Training the physician-scientist: views from program directors and aspiring young investigators

Abstract

There is growing concern that the physician-scientist is endangered due to a leaky training pipeline and prolonged time to scientific independence (1). The NIH Physician-Scientist Workforce Working Group has concluded that as many as 1,000 individuals will need to enter the pipeline each year to sustain the workforce (2). Moreover, surveys of postgraduate training programs document considerable variability in disposition and infrastructure (3). Programs can be broadly grouped into two classes: physician-scientist training programs (PSTPs) that span residency and fellowship training, and research-in-residency programs (RiRs), which are limited to residency but trainees are able to match into PSTPs upon transitioning to fellowship (Figure 1). Funding sources for RiRs and PSTPs are varied and include NIH KL2 and T32 awards, charitable foundations, philanthropy, and institutional support. Furthermore, standards for research training and tools for evaluating programmatic success are lacking. Here, we share consensus generated from iterative workshops hosted by the Alliance of Academic Internal Medicine (AAIM) and the student-led American Physician Scientists Association (APSA).

Figure 1. The physician-scientist career path.

Representative schematic of the pipeline that yields the physician-scientist workforce and points of attrition, with best known estimates of losses. Also shown are multiple on-ramps for recruitment to this career path. Labeled block arrows represent training opportunities. Arrows indicate options for transitions between training programs, with solid black arrows denoting the standard research-based physician-scientist training pathway, solid gray arrows indicating on-ramps, and dashed gray arrows showing points of pipeline leakiness, where trainees opt not to pursue research-based careers. PSTP: physician-scientist training program; RiR: research in residency. The pipeline was adapted with permission from ref. , and the figure was conceptualized in its entirety by AJA and PJH.