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• W2969355983 abstract "Clinician scientists are commonly defined as those individuals holding an MD or MD/PhD degree who perform biomedical research of any type as their primary professional activity.1Zemlo T.R. Garrison H.H. Partridge N.C. Ley A.J. The physician-scientist: career issues and challenges at the year 2000.FASEB J. 2000; 14: 221-230Crossref PubMed Scopus (178) Google Scholar Here we discuss issues that affect the choice to pursue a clinician scientist career in the various areas of medical research, including pediatrics, and how these issues are changing in light of recent developments in the biomedical research environment and the practice of medicine. The clinician scientist has become a rare and distinct entity, or an “endangered species” as James Wyngaarden, former director of the National Institutes of Health stated 4 decades ago.2Wyngaarden J.B. The clinical investigator as an endangered species.N Engl J Med. 1979; 301: 1254-1259Crossref PubMed Scopus (377) Google Scholar Recent data show a consistent worldwide decrease in the rate of medical doctors pursuing this path.3Gordon R. The vanishing physician scientist: a critical review and analysis.Account Res. 2012; 19: 89-113Crossref PubMed Scopus (23) Google Scholar For instance, reports from the US have emphasized that although an absolute increase in medical students has been observed during the past few years, the number of MD/PhD applicants has plateaued.4Davila J.R. The physician-scientist: past trends and future directions.Mich J Med. 2016; 1: 66-73Google Scholar, 5Schafer A.I. The vanishing physician-scientist?.Transl Res. 2010; 155: 1-2Abstract Full Text Full Text PDF PubMed Scopus (57) Google Scholar According to the National Institutes of Health Physician Scientist Workforce report, in 2012 physician scientists comprised only 1.5% of the total physician workforce in the US.6National Institute of HealthPhysician-Scientist Workforce Working Group report.https://acd.od.nih.gov/documents/reports/PSW_Report_ACD_06042014.pdfDate: 2014Date accessed: June 21, 2019Google Scholar Also of concern is the aging of the clinician scientist workforce. The average age of the workforce has increased, as has the age of independence for researchers (grant holders), suggesting a decrease in the pool of young researchers and an inability to compete with PhDs for grants. Notably, an overall gender inequality was also reported, with females representing only 22% of MD/PhD physician scientists. There are divergent opinions on this issue. Some claim that an MD should concentrate on clinical work, and a basic research scientist should pursue their scientific career. A general growing perception is that there is more than enough work for both professional figures. The training to become a clinician scientist is time consuming, and each field is a challenging career by itself. Therefore, whether a hybrid of these 2 fields is truly necessary is a legitimate question. It is true that a clinician with training as a research scientist usually does not have the same wide technical education or the basic skills of an experienced scientist. However, having clinical experience offers several advantages. A clinician scientist who deeply understands a disease, its complications, and implications may raise specific questions and develop focused research projects, which can be more effectively translated into clinical benefits.7Yap K.K. The clinician-scientist: uniquely poised to integrate science and medicine.AMSJ. 2012; 3Google Scholar Being a clinician scientist may facilitate access to patient samples and thereby promote bench to bedside research projects, linking basic and clinical science. Physician scientists have the capability to transpose clinical observations into testable research hypotheses and translate research findings into medical advances. A clinician who is familiar with research can establish better links with patients, as well as medical staffs. Clinician scientists are able to better introduce patients to the objective of a cross-disciplinary study. This combination can result in good patient compliance and strengthen patient–clinician interactions.8Eisenberg M.J. Is a physician-scientist career right for you? The physician scientist's career guide.https://link.springer.com/chapter/10.1007%2F978-1-60327-908-6_2Date: 2010Date accessed: June 24, 2019Google Scholar Several reasons may account for the declining number of medical graduates who opt for a career as clinician scientists (Table; available at www.jpeds.com). In general, MD/PhD dual programs require extensive training and are demanding in terms of time and emotional commitment, making the integration of these 2 fields of practice a difficult task to pursue. Furthermore, different types of skills are needed to succeed in each field, which need to be integrated. Both fields share common denominators, purposes, and patient care goals, whether by treating disease or through shedding light on the mechanisms involved, however, substantial differences exist. Although the primary work of most physicians involves a direct caregiver–patient encounter and the responsibility for the patient as a whole, the basic research scientist rarely has interacts directly with patients and the benefits of successful research usually impact patients' health. A further important difference between the MD and PhD fields relates to the immediate vs prospective satisfaction in patient care. Although the physician may get an immediate satisfaction from helping a patient, the results