The Vanishing Physician-Scientist?

1. The Vanishing Physician-Scientist? Andrew I. Schafer Chairman, Department of Medicine Weill Cornell Medical College Indiana University School of Medicine April 26, 2011

2. Physician-Scientists • Conduct medical research along entire continuum • Devote majority of effort to research • Vital and unique role in medical research enterprise

3. Original “endangered species” article:

5. Evolving Role of Physicians in Medical ResearchThe 19th Century and Earlier • Physicians make most major contributions to medical knowledge

6. Evolving Role of Physicians in Medical ResearchThe 19th Century and Earlier • Physicians make most major contributions to medical knowledge Andreas Vesalius(1514-1564) Founder of Modern Human Anatomy Foundation of medicine as “observational science”

7. Evolving Role of Physicians in Medical ResearchThe 19th Century and Earlier • Physicians make most major contributions to medical knowledge • William Harvey (1578-1657) • Foundation of medicine as “functional science”

8. Evolving Role of Physicians in Medical ResearchThe 19th Century and Earlier • Physicians make most major contributions to medical knowledge • Claude Bernard (1813-1878) • Founder of modern experimental medicine

9. Evolving Role of Physicians in Medical ResearchThe 19th Century and Earlier • Physicians make most major contributions to medical knowledge • Rudolph Virchow (1821-1902) • Cellular basis of disease

10. Evolving Role of Physicians in Medical ResearchThe 19th Century and Earlier • Physicians make most major contributions to medical knowledge • Robert Koch (1843-1910) • Germ theory of disease

11. Evolving Role of Physicians in Medical ResearchThe 19th Century and Earlier • Physicians make most major contributions to medical knowledge • Louis Pasteur (1822-1895) • (Chemist) • Germ theory of disease

12. Evolving Role of Physicians in Medical Research1890s - 1930s • Dramatic rise of science and research in medicine • Science becomes integral to medical education • Inspired by clinical observations “bedside to bench” • Research labs located in hospitals

13. Evolving Role of Physicians in Medical Research1930s - WWII • Dramatic therapeutic advances heighten glamour of medical research • Rising public opinion of medical research • Philanthropy • Physicians (and increasing number of PhDs) doing basic research that is becoming more detached from clinical relevance • Interrupted by WWII, when researchers support war effort by returning to applied work

15. Evolving Role of Physicians in Medical ResearchWWII – 1970s • “Golden Age” • Vannevar Bush: primacy of fundamental research

16. Vannevar Bush

17. SCIENCE: THE ENDLESS FRONTIER Vannevar Bush A Report to the President by the Director of the Office of Scientific Research and Development United States Government Printing Office, 1945

18. Evolving Role of Physicians in Medical ResearchWWII – 1970s • “Golden Age” • Vannevar Bush: primacy of fundamental research • Burgeoning of NIH: strong basic sciences orientation

19. Dedication of the New NIH Campus in Bethesda 1940, FDR

20. Evolving Role of Physicians in Medical ResearchWWII – 1970s • “Golden Age” • Vannevar Bush: primacy of fundamental research • Burgeoning of NIH: strong basic sciences orientation • PhDs flood medical research arena • Age of “triple threat” MD

21. Evolving Role of Physicians in Medical Research1970s - • Basic and applied research becoming polarized • Mounting pressure from Congress and public advocacy groups for practical payoff in conquest of disease • “Bench to bedside”

22. Evolving Role of Physicians in Medical Research1980s - • Rising concern about future of physician-scientist • IOM, NIH, AAMC reports on “clinical” research

24. PhD Percentage Increase in First Time R01 Applicants (1998-2003)

25. Percentage Increase in First Time R01 Applicants (1998-2003)

26. Percentage Increase in First Time R01 Applicants (1998-2003)

27. 1980 Sources: IMPAC II Current and History Files and AAMC Faculty Roster September 2007, Age Distribution of NIH RPG Investigators and Medical School Faculty

