitioning from mentored and other training grants to non-mentored grants and setting up ones own lab. The standard is and will likely to remain the R01 and it is the R01 holders who serve as mentors for the training grants, so enhancing the R01 mechanism is crucial to developing and supporting physician-scientists. I was only partly joking about different scoring for R01s for physician-scientists. There needs to be true bridging money to get labs started. With the loss of the R29 mechanism, its difficult to jump to that first R01 from a training grant usually much harder than getting a training grant.
At the present time, with all NIH funding, especially R01 funding, becoming more difficult to obtain, it is not surprising that institutions are pushing their junior faculty into revenue-generating clinical tasks. This is due to many things, including a lack of mutual understanding between clinical departments and basic science mentors about the time needs of starting faculty, the relative ease with which physician-scientists can have new clinical responsibilities eat into their time and, the agonizing process of writing grants. Few physician-scientists after a clinical fellowship would rather write a grant than take care of a patient. Im really not trying to get the institutions off the hook here, just reflecting on the reality of the situation as I have seen it over many years and watching many, many unsuccessful starts to academic careers.
Institutions have a strong interest in getting physician-scientists funded as this brings in dollars, reputation and publicity. But start-up funds do not a career make. Ive seen many folks go nowhere with institutional start-up funds. Institutions should provide this money if they are not, its because they have seen a pattern of it not working in that department or institution or there is a very, very short-sighted department head. Personally, I have not seen institutional start-up funds be as useful as they could I think the emphasis should be on getting the motivated individuals to submit NIH training grant applications and using institutional support primarily to increase the lab money for those who get the training grants. As I said, training grants are notoriously low in the amount they give for actual lab personnel and supplies. If a starting faculty is doing all their own lab work, they dont have time to move forward quickly.
What are some solutions? Well, I dont think they are simple at all. Ultimately, there must be a clear understanding for physician-scientists that the initial years of their career, AFTER residency are going to be primarily spent on research (including lots of grant writing-time) and little clinical work. The institutions must be willing to support this but they will only be willing if the people are well selected and they see a high success rate for those they support. Im not sure this means MORE physician-scientists being trained via MD/PhD or research year programs I think it might be better right now to support fellows and junior faculty who have clear evidence of successful initial efforts and a commitment to research. But, this is very hard to demonstrate impossible at the medical school level.
I will pass for now on discussing the role of debt in limiting physician-scientists. A real issue, but Id rather first discuss these other aspects of developing successful physician-scientists.
Regards
OBP
