Princeton Weekly Bulletin February 8, 1999
Rosenberg advocates MD-PhDs
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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, who is lecturer with rank of professor in Molecular Biology and the Woodrow Wilson School. In the January 15 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.
If current trends continue, Rosenberg believes, 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 might 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 have won Nobel Prizes in physiology and medicine since World War II. "Part of the genius of the American way of doing medical research has been having MD scientists as part of the research establishment along side PhDs," he said.
No first-time applicants by 2003
Now, 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 estimates.
In 1992, there were 2,613 MD 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, according to Rosenberg. 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 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, because salaries are much higher than the stipends 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.
Dean of Yale Medical School
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, he 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 com- pany, where he was responsible for shepherding new drugs from research labs to the marketplace.
"All of my research started out at the bedside. All of my inspiration came from taking care of patients," Rosen-berg 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."
Wider range of grants
There is no simple solution to the problem, said Rosenberg, who has proposed that Congress form a panel with leaders from the NIH, academia, industry, foundations and public life to develop recommendations. He 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," he said.
After coming to Princeton a year ago, Rosenberg became involved in another aspect of medical research policy when he was asked by the Institute of Medicine to lead a panel of experts looking into the issue of adding more public input to the process of setting NIH funding priorities. The NIH has sometimes been criticized for giving more funding for research in diseases that afflict fewer people than other areas that receive less money. The NIH does a great job assessing scientific opportunity, but does not do a particularly good job assessing public health needs and gauging what the public wants, Rosenberg said.
The panel worked for five months and came up with a recommendation that the NIH form a network of committees that each represent a different public interest. These panels would offer input to the NIH director and the agencies' 21 institutes.