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Influencing the Next Generation of Physician-Scientists

November 01, 2021
by Amy Anderson

There is not one set path to becoming a physician-scientist.

Some physician-scientists attend medical school and obtain their PhD as part of an MD-PhD program. Some obtain their PhD prior to medical school or later during clinical fellowship. Others go to medical school, while simultaneously conducting research outside of a formal program. But there is one common thread—the love for both clinical care and scientific research.

“At the end of the process, you learn how to multitask and combine both of them well—taking care of patients and working on medical discoveries that can help patients,” said Charles Dela Cruz, MD, PhD, associate professor of medicine (pulmonary, critical care and sleep medicine, Yale-PCCSM ). Dela Cruz was recently named program director of the ABIM (American Board of Internal Medicine) Physician-Scientist Research Pathway, part of the department’s Internal Medicine Traditional Residency Training Program.

“In addition to clinical training, you have to be trained for the research and learn to ask important questions, troubleshoot problems, write papers and grants, effectively build a research team, collaborations, and a successful gratifying career, and be known in that field while maintaining a work-life balance.”

As a physician-scientist himself and an alumnus of the program, Dela Cruz understands the challenges that come with a career in juggling both clinical medicine and research.

“Being a first rate clinician is hard enough, but you're also trying to keep up-to-date on your field of research and think about how to balance those two efforts. And Charles is somebody who's been successful at that and understands the challenges that come along with that, but he is able to do this in a way that is gentle, effective, and kind, and that makes him a perfect person for this role,” said Mark D. Siegel, MD, professor of medicine (pulmonary) and program director of the Internal Medicine Traditional Residency Training Program.

Prior to Dela Cruz’s appointment, the program director role had been held from 2012 until 2021 by physician-scientist John Wysolmerski, MD, professor of medicine (endocrinology) who recently was named chief of the Section of Endocrinology & Metabolism.

Together, Wysolmerski and Siegel worked to establish a separate match process with a separate two-day interview process that would allow prospective physician-scientists to better explore the depth and breadth of scientific opportunities at Yale, as well as to explore their medicine subspecialty interests when they interviewed for residency. This process also provides a number of guaranteed physician-scientist spots in the residency each year. Currently, the program interviews 60-70 applicants and recruits six individuals into the training track each year.

A unique aspect of the track is that it guarantees fellowship, something that is not found in all programs. Recruiting a physician-scientist is a bigger commitment than categorical residents because the training involved leads to fellowship in a subspecialty, followed by post-doctoral research training, all to prepare individuals for investigative careers in academic medicine.

“The program is essentially designed to be an intern to faculty ladder,” said Wysolmerski. “Our goal is to attract the best and brightest budding investigators into our residency, provide them with outstanding clinical and research training, and then help them become faculty members at Yale.”

The ABIM Physician-Scientist Research Pathway was established in the 1970’s, and has since evolved to become an important mechanism by which the department attracts aspiring physician-scientists to come to Yale and develop into the next generation of junior faculty.

Over the last decade the program has increasingly become an important source of junior faculty for the Department of Internal Medicine. “We have recruited very talented physician-scientists to our program, many of whom are making names for themselves as faculty,” said Siegel.

Another advantage of the program is the opportunity for physician-scientist residents to serve as important role models for students and fellow residents on the wards. Wysolmerski notes, “We wanted to create an atmosphere where students or other residents who may not have had extensive prior research experience get excited by a potential career that combines clinical care with investigation. However, for a variety of reasons, the evolution of academic medicine has led to a diminishment of the participation of active physician-scientists on attending in the general medicine wards. So for both peers and students—having a cadre of trainees who can talk about molecules or clinical trial design, as well as practice guidelines, is really important in an academic medical center.”

Over the last decade, Yale School of Medicine (YSM) has increased support and resources to encourage physician-scientist careers.

“Fewer MDs are choosing careers in research, but physician-scientists are a very important part of the research workforce because they bring a unique perspective. PhD scientists are extremely talented and do fantastic work, but can’t bring clinical training or patient care experience to inform their research activities as can physician-scientists,” said Peter Aronson, MD, C.N.H Long Professor of Medicine (nephrology) and associate director of the MD-PhD Program at Yale School of Medicine (YSM).

Aronson, a physician-scientist as well, was director of the Physician-Scientist Research Pathway from 2006-2011, preceding Wysolmerski.

“There has been a tremendous expansion of opportunities with all the advances in science, both basic science, as well as clinical and translational science, and handling large data from clinical databases. There are new methods that were not available decades ago, so research opportunities have never been better, but the technical training required is more extensive,” said Aronson.

In addition to the time restraints of managing a career in both clinical care and research, there are several factors that can affect the success of becoming a physician-scientist. One of the major factors that impede one's success is the uncertainty of securing funding. And adding the challenges of work-life balance into the equation makes it more difficult.

The demands that go along with a physician-scientist career can present themselves long before becoming established and completing a program. These demands include having to juggle clinical service and research projects, publish well and secure stable grant funding, obtain medical competencies and board certification, while having competing personal and familial responsibilities.

One of Dela Cruz’s goals as director is to work on a pipeline for the track to help prospective physician-scientists succeed.

“There are many talented trainees who are interested in combining medicine and research for their academic career, and for these potential physician-scientists, we should fully commit and help them to make this happen and to make this process better. For example, during this COVID-19 pandemic, many physician-scientists who are on their K awards in their transitions received bridge funding. This sends the message to the early career physician scientists that the institution is fully supportive of their efforts.”

Back in March 2020 when COVID hit and laboratories started shutting down, physician-scientists’ careers were at risk. They spent their time caring for patients in the hospital, as all research activities ceased. This created financial gaps for many investigators, until Yale School of Medicine (YSM)’s Dean Nancy Brown announced a program in August of the same year to offer gap funding to support junior investigators.

Dela Cruz wants to be upfront and honest about such challenges. He is planning to organize talks that feature guest speakers from both the Janeway Society and YSM’s Dean's Office of Physician-Scientist and Scientist Development, led by Keith Choate, MD, PhD, associate dean for physician-scientist development and professor of dermatology, pathology and genetics.

“The hope of these talks and other activities is to provide career mentorship, networking, and encouragement,” said Dela Cruz.

Looking forward, Dela Cruz says one of the most exciting aspects of his new role is the involvement in physician-scientists' early careers, helping individuals find their motivation and passion, and ultimately, helping them succeed in achieving their dreams to discover, to be effective leaders in their field, and more importantly—to help patients.

Submitted by Amy Anderson on November 01, 2021