Physician-Scientist Development
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
Abstract
MD-PhD programs provide interdisciplinary training in medicine and research. Undergraduate pre-health advisors (PHAs) play a critical role in counseling prospective applicants, yet there have been no studies to our knowledge of MD-PhD pre-health advising. Here we surveyed 280 PHAs from US colleges and universities using both qualitative and quantitative measures that assessed their real-world advising behaviors as well as standardized evaluation of 1 of 2 fictional MD-PhD applicants, identical except for gender. We identified 3 factors that influenced advising behaviors: experience advising MD-PhD applicants, attitudes toward MD-PhD programs, and gender bias. Those PHAs with less experience and who held negative attitudes toward MD-PhD programs were less likely to initiate discussions about MD-PhD programs with qualified applicants and less likely to recommend the fictional applicants apply to MD-PhD programs. Finally, there was subtle gender bias that favored the male applicant. PHAs face challenges in advising MD-PhD applicants because there are relatively few MD-PHD applicants overall and there is a lack of resources to guide them. Addressing these challenges by strengthening collaborations with PHAs and providing comprehensive information about the value of and applicant qualifications for MD-PhD programs is crucial to enhancing MD-PhD advising, mitigating effects of bias, and expanding the pool of qualified applicants.
Authors
Amara L. Plaza-Jennings, Christie B. Ryba, Jessica Tan, Jennifer E.L. Diaz, Grace E. Mosley, Talia H. Swartz, Margaret H. Baron, Robert Fallar, Valerie Parkas
Abstract
Efforts dating back to the 1950s have sought to formalize educating physician-scientists, individuals trained in both science and medicine and who devote the bulk of their professional time to investigative work. The return on investment has been huge, because, as a group, these individuals have made outsized contributions to advancing human health. However, efforts at supporting the physician-scientist career path have been accompanied by repeated concerns regarding the lack of intentional support needed to sustain trainees and faculty. This Perspective reviews the history of the career path, highlighting both opportunities and challenges, and offers seven recommendations with the potential to both promote its vitally and reinvigorate its future at all its stages.
Authors
Gary Koretzky
Abstract
The Alliance for Academic Internal Medicine (AAIM) first convened a workshop in 2015 that brought a small group of internal medicine program directors together who recognized the growing success of early-phase physician-scientist training programs but the unclear path afterward for these trainees. The meeting subsequently evolved into what is now the annual American Society for Clinical Investigation/AAIM/Burroughs Wellcome Fund (ASCI/AAIM/BWF) Physician-Scientist Pathways Workshop, which continues to bring stakeholders together to discuss the obstacles to success that physician-scientists face at all stages of their careers. This perspective presents the history and goals of the workshop, with an emphasis on the most recent meeting in 2024, and looks ahead to the work that still needs to be done to ensure a robust physician-scientist workforce.
Authors
Kyu Y. Rhee, Charles W. Emala, Emily Jane Gallagher, Don C. Rockey, Patrick J. Hu, Jatin M. Vyas, Daniel P. Cook, Tiffany C. Scharschmidt, Olujimi A. Ajijola, ASCI Research Pathways Working Group, Christopher S. Williams
Abstract
MD-PhD programs prepare physicians for research-focused careers. The challenge for admissions committees is to select from among their applicants those who will achieve this goal, becoming leaders in academic medicine and biomedical research. Although holistic practices are encouraged, the temptation remains to use metrics such as grade point average, MCAT scores, and postbaccalaureate gap length, combined with race/ethnicity, age at college graduation, and sex to select whom to interview and admit. Here we asked whether any of these metrics predict performance in training or career paths after graduation. Data were drawn from the National MD-PhD Program Outcomes Study with information on 4,659 alumni, and 593 MD-PhD graduates of the Albert Einstein College of Medicine and the University of Pennsylvania. The Penn-Einstein dataset included admissions committee summative scores, attrition, and the number and impact of PhD publications. Output metrics included time to degree, eventual employment in workplaces consistent with MD-PhD training goals, and self-reported research effort. Data were analyzed using machine learning and multivariate linear regression. The results show that none of the applicant metrics, individually or collectively, predict in-program performance, future research effort, or eventual workplace choices even when comparisons were limited to those in the top and bottom quintiles.
