National Institutes of Health

Physician-Scientist
Workforce Working
Group Report

June 2014

In a word, I consider hospitals only as the entrance to scientific medicine; they are the first field ofobservation which a physician enters; but the true sanctuary of medical science is a laboratory; only there
can he seek explanations of life in the normal and pathological states by means of experimental analysis.1
Claude Bernard, 1865

1

Bernard, Claude, An Introduction to the Study of Experimental Medicine (Dover edition 1957; originally published in 1865; first
English translation by Henry Copley Greene, published by Macmillan & Co., Ltd., 1927

i

The Physician-Scientist Workforce Working Group
Rena N. D’Souza, DDS, PhD
Professor and Dean, School of Dentistry
University of Utah
Salt Lake City, UTDavid Ginsburg, MD, Co-ChairJames V. Neel Distinguished University
Professor
Departments of Internal Medicine, Human
Genetics, and Pediatrics and Communicable
Diseases
Howard Hughes Medical Institute
University of Michigan Medical School
Ann Arbor, MI

James G. Fox, DVM
Professor and Director of the Division of Comparative
Medicine
Professor, Department of Biological Engineering
Massachusetts Institute of Technology
Cambridge, MA

Sherry Mills, MD, MPH, Co-Chair
Director, Office of Extramural Programs
National Institutes of Health
Bethesda, MD

Helen H. Hobbs, MD
Investigator, Howard Hughes Medical Institute
Professor of Internal Medicine and Molecular Genetics
University of Texas Southwestern Medical Center
Dallas, TX

Susan Shurin, MD, Co-Chair
Deputy Director, National Institute of Heart,
Lung and Blood
National Institutes of Health
Bethesda, MD

Ann R. Knebel, RN, PhD, FAAN
Deputy Director
National Institute of Nursing Research
National Institutes of Health
Bethesda, MD

Nancy Andrews, MD, PhD
Dean, Duke University School of Medicine
Vice Chancellor for Academic Affairs
Nanaline H. Duke Professor of Pediatrics
Professor of Pharmacology and Cancer Biology
Duke University Medical Center
Durham, NC

Elaine Larson, RN, PhD, FAAN, CIC
Anna C. Maxwell Professor of Nursing Research
Associate Dean for Nursing Research
School of Nursing
Professor of Epidemiology, Mailman School of Public
HealthColumbia University
New York, NY

Gordon R. Bernard, MD
Melinda Owen Bass Professor of Medicine
Associate Vice Chancellor for Research
Director, Vanderbilt Institute for Clinicaland Translational Research
Vanderbilt University School of Medicine
Nashville, TN

Vivian S. Lee, MD, PhD, MBA
Senior Vice President for Health Sciences
Dean, School of Medicine
CEO, University Health Care
University of Utah
Salt Lake City, UT

Lawrence F. Brass, MD, PhD
Professor, Department of Medicine
Associate Dean for Combined Degree
and Physician Scholars Programs
University of Pennsylvania
Perelman School of Medicine
Philadelphia, PAii

David G. Nichols, MD, MBA
President and CEO
The American Board of Pediatrics
Chapel Hill, NC

Timothy J. Ley, MD
Professor of Medicine and Genetics
Division of Oncology
Washington University School of Medicine
St. Louis, MO.

Leon E. Rosenberg, MD
Professor, Department of Molecular Biology
Princeton University
Princeton, NJ

Richard P. Lifton, MD, PhD
Chairman, Department of Genetics
Professor, Genetics, Internal Medicine andInvestigator, Howard Hughes Medical Institute,
Yale University School of Medicine
Haven, CT

Andrew I. Schafer, M.D.
Professor of Medicine
Weill Cornell Medical College
New York, NY

David Meltzer, MD, PhD.
Associate Professor of Medicine
Chief, Section of Hospital Medicine,
Director, Center for Health and Social Sciences
University of Chicago
Chicago, IL

Susan VandeWoude, DVM
Professor and Associate Dean for Research
Department of Microbiology, Immunology
and Pathology
College of Veterinary Medicine & Biomedical
Sciences
Colorado State University
Fort Collins, CO

Juanita L. Merchant MD, PhD
H. Marvin Pollard Professor of
Gastrointestinal Sciences
Professor of Internal Medicine andMolecular and Integrative Physiology
University of Michigan
Ann Arbor, MIiii

Acknowledgments
The Working Group gratefully acknowledges the following individuals who served as ad hoc members of
the Physician-Scientist Workforce Subcommittees and whose insights contributed to the discussion ofissues and recommendations presented in this report:

Ad Hoc Subcommittee Members
Robert M. Califf, MD
Professor of Medicine
Director, Duke Translational Medicine InstituteVice Chancellor for Clinical and Translational
Research
Department of Medicine /Cardiology
Duke University
Durham, NC

Harry W. Dickerson, BVSc, MS, PhD
Professor
Associate Dean for Research and Graduate
Affairs
Department of Infectious Diseases
College of Veterinary Medicine
The University of Georgia
Athens, GA

Janine Austin Clayton, MD
Director, Office of Research on Women’s
Health andAssociate Director for Research on Women’s
HealthNational Institutes of Health
Bethesda, MD

Robert Dittus, MD
Professor of Medicine
Division of General Internal Medicine
Vanderbilt University
Nashville, TN
Mildred C. Embree, DDS, PhD
Assistant Professor of Dental Medicine
College of Dental Medicine
Columbia University
New York, NY

Barry Coller, MD
David Rockefeller Professor and Physician-InChief
Laboratory of Blood and Vascular Biology
The Rockefeller University
New York, NY

Mark C. Fishman, MD
President
Novartis Institutes for BioMedical Research(NIBR)
Cambridge, MA

Thomas O. Daniel, MD
Executive Vice President and Presidentof Research & Early Development
Celgene Corporation
Summit, NJ

Don Ganem, MD
Global Head of Infectious Diseases Research &Vice President
Novartis Institutes for Biomedical Research
Cambridge, MA

Timothy DeRouen, PhD
Professor of Biostatistics, Oral Health Sciences,and Global HealthDirector, Center for Global Oral Health
School of Dentistry
University of Washington
Seattle, WAiv

Peter J. Gruber, MD, PhD
Johann L. Ehrenhaft Professor and Chairman
Department of Cardiothoracic Surgery
University of Iowa
Iowa City, IA

Willie M. Reed, DVM, PhD, DACVP, DACPVDean and Professor
College of Veterinary Medicine
Purdue University
West Lafayette, IN

Michael Dale Lairmore, DVM, PhD
Dean and Professor
Veterinary Medicine
University of California Davis
Davis, CA

Mike J. Welsh, MD
Roy J. Carver Biomedical Research Chair inInternal Medicine and Molecular Physiology
and Biophysics
Professor of Neurosurgery,
Director of the University of Iowa Cystic Fibrosis
Research Center
Director of the University of Iowa Institute for
Biomedical Discovery
Roy J. and Lucille A. Carver College of Medicine
University of Iowa
Iowa City IA

Jeffrey Myers, MD, PhD
Professor
Department of Head and Neck Surgery
The University of Texas MD Anderson Cancer
CenterHouston, TX

External Reviewer
Steven M. Altschuler, MD
President and CEO
The Children’s Hospital of Philadelphia
Philadelphia, PA
The Working Group also wishes to acknowledge the support and contributions of NIH staff who provided
administrative support to the Subcommittees, and of the contractors who provided research support.

NIH Staff Contributors
Mercedes Rubio, PhD
Program Chief, Psychopathology Risk andProtective Factors Research Program
Assistant Director, Individual Research
Fellowship Programs
National Institute of Mental Health
Bethesda, MD

Yvonne Lau, MD, MBHL, PhD
Executive Secretary
NIH ACD Physician-Scientists
Workforce(PSW) Working GroupNIH Extramural Research Integrity Officer
Office of Extramural Research/Office ofExtramural Program
National Institutes of Health
Bethesda, MD

Xiaodu Guo, MD, PhD
Scientific Review Administrator
Review Branch
National Institute of Diabetes and Digestive andKidney Diseases
Bethesda, MDv

Lynn Morin, MA
Public Health Analyst
National Institute of Alcohol Abuse andAlcoholism
Rockville, MD

Lisa Evans, JD
Scientific Workforce Diversity Specialist
Office of Extramural Research/Office ofExtramural Program
National Institutes of Health
Bethesda, MD

Mary L. Garcia-Cazarin, PhD
Health Scientist, Office of Dietary Supplements
AAAS Science & Technology Policy Fellow
National Institutes of Health
Bethesda, MD

Rosemarie Filart MD, MPH, MBA
Medical Officer
Detail at Office of Research on Women's HealthNational Institutes of Health,Bethesda, MD

Jennifer Sutton, MS
Extramural Program Policy and Evaluation
Officer
Office of Extramural Research/Office ofExtramural Program
National Institutes of Health
Bethesda, MD

Staff of OERStats
Division of Statistical Analysis & Reporting(DSAR)
Office of Extramural Research
National Institutes of Health
Bethesda, MD
Sarah Shane
Executive Assistant to OEP Director
Office of Extramural Programs
National Institutes of Health
Bethesda, MD

Misty L. Heggeness, PhD
Labor Economist
Office of Extramural Research/Office ofExtramural Program
National Institutes of Health
Bethesda, MD

Contractors
Contractor support for this report was provided under the NET ESOLUTIONS CORPORATION (NETE)
NIH Prime Contract HHSN276201300089U. NETE was supported by its subcontractors, Thomson
Reuters and Catalyst Research & Communications. Individual team members include: NET
ESOLUTIONS (NETE): Sandeep Somaiya, Contract Program Manager; Meghan Hudson, Task
Coordinator; Sydney Gomes and Chrissy Juarez, Graphic Designers. Thomson Reuters: Joshua Schnell,
PhD., Subcontract Director and Task Lead; Elmer Yglesias, David Jones, Leo DiJoseph, and Di H. Cross.
Catalyst Research & Communications: Glora Stables, PhD, RD, Subcontract Director; Donna LloydKolkin, PhD, Task Lead and Report Writer; Heather Handel, MHS, Researcher.
Meeting support for this contract was provided by Palladian Partners under Contract
HHSN2632012000201. Individual team members include Joel Yaccarino, Chris Guilfoy, Helena Mickle,
Samantha Wright and Daniel Greenstein.

viSpecial Recognition
Hershel Alexander, PhD
Director, Data Operations and Services
Association of American Medical Colleges
Washington, DC

Professional Organizations
The PSW-WG also gratefully acknowledges the assistance of the following organizations in providing
insights and/or data used in the analyses presented in this report:
American Association of Colleges of Nursing
American Association for Dental Research
American Association of Medical Colleges
American Board of Internal Medicine
American Board of Medical Specialties
American Board of Pediatrics
American Dental Education Association
American Medical Association
American Physician Scientists Association
American Veterinary Medical Association
Association of American Medical Colleges
Association of American Veterinary Medical Colleges
Federation of American Societies for Experimental Biology
Howard Hughes Medical Institute
Merial Veterinary Scholars Programvii

Executive Summary
Dr. Francis Collins, NIH Director, convened and charged the Physician-Scientist Workforce Working
Group (PSW-WG) with analyzing the current composition and size of the physician-scientist biomedical
workforce and making recommendations for actions that NIH should take to help sustain and strengthen arobust and diverse PSW. The need for the PSW-WG emerged from the recommendations of the
Biomedical Research Workforce Working Group for strengthening the biomedical workforce. Its June2012 report concluded that the training and career paths of physician-scientists were different than that of
the non-clinician PhD workforce and that further study of this important segment of the workforce wasneeded.
Warning bells about the health of the physician-science workforce were sounded as early as 1979 when
future NIH Director James Wyngaarden observed that the physician-scientist with a medical degree was
becoming “an endangered species.” He had observed that MD applicants for NIH project grants
represented a progressively smaller fraction of all applicants than previously, while the corresponding
fraction of PhD applicants had increased dramatically. In 1996, NIH established a committee headed byDavid G. Nathan to make recommendations about the perceived shortfall of clinician scientists. The
Nathan Committee recommended creating new career development grants for patient-oriented researchand loan repayment programs to help young physician-scientists pursue research careers despite anincreasing load of educational debt.
In spring 2013, the PSW-WG met and established subcommittees to discuss issues confronting thephysician-scientist workforce. To inform its deliberations, the PSW-WG directed quantitative analyses of
NIH IMPACII and other relevant databases to answer key questions, and considered the findings from
qualitative research based on focus groups and interviews with students, research deans, and early career
investigators.
The PSW-WG defined physician-scientists as scientists with professional degrees who have training inclinical care and who are engaged in independent biomedical research. The PSW thus includes
individuals with an MD, DO, DDS/DMD, DVM/VMD, or nurses with research doctoral degrees who
devote the majority of their time to biomedical research. The PSW-WG recognizes that the primary goalof professional clinical education is the training of a skilled clinical workforce in the respective areas ofpractice, and that the portion of such professionals devoted to research will be small. However, findings
which lead to advances in practice are driven largely by the work of investigators with a variety ofdegrees, of whom those with clinical training contribute essential knowledge and skills.

Key Findings
NIH is the primary funder of biomedical research and research training in the United States. The strengthof the physician-scientist workforce reflects the nature of the nation’s investment in this arena. NIH
funding increased greatly in the late 1990s from $13.675 billion (1998) to $27.167 billion (2003). During
this period, institutions expanded their research capacity and training programs, and the number ofphysicians and non-clinically trained researchers applying for NIH R01 grants increased. NIH’s budget
growth came to a halt in 2004 and has since remained static. After adjusting for inflation using the
Biomedical Research and Development Price Index, the 2013 NIH budget was 21.9 percent below itsviii

2003 level. The 2008 recession also reduced research funding from other sources, including
pharmaceutical companies.

Size and Composition of the NIH-funded Physician-Scientist Workforce
It is difficult to obtain accurate numbers about the total size of the physician-scientist workforce because
the data are considered proprietary by the pharmaceutical and medical device industries, and because data
are not available on the number of physician-scientists whose research is funded by non-NIH sources.
PSW-WG analyses indicate that there were approximately 9,000 physician-scientists in the NIH-funded
workforce during 2008-2012, including 4,192 with an MD, 4,086 with an MD/PhD, 341 nurse-scientists,
253 veterinarian-scientists, and 161 dentist-scientists.
Though their percentage of the overall biomedical workforce has been steadily decreasing since the1970s, the total number of physician-scientists with a medical degree has remained remarkably steadyover the past few decades, with MDs and MD/PhDs each comprising about 50 percent of the physicianscientist workforce with a medical degree. At the same time the average age of entry into the independent
workforce (marked by receipt of an NIH RPG) has increased steadily, as has the average age of thephysician-scientist workforce.
Nearly three-quarters of the MD RPG awardees were white and another one in five were Asian. Although
there has been significant growth for Asian and Hispanic awardees over the past decade, there has beenless growth for African-Americans and Native Americans. The lack of diversity of the physician-scientist
workforce is a source of very serious concern to the NIH and to the professions. Other groups are
addressing these difficult issues; the PSW-WG did not attempt to duplicate their efforts, and endorses
strong investment in improving minority participation in scientific leadership.
Female physician-scientists remain underrepresented in some segments of the NIH-funded physicianscientist workforce. For physician-scientists with a medical degree, the percentage of female MDs who
are RPG grant holders has increased from 17 percent in the mid-1990s to 29 percent currently. However,for MD/PhDs, growth in women investigators has been slower, increasing from 17 percent in the mid1990s to 22 percent at the present time. Among veterinarian-scientists who receive RPGs from the NIH,
men outnumber women by about three to one, despite the fact that the overwhelming majority (90percent) of students enrolled in schools of veterinary medicine are women.
In contrast, among nurse-scientists applying for and receiving RPGs from NIH, women outnumbered men
by approximately nine to one, reflecting their numerical dominance in the profession. Among dentistscientists, women received about one-third of the RPGs awarded, yet constitute only about one-quarter ofthe dental-research workforce.

Challenges Confronting the Physician-Scientist Workforce
Several challenges confront the physician who elects to pursue a research career. Increases in the cost ofobtaining medical education can burden students with high amounts of debt, especially those who were
not enrolled in an integrated MD/PhD program. The training required to obtain competency in clinicaland scientific research continues to increase, resulting in a marked prolongation of the training process.
The transition between finishing a clinical or post-doctoral fellowship and initiating an independent
research position is a very vulnerable period in the career path of all physician investigators. Funding
pressures have mounted with the decrease in NIH funding and physician-scientists are increasingly being
asked to support a higher percentage of their income by seeing patients. Financial opportunities inix

practice offer an attractive option for clinically-trained physician-scientists, who are also valuable asclinicians to academic medical centers, pulling them away from their investigative work and creating
conflicting demands on time and energy.
Other challenges that particularly confront younger physician-scientists are finding ways to balancework/life demands, finding mentors who can support and guide early career investigators, and theincreasingly time-consuming and demanding requirements to maintain clinical credentials.
Physician-scientists across all domains face similar challenges, although the extent of the challenges
varies from discipline to discipline. The non-MD segments of the PSW have lacked a critical mass ofscientific researchers due to the strong focus of veterinary, dental and nursing training programs on
producing clinical practitioners. As a result, a major challenge among these segments of the physicianscientist workforce is a shortage of faculty members with scientific research programs who can serve asrole models and mentors to students in training.
Nurse-Scientists. Nurses often obtain research training after several decades of clinical work, and thus
begin their research careers later than other clinical researchers. This contributes to the shortage ofnursing faculty to train the next generation of nurse-scientists.
Veterinarian-Scientists. The curriculum in veterinary schools of medicine does not typically promote therole of the veterinarian-scientist, reflected in the significant lack of investment and lack of critical mass ofveterinarian-scientists. Students graduating from veterinary school carry a heavy load of student debt,
which discourages pursuit of a research career that may pay less than clinical practice.
Dentist-Scientists. A significant concern in dental education is the number of vacant faculty positions.
Other challenges include financial pressures on dental schools, leading to increased emphasis on clinicalrevenue generation and a decreased emphasis on research. As a result, the culture and environment within
dental schools has led to a diminished pool of research faculty mentors for dentist-scientist trainees,
coupled with a lack of understanding and support for the training and career development of dentistscientist graduates.
Future Challenges. A number of forces outside the NIH pose great challenges to the future physicianscientist workforce, including dramatic changes in the economics of medicine and healthcare more
broadly, rising educational debt, increasing length of training, growing regulatory burdens, challenges tothe overall quality of Science, Technology, and Mathematics (STEM) education in the United States, andthe changing demographics of students in medical, dental, and veterinary schools. Individuals who haveobtained one or more degrees outside the United States also comprise a significant component of thephysician-scientist workforce, which has not been adequately characterized.

Challenges Confronting the National Institutes of Health in Assessing the
Health of the Biomedical Workforce
As part of its charge, the PSW Data Subcommittee reviewed, assessed, and assembled a wide array ofdata sources in order to describe the size and composition of the current physician-scientist workforce, as
well as to evaluate the impact that NIH Research Project Grant (RPG) funding has on the workforce andits development. An important outcome of that investment is the identification, organization, and analysis
of a large database of key information about the workforce, drawn not only from NIH’s IMPACII
database but also from key external organizations such as the Association of American Medical Colleges(AAMC). NIH now has the opportunity to utilize this data in an ongoing and systematic way to addressxkey biomedical workforce issues—now and in the future--that the agency as a whole, as well as
individual NIH Institutes and Centers, must confront as it seeks to strengthen the biomedical research
capacity of the United States.

Early Career Investment in the NIH-funded Physician-Scientist
Workforce
NIH’s investment in the training of physician-scientists has a significant return. The RPG award rates forfirst-time RPG applicants with a prior LRP or K award are much higher than for those without: For MDs:
44.1 percent vs 9.2 percent and for MD/PhDs: 60.0 percent vs 10.1 percent. Similarly, early career
support for physician-scientists through the Medical Scientist Training Program (MSTP) has also beensuccessful at bolstering the physician-scientist workforce. Close to 80 percent of a cohort of MD/PhDs
with past MSTP Appointments (1980-1989) have applied for RPGs, and approximately 78 percent havebeen successful. Despite this track record, the number of new physician-scientists with a medical degree
entering the workforce is now declining, as reflected in the reduced numbers of applicants for early career(K and LRP) awards over the last 5 years.
Analysis of AMA and NIH data demonstrate continued aging over the past decade of physicians engaged
in research, which presage a significant decline in the PSW, especially as the current cohort of senior
physician-scientists retires. Our key recommendations thus focus on the early stages of the pipeline, on
enhancing the ability of the NIH to evaluate the relative effectiveness of its programs to build andmaintain the pipeline, and on systematically collecting and reviewing data so the biomedical workforce
can more easily and readily be assessed.

Recommendations
The following recommendations apply to all clinically-trained investigators, including veterinarianscientists, dentist-scientists, and nurse-scientists.
1. NIH should sustain strong support for the training of MD/PhDs. MD/PhD programs(including the Medical Scientist Training Program [MSTP] program funded by NIH) have beensuccessful in promoting the development of physician-scientists and should be continued.
2. NIH should shift the balance in National Research Service Award (NRSA) postdoctoral
training for physicians so that a greater proportion are supported through individual
fellowships, rather than institutional training grants. The number of individual fellowshipawards for MD-PhD students (F30/F31 grants) should also be increased. The PSW-WG endorses
the similar recommendation from the Biomedical Workforce Working Group that support for
both pre- and post-doctoral PhD trainees and individual fellowship for MD/PhD trainees should
be expanded. It is critical to obtain accurate long-term follow-up on trainees through all of these
programs to assess comparative effectiveness. These results should guide future allocation of NIH
funds to these various mechanisms.
3. NIH should continue to address the gap in RPG award rates between new and establishedinvestigators. Although NIH policies have narrowed the gap for new RO1 applicants, thisproblem remains significant and needs continued attention. A number of pilot approaches should
be explored, and rigorously assessed, with the most successful given expanded support (also see#7 below).

xi

4. NIH should adopt rigorous and effective tools for assessing the strength of the biomedical
workforce, including physician-scientists, and tracking their career development andprogression. NIH should collaborate with external organizations that also have a strong
investment in workforce development to collect, monitor, and report on key indices related toworkforce issues. Specifically, NIH should establish an ongoing workgroup of NIH employees
and external partners to support the development of a Biomedical Workforce Dashboard
application that provides real-time tracking of the career development and progression of theworkforce. The Dashboard would be a tool that both NIH employees and the public could use to
instantly answer questions related to important workforce issues at the agency or I/C level.
5. NIH should establish a new physician-scientist-specific granting mechanism to facilitate thetransition from training to independence. This program should be similar to the K99/R00
program whose funding currently goes almost exclusively to individuals holding a PhD degree.
This new grant program could serve either as a replacement or transition from existing K Awards
for physician scientists, and should provide a longer period of support, potentially lengthening theR00 phase to 5 years (with an interim staff review at year 3). This new grant series, as well as K
and all other training awards, should rigorously enforce protected time of at least 75 percent effort
and provide sufficient salary support to make that possible.
6. NIH should expand Loan Repayment Programs and the amount of loans forgiven should be
increased to more realistically reflect the debt burden of current trainees. This program
should also be made available to all students pursuing biomedical physician-scientist researcher
careers, regardless of particular research area or clinical specialty.
7. NIH should support pilot grant programs to rigorously test existing and novel approaches
to improve and/or shorten research training for physician-scientists. These programs should
include (but not be limited to) mechanisms to shorten medical and/or laboratory training, explore
timing and spacing of the research and clinical components of post-graduate training, and otheralternatives. New opportunities for training in informatics and social science research that address
emerging needs of the health care system should also be evaluated. Those programs exhibiting
the most promising results should receive expanded support.
8. NIH should intensify its efforts to increase diversity in the physician-scientist workforce.
This Working Group recognized major deficiencies of the physician-scientist workforce withregard to diversity. The PSW-WG strongly endorses the previous recommendations of thepreceding biomedical workforce Working Group and the Working Group on diversity, all ofwhich should be extended to the physician-scientist workforce.
9. NIH should leverage the existing resources of the Clinical and Translational ScienceAwards (CTSA) program to obtain maximum benefit for training and career developmentof early-career physician-scientists. This process should include critical review and analysis of
rigorous outcome data, as outlined in #7 above.

xii

Table of Contents
Acknowledgments........................................................................................................................................iv
Executive Summary ...................................................................................................................................viii
Chapter 1: Introduction ................................................................................................................................. 1
Methodology............................................................................................................................................. 2
Presentation of Findings ........................................................................................................................... 4
Chapter 2: The Physician-Scientist Workforce: Past, Present, & Future...................................................... 5
Historical Concerns about the Physician-Scientist Workforce ................................................................. 5
The Physician-Scientist Workforce .......................................................................................................... 6
NIH Support for the Development of the Physician-Scientist Workforce ............................................... 8
Future Trends Affecting the Physician-Scientist Workforce.................................................................... 8
Chapter 3: Physician-Scientists with a Medical Degree ............................................................................. 11
Training of Physician-Scientists with Medical Degrees ......................................................................... 11
Research about Medical Students’ Decisions to Pursue a Research Career ........................................... 13
Size and Composition of the Physician-Scientist Workforce in 2012 .................................................... 14
Physician-Scientists with a Medical Degree in the NIH-Funded Workforce ......................................... 18
NIH RPG Award Rates by Degree Type and Experience ...................................................................... 27
Persistence Quality by Degree and Gender ............................................................................................ 31
Effects of Early Career NIH Programs on Physician-Scientists with a Medical Degree ....................... 32
Challenges Facing the Physician-Scientist Workforce........................................................................... 39
Chapter 4: Nurse-Scientists......................................................................................................................... 44
Training of Nurse-Scientists ................................................................................................................... 44
The Nurse-Scientist Workforce .............................................................................................................. 47
Qualitative Research Findings Related to Nurse-Scientists ................................................................... 49
Nurse-Scientists as Participants in the NIH-funded Workforce ............................................................. 49
Summary of Challenges Facing the Nurse-Scientist Workforce ............................................................ 53
Specific Recommendations Related to the Nurse-Scientist Workforce ................................................. 54
Chapter 5: Veterinarian-Scientists .............................................................................................................. 55
Training in Veterinary Medicine ............................................................................................................ 55
Qualitative Research Findings Related to Veterinary Students .............................................................. 56
Veterinary-Scientists as Participants in the NIH-Funded Workforce ..................................................... 57
Summary of Challenges Facing the Veterinarian-Scientist Workforce.................................................. 63
Specific Recommendations for the Veterinarian-Scientist Workforce................................................... 64

xiii

Chapter 6:65 Dentist-Scientists................................................................................................................... 65
Training of Dentist-Scientists ................................................................................................................. 65
Qualitative Research Findings Related to Dentist-Scientists ................................................................. 66
Dentist-Scientists in the NIH-funded Workforce ................................................................................... 67
Summary of Challenges Facing the Dentist-Scientist Workforce .......................................................... 72
Specific Recommendations for the Dentist-Scientist Workforce ........................................................... 73
Chapter 7: Recommendations ..................................................................................................................... 74
Recommendations .................................................................................................................................. 74
Appendix 1: Physician-Scientist Workforce Working Group .................................................................... 77
Appendix II: Quantitative Analysis Methodology ...................................................................................... 78
Appendix III: Data Definitions ................................................................................................................... 81
Appendix IV: Summary of Quantitative Findings ...................................................................................... 86
Appendix V: Qualitative Research Findings .............................................................................................. 87xiv

List of Tables
Page
Table 3.1. Subsequent RPG and R01 Applications and Awards Among T32 Postdoctoral
Appointees, by Degree and Gender (FY1999-2008)

32

Table 3.2. Subsequent RPG and R01 Applications and Awards Among L Awardees, by Degree
and Gender (FY2003-2008)

35

Table 3.3. Subsequent RPG and R01 Applications and Awards by K awardees, by Degree andGender (FY1999-2008)

36

Table 3.4. Subsequent RPG and R01 Applications and Awards Among MSTP Appointees(FY1980-1989)

37

Table 4.1. Enrollment Changes in Nursing Schools (2011-2012)46

Table 4.2. Subsequent RPG and R01 Applications and Awards Among T32 Postdoctoral
Appointees, Nurse-Scientist (FY1999-2008)

52

xv

List of Figures
Page
Figure 2.1. NIH-funded Physician-Scientist Workforce (FY2008-2012)

