The term physician-scientist may be confusing to some, and the pathway to becoming a successful physician-scientist is probably unclear to many.
For purpose of this column, a physician-scientist is defined as an individual trained as an MD/DO, with specialty training (i.e., completing a postdoctoral residency), who conducts funded basic or clinical research. Ideally, this is research funded by the National Institutes of Health, and represents a significant amount (>25 percent) of effort.
Physician-scientists can fill the gap between bench research and actual experience with human disease. Combined MD/PhD programs can provide this level of training. But there are other ways. Medical school education offers little time for students to conduct research. However, it is a time when exposure to physician-scientists can occur in the classroom or clinical settings. In addition, the “culture” of the medical school can also set a tone which plants the seed that a career in research is possible, and, rewarding.
In most cases, residency training does not provide much time for research either. But, again, programs can display a commitment to research and substantially influence career choice. Indeed, as a resident in internal medicine at Washington University School of Medicine in St. Louis, I had attending physicians who were members of the Institutes for Medicine, National Academy of Science, and Nobel Laureates. The way they discussed cases and diseases in a highly mechanistic and molecular manner was what attracted me to an investigative career.
The subspecialty fellowships are often the first opportunity to devote significant effort to research. Even then, the time may be only one or two years. At this juncture, potential physician-scientists typically take one of two paths. One is to complete another postdoctoral fellowship that is purely research based, preferably studying under a mentor who is highly accomplished (and funded). This is the opportunity to become fully immersed in research and catch up with PhD colleagues who have been speaking the language longer. The other path is to become a faculty member, but with a significant amount of protected time, and direct mentorship, for several years. This can be perilous if you get pulled into too many clinical responsibilities. The K grants from the NIH (such as the K08) can be quite helpful at this stage, providing a modest amount of salary support and an institutional commitment of protected time.
Regardless, I advise those at this stage to live in the lab, don’t volunteer for anything, and basically “lay low.” Your time will come, and despite all the years of training up to this point, you need to keep at it a few more years. The future of the physician-scientist has been under duress lately, due to increased medical school debt, decreased clinical reimbursements, and the decreased NIH pay lines. I hope this unique phenotype remains within our complex mix of biomedical researchers.
Stephen Liggett, MD
Vice Dean for Research
Professor of Medicine, Molecular Pharmacology and Physiology
USF Health Morsani College of Medicine
Co-director, USF Health Heart Institute
