Chair's Column: Physician Scientists in Medicine: An Endangered Species?

Happy New Year everyone! I hope you got some downtime to recharge batteries, get some exercise, eat well and spend some time with loved ones. As we kick off the new year, I want to use this Chair’s Column to talk about an important topic: the pipeline of Clinician and Physician Scientists.

The Physician Scientist = Invaluable

There is no question that physician scientists – also often known as clinician scientists – are invaluable in academic medicine. In his keynote address to the American Association for the Advancement of Science in 2012, U of T surgeon scientist Dr. Charles Tator remarked, “Physician scientists, with in-depth training in both medicine and research, are uniquely poised to address pressing challenges at the forefront of biomedicine.”

The report of the American physician scientist workforce concluded that “It is through biomedical research [conducted by physician scientists] that certain diseases have been eliminated, cures for others have been discovered, and medical procedures and therapies that save lives have been developed.”

The 2017 Canadian National Consensus Conference on the Rising Challenge of Training Physician Scientists, led by Dr. Michael Strong, now-CIHR President, similarly noted that physician scientists, who have a foot in both clinical and research camps, are essential to the translation of “fundamental new knowledge in the pathobiology of disease with advances in health care and health policy in a timely manner.”

So why then are physician scientists considered by some an ‘endangered species,’ and what is being done to support the training, recruitment and enrichment of this invaluable field?  

An Endangered Species?

I was at a CIHR Strategic Retreat just before the holidays and caught a cab ride with Dr. Norm Rosenblum, former director of the University of Toronto Faculty of Medicine MD-PhD program and now one of the CIHR Institute Directors. He shared with me an article from the United States about a particular clinician scientist (CS) pipeline program that had success in building capacity in the basic sciences. He lamented the growing obstacles that we are all facing when it comes to maintaining our own pipeline of physician-scientists, such as length of training, lack of support at key training transition points, growing complexity of clinical medicine, health care reform and fiscal restraint. These challenges have prompted some to refer to the physician scientist as an endangered species. The lack of diversity among physician scientist trainees has also been raised as a concern. Studies suggest that barriers to women pursuing careers as physician scientists include concerns about family responsibilities, lack of role models and insufficient mentorship and sponsorship to do so.

Dr. Rosenblum then asked me how the Department of Medicine was doing with respect to sustaining the physician scientist career path. I gave him my best guess, which was that we were doing ok! But I realized I hadn’t really taken a close look at our data, and that it was time to do so.

So, using the data available on who we have recruited over the past two decades, I thought it would be interesting to take a look at the patterns of recruitment of clinician scientists overall and by discipline (basic vs clinical science). Here is what I learned:

Patterns of Recruitment of CS Faculty (1999-2019)

Between 1999 and the end of 2019, we recruited 669 full time clinical faculty members (approximately 30 per year). Patterns of recruitment over time are shown in the figure below, by position descriptions and for overall male and female faculty. 

The take home messages from this figure are as follows:

• Recruitment declined for all academic positions descriptions around the financial crises of 2008, but subsequently increased since. The rate of increase was highest for teachers and investigators, followed by quality innovators and then scientists.
• Recruitment of male faculty outstripped that of female faculty until the last five years, where the rates have converged.
• Over the two decades of review, the proportion of Clinician Scientist recruits declined from 31% (1999 to 2004) to 21% (2015 to 2019).

Over the past two decades, we have recruited 154 full-time faculty members as Clinician Scientists, which represents almost one-quarter of our recruits (23%); of these, 60 (39%) were recruited to do basic science research and, of the 60 basic science recruits, 17 were female (28.3%).  

From these data:

• The proportion of CS recruits who are conducting basic science research has remained stable at approximately 40%
• The proportion of female CS recruits has increased, from 35% to 39%, as has the proportion of female CS faculty who are conducting basic science research (from 10% to 13%)

Most of our CS faculty members hold a primary graduate appointment at either the Institute for Medical Sciences (37%) or the Institute for Health Policy, Management & Evaluation (28%). 12% currently do not hold a graduate appointment, and the remainder are distributed broadly across 14 additional university graduate departments, including but not limited to Biomaterials and Biomedical Engineering, Laboratory Medicine and Pathobiology, Immunology, Physiology, Chemistry and Medical Biophysics.

The Bottom Line

We are very fortunate to have strong support for physician scientists at all levels, including our MD-PhD trainees in undergraduate medicine, the Phillipson Clinician Scientist Training Program, a robust mentorship program and dedicated funding from our hospital practice plans and university department, including CS Start-Up Funding and Merit Review. This fundamental commitment to sustaining - and enhancing - the success of our physician scientists, despite all the obstacles, is demonstrated with these data. Further, contrary to what others have shown, the number of recruited physician scientists to the Department of Medicine who are female is on the rise, and the proportion dedicated to careers in the basic sciences is stable at approximately 40%. I am not saying that we face no challenges, but simply that our efforts to build and maintain the clinician scientist pipeline are paying off. And about this, we should be proud!