7

Figure 2.2. NIH Support for the Physician-Scientist Workforce

8

Figure 2.3. A Brief Primer on NIH Support for Physician-Scientists

10

Figure 3.1. Number of Physicians Reporting Medical Research, Medical Education as
Primary Practice Areas (2003-2012)15

Figure 3.2. Howard Hughes Medical Institute Investigators, PhD, MD, and MD/PhD
Degree (1976-2012)16

Figure 3.3. Individual NIH Research Project Grant Awardees, PhD, MD, and MD/PhD
Degree (FY1995-2012)16

Figure 3.4. Tenure Track Faculty at US Medical Schools, PhD, MD, and MD/PhD
Degree (FY1999-2012)17

Figure 3.5. Non-Tenure Track Faculty at US Medical Schools, PhD, MD, and MD/PhD
Degree (FY1999-2012)17

Figure 3.6. Individual First-time NIH Research Project Grant Applicants, PhD, MD, and
MD/PhD Degree (FY1999-2012)18

Figure 3.7. Physicians in Medical Research, by Age Cohort (2003-2012)

19

Figure 3.8. Individual NIH Research Project Grant Awardees, MD Degree (FY19952012)20

Figure 3.9. Individual NIH Research Project Grant Awardees, MD/PhD Degree (FY
1995-2012)20

Figure 3.10. Average Age of NIH Research Project Grant Awardees, PhD, MD, and
MD/PhD Degree (FY1999-2012)

21

Figure 3.11. Average Age of First-time NIH Research Project Grant Awardees, PhD,
MD, and MD/PhD Degree (FY1999-2012)

21

Figure 3.12. Percent Female NIH Research Project Grant Awardees, PhD, MD, and
MD/PhD Degree (FY1999-2012)

23

Figure 3.13. Percent Women Faculty on Tenure Track at US Medical Schools by
Seniority (FY1999-2012)

23

xvi

Figure 3.14. Individual NIH Research Project Grant Applicants and Awardees, MD and
MD/PhD Degree by Gender (FY 1999-2012)

24

Figure 3.15. Individual NIH Research Project Grant Awardees, MD Degree by
Race/Ethnicity, White and Asian (FY1999-2012)26

Figure 3.16. Individual NIH Research Project Grant Awardees, MD Degree by
Race/Ethnicity, Underrepresented Groups (FY1999-2012)26

Figure 3.17. Individual NIH Research Project Grant Awardees, PhD Degree by
Race/Ethnicity, White and Asian (FY1999-2012)26

Figure 3.18. Individual NIH Research Project Grant Awardees, PhD Degree by
Race/Ethnicity, Underrepresented Groups (FY1999-2012)26

Figure 3.19. Individual NIH Research Project Grant Awardees, MD/PhD Degree by
Race/Ethnicity, White and Asian (FY1999-2012)26

Figure 3.20. Individual NIH Research Project Grant Awardees, MD/PhD Degree by
Race/Ethnicity, Underrepresented Groups (FY1999-2012)26

Figure 3.21. Award Rate of Individual NIH Research Project Grant Applicants, MD
Degree (FY1999-2012)

27

Figure 3.22. Award Rate of Individual NIH Research Project Grant Applicants,
MD/PhD Degree (FY1999-2012)28

Figure 3.23. Award Rate of Individual NIH Research Project Grant Applicants, PhD
Degree (FY1999-2012)28

Figure 3.24. Award Rate of Individual NIH R01 Applicants, MD Degree (FY19992012)

29

Figure 3.25. Award Rate of Individual NIH R01 Applicants, MD/PhD Degree (FY
1999-2012)30

Figure 3.26. Award Rate of Individual NIH R01 Applicants, PhD Degree (FY19992012)30

Figure 3.27. Male First-time NIH Research Project Grant Applicants, PhD, MD, and
MD/PhD Degree (FY1999-2008)

31

Figure 3.28. Female First-time NIH Research Project Grant Applicants, PhD, MD, and
MD/PhD Degree (FY1999-2008)

31

Figure 3.29. Individual NIH Loan Repayment Program (L) Applicants, PhD, MD, and
MD/PhD Degree, without Prior RPG (FY2003-2012)33

Figure 3.30. Individual NIH Career Development Award (K) Applicants, PhD, MD, and

34

xvii

MD/PhD Degree, without Prior RPG (FY1999-2012)
Figure 3.31. Institutional Career Development Appointees, PhD, MD, and MD/PhD
Degree (FY2010-2012)34

Figure 3.32. Individual NIH K99 Award Applicants, PhD, MD, and MD/PhD Degree(FY1999-2012)

35

Figure 3.33. Award Rates of NIH Research Project Grant Applicants, MD/PhD Degree
with/without Prior MSTP Appointment (FY1999-2012)37

Figure 3.34. Individual NIH Research Project Grant Applicants, MD/PhD Degree
with/without Prior MSTP Appointment (FY1999-2012)38

Figure 3.35. Individual First-time NIH Research Project Grant Applicants, MD/PhD
Degree with/without Prior MSTP Appointment (FY1999-2012)38

Figure 4.1. Five-Year Doctoral (Research-Focused) Enrollment and Graduation
Changes in the Same 131 Schools of Nursing (2008-2012)46

Figure 4.2. Age Distribution of Registered Nurses who Work as Faculty48

Figure 4.3. Individual NIH Research Project Grant Applicants, Nurse-Scientist (FY
1999-2012)50

Figure 4.4. Individual NIH Research Project Grant Awardees, Nurse-Scientist (FY
1999-2012)

51

Figure 4.5. Individual NIH Research Project Grant Applicants, Nurse-Scientist by
Gender (FY1999-2012)

51

Figure 4.6. Individual NIH Research Project Grant Applicants, Nurse-Scientist
with/without Prior K Award (FY1999-2012)

52

Figure 4.7. Award Rate of NIH Research Project Grant Applicants, Nurse-Scientist
with/without Prior K Award (FY1999-2012)

53

Figure 5.1. Historical Trends of Animal Use in NIH Grant Portfolio (1986-2002)

58

Figure 5.2. Individual NIH Research Project Grant Awardees, PhD and Veterinarian
Degree (FY1995-2012)

59

Figure 5.3. Individual NIH Research Project Grant Awardees, Veterinarian Degree by
Gender (FY1995-2012)

59

Figure 5.4. Award Rates of Individual NIH Research Project Grant Applicants,
Veterinarian Degree by Gender (FY1999-2012)60

Figure 5.5. Average Age of Individual NIH Research Project Grant Awardees,

61

xviii

Veterinarian Degree by Gender (FY1999-2012)
Figure 5.6. Award Rate of Individual NIH Research Project Grant Applicants, PhD and
Veterinarian Degree (FY1999-2012)

61

Figure 5.7. Award Rate of Individual First-time NIH Research Project Grant Applicants,
PhD and Veterinarian Degree without Prior L or K (FY2004-2012)

62

Figure 5.8. Award Rate of Individual First-time NIH Research Project Grant Applicants,
PhD and Veterinarian Degree with Prior K (FY1999-2012)

62

Figure 6.1. Full-time Research Faculty at US Dental Schools, Selected Degrees (20032011)

67

Figure 6.2. Individual NIH Research Project Grant Awardees, PhD and Dentist Degree(FY1995-2012)

68

Figure 6.3. Individual NIH Research Project Grant Awardees, Dentist Degree by
Gender (FY1995-2012)

68

Figure 6.4. Individual NIH Research Project Grant Applicants, Dentist and Veterinarian
Degree (FY1999-2012)

69

Figure 6.5. Award Rate of Individual NIH Research Project Grant Applicants, PhD and
Dentist Degree (FY1999-2012)

69

Figure 6.6. Award Rate of Individual NIH Loan Repayment Program (L) Applicants,
PhD, Dentist, Veterinarian, and Other Degree, without Prior RPG (FY2003-2012)70

Figure 6.7. Individual NIH Career Development Award (K) Applicants, PhD and
Dentist Degree, without Prior RPG (FY1999-2012)70

Figure 6.8. Award Rate of NIH Career Development Award (K) Applicants, PhD and
Dentist Degree, without Prior RPG (FY1999-2012)

71

Figure 6.9. Award Rate of Individual First-time NIH Research Project Grant Applicants,
PhD and Dentist Degree with Prior K (FY1999-2012)

71

xix

Chapter 1
Introduction
The Physician-Scientist Workforce Working Group (PSW-WG) is a working group of the Advisory
Committee to the Director at the National Institutes of Health (NIH), established in the spring of 2013.
Dr. Francis Collins, NIH Director, charged the PSW-WG to:

Develop approaches that can inform decisions about the development of the U.S. physicianscientist (PS) biomedical workforce for the advancement of science and the promotion of health.



Analyze the size and composition of the physician-scientist biomedical workforce to determine
the impact of current funding policies of NIH and other analogous entities on clinicians’ decisions
to engage in research.

Assess present and future needs and career opportunities available to support physician-scientist
trainees in diverse biomedical research sectors.

Further identify the incentives and barriers to clinicians entering and continuing to engage inscientific activities.



The committee will make recommendations for actions that NIH should take to support asustainable and diverse clinical research infrastructure, as well as recommendations for actions
needed by other relevant stakeholders.

The PSW Working Group defined physician-scientists as scientists withprofessional degrees, who have training in clinical care and who are
engaged in independent biomedical research. Those who engage in thistype of research could include individuals with an MD, DO, DDS/DMD,
DVM/VMD, or nurses with research doctoral degrees who devote themajority of their time to biomedical research.
The Working Group retained the title of “Physician-Scientist” as this is
the term historically associated with discussions of this component of thebiomedical workforce.

The charge outlined above emerged from the recommendations of the Biomedical Research Workforce
Working Group, a constituent working group of the Advisory Committee to Director Francis Collins at
the National Institutes of Health (NIH), tasked with addressing how to support a future sustainablebiomedical research infrastructure. Its June 2012 report concluded:
The economic and educational drivers which affect the training and career paths of thephysician-scientist workforce are very different from those underlying non-clinician PhD
research training and career paths and there was not sufficient time for the working group
to examine this important part of the biomedical workforce in detail. In addition, thechanging landscape of health care and the effects these changes likely will have on1

academic medical centers need to be projected carefully and considered when analyzing
the future physician-scientist workforce.
Therefore, the working group recommends that NIH conduct a follow-on study that
focuses on physician-scientists and involves people who train physician-scientists, aswell as economists who focus on medical education costs, career choices, and therole of these as incentives.

Methodology
The PSW-WG met by telephone in April and June of 2013 to begin planning its work, including dataneeds and organizational approaches that would most efficiently allow the geographically-dispersed
members to address the Working Group’s charge.

Subcommittee Organization
Based on input from Working Group members, the Co-Chairs created three Subcommittees to consider
issues specific to different segments of the physician-scientist workforce:Clinical/Translational Physician-Scientists, including Nurse-Scientists
Laboratory-based Physician-Scientists
Non-MD Physician-Scientists (Dentist-Scientists, Veterinarian-Scientists)

as well as a Data Subcommittee to oversee data collection and analysis to support the PSW-WG report.
The Subcommittees invited ad hoc members to expand expertise in areas underrepresented by the original
Working Group membership. These Subcommittees met on a regular basis by telephone between August
2013 and February 2014.
Appendix I contains a list of the Subcommittees and their membership.

Working Group Meetings
Face-to-face meetings of the full PSW Working Group were held on July 19, 2013 and March 11, 2014,
with monthly telephone meetings held between August 2013 and Feb 2014. The last group meeting byphone was held on April 23, 2014.

Quantitative ResearchContractor Thomson Reuters provided support to the Data Subcommittee in mining data from multiple
sources to answer key questions identified by the various PSW subcommittees regarding historic trends
and current patterns that impact the physician-scientist workforce. The two primary data sources for thisSubcommittee were:

NIH IMPACII Data
Association of American Medical Colleges (AAMC) Faculty and Student Data2

To best understand trends in the workforce, the Data Subcommittee sought to analyze individual
physician-scientists, as opposed to applications, since many scientists submit more than one application ina given year. To do this, a record of an individual was created based on all available demographic records
within the IMPACII and AAMC Faculty Roster data. As an initial data preparation step, similar applicant
profile records were compared and duplicate records were collapsed using automated methods based on
NIH’s own data management methods but with enhancements that consider additional demographic andapplication evidence to identify duplicate records. Next, each individual’s entire NIH application andappointment history was analyzed to generate a history of prior support at each year in the PSW analysis
time frame during which the individual applied to the NIH for support. This history was used to establish
an applicant’s prior training and fellowship support, as well as prior and subsequent research grantsupport. In addition, all available educational and demographic information was used to assign
individuals to appropriate degree, gender, and race/ethnicity categories as described in Appendix III.
For the purpose of analysing trends over time, an individual applicant was counted only once per
Institute/Center (IC) and mechanism in each Fiscal Year (FY). In the event an applicant applied morethan once in a given FY to an IC and mechanism, the most recent awarded application was selected todesignate him or her as an awardee. Even if an individual submitted applications to more than one IC, heor she was counted once within a given Fiscal Year. In select analyses, termed “5-year rolling windows,”
an individual was counted once if he or she submitted one or more applications within a 5-year period.
The approach used by the PSW Data Subcommittee differs from standard data reporting at NIH, which
normally focuses on reporting application and award total counts and breakdowns. These differences maylead to discrepancies when comparing trends presented here to those reported for applications and awards.
Unless otherwise noted, the source of data for all charts and tables included in this report are from NIH’s
IMPACII data system, supplemented with AAMC Faculty Roster data, as provided under a data sharing
agreement with AAMC. Select reports were generated using data from the NIH Medical Scientist
Training Program (MSTP) and summary data from the AAMC’s Matriculating Student Questionnaire andMedical School Graduation Questionnaire. Aggregate data on faculty and physician-scientists were
provided by the American Medical Association (AMA), the American Dental Education Association, theAmerican Veterinary Medical Association and the Association of American Veterinary Medical Colleges.
In addition, data analyses were carried out with significant support form NIH’s Division of Statistical
Analysis and Reporting (DSAR) within the Office of Extramural Research. Specifically, DSAR staff
provided data on T32 appointees’ outcomes and other data review and analysis.
Appendix II contains information about the methodology used in the quantitative data analysis.
Appendix III is a description of data definitions used to extract the NIH IMPACII data.
Appendix IV contains the complete set of relevant graphs generated by the working group with links tounderlying data available at NIH RePORT website.

Qualitative Research
The Lab-based PS Subcommittee members conducted focus groups with young faculty at their
institutions to identify career retention and advancement concerns. Catalyst Research & Communications
conducted telephone-based focus groups with medical, dental, and veterinary students. Questions focusedon the factors that influenced their decision to pursue a research career. Telephone interviews were also
carried out with deans at 15 US medical, dental, and veterinary schools to ascertain their perceptions of
how students choose whether to pursue a career in research. Catalyst also conducted interviews withyoung faculty holding K08 and K23 grants that paralleled the demographics of the faculty members

3attending the Lab-based Physician-Scientist Subcommittee’s focus groups. Detailed findings of thequalitative research may be found in Appendix V. In January 2014, the National Institute of Nursing
Research (NINR) conducted an open-ended survey of a purposive sample of nine deans of nursing
schools with research-focused training programs. The purpose of the survey was to gather information
regarding the experiences of schools of nursing in training successful nurse-scientists. A summary of thefindings may be found in Chapter 4.

Presentation of Findings
This report of the PSW-WG is organized as follows:
Chapter 2 provides the historical context for concern about the vitality of the workforce.
Chapter 3 considers the contributions and challenges of the MD, DO and the MD/PhD physician-scientist
workforce.
Chapter 4 considers the contributions and challenges of the nurse-scientist workforce, along with specificrecommendations for strengthening this segment of the biomedical research workforce.
Chapter 5 reviews the contributions and challenges of the veterinarian-scientist workforce, including
specific recommendations for strengthening this segment of the workforce.
Chapter 6 examines the contributions and challenges of the dentist-scientist workforce, including
recommendations for strengthening this segment of the research workforce.
Chapter 7 presents the recommendations of the Physician-Scientist Workforce Working Group forstrengthening the workforce overall.
Appendices at the end of the report contain technical materials that further elucidate the information
presented in the body of the report.

4Chapter 2
The Physician-Scientist Workforce: Past, Present, & Future
Historical Concerns about the Physician-Scientist Workforce
Despite the critical role that the physician-scientist plays in the biomedical workforce, concern regarding
the health of this sector of the scientific enterprise began to grow in the latter decades of the 20th century.
The physician-scientist with a medical degree was becoming “an endangered species,” according to James
Wyngaarden, who later became an NIH Director, in a 1979 paper in the New England Journal of
Medicine).2 He had observed that MD applicants for NIH project grants represented a progressively
smaller fraction of all applicants than previously, while the corresponding fraction of PhD applicants
increased dramatically. Subsequently, in 1984, Gordon Gill published an essay titled “The End of the
Physician Scientist?” in American Scholar.3 He argued that physicians who were engaged in researchwere increasingly being drawn toward basic laboratory science, excited by the revolution in molecularbiology. In 1987, Moody published a paper in the American Journal of Surgery that drew attention to theadverse impact of cost containment policies on research in clinical settings.4
In response, the Institute of Medicine (1994) undertook a study on overcoming barriers to career paths forclinical research. In 1996, NIH director Harold Varmus established a task force headed by David G.
Nathan to make recommendations about how to address the perceived shortfall of clinical investigators.
The Nathan Committee recommended creating new career development grants for patient-oriented
research and loan repayment programs to help young physician-scientists pursue research careers despite
an increasing load of educational debt.5
The Association of American Medical Colleges established two task forces on clinical research byphysician-scientists. These task forces recommended that clinical research be introduced in undergraduate
and graduate medical education curricula and training in clinical research be restructured to accelerate
training. In addition, private foundations such as the Burroughs Wellcome Fund, the Doris Duke
Charitable Foundation, the Howard Hughes Medical Institute, and the Robert Wood Johnson Foundation
created initiatives aimed at revitalizing the physician-scientist workforce.6
Nonetheless, an analysis by Zemlo, Garrison, Partridge, and Ley, based on data through the mid-1990s,
indicated that medical school students’ intentions to pursue a research career had declined; at the sametime, the average debt levels of medical school graduates increased. Their study also found that the
number of MDs with NIH training and fellowships declined during this period and that the number offirst-time grant applications submitted by MDs remained stagnant.7

2

Wyngaarden, J.B. (1979). The clinical investigator as an endangered species. New England Journal of Medicine, 301(23), 125459.
3Gill, G.N. (1984). The end of the physician-scientist? American Scholar 53, 353—69.
4
Moody, F.G. (1987). Clinical research in an era of cost containment. American Journal of Surgery 153, 337-340.
5Nathan, D.G. & Wilson, J.D. (2003). Clinical research and the NIH: A report card. New England Journal of Medicine, 349(19),1860-65.
6
Schafer, A.I. (2009). The Vanishing Physician-Scientist? Ithaca, NY: Cornell University Press.
7
Zemlo, T.R., Garrison, H.H., Partridge, N.C. & Ley, T.J. (2000). The physician-scientist: Career issues and challenges at the year
2000. The FASEB Journal 14, 221-230.

5

In 1999, Rosenberg emphasized that numerous forces, including the increasing debt burden of medical
school graduates, the increasing length of postdoctoral training required, and the instability of NIH
funding were responsible in large part for putting the future of the physician-scientist career path atsignificant risk.8
NIH funding increased greatly in the late 1990s from $13.675 billion (1998) to $27.167 billion (2003).
During this period, institutions expanded their research capacity and training programs, and the number ofphysicians applying for NIH R01 grants increased. NIH’s budget growth came to a halt in 2004 and hassince remained static. After adjusting for inflation using the Biomedical Research and Development Price
Index, the 2013 NIH budget was 21.9 percent below its 2003 level.9 The 2008 recession also reduced
research funding from other sources, including pharmaceutical companies.
Garrison & Deschamps’ analysis of data from multiple sources, including NIH, through 2011 indicatedthat physician-scientists’ role in biomedical research is more limited than in the past. Among their chieffindings, however, was that the decline in the number of physicians entering research careers was
temporarily mitigated during the 1998-2003 period of growth in the NIH budget. 10
Although nurse-scientists, dentist-scientists and veterinarian-scientists face many of the same issues—
debt, length of training, and funding instability—as physician-scientists with a medical degree, eachsegment of the workforce contends with other threats. Traditionally, these non-MD segments of theworkforce have lacked a critical mass of individuals trained in science and research due to the heavy
focus of these training programs on producing clinical practitioners; these professions have been viewed
as entirely clinical entities by the public, which has impacted adversely on the number of trainees
pursuing a research career in these profession. As a result, there is a shortage of faculty members with
scientific research programs who can serve as role models and mentors to students in training.

The Physician-Scientist Workforce
Physician-scientists typically engage in both clinical care and basic or clinical research (though notalways at the same point in their career). That combination of experience and training allows thephysician-scientist to contribute a unique perspective that encompasses both the “bedside-to-bench” andthe “bench to bedside” approach. By both seeing patients and performing research, they can translateclinical observations to the laboratory to help identify the mechanisms of disease, as well as applying thefinding of basic science to patient care.
It is difficult to obtain accurate numbers about the total size of the physician-scientist workforce because
data is not available on the number of physician-scientists whose research is funded by non-NIH sources,or those employed in the pharmaceutical or medical device industries. PSW-WG analyses indicate that
there were approximately 9,000 physician-scientists in the NIH-funded workforce during 2008-2012,
including 4,192 with an MD, 4,086 with an MD/PhD, 341 nurse-scientists, 253 veterinarian-scientists,
and 161 dentist-scientists (Figure 2.1).

8

Rosenberg, L.E. (1999). Physician-scientists—endangered and essential. Science 283, 331-332.
NIH/OEP Staff Calculations.
10
Garrison, H.H. & Deschamps, A. (2014.). NIH research funding and early career physician-scientists: continuing challenges instthe 21 century. The FASEB Journal 28, 1-10.
96

*MD/PhD includes: MSTP Programs graduates; non-MSTP MD/PhD Program graduates; PhD and MD in series;
PhD and/or MD obtained outside U.S.

Among MDs, most physician-scientists fall into one of two broad categories: those who perform research
directly with patients in their practice, and those who conduct laboratory-based research. Despite
increasing efforts to educate physicians in research methods, the dramatic advances in molecular and cellbiology in the second half of the 20th century accelerated a reductionist approach to basic biomedical
research, leading to a language barrier between basic scientists and clinical practitioners.11
Among non-MD physician-scientists, each makes specific contributions to biomedical research:
Dentist-scientists. These physician-scientists, like MD-scientists, are positioned to derive their researchquestions and concepts from clinical (chairside) observations. The 2000 publication “Oral Health inAmerica: A Report of the Surgeon General,” concluded that there is a need to support and maintain abiomedical research infrastructure to enhance knowledge about oral disease and improve the oral andgeneral health of the U.S. population.
Veterinarian-scientists. The National Research Council (NRC)’s Committee on Increasing Veterinary
Involvement in Biomedical Research (2004), Committee on the National Needs for Research in
Veterinary Medicine (2005), and Committee to Assess the Current and Future Workforce Needs in
Veterinary Medicine (2013) described multiple roles for veterinarians in biomedical research, including
serving as principal investigators, co-investigators, research scientists, and technical advisors. They notedthat these individuals also perform important supportive roles as attending veterinarians at research
institutions, where they provide medical care for research animals, serve as federally-mandated membersof animal care and use committees, and provide technical instruction and advice on experiments utilizing
animals.
Nurse-scientists. As the largest group of clinical practitioners in the U.S. healthcare workforce, nurses are
uniquely positioned to make important contributions to improving health and quality of life. Nursescientists, many of whom conduct clinically-based, patient-oriented research, develop science that
11

Schafer, ibid.

7

informs clinical practice. While some nurse researchers conduct basic science to uncover the biologicalmechanisms of disease, the main focus of nursing research is minimizing the impact of disease on
individuals, their families and caregivers, and communities.

NIH Support for the Development of the Physician-Scientist Workforce
NIH has provided support for the training and early career development of physician-scientists through avariety of funding mechanisms. Many of these award mechanisms are referenced throughout this report.
Figure 2.2 illustrates the points of support provided along the physician-scientist pipeline, as well as thetraining/career stages in which individuals originally intent on a career modeled on their academic
physician-scientist mentors find alternate paths. Figure 2.3 provides an overview of the major institutional
and individual awards that appear in Figure 2.2.

Figure 2.2. NIH Support for the Physician-Scientist Pipeline12

Future Trends Affecting the Physician-Scientist Workforce
The Affordable Care Act
The Patient Protection and Affordable Care Act (PPACA, or ACA), signed into law by President Barack
Obama in 2010, will have a significant impact on the delivery of health care services in the United States.

12

Figure 2.2 is not drawn to scale, i.e., more physician-scientists are employed in clinical practice than in academic or industry
research.

8

While some changes may pose threats to the physician-scientist workforce, others will create newopportunities.
Changes in reimbursement policies for the delivery of health care services under ACA will posechallenges for academic medical centers (AMCs), the traditional home of physician-scientists with a
medical degree. These challenges include an increased number of patients with Medicaid, which
traditionally has provided low reimbursement rates; a move away from fee-for-service medical care and adecrease in Medicare reimbursement for specialty services, both traditionally major sources of revenue
and margin for AMCs; and threats to direct and indirect medical education payments, which fund costs ofresidents and faculty. As a result, AMCs will have fewer funds available internally to support physicianscientists and their research. Funding for physician-scientists in specialties such as surgery that have been
relatively well compensated may be especially affected.
At the same time, new opportunities may arise for AMCs and physician-scientists. The emergence of
population-health models, such as Accountable Care Organizations (ACOs), will create new opportunities
for AMCs if they can master new organizational skills and re-position themselves in a competitiveenvironment. Those AMCs that learn to manage costs successfully within population health risk models
will earn profits that can help them invest in physician-scientists. Physician-scientists with expertise inareas such as clinical informatics, outcomes research, and economics will find important roles in AMCs
responding to these new incentives, and new research funding sources, such as through the Patient
Centered Outcomes Research Institute and the Centers for Medicare and Medicaid Innovation. Clinician
scientists in diverse areas such as nursing, dentistry, and psychology may find their clinical and scientificskills increasingly valued by health systems that are increasingly responsible for patient outcomes andaware of the need for team approaches to care and research. Physicians in specialties that have historically
been highly paid and anticipate declines in clinical earnings may be more likely to invest in training
themselves for research and in maintaining research activity over their careers. Finally, at the Federal
level, success in controlling costs could provide resources to increase investments in scientific research;
the entire annual NIH budget is small compared to the increases in annual Medicare spending.

Team Science
The increasing complexity and specialization of modern research methods has led many to suggest a
growing need for team science approaches in biomedical research.13 Team science provides opportunities
for MD physician-scientists, nurse-scientists, dentist-scientists and veterinary-scientists, along with nonclinician PhDs, to work side-by-side in addressing health challenges, with more diffused and/or shifting
leadership roles.
This new approach enables clinicians to have varying levels of percent effort involvement in science andthereby play an important role, while also maintaining their clinical, teaching, and administrative
commitments. If the current “all or none” approach whereby a scientist is defined as having an individual
R01 is de-emphasized in the future, this could draw more clinicians interested in participating in clinicalor translational research back into the scientific workforce. However, shifting to a team science approach
will require a major cultural shift in the promotion and tenure process, which has long been oriented
toward individual achievement. This means new investigators may be jeopardizing their career

13

Bennet, L.M., Gadlin, H. & Levine-Findley, S. (2010). Collaboration and team science: A field guide.
http://ombudsman.nih.gov/collaborationTS.html

9advancement opportunities if they serve as key personnel, rather than principal investigator, on a grant. In
addition, funding opportunities and training in team science leadership roles would need to be developed.

Figure 2.3. A Brief Primer on NIH Support for Physician-Scientists
Health Professional Training (http://grants.nih.gov/training/T_Table.htm):
T32 Institutional Training Grants: supports predoctoral and postdoctoral research training programs since1974. Research training activities can be in basic biomedical or clinical sciences.
T35 Short-Term Institutional Training Grants: supports intensive, short-term research training experiences
for health professional students (medical students, dental students, and/or students in other healthprofessional programs) during the summer.
Medical Scientist Training Program (MSTP)(http://www.nigms.nih.gov/Training/InstPredoc/Pages/PredocOverview-MSTP.aspx):
Supports MD/PhD training programs at 43 institutions across the country, providing tuition and stipends toselected students for up to 6 years.

