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OriginalContribution |

The Physician-Scientist Career Pipeline in 2005:  Build It, and They Will Come

Timothy J. Ley, MD; Leon E. Rosenberg, MD
JAMA. 2005;294(11):1343-1351. doi:10.1001/jama.294.11.1343.
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Published online

Context Physician-scientists play a unique and critical role in medical research. Nonetheless, a number of trends followed during the 1980s and 1990s revealed that this career pathway was in serious jeopardy. Physician-scientists were declining in number and were getting older. A variety of factors were thought to contribute to this problem, including increasing indebtedness of medical school graduates caused by rapidly rising medical school tuition costs.

Objective To evaluate the impact of recently initiated programs from the National Institutes of Health (NIH) and several not-for-profit institutions designed to revitalize the physician-scientist career pipeline.

Design We assessed recent trends in the physician-scientist career pipeline using data obtained from the NIH, the American Medical Association, the Association of American Medical Colleges, and other sources.

Main Outcome Measures Total numbers of physicians performing research, grant application numbers and success rates for MDs, MD-PhDs, and PhDs at various stages in their careers, interest in research among medical students, medical school tuitions and postgraduate salaries, numbers and composition of applicants for NIH loan repayment programs, and gender distribution of young physician-scientists.

Results The number of physician-scientists in the United States has been in a steady state for the past decade, but funded physician-scientists are significantly older than they were 2 decades ago. However, the study of early career markers over the past 7 to 10 years has demonstrated increasing interest in research careers by medical students, steady growth of the MD-PhD pool, and a new burst of activity in the “late bloomer” pool of MDs (individuals who choose research careers in medical school or in residency training), fueled by loan repayment programs that were created by the NIH in 2002. Several recent trends for more established physician-scientists have also suggested improvement.

Conclusions Although it is too early to assess the impact of these indicators on the long-term career pathway, the recent growth in activity in the physician-scientist career pipeline is an encouraging development. Continued funding of these new programs, coupled with sustained support for physician-scientists committed to the pathway, will be required to maintain these positive trends.

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Figures

Figure 1. Composition of the Physician Workforce in the United States, 1980-2003
Graphic Jump Location

A, Number of physicians engaged in each of the major professional activities. B, Data for physicians engaged in research or teaching as their major professional activity is shown on an expanded scale for increased clarity. Source: American Medical Association.

Figure 2. Aging of Funded NIH Investigators, 1985-2004
Graphic Jump Location

The percentage of total research project grant awards awarded to investigators older than 50 years is shown for each degree type. For this and all other figures, MDs include individuals with an MD degree alone plus all individuals with an MD plus another professional degree other than PhD. Similarly, MD-PhDs include all individuals with these 2 degrees plus any other professional degrees. Source: National Institutes of Health (NIH).

Figure 3. NIH RPG Funding Success Rates for MD, MD-PhD, and PhD Investigators, 1985-2003
Graphic Jump Location

A, Funding success rates for all investigators, regardless of experience. B, Funding success rates for previously experienced investigators (ie, investigators with a previously funded research project grant [RPG] award). C, Funding success rates for investigators who have not previously been awarded an RPG are shown. Source: National Institutes of Health (NIH).

Figure 4. Medical Student Interest in Research
Graphic Jump Location

A, Percentage of Association of American Medical Colleges (AAMC) questionnaire respondents (surveys taken at medical school matriculation or graduation) exhibiting an exclusive or significant interest in pursuing research as a career activity, 1987-2003. B, Percentage of graduating respondents who exhibited an interest in clinical or basic science teaching or research as part of their careers, 1977-2003. Source: AAMC Matriculating and Graduating Medical Student Questionnaires.

Figure 5. Numbers of Matriculating MD-PhD Students in the United States, 1990-2004
Graphic Jump Location

The total number of male and female matriculants is shown. Source: Association of American Medical Colleges and Harvard Medical School.

Figure 6. Average 4-Year Medical School Tuition Costs Compared With Average Postgraduate Year 1 (PGY-1) Wages, 1977-2004
Graphic Jump Location

Average 4-year tuition costs were obtained by adding the average costs for each of the 4 years ending in the date shown. Source: Association of American Medical Colleges.

Figure 7. NIH Loan Repayment Program (LRP) Activity, 2002-2005
Graphic Jump Location

A, Applications by degree and year. Definitions of MDs, MD-PhDs, and PhDs were described in the legend for Figure 2. All data were obtained by summing information from all of the LRPs except for contraception and infertility, which was established before 2002 and which is very small compared with the new programs. New applications refer to applicants who had not previously applied for an LRP. B, New (first-time) applications by degree and gender. Small numbers of applicants did not specify gender, accounting for the small difference between the total number of new applicants shown in panel A and the data shown here. Source: Office of Loan Repayment and Scholarship, National Institutes of Health (NIH).

Figure 8. The NIH K08 Program, 1972-2004
Graphic Jump Location

A, Total cost in millions of funded K08 awards from all National Institutes of Health (NIH) institutes, 1972-2004. B, Total numbers of K08 applications and funded awards by year. C, Percentage of funded K08 applications by year. Source: NIH.

Figure 9. Application Trends for NIH Grants
Graphic Jump Location

A, Applications for K08 grants by degree, 1992-2004. Degree holders were defined as in Figure 2. B, Applications for K23 grants by degree, 1999-2004. C, First-time applicants for all research project grant (RPG) awards by degree, 1970-2003. D, Data for MD and MD-PhD applicants are shown on an expanded scale. First-time applicants indicates that no other RPG application had been submitted before. E, Total R01 applications by degree, 1992-2004. F, Applications from MD and MD-PhD applicants are shown on an expanded scale. Source: National Institutes of Health (NIH).

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