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The Vanishing Physician-Scientist?

The Vanishing Physician-Scientist?

Edited by Andrew I. Schafer
Copyright Date: 2009
Edition: 1
Published by: Cornell University Press,
Pages: 304
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  • Book Info
    The Vanishing Physician-Scientist?
    Book Description:

    Throughout history, physicians have played a vital role in medical discovery. These physician-scientists devote the majority of their professional effort to seeking new knowledge about health and disease through research and represent the entire continuum of biomedical investigation. They bring a unique perspective to their work and often base their scientific questions on the experience of caring for patients. Physician-scientists also effectively communicate between researchers in the "pure sciences" and practicing health care providers. Yet there has been growing concern in recent decades that, due to complex changes, physician-scientists are vanishing from the scene.

    In this book, leading physician-scientists and academic physicians examine the problem from a variety of perspectives: historical, demographic, scientific, cultural, sociological, and economic. They make valuable recommendations that-if heeded-should preserve and revitalize the community of physician-scientists as the profession continues to evolve and boundaries between doctors and researchers shift.

    eISBN: 978-0-8014-6242-9
    Subjects: Health Sciences

Table of Contents

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  1. Front Matter
    (pp. i-vi)
  2. Table of Contents
    (pp. vii-viii)
  3. Preface
    (pp. ix-xii)
  4. Introduction
    (pp. 1-16)
    Andrew I. Schafer

    Few members of the general public are even aware that much of the original research which has driven progress in medical knowledge throughout history has been conducted by physicians who are themselves directly involved in the practice of medicine.

    Yet throughout history physicians have played a central role in advancing the science of medicine. They have brought to medical research the unique perspective of being able to ask questions inspired by their personal experience of caring for patients. Indeed, during the first half of the twentieth century, the physicianʹs position as a ʺtranslatorʺ of medical research predominantly took the route...

  5. 1 History of the Physician as Scientist
    (pp. 17-38)
    Andrew I. Schafer

    While physicians have played a pivotal, often leading role in medical investigation throughout history, the manner of their involvement in the research enterprise has evolved over time. As the ability or even necessity of physicians also to function as scientists is increasingly questioned in todayʹs era of extraordinarily rapid advances in the biomedical sciences, it is instructive to begin the discussion with a historical perspective. In this chapter I first illustrate why and how physicians have pioneered many of the great breakthroughs in medical science, and then provide an overview of their central but ever-changing role in the medical research...

  6. 2 Demographics of the Physician-Scientist Workforce: IMPACT OF AGE, GENDER, DEGREES, AND DEBT
    (pp. 39-49)
    Timothy J. Ley

    Physician-scientists are individuals who hold an MD degree and who perform medical research as their primary professional activity. Most physician-scientists have only the MD degree, but many have a second degree (e.g., PhD, MPH, MBA, JD). Although physician-scientists conduct scientific investigation along a broad range of topics, virtually all have been imprinted during their training by caring for patients. These clinical experiences shape the approaches of this unique group of investigators during their subsequent scientific careers.

    A number of trends during the 1980s and 1990s suggested that this career pathway was in serious jeopardy (Gill 1984; Wyngaarden 1979; Zemlo et...

  7. 3 The Ecology of Physician-Scientists in Academic Medicine
    (pp. 50-66)
    David Korn and Stephen J. Heinig

    Although few would deny that physician-scientists are essential to fulfilling the core missions of academic medicine—research, education, and patient care—or, indeed, that they are the only faculty who ideally embody all three of these missions, these investigators do not always see themselves as being thought essential or even welcomed within the maelstrom of the contemporary academic medical center. Yet since medical schools and teaching hospitals provide the unique breeding grounds for physician-scientists, whatever their later career paths, academic medicine is obliged to ensure that the national corps of physician-scientists is continually replenished and its robustness sustained. Not only...

  8. 4 Translational Research and the Physician-Scientist
    (pp. 67-83)
    Barry S. Coller

    Harnessing the power of the scientific method to improve health and alleviate suffering from disease is perhaps humankindʹs greatest achievement. We take for granted the connection between science and medicine, and so it is worth emphasizing that human observational science only began with Renaissance artists (Lucas 1955) and anatomists (Vesalius 1543) making detailed drawings of living and dead humans. Modern human experimental science really only began in 1865, when the French physiologist and physician Claude Bernard argued passionately that it was vital to develop human experimental science (Bernard 1927; Grande and Visscher 1967). It is probably no coincidence that Bernard...

