So You Want To Be A Physician Scientist?
Physician Scientist. Did that job title catch your eye? This medical profession, unbeknownst to many, is actually one of the foundations of contemporary health knowledge. Without physician scientists, antibiotics, insulin medication, organ transplantation, open-heart surgery, vaccines, genetic knowledge, and much more would not be available to us today. What makes the creators of these medical breakthroughs physician scientists is the way that they used their knowledge of the convergence between research and medicine to change the way healthcare looks like today. Generally, physician science is delivering patient-care through research and discovery — using the combination of medical and scientific knowledge to connect biomedical research findings to healthcare applications. In this “So You Want To Be” series post, we will explore what a physician scientist is, the educational pathways required to pursue a career in the field, and the pros and cons of choosing to become one of them.
What is a Physician Scientist?
A physician scientist, also known as a clinician scientist or clinician investigator, is a highly-specialized physician who has pursued further research training which allows them to, in addition to working in clinical settings, place a significant emphasis on research and discovery within their career. They work with both clinical physicians and different types of scientists to implement what is learned in laboratories in clinical settings, bridging the gap between the two areas of science and medicine. This translation of scientific data into clinical practice is what makes these individuals integral to the discovery and application of health-related knowledge.
Due to the duality of their careers, the role of physician scientists varies from a patient’s bedside to the researcher’s bench. When in clinical settings, they have the responsibilities of typical physicians including conducting patient histories and physical examinations, ordering and interpreting diagnostic tests, diagnosing and treating illnesses, prescribing medication, and observing/monitoring their patients’ conditions for indications of change. As physician scientists conduct research, though, they are required to develop and test potential therapies; treatments; and preventative measures, detect threats to human health, guide policy decisions related to their research such as treatment approvals, supervise and collaborate with scientific staff and/or organizations, and maintain laboratories. Unitedly, these responsibilities work together to allow physician scientists to develop research questions based on the clinical issues they face and, as mentioned, translate research findings into the healthcare applications that will resolve them. This makes these physicians a critical part of the medical community and the innovators continuing to improve the way patients are treated around the world. For example, a physician-scientist specializing in neurosurgery would first identify areas of research that would significantly improve the outcomes of patients suffering from a type of cancer or symptom, discover a new treatment option, and test it which is a process often executed through clinical trials. The physician-scientist would then monitor the trial and publish its results confirming the treatment option’s outcome.
Interestingly, this case is evident in Toronto Western Hospital’s BRAINFUL (BRAIN Tumor Focused Ultrasound-enabled Liquid Biopsy) Trial clinical trial. This research project, which began on June 10, 2021, aims to use High Intensity Focused Ultrasound (HIFU) to enhance the release of brain tumor DNA into the circulation so that it can be better detected in blood samples/liquid biopsies. This is an important trial because the more common and invasive forms of biopsy (accessing brain tumor tissue for pathological diagnosing purposes) can result in brain bleeds and death while liquid biopsy is a mere test done on a blood sample. The present problem with liquid biopsies, however, is that they usually do not possess the sufficient amount of circulating tumor DNA required to accurately make the molecular diagnosis of brain tumors. Therefore, with the physician scientists on this team using HIFU to enhance its presence in the blood, the clinical diagnosis of brain tumors may become far less invasive in the future. To learn more visit this link!
However, while it seems as though the aspect of research and scientific discovery acts as the dominant side of the career, the distribution of a physician scientist’s time depends on their personal interests and the funding available for them to do their jobs. Some of them who favour doing more research than clinical, administrative, or educational activities may choose to become clinically-trained full-time scientists who complete limited clinical work. Others may remain highly engaged in clinical work while also maintaining a funded research program, allowing them to completely fulfill their interests and both areas of their profession.
Fact: Some physician scientists choose to devote part of their careers to being educators! They spend the majority of their time attending to administrative duties, providing patient care, consulting on research projects, and teaching medical students, residents, and fellows. This, however, creates less time for them to undertake the research portion of their training.
As can be seen, physician scientists jump back and forth between lecture halls, patient bedsides, and research benches. Therefore, the places they work include academic medical centres, universities, biotechnology or pharmaceutical companies, and government laboratories and health organizations — making this career one that is constantly challenging, changing, and full of opportunities.
