An Entire Medical School Devoted Training Physician Researchers? (Updated)

Mar 27 2008 Published by under Public Health

The past few years in NIH-funded research land have been peppered liberally with cries for "translational" research. The notion is that while the prior decades of research have been excellent at generating basic science observations, progress in using this information to improve health care has been insufficient. The reaction, of course, has been to revamp the NIH funding to try and enhance the degree to which research directly related to improved health care is supported. This has had the dual results of irritating basic scientists and revealing a rather spotty infrastructure of available physicians who also do biomedical research.
Apparently one basic biomedical research institution has decided to enthusiastically back this translational trend by starting a medical school devoted entirely to physician researchers.

One of my agents passed on this article from the San Diego Union Tribune:

The Scripps Research Institute and Scripps Health are working to set up what they hope will be the nation's first medical school entirely geared to training physicians for dual careers in research and patient care.
The coordinators, who plan to accept their inaugural group of students in 2013, would make the Scripps School of Medicine the county's first new medical school in 40 years.
They want to receive final accreditation for their school by 2018. Nationally, only one new medical school - at Florida State University - has been fully accredited in the past 20 years, said Dr. Dan Hunt, secretary of the Liaison Committee on Medical Education in Washington, D.C.

Wait a second. Back up. We have this apparent healthcare crisis. A shortage of doctors and nurses in certain key specialties and geographic regions. A plethora of bright faced young undergrads agonizing about not getting into medical school. And this monopolistic cabal of medical educators has managed to hold off any new schools for four decades?[Ed- As writedit noted in the comments, I originally misread "county" as "country". My bad. Still, one in 20 years? That doesn't sound all that great either. Nice to see at the end of the SD Union Trib article that there are 9 new schools in the process of accreditation.]
Ahem. Okay, back to the point. Are they serious about this?

Topol said the institute has hired Cary Thomas to help establish the program. Thomas was formerly vice dean for finance and operations for the medical school at the University of Southern California.
Several weeks ago, Scripps institute officials paid the liaison committee a $25,000 fee to file its accreditation application. The committee, which requires all medical school applicants to meet 133 standards in five lengthy phases, will visit the facility early next month for the first phase.

Well, that seems reasonably serious.
Do we need this? After all, plenty of really top notch Medical School / Research University institutions already have physician-scientist programs. The much vaunted MD/PhD or MSTP training. Admittedly, the graduates that I know best tend to be more researchers than they do practicing clinicians. It is rare, again in my limited experience, that an individual active PI will really wed his or her medical practice to the research program.
Perhaps this is why a new and dedicated approach is needed? Or is it a suggestion that the enterprise is doomed to fail?
Update 4/2/08: Hmm. Now Nature is on the story with the angle that applicants to this proposed medical school will have to have a Master's degree in hand.

23 responses so far

  • writedit says:

    LCME doesn't stand in the way of new med schools ... money and state governments and existing med schools do. But, thanks to the NIH doubling era, a bunch are in the pipeline at LCME, including the true first med school in the works dedicated to training clinician researchers, Virginia Tech Carilion. Possibly a future home for me - I love (& miss) the New River Valley.
    On your parting comment, I humbly beg to differ. I work with some very innovative MD, PhD PIs who are actively practicing clinicians and who do excellent research (bench & clinical, with each informing the other). A remarkable New Innovator Award proposal comes to mind immediately. These folks work insane hours even with just one R01 or U01. Hard to believe, but the translational business really can work. A lot of MSTP programs turn out lab-only investigators who never complete a residency or touch a patient after med school, but a good number do keep up their skills in both worlds. I'm sure there are stats out there somewhere. There are also med school MD-MS programs for physician scientists who want to pursue clinical research without the full PhD component, plus, of course, the after-the-fact clinical scientist training programs for asst profs via the K12 mechanism (or individually via K23s/K08s). Anyway, I think Scripps won't have a problem filling its slots with qualified candidates, and biomedical research will be better for it.

