Pure Pedantry

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.

Money quote:

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.


  1. #1 Drugmonkey
    September 10, 2007

    and are you willing to put your money where your mouth is? Are you willing to consider yourself one of the “surplus trainees”?

    We have the same issues crop up in the Ph.D. only track too. Lots of calls at the moment to stop training all these surplus Ph.D.s. On the face of it this seems like the painless solution. But it only kicks the problems back down the line. How is telling some motivated undergrad not to pursue a research career fundamentally different from telling a 6yr postdoc, “well, I guess there aren’t any tenure track jobs for you”? Time wasted, blah, blah. sure. but said person also got to spend an awful lot of time, not starving, pursuing their desired intellectual pursuits. “At least they had the chance” might be the rebuttal of the undergraduate facing radical cutbacks in training funds and therefore no grad school slot…

  2. #2 Jake Young
    September 10, 2007

    I may not classify myself as a “surplus trainee” but I am willing to accept the fact that I may not be able to get grants and hence will need to enter either the industry or clinical training track.

    We are already telling postdocs that there aren’t tenure track jobs for them. We are already telling undergrads that science is a job that you may love, but that will be difficult and for which you will receive limited financial reward.

    Basically, I just see this as realism. You have to be honest with people about their chances of advancement. And I see it a quintessentially dishonest to admit larger and larger numbers of MD-PhDs while at the same time not telling them that they are unlikely to get tenure positions.

    Money is limited. Better to tell them that when they are undergrads or grad students.

  3. #3 PhysioProf
    September 10, 2007

    “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.”

    Some medical schools do spend their own money to support research programs.

    And if you peruse the information available at the new NIH “Enhancing Peer Review” Web site, you will see that a new–and, in my opinion, likely to become very prominent–talking point is that NIH grants are meant to be “grants-in-aid”, and not necessarily sufficient to fund entire laboratories and research programs. Accepting this new reality is going to be painful for many medical schools.

    Those with large endowments, clinical income, and financial support from donors and their parent universities will most likely just start footing more of the bill, but will keep the scale of their research enterprise intact. Those more strapped for cash will have to scale back the scope of their research programs, and get rid of substantial numbers of faculty.

    Accordingly, I am so glad that when I embarked on my first tenure-track independent position I took an offer from a wealthy private university medical school that was substantially smaller in terms of start-up, salary, and space than an offer I declined from a state medical school that is–from what I hear–getting rid of less successful junior faculty it hired the same year I received my offer.

  4. #4 boojieboy
    September 10, 2007

    The problem (as the govt sees it) with allowing researchers to carry over unused funds is that it could create an accounting nightmare for the big funding agencies. Right now you have to provide justification and receipts for all your expenditures under a grant. But what about after the grant runs out? Logically, you should still provide receipts and justification for their accountant and auditors. But can you imagine how long people would need to continue doing this for? I could see some guys going out ten years or more if they were allowed to. NSF and NIH would be buried under paperwork, that comes to them at unpredictable times. The program officers and their staffs would have to keep track of an even huger number of grantees, stretching them even thinner than they already are.

    Still, one wonders what could be done with a fully computerized reporting and auditing system.

  5. #5 Mike the Mad Biologist
    September 10, 2007


    good post, but one minor correction: you can carryover more than 25% of your funding, but the program officer and grants management officer assigned to your grant have to agree. A lot of people get confused if they are at large institutions where carryover requests (for <25%) and no-cost extensions which have the authority to roll these grants over.

  6. #6 Drugmonkey
    September 10, 2007

    Mike the Mad, think about the larger picture here though. The question is whether or not one could, say over the course of a 5 yr award, stockpile a growing fraction of the yearly award so as to end up with Yr 6 in the bank. Recall that Program can cut individual grants however they like and/or can invent new “funding strategies” however they like. Suppose one could bank funds, say 20% per year. Come Year 4 with 60% of a years’ directs still on account and a bad NIH funding year, well, they are going to figure out a way to remove that cushion. Either by cutting individual grants or by creating an anti-stockpile “funding strategy”.

