In Need of the Clinician-Scientist
Nicholas L. Tilney, Brigham and Women’s Hospital, MA, USA
Clinician-scientists have advanced modern transplantation and its associated biologies since the inception of the field. Although those with abiding interests were able to produce what they did for decades, higher hurdles currently face young academics. Throughout much of the history of the subject, clinical and basic investigators – not infrequently the same people - accepted research fellows into their laboratories because of their enthusiasm, energy, and technical skills. With research funding for the burgeoning subject relatively easy to obtain, many trainees returned to their hospitals, started their own programs, continued their investigations, and educated their own fellows to care for complex patients with organ failure and to answer questions from the bedside with experimental models. This productive scene began to shift in the late 1980s, however, with growing concerns about health care delivery, ballooning medical costs, and deficiencies in resident training overshadowing ongoing advances in applied sciences. Indeed, more than a few experienced leaders warned that clinician/scientists were becoming an “endangered species.”
As a result of these and other dynamics, young physicians and surgeons brought up in the new atmosphere are deprived of relevant scientific nourishment in their daily activities. They are forced to become business-oriented technicians, investing their creative energies in overseeing clinical trials sponsored by pharmaceutical companies, involving themselves in management training, and expending energy in outcomes research – subjects foreign to the traditional “triple threat” of clinicians, teachers, and investigators. They perceive, correctly, that declining NIH funding, excessive clinical burdens, and inadequate mentorship have become barriers to more traditional research careers (1).
But the field of transplantation remains too exciting to sink under all this gloom and doom. Despite serious the challenges facing them, talented and inquisitive individuals continue to investigate successfully the fascinating scientific possibilities surrounding the subject. Indeed, professional meetings remain packed with enthusiastic researchers presenting compelling data. Changes in the existing system, however, may be needed to ensure continued progress (2).
1) Englesbe MJ, Sung RS, Segev DL. Young transplant surgeons and NIH funding. Am J Transplant 2010, 11:245.
2) Crow MM. Time to rethink the NIH. Nature 2011, 471:569.