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March 2018

Physician-Scientist Career Awards and a Dilemma: National Institute of Child Health and Human Development K Awards—Individual, Institutional, or National?

Author Affiliations
  • 1Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri
JAMA Pediatr. 2018;172(3):218-219. doi:10.1001/jamapediatrics.2017.4240

Despite the critical role that physician-scientists play in the biomedical work force, often from bedside to bench and back, concern for the health of this enterprise was apparent to James Wyngaarden1 40 years ago when he described this “endangered species.” Former National Institutes of Health (NIH) director, Elias Zerhouni, in 2008, said of the young scientist conundrum, “I think anybody who thinks this is not the number one issue in American science probably doesn’t understand the long-term issues.” The myriad challenges this presents have been addressed recently by many (see Schafer2). In 2 striking articles, Alberts et al3,4 have focused attention on what they term “rescuing US biomedical research from its systemic flaws.” Among the key areas identified is the next generation of biomedical scientists (including both fundamental and clinician scientists), wherein 18% of NIH R01-funded investigators were aged 36 years or younger in 1980, yet only 3% were in that age group in 2010. Furthermore, the percent of R01 principal investigators older than 65 years increased more than 10-fold during this same period: the aging of the workforce. Daniels5 dissected many of the causes for this current young generation at risk and noted that the average age for an MD investigator to receive her or his first R01 was 38 years in 1980 and rose to more than 45 years in 2010. To address this, he suggested 4 areas for potential action: strategic reinvestment in scientific research, reform of external peer review, rebalancing the compact between universities and the government, and developing sustainable career paths for young scientists. Indeed, the 2014 NIH Physician-Scientist Workforce (PSW) Report (https://acd.od.nih.gov/), noted that there are approximately 9000 physician scientists in the NIH-funded workforce and discussed the challenges confronting them: the cost of medical education with resultant debt, prolonged training required in both clinical medicine and research, funding challenges, shifting finances of schools of medicine and academic health centers, funding mentors for guidance, work-life balance, and increasing as well as demanding compliance, among others.

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