Education:
The path to becoming a physician scientist in Canada is long, arduous, and expensive. There are 2 pathways to a career in physician science which are considered more formal and more well-established than others: a joint MD/PhD or MD/MSc program and through the Clinician Investigator Program (CIP). Generally, students would complete an undergraduate degree (4 years), enter into a specific post-graduate program that fits the criteria for what it takes to become a physician scientist (7–9 years), enter a residency training program (3–5 years), and then pursue further education through fellowships (2–3 years) and Areas of Focused Competencies (1–2 years). Between residency and AFCs, students also have the option to pursue post-doctoral studies! In the section below, the 2 pathway options will be explained further:
MD/PhD or MD MSc Program:
In an MD/PhD or MD/MSc program, students engage in both undergraduate medical and PhD/MSc education, which culminates in the earning of a dual-degree. MD/PhD programs take approximately seven to nine years to complete while MD/MSc programs can be completed in about five to six years. Usually, students in these programs are first immersed into the preclinical years of medical school, where they learn about basic sciences that relate to the understanding of clinical medicine, anatomy and physiology, and about normal and abnormal processes that occur within organ systems. Following this, medical school is halted so that the students can complete a doctoral degree and then return to complete their clinical years of medical school where they gain experience through clinical rotations. The doctoral degree is typically pursued through the institution’s graduate studies department, offering graduate programs such as Medical Sciences, Biochemistry & Biomedical Sciences, Health Research Methodology, Neurosciences, Biomedical Engineering, Chemical Biology, Health Policy, Medical Biophysics, and more! This makes combined programs like these quite interdisciplinary and a great option for those who have exceedingly curious minds. However, it is important to note that MD/PhD and MD/MSc are highly competitive, with most Ontario universities admitting 3–5 students annually. Something else that you should know is that, generally, studies show that MD-PhDs are making up an increasing number of funded physician-scientists and that their combination of skills makes them more competitive for prestigious career development awards. Therefore, an MD/PhD program is a great option for those wanting to become physician scientists! See below for an example of an excellent MD/PhD program in Ontario!
Western University MD/PhD Program (program website)
- This is a seven-year program operating under the department of Medicine and Dentistry as well as the School of Graduate Studies. Individuals who wish to apply are only eligible if they meet the admission criteria of both the MD and PhD programs
- Like most MD/PhD programs, this is exceedingly competitive and has a very low enrollment quota of approximately 3 people
- In the PhD aspect of the program, students have the option to pursue research in areas including anatomy and cell biology, epidemiology and biostatistics, neuroscience, physiology, microbiology and immunology, and more!
- This is a quite special program as it is able to suit the amount of research experience and the personal preference of a student by offering two different models in which the division of medical school and graduate school differ.
- In the first model, students enter the program by undertaking 2 years of undergraduate medical education (preclinical), then entering 3 years of research, and finally completing the program with the remaining 2 years of undergraduate medical training (clinical). This model is better suited for those with research experience because it allows them to enter a new area of study while also pursuing graduate research over the summer.
- In the second model, students enter the program by undertaking 3 years of research, which allows them to earn their PhD, and then enter into the 4 years of undergraduate medical education. This model is better suited for those with LIMITED research experience since it provides the opportunity for students to obtain more earlier.
- Tip: When applying to any MD/PhD program, however, it is extremely important that you have as much research experience as possible!!!! If your experience is limited, though, make sure to inform the admissions office as to why.
Clinician Investigator Program (CIP):
Unlike the MD/PhD or MD/MSc programs, the Clinician Investigator Program is one that is actually pursued during a medical residency, making it part of post-graduate medical education. It usually starts in the third or fourth year of residency and includes traditional laboratory and clinical research, as well as other areas of research including economics, management, social, behavioral, and others as they apply to healthcare! Residents enrolled in a specialty or subspecialty accredited training program are eligible to apply for the CIP. The program offers three pathways: The Continuous Training (CT) pathway, the Fractionated Training pathway, and the Distributive Curriculum Training Pathway. The CT pathway involves continuous intensive research training spanning a minimum of 24 months. The pathway, which can be pursued at different points in residency, requires that a minimum of 80% of professional time is devoted to research. The FT pathway is designed for clinical research and specifically for individuals who wish to undertake a research project that would need several years to complete and involves the recruitment and participation of patients. It distributes a minimum of 24 months of research during residency. Finally, the DCT pathway is intended for residents who have gained research experience before entering their residency program. It aims to integrate research throughout the years of residency training so that these individuals do not lose momentum from their strong research backgrounds. Generally, the CIP program equips residents with the knowledge, skill set, and attitude needed in order to embark on a career in clinical health research.
