Multiple Degrees and a Mountain of Debt

This past week the National Institutes of Health (NIH) Physician-Scientist Workforce Working Group (PSW-WG) published its findings and recommendations regarding the current state of the PSW field. They found that there are many challenges facing aspiring physician-scientists today, which may contribute to the imminent shortage in doctors pursuing this career.

Defined by the Working Group as, “scientists with professional degrees who have training in clinical care and who are engaged in independent biomedical research,” physician-scientists made up 1.5 percent of the total physician workforce in 2012. From the years 2008 to 2012, there were approximately 9,000 physician-scientists in the workforce funded by NIH biomedical research. Data from the American Medical Association surveys show that the physician-scientist workforce has decreased at a statistically significant rate over a ten-year period from 14,521 in 2003 to 13,717 in 2012.

What factors are contributing to this phenomenon?

In 2013, 86 percent of students graduating from medical school were graduating with debt. The median debt for medical school is $175,000. For those with substantial amounts of debt, becoming a physician-scientist involves a longer training period, further pushing off the beginning of a clinical career when one earns greater compensation.

From a financial point of view, there is also the concern of research funding. This uncertainty of funding was by far the biggest concern of young physician-scientists, as indicated by qualitative research done by the PSW-WG. Academic medical centers, where most physician-scientists are employed, are facing increasing financial pressures. In order to maintain their levels of operation, they need to increase their revenues from clinical visits. This often translates into pressure put on the physician-scientists to see more patients instead of conducting their research.

The length and structure of the training to become a physician-scientist is also of concern. Those students pursuing double degree programs (e.g., M.D.-Ph.D. programs) face eight years of schooling between their studies in medical school and graduate school. Only after all of this schooling would students begin their residency and fellowship. By the end of this process, the research skills of the students are often outdated before they even have an opportunity to return to the lab and conduct their own research.

Data collected by the PSW-WG indicates that young physician-scientists are particularly vulnerable to leaving this career path, specifically women. By the time females have completed all of their training, or even in the process of the training, they are starting their family and have difficulty establishing a work-life balance. Family leave and child care policies also factor into a female’s choice to enter the career path of a physician-scientist.

Career success was positively linked to an effective mentor-mentee relationship. The results of NIH supported research, which investigated interventions and causal factors that influence the careers of women in biomedical and behavioral science and engineering, showed that effective mentoring is achieved by a mentoring network, rather than a single mentor. It is important for these mentors to represent varied areas of expertise, background and experience. However, as only 22 percent of female physician-scientists holding MD/PhDs are RPG grant holders (marks entry into the independent workforce), there are not many female mentors for aspiring physician-scientists. Further, with nearly three-quarters of MD RPG awardees being white, the lack of racial diversity for RPG awardees makes it difficult for minorities to find mentors in the field.

The PSW-WG estimated that if the average career of a physician-scientist is 30 years, 1,000 individuals would need to enter the physician-scientist workforce each year to maintain the steady state it is currently at. This estimate is assuming that 50 percent of people who enter the pipeline will not succeed.

With the impending possibility of a physician-scientist shortage, the proper support needs to be available and provided to those interested in pursuing this career path. Physician-scientists have the medical training and hands-on experience to target the areas of health care that need the most innovation and increased knowledge. These professionals have the necessary skills to take the lessons they learn from the bedside of patients and translate them into treatments and cures. A physician-scientist career path is one that is imperative to the future of medicine

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