of scientific research are usually seen after a longer time period. Reconciling a distinctive approach to the work performance and expectations between MD and PhD professionals is also an issue. MDs are typically trained to follow and implement consolidated standards of practice and research scientists are typically encouraged to challenge existing paradigms through novel ideas. Economic factors play a role in the choice to pursue a clinician scientist career, because it could hinder economic opportunities, such as private clinical practice. Students may also hesitate to pursue a career involving research owing to the burden of debt they may incur and the need to repay the loans they receive during this period.9Donath E. Filion K.B. Eisenberg M.J. Improving the clinician-scientist pathway: a survey of clinician-scientists.Arch Intern Med. 2009; 169: 1241-1247Google Scholar The expectations from a clinician scientist can be stringent and at times unrealistic. A clinician scientist is typically involved in 2 different yet demanding professional settings, involving different personnel. Different teams might feel dissatisfied owing to a perceived lack of commitment, often caused by the need for clinician scientists to divide their time, which could lead to conflicts. MD/PhD dual programs are long, tiring, and complex; the candidate is required to learn new techniques, new approaches, and new technical languages. Moreover, the professional competence that MD physicians gain after graduation and completing their residency may look unhelpful or underused when they are required to interact in the laboratory settings with partners from different fields of science who are trained in basic research. These factors may have independently contributed to the gradual reduction in the number of MDs who decide to gain a PhD degree and pursue a clinician scientist career in favor of a more economically secure and less complicated, although demanding clinical career. Diversity is one of the main factors that may favor the decision of MDs to pursue a basic science path. In fact, MDs typically concentrate on a specific path and subspecialize in a certain field. However, the routine of practice, although often professionally and economically satisfying, could become monotonous, leading to professional frustration. This could generate a decrease in interest, satisfaction, and excitement, and ultimately impair the motivation to pursue personal and professional goals in the clinical field. Integrating different, yet complementary fields in an MD/PhD career could stimulate the desire to engage in translational research with the goal of applying knowledge from basic biology and clinical trials to techniques and tools that address critical medical needs. Recent reports have emphasized the importance for MDs to participate in basic research projects aimed at developing new therapies, medical procedures, or diagnostics.10Mahla R.S. Stem cells applications in regenerative medicine and disease therapeutics.Int J Cell Biol. 2016; 7: 19-43Google Scholar A study from Israel documented that translational research served as an anti-burnout remedy for Israeli pediatricians.11Grossman Z. Chodick G. Kushnir T. Cohen H.A. Chapnick G. Ashkenazi S. Burnout and intentions to quit the practice among community pediatricians: associations with specific professional activities.Isr J Health Policy Res. 2019; 8: 2Google Scholar Tutoring students and conducting research were shown to be the 2 activities that brought high satisfaction, and the academic status was also correlated with high satisfaction among pediatricians.12Kennedy P.G.E. My life as a clinician-scientist: trying to bridge the perceived gap between medicine and science.DNA Cell Biol. 2015; 34: 383-390Google Scholar The awareness about the importance of basic research for the advancement of clinical knowledge in the area of developmental medicine is growing.13Somekh E. Katz M. Grossman Z. Planning the pediatric workforce in Israel.J Pediatr. 2019; 206: 308-309Scopus (3) Google Scholar Such informational activities and programs need to be developed and further implemented, and the European Paediatric Association/Union of National European Paediatric Societies and Associations is actively engaged in this task. A key element for attracting students to pursue a career as clinician scientists is the creation of well-structured MD/PhD dual programs focused on developing a strong competence in translational medicine and regularly updated to include cutting-edge medical advances. The quality of mentorship, the availability of a stimulating research environment, and well-equipped facilities are also crucial conditions for the success of dual programs. Medical schools, hospitals, and research centers should be aware of the advantages of promoting physicians to grow as clinician scientists.14Kushnir T. Cohen H.A. Job structure and burnout among primary care pediatricians.Work. 2006; 27: 67PubMed Google Scholar Several medical schools have created specific educational channels for clinician scientists, including financial benefits for clinicians who choose this career path.11Grossman Z. Chodick G. Kushnir T. Cohen H.A. Chapnick G. Ashkenazi S. Burnout and intentions to quit the practice among community pediatricians: associations with specific professional activities.Isr J Health Policy Res. 2019; 8: 2Google Scholar This strategic approach is based on the awareness that such investments would ultimately have a high rate of positive return in terms of both research grants and prestige for the university. The selection of clinician candidates for this combined career should be done during residency. In fact, some European residency programs in pediatrics include periods specifically dedicated to research.15Corsello G. Ferrara P. Chiamenti G. Nigri L. Campanozzi A. Pettoello-Mantovani M. The child health care system in Italy.J Pediatr. 