Fellowships (https://grants.nih.gov/training/F_files_nrsa.htm):
F32 Individual Postdoctoral Fellows: Applicants with a health professional doctoral degree may use theproposed postdoctoral training to satisfy a portion of the degree requirements for a master's degree, aresearch doctoral degree or any other advanced research degree program.

Career Development Awards (http://grants.nih.gov/training/careerdevelopmentawards.htm)
K08 Mentored Clinical Scientist Award: provides support and “protected time” to individuals with a clinicaldoctoral degree for an intensive, supervised research career development experience in the fields ofbiomedical and behavioral research, including translational research.
K23 Mentored Patient-Oriented Research Award: supports the career development of individuals with aclinical doctoral degree who have made a commitment to focus their research endeavors on patient-oriented
research via a supervised research career development experience.
K99/R00 Pathway to Independence Award: facilitates a timely transition of outstanding postdoctoral
researchers from mentored, postdoctoral research positions to independent, tenure-track or equivalentfaculty positions, and provides independent NIH research support during the transition that will help these
individuals launch competitive, independent research careers

Loan Repayment Program (http://www.lrp.nih.gov/about_the_programs/index.aspx): Encourages
outstanding health professionals to pursue careers in biomedical, behavioral, social, and clinical research by
repaying $35,000 per year of student loan debt for up to 3 years for those employed in a research capacity.

10Chapter 3
Physician-Scientists with a Medical Degree
Physician-scientists with a medical degree make unique contributions to biomedicine. From Alexander
Fleming’s discovery of penicillin in 1928 to Bruce Beutler’s and Ralph Steinman’s discoveries related toinnate and adaptive immunity, for which they were awarded the Nobel Prize in 2011, MD physicianscientists have advanced human knowledge of disease and uncovered new treatments.
The importance of MD physician-scientists has been widely recognized:Over the last 25 years, 37 percent of Nobel Laureates in Physiology or Medicine had an MD
degree.

Over the Lasker Awards’ last 30 years, 41 percent of the Basic Awards and 65 percent of theClinical Awards have gone to MDs.



69 percent of NIH Institute Directors have an MD degree.

60 percent of the National Academy of Sciences Class IV (Biomedical Sciences) members havean MD degree.



70 percent of the chief scientific officers at the top 10 pharmaceutical companies have an MD
degree.

This chapter summarizes the findings of the PSW-WG regarding the current composition of the MD, DO,
and MD/PhD physician-scientist workforce, based on an analysis of data from multiple sources, including
the NIH IMPACII data system, the American Medical Association, and the American Association of
Medical Colleges, as well as focus groups discussions and interviews with early career physicianscientists.

Training of Physician-Scientists with Medical Degrees
Physician-scientists include those with a medical degree (MD or DO), as well as those with both MD and
PhD degrees. Becoming an MD physician-scientist requires an investment of many years of training thatbegins in medical school, graduate school, or both, and typically proceeds through multiple years ofspecialty and subspecialty clinical and research training (residency/fellowship).
NIH supports the training of physician-scientists at several points during their training (see Figure 2.2).
Institutional T32 grants support predoctoral and post-doctoral research training of health professionals;
institutional T35 grants support intensive short-term research training for predoctoral students.
The largest group of NIH-funded US physician-scientists continue to be those who hold an MD as their
only professional degree (see Figure 2.1). Of the 8,278 physician-scientists who held an NIH RPG award
in 2012 (using a rolling 5-year window estimate, see Figure 3.3), 4,192 (50.6 percent) were MDs (withouta PhD), with this group comprising 57.9 percent of first-time physician-scientist applicants for RPGs in2012 (Figure 3.6) (and 57.8 percent of awardees from this pool). These trends have been stable for morethan a decade, despite an ever-increasing number of graduates from MD/PhD programs, and despite theincreasing debt burden of MDs outside of these programs.

11

MD/PhD physician-scientists are a heterogeneous group of individuals that includes those who pursued
their degrees in series (including many who may have gone through medical education or researchtraining outside the United States), as well as those who earned both degrees simultaneously throughparticipation in a combined MD/PhD program, including those offered by an institution receiving Medical
Student Training Program (MSTP) funds from the National Institute of General Medical Sciences(NIGMS). Disaggregating MD/PhDs into these various career paths was not possible for this workforce
study, in part because matching individuals tracked within data sources on combined MD/PhD program
graduates collected by non-NIH organizations to NIH data was limited by data availability and data
quality. Nevertheless, information on NIH support for combined MD/PhD programs reveals someinteresting aspects of this part of the MD/PhD physician-scientist workforce.
The NIGMS-sponsored Medical Student Training Program (MSTP) supports MD/PhD training through43 participating programs currently, with a total of 932 trainees supported each year.14 In addition to the
43 MSTP-funded programs, there are approximately 34 active MD/PhD programs in the U.S. that do notreceive NIGMS support. In 2013, 609 students entered an MD-PhD program, 444 (73 percent) admitted
to programs with MSTP support.15 Students in MD/PhD programs can apply for individual F30, and inselected cases, F31, predoctoral fellowship awards, which typically provide support during the graduate
phase of the program, but can also support completion of medical school after thesis research iscompleted. The Biomedical Workforce Working Group recommended that NIH expand the F30 and F31
to all NIH Institutes and Centers, and that occurred in March of 2014.16
MD/PhD trainees in the MSTP typically receive their PhDs in one of the biological or physical sciences,
A very small number of MSTP MD/PhDs have received their PhD in a social science (e.g., economics),
outcomes research, clinical informatics, or other field outside the biological or physical sciences.
MD/PhD programs commonly provide full or substantial tuition and stipend support for students. As aresult, MD/PhD program graduates usually have far less student debt than other medical school graduates.
The costs related to MD/PhD programs are high and MSTP T32 awards typically provide only 20-25
percent of total MD/PhD program expenses. As a result, medical schools use a combination of other NIH
training and research grant dollars, philanthropic and, most prominently, institutional resources to fundstudents. An analysis in 2008 of outcomes data from 24 MD-PhD programs enrolling 43 percent of thethen-current trainees showed that 67 percent were employed at academic medical centers and universities,
4 percent were working at research institutes such as the NIH, and 8 percent were employed in industry.17
Attrition from MSTP-funded MD/PhD programs is relatively low. The rate of obtaining the PhD (andpresumably the MD as well) for individuals who were appointed to a NIGMS MSTP T32 training grant
for the first time in 1980-1989 was approximately 88 percent.18 Consistent with the result from reference
17, 68 percent of graduates in that cohort became medical school faculty. Data on NIH RPG applications
and awards are included later in Chapter 3.
NIH also provides support for MD/PhD training through the MD/PhD Graduate Partnership Training
Program (http://mdphd.gpp.nih.gov/). The GPP represents a unique physician-scientist training model inwhich graduate training at the NIH is combined with medical school completed elsewhere. Students
complete their thesis research at the NIH or through one of NIH's graduate partnership programs. They14

http://www.nigms.nih.gov/Training/InstPredoc/Pages/PredocOverview-MSTP.aspx
2013 MD-PhD matriculants from AAMC internal report16
http://grants.nih.gov/grants/guide/notice-files/NOT-OD-14-056.html and http://grants.nih.gov/grants/guide/noticefiles/NOT-OD-14-066.html
17
Brass, L.F., Akabas, M.H., Burnley, L.D.. Engman, D.M., Wiley, C.A., & Andersen, O.S. (2010). Are MD–PhD programs meeting
their goals? An analysis of career choices made by graduates of 24 MD–PhD programs. Academic Medicine 85(4):695-701.
18
Preusch, P. Personal communication.
15

12

then complete their MD education at an MSTP-associated medical school. Partial funding for medical
school is provided through an additional training slot co-funded by the NIH institute in which the student
performs his or her research. There have been 38 graduates of the program since 2007 and there are 46
current students. The majority of these students have done their PhDs in the NIH-Oxford-Cambridge
Scholars program (http://oxcam.gpp.nih.gov/), in which students are co-mentored by investigators at NIH
and either Oxford or Cambridge University in the U.K. Long term outcomes data from the GPP are not
yet available; all of the program graduates are currently completing postgraduate residencies andfellowships.
To shorten the post-graduate training period for physician-scientists, Short-Track Programs are offered byvarious medical specialty boards. Physician-Scientist Training Programs (PSTP) are offered at several
institutions. In these programs, the number of years in clinical specialty and subspecialty training are
reduced to accommodate more training in clinical or laboratory-based research. Data from the American
Board of Internal Medicine suggests that such short-track research residency programs are effective atdeveloping physician-scientists. Surveys of 385 (of 813) participants who completed the American Boardof Internal Medicine’s ‘short track’ research pathway residency (1995-2007) revealed that: 91 percent are currently involved in research Mean percentage effort spend in research was 59 percent.19
During the late phases of fellowship training and initial employment as a faculty member or researcher,
NIH supports early career investigators primarily through two mechanisms:
 K08/K23 awards that provide up to 5 years of mentored research experience.
 A Loan Repayment Program that repays up to $35,000 per year of qualified student debt forbiomedical researchers who commit for up to 3 years of research (the maximum repayment
amount is currently $105,000).

Research about Medical Students’ Decisions to Pursue a Research Career
Qualitative research20 conducted with MD/PhD students identified one striking difference between thesestudents and the general medical student population: the MD/PhD students almost universally made adecision to enter a research career well before they entered medical school, often as early as middle
school and/or high school. They spoke of being exposed to grandparents or parents who were scientists,
encountering physician-scientists during a health crisis of their own, or being excited by a high school
biology teacher. They spoke of mentors they encountered during science courses in their undergraduate
studies that convinced them that this career path was possible.
Similarly, interviews with deans at medical schools reported that students at their schools who expressed
an interest in research typically developed that interest prior to their arrival in medical school. One deansuggested that the most important strategy to strengthen the biomedical workforce would be to foster
students’ natural curiosity and excitement about science beginning in elementary school.
Nonetheless, exposure to research during medical school increases students’ interest in research. Students
graduating from medical school express more interest in research than students entering medical school,according to an AAMC study of students between 2006-2010. In this study, only 12.5 percent [Percent
19

Todd R.F., Salata R.A., Klotman M..E, et al. (2013). Career outcomes of the graduates of the American Board of Internal
Medicine Research Pathway, 1995-2007. Academic Medicine, 88(11):1747-1753.
20
Appendix V contains a summary of qualitative research conducted to inform this PSW-WG

13

Error Corrected] of students expressed an interest in research when they entered medical school; thatpercentage had increased to 16.4 percent upon graduation. Further, approximately 45 percent of
medical school graduates expect to be “somewhat involved” in research during their careers.21
Medical students from underrepresented racial/ethnic backgrounds who participated in the qualitative
research indicated that they never considered a career in research because they knew nothing about it,
having never encountered a physician-scientist as they were growing up. This point underscores thecritical role of mentorship for both students and faculty.22 Recent reports have emphasized an intrinsic
bias against women and minorities in mentoring as contributing to the disparities.23,24
Financial pressures on these students reduced their interest in pursuing lengthy training in addition to
obtaining an MD degree, as did the lower salaries they would earn as researchers. These students
advocated for more programs that gave promising minority students exposure during high school andcollege to physician-scientists and to biomedical research.25
Paik, Howard, & Lorenz analyzed graduate placement data from NIH-funded MSTP programs from 2004
to 2008. They reported that the most common residencies for MSTP graduates were internal medicine(24.6 percent), pathology (10.3 percent), pediatrics (10 percent) and diagnostic radiology (6.9 percent).
MSTP graduates were least likely to enter residencies in family medicine, emergency medicine, andobstetrics/gynecology.26 A 2013-2014 survey of MD/PhD trainees by the American Physician Scientists
Association yielded similar results. Brass, et al. found in a 2010 review of 4 decades of outcomes datathat nearly all (95 percent) MD/PhD program graduates enter clinical residencies. They also found thatthe proportion of graduates choosing clinical training in internal medicine, pediatrics, pathology andneurology declined from 73 percent for the 1965-1978 cohort to 57 percent for the 1999-2007 cohort.27

Size and Composition of the Physician-Scientist Workforce in 2012
Using a definition of research as the self-reported primary activity, data from AMA annual surveys showthat the overall size of the segment of the physician-scientist workforce with a medical degree has
experienced a small but statistically significant decline over the past ten years from 14,521 in 2003 to
13,717 in 2012. In 2012, physician-scientists comprised 1.5 percent of the total physician workforce. Of
particular concern is the aging of the workforce and persistent patterns of unequal participation by womenand racial/ethnic minorities.
21

Courtesy of Ann Bonham, AAMC
Merchant J.L. & Omary M.B. (2010). Under representation of underrepresented minorities in academic medicine: The need toenhance the pipeline and the pipe. Gastroenterology, 138, 19-26
23
Moss-Racusin, C. A., Dovidio, J. F., Brescoll, V. L., Graham, M., & Handelsman, J. (in press, published online ahead of print).
Science faculty’s subtle gender biases favor male students. Proceedings of the National Academy of Sciences, 109, 1647416479.;
24
Milkman, K.L., Akinola, M. & Chugh, D. (2012). Temporal distance and discrimination: An audit study in academia
Psychological Science 23(7), 710-717.
25
Of note, substantial efforts in this area are already in place through organizations such as Annual Biomedical Research
Conference for Minority Students (ABRCMS)ociety for Advancement of Chicanos and Native Americans in Science (SACNAS), theNational Science Foundation, and the Ivy Plus consortium of universities, as well as the NIH-sponsored MARC U-STARS programthat provides support for undergraduate students who are underrepresented in the biomedical and behavioral sciences toimprove their preparation for high-caliber graduate training at the PhD level.
26
Paik, J.D., Howard, G., & Lorenz, R.G. (2009). Postgraduate Choices of Graduates from Medical Scientist Training Programs,
2004-2008. Journal of the American Medical Association, 302(12), 1271-1273.
27
Brass et al, ibid.
22

14

Key findings include:

There were 13,717 physicians with research self-reported as their primary activity in 2012 (Figure3.1). The number of self-reported physician-scientists has declined from an average of 14,467 (20032005) to an average of 13,676 (2010-2012), (p<0.0001)

SOURCE: Those MD-holding Physicians that indicated they were in primarily Medical Education or Medical Research from theAmerican Medical Association (AMA) Physician Masterfile Annual Year-end Snapshots.

In September 2013, of the 1,176 intramural researchers employed by the NIH, 692 (59 percent)had PhDs, 295 (25 percent) had MDs and 168 (14 percent) had MD/PhDs.

 There are approximately 1800 funded clinician investigators working for the Veterans

Administration (VA), of whom 82 percent are MDs, 15 percent are MD/PhDs, and 3 percent are
RN/PhDs. There is also one DVM/PhD, but no DVM-only or dentist-scientists. Physicianscientists who work at the VA may also have NIH RPGs that are administered through an
academic affiliate or the VA nonprofit corporation.28 The number of these "dually funded"
individuals is currently unknown.

28

From 1976-1985, ~60-70 percent of Howard Hughes Medical Institute (HHMI) investigators
were MDs (~ 1/4 MD/PhDs). Since that time, the total number of HHMI investigators has
increased from 50 to the current 371, with a gradual decline in the percentage of MDs. In 2012, ofthe 371 HHMI investigators, only 92 (24.8 percent) are physician-scientists (42 MDs and 48
MD/PhDs). This pattern (as shown in Figure 3.2 below) is very similar to the change in NIH RPG
awards by degree over the similar timeframe.

M. Cody (personal communication, April 22, 2014)15

Accurate numbers regarding the number of physician-scientists in biotechnology andpharmaceutical companies are not currently available.



4,192 MDs and 4,086 MD/PhDs held NIH RPG awards during the 5-year period 2008-2012, asshown in Figure 3.3. 29

Data were aggregated over 5 year windows to reduce double counting of individuals who apply multiple times or were awarded
multiple grants during that window.

29

Other than in a few select graphs, the data presented in this report are for Research Project Grants (RPG) applicants andawardees. Similar analyses for R01 grants may be found in Appendix IV.

16

25,921 MDs and 5,214 MD/PhDs are tenure-track faculty at U.S. medical schools (Figure 3.4).

67,611 additional MDs and 4,837 additional MD/PhDs are non-tenure track faculty at medical
schools, as displayed in Figure 3.5.

The vast majority of physician-scientists (whose primary affiliation is at a medical school) with
NIH RPGs are on the tenure track. In 2012, for example, 72 percent of the RPGs awarded to MDs
at U.S. Medical Schools went to individuals on the tenure track; for MD/PhDs, 84 percent ofRPGs went to those on the tenure track.

17

Physician-Scientists with a Medical Degree in the NIH-Funded Workforce
As noted in the previous section, about 8,000 of the 14,000 physician-scientists in the United States have
Research Project Grants (RPG) from NIH. This section examines the patterns of RPG applications andfunding, as well as the impact of NIH early career awards on the careers of these physician-scientists.
Note that unless otherwise stated in the text, “MD/PhD” includes individuals who were trained in
combined MD/PhD programs, as well as individuals who obtained their degrees sequentially in the U.S.
or elsewhere.

Physician-Scientist Application and Award Patterns
 Numbers of First Time RPG Applicants for MDs (2,356 in 2012) and MD/PhDs (1,714 in2012) have been stable for 10 years, despite declining award rates (Figure 3.6). During the same
period, however, there was a near doubling in the number of first time applicants for PhDs (7,785
in 2002, vs. 13,748 in 2012). The growth of new physician-scientists has therefore not kept pacewith that of PhDs.

18

Age


The average time to degree in MD/PhD programs is currently 8 years, and the average time from
graduation to the first RPG is 13 years. For MDs, the average time from medical school
graduation to the first RPG is currently 17 years.

The age profile of the physician-scientist workforce has increased slowly over the past decades,
as seen in Figure 3.7. There was a decline in the number of individuals from the ages of 31-60,
and an increase in individuals over the age of 60.

SOURCE: Those MD-holding Physicians that indicated they were in primarily Medical Education or Medical Research from theAmerican Medical Association (AMA) Physician Masterfile Annual Year-end Snapshots.

19The average age of physician-scientists with NIH RPGs has slowly increased over the past decade(Figures 3.8 and 3.9). There was a decline in individuals from the ages of 31-50, and growth in
grant holders over the age of 50.

20



The average age of MD RPG grant holders was 48 in 2003, and 51 in 2012; the average age for
MD/PhDs with RPGs was 48 in 2003 and 52 in 2012; and for PhDs, 46 in 2003 and 48 in 2012.
See Figure 3.10 for a graphic display of these findings.

.



In 2012, the average age of First Time RPG awards for MDs was 43.8 years, for MD/PhDs, 44.3
years, and for PhDs, 41.9 years (Figure 3.11).

21

Gender
U.S. Medical Schools matriculants and applicants:
 The percentage of female medical student matriculants peaked at 49.6 percent of U.S. medical
school students in 2003 and has shown slight decreases in subsequent years.30
 There have been small decreases in the percentage of women applicants into medical school
since 2003-2004, however, the total number of women applicants increased to a high of 20,780
in 2011-2012.31
MD degrees
 In 1982-83, 26 percent of MD degrees in U.S. Medical Schools were awarded to women and in
2010-2011, 48.4 percent. 32
 The percentage of female MDs who are RPG grant holders has increased from 17 percent in the
mid-1990s to 29 percent currently. However, for MD/PhDs, growth has been considerablyslower, increasing from 17 percent in the mid-1990s to only 22 percent at the present time,reflecting a more persistent disparity in gender for this group.
MD/PhD degrees: There remains a disparity in the percentage of male and female students of MD/PhD programs
U.S. Medical Schools. In 2011, 39 percent of applicants, 37 percent of matriculants, and 42
percent of graduates were women. From 2001 to 2011, the percentage of female MD/PhD
graduates increased from 30 percent to 42 percent.33

30

Association of American Medical Colleges. (2012, March). Analysis in brief: The changing gender composition of U.S. medical
school applicants and matriculants.12 (1). Retrieved from https://www.aamc.org/download/277026/data/aibvol12_no1.pdf)(Association of American Medical Colleges U.S. medical school applicants and students 1982-1983 to 2011-2012, Retrieved,
from https://www.aamc.org/download/153708/data/
31
AAMC (2012, March), ibid.
32
Association of American Medical Colleges. U.S. medical school applicants and students 1982-1983 to 2011-2012, Retrieved
from https://www.aamc.org/download/153708/data/
33
Association of American Medical Colleges. (2012, December) Table 32: MD-PhD applicants, acceptees, matriculants, andgraduates of U.S. medical schools by sex, 2001-2012. Retrieved, fromhttps://www.aamc.org/download/321542/data/2012factstable32.pdf

22Although the percentage of male and female medical school students and of instructor-levelfaculty have become nearly equal, the gender gap is greater with higher academic ranks4.
However, the gender gap is slowly narrowing for all academic ranks, as seen in Figure 3.13.

23



The NIH RPG award rates in 2012 were not significantly different for men and women (men 22.9
percent, women 23.8 percent, p=0.115). There were also no significant differences in award rates
by gender with any degree type (for MDs, 21.2 percent vs. 23 percent, p=0.1571; for MD/PhDs,
24.6 percent vs. 24.8 percent, p=0.8918; for PhDs, 21.8 percent vs. 20.9 percent, p=0.0959).
However, large differences in the number of male and female applicants persist, although the gap
is slowly closing (women were 26 percent of RPG applicants holding MDs and MD/PhDs in2012, compared to 18 percent in 1999) (Figure 3.14).

24

Race/Ethnicity34
Figures 3.15 through 3.2035 illustrate the following findings:


The RPG applicant pool in 2012 included 22,635 Whites (69.5 percent of the total applicant
pool), 7,403 Asians (22.7 percent), 1,469 Hispanics36 (4.5 percent), 768 African Americans (2.4
percent), and 56 Native Americans (0.17 percent).



The RPG awardee pool in 2012 included 5,310 Whites (73.6 percent of the total awardee pool),
1,458 Asians (20.2 percent), 261 Hispanics (3.6 percent), 120 African Americans (1.7 percent),
and 10 Native Americans (0.13 percent).

RPG award rates for underrepresented race/ethnic minorities in 2012 were lower than that ofwhite applicants (Whites, 23.5 percent; Asians, 19.7 percent, p<0.002; African-Americans, 15.6
percent, p<0.002; Hispanics, 17.7 percent, p<0.002; Native Americans, 17.8 percent, p=0.3232)

Although there has been significant growth for Asian and Hispanic awardees over the past
decade, there has been less growth for African-Americans and Native Americans. The proportionof white awardees is shrinking.

In 2012, the PhD RPG awardee pool included 3,703 Whites (74.9 percent), 954 Asians (19.3
percent), 166 Hispanics (3.4 percent), 76 African Americans (1.5 percent), and 7 Native
Americans (0.14 percent).



In 2012, the MD RPG awardee pool included 750 Whites (74.0 percent), 183 Asians (18.1
percent), 47 Hispanics (4.6 percent), 26 African Americans (2.6 percent), and 2 Native Americans(0.2 percent).



In 2012, the MD/PhD RPG awardee pool included 763 Whites (68.4 percent), 291 Asians (26.1
percent), 36 Hispanics (3.2 percent), 14 African Americans (1.3 percent), and 1 Native Americans(<0.2 percent).

34

Country of Origin was not factored into the Race/Ethnicity categorization.
In Figures 3.16 and 3.20, the annual number of Native American awardees was less than 10. Therefore, per NIH guidelines on
privacy, the line representing this demographic group is not included on these graphs.
36
For the purposes of this workforce analysis, it was necessary to have individuals categorized into one and only one
Race/Ethnicity category. Individuals who reported both a non-White race (e.g. Native American) and Hispanic ethnicity werecategorized as the reported Race (e.g. Native American). Individuals who reported White race and Hispanic ethnicity werecategorized as Hispanic.
35

25

26

NIH RPG Award Rates by Degree Type and ExperienceIn 2012, MD/PhDs overall had higher award rates for RPGs (24.6 percent) than MDs (21.7
percent, p<0.01) or PhDs (21.4 percent, p<0.01) (Figures 3.21 to 3.23).

Experienced investigators have much higher award rates than first-time RPG applicants. In 2012,
the award rate for MD/PhDs with a prior RPG was 30.7 percent; without a prior RPG, it was 14.1
percent. The award rate for MDs with a prior RPG was 28.7 percent; without a prior RPG, it was
14 percent. The award rate for PhDs with a prior RPG was 32.3 percent; without prior RPG it was
12.5 percent (p<0.0002 for all three groups).

27

28



However, for R01 applications, the difference in the gap between first-time and experienced
investigators has narrowed in recent years (Figure 3.24-3.26). This reduction is likely due in partto NIH’s New Investigator policies implemented in 2007 and strengthened in 2009. In 2012, theaward rate for MD/PhDs with a prior R01 was 23.3 percent; without a prior R01, it was 14.9
percent. The award rate for MDs with a prior R01 was 23.3 percent; without a prior R01, it was
14.7 percent. The award rate for PhDs with a prior R01 was 24.9 percent; without prior R01 it
was 13.3 percent (p<0.001 for all three groups). See Figures 3.24 through 3.26 for graphic
illustrations of these findings.

29

30

Persistence Quality by Degree and Gender
In Figure 3.27 below, the upper panels show the percentages of First-Time RPG applicants whose initial
application in that fiscal year was not funded, but who re-applied for NIH RPGs in subsequent years. This
analysis shows that a high percentage of the physician-scientist workforce persists in applying for NIH
RPGs despite an unsuccessful first attempt.
The lower panels show the percentages of first time awardees by fiscal year who re-applied for NIH
RPGs in subsequent years. Receipt of an NIH award slightly increased the persistence of the physicianscientists, as a higher percentage of awardees reapplied in later years compared to unsuccessful
applicants.
Interestingly, MD/PhDs were generally more persistent than MDs (75.9 percent of male MD/PhD
applicants in 2012 persisted compared to 67.1 percent of male MD applicants). There did not appear to besignificant differences in persistence by gender.

31

Effects of Early Career NIH Programs on Physician-Scientists with a
Medical Degree

In 2012, 1,630 MDs and 365 MD/PhDs were appointed to Postdoctoral Training appointments
under a T32 grant. Only 20 MDs and 9 MD/PhDs were awarded Postdoctoral F32 Fellowships.
Additional information about trends of postdoctoral fellowships and training appointments maybe
found in Appendix IV.

Analysis of a cohort of individuals who received their first postdoctoral appointment to a T32
grant between 1999 and 2008 shows that only one-quarter subsequently applied for an RPG.
While half of those who applied were successful, only 10 percent of those with a T32
appointment subsequently received an RPG (Table 3.1 below).37

Table 3.1. RPG Applications and Awards Among T32 Postdoctoral Appointees, 1999-2008

Source: IMPACII

MD and MD/PhD applicants to LRP and K award programs have declined significantly over the
past 5 years, despite stable award rates. Specifically, MD applicants for LRPs declined 36 percent(from 557 in 2008 to 359 in 2012); among MD/PhDs in the same period, applicants declined by
34 percent (from 88 to 58). PhD applicants declined by 45 percent (718 in 2008 to 391 in 2013)(Figure 3.29).

37

The 1980-1989 appointees were chosen in order to have a cohort of individuals who have had time to complete all levels ofsubsequent training. Since MSTP T32 appointments typically begin in year 1 of an MD/PhD program and completion of the
program was 7-8 years on average at that time, this cohort would have graduated in 1987 to 1997.

32For the individual K award programs, MD applicants declined 21 percent (from 733 in 2008 to
582 in 2012); MD/PhD applicants declined 35 percent (from 413 in 2008 to 270 in 2012) (Figure3.30). During approximately the same period, however, PhD applicants increased, primarily
because of the launch of the K99/R00 program (see below). At the same time, appointments ofindividuals with MDs and MD/PhDs to K12 and KL2 institutional career development awards
were also increasing, due in part to the introduction of Clinical and Translational Science Awards(CTSAs) and their associated institutional career development programs. By 2012, appointments
to NIH institutional career development awards had grown to include 487 individuals with MDs
and 106 holding MD/PhDs, as seen in Figure 3.31 below.

