The Decline and Fall of the Clinician–Scientist

The COVID-19 pandemic exposed vulnerabilities in the healthcare system’s ability to provide sustained services, medicines, and assorted basic supplies, such as personal protective equipment. It also exacerbated elements in the system already undergoing decline, like the

academic health centers (AHCs) central mission to connect and integrate patient care, research, education, alongside overall public health. A Cell Press article published in 2021 points a finger toward the accelerated siloed activities of most specialties and draws attention to micro economics conditions embedded within hospital systems (1), and jibes with a more recent paper from Nature Medicine (2), which echoes the precept that even education and training exigencies are exaggerating this siloed skills predicament.

The Cell Press article outlines that because of COVID-19 there was a “massive reduction in elective medical care [which] reduced patient volumes and consequently revenue to the AHC. At no other point in modern medical history has there been such a synchronous, worldwide disruption of elective medical care. In AHCs, especially in the United States, the transfer of funds to research, education, and community health generally emanate from revenue from positive margins associated with income generated from patient care” (1). Without the dollars necessary to execute new types of investigations, new insights into basic medical science necessarily declines, and a large element of the open end of the funnel for pharmaceutical research becomes increasingly constricted, or in the language of a physician-clinician, think of an occluded artery, and what kind of silent damage that does.

Stephen O’Rahilly, from the Institute of Metabolic Science, University of Cambridge, makes clear that this is not new news. “Concerns about the future of the clinician–scientist have been expressed for many decades. In 1984, Gordon Gill wrote of ‘the end of the physician scientist’ as he observed academically oriented US doctors move into basic science labs to learn the new techniques of molecular biology. In the following decades, fewer medical doctors remained active in biomedical science. In the 1980s, physicians represented 4.5% of the US biomedical research workforce: that has dropped to 1.5% today”(2).

As a counterbalance, the conditions for federally funded physician-scientists at national institute of health (NIH) programs have rode this wave out in considerably better shape. While “several international and national biomedical funding agencies such as Horizon 2020 (EU), Wellcome (UK), Cancer Research UK, Australian Research Council, German Research Foundation (DFG), and others have offered costed extensions, no-cost extensions, scope changes, paperwork reductions, and other flexibilities to their grantees that may enable continued research funding during the height of the pandemic” (1). However, that trend is not sufficient nor something to be leaned on, as “already, the transition to independence, and maintenance of an independent research program, are major leak points in the career pipeline of physician-scientists during which many leave academic medicine, and the pandemic may further hobble promising careers. Broad hiring freezes have swept across universities and AHCs throughout the world, further decreasing potential opportunities and resources to bring the next generation of physician-scientists into the field” (1).

The reason to ring the alarms bells more vigorously now is that physician-scientists “account for nearly ∼40% of winners of Nobel Prizes in Physiology or Medicine and some 70% of chief scientific officers of major pharmaceutical companies and NIH institute leadership, their retreat from research is expected to have a profound impact on medical sciences” (1). For the overall health of the medical and pharmaceutical innovation pipeline, the time to look the other way has long since passed.

References

1. Rao, R.; Dlouhy, B.; Capell, B.; Akeju, O. The Endangered Physician-Scientist and COVID-19. Cell Reports Medicine, Cell Press. February 2021.
2. O’Rahilly, S. Academic Clinician–Scientists Risk Becoming an Endangered Species. Nature Medicine, 2023. 29, 2989. Dec. 12, 2023.