As directors of the Medical Scientist Training [M.D.-Ph.D.] Program  (MSTP) at the University of Pennsylvania Perelman School of Medicine, the two of us spend a lot of our time talking with undergraduates, medical students, residents, and fellows about career choices. We both have found that the life of a physician-scientist is incredibly rewarding, but we recognize that it is often daunting to navigate the long path toward becoming one, particularly if you are not exposed to mentors or role models in college or even earlier. Here we have addressed some common questions that arise when considering a career as a physician-scientist.
A physician-scientist is an individual with an M.D. degree (with or without other graduate degrees) for whom research and discovery are at least a major commitment. Physician-scientists are likely to spend time in a clinical setting related to their research, but clinical care is not their major role. If in academia, he or she is likely to teach and have administrative roles as well. Most physician-scientists are employed at academic medical centers or universities, but some work at research institutes such as the National Institutes of Health (NIH) or in the biotechnology and pharmaceutical industries. Again, wherever they work, research and the discovery and application of new knowledge are their focus, rather than the application of existing knowledge. For example, physician-scientists are more likely to focus on the development of entirely new approaches to killing bacteria or curing cancer than on prescribing existing antibiotics or chemotherapy agents. No one knows precisely what the future holds, but physician-scientists of the future are likely to still be working in academia and to be encouraged to spend an even larger percentage of their professional time focused on discovery.
The focus of research can span a broad range of biomedical sciences aimed at understanding and improving human health. Basic and translational research investigates mechanisms of disease, which can help develop better diagnosis and treatment strategies. Clinical research focuses on interventional human trials to evaluate drugs and treatments in a controlled setting. Epidemiology research studies patterns of disease within specific populations. Health services research examines how the process of health care affects patient outcomes. Physician-scientists can also perform research in relatively nontraditional fields, such as anthropology or the history and sociology of science.
There are multiple ways that physician-scientists can pursue their training, including:
-an M.D.-Ph.D. program
-an M.D. program plus a Ph.D. completed separately, either before or after medical school
-an M.D. program plus a master's degree during or after medical school
-an M.D. program plus nondegree-awarding research time during or after medical school, through either local or national programs
Once upon a time, physician-scientists were either self-taught or trained through an extended apprenticeship without formal training in research methods. Today, it is generally thought that becoming an investigator as well as a clinician requires training beyond what is normally included in the medical school curriculum even at research-intensive universities. However, just as there is more than one kind of physician-scientist, there is more than one way to become a physician-scientist. The "right" way for you is influenced by when you first became interested in medicine and research and the type of research you wish to pursue.
M.D.-Ph.D. programs—also known as MSTPs and combined degree programs—are outstanding training opportunities for those who have an interest in research and demonstrate a talent for it during or shortly after their undergraduate careers. It is also for those whose future careers will focus on investigator-initiated research. Many of these programs (particularly MSTPs, which are funded by NIH) offer full tuition support for medical school and graduate school as well as a stipend for living costs. Combined degree programs offer in-depth training and mentoring in both the clinical and research sciences, with an average time to earn both degrees of 8 years1—shorter than the time it takes to obtain the M.D. and the Ph.D. separately. These spots are limited and highly competitive (around 1800 applicants for about 600 slots). Studies indicate that M.D.-Ph.D.s constitute a growing fraction of funded physician-scientists2, are more competitive for prestigious career development awards3, and are more likely to obtain NIH R01 funding than M.D.s4. However, M.D.-Ph.D.s make up a minority of the total physician-scientist workforce, and Ph.D. training is not required for many types of research (see below), so an M.D.-Ph.D. program is by no means the only or even the best way to become a physician-scientist.
Many physician scientists involved in clinical trials, epidemiology, and health services research are trained through master's programs completed either during or (more frequently) after medical school, with degrees in clinical epidemiology, biostatistics, public health, or health services and outcomes research. "After medical school" usually means after completion of a clinical residency and fellowship. Even physician-scientists who pursue basic and translational research often do not train in M.D.-Ph.D. programs. They may have become interested in research after enrolling in an M.D. program or during clinical residency. (Like flowers that emerge in the summer rather than the spring, these folks are sometimes referred to as "late bloomers.") Some may have pursued substantial research during medical school through a nondegree-granting program such as the NIH Medical Research Scholars Program (MRSP). The success of the NIH MRSP in its various manifestations is evidenced by the finding that its graduates are more likely to go on to receive NIH postdoctoral research grants and medical school faculty appointments with research responsibility5. Individual or institutional training grants can help to support the cost of tuition and salary during postgraduate training. Additionally, NIH-funded (and, rarely, institution-funded) loan-repayment programs can help to pay back the cost of undergraduate and medical school loans.
