Dean's Message - June 2008
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Dear Colleagues:
What's on my mind this month is how to avert a ‘gathering storm'! We have witnessed in recent years historic advances in biomedical research, and meeting the challenge of translating basic science insights into effective therapies for patients is not as easy as some might think. We all know that it requires the creation of a robust translational research enterprise.
The foundation for this enterprise is currently being built. According to a number of recent reports, however, its full realization is likely to be hampered due to a looming shortage of physician-scientists to carry on this critically important work. This is a gathering storm, indeed.
Unfortunately, there are not enough medical students and physicians currently entering the MD/PhD or post-undergraduate medical education fellowship pipelines. In 1983, the total number of physicians in the United States was 479,439, and the number of physician-scientists was 18,535 (3.9 percent of the total); by the late 1990s, the total number of physicians had increased to 707,032, whereas the number of physician-scientists had fallen to 14,479 (2.0 percent of the total).
The physician-scientist population in the United States is becoming an "endangered species" compared to 25 years ago. Since the mid-1980s, the percentage of total research project grants awarded by the National Institutes of Health (NIH) to investigators younger than 50 has gradually decreased for MD, PhDs and MD/PhDs.
One beacon of hope in this otherwise disturbing picture is the NIH's Clinical and Translational Sciences Awards (CTSA) program. To date, the CTSA has provided funding to about a dozen academic medical centers, which are required to include training in clinical and translational research and career development as part of their overall program. Although the NIH plans to fund 60 CTSA centers by 2012, the future of this critically important training program is not guaranteed as the NIH budget has been slashed by almost 16 percent in real dollars over the past five years.
There are many possible reasons why medical students and physicians are eschewing careers in clinical and translational research, including accumulated debt, long training periods and the uncertainty of success. However, I believe the most important factor involves the initial decision of whether or not to pursue a career in research, which often comes early in their training.
A major restructuring of medical education in which training in research methods takes center stage throughout the curriculum is one way we can avert this gathering storm of a significantly deficient workforce of physician-scientists. Stimulating students' curiosity, providing exposure to research and making research training an interwoven component of medical education curricula would require the development of a new paradigm for how we educate and train our doctors - one where every future physician receives thorough instruction in the basic principles of research methods, beginning at virtually the first day of medical school and continuing through residency training.
We at the University of Maryland School of Medicine could, of course, change our curriculum to reflect this paradigm shift. However, in order to ensure that all medical students in the United States graduate with research competency, the two major accrediting bodies for undergraduate and subspecialty medical school training - the Liaison Committee on Medical Education and the Accreditation Council for Graduate Medical Education - would need to include training in research as one the core competencies for medical school and residency program accreditation. Such a standard would give medical schools a powerful incentive to stimulate students to understand the importance of research and give them the opportunity to participate in it.
This is likely to motivate many medical students to enter into research careers, but even for the students who do decide against a full-time career in research, there are still many ways for them to contribute. They could become part-time researchers, associate investigators, part-time clinical consultants, or members of an institutional review board or clinical trial data safety monitoring committees.
By accelerating training in research through a careful modification of medical school curricula, those trainees who do decide to become independent physician-scientists may be able to do so much earlier in their careers. The current average age for new investigators to receive their first R01 grant from the NIH is 42 years old for a PhD and 43 years old for an MD, and those averages are rising. This clearly must change. Many significant contributions come from younger investigators, and we must find ways to help them to receive RO1s earlier in their careers.
Reversing this trend not only would avert the impeding tempest, it would also permit graduates to begin contributing to science during their years of highest creativity and have more productive years in their careers. Furthermore, providing trainees with opportunities to develop a record of accomplishment would significantly enhance their ability to obtain faculty appointments. Ultimately, I believe such a trend reversal would translate into much-needed therapies reaching patients far earlier than would otherwise be possible.
Only when we begin to teach young, aspiring physicians the true value of research from the outset will we be able to maximize the potential of these talented individuals. Moreover, it will greatly improve our ability to fully reap the benefits tomorrow of the unprecedented level of research findings being generated today.
In the relentless pursuit of excellence, I am
Sincerely yours,
E. Albert Reece, MD, PhD, MBA
Vice President for Medical Affairs, University of Maryland
John Z. and Akiko K. Bowers Distinguished Professor and
Dean, School of Medicine