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October 25, 2021

Practical Advice on Surviving and Thriving as an Academic Physician-Neuroscientist

Author Affiliations
  • 1Division of Child Neurology, Neurology & Neurological Sciences at Stanford, Stanford Medicine, Palo Alto, California
JAMA Neurol. 2021;78(12):1439-1440. doi:10.1001/jamaneurol.2021.3889

Training programs combining MD and PhD degrees provide critical instruction in disease mechanisms, gaps in treatment, and rigorous scientific methodology. Physicians with both MDs and PhDs provide a vital and unique service to society through biomedical research and tend to achieve greater academic rank and grant funding.1 Within MD-PhD programs, 75% to 90% of matriculants graduate with both degrees.1 Greater attrition occurs after residency and fellowship training, with only approximately 60% of MD-PhD graduates becoming medical school faculty members per the Association of American Medical College National MD-PhD Program Outcomes Study (2018).2 Of those remaining engaged in research, approximately 50% to 60% conduct basic or translational research. The pronounced decline in the percentage of women, across medical specialties, with each subsequent promotion after training suggests professional hurdles may affect women physician-scientists disproportionately.3 What can individuals and academic and government institutions do to retain and promote junior physician-scientists in academic neurology?

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1 Comment for this article
It is not a failure when research-trained physicians become primarily clinicians
James Dickinson, MBBS PhD | Family Medicine and Community Health Sciences, University of Calgary
The author is thoughtful about the issues of career ladders, but possibly limited. It is concerning that academic training appears to mean less clinical experience and skills, leading to a sub-sub-specialty niche. Does that lead to progressive balkanization of each field, meaning that each can only work in large centres where there are enough patients to support that specific skill, and the full range of other sub-specialists is available? Is that the right direction for serving society’s needs?
Many trainees who were attracted to research: for the ideas, by a charismatic teacher etc, complete their degree, but then recognize that
they prefer the rewards of being a clinician to those of the researcher, especially with the intensely competitive nature of obtaining grants, and writing publications. Not all enjoy the negativity of rejection that occurs so frequently in academia. Perhaps they wish to live and practice outside a major centre? But having an academic research background can also make that person a more critical clinician, better able to interpret new research findings and use them in practice. Perhaps we need to ask those who left the "academic rat race" why they did so, whether they were pushed out or stepped away, and how they use the intellectual skills they learned in that process. They may be more successful in life than many who stayed on the ladder.