  • ---"Perhaps this is why a new and dedicated approach is needed?"---
    Yeah, I think that's why it is a direction worth exploring; a paradigm-shift in thinking right from the start.
    And "First new medical school in 40 years"??!!! That has GOT to be wrong. Right?

  • homo sapiens attitudus says:

    "First new medical school in 40 years"
    What happens when all the baby-boomers finally die and we suddenly have a surplus of not only doctors but medical schools and students? Can't have that now can we?

  • writedit says:

    "the county's first new medical school in 40 years"
    The COUNTY's first new med school, as in San Diego County (I assume) ... not the Country, as in US. Came back to point this out to DM and I see other's are mentally filling the "r" as well.

  • One of the odd things about this news is that it's not as though Scripps is located in an underserved area. UCSD, which has a medical school and an MSTP program, is about 1 mile away. Seems like they're doing the physician-scientist thing as a way to carve out a niche?

  • DrugMonkey says:

    I take your point Dr. Jekyll but regional "serving" is a bit beside the point when talking about a medical school isn't it? The only thing "regional" about it is the way the associated hospital(s) function as "teaching hospitals". Assuming the "Scripps Health" hospital is doing well patients-wise, where's the overalap?
    but the dean of the UCSD medical school sure sees it your way!

  • PhysioProf says:

    Everybody is trying to suck the "translational" teat. We had a heated discussion in my department in the context of our current job search about just this topic. Fortunately, the voices of reason won out and we are making an offer to an outstanding basic scientist and not to some bandwagon-following translational doofus.
    Apropos of this topic, Bruce Alberts--new Editor-in-Chief of Science--just wrote a powerful editorial on the importance of basic biomedical science for actually achieving amelioration of human suffering and disease, and the short-sightedness of putting too much emphasis on translational research at the expense of basic science.
    Thankfully, my basic science department did the right thing in the context of our job search, instead of hiring some lame-ass translational scientist who wouldn't know a real biological mechanism if it bit him on the fucking ass.

  • Biophysicsmonkey says:

    Is it really a problem of supply?
    Although it's not exactly my area, my understanding is that many people left the physician-scientist career track because it was becoming financially unworkable. The way that medical schools are organized (to squeeze every possible dollar out of both basic research programs and clinical practice) meant that physician-scientist types were constantly getting screwed from both ends. At least that seems to be the case at my institution.
    I suppose Orac might have more insight into this issue.

  • Becca says:

    What we need is an entire medical research center devoted to *hiring* physician researchers. The folks I know who got both degrees are often being forced into choosing one track or the other by the job descriptions they get. Oh yeah, we'd *love* to hire you as a researcher-physician, just take care of X clinic hours- you can 'write your grants in your spare time'.

  • Jo Ann says:

    @writedit: "I work with some very innovative MD, PhD PIs who are actively practicing clinicians and who do excellent research (bench & clinical, with each informing the other)."
    I am so fortunate as well. In fact, these are among the clinicians / researchers that I respect the most.

  • Oh, fair point that med programs draw from all over the place. I think the real question is whether Scripps will succeed in designing a program that truly integrates the MD and PhD portions. If so, it'll be a huge draw for the mud-phuds who want classes taught with an eye towards research directions, rather than as cram sessions. Also, if they can accomplish a good merge of the two degrees, it will probably be a bit faster than the usual 8-10 year slog in current MSTP programs.....and that alone would make them popular!
    Funny about the dean, I hadn't read the article till you mentioned it....UCSD must feel poached.

  • I've had the great pleasure of training with and under some superb physician-scientists, both MD/PhDs and MDs who did research-intensive fellowships. These training environments are great for sole PhDs: my endocrine buddy and I used to play a game of 'tell me something I don't know' each time he came back from clinic. It made me think about real-world questions I might not have considered and helped him develop his lab chops.
    However, as Becca and Biophysicsmonkey note, academic medicals centers suck the research soul out of the average physician-scientist. Docs are increasingly viewed as service providers and cash cows, damn the research and, yes, write grants on your 'own' time. Administrators take the attitude of why should they underwrite a doc's time to write research grants with 1 in 10 chance of succeeding when they can have the doc go to clinic where the hospital has one 1 in 2 chance of recovering hundreds of thousands of dollars in clinical billing. Guess what approach wins?
    People like Orac succeed in spite of the system, solely because they are dedicated to research as a satisfying intellectual endeavor that can ultimately benefit their patients. And my buddy mentioned above, he is now a private practice psychiatrist - with great research training.

