Linda L. Demer, MD, PhD and Tamer Sallam, MD, PhD on building pipelines for the researchers of tomorrow
Physician-scientists are an essential bridge between scientific discovery and advances in patient care. However, the limitations of dedicated national infrastructure to support researchers along this career path presents challenges, even as the need for them grows. In 2024, the NIH estimated that number of MD-PhD graduates is just over half the number that the physician scientist workforce report estimated will be needed to sustain the workforce at current levels.
Recently, Department of Medicine Chair E. Dale Abel, MD, PhD contributed to a white paper published in the Journal of Clinical Investigation (JCI-Insight) outlining a national framework to support physician-scientists.
“Physicians-scientists are the lifeblood of academic medical centers,” Dr. Abel shared. “Their innovative discoveries are responsible for many of the therapeutic advances that we now take for granted. We are proud of the Department of Medicine’s recent success in training, retaining and recruiting physician scientists, whose creativity and insights will position us to sustain our leadership position in health care delivery and innovation.”
A roadmap for growth
The framework calls for three interconnected pillars to support scientific success: academic support through protected research time and mentorship, financial models that support long-term investment in research careers, and organizational infrastructure that coordinates resources and career development opportunities at institutions.
Faculty members Linda L. Demer, MD, PhD and Tamer Sallam, MD, PhD, executive co-directors of the UCLA Specialty Training and Advanced Research (STAR) Program, came together to continue the conversation about the underlying factors and potential solutions to the physician-scientist shortage. Dr. Sallam is also vice-chair and incoming chair of the American Society for Clinical Investigation Physician-Scientist Development Committee, which played an important role in facilitating the workgroup behind the new white paper.
“The development of these recommendations is important because it recognizes the shortcomings of current paradigms for supporting physician-scientists,” Dr. Sallam said. “There is a collective need to take action to preserve a robust physician-scientist workforce. One critical element is providing insight into how we communicate value.”
He added that the unique contribution of physician-scientists is easy to celebrate on paper but hard to defend in a budget meeting.
“Making that value legible in financial and organizational terms, not just aspirational ones, may be what determines whether this workforce survives the next generation,” Dr. Sallam said.
Historical concerns remain today
Dr. Demer has spoken out about this problem since 1995, when she was a co-author on a seminal article sounding the alarm titled “Physician-Scientists as Missing Persons” in the Journal of Investigative Medicine. She and Olujimi Ajijola, MD, PhD, a STAR graduate who serves as co-director of the UCLA-Caltech Medical Scientist Training Program (MSTP) both contributed to another key article on the topic published in 2018, titled “Training the Physician-Scientist: Views from Program Directors and Aspiring Young Investigators”.
“I’ve seen this shortage growing relentlessly for the past three decades,” Dr. Demer said. One major problem is a leaky pipeline: While there is no dearth of talent or interest in medical science among first-year medical students, about half of all fellows who receive funding from the National Institutes of Health (NIH) Ruth L. Kirschstein National Research Service Award (NRSA) program — a major mechanism for financing physician-scientist training — drop out within a few years. The biggest barrier appears to be the transition from K awards to R awards that is, from awards that fund career development to those that are awarded for specific independent research projects.
“That could be because it’s the time when MD-PhD graduates, who are four to six years older than their clinical peers, are often taking on large personal responsibilities with families,” Dr. Demer said. “The financial gradient between academics and non-academic careers is steep, easily drawing away those with less developed interest or ability to commit.”
Other factors prevent would-be physician-scientist trainees from embarking on the path in the first place. One common reason Dr. Demer hears is the sheer duration of training — it takes about 14 years from the start of college merely to complete subspecialty clinical training, and an additional three to five years is required for meaningful research experience. A related reason is the time it takes to obtain independent research funding.
As Dr. Demer pointed out, the competitive nature of today’s healthcare systems understandably excludes physician-scientists from serving as attendings, as discussions about research during rounds may delay discharge and lower the efficiency of healthcare delivery. This loss of role models for medical students and house staff is likely to contribute to loss of interest in a research career.
“Lastly, what’s often said only in one-on-one discussions, is the stress and distress that medical students observe in more senior physician-scientists engaged in grant writing,” Dr. Demer said. “This is exacerbated by recent changes at the NIH, including grant suspensions, delays and non-scientific review criteria.”
Hope for the future
While the complex work continues across academic medical schools like the David Geffen School of Medicine at UCLA, the Department of Medicine’s STAR program is one example of how UCLA has been a national model for infrastructure thanks to its flexible training model, fellowship schedule, as well as a strong community of mentors. STAR also provides stable funding through the completion of research training and transition to faculty.
“This puts us great strides ahead of our peer institutions,” Dr. Demer said.
