Clinician-Investigator Training and the Need to Pilot New Approaches to Recruiting and Retaining This Workforce

Abstract

Clinician-investigators, also called physician-scientists, offer critical knowledge and perspectives that benefit research on basic science mechanisms, improved diagnostic and therapeutic approaches, population and outcomes medicine, health policy, and health services, yet few clinically trained health professionals pursue a research career. Sustaining this workforce requires attention to the unique challenges faced by investigators who must achieve clinical and research competence during training and their careers. These challenges include the duration of required clinical training, limited or discontinuous research opportunities, high levels of educational debt, balancing the dual obligations and rewards of clinical care and research, competition for research funding, and the need for leadership development after training. Women and individuals from underrepresented racial and ethnic groups comprise a small percentage of this workforce.The authors summarize the recent literature on training for clinician-investigators, emphasizing approaches with encouraging outcomes that warrant broader implementation. Using this overview as background, they convened three workshops at the National Institutes of Health in 2016 to identify and refine key priorities for potential new pilot programs to recruit and retain the clinician-investigator workforce. From these workshops emerged three priorities for future pilot programs: (1) support for research in residency, (2) new research on-ramps for health professionals at multiple career stages, and (3) national networks to diversify and sustain clinician-investigator faculty. Implementation of any pilot program will require coordinated commitment from academic health centers, medical licensing/certification boards, professional societies, and clinician-investigators themselves, in addition to support from the National Institutes of Health.

Figure 1

Comparison of the pools of MD and MD–PhD graduates with the number of National Institutes of Health (NIH) grants awarded. Of all NIH-funded MD or MD–PhD researchers, more than half hold an MD degree, and around 40% hold both MD and research doctorate degrees (see the percentages in the right panel of the figure). These percentages apply for both new investigator awards and research project grants. Based on the average age at which an investigator receives her or his first NIH grant (about 44 years of age), about 15 years elapse between MD graduation and receipt of one’s first NIH grant. When the numbers of MD and MD–PhD graduates in 2000 are compared with the numbers of NIH grants awarded to MDs and MD–PhDs in 2015, it is clear that few clinically trained health professionals elect to pursue a research career. Data on MD and MD–PhD graduates are from an analysis by the NIH Office of Extramural Research.

Figure 2

Depiction of the research on-ramp model for a clinician–investigator career. Existing National Institutes of Health support is indicated at the bottom of the figure. New, proposed on-ramps are indicated at the top of the figure. These on-ramps include additional research opportunities for health professionals at multiple career stages. Priorities for potential new pilot programs to recruit and retain the clinician–investigator workforce, indicated by the arrows in the middle of the figure, include support for research in residency, programs to complete a research degree during fellowship (or other stages), and national faculty networks to diversify and sustain this workforce.