  9. 5 Women as Physician-Scientists
    (pp. 84-96)
    Reshma Jagsi and Nancy J. Tarbell

    One of the most significant changes in the medical profession in recent years has been the dramatic transformation of the demographic composition of its entering members. The gender distribution of the current medical school class now mirrors that of society more generally. Yet women still remain distinctly in the minority on medical school faculties, especially at more senior levels.

    One can advance several arguments to support the investigation of gender issues in the physician-scientist community. One argument is deontological in nature. Given that senior positions in academic medicine are among the most highly sought after in our society, gender disparities...

  10. 6 Generation X and the Millennials in Academic Medicine: DEVELOPING THE NEXT GENERATION OF PHYSICIAN-SCIENTISTS
    (pp. 97-112)
    Ann J. Brown

    The generations queuing up to replace aging baby boomer faculty in academic medicine are different from their predecessors. Whereas boomers are comfortable with total commitment to their careers, Generation X and the millennials will demand a different relationship to work. They will look for environments that support flexible work schedules and policies that support their dual priorities of a stimulating career and time for family and avocations. This raises a question important to those concerned about the future physician-scientist workforce: Will academic health centers (AHCs), with their traditional demand for total devotion to work, be able to continue to attract...

    (pp. 113-119)
    Stephen G. Emerson, Philip Meneely and Jennifer Punt

    As the twenty-first century opens, the potential for biomedical research to yield meaningful discoveries that enhance human health and mitigate disease is clearly greater than ever before. Targeted therapeutics, tissue engineering, genotype-selective diagnostics, and many other new fields beckon. Making the most of these exciting opportunities will require physician-scientists who are as excited by these possibilities as they are trained to contribute to the development of these fields. So while it is clearly important to ask, ʺHow do we keep interested physician-scientists in the field?ʺ it is equally and perhaps more useful to ask, ʺHow do we best entice, educate,...

  12. 8 The Role of Academic Medical Centers and Medical Schools in the Training and Support of Physician-Scientists
    (pp. 120-137)
    Philip A. Pizzo

    The education, training, and career development of physician-scientists has evolved in parallel with the sweeping changes in medicine that have occurred in the United States beginning in the post–Civil War era. As described in chapter 1 by Andrew Schafer, in the last half of the nineteenth century, medical education was largely devoid of a scientific tradition or foundation. Physicians interested in research traveled to Europe (especially Germany, Italy, and France) to pursue their training and career goals. In the 1880s Charles Eliot of Harvard, along with the presidents of several other public and private universities, began a reformation of...

  13. 9 The Relationship between Physicians and PhD Scientists in Medical Research
    (pp. 138-155)
    Roy L. Silverstein and Paul E. DiCorleto

    Only a small number of individuals have been charged with directing the National Institutes of Health (NIH) during its modern era, and each has left behind an important legacy. One of the significant accomplishments of Dr. Elias Zerhouni, director of the NIH from 2002 to 2008, was to awaken the scientific, government, and lay communities to the large gap that exists between research progress at the laboratory bench and its impact in the clinic. The once rarely heard term ʺtranslational researchʺ—that is, research designed to bridge that gap—has now become a common phrase in the scientific lexicon, appearing...

  14. 10 Mentoring Physician-Scientists: REPAIRING THE LEAKY PIPELINE
    (pp. 156-178)
    Kenneth Kaushansky

    Physician-scientists are individuals with medical training who spend most or all of their time performing disease-oriented or patient-oriented research. Physician-scientists are critical members of the medical research community, as the scientific questions they ask derive from taking care of patients. While the pathway to becoming a physician-scientist can be varied, there are two basic models. One is represented by the MD-PhD who entered a combined degree program after graduation from college and has had a clear path toward a career in biomedical science. The alternate pathway, characterized by many as the ʺlate bloomer,ʺ comprises approximately two-thirds to three-quarters of all...

