As medical practice becomes more complex and biomedical research evolves as an amalgam of multiple disciplines, the path for those attempting to bridge medicine and research becomes more circuitous and difficult to navigate. Identifying and mitigating the challenges for those attempting to embrace both medicine and research as physician-scientists is crucial to the continued success of both.

Historical Precedence

The concept of physicians advancing science is not new, with many fascinating historical precedents such as Willem Einthoven, MD, inventor of the electrocardiogram and renowned and beloved physician. Einthoven exemplifies the concept of a physician-scientist – a doctor whose compassion, drive and scientific grounding empowered him to make a dramatic impact not only on the daily care of his patients but also on the industry. It is unfathomable in modern medicine to not have access to an electrocardiogram machine even in the most basic of health care settings. The importance of those rare individuals able and willing to challenge traditional ideas and push scientific boundaries is therefore easy to recognize and important to cultivate.

Challenges For Physician-Scientists Today

The health care model today is very different from that of twenty years ago. Physicians now manage larger volumes of patients requiring coordinated care, navigate various complex socio-economic and insurance issues, maintain their credentials, and pay attention to performance metrics contrived by a myriad of governing entities. This means that there is a greater need for mentorship and proven processes. Cultivating a physician-scientist today requires a deliberate investment in trainees by institutions and mentors. With ACC's Physician Scientist Portal, we hope to identify and nurture those pathways to success.

The National Institutes of Health has supported various structured programs that train physician-scientists from medical school forward, including the Medical Scientist Training program (MSTP). In addition, the American Board of Internal Medicine supports the physician-scientist pathway. These programs are developed with the goal of creating a productive research and clinical education for trainees. A 1998 National Institute of General Medicine report on the MSTP program stated that the 1990 cohort MSTP graduating class of MD and PhDs had higher percentages employed in academia compared to grads holding only MD or PhDs (90 percent vs. 50 percent and 64 percent). The recently released National MD-PhD Outcomes Study reported that 53.7 percent of survey respondents with full-time academic appointments spent at least half their time dedicated to research and that the average time from degree to first faculty position increased to 8.0 years from 6.2 years previously. Structured training grants that financially support the education of the physician-scientist, whether pre-doctoral, post-doctoral or early career, are invaluable in providing an institutional incentive to attract promising trainees. These programs also provide accountability for creating training environments that lead to career independence.

Despite these efforts by national institutions, the pathways to success are frequently obscure. Physician-scientists experience numerous vulnerable periods during their careers that create seemingly impenetrable barriers in lack of mentorship and opportunities. For a young physician-scientist, it is challenging to foresee these barriers while in the midst of a training pathway that can take 15 or more years to complete.

Goal of the Physician Scientist Portal

Through the Physician Scientist Portal, we intend to collect information about the various physician-scientist training pathways in cardiovascular programs within the U.S. The collected information is intended for upcoming residents, fellows and early faculty potentially interested in pursuing physician-scientist careers within cardiology. We hope that this portal will allow them to identify and chose training environments that are best suited to their career goals. Over time, we also hope to provide more tools, greater transparency and more objective information about these programs. The Physician Scientist Portal will allow institutions to better define their strengths, alumni to share their experiences and provide peer-support to aide in cultivating the budding physician-scientist. Learn more on ACC.org.

This article was authored by Olivia Hung, MD, recent Fellow in Training (FIT) graduate from the Emory University Hospital in Atlanta, GA, and Anita Saraf, MD, PhD, adult congenital heart disease FIT at the Emory University School of Medicine in Atlanta, GA.