Over the years I have spoken to hundreds of people about career development (K) awards. One of the best days of my week is Tuesday, when I reserve the full day for phone calls with investigators, mentors, and prospective applicants.
Questions I hear often include:
How many mentors should I have given that…
- my research is interdisciplinary?
- my research has a translational component?
- my interest bridges epigenetics and multimorbities?
These conversations indicate how research has fundamentally changed. Technological advances, sophisticated tools, and the need to be facile with large data sets both define and demand a team science approach. Yet, one critical member of the team—the physician-scientist—is unaccounted for. First you see MD, now you don’t!
Clinician-scientists are critical to research.
We at NIA have always recognized the unique perspective of clinically trained research scientists in the development of treatments for diseases and disorders of aging. Whether it is a physician driven by a frustrating problem in the clinic, or the physician in basic research with a vision of future success in treatment, we need MDs. We need MDs active in research, and we need them to mentor subsequent generations of scientists. Career development (K) award programs play a key role in training clinician-scientists in aging and geriatric research.
But fewer physician-scientists are applying for career development funding.
A review of NIA K applications from 2002 to 2013 shows a steady decline in awards to clinician-scientists, both MD and MD-PhD.
The number of awards to clinicians conducting basic research shows an especially sharp decrease in both our general NIH K program and the NIA-specific Beeson K award program (K08, K23, etc). K08 submissions by MDs have decreased in a big way: from a high of 40% down to 5% of submitted K08 applications over the 12-year period examined.
What’s happening to MD applicants for career development awards and what’s NIA/NIH doing about it?
Although we don’t know yet exactly why this is happening, NIA and NIH take this very seriously. NIA’s Council has formed a task force to look into the extent of the problem and an appropriate response. Kevin High, chair of the group, explains, “…new pathways to support and nurture early faculty are needed to ensure their survival. ‘Pre-K’ models with greater flexibility with regard to percentage of protected research time, leveraged private/philanthropic funding, and allowed salary support for junior faculty should be considered.”
The NIA GEMSSTAR program has been successful in identifying and funding some research-oriented MDs and MD-PhDs. And, our Beeson program is a public-private collaboration that effectively enables larger compensation and lifelong access to a professional peer group for clinician-scientists.
The NIH Advisory Committee to the Director is also tackling this issue. An interim report of the Physician-Scientist Workforce Working Group (PDF, 168KB) is available. The final report is due in June. [Editor's Note, 6/24/2014: The final presentation (PDF, 1.65 MB) and report (PDF, 6.18 MB) are now available.]
If you have an MD and are active in research, what was your career development experience? If you are currently mentoring a physician-scientist, what are the unspoken challenges you both face? Do you have thoughts about how NIA might best nurture the clinician-scientist pipeline? Join the conversation!