33Introduction of the K99/R00 program in 2007 has increased K applications from PhDs by 48
percent (979 K applications from PhDs in 2006 vs. 1,446 in 2012). Very few of the applicants andawardees are physicians: In 2012, 93 percent of all K99/R00 applicants were PhDs, and 87
percent of the awardees (189/207) were PhDs, as seen in Figure 3.32.

34



About 50 percent of LRP recipients (from 2003-2008) have applied for RPGs, and nearly 50
percent have been successful, as seen in Table 3.2, although the numbers are significantly lower
for RO1s.

Table 3.2. Total Number of Individuals and Percentage of L awardees (FY 2003-2008)
that Applied, were Awarded Subsequent RPG, Subsequent R01

Source: IMPACII

35



More than 80 percent of K program recipients (1999 through 2008) have applied for RPGs. Of
those who applied, more than 60 percent have been successful, for an overall K to RPG rate ofjust 54 percent (Table 3.3).

Table 3.3. Total Number of Individuals and Percentage of K awardees (FY 1999-2008)
that Applied, were Awarded Subsequent RPG, Subsequent R01

Source: IMPACII The award rates for first-time RPG applicants with a prior LRP or K award are much higher thanfor those without: For MDs: 44.1 percent vs 9.2 percent; for MD/PhDs: 60.0 percent vs 10.1
percent; and for PhDs: 66.3 percent vs 10.9 percent.


Although more successful in their award rates, physician-scientists with LRP and/or K awards
comprised only a small part of the First Time Applicant pool. In 2012, only 14.8 percent of MDs
and 13.4 percent of MD/PhDs had a prior LRP or K award.



Most physician-scientists who were appointed to NIH funded Medical Scientist Training
Programs (MSTP) slots in the 1980s have applied for and received RPG and/or RO1 awards.
Nearly 80 percent of a cohort of MD/PhDs with initial MSTP appointments in 1980-1989 haveapplied for RPGs, and approximately 78 percent have been successful (Table 3.4). This cohort
was chosen to allow for MSTP appointees (often in the first years of their medical education) tocomplete education (up to 8 years) and subsequent residency and postdoctoral training.

36

Table 3.4. RPG Applications and Awards Among MSTP Appointees, 1980-1989



The award rates for first-time RPG MD/PhD applicants with a prior MSTP appointment are muchhigher than for those without: in 2012, 36.2 percent for those with MSTP appointments and 12.3
percent for those without, as illustrated in Figure 3.33.



MD/PhDs with past MSTP support comprise only a small part of the total pool of RPG applicantswith MD/PhDs (for all applicants as well as first time). In 2012, only 13.4 percent of MD/PhD
applicants had prior MSTP support (Figure 3.34) and 7.4 percent of first-time applicants with
MD/PhDs had prior MSTP support (Figure 3.35).

37

.

38

Current Status of the Physician-Scientist Workforce
Based on our analysis of the current workforce, we estimate that there are currently
14,000 physician-scientists in the United States, of whom ~8,000 have Research Project
Grants from the NIH. The total number of physician-scientists with a medical degree is
now slowly declining. If the average career of physician-scientists is 30 years in duration,
we estimate that about 1,000 individuals will need to enter the pipeline each year tomaintain the steady state, assuming that 50 percent of people who enter the pipeline will
not succeed. About 500 of these individuals currently come from among those who hold
both an MD and PhD (earned in a combined program or sequentially in the United States
or abroad). The rest must come from the pool of MDs who become interested in researchduring their clinical training. The average age of physician-scientists is steadily
increasing due to factors that include longer training times, higher grant success rates forestablished investigators, and postponement of retirement.

Challenges Facing the Physician-Scientist Workforce
A number of challenges confront the physician who elects to pursue a research career. Increases in thecost of obtaining medical education can burden students with high amounts of debt, especially those who
were not enrolled in a combined MD/PhD program. The training required to obtain competency in clinicaland scientific research continues to increase, resulting in a marked prolongation of the training process.
The transition between finishing a clinical or post-doctoral fellowship and initiating an independent
research position is a very vulnerable period in the career path of all physician investigators. Financialpressures have mounted with the decrease in NIH funding, and physician-scientists are increasingly being
asked to support a higher percentage of their salaries by seeing patients.
PSW-WG data clearly indicate that young physician-scientists are at the greatest risk of leaving the career
path. There has been a steady decline in the size of the applicant pool for early stage NIH grants in thepast five years, as shown above.
Women appear to be particularly challenged because they are often having their children at the same timethat they are starting their laboratory. Finally, more cumbersome requirements have been added to theprocess of maintaining board certification for clinical practice, which may accelerate the exit ofphysician-scientists from the bedside.
Key factors that put pressure on early career physician-scientists include:








Impact of research funding
Length and structure of training
Debt
Work-life balance/ integration including leave policies, family life and child care
Influence of Mentoring
Tension between clinical and research responsibilities
Maintenance of board certification

39

Impact of Research Funding
Qualitative research undertaken by and on behalf of the PSW-WG indicated that the uncertainty offunding is by far the biggest concern of young physician-scientist faculty; its importance cannot be
overestimated. K awards, other than the K99/R00, typically provide inadequate support at the time needed
to launch a career as an independent investigator. Therefore, new investigators may spend time writing
grant applications and seeing patients, rather than generating preliminary data for an R01 application.
Furthermore, MD applicants for R01 grants may be at a disadvantage during the grant review process
because study section reviewers do not understand the career paths of physician-scientists, and may
interpret fewer publications (compared to PhD scientists) as a lack of productivity, rather than time spentin training and clinical responsibilities.
Laboratory-based physician-scientists have all the challenges of other investigators, but additional factors
contribute to the decrease in numbers and proportions of MD investigators who successfully transition
through this period of their career. The PSW’s qualitative research suggests that start-up packages forlaboratory-based physician-scientists are often not as large as those for PhDs, potentially due to a muchhigher percentage of MD investigators staying at their training institution.

Length and Structure of Training
The number of years required to become a physician-scientist is daunting and may be a barrier torecruiting an adequate supply of physician-scientists. The sequence and structure of training is also
problematic. For those pursuing dual degree programs that are structured as two years of medical school,then four years of graduate school, followed by two more years of medical school and then residency andfellowship, their research skills often become outdated before they can return to the laboratory. Thosewith medical degrees who wish to pursue in-depth research training may find their options limited, unlessthey are at research-intensive institutions.
Integral to these aspects of training is the age factor. The extended education and training in the dual
degree MD/PhD track, delay for family leave, and other factors contribute to the increasing age of earlystage investigators and attrition from the physician-scientist track towards other careers.38 The age factor
is illustrated by the trend of the average age of first time RPG awards increasing since 1999 for MDs,
MD/PhDs, and PhDs.39 With the 2014 release of the NIH Pathway to Independence Award (Parent
K99/R00, PA-14-042), NIH encourages applicants to apply before they complete 4 years of post-doctoral
experience, thereby moving researchers’ timetable to become an independent investigator earlier in theircareer.40 Of note, very few MDs have been applying to the K99/R00 mechanism: In 2012, only 51 MDs
and MD/PhDs applied for a K99/R00, compared to 700 PhDs.

38

Gordon, R., (2012) The vanishing physician scientist: a critical review and analysis. Account Res. 19(2, 89-113
Koniaris, L.G., Cheung, M.C., Garrison, G, Awad, W.M. Jr, Zimmers. T.A., (2010, Apr). Perspective: PhD scientists completing
medical school in two years: looking at the Miami PhD-to-MD program alumni twenty years later. Academic Medicine. 85(4),687-9140
NIH Office of Extramural Research (OER), Research training & research career development. (2014). Retrieved, fromhttp://grants.nih.gov/training/index.htm
39

40

Debt
Debt burdens limit career options for laboratory-based physician-scientists. Eighty-six percent of students
graduating from medical school in 2013 carried a student debt burden; the median debt was $175,000.
Resident/fellowship stipends at this same period were in the low-to-middle $50,000 range.41
Becoming a physician-scientist prolongs the training period at compensation levels lower than clinicalcareers; this can be particularly difficult for individuals with substantial debt and/or young families.

Work-Life Balance/Integration
NIH supported research on causal factors and interventions that affect the careers of women in biomedical
and behavioral science and engineering. Results from the research described one of the factors as
struggling to attain a work-life balance in order to establish a healthy work climate. The work-life issues
faced by both male and female professionals included family life, child care, finances (debts and wage
compensation), geographic location, and other interests. Among the study population of NIH K08 andK23 trainees, women were less likely to apply for tenure-track positions especially among women withchildren or planning to have children. The flexibility policies that address work-life balance were reported
to vary widely throughout the range of scientists and physicians workplaces. Institutional flexibility
policies were reported to be under-recognized and under-used. Challenges to overcoming academic
culture which countered these policies contributed to frustrations in workplace satisfaction among both
men and women.42

Influence of Mentoring
The impact of an effective mentor-mentee relationship is a well-recognized factor in career success of thementee. Both men and women linked their career satisfaction with their mentoring experience. Resultsfrom the NIH supported research on causal factors and interventions that affect the careers of women inbiomedical and behavioral science and engineering described the importance of receiving effective
mentoring. Among the study population of NIH K08 and K23 trainees, women described different
mentorship of their career development than men. The results showed that in order to achieve effective
mentoring, a mentoring network, rather than a single mentor, is important as well as including multiple
mentors representing diverse expertise, experience, resources, and background.43
A major difference between physician-scientists and PhD scientists is that the physician-scientists often
have multiple individuals who have control over their careers. They have a scientific mentor, a clinicalmentor and sometimes also have to answer to the leadership of the health care system. All of thesesupervisors request different things from the physician-scientists: to focus on their research, to take careof patients, to participate in the education of scientists in the laboratory and classroom, to participate in
the education of medical students and fellows in the classroom and clinic, to maintain a clinic and to41

Association of American Medical Colleges. (October 2013). Medical student education: Debt, costs, and loan repayment factcard. https://www.aamc.org/download/152968/data/debtfactcard.pdf
42
NIH causal factors and interventions workshop summary. (2012). Retrieved, from http://orwh.od.nih.gov/career/pdf/CausalFactor-Summary.pdf
43
Ibid.

41

attend on ward services. Oftentimes, the physician-scientists lack a mentor who can help balance andprotect them, especially during the most vulnerable part of their career, at its beginning.

Tension between Research and Clinical Responsibilities
Academic medical centers, where most physician-scientists are employed, are under increasing financialpressures. Their need to increase clinical revenue to maintain current levels of operation can translate into
pressures on physician-scientists to see more patients at the expense of protected research time.
At the same time, the current environment does not encourage laboratory-based physician-scientists withclinical training to maintain their clinical skills. In some cases, laboratory-based physician-scientists arepressured to give up all patient care activity because their clinical revenue-generating capacity is
exceeded by their practice expenses. For example, malpractice expenses are usually not prorated foramount of clinical activity and can exceed clinical revenue, so laboratory-based physician-scientists canbe viewed as “money losers.” Therefore, many abandon (or are pressured to abandon) clinics to maintaintheir research program.
Finally, many lab-based physician-scientists are housed in clinical departments where some feelincreasingly out of place and unsupported. The fraction of MD/PhD program graduates with a primary
appointment in a basic science department, never high to begin with, declined to 9 percent for the cohort
of individuals who graduated after 1998.44 Due to the recent financial pressures facing the clinicaldepartments, emphasis has increasingly been focused on maximizing the efficiency and financial health ofthe clinical services, rather than on the generation of new knowledge. Physician-scientists often do not get
sufficient administrative support as the regulatory demands of conducting both clinical and lab-based
science continue to increase.

Maintenance of Board Certification
Specialty and subspecialty board certification and recertification are becoming increasingly timeconsuming and demanding, which is impacting the decisions made by junior physicians about their career
paths. Such certification is necessary for a professional with clinical activities to maintain hospitalprivileges and to bill as a specialist. Although a number of boards have designated research tracks, someof the boards impose requirements that may discourage trainees from a research career. Maintenance ofcertification processes developed by some boards appears to be discouraging physician-scientists frommaintaining their clinical privileges.
A large percentage of physician-scientists voluntarily restrict the scope of their practice to narrow “super
subspecialties” and are often the most clinically knowledgeable physicians in these areas because of theirexperience in assessing cohorts of patients with rare disorders. Thus, they can have a profound effect on
the quality of care delivered by large numbers of more general subspecialty physicians who seek theiradvice and refer patients for consultation.
Finally, policies that discourage physician-scientists from maintaining certification also diminish thevalue of the physician-scientists to the biomedical enterprise, since a physician-scientist becomes a
44

Brass et al, ibid.

42

depreciating asset when she or he stops being actively engaged in medical practice: clinical acumen
begins to decay with lack of use.
There is a need for certifying boards to collaborate with the physician-scientist community, federal
agencies and payers to find more targeted and efficient ways to assess the very focused practice of suchphysician-scientists. The PSW-WG applauds the plans of the American Board of Medical Specialties(ABMS) and its member boards to consider the special issues of physician-scientists through a special
committee review planned later in the year.

43Chapter 4
Nurse-Scientists

Nurse-scientists occupy a unique and fundamental position in the health research enterprise. Nursing
science provides the evidence base to support the practice of the largest healthcare profession, as well as
to improve wellness and quality of life for all individuals. For example, Dr. Margaret Grey developed
approaches to teaching adolescents the skills needed to successfully manage their diabetes; Dr. Loretta
Sweet Jemmott pioneered ways to help young minority men and women reduce their risk for acquiring
HIV; and Drs. Jon Levine and Christine Miaskowski increased medicine’s understanding of why men andwomen respond differently to pain medication. Given the rise in the incidence of long-term chronic
illness, it is critically important that improving the quality of life for those with chronic illness remains a
primary focus of nursing research. Nurse-scientists provide evidence-based strategies for maintaining
wellness and preventing illness from occurring in the first place. The patient-centered, interdisciplinary
field of nursing science plays a vital role in achieving this vision:

Nurse-scientists have improved clinical practice and patient outcomes through the developmentof interventions that have been implemented across the U.S. These interventions have included
early child care programs, programs to reduce risk behaviors in adolescents, self-management
strategies for chronic illnesses in youth and adults, and programs incorporating new technologies
to enhance quality of life.



Health care policy and legislation have been influenced by nurses who serve as elected officials
or staff in state and federal legislatures and by nurses who lead governmental agencies such as the
Health Resources and Services Administration and the Centers for Medicare and Medicaid
Services. Nursing science has informed legislation and policy through studies that have tested
transitional care models, and others that have documented the impact of nurse education andstaffing levels on patient outcomes.

Research training and career development are critical elements to cultivate the next generation of nursescientists. To ensure continued advancements in science and improvements in health, it is essential thatthe scientific workforce of the future be innovative, multidisciplinary, and diverse. Nurse-scientist
training programs are designed to achieve this vision. Improving research capacity in nursing science has
been recognized as an essential component for improving health care and health systems. In 2011, forexample, the Institute of Medicine (IOM) released The Future of Nursing: Leading Change, Advancing
Health, highlighting the importance of nursing science and capacity building for improving the health of
the Nation.

Training of Nurse-Scientists
Nurse-scientists usually begin their education with a Bachelor of Science in Nursing (BSN) degree; mostenter clinical practice at that point. The nursing profession traditionally has viewed clinical experience asa prerequisite to graduate education and new graduates were encouraged to practice clinically by faculty44and peers between degrees rather than continuing straight on to obtain a PhD.45 This career path has
resulted in the norm of nurses returning for a master’s degree in their mid-thirties to become an advanced
practice nurse (e.g., nurse practitioner or clinical nurse specialist) or administrator, then returning to thework force for another decade, and finally returning to graduate school to obtain a PhD in their latethirties or even older.46 Nurse-scientists complete their doctoral degrees, on average, at the age of 47,
which limits the number of years they have to build a scientific program and contribute to the scientificbase of nursing practice.47
Nurses with advanced degrees such as nurse practitioners, nurse anesthetists, and nurse executives
command significantly higher salaries than nurse-scientist faculty at research institutions. This is an
important disincentive to return to school to obtain a PhD. Although academics in all disciplines are
rarely compensated at the same level as their peers in practice or industry, the disparity for nurses is oneof the largest. In fact, clinical nurses working in hospitals or ambulatory care, nurse practitioners, nurse
anesthetists and others have average salaries that are 30 percent higher than those of assistant professorsof nursing.48

Trends in Nurse-Scientist Training
Despite the barriers cited above, nurse-scientist training has been on the upswing:

In 2012, 131 schools of nursing (19 percent of 677 nursing programs) offered research-focused
PhD programs.49
Enrollment in nursing doctoral, research-focused education increased 28.6 percent from 20082012.50
Graduations from nursing, research-focused doctoral programs increased 11.7 percent from 20082012.51

45

Dracup, K, Greiner, D.S., Haas, S.A., Kidd, P., Liegler, R., MacIntryre, R., et al.(2009). Faculty shortages inbaccalaureate and graduate nursing programs: Scope of the problem and strategies for expanding the
supply .Retrieved from: http://www.aacn.nche.edu/Publications/WhitePapers/FacultyShortages.htm
As cited in: IOM (Institute of Medicine). 2011. The Future of Nursing: Leading Change, Advancing Health. Washington, DC: The
National Academies Press p.I-36-37
46
IOM, 2011.
47
Dracup, 2009.
48
IOM. 2011.
49
Fang, Li, Bednash, AACN, 2013.
50
Ibid.
51
Ibid.

45

Schools of nursing offer both full- and part-time doctoral programs in order to attract and accommodate
the best talent. In Fall 2012, 45 percent of 5,110 individuals enrolled in research-focused doctoral
programs were enrolled part-time.52 However, part-time programs take longer to complete, which
contributes to the older age of research faculty.

Table 4.1. Enrollment Changes in Nursing Schools, 2011-2012
Enrollment Changes in Same Schools Reporting in Both 2011 and 2012 by Type of Degree (From Tables 11&12, AACN,
2013)
NUMBER OF

2011

2012

INCREASE/

PERCENTSCHOOLSSTUDENTSSTUDENTSDECREASE

CHANGE

Full-time

2,639

2,787

148

5.6

Part-time

2,268

2,323

55

2.4

TOTAL

4,907

5,110

203

4.1

DEGREERESEARCH-FOCUSED Doctorate

131

Influence of Doctor of Nursing Practice (DNP) Degree
The development of a professional doctorate may also affect the numbers of nurses pursuing a PhD. The
Doctor of Nursing Practice (DNP) was introduced in 2004 by the American Association of Colleges of
Nursing (AACN) with a recommendation by its members to adopt the DNP degree for all advanced
practice nurses by 2015. In 2012, 217 schools reported offering the DNP degree.

52

Fang, Li, Bednash, AACN, 2013.

46



The degree is designed as the terminal degree for advanced nursing practice with a focus
on quality improvement and research translation.



Whether or not DNP programs will attract applicants that would have been interested in a
PhD is unknown and what effect it will have on future PhD applications is also unknown.
However, it is important to note that the program is focused on preparing its graduates “tofully implement the science developed by nurse researchers prepared in PhD, DNSc, andother research-focused nursing doctorates.”53 Its graduates are not expected to contributescientific discoveries or to lead interdisciplinary teams of scientists. Thus, “the DNP will
not meet the need for more nurse-scientists and it may contribute to their shortage.”54 In
2012 there were over 11,000 students enrolled in DNP programs, a 27 percent increase
from 2011.55

NIH Support of Nurse-Scientist Training
At the NIH, the National Institute of Nursing Research (NINR) supports training of nurse-scientists
through intramural opportunities such as the Graduate Partnership Program and through extramural
opportunities that include both institutional and individual training awards. For the GPP program, 16
nursing PhD students have participated to date. From an extramural perspective, NINR supports the T32
institutional training grants; F31, F32, and F33 individual fellowship awards; and the K01, K23, K24, andK99/R00 awards for early career investigators. In the past NINR also supported the K08 mechanism.
In response to the need for new nurse researchers and faculty, NINR currently spends approximately 8
percent of its appropriated funds on the training of nurse-scientists. As a percent of budget, this is morethan most NIH Institutes and Centers (ICs) spend on pre- and post-doctoral training.

The Nurse-Scientist Workforce
Size and Composition of the Current Nursing Science Workforce
In 2008, an estimated 28,369 nurses (<1 percent of all RNs in the U.S.) had a doctoral degree in nursing
or a related field. This represents an increase of 64.4 percent since 2000. Of nurses with a doctorate
degree, over 22 percent had a primary focus on research.56
A study conducted by the AACN detailed the employment commitment for doctoral program graduatesfrom 2008-2012. Of note, 620 nurses graduated with a “research-focused doctoral degree.” At the time ofgraduation, they had employment commitments to: Faculty position – n=302 (48.7 percent) Federal or state government agency – n=10 (1.6 percent) Post-doctoral fellowship- n=36 (5.8 percent)53

American Association of Colleges of Nursing (2010). The research-focused doctoral program in nursing pathways to
excellence.
54
IOM (Institute of Medicine). (2011). The future of nursing: Leading change, advancing health. Washington, DC: The National
Academies Press.
55
Fang, D. Li, Y., Bednash, G.D. (2013). 2012-13 enrollment and graduations in baccalaureate and graduate programs in nursing.
American Association of Colleges of Nursing.
56
U.S. Department of Health and Human Services, Health Resources and Services Administration (2010). The registered nurse
population: Findings from the 2008 national sample survey of registered nurses.

47





Hospital/Ambulatory position – n=76 (12.3 percent)
Other positions – 36 (5.8 percent)No employment commitment – 160 (25.8 percent)57

Some schools of nursing offer options for doctoral education. For example, seven offer dual degree
options where graduates obtain both a research-focused doctorate and an MBA. Another option offeredby 79 schools is targeted to individuals who have a Baccalaureate degree in another field. These students
complete their RN to PhD with a goal of “fast tracking” completion of the research-focused degree.58

GenderNursing is a female-dominated profession with men representing only 6.6 percent of the U.S. nursing
workforce. In 2012, 7.9 percent of students in research-focused nursing doctoral programs were men.59

Age
The nursing science research workforce is aging. Most nurse-scientists are research faculty in nursing
schools. In 2008, 60 percent of faculty in schools of nursing were 50 years of age or older.60

FIGURE 4.2. AGE DISTRIBUTION OF REGISTERED NURSES WHO WORK AS FACULTY61

57

Fang, Li, Bednash,2013. Ibid.
Ibid.
59
Ibid.
60
HRSA, 2010.
61
Ibid.
58

48

Qualitative Research Findings Related to Nurse-Scientists
Qualitative research conducted on behalf of the PSW-WG (see Appendix V) included interviews withthree nurse-scientists with K23 awards. These individuals had each worked as a clinical nurse or clinicalnurse specialist before going back to school to earn a PhD. Thus, they were in their 40s or 50s when theyreceived their K awards.
These respondents asserted that a 3-year K award is too short of a time frame to get a research project up
and running, collect and analyze data, and then write and get manuscripts accepted in journals so that they
can write a competitive application for an R01. These nurse-scientists also said they needed more support
through the K award for lab equipment, lab space, and lab assistants.
The respondents indicated that they needed to carry a large teaching load to make up for salary deficits
from grant funding. This can make it difficult to keep their research projects moving forward. However,as one stated: "Nurses who want a research career are tied to academia. Some large hospitals are doingsome nursing research, but not as much."
All liked the idea of team science. They felt they were in a collegial atmosphere where team science
works well.
Work/life balance was definitely top of mind for those with children currently at home. However, theyalso noted that they have support from their colleagues and are able to resolve any work/life balanceissues that may arise.

In January 2014 the National Institute of Nursing Research (NINR) conducted an open-ended survey of apurposive sample of nine deans of nursing schools with research-focused training programs. The purposeof the survey was to gather information regarding the experiences of schools of nursing in training
successful nurse-scientists. The key findings were:
•
•
•
•
•

NINR funding allowed schools of nursing to attract more competitive trainees and recruit juniorresearch faculty with high potential for developing funded programs of research.
Schools equated trainee success with peer-reviewed publications, subsequent research funding,and post-training research positions.
Research experiences for trainees ranged from required “research residencies” to working on
mentor’s studies.
Interdisciplinary research and collaborations are encouraged at all schools.
Salaries for registered nurses are significantly higher than training stipends. Since NRSA and T32
grants have restrictions on outside work while providing low stipends, many pre-doctoral andpost-doctoral students opt not to apply for these training grants.

Nurse-Scientists as Participants in the NIH-funded Workforce
Identifying nurse-scientists who receive NIH support is difficult. Nurse-scientists have research degrees(generally a PhD) and their nursing degree often does not appear on the NIH application.
To gather data on the trends for nurse-scientists as participants in the NIH-funded workforce, thefollowing search strategy was employed in the NIH data system: Principal Investigators (PIs) werecategorized as nurse-scientists if they listed any nursing degree or license in the following list: RN, RNP,

49

BSN, MSN, ANP, PNP, ARNP, FNP, CRNA, DSN, CNM, DNSc, DNS, DNP, FAAN, DRNP, CAN,
APRN, CNRN.
This search strategy may substantially underestimate the number of nurse-scientists. To obtain moreaccurate numbers of nurse-scientists would require analysis of the “field of study” field and review ofbiosketches. Thus the numbers in the charts should be viewed as rough estimates of trends.

NIH RPG Award Rates
Between 1999 and 2012, there was a 53 percent increase in the number of nurse-scientist applicants for
NIH research project grants (RPG), as seen in Figure 4.3. Most of this increase happened between 1999
and 2005. Between 2005 and 2012, the number of applicants has been relatively flat.

The number of nurse-scientist awardees increased modestly until recent budget constraints (Figure 4.4).

50

Data were aggregated over 5 year windows to reduce double counting of individuals who apply multiple times or were awarded
multiple grants during that window.

GenderAmong nurse-scientists applying for and receiving RPGs from the NIH, women outnumbered men byapproximately nine to one (see Figure 4.5); during this period, men and women had similar individual
RPG award rates.

Effects of Early Career NIH Programs on Nurse-Scientists
Between 1992 and 2012, NINR supported 388 post-doctoral appointees via the T32 mechanism (seeTable 4.2). Of these, 219 could be identified in the IMPACII database using the previously described51

search strategy for the years 1999 to 2008. Of the T32 trainees identified, 91 (41.6 percent) subsequently
applied for a research project grant (RPG). Of those who applied, 31.87 percent were awarded grants.
When looking specifically at R01 RPGs, 47 of the T32 appointees applied and nine (19.2 percent) wereawarded grants.

Table 4.2. RPG Applications and Awards Among T32 Postdoctoral Appointees, 1999-2008

Source: IMPACII

Between 1999-2012, the number of nurse-scientists who had received K awards and then applied forRPGs remained relatively flat. In 2012, of the 486 nurse-scientists who applied for RPG funding, 47(approximately 10 percent) had a prior K award (Figure 4.6).

Between 1999 and 2012, nurse-scientist RPG applicants who had a prior K award had higher award rates
than did those without a prior K award, as seen in Figure 4.7. For example in 2012, 23.4 percent of nursescientists who had a prior K award received a RPG compared with 13.4 percent of those who did not havea prior K award.

52

Summary of Challenges Facing the Nurse-Scientist Workforce
All clinical scientists face similar challenges although the extent of the challenges on a spectrum varies
from discipline to discipline. Nurse-scientists especially are faced with:
 Balancing clinical and research responsibilities,
 The fact that ‘team science’ and interdisciplinary work is essential for addressing the complex
problems facing clinician-scientists, but it also takes more time and probably additional training
to work together, The aging nursing workforce and need to speed up the pipeline in nursing education to meetincreasing demands for complex nursing care and research, The impact of gender on ability to devote time to research skills (i.e., the majority of nurses andan increasing proportion of MDs and veterinarians are women who still assume the bulk of childrearing responsibilities).
As the need for nursing education and research and for nurses to engage with inter-professional researchteams has grown, the numbers of nurses with a PhD in nursing or a related field have not kept pace. The
main reasons for this lag are:o An inadequate pool of nurses with PhDs to draw upon,o Faculty salaries and benefits that are not comparable to those of nurses with advanced
degrees working in clinical settings, and53oA culture that promotes obtaining clinical experience prior to continuing graduate
education.62

Specific Recommendations Related to the Nurse-Scientist Workforce
Most of the recommendations that impact nurse-scientists may be found in Chapter 7. The following
recommendations are unique to nurse-scientists and responsive to the challenges identified above.
1. Increase NIH support for nurse-scientists to engage in team science, particularly at institutions where
there is an existing cadre of nursing researchers to serve as mentors.
2. NIH should encourage more people to take advantage of currently offered programs that provide
research training for nurses earlier in their careers, including programs that admit students into
doctoral-level training directly following their undergraduate degrees.