  • bayman says:

    I think it would be more effective to foster greater interactivity between professional researchers and professional clinicians than to try and create an army of superhumans who do it all.

  • bayman says:

    PP - I think the demand for translational research is legit, because there is a real bottleneck here. Of all the great basic research you are talking about, say the last 50 years of biology, very little of it has changed or improved the way medicine is practiced, despite the great potential. I think all the fuss and money is being thrown at it because people know there is a deficiency but haven't quite figured out a way to make it happen.
    Basic research and translational research need not be mutually exclusive, in fact ideally they would fuel one another.

  • PhysioProf says:

    Basic research and translational research need not be mutually exclusive, in fact ideally they would fuel one another.

    Yeah. But right now, funding is zero-sum. What is definitely happening right now, and what Alberts's editorial decries, is the deployment of resources in the academic sector to translational research at the expense of basic science.
    Saying, "it's all good", may be correct, but it is pointless right now.

  • DrugMonkey says:

    bayman, you are surely coming to realize that PP is an extremist basic science demented wackaloon, right? 🙂
    Seriously though, once you get beyond turf protection and personal interest advocacy, the notion of trying to come at some rational ways to balance basic research approaches with "translational" or (gasp) "applied" research is daunting. The essential problem being the completely fuzzy subjective concepts that there has been "too little progress" toward medical advances and "basic science cannot ever be directed or it loses it's SuperPowerz to advance knowledge". How would we every even operationalize our concepts? How would we devise criteria?

  • bayman says:

    PP - You are right of course, there's a finite pool of money that has to be divided here. I'm in total agreement that "basic" research must be carried on. However those who decry clinical-heavy funding (on a total dollar basis) have to realize that the funding needs in this area are massive. Basically the cost of doing biology experiments increases exponentially with the complexity of your model system. So bacteria are dirt cheap, yeast a bit more costly, mammalian cells more so. Going into mice requires a massive step up in funding, and going into humans, well, you're talking a few hundred mill just to do the most basic of experiments. So on the "basic" end of the spectrum you get a lot of bang for your buck, but if you want to get some "translational" or clinical shit done you have to expect it's gonna take a hell of a lot more cash.
    DM - I think you're right on in citing the need for conceptual clarification here. Maybe one one answer would be to categorize funding on the basis of different types of model systems as I described above. However this would not always properly distinguish between "basic" and "applied" research. For example, would screening chemotherapeutic agents on yeast cells be considered basic or applied? How about studying the biology of the human hematopoietic system?
    I think what is lacking here is a unification of modern biology with medicine. As I alluded to in my previous comment, I don't really think the last 50 or more years of advances in biology have yet been properly integrated into medical knowledge and teaching. Likewise, biologists haven't ventured out to embrace medicine, in many cases I would speculate because they are too busy doing real, manly-man, totally hard-core "basic" biology to give a shit about how their knowledge could benefit medicine.
    For example, take the fields of hematology and immunology. Distinct approaches for historical reasons. By the jargon in the papers you'd think they have nothing to do with one another, and yet both fields are studying the same damn things in relative isolation. We need to bridge these gaps and truly unify medicine and biology. Then we wouldn't have this sort of a rift that gives rise to the argument of whether medically-applicable research was detracting from "basic" biology. It's all biology in the end, we just need to recognize this.

  • bayman, I'm pretty sure you're Canadian - how are CIHR and NCIC angling their funding portfolios toward physician-scientist training?

