Job Outlook for Physician-Scientists

Susan Voglmaier describes herself as "the last one standing" in academic medicine from a residency class that included six M.D.-Ph.D. students. Voglmaier, a new assistant professor of psychiatry at the University of California, San Francisco (UCSF), is the only one of the six to choose a career in academic medicine. The others are either working in private practice or working in pharmaceutical industry jobs.

Voglmaier's M.D.-Ph.D. colleagues chose other career paths despite the fact that prospects in academic research are excellent for the approximately 500 M.D.-PhD. graduates who emerge each year from an arduous 9- to 10-year training period and decide to stay in academia. In stark contrast to many areas of academic science, researchers with clinical degrees have good jobs waiting for them at the end of their long roads, say administrators at the nation's academic medical programs. "The positions are there," says Richard Rudick, vice chair of neurology at the Cleveland Clinic Lerner College of Medicine of Case  Western Reserve University. The problem is that "there's somewhat of a lack of qualified applicants for those positions."

Rudick's experience corroborates from the results of a survey of 837 clinical department chairs conducted by the Association of American Medical Colleges (AAMC) in 2005 and published in 2007. Nearly two-thirds of the responding department chairs reported having junior faculty openings. More than half (52%) of those with openings reported that they were not able to fill all their open positions.

The issue is two-pronged. For those with very marketable degrees in clinical medicine, the lure of private practice and industry can be strong; three of Voglmaier's colleagues opted for research careers in the pharmaceutical industry, whereas the other two chose private practice. Deeply committed scientists like Voglmaier are proving hard to find as attrition exacerbates a shortage of clinicians interested in academic research careers. But the second and perhaps deeper problem is that "there simply aren't enough of them," says Lawrence "Skip" Brass, associate dean at the University of Pennsylvania (Penn) School of Medicine . Brass recently led another AAMC survey, this one of M.D.-Ph.D. graduates, to find out where they end up and to assess the pipeline of trainees.

All told, there seems to be a surplus of training slots for physician-scientists and plenty of job openings for clinicians who want to do research. That means excellent career prospects in academic medicine. But that doesn't mean that finding the right job is easy. The usual problem of matching the candidate to the opportunity still applies. Despite a happy outcome, Voglmaier herself is a good example of how the struggle to find the right position can play out. "Although there are many departments that do great clinical research, the pool of those that support basic research, which is what I do, is much smaller," she says. 

The results of the AAMC survey, which are still being prepared for publication, suggest that nationwide, a steady but inadequate number of students are enrolled in the 110 M.D.-Ph.D. programs, which are designed to prepare the next generation of clinical and translational researchers. Out of about 500 annual graduates, some 400 choose careers in research, about 270 of those in academic medicine. Considering all the medical subspecialties that exist, Brass says, attrition leaves a very limited talent pool in any one area.

The AAMC's numbers corroborate what has become conventional wisdom among program directors: Not enough people are choosing to go the M.D.-Ph.D. route. Last summer, at a meeting of M.D.-Ph.D. program directors, Brass reports that someone asked, "Who felt they had the resources to train more M.D.-Ph.D. students but weren't getting enough qualified candidates?" "Hands went up all over the room," Brass says.

This pipeline problem has mobilized the M.D.-Ph.D. program directors, Brass says. Most are developing outreach efforts geared toward demystifying translational-research career options for college students. Brass says that a major selling point for M.D.-Ph.D. programs is that the odds of having a meaningful career as a physician-scientist are quite high compared with Ph.D. scientists in other fields, in which competition for jobs in basic science departments is intense.

Many of those who complete the M.D.-Ph.D. process, which typically takes 7 to 8 years and is followed by a 2-year medical residency, end up choosing among several job offers. Still, every physician-scientist career has a unique balance of clinical and research duties, so it can be challenging to find a position that's a good fit for a clinician's practice and research specialty. Daniel Cahill, a surgical resident at Harvard Medical School in Boston, found that as a neurosurgeon who also conducts translational research, he had his pick of jobs. But he estimates that no more than 10 institutions in the United States offered an environment in which he would have time to do research in his specialty--the genetics of brain tumors--as well as surgical practice.

"The tricky part is trying to find a place where you can get general exposure to patients and focused, protected [research] time," says Cahill. "You have to balance how you are going to set all that up. You have to be successful in the lab, but by the same token, a major part of your research is driven by the care of patients. So you have to find a way to do all of that and still be able to sleep."

Source: Science Magazine, Karyn Hede, 12/5/08