Addressing the physician-scientist pipeline: Strategies to integrate research into clinical training programs

Funding

Figure 1. Institutional approaches and funding opportunities for physician-scientists in training and the early career stage. (A) Structure and approaches taken by MGH Internal Medicine, Duke University School of Medicine (centralized in the Office of Physician Scientist Development [OPSD]), and Vanderbilt University School of Medicine to train and support new physician-scientists. (B) Funding from the NIH, the US Department of Veterans Affairs (VA), the Burroughs Wellcome Fund (BWF), the Doris Duke Charitable Foundation (DDCF), and Howard Hughes Medical Institute (HHMI). These mechanisms include the Physician-Scientist Institutional Award (PSIA), the Physician Scientist Fellowship (PSF), the Loan Repayment Program (LRP), the Fund to Retain Clinical Scientists (FRCS), and the Career Development Award (CDA). Symbols highlight mechanisms used to fund the institutional physician-scientist programs featured in this perspective. CSDA, Clinical Scientist Development Award: DSP, Diversity Supplement; HHGF, Hannah H. Gray fellows; MSTP, Medical Scientist Training Program; PS, physician-scientist. Adapted with permission from Dr. Shawn Gaillard (NIH). The authors would like to thank Katrina Armstrong (Physician-in-Chief, Department of Medicine, MGH); Nancy Brown (Chair, Department of Medicine, Vanderbilt University School of Medicine); Mary Klotman (Dean, Duke University School of Medicine); and Jeffrey Balser (Dean, Vanderbilt University School of Medicine) for their thoughtful advice and support. This work was supported in part by NIH grants (R25AI147393, to JMV; R38AI140297 and R38HL143612, to SRP; and R38HL143619, to CSW) and a Burroughs Wellcome Fund Physician-Scientist Institutional Award (PSIA) (1018899, to RAG). Sustaining successful physician-scientist pipelines requires a funding strategy that includes coverage for (a) protected time for both research and professional training; (b) research funding for scholars at various points in their career development; and (c) administrative support for mentorship, training, and evaluation. MGH, Duke, and Vanderbilt have used a variety of funding mechanisms to achieve these goals. NIH and VA funding opportunities provide research and training support for premedical, medical, and graduate students (T32, R25, F30/31), residents and fellows (T32, F32, R25, R38, K38, VA-CDA), and fellows/ early career faculty (K12/KL2) (Figure 1B). These NIH-funded mechanisms aim to support research education activities (R25), stimulate access to research during residency (R38), and enhance mentored research training opportunities (T32, K12, K38). These mechanisms are not available through all NIH institutes; specifically, the R38 is currently offered by only four institutes. Structural and administrative support to build professional development programs and administer internal research funding programs has largely been funded internally through medical school deans’ offices, departments, and endowments and through large institutional grants (e.g., the Burroughs Wellcome Fund Physician-Scientist Institutional Award). Foundations such as the Doris Duke Charitable Foundation may be engaged to retain physician-scientists at early career faculty stages, when many struggle with balancing clinical, research, and home life responsibilities. Additional opportunities are offered by the Howard Hughes Medical Institute to promote diversity among physician-scientist trainees. Finally, for trainees who devote at least 50% of their efforts to research, the NIH Loan Repayment Program can offer a reduction in educational debt, and applications to this program should be highly encouraged beginning in residency. Overall, we have found that a strong and diverse portfolio of funding is necessary and that a variety of external opportunities exist to tackle the problem of a shrinking physician-scientist pipeline. Ultimately, institutional dedication to supporting trainees in pursuing these awards is critical to the success of a sustainably funded physician-scientist training program.