62

IOM, 2011.

54

Chapter 5
Veterinarian-Scientists
Veterinarians contribute to biomedical research through the application of their specialized training inanimal biology and medicine to the modeling of human physiology and disease. The veterinary
curriculum is analogous to medical school training but provides comparative overviews of normal
anatomy/physiology and abnormal disease states, providing an excellent basis for biomedical diseaseinquiry. Veterinary contribution in clinical research can be extremely helpful in determining strengths andweaknesses in animal disease models, and thus inclusion of veterinarians on translational research teams
can provide an invaluable dimension to pre-clinical studies.
Veterinarian-scientists have made important contributions to research in human diseases. For example, in
1991, Peter C. Doherty received the Nobel Prize in Physiology or Medicine for discoveries concerning
the specificity of the cell-mediated immune response in virus infections. James Thomson, a veterinary
pathologist, derived the first human embryonic stem cell line in 1998. Veterinarians William Karesh andJonna Mazet lead large, multi-disciplinary studies at the human-animal interface and wildlife health havebeen instrumental in elucidating the origins and potential 'hotspots' for emergence of MERS coronavirus,
Avian Influenza, Ebola, and other emerging diseases. Work by veterinarian James Fox has advanced thefield of infectious disease of the GI tract, including performing seminal studies on Campylobacter andHelicobacter pathophysiology.
The majority of diseases that occur in humans also occur spontaneously in animals.63 Approximately 75
percent of recently emerging infectious diseases affecting humans are diseases of animal origin;approximately 60 percent of all human pathogens are zoonotic.64 Thus, a physician-scientist workforce
that includes practitioners with broad understanding of animal anatomy, physiology, pharmacology, anddiseases is paramount for the advancement of many human biomedical health initiatives. Recognition ofthis is evident in the worldwide One Health initiative that is dedicated to improving the health of all
species — human and animal — through the integration of human health care and veterinary medicine.

Training in Veterinary Medicine
There are 28 veterinary medical colleges, nine departments of veterinary science, and eight departmentsof comparative medicine in the United States, according to the Association of American Veterinary
Medical Colleges (AAVMC). Two additional schools are expected to open in 2014.
The American College of Veterinary Medicine Council on Education (AVMA COE) outlines anaccreditation process to assure high standards of achievement for veterinary medical education. One of63

Zoonoses and communicable diseases common to man and animals, Vols I-III, (Third Edition). (2003). Acha, P.N. and B.
Szyfres, eds., Scientific and Technical Publication No. 580. Washington, DC:Pan American Health Organization, Pan American
Sanitary Bureau, Regional Office of the World Health Organization, , D.C.
64
U.S. Centers for Disease and Prevention. (n.d.). Emerging and zoonotic diseases—at a glance. Retrieved fromwww.cdc.gov/ncezid.

55

the required standards for accreditation includes: “The college must demonstrate substantial research
activities of high quality that integrate with and strengthen the professional program.” 65
Accredited colleges meet this standard in a variety of ways, including didactic curriculum, research
externships, and other specialized instruction. Nineteen colleges offer a dual DVM/PhD degree.66 Of
these, only one, the University of Pennsylvania School of Veterinary Medicine, receives NIH MSTP
funding. A number of schools have established their own Veterinary Student Training Program (VSTP),
using their own endowment funding. The high cost of providing such training precludes developing asignificant workforce parallel to MD/PhD tracks.
Training grants available from the NIH Office of Research Infrastructure (ORIP) Division ofComparative Medicine to support the development of veterinarian-scientists include Postdoctoral
Programs (T32), Predoctoral Programs (T32), and Summer Programs for Veterinary Students (T35).
Seventeen veterinary programs currently have a postdoctoral T32 grant, five have a predoctoral T32
grant, and 15 have a T35 grant. Currently, only one VMD/PhD program (University of Pennsylvania)
shares an MSTP T32 grant with the MD/PhD program at the same institution. Funding, however, hasbeen flat for many years.67
Individual training grants for early career investigators, specifically K01 and K99/R00 awards, are alsoavailable from the Division of Comparative Medicine within ORIP. (See Figure 2-3 for a brief descriptionof these NIH training grants.) Funding available for this program has also not increased for many years.
The Merial Veterinary Scholars Program, whose mission is to expose veterinary students in their first or
second year of veterinary school to biomedical research and career opportunities in research is often used
to augment the NIH T35 program. Participating students spend 8 to 12 weeks during the summer in a
mentored research experience at a participating veterinary school. Students have an opportunity to present
their findings at the Merial-NIH National Veterinary Scholars Symposium (partially sponsored by an NIH
R13 award). The 2013 symposium was attended by students from 38 participating veterinary colleges inNorth America and Europe and included 456 students and had a total attendance of 600.
Evaluation of outcome data from three institutions with longstanding DVM-PhD training (UPenn,
Cornell, UC Davis) indicate that approximately 60 percent of postgraduate dual degree students enter
academic careers, and a substantial portion of these individuals enter fields focused on clinical ortranslational research of interest to NIH. This trend is parallel to outcomes for MD-PhD trainee entry into
the biomedical workforce arena, though as noted above, the lack of dedicated MSTP funding for
DVM/PhDs has significantly limited development of these programs.

Qualitative Research Findings Related to Veterinary Students
Qualitative research about the training of veterinary scientists included two focus groups, one with seven
DVM students and one with five DVM/PhD students, as well as an interview with the dean of one schoolof veterinary science that offers a DVM/PhD degree.

65

https://www.avma.org/ProfessionalDevelopment/Education/Accreditation/Colleges/Pages/coe-pp-requirements-ofaccredited-college.aspx
66
http://veterinary-schools.findthebest.com/d/d/DVM_-_Ph.D
67
NCRR, 2008

56

Only one of the seven participants in the DVM-only focus group expressed a specific interest in
conducting research. The others entered veterinary school seeking to pursue clinical careers caring foranimals; some became more interested in research as a result of their academic training.
In general, these students believed that a DVM degree should be a sufficient credential to do research, andbelieve that research can be incorporated into clinical practice setting. At the same time, they felt
frustrated that research organizations wanted individuals who also had a PhD degree. They also found thatthe additional training time required to earn a PhD was a daunting prospect and were anxious to begin
working so that they could pay off their student loans, which they consider out-of-proportion to veterinary
salaries. An accelerated DVM/PhD program was recommended as one alternative.
DVM students would also like to have opportunities to work with medical students. There is a direct
relationship between human medicine and animal medicine research, but little is taught to either groupabout the concept. They also recommended earlier exposure to veterinary research programs be developed
to encourage greater student interest.
The DVM/PhD students felt there was little to no support or guidance for someone looking to pursue a
research career. The prevailing feeling was that veterinary schools were not equipped to help graduates
move on to a research career after finishing a combined DVM/PhD. Further, there was a perception that
there are not many opportunities in veterinary research.
The dean of a veterinary science school who participated in the qualitative research estimated that 10-20
percent of students are interested in a research career. He cited the lack of research mentors and highlevels of student debt as factors in students’ decisions not to pursue a research career. He noted that there
is only one MSTP program funded for veterinarians and urged more funding for veterinary dual degree
programs, as well as greater access to the Loan Repayment Program for veterinarians.

Veterinary-Scientists as Participants in the NIH-Funded Workforce
Veterinarians are an overlooked component of the physician-scientist workforce. This is despite three
NRC reports within the last 10 years concluding that the veterinary workforce is underrepresented andunder-utilized in the biomedical research arena, and that veterinary recruitment and training is notproviding a fertile ground for capitalizing on this opportunity.68,69,70
From 1990 through 2002, live, vertebrate animal-based research accounted for approximately 43 percentof the research grants competitively funded annually by NIH, as shown in the figure below. However,since the mid-1990s, the total number of research grants has increased, resulting in a 31.7 percent increasein the number of competitive grants utilizing animals between 1995 and 2002. In essence, there wereapproximately 1,300 more competitive grants utilizing animals funded in 2002 than in 1995.

68

National Research Council (2004). (US) Committee on Increasing Veterinary Involvement in Biomedical Research. National
need and priorities for veterinarians in biomedical research. Washington (DC): National Academies Press.
69
National Research Council. (2005). Committee on the National Needs for Research in Veterinary Science. Critical needs forresearch in veterinary science. Washington (DC): National Academies Press.
70
National Research Council. (2013). Workforce needs in veterinary medicine. Washington, DC: The National Academies Press.

57

Figure 5.1. Historical Trends of Animal Use in NIH Grant Portfolio (1986-2002)71
Despite the central role that veterinary expertise can bring to biomedical research teams, veterinarians areoften overlooked when collaborative biomedical research teams are being formed. This factor is perhaps
the greatest impediment for veterinarians entering the physician-scientist workforce.

The Size and Composition of the Veterinarian-Scientist Workforce
The PSW-WG analysis indicates that in 2008-2012, approximately 250 veterinarians were funded by NIH(Figure 5.2). To provide some context, there are 4000 veterinarians employed as academic faculty at
schools and colleges of veterinary medicine, according to the American Veterinary Medicine
Association.72 Thus, the PSW-WG estimates that veterinarians comprise approximately three percent of
the total NIH-funded physician-scientist workforce.

71
72

NRC (2004), p. 18
NRC (2013), ibid.

58

Gender
Among veterinarian-scientists who receive RPGs from the NIH, men outnumbered women by about three
to one, as shown in Figure 5.3.

59

Women comprise about 90 percent of students in veterinary schools.73 The award rate for RPGs was not
significantly different for females in 2012 (p=0.59612) (Figure 5.4).

Age
In 2012, the average age of a veterinarian RPG grant holder was 50.4 years, as seen in Figure 5.5. (Incomparison, the average age of MD RPG grant holders was 51 years; for MD/PhDs, 51.8 years, and for
PhDs, 48.3 years.

73

JustVetData. (2013). Meet the pink elephant in the room: Gender in veterinary medicine. Retrieved fromhttp://www.justvetdata.com/meet_the_pink_elephant_in_the_room_gender_in_veterinary_medicine

60

The average age of first-time veterinarian applicants for a research award is 45.5. In contrast, the averageage of First Time RPG awards for MDs was 45.2 years, for MD/PhDs, 44.3 years, and for PhDs,

41.9 years.

NIH RPG RateOf those veterinarians who applied for NIH funding, the award rate has remained below 20 percent during
the past five years (see Figure 5.6). Award rates for MDs and MD/PhDs were significantly higher (seeChapter 3).

61Effects of Early Career NIH Programs on Veterinarian-Scientists
The number of veterinarians participating in the MSTP program and the LRP awards is so low that thedata are not included here. Similarly, the number of veterinarian-scientists who receive K awards is small
and declining, as shown below in Figure 5.7.

Similar to trends noted for larger numbers of MD scientists, those veterinarian-scientists with a K award
compete quite successfully for R01 awards (Figure 5.8), compared to those without a K, as seen in thenext two figures.

62

These findings suggest the key importance of the K award in fostering research excellence in veterinary
medicine.

Summary of Challenges Facing the Veterinarian-Scientist Workforce
Challenges faced by the veterinary physician-scientist workforce include:
Recruitmento Many veterinary students are not oriented toward research careers, and the general public does
not associate veterinary training with advances in or contributions to medical science.
 Trainingo Veterinary students encounter few research-oriented mentors and role models during their years
in veterinary school.
o Veterinary students typically graduate with high levels of student debt (average=$162,113)74
and are rarely eligible/encouraged to participate in NIH loan repayment programs.
o Public, private, and governmental entities do not consider the versatility of veterinary educationand training relative to pressing societal needs such as global food security, animal modelutilization for development and testing of novel therapies, emergent diagnostics, genetic disease
and therapies, etc. Without raised awareness of veterinary capabilities in this area, it will bedifficult to change recruitment priorities or paradigms to result in a research-capable veterinary
workforce.
o NIH funding for pre-doctoral training programs supporting training of veterinarian-scientists
has been flat and MSTP-like programs are generally not available to veterinary colleges.
o Veterinary curriculum does not typically promote the role of the veterinarian-scientist.
 Retentiono Colleges of veterinary medicine and/or veterinarians do not always qualify for or capitalize on
NIH and other federal research awards.
o There is no single Institute or Center at NIH focused on veterinary research following thedissolution of the NCRR in 2011.
o Employment in public health or academic research is a demanding career that often provides
less salary support than private sector private practice positions.
o Though there is the perception that veterinarians are less successful at competing for NIH RPGs
than MDs and PhDs, the differences in funding rates for veterinarians are only modestly lower
than PhDs. The factors contributing to this discrepancy have not been determined.


74

The mean educational debt among the 90 percent of respondents to the !VM!’s 2013 survey of veterinary school graduates.
The figure increased 7 percent from 2012. Sixteen percent of respondents had a debt load of $230,000 or greater; only 1
percent of respondents reported a debt load of less than $10,000; and 10 percent reported having no debt. (source: dvm360, V
45 (2), Feb 2014)63

Specific Recommendations for the Veterinarian-Scientist Workforce
Most of the recommendations that impact veterinarian-scientists may be found in Chapter 7. The
following recommendations are unique to veterinarian-scientists and responsive to the challenges
identified above.
1. NIH should encourage inclusion of veterinarian-scientists in the review and as team members
for applications relying on use of vertebrate animals.
2. NIH should highlight the availability of F30 and F31 awards for DVM/PhD training, andshould expand MSTP programs to allow DVM/PhD institutional training awards. K award
program expansion for veterinary scientists should be encouraged, given the positive
association between K award and RPG success.
3. In light of the enormous percentage of veterinary school graduates who are women, NIH
should consider developing innovative programs to encourage female veterinary students andfemale veterinarians to join the physician-scientist workforce. As part of this effort, NIH
should evaluate parameters relating to poorer RPG application rate by veterinarian-scientists,and particularly success by female veterinarian-scientists.

64Chapter 6
Dentist-Scientists
It was at the beginning of the last century that dentists sought to transform a respectable craft into ascience-based profession by boldly aligning with institutions of higher learning. Discoveries by dentistscientists have transformed fields of medicine. For example, in 1952, a dentist-scientist named Norman
Simmons designed the techniques for isolating pure DNA that made it possible for Rosalind Franklin tocreate the first x-ray crystallography images of DNA. This led to the prediction of the structure of DNA
by James Watson, Francis Crick, and Maurice Wilkins in 1953. In the post-World War II era, dentist
Robert Ledley pioneered computerized tomographic scanning and 3-dimensional imaging that led to thedevelopment of modern diagnostic imaging for both dentistry and medicine. In the late 1960’s, the workof another dentist-scientist, Russell Ross, and his colleagues advanced our understanding of the molecules
involved in wound healing and proved that atherosclerosis is an inflammatory disease.
Dentist-scientists are committed to the development of new therapeutics and therapies for common andrare diseases and disorders that affect craniofacial tissues. Investigators most committed to this field of
inquiry will come from the ranks of faculty and students in dental schools across the US. Hence, thetraining of dentist-scientists and the development of academic faculty with research training are criticalcomponents of strengthening the dentist-scientist workforce.

Training of Dentist-Scientists
There are 65 dental schools in the United States, according to the American Dental Education
Association. Eighteen of these schools offer a dual degree program; an additional 10 schools offer a PhD
in oral biology, oral health, or oral science.75,76 The National Institute of Dental and Craniofacial Research(NIDCR) currently funds 19 institutions with T32 or T90/R90 awards. Of these, 13 offer a dual DMD or
DDS/PhD degree and 9 provide support for PhD or postdoctoral training for non-U.S. citizens and/or
permanent residents.77
Dual degree programs are relatively new in dental education; traditionally, dental education has been
primarily focused on the clinical preparation of students who receive little exposure to research during
their dental education. As a result, a 2004 survey of more than 4,000 dental school graduates by theAmerican Dental Education Association found that only 0.5 percent had plans to focus on teaching or
research.78
DDS/PhD programs typically take 6 to 8 years to complete and the number of students enrolled in eachprogram is small, 1-2 students per year.79 Students enrolled in these programs typically graduate with lessdebt than other dental school graduates, due to the availability of NIH training funds. However, theintegration between scientific and clinical training is often poorly defined in these programs withincongruent clinical and scientific program requirements that may be challenging for students to resolve.
75

http://forums.studentdoctor.net/threads/the-official-dds-phd-or-dmd-phd-thread.987946/
Roger. J.M. (2006). A survey of dual-degree training opportunities at U.S dental schools. Journal of Dental Education 70(9),909-917..
77
NIDCR. National Research Service Award Institutional Research Training Grants (T32 or T90/R90).
http://www.nidcr.nih.gov/CareersAndTraining/Fellowships/Institutions/ParticipatingInstitutions/78
Roger, ibid.
79
Ibid.
76

65

In addition, there are few senior faculty mentors available to DDS/PhD trainees, and few dentist-scientist
role models.
Following completion of DDS/PhD programs, most graduates enter specialty training or private practice.
Consequently, the number of DDS/PhD scientists entering the dentist-scientist workforce is relatively
low.
An additional barrier to the recruitment of more DDS/PhD candidates is the absence of a centralized
information source where prospective students can learn about available programs, application
requirements, and research career opportunities.

Qualitative Research Findings Related to Dentist-Scientists
Qualitative research about dental students included one focus group of 6 dental students as well asinterviews with the deans of two dental schools, one of which was research-intensive. In addition, one
DDS/PhD candidate participated in a focus group where other participants were DVM/PhD candidates.
Among the non-PhD dental students, most reported that they chose dental school because they wereinterested in patient care and wanted to own their own business. Although students reported some limited
exposure to research during their undergraduate years, none applied to dental school with a research
career in mind. They also expressed uncertainty about how a career in dentistry and research could beachieved. Most did not think it should be necessary to get a PhD and were not interested in pursuing
additional training due to the length of such research programs and the high amount of student debt they
were carrying.
The overriding sentiment among students in this group was that they chose dentistry because it is a highpaying profession in which individuals in private practice can own their own business, control their own
hours, and hence create a desirable lifestyle.
When pressed to suggest initiatives that would make a research career more attractive, these students
identified: Greater networking opportunities and better knowledge of NIH opportunities as they relate todentistry. Webinars, listservs, and conferences as vehicles for learning more about NIH
opportunities
 Early (including pre-dental school) exposure to dental research programs, particularly
information on funding opportunities for school/training More publicity about loan repayment options for research careers that are currently available
 More networking and travel funds
 More concise training periods for better integrated dual DDS/PhD Program
The dental school deans confirmed that interest in a research career was low among dental students; oneestimated less than 2 percent of students were interested in research. Lack of early exposure to research,lack of dentist-scientist role models, low salaries for academic researchers, and high levels of student debt
were cited as factors deterring students from considering a career in dental research.

66

Dentist-Scientists in the NIH-funded Workforce
Size and Composition of the Dentist-Scientist Workforce
Approximately 1000 individuals are full-time research faculty in dental schools, spending 80 percent ormore of their time doing research. Over half of these faculty members hold a PhD, 163 hold aprofessional dental degree, and 118 hold a DDS or DMD/PhD. Figure 6.1 illustrates these findings.

Source: American Dental Education Association’s Comprehensive Faculty Survey (Annual); PrimaryAppointment: Research is defined as faculty who spent more than 80 percent of their time in research
related activities.80

In 2012, 161 dentist-scientists were awarded an RPG from NIH (see Figure 6.2).

80

A select number of other degree holders are not shown, so the PhDs, DDS/PhDs and Dental Degrees (all) will not total the
Total numbers.

67

Data were aggregated over 5 year windows to reduce double counting of individuals who apply multiple times or were awarded
multiple grants during that window.

Thus, the PSW-WG estimates that approximately two percent of the NIH-funded physician-scientist
workforce are dentists.

GenderAmong professionally active dentists, men outnumbered women almost 3 to 1 in 2012.81 That same year,
female dentist-scientists received almost one-third of the RPGs awarded, i.e., a disproportionately highamount, as shown in Figure 6.3.

Data were aggregated over 5 year windows to reduce double counting of individuals who apply multiple times or were awarded
multiple grants during that window.

81

http://kff.org/other/state-indicator/total-dentists-by-gender/

68

NIH RPG Award Rates
Between 1999 and 2012, there was a 41 percent increase in the number of dentist-scientist applicants,
versus an 88 percent increase from veterinarian-scientist applicants (Figure 6.4). Despite the increase inapplicants, the number of awards made annually to dentists remained relatively constant, attributable tothe decreasing award rate among dentists which went from a one time high of 35.6 percent to the mostrecent rate in 2012 of 15.4 percent, as shown in Figure 6.5.

.

69

Participation in Early Career NIH Programs by Dentist-Scientists
The number of dentists participating in the LRP awards is so low that the data are not included here. The
annual award rates vary because of the small numbers, but in general have gone from better than 40
percent from 1999-2001, to a range of 20-40 percent more recently (Figure 6.6). This is clearly a potential
resource for encouraging research in junior dental faculty that has been underutilized.

In 2012, the number of applicants for K awards from dentists was 13, a substantial decrease from a highof 36 applicants in 2006 (Figure 6.7). In 2012, the award rate for K awards among dentist-scientists was
30.8 percent, as seen in Figure 6.8.

70

Effects of Early Career NIH Programs on Dentist-Scientists
The number of dentist-scientists with L or K awards is so small that meaningful interpretation of the data
is not possible. Despite the small numbers, the award rate of first-time RPG dentist-scientist applicants
who had a prior K award appear higher than the award rate of first-time RPG dentist-scientist applicants
who have not had a prior K award.

71

Summary of Challenges Facing the Dentist-Scientist Workforce
A significant concern in dental education is the number of vacant faculty positions; in 2003-2004 there
were an estimated 241 vacant full-time and 55 part-time faculty positions at U.S. dental schools.82
Foreign-trained dentists who have received advanced specialty training in the United States are a prime
source for filling these positions. These individuals often have less student debt than U.S.-trained dentists,view faculty positions as prestigious, and can more easily practice dentistry as a faculty member without
the more burdensome prerequisites for private practice. However, many lack research training and areusually not eligible for NIH training support programs because of citizenship status.
The primary source of faculty in U.S schools of dentistry is U.S.-trained dentists with specialty or
advanced clinical training. However, many of these individuals carry high educational debt loads making
academic salaries unappealing in comparison to clinical practice. Those who do pursue academic
appointments frequently become excellent clinical teachers, but often contribute little to research due tolack of research training and minimal expectations by their institutions. Financial pressures on dental
schools also resulted in an increased emphasis on clinical revenue generation, thereby relaxing theemphasis on research. Further, once hired, young faculty members have difficulty finding senior facultywith the appropriate research background to mentor them during their early career years.
Non-DDS faculty, those with MS and/or PhD degrees, have often provided research training andmentoring in dental schools. These individuals can pursue their research interests without conflicting
teaching and clinical service commitments. However, this valuable pipeline of committed researchers is
rapidly dwindling for academic dentistry due to shifts in priorities away from research within dental
schools and difficulties in succeeding with R01-level research.
Several factors threaten the biomedical workforce of dentist-scientists. These include:A low priority given to research within dental schools: An overwhelming majority of the 13 newschools that have launched in the past 15 years can be classified as non-research-intensive.



There has been a gradual decline of research productivity in dental schools, in general. This has
resulted in the lack of competitiveness of dental school-based researchers for NIH funding. For
example, the percentage of NIDCR funding to dental schools has declined from 68.7 percent to46.7 percent between 1993 and 2008 and this downward trend continues.83

The last decade has seen an upward trend in income levels for dentists in the private sector. The
significant differentials seen in compensation with academic salaries has led to a highly
competitive pool of dental applicants who are more drawn to private practice careers.



As commitments to research have declined in more established dental schools, the new dental
schools have developed tuition-based financial plans that are driven by non-research intensive
training programs.

82

Weaver, R.G., Car, J.E., Haden, N.K., Valacovic, .RW. (2005). Dental school vacant budgeted faculty positions: Academic year
2003-04 Journal of Dental Education 69: 296-30.
83
Lipton, J.A. &Kinane,D.F. (2011). Total NIH support to U.S. dental schools, 2005-2009. Journal of Dental Research, 90(3) : 283288.

72The average dental student debt burdens have risen to alarming levels; current loan values areapproximately $220,000.84 While ADEA and ADA are brainstorming strategies for loan
repayment, these mechanisms are not in place currently. This has profound effects on theretention of dentist-scientist in the biomedical workforce.

Research in the oral health sciences has steadily built in medical schools/hospitals, schools ofengineering, etc. further contributing to a disengagement from research within dental schools.



Taken together, the culture and environment within dental schools has led to a diminished pool ofresearch faculty mentors for dentist-scientist trainees, the lack of understanding and support for
the training and career development of dentist-scientist graduates and a transition away from the
granting of tenure.

Specific Recommendations for the Dentist-Scientist Workforce
Most of the recommendations that impact dentist-scientists may be found in Chapter 7. The following
recommendations are unique to dentist-scientists and responsive to the challenges identified above.
Encourage/incentivize promising dental school graduates to consider careers in developing teamscience perhaps by creating post/doctoral fellowships-faculty transition plans at their school- with
post-doctoral fellowships to be performed at leading centers for team science.



NIH should partner with the American Association for Dental Research and the American Dental
Association in efforts to emphasize Evidence-Based Dentistry and in providing access to shortterm training in research methodology for dental faculty.



NIH should partner with ADA and other professional dental organizations to develop a'prescribed program' with ‘best practices’ for training DDS/PhD researchers.

84

2013 !DE! President’s Report: Looking !round the Corner. Retrieved fromhttp://www.adea.org/ADEA/Content_Conversion/about_adea/2013_ADEA_President_s_Report__Looking_Around_the_Corner
.html

73

Chapter 7
Recommendations
A number of forces outside the NIH pose great challenges to the future PSW including: changes in the funding and practices of academic medical centers dramatic shifts in the economics of medicine and healthcare rising educational debt
 increasing length of training growth in the regulatory burdens required to maintain clinical practice challenges to the overall quality of Science, Technology, and Mathematics (STEM) education in
the United States, and changing immigration policy affecting a significant component of the physician-scientist
workforce.
Wherever possible, NIH should engage with appropriate other private and public agencies to addressthese larger societal issues. Here, we will provide our specific recommendations regarding what NIH candirectly do to enhance and maintain the physician-scientist pipeline and workforce.
Although the absolute number of physician-scientists has declined only slightly over the past decade, theworkforce is progressively aging. The number of new physician-scientists entering the workforce isfalling, as reflected in the reduced numbers of applicants for early career (K and LRP) awards over thelast 5 years. These data presage a decline in the physician-scientist workforce as the current cohort ofsenior physician-scientists retires. Our key recommendations thus focus on the early stages of thepipeline, on enhancing the ability of the NIH to evaluate the relative effectiveness of its programs to build
and maintain the pipeline, and on systematically collecting and reviewing data so the biomedical
workforce can more easily and readily be assessed.
The recommendations outlined below should be extended to all clinically-trained scientists, including
veterinarian-scientists, dentist-scientists, and nurse-scientists. Recommendations that are specific to agiven segment of the workforce may be found in the previous chapters.

