Changes are occurring rapidly in academic medical centers, driven by financial (managed care), technological, and sociologic factors [1], [2]. The physician-scientist has traditionally been expected to have a modest clinical practice, a dedication to teaching, and more often than not, an independent basic research laboratory. At major research medical schools, extramural funding such as from the National Institutes of Health is expected to be secured by most assistant professors. However, over the past 20 years, the number of physician-scientists has actually declined as described in a recent article by Rosenberg [3] and corroborated by others [4], [5]. Multiple factors, including increased clinical responsibility and documentation, highly competitive extramural funding, and monetary pressures from student loans are likely responsible for the diminished interest in pursuing clinical basic science [6], [7].
Other less well-acknowledged factors may be the initial laboratory experience. Excluding formal M.D.s and Ph.D.s, research experience is most often first performed during residency or fellowship. This initial experience, often of 1 to 3 years’ duration, sets the stage for future endeavors and the value of which is directly related to the mentor’s project and guidance [8]. These critical early years as a first time researcher or as a junior faculty, is where the physician-scientist is either able to get a productive laboratory and independent extramural funding, or fails.
In response to the “vanishing physician-scientist,” this proposal outlines a partial, but concrete solution to improve the laboratory experience for the first time researcher, as well as starting junior faculty. Simply, this proposal outlines a formal, voluntary, and direct collaboration between intrainstitutional (eg, biomedical departments) junior and senior physician scientists and basic biomedical researchers in a manner that can be likened to a clinical service—where the junior faculty member or research resident is an “intern” and the established physician-scientists or biomedical researchers with particular expertise (specialties) act as the consultant senior resident. Put another way, this is a voluntary arrangement where the junior faculty has at his/her disposal a catalogue of resource investigators to “jump start” the research effort and bypass many of the frustrations of reinventing the wheel each time a new method or assay central to their research effort is needed. Furthermore, this proposal is not necessarily one for intensive mentoring, which while of clear benefit is harder to arrange and takes a much greater time commitment from the senior investigator.
The specifics of the collaborative arrangement should be as follows: (1) a printed booklet or website, or both, with overview of each investigator’s laboratory in the biomedical center, the personnel in their laboratory, current techniques and assays used, and pertinent available equipment; (2) a selected bibliography and current grant funding; (3) an entirely voluntary and agreed to be short-term, technically oriented collaboration (perhaps 1 to 3 months, depending on the methodological question); and (4) updated information on a 6-month basis. This information should be distributed to all fellows and residents in research, junior faculty, and department heads. It is important to emphasize this must be a strictly voluntary arrangement, with the senior faculty understanding that personal contact and some time commitment is necessary. The liaison would be between basic biomedical senior scientists (Ph.D.) or well-established physician-scientists that have an active laboratory effort and the junior faculty or first time resident researcher under the guidance of their mentor. The senior scientist’s laboratory technician may be a proxy for the specifics of the assay or method, but the initial contact is with the senior primary researcher.
The collaboration would not be a fee-for-service system and is not a way to eliminate the learning and lessons of independent research. The excitement of research is the thought processes that go into analyzing a particular phenomenon, the experimental organization, and setting of proper controls to address a specific hypothesis. This collaboration must not undermine any of these things. All that is required to start this is a mandate from the dean for such a voluntary program and a secretarial coordinator to promote the contacts, paperwork and website.
How will this system benefit the young investigator? First, direct human contact to clarify modifications on an established laboratory technique is invaluable and saves much time. The senior investigator often has a technically demanding assay up and working with the unmentioned critical little details often learned only by trial and error and not generally printed in method texts. These are discussed and can be responded to in real time. Secondly, the young investigator can get the benefit from knowing what manufacturers have the most reliable products; what works, what does not, and where to buy certain materials. Further, the young investigator has the opportunity to further discuss the assay after initial attempts and to further troubleshoot and focus modifications on what are the likely problems. It does not imply that the new trainee/investigator is solely “spoon fed” because again, the hard part of scientific investigation is evaluation of the current literature, the design of the experiment, and analyzing the data produced.
An idealized example will clarify the usefulness of this proposal. A junior faculty desires to get preliminary data for a grant proposal, has start up funding and an inexperienced technician. A specific cellular based assay is critical for the experimental data but neither the junior faculty nor the technician has performed it. The junior faculty reviews the local resource website and identifies an investigator who is currently running the assay. A contact is made between the junior faculty and the established investigator. A mutual time is set up for the junior faculty to meet with the primary technician who is running this, and observation and the details of the assay are learned. The junior faculty then takes this protocol back to their own laboratory and the assay is run. However, it does not work. The junior faculty contacts the established investigator and they troubleshoot what was done. With this new information, the assay is repeated and now works. The collaboration is now complete and the junior faculty has saved potentially many months of frustration in assay development. Obviously, this latter troubleshooting may take some time and several contacts before the methodological steps are worked out between the two participants.
The benefit is a two-way street. The more established investigator makes a new creative professional contact and has a potential collaborative arrangement for the future when the young investigator gets up and running with their independent research. The senior investigator garners a way to meet and discuss the junior investigator’s project, may stimulate a new direction for that senior investigator and they derive personal satisfaction from helping and mentoring a young investigator in an externally defined agreement. However, it does not force a prolonged undefined mentor relationship that may be nonproductive and uncomfortable.
An analogy to the practice of clinical medicine further illustrates the appeal of the proposal. Patient care is improved when a team approach is taken for a complex problem. A patient with multiorgan failure from an unknown cause benefits from physicians of various specialties coming together to solve the problem. Too many consultants are not always good for the patient, but in the role of teacher or expert, they have the ability to save time, money, and lives knowing which tests are important and what is the most direct way to solve a specific patient problem. As is the standard training in graduate surgical education, the intern or young trainee physician does not have to reinvent the wheel when first encountering a new patient problem. The young trainee consults a senior resident who has often experienced the same clinical scenario and can save them much time and frustration and furthermore, benefit the patient in question. While most any physician can find a text to help with a clinical problem, nothing can take the place of experience and doctor to doctor contact.
Arguments for collaboration inside a rapidly changing health care system are even more sensible. First, a decrease in graduate medical education trainee reimbursements and less clinical practice money for research projects is declining even now [1], [2]. Already faculty practice plans help support the resident’s (or fellow’s) time in the laboratory if extramural training grant funds are not acquired. Faculty time for research outside of clinical activities have been further reduced as HFCA requirements of increased documentation and supervision, essentially perfect compliance with procedures where much reimbursement derives. Thus, ways to make the laboratory run more efficiently are certainly essential to all involved.
A special benefit is the cost savings for each laboratory when wasted time and money on developing assays are eliminated. Furthermore, increasingly advanced technology is getting harder to master. This is especially the case with such techniques as site-directed mutagenesis, quantitative real time polymerase chain reaction and hybrid yeast systems. These complex techniques take time to learn but are powerful tools commonly needed in today’s best science. The collaboration may also stimulate a more cohesive intrainstitutional biomedical community and these multidisciplinary approaches are being more favored by governmental funding agencies such as the National Institutes of Health. This proposal really only formalizes and promotes the communication between junior and senior investigators that now often relies on chance, serendipity, and luck.
Improving the first time experience for a resident/fellow, and decreasing the frustration for the junior faculty by having a formal system in place to communicate the technically important points of assays and techniques may help diminish the alarming decrease in physician-scientists. As more government money is allocated to fewer biomedical institutions [9], those with the most productive researchers will clearly benefit the most. Hopefully, this small but concrete plan will help stem the tide such that more junior faculty and first time researchers will persist with research endeavors that are the foundation of future medical progress.
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