Hey EVERYONE!
I just got back from the conference in San Diego and it was really cool! The majority of the participants were MD/PhDs and they discussed cardiac/neuro research that really took things from the bench to bedside!
Anyhow, I thought some of you might be interested in what was discussed at the "physician-scientist roundtable".
it started with a keynote by leon rosenberg [former dean of yale and huge proponent of physician-scientists...in fact, we probably owe our funding to his efforts]. he gave a bunch of statistics about the decline of phy-sci: the percent of MDs doing research fell from 4% to 2% in the last 15 yrs, MDs or MD/PhDs once comprised of 43% of NIH investigators...now it is <30%, less MDs in NIH review panels and huge drop in 1st time MD applicants for grants or seeking postdoc research at NIH.
there are essential two paths to becoming a phy-sci: [1] MSTP and [2] "late bloomer."
MSTP - decide on path EARLY in college life. applicant pool slowly increasing because of funding & high probability of success. usually graduate with little or no debt. only comprises 2.5% of all MD graduates but 30% of NIH MD PIs. usually focus on basic science topics. but not enough graduate to fill gap left by decreasing interest by MDs to pursue academic medicine.
"late bloomer" - decide on research path LATE, during med school/residency/fellowship. VARIABLE time/quality of research training. usually focus on CLINICAL/patient-based research. once accounted for all phy-scis and still accounts for most. less MDs seek this because of HIGH DEBT [avg grad debt is $99K, only 17% of MD grads do not have significant debt]. declining "breed" b/c college undergrads are usually steered towards med or grad schools, admission committees focus less on research, opportunities in research at med schools vary, MANAGED CARE makes it difficult to pursue research.
suggestions by leon [echoed by faseb rep, nih rep, mstp directors, biotech reps]: FUND MORE MSTP slots, set up more structured postdoc training for MDs, give LOAN REPAYMENT plans to MDs seeking research.
but: for now, nigms is NOT planning to expand funding for mstp in its budget! other institutes within nih are willing to fund phy-sci development programs but NIH POLITICS makes it impossible to funnel money from other institutes in mstp. so instead, other institutes [nci, nhlbi, etc] fund postdoc/new investigators with grants. some suggested having the nigms considered a "core grants" to med schools and allowing other institutes to give "supplemental grants" but this is essential transfering $$ from other institutes to nigms which is not kosher for nih politics.
another problem discussed: if the mstp is expanded, is the applicant pool BIG & TALENTED enough? the directors acknowledge that they are pretty much interviewing the same group of students and privacy laws prevent them from compiling SSN to get the actual number of MSTP applicants. instead, directors can compare total number of applications which are obviously redundant.
i don't know where this number came from but its believed that we need to graduate ~1500 physician-scientists each year to maintain the current number. right now ~450 MD/PhD graduate each year [40% are MSTP] and ~550 MD/PhD matriculate each year[50% MSTP]. is it possible to TRIPLE/QUADRUPLE the size of MSTP programs to fill the need [this is essentially giving up on "late bloomers"]? to attract more applicants, [a] need to provide more $$, shorten the overall track, and offer more [c] clinical type research training.
argument again giving up on "late bloomers:" lots of great ideas surface AFTER going through med school, "late bloomers" made up the biggest source of past phy-sci [83% of Nobel laureates have/had MD], MSTP is not graduating enough to fill need [especially since NIGMS is not expanding funding], not enough talent to fill MSTP slots even if it were expanded, "late bloomers" contribute more to translational medicine
[a] ideas for providing more funding: getting biotech support [since lots of MD/PhD end up running R&D at these pharm/biotech companies], getting non-profit support problem: these groups are interested in seeing "return" on their "investment" i.e. having MSTP grads focus on their non-profit organization's topic or dedicating time to the biotech company
how to shorten overall: MSTP directors have shortened the MSTP programs as much as they can to ~7 years [which is a difficult design to for students to follow anyway]. thus, need to look at SHORTENING the residency/fellowship tracks by cutting residency time? or CUTTING subspecialty training?
[c] expand applicant pool by expanding type of research training in MSTP? i.e. not just basic science but also clinical/patient-based research which requires rigorious research training of different sort [biostatics, epidemiology, informatics]. PROBLEM: this clinical-oriented research training would require students to be clinically trained or have their MD completed. this goes against the NIGMS structure of squeezing the PhD in between the MD program. MSTP directors believe that a different track or entirely different program should be set up for this.
Okay, so the roundtable talked about other stuff like having foreign MD/PhD fill need, residency choices by MD/PhDs [is RESIDENCY a must?], need for MENTORING MSTP grads by established MD/PhD investigators, getting $$ for PROTECTED RESEARCH TIME [a problem b/c hospital are under pressure by managed care to have doctors put more time in clinics]
Well, that's all I'm going to post for now...I hope you found some of this stuff interesting.
MapK