As mentioned above, every year in the United States there are men and women who, having completed medical school or graduate school, decide that their career plans call for completing the other degree as well. Some of the Ph.D. scientists who go on to earn an M.D. are making a career switch and do not intend to be physician-scientists, but many are acquiring additional training with the goal of being a better physician-scientist. Taking the series route requires more time than an M.D.-Ph.D. program does, but it may be the only option for those who make the decision farther along in their training.
At the present time, most physician-scientists who work in academia are in clinical departments rather than basic science departments. That means that they are in a Department of Medicine or a Department of Pediatrics rather than in the biochemistry or molecular biology departments, although many of us have joint appointments that span both worlds. Most academic medical centers and universities offer two types of positions to physician-scientists based on how they spend their time and how they anticipate being paid. Tenure-track candidates are usually more than 75% research and are expected to provide the majority of their salary and funding for their research laboratory from research grants. Faculty have six to 10 years to achieve tenure, and in most institutions the track is "up or out" meaning that faculty that don’t achieve tenure are asked to leave. Tenure is awarded largely on the basis of grant funding, publications, and scientific renown (evaluated via letters of recommendation from scientific peers), although the criteria for tenure can vary. Tenure (at some institutions, but not all) means that an academic base salary is guaranteed, although tenured investigators who are unsuccessful in publishing and winning grants often seek other employment. The tenure track is intended for physician-scientists conducting investigator-initiated research, affording adequate protected time and resources to develop an independently funded research program.
Most universities also offer a track variously called "clinician-educator" or "clinician-scholar." These scientists may spend most of their time on research, but will always spend some time in the clinic. These positions may or may not come with protected time or startup packages. This track may be ideal for investigators who are interested in research that is more intermittent or not as easily funded through investigator-initiated grant mechanisms (including industry-sponsored multicenter clinical trials). These tracks are also excellent options for physicians who are interested in research but wish to focus on clinical medicine, and who are not the principal investigator on a research team.
It takes a long time to become a physician-scientist, but we love what we do and encourage you to think about pursuing such a career. It is a luxury and pleasure to have the intellectual freedom to pursue our scientific ideas, interact with talented and thoughtful physicians and scientists across the world, and mentor the next generation of physician-scientists. Furthermore, in contrast to some other areas of science, physician-scientists enjoy a strong employment market and abundant opportunity.
Our discussions here are by no means comprehensive. We haven’t addressed work-life balance (yes, it’s possible), the importance of mentorship (that will always be the case) and how to find it, the demographics of the physician-scientist workforce, or the changes in training and hiring that may occur over time as team science and big data become more common.6
A robust physician-scientist workforce is key to bridging the gap between scientific knowledge and medical practice. Our success in this endeavor relies on recruiting and retaining diverse, talented, and well-trained individuals. We hope you join us and our colleagues in this mission.
1 L. F. Brass , M. H. Akabas, L. D. Burnley, D. M. Engman, C. A. Wiley, O. S. Andersen, Are M.D.-Ph.D. programs meeting their goals? An analysis of career choices made by graduates of 24 M.D.-Ph.D. programs. Acad Med. 85, 692-701 (2010).
2 T. J. Ley, L. E. Rosenberg, The physician-scientist career pipeline in 2005: build it, and they will come. JAMA 294, 1343-1351 (2005).
3 S. N. Escobar-Alvarez, E. R. Myers. The Doris Duke Clinical Scientist Development Award: Implications for early-career physician scientists. Acad Med (2013).
4 H. B. Dickler, D. Fang, S. J. Heinig, E. Johnson, D. Korn. New physician-investigators receiving National Institutes of Health research project grants: a historical perspective on the "endangered species". JAMA 297, 2496-2501 (2007).
5 D. Fang, R. E. Meyer. Effect of two Howard Hughes Medical Institute research training programs for medical students on the likelihood of pursuing research careers. Acad Med. 78, 1271-1280 (2003).
6 A. Schafer. The Vanishing Physician-Scientist? (Cornell Univ. Press, New York, 2009).