The Howard Hughes Medical Institute recently announced the expansion of its Physician-Scientist Early Career Award Program, which provides five-year grants to selected alumni of two other research programs to support them as they begin careers as independent physician-scientists. The funds, which must be used for direct research expenses, are intended to provide resources during a critical time for scientists: once they have completed their mentored training and are working toward establishing and obtaining funding for their own laboratories. Dr. Bill Galey is the director of HHMI’s graduate and medical education programs.
Philanthropy News Digest: Why do so few medical doctors pursue careers in research?
Bill Galey: There are several reasons. For starters, the orientation of our medical culture has been more toward the physician-as-healer rather than to the physician as the developer of healing methodologies. At the same time, because of the need to master both the medicine and a specific area of research, a career in medical research is more difficult to establish. Last but not least, it's generally not as financially rewarding to be a researcher as it is to be a practitioner.
PND: Well, why do we need medical researchers who are also doctors?
BG: If we truly want to improve the quality of health care, we must improve our medical treatments, whether through new drugs or through new therapies. And the only way to do that is to have physicians who are willing and able to translate the exciting findings of modern biology into medical practice. That's where the physician-scientist is especially needed.
PND: Is it easy for a physician who pursues a career in research to return to clinical work if he or she chooses?
BG: Generally speaking, it's not difficult. Physicians who complete their clinical training, including medical school and residency training, typically find that it's fairly easy to return to clinical practice, should they decide to do so. It's somewhat harder, though, to move from being a practicing physician to a researcher once one has spent time away from the research environment. Research requires a continued commitment to the maintenance of a specific knowledge base, independent of a person's clinical knowledge. Keeping up with the literature in a specific field, for example, is a formidable task, but it's also a vitally important one. On the other hand, understanding the modalities and practices of a particular clinical field of medicine helps the scientist to address important research problems that are relevant to the practice of medicine.
PND: You and your colleagues launched the Physician-Scientist Early Career Award Program in 2006. Why the change?
BG: Initially, the program was designed as a redistribution of existing funds that were not being used as effectively as we thought they could be. After the first year of competition, however, the institute decided that the high quality of the applicants justified an expansion of the program and we increased the amount of money awarded to each physician-researcher from $150,000 over three years to $375,000 over five years and increased the number of awards from thirteen to twenty.
The candidates for the awards are all alumni of two HHMI programs: the HHMI-NIH Medical Research Scholars Program, which enables medical students to take a year off from their studies and come to the National Institutes of Health, where they live together in a facility we manage and do research in NIH laboratories; and the Medical Research Fellows Program, which enables promising medical students to either work in a research laboratory at their home institution, or to work at an institution other than their home school for a year. Participation in either program makes a young researcher eligible for the program. Additionally, applicants must be in the first years of an academic position and provided by their department with sufficient time to do research. Currently, HHMI is supporting more than a hundred young physician-researchers each year through the two "year-out" programs and will eventually support as many as one hundred Physician-Scientist Early Career Awardees at any given time.
PND: Is it a challenge to get young doctors to pursue research, and if so what can philanthropy do to improve the situation?
BG: It is pretty clear that the early stage of a physician-researcher's career is when he or she is most likely to leave research. It's the period when young researchers need time and resources to collect the data to attract funding entities to support their research. One of the issues that predominates in medical education institutions' clinical departments is the high demand for patient care. The unusually great need to provide care and generate the revenue that such care provides often makes it difficult for the chairs of departments to free up the time of junior faculty for research, which is not as financially rewarding to the department. Often this means less time and fewer resources are available to young physician-scientists at a period in their careers when they need them both. I believe philanthropy should be especially aware of this vulnerable time and focus resources to support young physician-scientists early in their careers.
The institute also is concerned about the level of debt young medical school graduates have incurred by the time they graduate from medical school. The average debt load for a medical school graduate these days is in excess of $150,000. Naturally, anyone with that kind of debt is going to be anxious about paying it off and therefore may be less likely to pursue additional training.
Medical students often believe that, in order to be successful, a physician-scientist must have a Ph.D as well as an M.D. Currently it takes more than an additional four years for an individual to earn both degrees. This is a long time for an individual already facing at least seven years of medical training. It also is generally perceived that one must commit to the dual degree on entry to medical school at a time when a student's focus is usually on clinical medicine. Subsequently, when the student's interest in medical research is awakened, they may feel it is too late or will cost them too much in time or money to pursue research training. While a physician-scientist does not require a Ph.D and it is not too late to pursue research training, students often fail to obtain the needed research training because they lack opportunities and/or financial support. I would encourage philanthropic organizations to support programs that allow students, at any level of medical education, to obtain research training whether or not that training will lead to an advanced degree. Further, philanthropies may wish to consider providing financial aid to individuals who take time away from their medical studies to participate in research training.
— Matt Sinclair