How Medical Education Can Revive the Physician-Scientist Pipeline

The physician-scientist has long occupied a unique place in medicine — bridging the laboratory and the clinic, translating scientific discoveries into innovative patient care. But that role is becoming increasingly rare. The number of physicians involved in research has steadily declined over the past 50 years, raising concerns about the future of a workforce critical to improving human health.

A new study from Yale School of Medicine (YSM), published in JAMA Network Open, seeks to understand how the physician-scientist pipeline begins — and where it may be faltering. In a national analysis of more than 1,100 first-year medical students, Sarwat Chaudhry, MD, Alexandra Hajduk, PhD, MPH, and their colleagues looked at the factors that influence early interest in research careers. Their findings, from the ongoing NIH-funded Longitudinal Evaluation of Research Career Intentions Among Medical Students (LEAP) study led by Chaudhry and Dowin Boatright, MD, a physician-scientist at NYU Langone, suggest that these career paths are not fixed and can change earlier in training than previously thought.

For Chaudhry, professor of medicine (general internal medicine) and associate dean in YSM’s Office of Student Research (OSR), and Hajduk, research scientist (geriatrics) and deputy director of scientific affairs in OSR, the urgency of the question is grounded in experience.

Physician-scientists, Hajduk explains, bring a perspective that is not easily found elsewhere in medicine. “Their expertise spans two worlds, clinical medicine and research, and that’s an invaluable quality,” says Hajduk, who is also co-director of the YSM pre- clerkship course that introduces first- and second-year medical students to research methods.

However, with fewer than 2% of physicians choosing the physician-scientist pathway, this supply is dwindling, prompting a broader question: What can be done, even at the earliest levels of medical education, to encourage research career intentions?

Much of the existing research on physician-scientist development has focused on MD-PhD trainees, a small group of students who go through a competitive selection process and commit early to an average of seven to nine years of medical training to begin their careers. However, MD-PhD graduates represent only a fraction of the field.

“MD-PhD students make up about 3% of medical students,” Hajduk says, “but about 50% of physician-scientists emerge from the traditional MD pathway.” The LEAP study focuses on that broader group, asking how research interest develops among students who have not yet committed to a joint MD-PhD.

The initial findings from the study indicate that interest in research develops through experiences that start before medical school and continue during medical school. Many students enter medical school with prior exposure through research programs, authorship, or presentations, but these experiences do not always result in sustained interest.

“There appears to be a confluence of effects that span both pre-matriculation experiences and what happens during the first year that impact early research career intentions among medical students,” Hajduk says.

Chaudhry, Hajduk, and colleagues aim to identify the factors that sustain research interest throughout medical school among students who enter with early interest, as well as the experiences that spark research interest among students who begin medical school without it.

For example, in the study, students from groups historically underrepresented in medicine were slightly more likely to express early interest in research careers — 28.2% compared to 23.9% of their peers. “Our continued research can help us discern why certain students arrive with research curiosity and what we can learn from that to encourage and cultivate the interests students find along the way,” Hajduk says.

What happens during medical school may play an important role in determining whether students pursue the physician-scientist path. Mentorship and exposure to physician-scientist role models play a central role early on, helping students understand how research is conducted and what a career in the field can look like.

“If students are not seeing how physician-scientists function across the realms of their scientific, educational, and clinical roles, it’s impossible for them to visualize themselves in that role,” says Chaudhry. “Yet, at the same time, physician-scientists are less present in inpatient wards where most clinical training occurs due to a confluence of factors related to the clinical and research environments.” This is a loss, she explains, since many research questions stem from observations made at the bedside.

In her role as associate dean of Student Research, Chaudhry promotes efforts to engage all students in research early in their training.

“We see many students who may not have envisioned themselves in research, but after completing an immersive research experience, that can shift. Students acquire the research skills that impart a sense of ‘I can do this’ and learn about the fulfillment that a physician-scientist career can offer.”

As the LEAP study continues, researchers will follow how students’ intentions change during medical school. Early signs suggest that they are far from static.

“This is a dynamic process,” Hajduk says. “Students’ interest in research isn’t fixed — it’s changing in response to the experiences they have, and those early experiences may ultimately shape whether they see research as part of their path, and if they go on to drive the discoveries that shape patient care.”