    If you don’t think they would do this, then think about the current strategies vis a vis total award $$ to a given PI. After all, staggered grants being used to carry a total lab operation is the way this “stockpiling” is done at present. Not funding, or delaying for a few rounds, the app that is well within the fund line because the PI already has more-than-sufficient funding in the eyes of ICs is an anti-stockpiling approach.

  7. #7 kt
    September 15, 2007

    I came upon your post by way of Orac’s, and as I note on his blog, I’m not yet convinced that training or allocating devoted funds to supporting MD/PhDs is a good investment of research dollars. I’ve reposted the relevant part of my argument below, because I’d be interested in getting more perspectives on this issue.

    I’m always a bit nonplussed by articles like the Science piece that sparked your post. These calls for increased MD/PhD support are trotted out with some regularity – trolling through PubMed will turn up scores of them in the last few years. There is in fact already a very large chunk of research funding that is targeted to MD/PhDs. The MSTP program is the most obvious of these, and it funds the scientific and clinical education of around 1000 students nationally. This is a tremendous investment and one that appears to be made unconditionally – there is not, to my knowledge, any payback requirement for those who opt out of the PhD part of the program, and in the process receive two years of free medical education. It’s a bit difficult to find current numbers on the attrition rate, but an old study (1981) puts it at ~10%.

    At more senior levels, there are both public (e.g., K08 awards) and private (e.g., Burroughs-Wellcome, which has discontinued grants for basic scientists and replaced them with career awards for physician scientists; and Howard Hughes, which has long supported physician scientists, and recently expanded support for this group) funds that are targeted at MD/PhDs. Beyond these targeted mechanisms, NIH grants are in general heavily focused on translational research, which one would expect to benefit MD/PhDs substantially.

    Given these substantial funding commitments, a better question than “How can we increase MD/PhD funding?” is “Are MD/PhDs a good investment?” There’s little question that MD/PhDs are bright people who do well in academia. They are disproportionately represented in academic positions, and in measures of scientific success they do better than their MD colleagues. They publish at higher rates, and are more successful in obtaining NIH grants – roughly on par with PhDs in the latter two categories. But do they contribute disproportionately to translational advances? That is the critical question and remains very much an open question, as it’s precisely these translational advances that MD/PhDs are meant to facilitate. Most studies of MD/PhDs’ impact (mostly MSTP graduates) assess measures of professional success (academic positions, grant success) rather than attempting to quantify translational impact. My MD/PhD faculty colleagues that run research labs operate very much like basic scientists – their primary research interests lie in basic science questions and they publish in basic science journals. They are no more likely to be addressing translational issues than are their PhD colleagues. Nor are they more likely to be involved in biotech start-up efforts*, or to hold more patents – both of which provide very direct measures of the degree to which research efforts are translational. The unexamined assumption that underlies calls for more MD/PhD funding is that this group contributes something unique to the research community. Until this contribution is **quantified** the wisdom of devoting a larger portion of scarce research funding to MD/PhD careers is questionable.

    *After writing that, I was intrigued, and googled my own small study. Using figures from 2006 for the 10 most successful – biggest revenues – biotech companies, I tracked down the founders for each of these companies. PhDs were vastly overrepresented, accounting for 15 of 18 founders I could track down without much effort; there were no MD/PhDs – the remaining three founders were MBAs! Arguably a better measure would be track down the founders of newer and smaller biotechs, as the number of MSTPs graduated annually was quite small until the mid-1980s or so. If anyone wants to take on this, I’d be interested in the results. Incidentally, given their relative scarcity, chemists seem to be overrepresented among the ranks of the top 10 founders.
    **Some interesting quantification can be found here: http://publications.nigms.nih.gov/reports/mstpstudy/ and also in this (old) Bickel et al study “The role of M.D.-Ph.D. training in increasing the supply of physician-scientists” in NEJM.

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