In the parlance of evolutionary biology, “on the edge” refers to endangered species nearing extinction, which we believe aptly describes contemporary clinician-scientists (for the purpose of this discussion, we differentiate clinician-scientists, who maintain patient interactions, from physician-scientists, who exclusively focus on research).
Much has been said about the near extinction of clinician-scientists.1 In his landmark Archives editorial in 1991, Epstein2 noted the economic pressures faced by academic ophthalmology departments (and junior faculty members therein), alerting us to the dwindling numbers of ophthalmologists conducting discovery-oriented research. A decade later, Weinreb3 revisited the plight of clinician-scientists—underscoring the increasing difficulties they faced in getting grant funding while attempting to maintain clinical productivity in an ever more competitive environment with sharply declining clinical reimbursements. Whereas Epstein bemoaned an academic culture with misplaced priorities, Weinreb focused more on structural shortcomings in clinician-scientist education and development.
Dana R, Miller JW. On the EdgeThe Clinician-Scientist in Ophthalmology. JAMA Ophthalmol. 2013;131(11):1401-1402. doi:10.1001/jamaophthalmol.2013.4883