28. 1981 Sources: IMPAC II Current and History Files and AAMC Faculty Roster September 2007, Age Distribution of NIH RPG Investigators and Medical School Faculty

29. 1982 Sources: IMPAC II Current and History Files and AAMC Faculty Roster September 2007, Age Distribution of NIH RPG Investigators and Medical School Faculty

30. 1983 Sources: IMPAC II Current and History Files and AAMC Faculty Roster September 2007, Age Distribution of NIH RPG Investigators and Medical School Faculty

31. 1984 Sources: IMPAC II Current and History Files and AAMC Faculty Roster September 2007, Age Distribution of NIH RPG Investigators and Medical School Faculty

32. 1985 Sources: IMPAC II Current and History Files and AAMC Faculty Roster September 2007, Age Distribution of NIH RPG Investigators and Medical School Faculty

33. 1986 Sources: IMPAC II Current and History Files and AAMC Faculty Roster September 2007, Age Distribution of NIH RPG Investigators and Medical School Faculty

34. 1987 Sources: IMPAC II Current and History Files and AAMC Faculty Roster September 2007, Age Distribution of NIH RPG Investigators and Medical School Faculty

35. 1988 Sources: IMPAC II Current and History Files and AAMC Faculty Roster September 2007, Age Distribution of NIH RPG Investigators and Medical School Faculty

36. 1989 Sources: IMPAC II Current and History Files and AAMC Faculty Roster September 2007, Age Distribution of NIH RPG Investigators and Medical School Faculty

37. 1990 Sources: IMPAC II Current and History Files and AAMC Faculty Roster September 2007, Age Distribution of NIH RPG Investigators and Medical School Faculty

38. 1991 Sources: IMPAC II Current and History Files and AAMC Faculty Roster September 2007, Age Distribution of NIH RPG Investigators and Medical School Faculty

39. 1992 Sources: IMPAC II Current and History Files and AAMC Faculty Roster September 2007, Age Distribution of NIH RPG Investigators and Medical School Faculty

40. 1993 Sources: IMPAC II Current and History Files and AAMC Faculty Roster September 2007, Age Distribution of NIH RPG Investigators and Medical School Faculty

41. 1994 Sources: IMPAC II Current and History Files and AAMC Faculty Roster September 2007, Age Distribution of NIH RPG Investigators and Medical School Faculty

42. 1995 Sources: IMPAC II Current and History Files and AAMC Faculty Roster September 2007, Age Distribution of NIH RPG Investigators and Medical School Faculty

43. 1996 Sources: IMPAC II Current and History Files and AAMC Faculty Roster September 2007, Age Distribution of NIH RPG Investigators and Medical School Faculty

44. 1997 Sources: IMPAC II Current and History Files and AAMC Faculty Roster September 2007, Age Distribution of NIH RPG Investigators and Medical School Faculty

45. 1998 Sources: IMPAC II Current and History Files and AAMC Faculty Roster September 2007, Age Distribution of NIH RPG Investigators and Medical School Faculty

46. 1999 Sources: IMPAC II Current and History Files and AAMC Faculty Roster September 2007, Age Distribution of NIH RPG Investigators and Medical School Faculty

47. 2000 Sources: IMPAC II Current and History Files and AAMC Faculty Roster September 2007, Age Distribution of NIH RPG Investigators and Medical School Faculty

48. 2001 Sources: IMPAC II Current and History Files and AAMC Faculty Roster September 2007, Age Distribution of NIH RPG Investigators and Medical School Faculty

49. 2002 Sources: IMPAC II Current and History Files and AAMC Faculty Roster September 2007, Age Distribution of NIH RPG Investigators and Medical School Faculty

50. 2003 Sources: IMPAC II Current and History Files and AAMC Faculty Roster September 2007, Age Distribution of NIH RPG Investigators and Medical School Faculty