  • bayman says:

    I may not be the best person to answer since I don't fall into the physician category myself, although many of my colleagues do. My general sense is that plenty of funding is available for physician-scientists - the overall situation seems to be one of "ask and ye shall receive". Certainly the MD-graduate students I work with in the lab never have problems securing external salary awards, which is much more rarely the case for non-MD researchers doing the exact same work. Now, this is not to say they are all getting money from the federal agencies you mentioned. Also, the high level of available funding is not necessarily due to greater total dollars thrown at physician-scientists, but likely also has to do with lower numbers of available applicants who are willing to take time off from their residencies to do a lab degree. But I think there's certainly ample funding for physician-scientists, and a huge push by agencies to fund more of these types of applicants.
    For example the CIHR has a number of salary awards aimed specifically at funding MD clinician-scientists1. But in addition to these specific pools, they are also encouraged to apply for the regular type of doctoral and post-doctoral awards, in the same pools as non-MD research trainees. So it's difficult to say dollar for dollar what proportion of trainee funding goes to clinician-scientists, but I think it's safe to say that this is one of the major priorities of both the CIHR and NCIC2. Certainly I get that sense as a non-MD researcher when I peruse their websites looking for funding that I can apply for myself. To the point that I've wondered on more then one occasion whether a post-PhD MD would be better preparation for a career in *laboratory* medical research than a post-doc. But again, whether this is because they are actually throwing more dollar amounts at training clinician-scientists than training non-clinicians, or just trying to encourage MDs to enter research in order to fill a void I don't know. It's an interesting question. The general trend seems to be fewer number of awards granted specifically to train clinicians, but with a much higher success rate and higher individual value.
    1. Contests currently open include: Clinician-Scientist Salary Award, Clinician-Scientist Training Award, Clinical Investigatorship Award, Health Professional Student, MD/PhD Studentship Awards, in addition to regular graduate student awards and fellowships. The NCIC offers clinical fellowship awards in addition to doctoral and post-doc awards.
    2. Clinical Research is First on the CIHR's list of its 4 Major Strategic Initiatives. From their website: "There is a widespread consensus that clinical research has not kept pace with the advances in biomedical research and that there is an increasing gap between basic discoveries and their application to the understanding, treatment and prevention of human disease."

  • bayman says:

    Forgot one last point. It's interesting to note that while in Canada there's ample funding for clinical trainees to do full-time research in the lab, it seems most still basically end up as full-time clinicians when they get hired as "clinician-scientists". At the institute I work at, the big cheeses are mostly PhD scientists, but the makeup has been changing. There are now 3 resident clinician-scientists, and two were hired in the last year (100% of new hires). However it seems they are basically brought on with full clinical responsibilities (most commonly a huge surgical load which I believe pays their salaries) with a little piece of lab space and a technician to pursue research as they can. The lab science they do generally ends up to be through close partnership with a non-MD lab head who in some cases even shares grants, resources, grad students and technicians. Anyway point is they are well-funded as trainees in lab research but pretty much end up as mostly full-time clinicians when all is said and done - so far.

  • Thanks for the Canadian insights, bayman. Sounds like the end result for physician-scientists in the Great White North is as bad as down here - well-trained researchers get screwed into doing tons of clinic...because they can and because it brings in tons of steady revenue for the institution. A great idea to train physician-scientist but it ends of being a waste of money and a bastardization of the intention in the long run. The govt is underwriting physicians getting research training so they can then generate clinical income. What's wrong with that picture?
    btw, monkey boys, yesterday Jacob Goldstein at WSJ Health Blog had a post related to your original discussion interviewing the dean-to-be of a new medical school being established jointly between Hofstra and Long Island Jewish Hosp - the guy has a great sense of humor:

    Q: Are you looking to sell the med school's naming rights to a big donor?
    A: What's your middle initial?

  • PhysioProf says:

    Maybe I'm just a humorless fucking douchecornet, but I don't get the joke. Can you explain it?

  • Well, maybe it's just hysterical to me - in my experience with fundraising and academic development folks, they are always "on." Hence, to respond to an interviewer asking about naming the school for cash, the dean jokingly sizes him up as a prospect.
    The simple things make me laugh.

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