Queen’s University Clinician Investigator Program (program website)
- This is a program that spans a minimum of 24 months operating under the faculty of Health Sciences. Individuals who wish to apply are only eligible if they are currently enrolled in an accredited specialty or subspecialty residency program
- As explained above, residents have the option of entering one of the three pathways (CT, FT, and DCT) according to their research interests and circumstances.
- They will also learn from a thorough curriculum offering courses such as Research Ethics, WHMIS Training, Good Animal Practice, Technology Transfer (Patents, Copyrights, Trademarks, etc.), Knowledge Translation, Adding Health Economics to your Research Questions, Social Media, Balancing Clinical Work, Research & Life Outside Work, and many more!
- On the program’s website, be sure to visit the “Alumni” page as you will be able to explore the lives, career goals, and research pursuits of a variety of exceptional individuals!
What About Residency Opportunities?
Like all physicians, after graduating from a medical school, physician scientists are required to complete a residency training program that allows them to specialize into different areas of medicine and then undertake extra training through a subspecialty, fellowship or area of focused competence. For these physicians specifically, specialties in which clinical research potential is abundant are ones usually chosen to be pursued such as internal medicine and pediatrics. These programs’ wide breadth of physiology and organ systems allows its residents to further specialize in many different areas such as cardiology, endocrinology, oncology, nephrology and more. However, with the advancement of technology, knowledge, and more questions about different health-related topics in other areas of the body, every specialty is a head-turner for residents today, with them entering increasingly diverse programs such as psychiatry, neurology, dermatology, ophthalmology, anesthesiology, pathology, radiology, radiation oncology, and even surgery and surgical specialties. This specialization is what allows variation in the research focuses and responsibilities of physician scientists, since their study is based on issues that they face in the clinical portion of their career.
Pros and Cons of Becoming a Physician Scientist:
Some of the pros of becoming a physician scientist include its high salary, with the average salary for a physician scientist in Canada being approximately $120,000; the way it allows individuals to practice on the cutting edge of medicine, with the research done continually advancing the medical field and changing the ways that patients will be treated in the future; its limitless variety since physician scientists are able to work in many branches of research and medicine, the opportunity for these individuals to explore interesting topics and ideas such as the validity of animal models, and the profession’s demand, as the job outlook for physician scientists is generally described as good. Additional pros include the fact that you can work as part of a laboratory team, that individuals who pursue the career have very high job satisfaction rates, that you can expand your practice beyond clinical settings, and that the job is compatible with additional roles such as research, management, and teaching.
Some of the career’s cons include the fact that becoming a fully-trained physician scientist is a very long process, involving over 10 years of schooling after obtaining a Bachelor’s Degree; that it is very difficult to keep up with the licensing requirements and increasingly complex clinical skills that the duality of this career provides, that it is becoming increasingly more difficult to receive independent grants, that gaps in research publications caused by clinical responsibilities may be met with criticism, and that there are several barriers which hinder the success of physician scientists in Canada such as the financial requirements for education, being a woman, minority, or immigrant, competing career demands, and more. Even so, the work that these highly-specialized physicians do provides an integral contribution to what is known about human health and how it can be advanced through research.
Even though you may have never even heard of this career, I think it’s pretty safe to say that Physician Scientists make up one of the most interesting parts of the medical field — the combination of curiosity and medicine is always a good one. But having understood these new details of what being a Physician Scientist entails and considering your own interests and career goals, do you want to make the next medical breakthrough? Do you want to change the way patients are treated decades from now? Do you want to make a profound impact on the medical community and the potential in the unity of medicine and research? If you answered yes, Physician Scientist is definitely a career you should consider. Stay tuned for next week’s “So You Want To Be” post!
About the Writer: Hassan Hassan is a rising Grade 11 student from Brampton, ON passionate about writing and STEM. With a strong commitment to helping others, he plans to pursue a career in medicine and enjoys participating in activities related to the field. An interesting fact about him is that he aims to be fluent in French by the time he graduates high school. In his free time, you can expect to find him reading, planning his day, volunteering, or binge-watching The Office.
