Bolstering Clinical Research Careers
Physician-scientists—docs who work in the clinic and also pursue research—are invaluable in translating insights from the bench to patient care. Yet, physicians with this double expertise are an endangered species, says Wishwa Kapoor (above), an MD/MPH and director of the Institute for Clinical Research Education at the University of Pittsburgh. According to a comprehensive assessment by the National Institutes of Health last year, the average age of physician-scientists is rising, and pressures in today’s funding climate create additional challenges for young trainees. Kapoor notes that many programs at Pitt are attempting to address the shortage: from summer institutes for kids to seminars on work-life balance for junior faculty.
What are some of the factors contributing to the leaky pipeline?
Becoming a physician-scientist requires more training, and you often start out with more debt; research salaries are also lower than clinical salaries at the start. Also, in my view, these careers are a lot harder than being a physician in practice. Not that being a physician is easy, but the path is relatively straightforward: You join a practice and, generally, patients keep coming. As a physician-scientist, though, you have to take the reins and guide your career in a creative way—ask the right questions, develop your research program, get the grants. There’s a significant degree of burnout because of the stress of trying to get funding.
How can institutions help trainees succeed?
We need to make this track more accessible to younger researchers and to train and retain more women and minorities. There is no magic-bullet solution. The focus must be not just on recruitment, but on sustaining and supporting these investigators. But I think the most important component of success is mentorship. Young investigators need mentors who can devote time to them and who are committed to promoting their careers—both at the home institution and with outside colleagues.
What mentors from early in your career stand out?
I had a couple of excellent mentors [like Pitt’s former chair of medicine Gerald Levey and former chief of general internal medicine Michael Karpf ] who spent a lot of time with me. English is a second language for me, so I was a terrible writer. They helped me with study design, and they helped me learn to write—that’s what really made the difference.
WEB EXTRA: Let us count the ways
Pitt has been a leader in efforts to recruit, train, and sustain careers of physician scientists. According to Kapoor:
1. The School of Medicine has developed programs for medical students to do substantive research. These program help spark interest and are the beginning of research careers. The programs include: a) Medical Scientist Training Program (MD/PhD), long standing successful program for developing physician scientists. b) Clinical Scientist Training Program (CSTP), an extra year of training for medical students to learn research methods and do clinical research. c) Physician Scientist Training Program, an extra year for students to do basic and biomedical research. d) The scholarly project [now known as the longitudinal research experience]—required of all medical students to either do research or other scholarship. Most do research.
2. Pitt has summer programs for high school students who are mentored by investigators in their labs and do research. Many can get started at this early stage.
Last December, JAMA highlighted a doctor—and University of Pittsburgh School of Medicine’s Summer Premedical Academic Enrichment Program alum—who's benefited from this pipeline, Anthony Kulukulualani.
3. Institute for Clinical Research Education (ICRE, under me) is largely to support physician scientists interested in clinical and translational research. We support training and career development and have programs for medical students, residents, fellows and postdocs, and junior faculty.
4. We are also addressing underrepresented research faculty development through ICRE programs such as CEED. You can review this awardwinning program on our website.
5. The Office of Academic Career Development, the Dean’s Office, and ICRE have organized programs to help junior faculty write career development awards. This helps with success in early careers. We review grants before they are submitted and provide guidance in writing.
6. ICRE has structured mentoring program and works with 337 clinical researchers at Pitt to assist in finding and establishing mentors.
7. The dean and ICRE stress the importance of protected time for junior faculty to do research.
8. The dean has bridge funding for investigators that are on the verge of getting funding but need to wait for a cycle or two.
9. The leadership at Pitt and ICRE are repeatedly writing to congressional leaders for increases in NIH funding.
10. The Office of Academic Career Development and the Dean’s Office regularly put together seminars on work-life balance and seminars focused on issues specific to supporting women.