Because of decades of decreases in research funding, physician-scientists are an endangered species in the medical world. Now, COVID-19 presents a further threat to their ability to fulfill their dual mission. A Yale physician-scientist has conducted a survey on the pandemic’s impact on this rare breed; preliminary analysis indicates that the research of women physician-scientists is the most threatened.
“We need physician-scientists now more than ever,” says Yale Clinical Fellow Jennifer Kwan, MD, PhD. Dedicated to research, physician-scientists can conduct it with knowledge gained from being practicing clinicians. Their numbers have dwindled because funding for physician-scientists has not recovered since the 2013 federal budget sequestration. This measure saw NIH funding slashed across the board, thereby decreasing the number of academic appointments that allow for both protected research time and clinical practice. “These are going to be people who will help bridge the gap in understanding between basic science and translating that into therapeutics, vaccines, prevention,” says Kwan. “It is alarming that this cohort is actually declining.”
With the support of the American Physician Scientists Association (APSA), Kwan conducted a national survey this spring of more than 2,000 members in the field, ranging from current MD-PhD students to mid- and late-career researchers. The survey paints a picture of the choices physician-scientists make; the challenges they face; and how they are affected by the pandemic. Almost a third (30%) of survey responses came from residents, fellows, and junior faculty, all of whom are at a “fork in the road” when it comes to determining the trajectories of their careers.
Early analysis of the responses shows that women face additional challenges, Kwan says. “One of the biggest things that people noted at the resident and junior faculty level was the need for child care,” says Kwan. She points to recent external sources that show declining numbers of publications among women, while publications among men are on the rise. “Women have expressed [that] they have taken on the brunt of child care and homeschooling responsibilities. That is something funding bodies have to look at, or we will lose a whole generation of female scientists when they are particularly vulnerable.”
Other results: 35% of respondents say that they have experienced financial consequences due to the pandemic, leading many to seek work that does not include research, such as full-time clinical work. In addition, 22% report being unsure about their future job security, as institutions resort to hiring freezes.
Young physician-scientists are also bracing for the impact of COVID-19 on their mental health, with post-traumatic stress disorder a potential concern. Half the respondents report signs of stress, anxiety, and depression as a result of the pandemic, with many highly concerned for their own health as well as the health of their families. Yet only 49% are engaging in such activities as meditation to relieve their stresses and protect their mental health.
The study has yielded some insights as to how institutions might support physician-scientists, with strategies including resetting their tenure clocks (reported by 25%), as well as extending funding periods. About 4% of respondents have received hazardous duty pay as a result of working with COVID-19 patients—a practice that should be expanded, says Kwan.
The decline in the number of physician-scientists is having an impact on research into COVID-19 as well. “As a clinician, you see the problems your patients are facing with the disease,” says Kwan. “They have noted in practice that young, otherwise healthy patients are having massive strokes or major heart attacks. They can take what they observe and go back to the bench.” At Yale, Kwan is part of a research group that is investigating why the COVID-19 virus is deadlier in patients with coronary disease and histories of cancer.
Kwan also notes that trainees are also hard hit by COVID-19, as clinical rotations, research and volunteer opportunities, and standardized tests have been canceled with no clear plans yet to resolve this situation. “It’s an uphill battle to pursue a physician-scientist career, even after they go through all the training to become one. They want to do it, but the chips are stacked against them given the current climate.” Despite their best efforts, many budding researchers will make the choice to abandon research. “It’s incalculable in terms of the potential value that research could have provided, because it was lost.”