The Physician-Scientist Model: Does It Work in Our Specialty?

One of the factually unsubstantiated, yet well formulated, “conspiracy theories” is the notion that although the NIH has long advocated for translational research projects involving physicians with a scientific interest and background, the money hasn’t always followed the rhetoric. The theory states that from the scientists’ viewpoint, physicians are well-compensated individuals whose commitment to research should be questioned because they are driven more by clinical pursuits (i.e., money) than by their interest in answering fundamental scientific questions that may or may not have clinical relevance. The level-headed, reasonably honest, and circumspect physician–scientist responds that a simple glance at the pertinent NIH study sections, notwithstanding the wholesale restructuring of the study section organization, reveals the presence of few MD-only degree holders in basic science or translational areas. This patent partiality against MD representation on important study sections reflects a schism at the most crucial level of scientific review and awarding. On the other hand, there may be sound fundamental reasons for the evolution of this state of affairs.

The Current Climate

One very interesting and perhaps unanticipated ally to the physician–scientist mission is the American taxpayer. Recently, accountability has become a major concern for those of us who pay taxes and have been looking for a return on our investment. In response to Clinton administration initiatives to double NIH spending over five years, the NIH budget reached $27.7 billion in 2004.3 President Bush acknowledged the importance of this project and, along with Congress, continued to maintain the goodwill. Around that time, the newly installed director of the NIH, Elias A. Zerhouni, MD, unveiled the NIH Roadmap and said, “As the 21st century unfolds, discovery in the life sciences is accelerating at an unprecedented rate. As science grows more complex, it is also converging on a set of unifying principles that link apparently disparate diseases through common biological pathways and therapeutic approaches. NIH research needs to reflect this new reality.”4,5

The hope among physician–scientists was that this new approach to problem solving would involve those individuals closest to the problems being addressed (i.e., physicans). The evidence for improvement on this front is scant. Parochial and partisan concerns over terrorism, recent conflicts in Iraq and Afghanistan, as well as the post-Katrina reconstruction have made the climate for would-be investigators much more daunting for the short term. The current (FY 2007 first and second funding cycles) payline for percentiled R01 projects is the 12.0 percentile. Recognizing the need to encourage new investigators to participate, the payline for applicants considered as first-time R01 investigators will be paid with the extended percentile payline up to the 18.0 percentile. These numbers are close to historic lows.