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As part of a wider initiative to shape the future direction of research training for the biomedical workforce as a whole, we at the NIH are actively pursuing ways to examine the physician-scientist workforce and to optimize training for clinicians seeking research careers. Physician-scientists face some challenges and career transition pathways unique to being in a clinical career track, hence the need for a specific focus on this workforce.
In 2014, the Advisory Committee to the NIH Director (ACD) working group on the physician-scientist workforce (PSW) recommended that NIH intensify its efforts to increase diversity among physician-scientists. The group recognized major deficiencies of the physician-scientist workforce with regard to diversity, and strongly endorsed extending the recommendations of the preceding biomedical workforce diversity working groups to the physician-scientist workforce.
Since the ACD PSW report contained few concrete recommendations for enhancing diversity, this month NIH issued a request for information, with the goal of gathering community input on questions such as: What are the career trajectories unique to underrepresented groups among physician scientists? What are potential barriers to a diverse physician-scientist workforce? And what strategies could successfully enhance the diversity in this subset of researchers?
If this is a topic you’d like to share your perspective on, be sure to read the request for information published in the NIH Guide, and use the submission website to send your formal comments to NIH.
Armed with evidence-based research and concrete information from individual respondents and professional organizations alike, we hope to develop and pilot strategies for removing barriers preventing a diverse workforce, and most importantly, apply such strategies broadly.
The report has good recommendations for recruitment and retention of physician-scientists. But it shouldn’t really be a mystery why there’s a shortage of researchers with medical degrees. They’re getting out of research because they can! The health care industry is booming, while researchers are struggling.
With regard to diversity in particular, I think the biggest barriers are continued focus on pedigree and environment. Underrepresented minorities are more likely to come from and eventually take jobs at institutions that are biased against during typical NIH review processes.
Let me disagree with your views towards biomedical researchers with a clinical background (i.e., “physician-scientists” as we call them for lack of a better term). I can tell you about my own personal experiences regarding the way physician-scientists are viewed while seeking support for research. One of the senior members of my institution once said: “if MDs cannot get grants, they can go and see patients so we have to support our PhDs that have fewer options”. It is hard to argue with this logic in these difficult budgetary times even though if MDs happen to get a grant, they will end up hiring their PhD colleagues anyway! I think there is a misconception here; physician-scientists are in fact being pushed out of the system.
Regarding the share of individuals with different backgrounds in biomedical research, I agree with you. I don’t think their lack of representation is from lack of trying. Let’s look into how they are being perceived.
I agree.
The physician-scientist is being uniquely squeezed from both sides. The scientific imperative to procure extramural funding has become fiercely competitive, because the cost of science at the cutting edge is more expensive, the NIH budget is stagnant, yielding obligate lower funding rates. That and an imperfect review process weigh heavily. Combine that with the accelerating clerical/bureaucratic demands of even part-time practice of medicine on the physician, on top of medicine’s increasingly complex imperative, and even the best/brightest are shaking their heads.
So whether one is of minority color, or of majority pallor, the demands of the dual physician-scientist role can be synergistically onerous at this moment in time. In the context of institutions that have been weakened by the meager federal funding in both scientific and medical care realms, this equates to a meager ability to span the physician-scientist gap.
The answer would seem to lie in Congressional appropriations patterns for NIH and HHS. And the answer to Congressional appropriations dysfunction would seem to lie in campaign finance reform.
Diversity of physician-scientists including women and under-represented minorities has always been a daunting task. The very people sought are often responsible for domestic and financial obligations of extended family. In contrast the white male is still at the top of the ‘food chain’. Diversity recruitment must begin early in life–way before a young person needs to learn the ways of NIH. That is schools and families must turn young people on to the idea of being curious. Curiosity and drive should be a key consequence of an excellent elementary and secondary education. Furthermore, science must be valued by the leaders of society, just as society values star professional-athletes and professional actors and recording artists. In other words there must be a renewed spirit in the fabric of American culture about what good science is, and is not. Why science is important and why question-asking about nature is vital to our lives. Yes we know that NIH funding is exceedingly hard to obtain. We already know that tuition indebtedness is already too high for the average MD scientist. Then add the burdens of being a single mother, etc., into the mix. People cannot worry about ‘turning discovery into health’, they just want to be healthy to survive and make a living. Indeed a physician can always make a decent living. Until we have a fundamental change in our society about values–values that endure–the physician-scientist model for any minority is not going to survive. On the other hand, if our society has a rebirth in enduring values that matter to the common good, I would dare say the physician-scientist pathway would return and many more people–including women and minorities–would enter this career. Funding would then increase–don’t forget that our nation’s leaders who set priorities are driven by society. Scientists must therefore do more to reinvigorate the culture and beauty of doing science for a living.
I am a hispanic female surgeon scientist. Before you can even hope to recruit diverse talent to a career as a physician scientist you have to make it appealing. Right now the amount of time spent completing documentation for compliance and other regulations either to practice medicine or maintain a research lab are overwhelming. There are economies of scale for both clinical and research practices and physician-scientists lose them on both sides. The degree of financial uncertainty in medicine has placed a crushing burden on all physicians, including physician scientists, to generate clinical revenues. The NIH salary cap penalizes physician scientists and forces them to do more clinical work to cover the cost-share portion of their effort that should be spent on research. The capricious nature of NIH funding further undermines the calling to be a physician scientist. It will take real innovation and sustained commitment to generate a pool of new talent to replace the small pool that remains.
There are many economically-disadvantaged students that do not have the resources to prepare well for gate-keeper tests, such as the SAT, ACT, GRE and MCAT, such as the Princeton Review. Despite strong performances at their home institution, their test performance does not reflect their intellectual capacity. It is actually a poor predictor of their capacity to succeed. Here are a few suggestions:
1) The NIH should consider providing incentives for institutions to admit such students to research intensive environments, such as increasing their indirect cost rates. The institutions will need additional resources to help these students master doing well on the future gate-keeper tests.
2) The NIH could also dispense RFA, specifically for research experiences for economically disadvantaged students of all races, with clear objectives, such as manuscripts, poster presentations, as well as successful admittance into a research intensive institution. Many URM students have a passion for science as early as eight grade, so providing funds to academically gifted URM students or economically disadvantaged students of all races at early time points in their professional developments will greatly increase the pool.
3) The NIH should consider salary support (akin to Kaward) for URM faculty to specifically mentor these students, based upon previous the mentees prior success rates and provision of a clear mentoring plan. URM faculty, as well as a minority of majority faculty, spend a significant amount of uncompensated time mentoring undergraduates, graduates and junior faculty, while keeping their own research program competitive. NIH-provided protected time would relay to the home institution the value that the NIH places on these activities.