  15. 11 Mentoring the Physician-Scientist: A DEVELOPMENTAL APPROACH
    (pp. 179-192)
    Alan L. Schwartz and Margaret K. Hostetter

    Mentoring future physician-scientists involves the identification, recruitment, and retention of those who have the potential to become the successful investigators of the next generation. Therefore it is essential to encourage the participation of junior and senior physician-scientist faculty members—potential future mentors—in such medical student activities as combined MD-PhD degree Medical Scientist Training Programs (MSTPs), first- and second-year student teaching activities, and special programs for students considering research careers.

    These ʺcultivationʺ activities should complement time spent in specialty education. Wright and colleagues (1998) found that role models identified by internal medicine residents at four institutions consistently spent more than...

  16. 12 The Attrition of Young Physician-Scientists: PROBLEMS AND POTENTIAL SOLUTIONS
    (pp. 193-207)
    Mark Donowitz, James Anderson, Fabio Cominelli and Greg Germino

    There is little doubt of the important and growing role played by the physician-scientist in generating medical advances in the post-genomic era.¹ Without extensive involvement of scientists who understand both basic physiologic mechanisms and the subtle aspects of human diseases, there will be significant delays in the application of molecular breakthroughs to the diagnosis of diseases and the development of cures. With this in mind, the current situation of physician-scientists selecting investigative careers bears some scrutiny. As discussed in chapter 14 by Andrew Schafer, the Association of Professors of Medicine (APM) in its 2007 conference ʺRevitalizing the Nationʹs Physician-Scientist Workforceʺ...

  17. 13 Restoring and Invigorating an “Endangered Species”: INITIATIVES BY THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES
    (pp. 208-226)
    David Korn and Stephen J. Heinig

    In this chapter we review lessons from a national ʺclinical research summitʺ meeting that embedded academic clinical research within the larger construct of a national clinical research enterprise, and from the Association of American Medical Collegesʹ (AAMC) initial task force on clinical research that recommended wide-ranging organizational and programmatic reforms to strengthen clinical investigation in medical schools, teaching hospitals, and health care systems. We then discuss the recommendations of a second AAMC task force on clinical research, which focused exclusively on concrete and measurable actions to strengthen the environment for academic clinical and translational physician-scientists. We conclude by summarizing the...

  18. 14 Revitalizing the Nation’s Physician-Scientist Workforce: THE ASSOCIATION OF PROFESSORS OF MEDICINE INITIATIVE
    (pp. 227-244)
    Andrew I. Schafer

    The academic medical community and the National Institutes of Health (NIH) have long been aware of jeopardy to the physician-scientist career path. As discussed elsewhere in this book, the number of physicians electing to pursue a primarily research-oriented career has declined in recent decades. The percentage of physicians engaged in research as their major professional activity in the United States decreased from a peak of 4.6 percent in 1985 to 1.8 percent in 2003. At the same time, the absolute number of physician-scientists dropped from a peak of about 23,000 in 1985 to 14,000 in 1995. This decline subsequently leveled...

  19. 15 A Half Century of Clinical Research
    (pp. 245-256)
    David G. Nathan

    When my father, who dearly wanted to be a physician and had actually been admitted to the Harvard Medical School in 1920, told my grandfather that he planned to go to medical school, the splendid Victorian gentleman whom I intensely admired categorically intoned, ʺNo son of mine is going to be a fake and a phony who comes to your house, drinks your coffee and canʹt do a damned thing for you.ʺ Which explains why my father dutifully entered a branch of the family business. My grandfatherʹs views were forged in an era when, as Paul Starr describes in his...

  20. Epilogue: LOOKING FORWARD
    (pp. 257-260)
    Andrew I. Schafer

    The central premise of this work has been that physicians, working as active researchers, have throughout history played, and must in the future continue to play, a vital role in the advancement of medical knowledge. Informed by their personal experiences in caring for patients, they are irreplaceably positioned at the interface between fundamental biomedical science and clinical practice. Yet today a convergence of transformational forces threatens the future viability of physician-scientists, at least in the form in which we currently recognize them. As described in the foregoing chapters, these forces are a combination of social, cultural, educational, demographic, ecological, and...

  21. References
    (pp. 261-274)
  22. List of Contributors
    (pp. 275-280)
  23. Index
    (pp. 281-288)