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Date: January 29, 1999
Data Show Declining Number of Physician-Scientists
U.S. Medical Research Capacity May Be Hurt
PRINCETON, N.J. -- The U.S. medical research community, widely regarded as being in a heyday of dramatic advances, is rapidly losing one of its most important resources, according to Leon Rosenberg, a Princeton University professor. In an article in a recent issue of Science, Rosenberg said there is a dangerous decline in the number of physician-scientists, medical doctors who spend the majority of their time doing research.
Rosenberg said that if current trends continue the country will have no new physician-scientists entering the field within 10 years. The decline is worrisome, he said, because physician-scientists have historically made significant contributions to medical research that may have been much slower in coming if not for the unique perspective of people who apply their training in medicine to performing scientific research.
"Physician-scientists have made contributions far beyond their numbers," Rosenberg said. Even though scientists who hold MDs represent only a small percentage of the overall research community, they make up half of all the people who won Nobel Prizes in physiology and medicine since World War II. "Part of the genius of the American way of doing medical research since World War II has been having MD scientists as part of the research establishment along side Ph.D.s," he said.
That tradition may be in jeopardy. Rosenberg cites statistics from the National Institutes of Health, the federal agency that funds and conducts a major portion of the country’s medical research. Over the last 30 years, the number of physician-scientists seeking NIH grants has become a progressively smaller portion of the overall applicant pool, with first-time applications dropping off dramatically in the last few years. If the trend continues, there would be no first-time applicants by 2003, Rosenberg estimated.
In 1992, there were 2,613 M.D. postdoctoral trainees supported by NIH grants, but that number has since dropped by half, to 1,261. At that rate, there would be no scientists in this group by 2006.
There are several reasons for the decline, Rosenberg said. One is that over the last 30 years there has been a push in medicine to focus on primary care as opposed to specialties. That message, though important, has been so strong that medical schools did not spend as much time emphasizing the value of careers in research.
Another reason is that doctors, who are increasingly leaving medical school with high levels of debt, have an incentive to go into practice seeing patients because the salaries are much higher than the modest stipends that most researchers receive. Also, young doctors worry about job security in research; they need to continually reapply for NIH or other grants to fund their work. But perhaps most importantly, young doctors are given discouraging messages about how hard it is to do a good job at seeing patients and performing research.
Rosenberg’s quest to reverse this trend grows out of the experiences of his own career. After working as a physician investigator at the National Cancer Institute, Rosenberg became a professor of medicine and eventually dean of the Yale Medical School. At Yale, he divided his time between research in genetics, seeing patients and teaching. He then left Yale to become president of the research division of the Bristol Myers Squibb pharmaceutical company, where he was responsible for shepherding new drugs from research labs to the marketplace.
Rosenberg, who came to Princeton early last year, now holds a joint appointment in the Department of Molecular Biology and the Woodrow Wilson School of Public and International Affairs.
"All of my research started out at the bedside. All of my inspiration came from taking care of patients," Rosenberg said. He emphasized that his arguments do not mean that physician-scientists are better than scientists who have no medical training, only that they are likely to push research in new directions. "Because physicians are educated to think about health and disease, they ask different questions."
There is no simple solution to the problem, Rosenberg said. He proposed that Congress form a panel with leaders from the NIH, academia, industry, foundations and public life to develop recommendations. Rosenberg believes that one solution would be for academic institutions to recruit more students who express an interest in research and then reward them for seeking research experience. Another is for the NIH and other funding institutions to develop a wider range of grants and training programs for young scientists.
For his part, Rosenberg said he plans to spend the rest of his career working on the issue. It would be a shame, he said, to wait until there are no more physician-scientists to find out what the impact would be. "I don’t want to see the country do that experiment."