Physician-Scientist Development
Abstract
Physician-scientists link clinical investigation with biomedical discovery, yet sustaining research engagement across training and early career remains challenging. We conducted a structured evidence synthesis of physician-scientist training in China and selected comparator systems. PubMed and Web of Science searches covering 2010-2025 yielded 3,639 records; after deduplication, screening, and adjudication, 90 primary empirical studies were included, comprising 73 with direct physician-scientist evidence and 17 with supportive residency-context evidence. Research exposure varied across pathways and programs. Chinese residency studies documented substantial training burden, while formal protected research time was not consistently identified in reviewed residency settings, positioning residency as a plausible constraint on research continuity without establishing causality. The transition from structured training toward research independence also emerged as a recurrent vulnerability involving discontinuities in protected research opportunity, mentorship, and career-development support. Across systems, protected research opportunity, transition support, funding continuity, and early-career support recurred as structural features, with implementation varying by system, institution, program, and career stage. These findings support research continuity as an organizing framework and identify structural mechanisms warranting prospective evaluation rather than universal prescription.
Authors
Yaming Liu, Chunmeng Jiang, Zhiyu Liu
Abstract
Effective grant writing is an essential skill for physician-scientists to achieve academic independence and long-term career success. Previous studies have established that receiving an NIH F30 or F31 during predoctoral training is correlated with success in subsequent training stages and contributes to the retention of physician-scientists in academia. However, many trainees experience challenges in predoctoral grant writing that prevent them from submitting a grant or developing a well-rounded application. Identifying and addressing these challenges remains crucial; however, limitations in NIH public reporting exclude data on prospective applicants and applicants who were not awarded grants. In this study, we employed a national survey of trainees to identify perceived needs and barriers to grant writing as well as factors associated with NIH predoctoral grant funding success. We found that limited mentor and sponsor support to developing quality applications, constrained eligibility timelines, and limited available awards were prominent barriers to submission, while access to previously funded applications was the most valued resource among respondents. Using these findings, we highlight opportunities for interventions at the federal, institutional, applicant, and medical and scientific society levels to improve predoctoral grant writing feasibility and success.
Authors
Brian J. Thomas, Tiger S. Zhang, Daniel C. Brock, Timothy J. Ley, William D. Arnold, Cynthia Y. Tang
Abstract
The American Board of Internal Medicine Research Pathway (ABIM RP) is designed to train physician-scientists by shortening postgraduate clinical training and increasing research time. We surveyed ABIM RP graduates to understand career trajectories, research engagement, and barriers to physician-scientist retention in academic research careers. We performed an anonymous, structured, web-based survey of 700 ABIM RP current and former trainees (2011–2022). We received 105 survey responses (97 RP graduates). The survey queried about demographics, training background, career outcomes, research involvement, and perceived barriers to retention in physician-scientist careers. Responses were stratified by trainee status, gender, and Medical Scientist Training Program (MSTP) participation, and select results were compared to test for statistical associations. Most respondents (79%) remained in academia, with 61% engaged in research-dominant roles. More MSTP graduates held research-focused academic positions than non-MSTP graduates. The most commonly reported barriers to sustaining research careers were funding instability, financial concerns, and lack of protected research time. Although many of the trainees in the ABIM RP who completed the survey remained in academia, systemic barriers such as funding instability and gaps in institutional support persist. Strategies to enhance financial stability, protected research time, and mentorship appear to be necessary to enhance physician-scientist career retention.
Authors
Emily J. Gallagher, Barbara I. Kazmierczak, Michael Kisielewski, Nathan Schoettler, Clifford J. Steer, Robert A. Baiocchi, Jatin M. Vyas, Kyu Y. Rhee, Patrick J. Hu, Carlos M. Isales, Paul R. Conlin, Christopher D. Kontos, Michael Melfe, Furman S. McDonald, Don C. Rockey, Christopher S. Williams
Abstract
Programs at the medical school level to train students as physician-scientists include NIH-supported MD-PhD (Medical Scientist Training Program, MSTP), non–NIH-supported MD-PhD (MDPhD), and limited research pathways for MD-only students. Continued exposure to a research-rich culture in residency could sustain commitment to a physician-scientist career. We compared residency matches of 10,668 MSTP, MDPhD, or MD-only students from 2021–2023 match cycles, using the NIH funding level of the matched residency program’s department in the match year as the central measure. We also measured how medical school NIH funding levels influenced student matches to top-funded residency programs. Public individual-level match data were available from 13 top-NIH-funded medical schools (top quintile, highest 20% funding) and 8 mid-NIH-funded medical schools (mid quintile, 40%–60% funding). Top-quintile medical schools housed only MSTP programs, whereas mid-quintile schools had both MSTP and MDPhD programs. Across all medical schools, MSTP students matched at a higher rate than MD-only students to residencies in top-NIH-funded departments in their discipline. Within the mid-quintile schools, MSTP and MDPhD student matches did not differ significantly. Notably, students from the top-quintile medical schools (both MD-only and MSTP) matched to higher-NIH-funded residency departments than comparably trained students from the mid-quintile schools.