Recommendations
The following recommendations apply to all clinically-trained investigators, including veterinarianscientists, dentist-scientists, and nurse-scientists.
1. NIH should sustain strong support for the training of MD/PhDs. MD/PhD programs(including the Medical Scientist Training Program [MSTP] program funded by NIH) have beensuccessful in promoting the development of physician-scientists and should be continued.
2. NIH should shift the balance in National Research Service Award (NRSA) postdoctoral
training for physicians so that a greater proportion are supported through individual
fellowships, rather than institutional training grants. The number of individual fellowshipawards for MD-PhD students (F30/F31 grants) should also be increased. The PSW-WG endorses
the similar recommendation from the Biomedical Workforce Working Group that support for
both pre- and post-doctoral PhD trainees and individual fellowship for MD/PhD trainees should
be expanded. It is critical to obtain accurate long-term follow-up on trainees through all of these74

programs to assess comparative effectiveness. These results should guide future allocation of NIH
funds to these various mechanisms.
3. NIH should continue to address the gap in RPG award rates between new and establishedinvestigators. Although NIH policies have narrowed the gap for new RO1 applicants, thisproblem remains significant and needs continued attention. A number of pilot approaches should
be explored, and rigorously assessed, with the most successful given expanded support (also see#7 below).
4. NIH should adopt rigorous and effective tools for assessing the strength of the biomedical
workforce, including physician-scientists, and tracking their career development andprogression. NIH should collaborate with external organizations that also have a strong
investment in workforce development to collect, monitor, and report on key indices related toworkforce issues. Specifically, NIH should establish an ongoing workgroup of NIH employees
and external partners to support the development of a Biomedical Workforce Dashboard
application that provides real-time tracking of the career development and progression of theworkforce. The Dashboard would be a tool that both NIH employees and the public could use to
instantly answer questions related to important workforce issues at the agency or I/C level.
5. NIH should establish a new physician-scientist-specific granting mechanism to facilitate thetransition from training to independence. This program should be similar to the K99/R00
program whose funding currently goes almost exclusively to individuals holding a PhD degree.
This new grant program could serve either as a replacement or transition from existing K Awards
for physician scientists, and should provide a longer period of support, potentially lengthening theR00 phase to 5 years (with an interim staff review at year 3). This new grant series, as well as K
and all other training awards, should rigorously enforce protected time of at least 75 percent effort
and provide sufficient salary support to make that possible.
6. NIH should expand Loan Repayment Programs and the amount of loans forgiven should be
increased to more realistically reflect the debt burden of current trainees. This program
should also be made available to all students pursuing biomedical physician-scientist researcher
careers, regardless of particular research area or clinical specialty.
7. NIH should support pilot grant programs to rigorously test existing and novel approaches
to improve and/or shorten research training for physician-scientists. These programs should
include (but not be limited to) mechanisms to shorten medical and/or laboratory training, explore
timing and spacing of the research and clinical components of post-graduate training, and otheralternatives. New opportunities for training in informatics and social science research that address
emerging needs of the health care system should also be evaluated. Those programs exhibiting
the most promising results should receive expanded support.
8. NIH should intensify its efforts to increase diversity in the physician-scientist workforce.
This Working Group recognized major deficiencies of the physician-scientist workforce withregard to diversity. The PSW-WG strongly endorses the previous recommendations of thepreceding biomedical workforce Working Group and the Working Group on diversity, all ofwhich should be extended to the physician-scientist workforce.
9. NIH should leverage the existing resources of the Clinical and Translational ScienceAwards (CTSA) program to obtain maximum benefit for training and career developmentof early-career physician-scientists. This process should include critical review and analysis of
rigorous outcome data, as outlined in #7 above.

75

Recommendations specific to each segment of the non-MD workforce (nurse-scientists, veterinarianscientists, and dentist-scientists) may be found in Chapters 4 through 6.

76

Appendix 1
Physician-Scientist Workforce Working Group
Subcommittees
Clinical Research PS

Lab Research PS

Non-MD PS

Data

Chairperson

G. Bernard

H. Hobbs

R. D’Souza
S. VandeWoude

T. LeyL. Rosenberg

PSW-WG
Members

S. Shurin
V. LeeD. Nichols
A. Knebel
E. Larsen
Robert CaliffBarry Coller
Thomas O. Daniel
Robert Dittus

D. Ginsburg
N. Andrews
J. Merchant
A. Schafer

S. Mills
J. Fox

S. Mills
L. Brass
R. Lifton
D. Meltzer

Mark. C. Fishman
Donald Ganem
Peter Gruber
Mike J. Welsh

DentalTim DeRouen
Mildred Embree
Jeffrey Myers

Janine Clayton

Ad HocMembers

Vet
Harry W. Dickerson
Michael Lairmore
Willie M. Reed

77

Appendix II: Quantitative Analysis Methodology
During the process of supporting the PSW working group, in particular the PSW data subcommittee,
Thomson Reuters designed and built a reporting system that facilitated the many data requests from thesubcommittees. A first step was to work closely with the PSW working group and NIH staff to define theanalysis requirements and identify data sources. Once the available data was collected and centralized in a
database, the focus turned to the preferred delivery format. An automated reporting module wasdeveloped, one that queries the data system and produces tables and charts to committee specifications.
The intent was to avoid a one-time, one-report process in favor of a data system that can facilitate future
tracking and evaluation of any recommendations implemented by the NIH and other organizations in
response to the findings of the PSW working group.
A key feature of the PSW data analysis is how it differs from standard data reporting at NIH, which
normally focuses on reporting application and award total counts and breakdowns. Instead, PSW’s unit ofanalysis is the individual: Each individual is tracked by the data system throughout the PSW pipeline tocreate a history of research outcomes. Hence, trends can be established for different groups of people (notjust programs), and unique career tracks can be examined more carefully and compared to produce a
better picture and understanding of the physician-scientist workforce.
Data Sources
Unless otherwise noted, the source of data for all charts and tables included in this report are from NIH’s
IMPACII data system, supplemented with AAMC Faculty Roster data, as provided under a data sharing
agreement with AAMC. Aggregate data on faculty and physician-scientists were provided by theAmerican Medical Association (AMA), the American Dental Education Association, the American
Veterinary Medical Association and the Association of American Veterinary Medical Colleges.
Select reports were generated using data from the NIH Medical Scientist Training Program (MSTP) andsummary data from the AAMC’s Matriculating Student Questionnaire and Medical School Graduation
Questionnaire. Aggregate data on faculty and physician-scientists were provided by the American
Medical Association (AMA), the American Dental Education Association, the American Veterinary
Medical Association and the Association of American Veterinary Medical Colleges.
In addition, data analyses were carried out with significant support form NIH’s Division of Statistical
Analysis and Reporting (DSAR) within the Office of Extramural Research. Specifically, DSAR staff
provided data on T32 appointees’ outcomes and other data review and analysis.
The NIH awards and time period selected for inclusion in the system from IMPACII were:•
Research Project Grants for the following 25 activity codes between 1993 and 2012, Type
1 applications, including subprojects: DP1, DP2, P01, P42, PN1, R01, R03, R15, R21, R29, R33,
R34, R35, R36, R37, R55, R56, RL1, RL2, RL5, RL9, U01, U19, UC1, UC7•
L Applicants - 5 activity codes, between 2003 and 2012, Type 1 application, theseinclude: L30, L32, L40, L50, L60

78

•K Applicants - 24 activity codes, between 1993 and 2012, Type 1 application, including
subprojects, excluding K12, these include: K01, K02, K04, K05, K07, K08, K11, K14, K15, K16,
K17, K18, K20, K21, K22, K23, K24, K25, K26, K30, K99, KL1, KL2, KM1•
AAMC Faculty Data (tenure track and non-tenure track) from their AAMC Faculty
Roster (and MSQ/MSGQ) between 1993 and 2012•

MSTP program data between 1993 and 2012

Treatment and Disambiguation
As noted above, a key requirement for this analysis was to track individuals throughout the PSW pipelineat key career stages (i.e., a first-time RPG applicant RPG or, say, R01). Accordingly, a method wasdevised by Thomson Reuters to count individuals and their associated applications and awards on any
given year during the time-period.
An individual applicant was defined as: in a given Fiscal Year, an individual applicant is counted only
once per IC and mechanism. In the event an applicant applies more than once in a given FY to an IC andmechanism, the most recent awarded application is selected.
The approach used by the PSW data subcommittee differs from standard data reporting at NIH, which
normally focuses on reporting application and award total counts and breakdowns. These differences maylead to discrepancies when comparing trends presented here to those reported for applications and awards.
Degree categories and assigned groupings (individuals could have more than one degree) were reviewed
by the PSW data subcommittee, and the degree categories were set as:

DegreeCategory
PhD

Degree Grouping
PhD
PhD/otherMD

MD
MD/other
MD/Dentist
MD/Dentist/other

PhD/MD

PhD/MD
PhD/MD/Dentist
PhD/MD/other
PhD/MD/Veterinarian
PhD/MD/Dentist/other
PhD/MD/Veterinarian/other
PhD/MD/Veterinarian/Dentist
PhD/MD/Veterinarian/Dentist/other79

DegreeCategory
Veterinarian

Degree Grouping
PhD/Veterinarian
Veterinarian
PhD/Veterinarian/other
MD/Veterinarian
PhD/Veterinarian/Dentist
Veterinarian/Dentist/other
MD/Veterinarian/Dentist
MD/Veterinarian/Dentist/other
MD/Veterinarian/other
PhD/Veterinarian/Dentist/other
Veterinarian/Dentist
Veterinarian/otherDentistDentistDentist/other
PhD/Dentist
PhD/Dentist/other

Other

Other

Unknown

Unknown80Appendix III: Data Definitions
DATA DEFINITIONSIMPACII data reflects system updates as of September 13, 2013.
All counts in the tables and figures are by individual (applicants and awardees). ARRA/Recovery Act applications
and awards are excluded.
UPDATE NOTES
Since completing the MSTP report, we now recognize T-grant prior support for individuals in all reports. As a result,
the total counts of individuals with prior L support only (RPG Spreadsheet: 1.4.x and R01 Spreadsheet: 2.4.x), prior
K support only (RPG Spreadsheet: 1.5.x and R01 Spreadsheet: 2.5.x), and prior L and K support only(RPG Spreadsheet: 1.6.x and R01 Spreadsheet: 2.6.x) have been updated and reduced to reflect this change.
The sliding year ranges in these reports consider windows of applications beginning 5 years prior to each fiscal year
currently being considered. Because data for prior L-grant support are not available prior to 2004, the year ranges
2000-2004 through 2003-2007 do not contain a full five years of data.
Total columns for all sheets consider data from all years currently available, even though not all individual years
are shown in the reports.
Totals for Age brackets were omitted.
RPG, L, K DEFINITIONS
Research Project Grants or RPGs include the following 25 activity codes between 1993 and 2012, Type 1
applications, including subprojects:
DP1, DP2, P01, P42, PN1, R01, R03, R15, R21, R29, R33, R34, R35, R36, R37, R55, R56, RL1, RL2, RL5,
RL9, U01, U19, UC1, UC7
L Applicants - 5 activity codes, between 2003 and 2012, Type 1 applications, these include:
L30, L32, L40, L50, L60
K Applicants - 24 activity codes, between 1993 and 2012, Type 1, including subprojects, excluding K12, these include:
K01, K02, K04, K05, K07, K08, K11, K14, K15, K16, K17, K18, K20, K21, K22, K23, K24, K25, K26, K30, K99, KL1,
KL2, KM1

81

DEGREE DEFINITION

Degree groupings are defined by the following combinations:
Degree Grouping

Degree combination

PhD

PhD
PhD/otherMD

MD
MD/other
MD/Dentist
MD/Dentist/other

PhD/MD

PhD/MD
PhD/MD/Dentist
PhD/MD/other
PhD/MD/Veterinarian
PhD/MD/Dentist/other
PhD/MD/Veterinarian/other
PhD/MD/Veterinarian/Dentist
PhD/MD/Veterinarian/Dentist/other

Veterinarian

PhD/Veterinarian
Veterinarian
PhD/Veterinarian/other
MD/Veterinarian
PhD/Veterinarian/Dentist
Veterinarian/Dentist/other
MD/Veterinarian/Dentist
MD/Veterinarian/Dentist/other
MD/Veterinarian/other
PhD/Veterinarian/Dentist/other
Veterinarian/Dentist
Veterinarian/otherDentistDentistDentist/other
PhD/Dentist
PhD/Dentist/other

Other

other

Unknown

unknown82

Degree combinations consist of the following atomic degrees:
Degree Grouping

Degree Atom Codes

DentistDDS

Dentist

DMD

MD

BAO

MD

BCH

MD

BDS

MD

BDSC

MD

BE

MD

CHB

MD

DO

MD

MBBC

MD

MBBCH

MD

MBBCHB

MD

MBBS

MD

MBCHB

MD

MD

MD

MDCM

MD

MRCOG

MD

MSURGERY

other

APRN

other

BH

other

BVMS

other

BVSC

other

CRNP

other

DACVIM

other

DC

other

DCLINP

other

DCLINPSY

other

DDOT

other

DH

other

DNSCCNM

other

DOTH

other

DPHARM

other

DPM

other

DSN

other

FAAN

83

Degree Grouping

Degree Atom Codes

other

JD

other

JD1

other

LLD

other

MMED

other

ND

other

OD

other

OTH

other

PHAR

other

PHARMD

other

PHM

other

PHMD

other

PHRMD

other

PSYD

other

RN

other

RNP

other

VDOT

PhD

DMEDSC

PhD

DMSC

PhD

DNS

PhD

DNSC

PhD

DPH

PhD

DPHI

PhD

DPHIL

PhD

DPHL

PhD

DRPH

PhD

DRSC

PhD

DSC

PhD

DSW

PhD

EDD

PhD

PDFELLOW

PhD

PHD

PhD

POSTDOC

PhD

POSTDOCTRA

PhD

SCD

PhD

SD

Veterinarian

DVM

Veterinarian

VMD

84

In the above defined degree mappings, nurse-scientists fall primarily under the PhD or Other
categories. To gather data on the trends for nurse-scientists as participants in the NIH-funded
workforce, the following search strategy was employed in the NIH data system: Principal
Investigators (PIs) were categorized as nurse-scientists if they listed any nursing degree or
credential in the following list: RN, RNP, BSN, MSN, ANP, PNP, ARNP, FNP, CRNA, DSN, CNM,
DNSc, DNS, DNP, FAAN, DRNP, CAN, APRN, CNRN.
RACE/ETHNICITY DEFINITION
Race/ethnicity groupings are defined by the following categories:
Race Grouping

Race Categories

Asian

Asian

Black

African American

Hispanic

Ethnicity = Hispanic

NativeAmerican Indian/Alaska Native andNative Hawaiian or other Pacific

White

White

Other

More than one race

Unavailable

Unknown and Withheld

GENDER DEFINITION
Gender groupings are defined by the following categories:
Gender Grouping

Gender Categories

FemaleFemaleMale

Male

Unknown

Unknown and Withheld

NOTES
INDIVIDUAL APPLICANT DEFINITION
In a fiscal year, an individual applicant is counted only once per IC and mechanism.
In the event an applicant applies more than once to a specific IC and mechanism, the most recent awarded
application is selected.

85

Appendix IV: Summary of Quantitative Findings
A full set of graphs with corresponding raw data is forthcoming and will be available from the NIH
RePORT - WORKFORCE website.

86Appendix V: Qualitative Research Findings
Medical Students and Deans

Introduction and Method
On behalf of the Physician-Scientist Workforce Working Group (PSW-WG), Catalyst Research &Communications conducted two qualitative studies to explore how medical, dental, and veterinary
students make decisions to pursue or not pursue a career in research. The first of these studies was a seriesof focus groups with students; the second consisted of interviews with research deans at medical, dental,
and veterinary schools.

Focus Groups
To conduct the focus groups, Catalyst developed a moderator’s guide with a standardized set of questions
that responded to PSW-WG’s perceived needs for information from medical, dental and veterinarian
students about their career decision-making. The guide may be found at the end of this report. OMB
clearance was obtained to recruit and collect qualitative data using the set of questions. Catalyst recruiteda convenience sample of geographically diverse students via Facebook announcements on student
medical/dental/veterinary association pages, referrals from medical deans, and email requests forparticipation sent out from student medical associations to members and medical/dental/veterinary
schools to their students. Wherever possible, students were recruited from among those in their final yearof professional training.
Nine telephone-based focus groups were conducted between December 2013 and March 2014. The
groups were organized as follows:

Two groups of MD/PhD students (11 individuals)Three groups of MD students (15 individuals)One group of underrepresented minority MD and MD/PhD students (5 individuals)One group of DVM students (7 individuals)One group of DDS students (6 individuals)One group of DVM/DDS/PhD students (6 individuals)

Each focus group lasted approximately 90 minutes. Focus groups were audio- taped andtranscribed for analysis.

87Summary of Common Themes across All Groups
Key themes that emerged across all student focus groups include:














Students enrolled in a dual degree program, including those who obtained a PhD before or after
their MD/DVM/DDS degree, are considerably different from the general population of
medical/dental/veterinarian students. Notable differences include:o Dual degree enrollees typically fell in love with science at an early age (often prior to highschool) and speak more passionately than other students about the creativity they find inscientific research.
o Dual degree enrollees are motivated by a desire to make a bigger contribution to society
through the discovery of new diseases/treatments than they feel they could by seeing
individual patients.
o Dual degree enrollees (MD/PhD, DVM/PhD, DDS/PhD) accept that the path to becoming aphysician-scientist is a long and arduous one; they are willing to make the sacrifices neededto achieve their goals.
Students who are not enrolled in a dual degree program are usually primarily motivated to carefor patients. They may have enjoyed the research experiences they’ve had as undergraduates ormedical/dental/veterinary students, but are concerned about the length of training required to
become a physician-scientist, their ability to repay student loans, and the uncertainty of researchfunding.
Exposure to research as a career option played an important role in students’ decisions. Minority
students, in particular, noted that they were not exposed to physicians who conducted research as
they were growing up.
The majority of single degree students stated that they first became interested in research as
undergraduates in college. A few stated that they really had no interest in doing research before
they became exposed to research opportunities while in college. Others reported that the influenceof a professor or mentor in their undergraduate years greatly influenced their decision to pursue
research. In fact, some students reported that they felt they had chosen a specific career path (e.g.,
pursuing a basic science PhD) but research opportunities in the medical professions in college
helped steer them to new opportunities. Finally, a few participants credited family members withencouraging careers in science.
The uncertainty of research funding was the major challenge to a career in research articulated byboth dual degree students and single degree students interested in pursuing a research career. By
far, the largest concern from students interested in research is the issue of funding and theuncertainty of the funding. Job stability is very concerning to those who wish to pursue careerswith research components.
Having a positive experience with a mentor was often a primary influence on students’ decision
to pursue a research career. The importance of good mentors was stressed throughout the focus
groups. Students reported that while a good mentor could really help them and guide themthrough their training, a poor mentor can also be helpful in teaching a student what not to do or
how not to lead students. Mentors with good research funding seemed to make a better
impression on students than those without solid funding. Focus group participants reported thatsome mentors even discouraged them from pursuing research in a lab without good funding.
Students felt that conducting research is very time consuming and without the right support, in theform of mentorship, research is difficult. Students worried that even with a huge investment oftime committed to research, they may not achieve outcomes that are useful or publishable.
Work/life balance issues are uppermost in students’ minds as they contemplate a research career,
including their choice of specialties. This is true for men, as well as women. Dental students, in

88






particular, say that they chose dentistry because it is a high-paying profession in which they can
set their own hours.
For those less interested in pursuing research as part of their careers, the reasons cited were longwork hours, negative family-life balance, research funding issues, lower pay, and the perceived
inability to do research part-time and still be successful.
Achieving the trifecta of research, teaching, and clinical care seems nearly impossible to most ofthese students. The need to balance life and varying parts of work is daunting and they do notseem to have many role models who they feel have successfully achieved this in all areas.
Students pursuing an interest in research at non-research-intensive schools feel isolated and are
hungry for ways to connect with a greater physician-scientist community across the network.
Students, particularly those that are non-Medical Scientist Training Program (MSTP) programs
funded by the National Institutes of Health (NIH), are woefully uninformed about NIH early
career funding awards and the loan repayment program.

Summary of Common Themes and Recommendations by Group
MD/PhD Students
Students’ Background and Family Circumstances
Several of the students in the MD/PhD program applied to their dual degree program as a secondary
decision. They initially wanted to obtain a PhD and do scientific research, but decided that the additional
MD degree would enable them to do meaningful clinical research and would add variety to their career.
Others wanted to be a medical doctor first and then heard about the MD/PhD program, in which they
could obtain a dual degree. The MSTP program was also an attractive incentive to fund their training.
They spoke passionately about the creativity they find in scientific research and their interest in asking
questions and solving problems. The MD/PhD students had a variety of research interests, e.g.,bioengineering, behavioral neuroscience, HIV/infectious disease, immunology, epidemiology,
electrophysiology, lipid metabolism, ophthalmology (translational research), ontology, pediatric vascularphysiology, virology.
Over half of the MD/PhD students in the focus group were married or in a committed relationship. One
female had a teenage child and one of the male students was expecting a child.

Past Influences on Pursuing a Career in Research
The majority of the MD/PhD students who participated in the focus groups fell in love with the process of
research in high school, during summer research program, or as an undergraduate. Most were exposed at
an early age to research role models/mentors, either via a high school program or in a research lab as anundergraduate.
Some of the students were motivated to do research as undergraduates and during the summer in order tobe more competitive when applying to medical school, and were then drawn to a research career. The
MD/PhD program was a good way to incorporate all of their scientific interests.
One student noted:

89

"In my situation, I was meeting people that do research that informs clinicalpractice in my medical training early on--that really flipped the switch and mademe decide to get into the MSTP."In terms of mentors, most students noted that a variety of mentors were important throughout theirundergraduate years and medical school.
The students note that they need to be proactive about finding a research mentor. Even though mentors
are assigned to MD/PhD students at some institutions, not everyone in the MD/PhD track is able to find amentor at their own institution. It is critical to reach out and find mentors at other institutions that they
may meet at conferences and other venues:"So I would say that I have to be open to the possibility that anyone that I comeacross could be a mentor for some very particular part of my career. They playdifferent roles. I have scientific mentors, work/life balance mentors, and mentors
for certain areas of research that I want to go into in the future."
Most of the students agreed that early mentors in high school and undergraduate are found by chance.
Later, the mentorship search "tends to be a decentralized process." Schools try to set students up with amentor, but practically it becomes difficult and often depends on the size of the institution and otherfactors. Many mentors are found by working in a variety of labs, going to conferences, and hearing
lectures by those who are doing the type of research a student interested in. All of the students mentioned
utilizing the skills and expertise of many mentors during their training.
”A good mentor is able to give you the time and support to learn, but allows you
to do things on your own when you are capable--and knows the difference
between the two situations.”“A mentor should be focused on helping you advance your career by sending you
to meetings, connect with the best quality science researchers, and sharing
personal, professional connections.”“A good mentor combines the ability to be both an excellent scientist and ahuman with good social skills and knowledge of how to expand a career.”

Current Considerations about Pursuing a Research Career
All students in the MD/PhD focus groups had many positive comments about embarking on a career as aphysician-scientist. A research career is appealing for the following reasons:"My clinical research really matters - it has direct impacts on clinical practices.
I can see the people actually benefit from it. I really believe it is worth doing andit will better people's lives.”“You know...better therapeutics, better devices and instrumentation,
understanding a disease better or even understanding normal processes that are
not well understood because there is still a lot of that out there which I don't
think most medical students even realize that is true. The more we know the more
we know there is a lot more left to discover.”90

“I want a solid academic career and to do that, I need to do research in order toachieve academic ranking."
Thus, among the reasons are:

Asking questions that are relevant, meaningful, and make peoples’ lives better.
Being able to do something that benefits many people, not just one patient. Being able to answer
essential questions that have implications into disease pathologies.
Serve as a bridge between the basic science professionals and the clinical professionals.

The students admired successful physician-scientists, who are able to continue getting funded forresearch. They admire those who have the ability to communicate in both the research world as well as
the clinical world. They find it impressive that successful physician-scientist are able to maintain both
excellent research skills and excellent clinical skills.
On the other hand, these students described the older physician-scientists who are running a lab, being amentor, and an academic teacher/advisor, as looking tired.
Each student in the focus group verbalized that the uncertainty of research funding was the major
challenge to a career in research. Financing a career in research and the perceived politics of government
funding makes each one nervous about being able to sustain a career as a physician-scientist.
Other challenges include:







Having protected research time, especially in non-traditional specialties.
Finding the right balance between clinical interests and research interests.
The time required for grant writing is a concern: "Having to put in lots of energy toward things
that can often seem peripheral to the real goal."
Surgical research has its own specific challenges because to be a good surgeon, one needs to keep
up surgical skills. Research time is limited. It’s hard to be competitive in the field when one iscompeting with full-time PhD scientists. It is a struggle to do well in both fields. It’s sometimes
hard to get a surgical residency when the individuals wants/needs to have time to do research.
The salary inequity differences can be a challenge:"Sometimes, we have to make up the difference in lower research pay by doingclinical work. Researchers may be financially disincentivized by the institution
for them to do research."

In particular, residency is a time when there is lack of research mentorship. Students perceive this to be
the most vulnerable time of research training. When a student is not engaged in research for four to six
years, it may be difficult to re-establish a research career. During that time, a student won't be doing
research or publishing papers. It makes it harder to be competitive for a K award and ultimately for an
RO1.
The pay cap of NIH grants may make it difficult to be hired. Department chairs may think twice abouthiring someone who needs 50 percent protected time for research. The department has to supplement
salaries to achieve the typical physician-scientist salary.
Work/life balance in a research career is a topic that is top of mind to these students. Most are willing to
put in as much time as needed while a student and in training, but perhaps may not be willing to do so91

when they begin their careers. They understood from the beginning that finishing a dual degree is a long
and arduous process. Work/life balance was of biggest concern when looking ahead to their post-training
careers. Work/life issues are portrayed in the following student comments:"The whole work/life balance fear increases with the decrease in researchfunding rates. I do have a concern that the rest of my life may suffer in a negative
way that I am not sure I am completely willing to allow.""I hear a lot of my colleagues say I want to do well but I am not going to stressmyself out and I would settle for a little bit less as long as I am happy.""I want to do well in the workplace, but I also want to be that mother to my kids.
I don't want to be an absent parent." This is a stronger issue for women, but men
also stressed this point.
"This is something that concerns me a lot moving forward - not being able to see
many females being successful at making things work and balancing having kids
with having a career."
Most females did not think it was an option to take time off for family issues. It is hard to take time off inacademia or if the physician-scientists has his/her own lab. Many are afraid that it would negatively affecttheir promotion potential.
It may help to promote "team science"--- this may become more important, particularly with decreasing
funding opportunities.

Future Plans and Influences Regarding a Research Career
When asked where they expected to be in 10 years, the MD/PhD students said they would just be
finishing their residencies, and hoped to be involved in a research career that launches them into a career
where they become an independent researcher. Many mentioned they would like to be in an academic
setting with some clinical responsibilities.

Recommendations for Making Research More Appealing/Feasible in Medical
SchoolSeveral recommendations from MD/PhD students focused on obtaining adequate funding as a student andduring residency. Suggestions included:






Promote/expand the Ruth Kirschstein F30 programs for MD/PhD programs.
Recommend some kind of mechanism (K award) to help in transitioning between residency to
becoming an academic clinician-scientist. There should be K awards for every kind of specialty.
Have a funding mechanism for longitudinal support, i.e., smoother transitions to residency andfellowship. This is a really critical point in the career pathway where many MD/PhDs give up on
research. This would ensure protected research time during residency, even in less traditional
specialties. This funding mechanism should be awarded to the individual rather than theinstitution.
Create a K99 specifically for MD/PhDs applying for residency.

92

Other recommendations focused on increasing networking avenues and better communication with NIH.
Specific recommendations include:







Students in non-MSTP-funded dual degree programs are not included in networking opportunities
and often students are not aware of funding opportunities. A few suggested the need for abaseline protocol for all MD/PhD programs, whereby students participate in conferences andother networking avenues to enable them to network with experts. These non-MSTP programs
may not have faculty who value research, and therefore there is a need for better mentorship. The
MD and the PhD programs at these universities may not communicate well.
A webinar series that describes the student funding mechanisms at NIH and what MD/PhD
professionals can do with their careers. Many students at non-MSTP funded schools are notaware of the mechanisms.
Travel awards for students to attend conferences for networking and access to potential mentors.
NIH could send quarterly informational research newsletters to all universities that have MD/PhD
programs.
A mechanism for networking with experts, especially in those underrepresented areas of research,e.g., epidemiology, economics, biomedical engineering. NIH could set up an online center for
those who are contemplating a career in a certain specialty to gain more information and to
network with those doing research in that area.

Several students made suggestions for making their training more cohesive and relevant for the needs ofresearch and clinical practice. These suggestions are:






Develop guidelines for continuing the research experience during the residency years.
Streamline training: The training for MD/PhD programs is getting longer and longer. One idea
was to put all the research training into the residency to reduce the length of training. This would
consolidate the research to a student's preferred specialty and eliminate the gap in researchtraining during residency. Some trends in medical school are to decrease medical school from 4
years to 3 years.
Address the average age of obtaining the first RO1. It has increased to 46 years of age.
Increase the salary cap for researchers.

