An article in Science discusses the physician-scientist program (or MD-PhD) and the trouble in maintaining people in the basic sciences. Basically, most MD-PhDs say when they finish the program that they would like to remain researchers in some capacity, but many of them drop-out in order to become straight clinicians, instructors at medical schools, or work in industry.
The problem, he believes, stems from the fact that every lab chief “essentially is running a small business.” Like all businesses, “you have to pay your bills.” Lab chiefs, however, can only get the money they need by winning grants, which today’s tight funding and intense competition make unpredictable and unreliable. “You get them for a few years, then you lose them for a year, then you get them again. Consequently, people are continually essentially going bankrupt,” Donowitz says.
But unlike ordinary businesses that can use capital reserves to keep the doors open through hard times, government-funded researchers cannot save up for lean years. The rules decree that “at the end of the year, you can’t carry over more than 25% of what they give you. The grants are quite small, so you cannot weather a downturn,” Donowitz continues.
Unlike Ph.D. researchers, medical doctors can always make a living by hanging out their shingles. “But that’s not what this group of people wants to do,” Donowitz says. The substantial earnings gap separating research and practice is not an important factor in young physician-scientists’ decisions to leave the lab, he believes. “There are a bunch of us who are not interested in making this extra money but are turned on by the thought process of doing science. … The money is really, I’m convinced, not the major issue at all.”
Instead, “lack of security” drives physician-scientists from research, he says. “You’re always at risk of going bankrupt”–not personally, he emphasizes, but as a productive investigator. Anxiety and uncertainty produce “a very difficult life.” As proof that stress and discouragement, not lack of love for science, lead physicians to quit, Donowitz notes that “the people who drop out of science generally don’t leave the academic center. They become the clinician-teachers.”
And that, Donowitz and his co-authors believe, places squarely on Congress and the medical schools that administer federal grants the responsibility to change policies to assure that more of the small businesses that produce American scientific progress can keep going when times get tough. First, Congress needs to remove the “flaw” in the law that prevents labs from carrying over enough money to survive between grants, he says. Second, medical schools hiring faculty “should realize there’s an obligation” to use their funds to help productive scientists get through funding droughts. (Emphasis mine.)
Basically, their line is that it’s the money, stupid. The tight funding environment and bureaucratic hassles associated with procuring funding drive MD-PhDs away from science — at least in small part because they have other options that straight PhDs don’t have.
As a future MD-PhD, I certainly hear their concerns about a tight funding environment. (I actually had never heard that you can’t carry money over, and I would definitely like to see Congress change that.) When researchers have to become elaborate book-keepers, it distracts from the scientific mission.
However, I would add a note of realism in the following two senses. First, while I would love to see medical schools step-up to fund people during droughts, I am not going to hold my breadth. The medical schools are under the same funding pinch the researchers are under, and I just don’t see that happening in a broad way.
Second, we need to ask ourselves whether we can support the number of MD-PhDs that we are generating. There has been a big push over the last couple of years to enlarge MD-PhD programs to meet the needs of so-called translational medicine. Translational medicine is the application of basic research towards to creation of new technologies, particularly treatment. (It is a bit of a buzzword at the moment, and sometimes I think if I hear the phrase “bench-to-bedside” one more time I am going to puke.) There has been an increase in the number of MD-PhDs, but there has not been a commensurate increase in the availability of funding for basic or translational research.
We need to ask ourselves the following question in response to that. Is the problem that we aren’t enlarging research funding fast enough, or is the problem that we are trying to create so many potential researchers that we have no hope of funding them all? I would like to see more research funding, but I also recognize that exponential increases in the research funds will not necessarily improve the quality of the research performed. Likewise, those increases of funds are likely not sustainable in a, let us say, democratic funding environment. If we increase funding now and bring more people into research, we are just setting them up for failure later when the funding environment contracts again.
All that I am saying is that if we want to expand these programs, are willing to put our money where our collective mouth is? It costs a lot to fund an MD-PhD through 8 years of training, but it costs significantly more to fund a researcher through their entire professional life. How many of them do we want? How many of them are willing to consistently support?
Further, I am not certain that an MD-PhDs skills are being misspent as clinical instructors. Particularly in the early stages of medical school (the class part), good instructors are hard to find and physician scientists are ideally suited for this very academic part of medical training. I know people who end up splitting their time between patients and teaching medical students. There PhD was not wasted because whatever class they teach they understand the pure science and the applied science in exquisite detail.