2016; 177: S116-S126Abstract Full Text Full Text PDF Scopus (32) Google Scholar Planning for a future pediatric workforce should include an efficient use of periods dedicated to research during medical studies and residency, to identify potential candidates for a dual program. The entity of clinician scientist is in danger of vanishing.16Goldsmith L.A. The physician-scientist. A vanishing oxymoron?.Arch Dermatol. 1992; 128: 474Google Scholar, 17Schrier R.W. A Ph.D. in clinical science for physicians: one solution to the vanishing breed of the physician-scientist.Proc Assoc Am Physicians. 1998; 110: 88-89Google Scholar The overall pattern is clear and consistent; biomedical research has been expanding, but the rates of physician scientists have not kept pace.16Goldsmith L.A. The physician-scientist. A vanishing oxymoron?.Arch Dermatol. 1992; 128: 474Google Scholar, 18Coller B.S. Translational research and the physician-scientist.in: Schafer A.I. The vanishing physician-scientist? Cornell University Press, Ithaca (NY)2009: 67-83Google Scholar As we approach an era of personalized medicine, prompted by a better understanding of disease mechanisms and the use of novel therapeutic approaches, there is an increased need for a closer collaboration between research scientists and clinicians, and for clinician scientists who speak both languages fluently.19Molloy E.J. Modi N. Greenough A. Lagercrantz H. Bearer C.F. Turner M. The future of pediatric research: European perspective.Pediatr Res. 2017; 81: 138-139Google Scholar The career of a clinician scientist may be challenging, interesting, fulfilling, diverse, and ultimately rewarding owing to the unique opportunity to impact patient health through an effective and combined bench-to-bedside and bedside-to-bench approach.20Oates J.C. The magic of the Southern Society for Clinical Investigation: can we make the vanishing physician-scientist reappear?.Am J Med Sci. 2013; 345: 259Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar The quality of pediatric research may reflect the quality of clinical care in a given country.21Ehrich J. Tenore A. Del Torso S. Pettoello-Mantovani M. Lenton S. Grossman Z. Diversity of Pediatric Workforce and Education in 2012 in Europe: a need for unifying concepts or accepting enjoyable differences?.J Pediatr. 2015; 167: 471-476.e4Abstract Full Text Full Text PDF PubMed Scopus (37) Google Scholar The European Paediatric Association is actively exploring methods to improve child health care in Europe. This includes the expansion and updating of training programs for pediatricians.22Hoey H. Stephenson T. Namazova-Baranova L. Pettoello-Mantovani M. Mestrovic J. Vural M. et al.Prevention and therapeutic innovation in the management of child health.J Pediatr. 2019; 208: 300-301Abstract Full Text Full Text PDF Scopus (1) Google Scholar Pediatric research activities in Europe should take a life course perspective on child development, health, and disease, thus aiming to increase pediatric research activities.23Ehrich J. Namazova-Baranova L. Pettoello-Mantovani M. Introduction to “Diversity of Child Health Care in Europe: a Study of the European Paediatric Association/Union of National European Paediatric Societies and Associations”.J Pediatr. 2016; 177S: S1-S10Abstract Full Text Full Text PDF PubMed Scopus (35) Google Scholar Finally, in the view of European Paediatric Association/Union of National European Paediatric Societies and Associations, research projects should become integrated into long-term health care projects involving all age groups.24Ehrich J. Pettoello-Mantovani M. Views of the Presidents of National European Pediatric Societies on evolving challenges of child health care.J Pediatr. 2016; 177: 336-337.e1Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar, 25Beck A.F. Cohen A.J. Colvin J.D. Fichtenberg C.M. Fleegler E.W. Garg A. et al.The future of pediatric research: European perspective.Pediatr Res. 2017; 81: 138-139Google Scholar As written previously, “Clinicians know all of the problems, but none of the solutions; scientists know all of the solutions, but none of the problems.”26Heit W.N. Translating research into clinical practice: deliberations from the American Association for Cancer Research.Clin Cancer Res. 2005; 11: 4275-4277Google Scholar One of the ways to close this gap is to encourage a generation of clinician scientists. Let's fix it at the source! The disappearing clinician scientistThe Journal of PediatricsVol. 217PreviewWe read with interest the article by Somekh et al on the disappearing entity that is the “clinician scientist” and would like to thank them for highlighting this issue and applaud the European Paediatric Association/Union of National European Paediatric Societies for tackling it.1 The role of doctors in medical research is critical; the insight and knowledge they add through lived experience can help identify gaps in medical science. As medical students, we are the doctors of the future and take this opportunity to provide our perspectives as invited by the authors. Full-Text PDF" @default.
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• W2969355983 title "The Clinician Scientist, a Distinct and Disappearing Entity" @default.
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