MD Students
Students’ Backgrounds and Family Circumstances
MD students who were interested in pursuing a research career went to medical school because of theirinterest in science, in being able to interact with and help people, and in doing research that addresses
questions of clinical care:"I went to medical school because I wanted to do research that was clinically
relevant. And I thought doing that through an MD degree would be the way to doit."
The research interests of those interested in pursuing a research career included computational
biology/applied math, neurosciences, neurology, and translational research.
Those students not necessarily interested in research career went to medical school because they liked
patient care; were interested in the concept of healing, health disparities, and/or teaching; and liked
working with people. They would like to conduct clinical research if they could also have a clinical93practice that was over 50 percent of their work time. Their research interests were mostly along the line of
their clinical specialties, such as orthopedics, anesthesiology, neonatology, oncology, etc.
The majority of the MD students were in a committed relationship or were married, but none hadchildren.

Past Influences on Pursuing a Career in Research
All the MD students who participated in the focus groups thought that research experiences help toincrease their critical thinking skills and makes them more competitive for residencies and fellowships.
Those who are interested in pursuing a research career initially became interested in research because it
was required for an undergraduate degree, a professor pointed out that there were research opportunities,
or they attended a summer research experiences for undergraduates (REU) program.
Many had professors during their undergraduate careers who served as mentors. These students look to
mentors who have a supportive financial infrastructure, so they can learn research methods from thesenior scientist and lab manager and also be allowed to have an independent project. In addition, theylook to mentors for tips on work/life balance. Students mentioned that enthusiastic mentors have broad
overlaps with them as far as professional and academic interests.
“And then just because a lot of time we look to these mentors as much more thanjust a research mentor but sort of as a guidepost for our careers, I think it was -some of the most memorable things are when they involved me in their own
social outlets. We sort of identified areas where they struck work/life balance.”
For those students who were not particularly interested in a research career, they got involved in research
as an undergraduate to make them more competitive in their applications to medical school and residency,
especially for the more competitive residencies, such as plastic surgery, orthopedics, and radiology .
Students feel like they need to check the research box to be competitive, it is a "CV booster.""To be honest, I started to get involved with research initially for applying to
medical school; it was one of the boxes that needed to be checked off. And then I
got involved in simulation and medical education at school because it relates tomy previous career where I was a software engineer so I had that sort of interest
and was able to explore it in that direction. But I think I initially got interested
mostly because I felt like it would make me a more competitive applicant morethan anything else."" I started doing research to improve my application for residencies but what I
found really compelling about it was that both of the projects that I have workedon have been things that my PI was just interested in understanding a little bit
more about, and so we designed a project to kind of look at it, and you now see
the actual quantitative data behind things."“I started research in undergrad, mainly to boost my application for medical
school, and it was mostly basic science stuff, really. Just get your name on apaper. No true interest in anything. As I went through medical school--thecommon theme again--you need research to get a competitive residency, so I kindof like -- it has transitioned over a little bit. “

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“But I think that it is more of just like, you know, a check box, and not a lot ofstudents are really passionate about it. And not to say that they don’t likeresearch. I think they are just more passionate about clinic, about patient careand that realm of medicine as opposed to the behind-the-scenes aspect of it.”Some students have had good mentors. They mostly met their mentors fortuitously via summer research
programs or in labs at school. In general, these MD students have had mixed luck with finding a good
mentor.

Current Considerations about a Research Career
A common concern about embarking on a research career centered around the perception of not being
able to have a thriving clinical practice while engaged in a research career:"The only thing probably holding me back may be not having as much patientinteraction as I would like. If patient interaction and research could go hand in
hand, being a physician and physician scientist--that would be the best of bothworlds.""I would need to find a balance between being able to see my patients andfulfilling my role as a researcher. And if I could, you know, find that balance,then I would definitely do both but it is hard."
Regarding potential pay differences between those in private practice and those engaged in research,
students who are very interested in building a career in research accepted that they will be making lessmoney. They were hoping that the funding landscape will be better by the time they are applying for
grants.
"I have the expectation that I would be making less money doing researchcompared to the private practice. I think that is something that I have accepted to
be true.""And I guess that uncertainty about the future of how funding works and thesituation that the government is in now, I think that -- it makes me worry a little
bit but at the same time I think it is so far away that it is not something that is in
the front of my mind."
These students were concerned about clinical/research balance. When they observed physician scientists
in their schools, they found these individuals were mostly doing bench research and not seeing patients.
The students thought that was unacceptable for their careers. They believed that a 50/50 split is possible
depending on the clinical specialty, and that would be determined when they apply for residency.
Length of training to get a PhD is also a concern. This quote is from an MD-only student with her
thoughts about the length of training for an MD/PhD:“I think in terms of the training, what concerns me about the MD/PhD is--it is
not just the not wanting to be in school for that long. I have heard somecriticisms of the structure of MD/PhD programs because if you are going down
more of a basic science path, which I think a lot of people who do MD/PhD
pursue--since the science field is changing rapidly as well, just the techniquesthat are being used in practice--that by the time you finish your PhD and you go95back and finish what you have left of medical school -- you know, you got out andyou finished your residency. You got out and you start practicing for yourself andstart to have your own lab, and the science has just changed a lot.
Work/life balance issues were also of mind for the MD students:"I think for me too, you know, time right now is not a big deal, but I feel like, youknow, planning a family and raising a family, that is definitely going to takeaway from the time you have to practice and any time you have to do research.
It is something I would have to balance and consider." (male student)"For me, family is a big priority so I think in terms of the specialty I would
choose, I would choose a specialty that wouldn’t take me away from my family
too much. So I guess something like surgery, if I get stuck in a surgery and can’t
go home, that is not something I would really like. So I probably wouldn’t want
to go into surgery because of that lifestyle, and just me personaly, I have wanting
to raise a family as a high priority." (male student)
Students wanted to be autonomous when they get out of training. They wanted the flexibility and time to
be able to enjoy a family and a life. They were looking to create a work/life balance and also love thework they do. Work/life balance played a major role in the decisions these students were making for theircareers.
Most students respected and admired those who are physician-scientists, but they were not particularlyinterested in navigating the grant funding process. Many students pointed to the reason they went tomedical school and that was to take care of patients. That is what they intend to focus on.
“And it is almost like being, to me, how artists have to go out and get gigs and dothat whole thing. I feel like researchers have to like go out and find grants, findfunding, find people who believe in them, and it just seems really, really tedious.”
From a student who has aspirations to do research:“I think the funding environment now is something that is pretty scary. I think,
too, as somebody who has not elected the MSTP track, I am even more nervous
about how much legitimacy I will have as a PI one day. But to me something thatis comforting too, as someone going into academic medicine, I feel like I have got
a marketable skill set in my clinical training that I can fall back on should
research need to fall by the wayside if funding, you know, doesn’t work out orsomething like that.”
When asked about their observations of physician-scientists in their school, these MD students admired
their incredible focus on a specialty, as well as their persistence and ability to prioritize and juggle
multiple roles. They do the groundwork for the rest of medicine. Some felt that, as a whole, physicianscientists may be a bit out of touch with the clinical world because their clinical time is limited; and they
have fewer social skills than what they would like to see in a clinician. They were quick to point out, that
there were certainly some top-notch clinician-scientists serving as role models in their settings.

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Future Plans and Influences Regarding a Research Career
For those students contemplating a career in research, the amount of training time, the perceived lower
salary, and uncertain potential funding for research were the major influences on their decision to pursue
a career in research.
"I don’t want to sacrifice what I want to do in the field of medicine itself to be
doing research either. I want to be able to choose a career in medicine, nomatter how rigorous, and still have time to be doing well in that and learning inthat field but also be doing my research."
School debt/loan repayment was also a big concern.
"I know that I am going to be graduating with a lot of debt, and knowing that
research makes less money, I think it makes me feel a little hesitant about it justbecause I know if I have a lot of loans to pay off. And I know the situation isdifferent for MD/Ph. students, but I think for MD-only students who want tobecome physician-scientists that having a lot of debt presents a barrier."
When feasible with medical school commitments, MD-only students with an interest in research found amentor to work with and spent between 10-20 hours/week on research projects, mainly in a lab setting.
These mentors may or may not be a part of the medical school. The student proactively sought them out
and made the connection.
Funding was an issue for those MD students who would like to pursue a PhD, and are not in an MD/PhD
program:"For me, I am actually considering that right now. My school has a way for MD
students to get into the MD/PhD program, so I am in the process of trying toapply for that. It has been kind of difficult for a number of reasons, and I might
be in a situation where instead of going into the MSTP, I would have to take aleave of absence and do the PhD separately."
These students would like to be in academia and combining clinical practice with research.
Many of the MD-only students foresaw an academic or clinical career with some research involvement
for themselves, but not necessarily having their own lab or lab group.
To a person, the MD-only students were not planning or interested in seeking a PhD after medical school.
They may consider an MPH or take a year out for research training. One said she would consider working
towards a PhD if she could see a very specific reason why she needed it. Many felt that they could do
research with their MD degree, especially if they partnered with a PhD researcher.

Recommendations for Making Research More Appealing/Feasible
The MD-only students made the following recommendations for making a research career more appealingor feasible:

Create exposure to what a physician-scientist career looks like.

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"I think in the MD/PhD program, that program provides a lot of -- whether it islike seminars or just workshops that sort of educate about what it looks like to bea physician scientist and the things you need to do now in medical school to build
a career toward that. I don’t think the MD students get much exposure to that.
Maybe it has to be a top down thing from in the medical school curriculum orjust having workshops or seminars that would educate us that a physicianscientist is something that exists, and these are the ways others have done it. I
think having that information would help MD students work toward a career as aphysician-scientist."Create a more equitable loan repayment program for MD-only students.
“So for the NIH to further promote research, I think having grants available tojunior faculty members or more to fellows, that would encourage people orwould allow people to take time early in their career, a little bit of time awayfrom their clinical practice, in order to supplement their income so they are able
to do research.”Offer a fast track research or fast track residency option to MD-only students with interest in
research.

“I know that MD/PhD students are sort of educated about fast-track research or fasttrack residency options where effectively your residency is shortened because of theassumption that you will engage in research in your future. And I don’t honestly
know if that is even offered to people who may not have completed a PhD but still
have significant research experience. I think it could really expand the number ofphysicians interested in research if their residency was also equipped with somebenefits or a fast-track option as well.”Create programs with continuing medical education (CME) credits for basic science, such as
methodology training.
“And to my knowledge there are not CME credits available for basic science,
like methodology training. And as somebody who is interested in basic science
training, like my greatest fear is that I will forever be inadequately equipped tohandle changes in science, especially if it only occupies a fraction of my work.”Continue to fund Summer Research and Diversity Programs.
“They should continue to focus on funding the Summer Research Programs andthe Summer Diversity Programs, that bring students from multicultural
backgrounds into labs, research labs and medical schools in the summer to doresearch because the program that I was involved with, it was NIH-funded. And
also continue to offer research summer fellowships during medical school for
medical students because most of the time we can, if we do research at our
medical school, we can get funded by internal grants. But when we go outside ofour medical school, it is a little bit harder to find funding.”“There is a program called the Summer Medical and Dental Education Programthat I participated in as an undergrad that targets underrepresented minority
students to prepare them for medical school. And I think that is a program98through the AAMC [Association of American Medical Colleges] that the NIH
should target. Also implement a research component to that program.”

Fully embrace pre-med and MD-only students in Science, Technology and Mathematics (STEM)
programs and summer program application processes:“And what I found is that it is really hard to find a program -- like if you say you
are pre-med, a lot of STEM programs, they like look down, like don’t want you toapply if you are trying to do pre-med. Like they want you to go strictly into a
PhD or MD/PhD program. Like I found a lot of programs that were like that andvery few that were looking for pre-meds.”

Consider a program that provides mentors for underrepresented minorities in research, beginningat the high school level.
“I think that having mentors and having role models that are fromunderrepresented minority groups really inspires a lot of the minority students toknow that they can achieve something. They can achieve and should aspire toachieve a career in research or a career in medicine. I know that, and for me
personally that was a big driving factor to work hard to, you know, work hardthrough undergrad, through medical school, knowing that I can achieve what
they achieved. And also having them available, having them on the faculty or as
mentors for undergraduates and for medical students I think would be anotherway to increase the number of minority students in medicine and in research.”Encourage incorporation of research training in medical schools, to take advantage of the trend tocondense the pre-clinical years of medical school. Students could become more involved inresearch during this flex time:“So having the NIH encouraging kind of a physician research pathway -whether it is basic science, public health, clinical research -- in medical schools,
and encouraging medical schools to have a set curriculum with mentors in place,with lectures, physician panels in place, for example, would be I think very
helpful for doing the first and second years of medical school.”Provide information to communicate research opportunity and loan
reimbursement mechanisms to MD-only programs:“I think that there are programs out there that I have been lucky enough to heara little bit about, but I am not sure their overall exposure to people in our shoes
is that fantastic.”“I would really love to have some information on how to write grants and where
to apply for them and how that all works. So I think that would definitely besomething I would be interested in.”“I think honestly having this information more advertised at individual schools,
because to be honest I hadn’t heard of anything moneywise that has been talked
about in the last two minutes.”

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Minority MD and MD/PhD Students
Students’ Background and Family Circumstances
Minority MD and MD/PhD students all expressed an interest in careers focusing on health care inunderserved areas, public health, health policy, and health disparities They were aware of the National
Health Service Corps (NHSC) payback programs for working in medically underserved areas of thecountry.
Those interested in doing research would like to combine clinical or academic medicine with research.
Hopefully a 50/50 split: "I need to find the right balance of the two."
The majority of these students were single, without children.

Past Influences on Pursuing a Career in Research
Research mentors have had a big influence on these students as undergraduates and medical students.
The consensus of the group was that many do research in medical school to make themselves morecompetitive for hard to get specialties or residencies at institutions that have a strong academic andresearch base: "People who apply in more competitive specialties take a year out to do some researchand to get a couple publications or abstracts that help improve your resume."
Minority students wanted more exposure to minority role models in the sciences, medicine, and research.
These students reported that they needed to see the possibilities of a research career early in life, e.g., inelementary or middle school, so they can start in the science track. Most reported growing up seeing
physicians provide patient care only. In addition to this exposure, there needs to be opportunity.
There was a perception among the minority MD and MD/PhD students that there isn't a lack of minorities
in medicine, but there is a lack of minority role models in research.
“But definitely when I got to the research aspect, and I got in a lab, I did noticekind of a disparity. I definitely saw more Caucasian and Asian physiciansparticipating in research whereas the community physicians that I saw working
at some of the clinics that were on sliding-fee scales and in the underserved
minority communities--I did see a lot more ethnic diversity there.”

Current Considerations about a Research Career
The minority MD and MD/PhD students who participated in the focus groups felt that at this point in theircareers they don't have to worry about getting funded, but they have observed their research mentors andheard about the dire funding situation and how hard it is for young PIs start out.
“I personally don’t have a really good sense of what it is like to be a PI. I sort ofsee what my PI did. He was a more senior person, but sort of also overseeing themore junior people. They spend a lot of time worrying about their funding
situation and whether or not it is going to be there, the next funding cycle…if it isgoing to be renewed.”
The amount of time needed to pursue a career in research was not appealing to these students, particularly100

in light of the importance they placed on work/life balance:“You see PIs, especially young PIs, regularly working 80-hour weeks. Even in
fellowships I have seen people working 60, 80 hours, like nonstop, while trying tohave a family. And it just looks difficult and draining and tiring.
The uncertainty of finding positive answers to research questions was also daunting to students.
“And if you don’t really love it, then I can see you getting burned out very, very
quickly. And that is kind of scary to me. I think the other aspect is that as much as
you want -- I think you have to enjoy the journey more than anything else. I
think some people really like research and they don’t mind failing and they don’t
mind getting answers that are wrong -- well, not wrong, but that go nowhere. ““It is important that you enjoy the pursuit of that answer. And I think for me, I
don’t, I would rather -- I would be very upset if I chased something for 10 or 15
years and found nothing at the end of it.”
Another concern was the perception that there are not a lot minority physician-scientist role models in
research:“I think a concern for me about going into a research career, what would bescary for me, with me being an African-American woman, a black female, and I
mean facing the facts of things -- I have done research before, and I feel like, youknow, you see a lot of either white males or you see a lot of Asian males.”“I have been the only person, black person in biology class since I was 14.”

Future Plans and Influences Regarding a Research Career
Most minority medical students saw themselves 10 years from now in clinical medicine careers withresearch as a smaller percentage of their time. They also would like to be affiliated with an academic
medical institution.
Lifestyle and work balance was quite important to minority medical students. They believed the length oftraining eats into family life and recreation. They want to enjoy a family:101

“I think it is really important consideration because, you know, if you are doing
something and that is all you can do, you can’t do anything else, you can’t see
your family, you can get kind of miserable.”
The amount of loans they need to pay back also played a big role in their assessment of how quickly they
are able to get out and practice and make a good salary.

Recommendations for Making Research More Appealing/Feasible
MD and MD/PhD students from underrepresented minority groups made the following recommendations
for making a research career more appealing and/or feasible:

Create a viable pipeline for promising minority students in science to become minority physicianscientists. There are some minority programs, but there aren't enough of them and they don't tend
to follow through in the sciences and research.
“And by senior year I would say 75 percent [of my minority classmates inundergraduate school] were done and they had gone to more of a sociologicalor humanities-focused majors because that is where, at this point, a lot ofminorities tend to flock to just because there are no minorities in science. And
I think that is frustrating. People tend to go where they see people who look
like them.”“I think it all starts very young because I think better STEM education has tobegin way, way early to even like consider how to build that pipeline. I think a
lot of times we have done a disservice to very young children who just don’t
have a chance later on.”Provide more information to students about what a physician-scientist career look like and what is
the typical salary.

DDS Students
Lifestyle seems to be an important factor in choosing to pursue a DDS degree. The DDS students who
participated in the focus groups really wanted to be able to set their own schedules and be their own
bosses. How this plays into a career that includes research was not totally clear to the students. Still, one
student clearly felt that the time commitment to get a PhD on top of a DDS degree would detract from her
ability to have a family and stabilize a career.

Students’ Background and Family Circumstances
Dental students who participated in the focus group offered several different reasons for attending dental
school. Most reported attending school in order to provide patient care and because they liked the idea ofowning their own business. One student reported that there were many dentists in her family and that
helped her choose dentistry as a career. No dental students reported attending dental school with a goal of
doing research.
Most DDS students mentioned that their student loan debt is high.

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These students were primarily in committed relationships or married, but there were several who were
single. None of the participants had children. The vast majority of participants were female.

Past Influences on Pursuing a Career in Research
DDS students reported a variety of reasons for being interested in research. Some were exposed asundergraduates. Others had research interests early on, but when they began to hone in on their true
interest figured out that it was not for them and ended up going to dental school. One student reported
doing research as a way to help strengthen her application to dental school. However, she ended up
enjoying her experience. According to focus group participants, DDS students who are interested inpursuing a residency following graduation have an added incentive to do research. Research is a goodthing to help their residency applications.

Current Considerations about a Research Career
Even those students who professed an interest in research were unsure how to be good researchers as wellas good dentists. DDS students felt that in order to do a good job as a researcher one needed to devote alarge proportion of time to research, and that is not why most of them went to dental school.
Dental students reported that they want to be more autonomous in their employment situations. They were
not interested in working in a hierarchy of people. They wanted to be their own bosses and set their own
schedules. Research doesn't lend itself to that as nicely as private practice does.
DDS students were similar to veterinary students (see below) in that they admire the clinician-scientists
they see at school. They were impressed with how they are able to balance their time and how dedicatedthey are to their careers. However, they do not admire their lifestyles. And, like veterinary students, DDS
students felt that dentist-scientists may have lost touch with the bigger picture in dentistry and don't thinkthey are the best teachers.

Future Plans and Influences Regarding a Research Career
DDS students in the focus group wished that they had more information about careers in research,especially during dental school. Students reported not knowing about NIH opportunities as they relate todental training and that there isn't much exposure to research as part of their schooling. One student said
that she wished she had known that a DDS/PhD was an option if the PhD portion of her schooling would
have likely been paid for. Students were familiar with loan repayment from the military, but they didn't
know about other training grant opportunities in dentistry.
DDS students were interested in learning from each other and wanted to find colleagues that are likethem. They were particularly open to networking with other students who are interested in research andhaving people to bounce ideas off of.
The DDS students in the focus group were not interested in pursuing a PhD following their DDS degree.
A PhD for science other than bench science seemed unnecessary to these students. They all felt that thetime needed to complete such a program was a major drawback. One student felt that it would be very
difficult to earn money and stabilize her career prior to having a family if her training took that long.
Students do see the value in the PhD degree and understand that it may be a necessity, depending on the
career they are choosing (e.g., academic dean).

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Two of the students in the focus group hoped to become part-time professors and part-time clinicians in
the future, but the remaining participants saw themselves in private practice. They chose private practiceprimarily for the lifestyle it will afford them.

Recommendations for Making Research More Appealing/FeasibleProvide networking opportunities and better knowledge of NIH opportunities as they relate todentistry. Webinars, listservs, and conferences were mentioned as vehicles for learning more
about NIH opportunities.
Provide early exposure to research programs. DDS students need to be educated on funding
opportunities for school/training at an early point; ideally, even before dental school.
Educate students on loan repayment options that are currently available.
Provide more networking and travel funds

DVM Students
DVM students want more collaboration between them and medical students.

Students’ Background and Family Circumstances
Veterinary students participating in a focus group chose to attend school for a variety of reasons. Somewent to school with the goal of being practitioners, both large and small animal. Some reported verytargeted goals, such as working with seeing-eye dogs or lab animal medicine. One student reported
having an interest in research and said that was her real reason for getting her DVM degree.
These students reported a variety of family situations. The majority of students we spoke with are either
married or in a committed relationship. No participants reported having children. The vast majority ofparticipants were female.

Past Influences on Pursuing a Career in Research
Veterinary students in the focus group generally admitted to not really being interested in a research
career at all. Some said that their undergraduate experiences helped shape their research interests.
One veterinary student said that she decided to pursue a DVM because her mentor made her feel like she
might not be smart enough or able to pursue a research career. Several students credited their first mentors
to really guiding them and helping them choose what further education to pursue.

Current Considerations about a Research Career
Veterinary students, while passionate about the care of animals, did not have as positive of an outlook oncareers in research. The majority of DVM students wanted to practice clinical medicine. They were notresearch driven. They felt that veterinary schools were best equipped to prepare them for clinical jobs.
Also, they noted that NIH does not have a center dedicated to veterinary science.
These veterinary students would like other professionals to better acknowledge the value of a DVM
degree. They thought the DVM degree should be a viable degree to do research, and don't feel the needfor a PhD to do research. A PhD for science other than bench science seems unnecessary. Instead, DVM

104students would like to see more research done by folks who are primarily clinicians. They believed that
research can be incorporated into clinical practice settings.
At the same time, some felt that the time commitment of research would be very intimidating, hence
raising work/life balance concerns. They felt that their DVM degree might appear to be insufficient in the
research world and the time it would take to get a PhD in addition to their DVM was daunting. In terms ofbalancing research and clinical, most felt that after learning how to balance school and family they would
be able to manage their time upon graduation.
A concern about paying off student loans was also raised. Participants wanted to graduate and startpracticing medicine in an effort to start paying off their debt. Further studies would only increase the debt
and time to pay it back. For those DVM students that wanted to pursue an internship or residency, thatmeans more years of low pay. Lost wages were an issue for these DVM students.
Still, DVM students tended to admire clinician-scientists in their field. They were consistently impressedwith their ability to stay current in their field and use their intelligence to problem solve. However, theyreported that not all clinician-scientists were good teachers. Students see their clinician-scientist rolemodels as being “out of touch” or lacking certain social/teaching skills. They also observed that clinicianscientists have to deal with a lot of politics related to the university setting as well as communication
issues. These factors may be a deterrent to becoming a clinician-scientist.
In an ideal world, DVM students would like to see that their degree has value in the research world.
Students were not sure why they need a PhD to do research or if that is just a perception. Veterinary
students wanted hands-on experience – that is why they went to school in the first place. The need to finda way to balance that with research would help DVMS in their effort to pursue research as part of theircareer.

Future Plans and Influences Regarding a Research Career
Most of the veterinary students in the focus groups were on a clinical career path. Only one wascommitted to further schooling and the idea of a future PhD. She would still like to have a clinical career
but is worried about the long time it is going to take to achieve her goals. Other students saw themselvesteaching at universities or furthering their training to align their education with their specific career goals.
For example, there was one student hoping to be a rural food animal veterinarian in a farming community.
She wants to help the farmers in addition to the animals and noted that there is no direct career path formaking that happen – she will have to find her way. Another student who was interested in sled dogs andwildlife research also noted that there is no direct way to get to her end goal. She was just figuring it out
as she goes.
Veterinary students wanted to see more research being done by veterinary clinicians. They felt that their
day-to-day experiences are valuable and could be incorporated into larger research projects. This would
aid in integrating research and clinical practice.
Student would also like to see more avenues to work with medical students. There is a direct relationshipbetween human medicine and animal medicine research, but little is taught to either group about theconcept.
The concern over funding and loan repayment was brought up again in relation to career planning. DVM
students would like to see more funding available for DVMs and some felt that there isn't enough respect
for the degree on its own. Student loans are massive in comparison to salaries in the field and that is alarge issue for new graduates.

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Recommendations for Making a Research Career More Appealing/Feasible
Veterinary students made the following recommendations to help make a research career more appealingor feasible:Provide information about opportunities in research and employment in one place. Ideally there
would be a database that had research opportunities including the funding levels and then they
could find out if a clinical position was available in the same location. This would make pursuingresearch and clinical together easier.
Promote the value of a DVM degree. Veterinary students seemed frustrated that research entities
see a need for those holding a DVM degree to still obtain a PhD. If a PhD is necessary, one
participant suggested being able to work on a PhD while employed at a pharmaceutical company,
for example. This would be a way to collect a salary while still working on education. Other ideas
related to this frustration were the ability to get some type of accelerated PhD.
Provide early exposure to research careers so veterinary students begin to understand thepossibilities and career pathways.

DDS/PhD and DVM/PhD Students
The DDS/PhD and DVM/PhD students participating in the focus group research were truly committed totheir passions and determined to achieve their end goals regardless of the path they need to take to getthere. They were not deterred by the amount of time it will take them to complete all their training. With
that said, they were very concerned about debt and the ability to achieve the trifecta of research, teaching,and clinical care. Some were worried that they will need to spend a large proportion of their time writing
grants and that this will take away from their time to do other things.

Students’ Backgrounds and Family Circumstances
The DVM/PhD students unanimously reported that they had always wanted to be veterinarians. However,they were each interested in different types of research, ranging from retrovirology to food production.
The DDS/PhD student participant originally wanted to attend school to become a veterinarian. However,she chose to go to dental school and is now interested in public health dental research.
More than half of the combined degree students in this group were currently single. One participant, who
was married, had a young child. Again, the vast majority of participants were female.

Past Influences on Pursuing a Career in ResearchStudents pursuing combined degree programs (DVM/PhD or DDS/PhD) seemed to become interested inresearch earlier on in their education than those pursuing only a DVM or DDS. Several of theseparticipants reported that their interest in research was piqued in high school. Others stated that they met a
mentor early on in their research careers that was helpful in guiding them in their education choices.
The combined degree students really emphasized the need for good mentors.

106Current Considerations about a Research Career
The appeal of a research career was clear amongst all DVM/PhD and DDS/PhD students. They werepassionate about research and love the challenges associated with performing research. They all reported
the appeal of problem solving and passion for their chosen research area. Also, the idea that one can truly
make an impact in a specific field was a driving factor for some students pursing research.
Most students indicated that the length of training is very long and makes it difficult to have a family life.
“It really is hard to just try and have a family life, try and have children, try andhave a husband. Like any of that is just hard because at least the way I do
research, you spend a crazy amount of hours in the lab. And when you are not in
the lab you are researching and you are thinking.”“I would just comment that the process is, along with being poor for a very longtime, the process is just really long and, I mean, I am sure there are some careers
like, you know, becoming president or other things that take longer but, youknow, I am not aware of too many other careers that take as long as it is going totake us. “One student in a combined DDS/PhD program felt that dental schools try to engage students in NIH
opportunities and help them find career opportunities. She has gotten quite a bit of support from her
dental school. She feels it is because of the National Institute of Dental and Cranial Research (NIDCR),
which provides research information to students. There is not an Institute at NIH that focuses onveterinary research.
The DVM/PhD students believed there was little to no support or guidance for someone looking to pursue
a research career, even though they are close to graduating with a combined clinical/research degree. The
prevailing feeling was that veterinary schools were not equipped to help graduates move on to a research
career after finishing a combined DVM/PhD. There was concern about the transition from research during
school to a true research position. In addition, even though there is a big push at veterinary schools to go
into research, there is a perception that there are not many opportunities in veterinary research.