Authors
Lawrence F. Brass, Maurizio Tomaiuolo, Aislinn Wallace, Myles H. Akabas
Abstract
To reduce debt burden and encourage the pursuit of research-focused careers, most MD-PhD programs provide medical school tuition remission and an annual stipend. However, prolonged training compared with MD physicians postpones the time until MD-PhD physicians earn a full salary. We compared lifetime earning potential for MD-PhD physicians in academia with their MD colleagues in the same clinical specialty. We examined the relationship between earning potential based on specialty and the likelihood that MD-PhD physicians reported being engaged predominantly in research. Lifetime earning potential was estimated using 2020–2021 debt and compensation data for 77,701 academic physicians across 47 specialties. Self-reported research effort for 3,025 MD-PhD program alumni in academia was taken from the National MD-PhD Program Outcomes Study. We found that (a) MD-PhD physicians had a lower lifetime earning potential than MD physicians in the same specialty; (b) there was an inverse relationship between earning potential and research effort in different specialties, with MD-PhD physicians in high-earning specialties tending to spend less time on research; and (c) despite this, MD-PhD physicians in academia were more likely to choose clinical fields that allow more time for research.
Authors
Eva Catenaccio, Jonathan Rochlin, Myles H. Akabas, Lawrence F. Brass, Harold K. Simon
Abstract
The earliest MD/PhD programs were small and enrolled mostly men. Here we show that since 2014 there has been a steady increase in the number of women in MD/PhD programs, reaching parity with men in 2023. This change was due to an increase in female applicants, a decrease in male applicants, and an increase in the acceptance rate for women, which had previously been lower than for men. Data from the National MD/PhD Program Outcomes Study show that training duration has been similar for men and women, as have most choices of medical specialties and workplaces. However, women were less likely to have full-time faculty appointments, fewer had NIH grants, and those in the most recent graduation cohort at the time of the survey reported spending less time on research than men. Previously-cited reasons for these differences include disproportionate childcare responsibilities, a paucity of role models, insufficient recognition, and gender bias. Institutions can and should address these obstacles, but training programs can help by preparing their graduates to succeed despite the systemic obstacles. The alternative is a persistent gender gap in the physician-scientist workforce, lost opportunities to benefit from diverse perspectives, and a diminished impact of valuable training resources.
Authors
Lawrence F. Brass, Myles H. Akabas
Abstract
The average time-to-degree for completing a life sciences PhD in the U.S. is longer for single-degree than dual-degree trainees, supporting a perception that the PhD training of MD-PhDs is less rigorous or fulsome. To determine whether the duration and impact of graduate training is influenced by degree format, we analyzed data for the 2011–2016 graduates of three Harvard Medical School PhD programs. Linear mixed effects models were used to determine the association between degree type (MD-PhD vs. PhD) and research outcomes, including time-to-degree, time-to-thesis-defense, and publications submitted during the PhD. Although pursuing an MD-PhD was associated with a 1.5-year shorter time-to-PhD-degree, basing this calculation on the official PhD period does not account for completion of early PhD requirements, including research rotations and qualifying coursework, during the first two years of medical school. There was no association between degree format and the total number of first-authored or overall publications, although pursuing a dual degree was associated with increased impact metrics of published papers. The results highlight that despite the optically shorter PhD durations of MD-PhD graduates based on graduate program enrollment period, research training is on par with their single-degree peers, rendering MD-PhD graduates well equipped to become successful scientific investigators.
Authors
Rory Vu Mather, Temperance R. Rowell, Steve Obuchowski, Loren D. Walensky
Abstract
Physician-scientists play a crucial role in advancing medical knowledge and patient care, yet the long periods of time required to complete training may impede expansion of this workforce. We examined the relationship between postgraduate training and time to receipt of NIH or Veterans Affairs career development awards (CDAs) for physician-scientists in internal medicine. Data from NIH RePORTER were analyzed for internal medicine residency graduates who received specific CDAs (K08, K23, K99, or IK2) in 2022. Additionally, information on degrees and training duration was collected. Internal medicine residency graduates constituted 19% of K awardees and 28% of IK2 awardees. Of MD-PhD internal medicine–trained graduates who received a K award, 92% received a K08 award; of MD-only graduates who received a K award, a majority received a K23 award. The median time from medical school graduation to CDA was 9.6 years for K awardees and 10.2 years for IK2 awardees. The time from medical school graduation to K or IK2 award was shorter for US MD-PhD graduates than US MD-only graduates. We propose that the time from medical school graduation to receipt of CDAs must be shortened to accelerate training and retention of physician-scientists.
Authors
Emily Jane Gallagher, Paul R. Conlin, Barbara I. Kazmierczak, Jatin M. Vyas, Olujimi A. Ajijola, Christopher D. Kontos, Robert A. Baiocchi, Kyu Y. Rhee, Patrick J. Hu, Carlos M. Isales, Christopher S. Williams, Don C. Rockey
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