Authors
Shannon Baker, S. Mehdi Nouraie, Richard A. Steinman
Abstract
Physician-scientists represent one of the most impactful, yet underrecognized, innovations of 20th century academic medicine. Defined by a commitment to full-time careers in investigative work, physician-scientists have repeatedly demonstrated a unique ability to identify and solve problems of unmet medical need in a focused and intentional manner using their dual training in clinical medicine and the scientific method as both stethoscope and scalpel. Unfortunately, mounting financial pressures from both the clinical and research marketplaces have placed this storied workforce in jeopardy due to the absence of a dedicated and explicitly defined vocational structure and business model. This white paper reports the output of a consortium of academic medical centers, foundations and professional societies seeking to remedy this deficiency. This consortium specifically developed a framework to formalize the career path of physician-scientist faculty into a professionally unified and financially sustainable structure in a way that could be adopted to different U.S. academic medical centers and health systems. Key components of this framework included an administratively operational definition of physician-scientists, and three central and interconnected pillars (academic, financial, and organizational) that are rooted in this foundational definition. Herein, we detail core concepts and concrete recommendations.
Authors
Christopher S. Williams, Megan Allen, Paige Cooper Byas, John B. Hawley, Louis J. Muglia, E. Dale Abel, Julie A. Bastarache, Carolyn S. Calfee, John M. Carethers, David N. Cornfield, Oliver Eickelberg, Emily J. Gallagher, Anna Greka, Peter J. Gruber, Anthony N. Hollenberg, Heidi H. Kong, Barbara I. Kazmierczak, Gary A. Koretzky, Mark Lachs, Deborah J. Lenschow, Geoffrey S. Pitt, Don C. Rockey, Lisa M. Satlin, Barry P. Sleckman, David A. Stoltz, Jatin M. Vyas, Thomas J. Wang, Kyu Y. Rhee
Abstract
The physician-scientist career has historically progressed through individual persistence and improvisation, as physician-scientists have navigated the demands of clinical practice combined with biomedical research without a clearly structured path. While this approach has sustained the field for several decades, individual determination is increasingly insufficient in the current climate, given the growing complexity within both clinical and research training, as well as potential disruptions to research funding and health care reimbursement. The 2025 ASCI / AAIM / Burroughs Wellcome Fund Physician-Scientist Pathways Workshop convened national leaders and faculty at all career stages to assess existing structures and envision new and more deliberate approaches. Discussions highlighted the impact of NIH initiatives in supporting early careers, institutional vulnerabilities, and need for intentional investments in physician-scientist careers. Breakout sessions emphasized the importance of dedicated funding for physician-scientist pathways, mentorship, social supports, and national benchmarks for compensation and promotion for this unique career pathway. The physician-scientist career path now stands at a crossroads. Going forward, sustained investment, longer and more flexible funding mechanisms such as the R37 and R35 Maximizing Investigators’ Research Award (MIRA) programs, and transparent standards are required. Federal funding alone cannot ensure the stability of a physician-scientist’s career; therefore, new approaches and commitments from academic health centers, philanthropy, and industry will be essential to ensure the viability of this career. With coordinated, intentional strategic planning, the physician-scientist workforce can thrive and remain a driver of America’s biomedical research future.