Future Plans and Influences Regarding a Research Career
The students in the DVM or DDS/PhD focus group had a variety of ideas of where they will be in thenext decade. Some hoped to be in academia doing research. They understood the importance of a good
mentor and would like to be that person for others. One student was sure that she did not want to be inacademia and instead would like to work in industry while continuing some clinical work on the side.
Students were concerned with the ability to teach, see patients, and do research. One felt that it might beeasier to pursue one thing at a time instead of trying to achieve what might be impossible.
Combined degree students had big concerns about their loans. They pointed out that while some MD/PhD
programs may have full coverage for tuition, this is not the case for DDS/PhD and DVM/PhD programs.
As a result, combined degree students in these fields are graduating with high debt. Some students were
not aware that loan repayment programs were available. They believed that the NIH loan repayment
options do not really apply to their fields (the specific example was veterinary medicine) and that makes it
hard to achieve the trifecta of teaching, research, and clinical care. The fact that the NIH has little money
to help pay back loans is a major deterrent to becoming a clinician-scientist for these students.

107

Recommendations for Making Research More Appealing/Feasible
Students in the DDS or DVM/PhD focus group recommended:

Increase the length of time that a student can have NIH training support (T32/F30). Currently thefunding is only for 6 years and it is nearly impossible to complete a combined degree program in
6 years.
Provide more training and K awards for veterinarians.

108Form Approved
OMB Number 0925-0648
Expiration Date 1/31/2015

Moderator Guide
Medical/Dental/Veterinary Students with Research Interest
We’re exploring how students like you--those who may be considering a career in research--think about
their career decisions. The aggregate findings will be used to inform the deliberations of the Physician
Scientist Workforce Committee at the National Institutes of Health about how to improve and support asustainable and diverse physician-scientist workforce.
This focus group will last about 1½ hours.
A few ground rules for today’s discussion:
1. Please just use your first name in your introduction and discussion.
2. We want you to do the talking and we would like everyone to participate. I may call on you if I
haven't heard from you in a while.
3. There are no right or wrong answers. Every person’s experiences and opinions are important.
Please speak up whether you agree or disagree with what’s being said.
4. What is said in this conversation is private to the extent allowed by law. That is, no one person’scontributions in the focus group will be identified to the Committee, and we will not provide any
information from the focus group to your school. Instead, the Committee will be provided withaggregated information to help them in their deliberations. We want you to feel comfortable
sharing when sensitive issues come up.
5. We will be tape recording the group because we want to capture everything you have to say. You
will not be identified by name in the report so all comments will be anonymous. The taperecordings and transcripts will be stored in a locked file cabinet until June 30, 2014 and then they
will be destroyed. If anyone objects to being taped, now is the time to remove yourself from thegroup.
Any questions before we get started?
Public reporting burden for this collection of information is estimated to average 90 minutes per response, including the time forreviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing
the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, acollection of information unless it displays a currently valid OMB control number. Send comments regarding this burden
estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: NIH, Project
Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-0648). Do not return thecompleted form to this address.

109

Then let’s begin. First, let’s go around and briefly introduce ourselves. Can you share with us fourpieces of information?:
1. Your first name
2. Your current family situation: single, married or in a committed relationship, parent (how many
children and their ages)?
3. Your primary reason for attending medical/dental/veterinary school.
4. Your primary area of research interest (if you know)
Past Influences
5. What were the most important factors that made you think about pursuing a career in research?
(PROBE FOR: Exposure to research – family member/friend in research, Mentor,
Internship/summer fellowship program, college major; college vs. university setting)
6. Approximately when in your academic career did you make the decision that research might be agood career choice for you? (PROBE FOR: approximate time if they tie the decision to an
event.)
7. Have you ever had a mentor/role model in research? If so, who? How did you find your mentor?
Current Considerations
8. What appeals to you about a research career? What concerns you? (PROBE FOR: How
important is length of preparation, cost, potential income, lifestyle?)
9. When you observe physician-scientists around you at school or in the workplace, what do you
admire about them? What turns you off? (PROBE: How much would you like your career toemulate theirs? What, if anything, would you choose to do differently?)
10. What opportunities really interest you right now? Why?
11. What would make it easier for you to pursue a research career?
12. Are you currently involved in basic science research? If so, how did you get involved? Howmuch exposure do you have to research as part of your current schooling (coursework, etc.)?
13. FOR NON-PHD CANDIDATES ONLY: Would you consider an additional advanced degree (inscience)? Why or why not?
Future14. Where do you see yourself in 10 years? 20 years?
15. What factors do you see most influencing your career track? (PROBE FOR: length of
preparation, cost, debt repayment, potential income, lifestyle)Thank you very much!

110

Research Dean Interviews
Catalyst Research & Communications conducted telephone interviews with deans at 12 medical schools,
2 dental schools, and 1 veterinary school between December 2013 to February 2014. With two
exceptions, the interviews were conducted with the dean of the school; the two exceptions were with adean of education at the medical school and a director of an MSTP program.
The medical schools were selected randomly from among constituent members of the Association ofAmerican Medical Colleges. PSW Committee member Vivian Lee, M. D. , sent an introductory email tothe deans of the selected schools. Catalyst staff followed up with an email invitation to participate in aninterview. Twelve of the 20 deans contacted agreed to be interviewed, yielding a 60 percent response rate
among medical school deans. The dental school deans were nominated by the DDS Subcommittee andone veterinary school was selected among schools that offer a DVM/PhD degree. A 100 percent response
rate was achieved among the deans of the non-MD schools.
For this research, Catalyst used an interview guide for key informant interviews that was approved by
OMB. The interview guide may be found at the end of this report. Each interview lasted approximately 30
minutes.

Key Findings
Key findings from the interviews include:

Deans estimated that anywhere from 2 percent to 37 percent of their students were interested inpursuing a career in research. That percentage was smallest among dental school deans, including
the school that is regarded as the “powerhouse” in producing dentist-scientists. Many deans set
the general level of interest at about 10-15 percent.



Although some deans indicated that female students were more concerned about the impact that a
medical career and/or career as a physician-scientist might have on raising a family, most deans
indicated that there were few differences between men and women in their interest in pursuing acareer as a physician-scientist. A few with MD/PhD programs noted that there were more men
than women enrolled in their programs.



Opinion was divided about whether today’s medical students are different from their Boomer
predecessors in terms of their inclination toward pursuing a research career. Several deans said
no. Others suggested that students today are: 1) more technologically-inclined; 2) less willing towork hard; 3) more concerned about the stability of research funding; and/or 4) less able todevote sustained attention to a topic because they are used to earning quick reward for a quick
effort.



Deans identified the most important factors that they believe influence students’ career decisions.
The stability of research funding and ability to sustain a career as a physician-scientist was
frequently mentioned as an important factor, since students are observing their professors losing
research funding and complaining bitterly about it. Less competitive salaries in researchcompared to clinical work was also cited. The factors that were considered most important inpromoting interest in a research career was exposure to research, both in medical school andearlier, as well as students’ positive experience with a research mentor. As one pointed out,
becoming a physician-scientist is a socialization process and the importance of good mentoring increating a positive experience cannot be overlooked.

111

Recommendations for Strengthening the Physician-Scientist
Pipeline
When asked what suggestions they would make to the PSW-WG, a number of ideas were put forth tostrengthen the physician-scientist pipline. A sampling of these:A critical juncture of an MD/PhD student is when he or she is getting out of his/her residency
fellowship. At this juncture, students need gateway funding and mentoring. Gateway funding in
the form of increased KO8 and K23 funding to support them as they get their first independentfaculty position is key. If they go into private practice clinical work, they are lost to research.



The NIH should provide current information on the success rate of the K awards. How likely are
students to get a K award? How likely are students who got a K award to go on to get an RO1?

Change the eligibility requirements for the Clinical and Translational Science Awards (CTSA)
program that funds medical students so they can earn a Master’s in Clinical Research.

Support is needed as much in the post-doc phase/junior faculty position as any place else. When
dollars are short, the return on investment is highest if we can say to candidates: if you finish
your training and get a faculty position, we’ll call you Scholars in (Scientific Domain).

Both DDS/PhD and DVM/PhD programs need MSTP funding. Veterinary students need to beeligible for loan repayment programs.



Increase high quality mentoring programs. Develop ways to share best practices in mentoring
students.

The biggest challenge is early on--instilling scientific curiosity in kids so that they love science.

The biggest problem is how to deal with cost sharing. People don't want to lower their salaries
just to do research. There is pressure from the department chair and the university to makemoney, which is what make so many physician-scientists drop out of one or the other. There has
to be an institution-wide program with a home and with support.



NIH could create a Physician-Scientist Student Supplement… or junior faculty supplement to a
grant. Basically, a PI would take on a student or junior trainee in his/her lab and groom thatstudent. What’s most important is the actual mentorship. It can’t be just an individual sitting
across the desk. Mentoring can be the environment and the individual or several individuals. This
would require a long-term commitment, not a one-off exposure. The success of the PI’s
subsequent supplement would be based on the success of his or her students. This would have aninterest in mentoring students long-term.

112Form Approved
OMB Number 0925-0648
Expiration Date 1/31/2015

Key Informant Guide
Research Dean
Thank you for making time to talk to me today. As you know, we are conducting research to help informthe deliberations of the Physician-Scientist Workforce Committee at the National Institutes of Healthabout how to strengthen the nation’s physician-scientist workforce. In particular, we’re exploring how
young people make the decision to pursue a career in research. We are talking with other deans, likeyourself, as well as conducting focus groups with students.
What is said in this conversation will remain private to the extent allowed by law. That is, no one person’scontributions will be identified to the Committee. Instead, the Committee will be provided withaggregated information to help them in their deliberations. We would like to tape record the interview sothat we can be sure our notes are accurate. The tape recordings and transcripts will be stored in a locked
file cabinet until June 30, 2014 and then they will be destroyed. Is it okay with you if we tape thisconversation?
Do you have any questions before we get started?
1.

About what percentage of your medical/dental/veterinary students are interested in a career in
research, i. e., as physician-scientists?

2. When do most students who choose to become physician-scientists make the decision to pursue a
research career? (PROBE FOR: Are their minds already made up when they enter medical
school?)3. What are the factors that most influence students’ decision-making about a medical research
career as a physician-scientist? (PROBE FOR: Time commitment, cost, future earnings, facultyrole models who are pursuing research [e. g. , do large numbers of faculty members have NIH orother grants?] other)?
4. What kind of differences, if any, have you observed between male and female students in theirdecision-making about a medical research career as a physician-scientist?
5. What activities, if any, does your medical school provide to encourage promising students topursue a research career? (PROBE for: Research track? Formal mentoring program? Preceptor
programs? Internships? Technological approach? If programs exist, please describe them. )Public reporting burden for this collection of information is estimated to average 30 minutes per response, including the time forreviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing
the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, acollection of information unless it displays a currently valid OMB control number. Send comments regarding this burden
estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: NIH, Project
Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-0648). Do not return thecompleted form to this address.

113

1. How do you define success in the research-focused classes or activities that you described? Whatfactors contribute to their success or lack thereof?
2. How are today's students different from those of 20 years ago, in an inclination toward a research
career? If so, what is the difference? How would you describe today’s students?
3. We want to go directly to the source and ask medical school students about their decision process
regarding becoming a physician-scientist, and we could really use your help. Would you be
willing to help us make contact with students from your institution for an exploratory focus groupabout this? (PROBE: Nominate specific students? Share student contact information? Refer tostudent organization?
4. What kinds of things would you suggest to the Physician-Scientist Workforce Committee thatwould help strengthen the physician-scientist workforce?
Thank you very much!

114

K Awardees

Introduction and Method
On behalf of the Physician-Scientist Workforce Working Group (PSW-WG), Catalyst Research &Communications conducted qualitative research with early career physician-scientists with mentored K
awards to explore how they think about a career in research. The original plan for this research was toconduct a series of telephone-based focus groups. One focus group was conducted; however, it became
too difficult to recruit enough young faculty with K awards into groups because of conflicting schedules
and the 90-minute focus group format. Therefore, the methodology shifted to 30-minute individual
telephone-based key informant interviews. This worked better as the interviews could be scheduled when
it was convenient for each individual. OMB clearance was obtained to recruit and collect qualitative data
either via a focus group or key informant interviews, using a standard set of questions. Thapproved
instrument appears at the end of this report.
A list of MD, DDS, and DVM researchers with K awards from the National Institutes of Health (NIH)
was provided by another NIH contractor for recruitment purposes. Catalyst originally planned to take arandom sample of current K awardees, but this list was not up-to-date and had many errors. Therefore,
names of K awardees were obtained from a search of the Internet, including specific NIH Institute sites
and/or university sites, as well as by referral from members of the Physician-Scientist Workforce
Working Group . This resulted in a convenience sample for the study.
One telephone-based focus group of four (4) MD/PhD K awardees (one K23 and three K08 awards) was
conducted in February 2014. The focus group lasted approximately 90 minutes. The focus group was
audio- taped and transcribed.
During February, March and April 2014, 13 key informant interviews were completed with physicianscientists and clinician-scientists with K awards.
Between the focus group and key informant interviews, 17 physician-scientists and clinician-scientists
with K awards were interviewed. The breakdown is as follows:◦

Three MD and four MD/PhD scientists with K08 awards◦

Three MD and two MD/PhD scientists with K23 awards◦

Two DVM/PhD scientists with K01 awards◦

Three RN/PhD scientists with K23 awards

Although Catalyst contacted individuals from a list of young dentist-scientists with K awards, we were
not successful in recruiting any dentist-scientists to the study.
In keeping with the definition adopted by the PSW-WG, the term “physician-scientist” is used in thisreport to refer to scientists with professional degrees, who have training in clinical care, and who are
engaged in independent biomedical research. Those who engage in this type of research could include
individuals with an MD, DO, DDS, DVM/VMD, or nurses with research doctoral degrees who devote themajority of their time to biomedical research.

115Summary of Common Themes Across All Groups
Across the board, each K awardees interviewed for this study desired to spend that the majority of his/hercareer as a physician-scientist. Not one was interested in pursuing a dedicated career in clinical practice;among this group, only the nurse-scientists had spent a significant portion of time solely in clinicalpractice, and they had done so at an earlier point in their careers. These early career investigators werefrustrated, however, with the precarious funding situation for physician-scientists and were resigned to thefact that they may end up pursuing a career as a clinician if they are not successful in procuring adequate
grant funding.
Since K awards are mentored research awards by definition, mentors were very important to these
physician-scientists. Mentors were defined in the K award proposal and are valuable assets to the Kawardees. Most of those interviewed reported that they had protected research time. In some institutions,some physician-scientists were asked to take on a greater share of clinical duties and that could be
problematic for the individual.
The physician-scientist track for those with a medical degree (MD, MD/PhD) was seemingly morecompetitive and less collegial than for those in other segments of the workforce (DVM, RN/PhD). While
team science was preferred by all, the physician-scientists felt that the academic medicine culture was notin tune with team science. Physician-scientists understood they needed to publish first-author papers to be
successful in competing for R01 awards and were less willing to share their data with others.
The physician-scientists interviewed for this study expressed anxiety about being under multiple running
clocks during their K award years. Within the timeframe of the K award (3-5 years), they need tosuccessfully conduct the proposed research, collect and analyze the data, publish as many papers as
possible, and write a successful R award application. Competing work demands, such as clinical,
teaching, and other responsibilities, can erode into protected research time.
Most physician-scientists with K awards were in the stage of life where they were married, with smallchildren. Work/life balance issues were quite pressing, particularly for the MD/PhD scientists who are invery competitive institutions.
Three-year K awards made it very difficult to finish data collection and publish in time to put in a
proposal for an R award. Five-year awards gave them more time to finish their research and amass needed
publications to be competitive for an R award.
Because physician-scientists with a medical degree and veterinarian-scientists were notably different fromnurse-scientists in terms of age and career history, the following analysis discusses these two groups
separately.

116

Physician-Scientists with a Medical Degree and VeterinarianScientists
Past Influences on Pursuing a Career in ResearchPhysician-scientists in this study reported that they became interested in research early in life, most often
before high school and college. The challenge and fascination with science and discovery is what
motivates them to continue in the research arena. They talked about wanting to find out something
unknown and apply it in practice. Physician-scientists want to do research that is relevant to human healthand disease; DVM/PhD scientists expressed a desire to do research relating to the human-animal bond.

Current Considerations about a Research Career
Each physician-scientist interviewed had mentors for the K award and were happy with their assigned
mentors, but most found additional mentors that they need for success, identifying these other mentors atwork, during scientific meetings, or by referral.
Most expressed fear and frustration about the possibility of not being able to continue their research
careers if they are not able to secure an R award. They expressed the fear that they have invested so muchof their adult life preparing to do scientific research and it could all be ended by not being successful withan R award. They have sacrificed both a lucrative clinical salary, as well as precious time in the hopes ofbeing able to continue to build a research career.
Although most stated that on paper they have 75 percent or more protected research time, in reality manyother things erode into that time, including clinical service time, academic responsibilities, teaching
residents, and mentoring journal club. If they have a KO8 award, there may be patient-oriented researchbuilt in, such as bench-to-bedside research elements. Even with a KO8 award, there are often clinicalresponsibilities.
Balance at work becomes more of an issue as time goes on. Clinical responsibilities never shrink andmost likely increase. Research time tends to increase as time goes forward. One needs to write more grant
proposals and write more papers to support applications. And the extra duties, such as teaching,mentoring, and presenting at conferences, tend to increase over time.
Since most K awardees are at an age where they are starting families or already have young families, thestresses of life start to increase at about the same time when the stresses of work and research are
increasing. Men and women both reported this. Women, in particular have more of a difficult time
because they reported having to make time for obstetric appointments, maternity leave, and childcare,which does not fit in well with a hectic research career. Supportive spouses are crucial to help with thework/life balance. The men in the focus groups did not report having major child care chores, other thantheir interest to be home in the evening early enough to have dinner with their family and help withbedtime childcare.
One woman reported:"If NIH could give us some information on their feelings and whether we shouldbe open about these things in light of women leaving research. ‘Tips for young
parents facing NIH challenges’ would be helpful! In my initial K23 application-117

- we draft our own letters of recommendation and then the mentors edit them.
Mine said look at all she has done while having 3 kids in 4 years. My
recommenders took ALL that out of my letters. It didn't make me ‘special. ’
There is then tension between having a slower trajectory because of maternity
leave, but not wanting to admit that you have these pressures. "Another frustration for younger physician-scientists is equity in pay. Salaries for physicians who areprimarily clinicians are often twice or more what a physician-scientist makes.
Most physician-scientists at this stage are attempting to procure grant monies from several sources, suchas foundations and other research organizations, to make up salary deficits and help pay for the costs
above what the K award covers, such as lab needs.
Dual degree and MD physician-scientists reported a sense that they may not be as successful as a PhDonly scientist in obtaining an R grant. All thought that combining clinical training and experience withresearch should be more valued.
One physician-scientist described the research system as a funnel: You start in medical school, thenfewer go to residency, fewer get a K award, and ever fewer get an RO1. He found this to be very
discouraging.
Student loan debt was reported as a big concern among the veterinarian-scientists.

Future Plans and Influences Regarding a Research Career
Most of the physician-scientists in this study would like to stay in research and are working diligently tomake that happen. They would also like to combine academics, research, and some clinical practice intheir careers; most would like to eventually move into a leadership position.
Typical comments include:"I love what I do with research, and can't see myself doing anything else. ""It is not a terrible thing to be, you know, an academic clinician, essentially an
educator, within my department and to just do that. I mean, you still get tointeract with fellows. You still get to teach and you make a reasonable salary. So
it wouldn’t be the worst thing in the world. It is definitely not, you know, what I
want to do. I would much rather be doing research. But if it came down to it, andI just couldn’t sustain my research with funding, then I think that would be theway I would go. I think I am definitely not going to quit. They will have to kickme out. "Recommendations for Strengthening the Physician-Scientist Workforce
Provide bridge funding, if needed. Several of the informants thought that the focus should be onretaining as many researchers as possible between the K award and the R awards. This is a time where
many promising researchers drop out if they do not get funded for an R award right after the K award
ends. This potential gap in funding is problematic and gap or bridge funding is needed. Some researchers
need a little more time to obtain funding to become an independent investigator.

118

Increase mentor collaboration. Bring K awardees together and give advice on research careers. Protect
mentor time. They are being asked to do too much, in many cases.
Consider the use of the K24 mechanism to not only train other clinical researchers, but to also mentor
new physician-scientists, regardless of the type of research they are doing.
Increase K08/K23 funding to cover research technicians. K awardees reported needing funding within
the KO8/K23 to pay for a research technician to keep continuity in the lab and keep the research going,
especially if they are pulled out to do clinical work. Oftentimes, the lab work stops if the physicianscientist has to do clinical or academic work.
Increase all K award to five years. Three years is not enough for a K award. K awards should be at least
5 years duration.
Define protected research time in hours, not percentages.
Score proposals for R awards from K awardees, rather than triaging them. NIH has put a lot of money
into K awards with the hopes that the physician-scientist will be successful in research. The young
physician-scientist has sacrificed time and potentially a better salary to stay in the research track. To beable to successfully reapply for an R award, the scores and comments are very helpful in resubmissions.
Increase direct support for veterinary research. The DVM/PhDs recommended, more direct supportof veterinary research that has a bearing on human health, as well as efforts to increase awareness of theavailability of NIH resources/awards to DVM scientists.
Increase loan repayment options for veterinarian-scientists.

Nurse-Scientists
Past Influences on Pursuing a Career in Research
Nurse-scientists in this study reported that they love to generate new knowledge and discovery. While
working previously as a clinical nurse or clinical nurse specialist, these individuals observed many
research questions that were not being answered. They initially decided to get a master’s degree and whilein graduate school, mentors encouraged them or they became interested in continuing on to earn a
research doctorate.
As one described her perspective:"I love knowledge generation and discovery. I totally embrace that I might not beat the bedside making an impact, but that research will make an impact. This canbe hard for nurse clinicians because most people don't become nurses to beresearchers. Medicine and research are tied together, but not as much innursing. It is changing a bit as we see younger nurses getting their PhDs. "These nurse-scientists reported that there isn't a pipeline at most universities to encourage promising
nursing students to consider and embark on a career in research. They also reported a absence ofprograms that spark an interest in nursing-related research prior to college.
Nurse-scientists tend to seek out their own mentors, based upon their research interests, even before theyreceived their K awards.

119Current Considerations about a Research Career
Nurse-scientists in this study were older when they decided to return to school to get a PhD. They firstworked as either a clinical nurse or clinical nurse specialist, and then went back to earn a PhD. They werein their 40/50s when they got their K award.
Work/life balance was definitely top of mind for those with children currently at home. They did reportthat they have support from their colleagues and are able to resolve any work/life balance issues that may
arise.
A three-year K award, which is typical for those from the National Institute for Nursing Research, is too
short of a time frame to get research up and running, collect and analyze data, and then write and get
manuscripts accepted in journals. Nurse-scientists reported that this has to be all done before one canwrite a successful proposal for an R award.
The K award does not always cover lab resources. Nurse-scientists in this study felt they needed more
support in the form of lab equipment and lab space. Lab assistants are also not covered in the K award.
Nurse-scientists have to carry a larger teaching load at universities to make up salary deficits from grantfunding. This can make it difficult to keep research projects moving forward. But other career options areless available:"Nurses who want a research career are tied to academia. Some large hospitals
are doing some nursing research, but not as much. "All of those interviewed liked the idea of team science. They felt they were in a collegial atmosphere
where team science works well. The nurse-scientists worked in an interdisciplinary atmosphere where
team science was being used.

Future Plans and Influences Regarding a Research Career
The nurse-scientists interviewed for this study would like to stay in the research arena and teach in auniversity research setting. If that does not work out, they said that they can always teach and fall back on
their clinical skills.
Some, but not all, have plans to apply for an R award, continuing the research they have started.

Recommendations for Strengthening the Physician-Scientist Workforce
Develop an intermediate grant that can serve as a bridge between the K award and the R grants.
The K awards provide the basis for the next grant, but it may be a big jump from a K23 to an R award.
Expand K awards to five years. Three years is too short to be able to publish and reapply for the next
funding grant.
Expand the K award to allow research funds to pay for laboratory-related expenses.
Institute team science in research funding opportunities. Encourage nurses and physicians to work
together in team science.

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Educate nurse-scientists about how to get research funding.

121Form Approved
OMB Number 0925-0648
Expiration Date 1/31/2015
Moderator Guide
Young Faculty
We’re exploring how physician-scientists like you think about their research career decisions, and we’dlike to ask you some questions about your experiences and the decisions you’ve made. The aggregate
findings will be used to inform the deliberations of the Physician Scientist Workforce Committee at the
National Institutes of Health about how to improve and support a sustainable and diverse physicianscientist workforce.
This focus group will last about 1½ hours.
A few ground rules for today’s discussion:
1. Please just use your first name in your introduction and discussion.
2. We want you to do the talking and we would like everyone to participate. I may call on you
if I haven't heard from you in a while.
3. There are no right or wrong answers. Every person’s experiences and opinions are important.
Please speak up whether you agree or disagree with what’s being said.
4. What is said in this conversation will be kept private to the extent allowed by law. That is, no
one person’s contributions in the focus group will be identified to the Committee, and we will
not provide any information from the focus group to your institution. Instead, the Committee
will be provided with aggregated information to help them in their deliberations. We want
you to feel comfortable sharing when sensitive issues come up.
5. We will be tape recording the group because we want to capture everything you have to say.
You will not be identified by name in the report so all comments will be anonymous. The
tape recordings and transcripts will be stored in a locked file cabinet until June 30, 2014 andthen they will be destroyed. If anyone objects to being taped, now is the time to remove
yourself from the group.
Any questions before we get started?
Public reporting burden for this collection of information is estimated to average 90 minutes per response, including the time forreviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing
the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, acollection of information unless it displays a currently valid OMB control number. Send comments regarding this burden
estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: NIH, Project
Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-0648). Do not return thecompleted form to this address.

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Then let’s begin. First, let’s go around and briefly introduce ourselves. Can you share with us
three pieces of information?:
1. Your first name
2. Your current family situation: single, married or in a committed relationship, parent (howmany children and their ages)?
3. Your primary area of research
Past Influences
1. What were the most important factors that made you originally think about pursuing a careerin research? (PROBE FOR: Exposure to research – family member/friend in research,
Mentor, Internship/summer fellowship program, college major; college vs. university setting)
2. Approximately when in your academic career did you make the decision that research might
be a good career choice for you? (PROBE FOR: approximate time if they tie the decision toan event. )3. Have you ever had a mentor/role model in research? If so, who? How did you find yourmentor?
Current Considerations
1. Just as you were making the decision to build a research career, what do you remember asappealing to you most about it?
2. Now that you have a research career in an academic center, what appeals to you most aboutit?
3. What are the current challenges you face in your career? (PROBE FOR: uncertainty offunding, balancing the demands of strong science and other professional demands; salary;work/family balance)
4. What would make it easier for you to continue to pursue a bio-medical research career?
(PROBE for: policy changes; changes in financial support)
5. When you observe physician-scientists around you at school or in the workplace, what do you
admire about them? What turns you off? (PROBE: How much would you like your career toemulate theirs? What, if anything, would you choose to do differently or would have chosen
to do differently in the past?)
6. What formal activities does your school provide to encourage promising students to pursue a
research career? (PROBE for: Research track? Formal mentoring program? Preceptor
programs? Internships? Technological approach? If programs exist, please describe them)
Future1. Where do you see yourself in 10 years? 20 years?
2. What kinds of things would you suggest to the Physician-Scientist Workforce Committee thatwould help strengthen the physician-scientist workforce?
Thank you very much!

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