Friday, June 21, 2013

A Perspective with a misleading title

The New England Journal of Medicine prints its table of contents on the front cover. When my wife pulled the most recent issue from our mailbox and saw the article title "The Role of the NIH in Nurturing Clinician-Scientists," she naturally thought I would be interested. I was.

The Perspective article begins by stating the value of physician scientists. I have no quibble with this. Then it makes the oft-repeated point that increasingly, physicians don't want to do this basic research thing anymore. I wonder why?

Then the really disheartening part: the remaining 90% of the article turns out to mostly a pitch for a new NIH program supporting a total of 20 new physician investigators at any one time.  Let's think about this: 20 investigators at a time divided by the 10 to 12 years that the program spans (yes: the lucky few will get 10 to 12 years of support, including a 5 to 7 year stint on the NIH campus). So,1 to 2 new physician-investigators per year will enter the workforce via this pipeline. And this merits 2 pages of valuable real estate at the front of the NEJM?

The title of the article led me to believe that there might be a more general discussion of how the NIH could "nurture" physician-scientists at all stages of their careers. This seems to be especially topical in these tight times. There was no such discussion.

How many highly-trained (at great cost, mostly borne by taxpayers) physician-scientists at various stages of their careers or newly-trained MD-PhDs will leave basic or translational science each year that 1 or 2 new trainees are accepted into this new NIH program? Would it be more cost effective, instead of bringing new investigators into the system, to, say, encourage newly trained MD-PhDs to stay in research (rather than going into, for example, lucrative clinical practices, as many do)? The investment in already-trained physician-scientist should be protected by addressing some of the problems that are driving them away rather than initiating yet another training program.

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