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Figure.
Main issues discussed during semi-structured interviews with 16 clinician-scientists regarding the clinician-scientist pathway. Numbers in parentheses refer to the participant identification number. The Clinical Investigator Program (CIP) is a program instituted throughout McGill University Health Centers, Montreal, Quebec, Canada, in which clinical training is completed and followed by training in research methodologies; the physicians involved in this program are also referred to as “late bloomers.” CIHR indicates Canadian Institutes of Health Research; MD, doctor of medicine; and PhD, doctor of philosophy.

Main issues discussed during semi-structured interviews with 16 clinician-scientists regarding the clinician-scientist pathway. Numbers in parentheses refer to the participant identification number. The Clinical Investigator Program (CIP) is a program instituted throughout McGill University Health Centers, Montreal, Quebec, Canada, in which clinical training is completed and followed by training in research methodologies; the physicians involved in this program are also referred to as “late bloomers.” CIHR indicates Canadian Institutes of Health Research; MD, doctor of medicine; and PhD, doctor of philosophy.

1.
Canadian Institute for Health Research, The clinician scientist: yesterday, today and tomorrow.  Toronto, Ontario, Canada Canadian Institute for Health Research2002;http://www.cihr-irsc.gc.ca/e/22030.html. Accessed July 22, 2008
2.
Zemlo  TTGarrison  HHPartridge  NCLey  TJ The physician scientist: career issues and challenges at the year 2000. FASEB J 2000;14 (2) 221- 230
PubMed
3.
Ley  TJRosenberg  LE The physician-scientist career pipeline in 2005: build it, and they will come. JAMA 2005;294 (11) 1343- 1351
PubMedArticle
4.
Solomon  SSTom  SCPichert  JWasserman  DPowers  AC Impact of medical student research in the development of physician scientists. J Investig Med 2003;51 (3) 149- 156
PubMed
5.
Buddeberg-Fischer  BHerta  KD Formal mentoring programmes for medical students and doctors-a review of the Medline literature. Med Teach 2006;28 (3) 248- 257
PubMedArticle
6.
Ley  TJRosenberg  LE Removing career obstacles for young physician-scientists—loan-repayment programs. N Engl J Med 2002;346 (5) 368- 372
PubMedArticle
Research Letters
July 13, 2009

Improving the Clinician-Scientist Pathway: A Survey of Clinician-Scientists

Arch Intern Med. 2009;169(13):1241-1247. doi:10.1001/archinternmed.2009.173

There has been growing concern about an insufficient number of physicians engaged in research as their primary professional activity.13 Little is known about how we can increase the number of successful clinician-scientists or how to facilitate the success of those in the clinician-scientist pathway.

Methods

We surveyed a convenience sample of 16 clinician-scientists employed at 4 McGill University teaching hospitals in Montreal, Quebec, Canada. This survey consisted of 2 phases. Participants first participated in an individual, semistructured interview of approximately 15 minutes. This interview consisted of a mixture of closed- and open-ended questions concerning their experience in the clinician-scientist pathway. Participants were then e-mailed a short follow-up questionnaire consisting of open-ended questions.

Results

All 16 clinician-scientists whom we approached agreed to participate. Their ages ranged from 30 to 63 years, and approximately two-thirds were male. All participants had medical degrees, with approximately two-thirds possessing additional advanced degrees.

Participants were consistent in a number of their views concerning the clinician-scientist pathway (Figure). There was unanimous agreement regarding the importance of mentoring. Most participants also cited an early interest in research, usually occurring before or during medical school. In addition, most participants believed that there are certain character traits innate to those who are successful as clinician-scientists, including determination, curiosity, and the ability to withstand criticism.

Participating clinician-scientists consistently identified important barriers to success in the clinician-scientist pathway. Most participants found that there were economic disincentives to pursuing this pathway, with many suggesting mechanisms for overcoming this disadvantage. These mechanisms include doing clinical work at nights or on the weekends to earn money and to maintain clinical skills. When asked about the potential challenge of balancing their numerous roles, many participants suggested that certain sacrifices in family life are necessary to be successful clinician-scientists. This feeling was particularly prevalent among women. In addition, most participants have found it difficult to balance the various obligations of being a staff physician with the pursuit of their research endeavors. Furthermore, participants reported that their employment contracts do not appropriately delineate their various responsibilities. Consequently, time management represents an overbearing concern.

In the follow-up questionnaire phase of the study, we identified several additional trends. Most participants reported the need to increase funding, particularly during residency, as a key issue. The majority of participants also described a difficult environment for fledgling clinician-scientists as a major obstacle to success, highlighting the need for mentoring and better protection of research time.

Comment

The results of this survey have several implications. First, most successful clinician-scientists reported an early interest in research. Consequently, the crux of our efforts to train the next generation should focus on identifying potential clinician-scientists early in their training. Since 1997, there has been an encouraging increase in interest in research among medical students.3 We must continue efforts to maintain this trend via research scholarships.4 Second, we need to address the lack of formal mentoring programs by setting clear goals and proper evaluation methods.5 We also need to foster an early-career environment supportive of the needs of clinician-scientists. Third, there is a need to increase funding in the clinician-scientist pathway. This increase should include financial incentives, such as loan repayment programs,6 as well as increased research funding. Finally, we need to better protect their time for research. This protection should include clear delineation of their responsibilities in their contracts, as well as decreasing their administrative responsibilities.

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Article Information

Correspondence: Dr Eisenberg, Divisions of Cardiology and Clinical Epidemiology, Jewish General Hospital/McGill University, 3755 Cote Ste Catherine Rd, Ste A-118, Montreal, QC H3T 1E2, Canada (mark.eisenberg@mcgill.ca).

Author Contributions:Study concept and design: Donath, Filion, and Eisenberg. Acquisition of data: Donath. Analysis and interpretation of data: Donath, Filion, and Eisenberg. Drafting of the manuscript: Donath and Filion. Critical revision of the manuscript for important intellectual content: Donath, Filion, and Eisenberg. Administrative, technical, and material support: Donath, Filion, and Eisenberg. Study supervision: Filion and Eisenberg.

Financial Disclosure: None reported.

Funding/Support: Mr Filion is supported, in part, by a bursary from the Quebec Foundation for Health Research.

Additional Information: Dr Eisenberg is a National Researcher of the Quebec Foundation for Health Research.

References
1.
Canadian Institute for Health Research, The clinician scientist: yesterday, today and tomorrow.  Toronto, Ontario, Canada Canadian Institute for Health Research2002;http://www.cihr-irsc.gc.ca/e/22030.html. Accessed July 22, 2008
2.
Zemlo  TTGarrison  HHPartridge  NCLey  TJ The physician scientist: career issues and challenges at the year 2000. FASEB J 2000;14 (2) 221- 230
PubMed
3.
Ley  TJRosenberg  LE The physician-scientist career pipeline in 2005: build it, and they will come. JAMA 2005;294 (11) 1343- 1351
PubMedArticle
4.
Solomon  SSTom  SCPichert  JWasserman  DPowers  AC Impact of medical student research in the development of physician scientists. J Investig Med 2003;51 (3) 149- 156
PubMed
5.
Buddeberg-Fischer  BHerta  KD Formal mentoring programmes for medical students and doctors-a review of the Medline literature. Med Teach 2006;28 (3) 248- 257
PubMedArticle
6.
Ley  TJRosenberg  LE Removing career obstacles for young physician-scientists—loan-repayment programs. N Engl J Med 2002;346 (5) 368- 372
PubMedArticle
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