Authors
Christopher S. Williams, Emily J. Gallagher, Daniel P. Cook, David Mankoff, Rebecca M. Baron, Christopher Pittenger, Jatin M. Vyas, Don C. Rockey, Patrick J. Hu, Ashley L. Steed, W. Kimryn Rathmell, Jeffrey R. Balser, Nancy J. Brown, John M. Carethers, Jonathan A. Epstein, Keith A. Choate, Peter J. Gruber, Tiffany C. Scharschmidt, Kyu Rhee
Abstract
MD-PhD trainees increasingly pursue PhDs in humanities, social sciences, and public health (SSHPH). We characterized SSHPH trainee experiences and compared them to peers in traditional biomedical disciplines. From March-July 2023, a nationwide survey was sent to United States MD-PhD programs that accept SSHPH trainees. Both SSHPH and non-SSHPH trainees participated in a survey focused on belonging, challenges and barriers, funding, and leadership recommendations. Quantitative data were analyzed using Fisher’s exact tests, Student’s t-tests, and Wilcoxon rank sum tests. Qualitative comments were analyzed using a hybrid deductive-inductive approach. 234 MD-PhD trainees across the U.S. participated, with 111 (47.4%) in SSHPH and 123 (52.6%) in non-SSHPH disciplines. Overall, there were many similarities between trainees across disciplinary groups, but small and consistent differences were noted among SSHPH trainees, including decreased belonging, difficulty identifying role models, and increased work requirements during graduate school. Respondents had 5 recommendations for MD-PhD leaders and 3 recommendations for the National Institutes of Health, such as integrating SSHPH scholars into speaker series and incentivizing funding parity. Limitations include high percentages of missing responses. This exploratory study provides insights into SSHPH MD-PhD trainee experiences, highlighting similarities and unique needs that can be addressed within and across MD-PhD programs.
Authors
Cambray Smith, Evans K. Lodge, C. Ray Cheever, Seth M. Holmes, Anna R. Kahkoska
Abstract
Dual-degree medical students pursue additional training to prepare for careers in research, public health, and administration, but how these experiences influence residency application behaviors and outcomes are poorly understood. We analyzed 36,298 residency applicants from the TexasSTAR database spanning 2017-2023 to compare application, interview, and match patterns among single-degree MD applicants and those with MD-PhD, MD-MPH, MD-MBA, or MD-MSc degrees. Despite differences in academic metrics, application strategies, and interview rates, match rates were similar across degree groups. MD-PhD students applied to fewer programs but had the highest interview offer-to-application rate and matched at more prestigious programs based on Doximity rankings. Beyond traditional application metrics such as board scores, research productivity, grades, and honor society membership, strategies including away rotations, geographic preferencing, and program signaling were associated with increased interview offers and match success among all applicants but were less influential for dual-degree applicants. These findings suggest dual-degree applicants require specialized advising and evaluation.
Authors
Daniel C. Brock, Deborah D. Rupert, Toni Darville, Caroline S. Jansen, Elias M. Wisdom, Cynthia Y. Tang
Abstract
Physician-scientists in academic medical centers require extramural grant support to launch and maintain their research careers. In order to cultivate the next generation of biomedical researchers, including physician-scientists, the NIH supports multiple career development (K series) awards. For many, their first experience in grant writing is composing a career development award (CDA) application. From the applicant’s perspective, this process can be difficult. For one, NIH institute–specific differences between the same K mechanism can be confusing. Additionally, the importance of the various elements that make up the K application are frequently misunderstood. Furthermore, many K applications will not be funded on the initial submission; therefore, the need to resubmit an application should not be viewed as a sign of failure, but rather can be viewed as an element of resilience in biomedical research. In this piece, we aim to provide guidance for aspiring K applicants — in particular, from the reviewer perspective — with the intent of making the application process more understandable. We offer dos and don’ts on different components of the K application, advice on when to reach out to a program officer, and tips on resubmission. Our overarching goal is to provide support for prospective K applicants in their effort to obtain a K award. While targeted to K applications, most of the contents of this summary apply to any CDA.
Authors
Don C. Rockey, Kyu Y. Rhee, Christopher S. Williams, Jatin M. Vyas, Charles W. Emala, Emily J. Gallagher
Abstract
High rates of physician-scientist attrition from the investigative workforce remains a significant problem despite the development of dedicated programs and initiatives designed to address the unique challenges faced by physician-scientists. However, many of these efforts are restricted to single career stages of physician-scientist training or to a single medical specialty, which may limit opportunities for beneficial vertical and horizontal mentorship regarding overcoming common career obstacles. Here, we outline the development of a physician-scientist symposium to break down silos and enable productive interactions between physician-scientists across career/training stages, academic and scientific disciplines, and medical specialties. Participants were mixed in (1) small-group problem-based discussions, (2) a cross-specialty keynote panel on overcoming barriers in a physician-scientist career, and (3) skill-building workshops. Attendees indicated that they fostered new connections, developed new skills to overcome career challenges, and increased their commitment to persevering in a career as a physician-scientist. Positive evaluations were not dependent on attendee career/training stage or gender. We suggest these elements of the symposium curriculum may be easily adapted for inclusion in a wide variety of physician-scientist training formats.
Authors
Kevin F. Dowling, Shohini K. Ghosh-Choudhary, Neil Carleton, Kathleen Prigg, Richard A. Steinman
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