To prepare for future pandemics we must support physician-scientists
Ugur Sahin and Ozlem Türeci are the physician-scientist husband-wife duo who leveraged years of research innovating cancer immunotherapy to bring the world the Pfizer BioNtech mRNA vaccine against COVID-19. As physician-scientists, they worked on cancer. They pivoted their technology to tackle COVID-19 when they recognized the global threat of the virus.
Across the Atlantic, starting almost a decade ago, Peter Hotez, a Baylor and Texas Children’s Hospital physician-scientist with expertise in vaccines assembled a team to understand coronavirus structure and infectivity, and was working on a coronavirus vaccine before the COVID-19 pandemic hit. Now, together with one of the large vaccine producers in India, they are advancing an affordable vaccine that would be made available to countries that would have a difficult time accessing current COVID-19 vaccines.
When the pandemic hit, Harlan Krumholz, a physician-scientist at Yale known for evaluating factors that lead to heart disease and ways to prevent them, started working with a team of physician-scientists and scientists to tackle COVID-19. One of these studies is trying to identify what is behind long COVID, a debilitating condition that includes brain fog, shortness of breath, arrhythmias that afflicts more than 30 percent of COVID-19 survivors.
Physician-scientists care for patients but spend a majority of their time carrying out research, which enables them to move forward with insights on how to better address their patients’ needs and diseases. From discovery of insulin to leveraging the immune system to attack cancer (and now tackling COVID-19), these significant contributions in science have led to physician-scientists making up 37 percent of Nobel Laureates over the past 25 years and 41 percent of Lasker Award winners (American Nobel Prize) over the last 30 years.
What if we lost the physician-scientists? Unfortunately at the start of their careers, research is becoming more often a pipe dream than a reality. Physician-scientists have dwindled from 4.7 percent of the entire physician workforce in the 1980s to only 1.5 percent today. This biomedical workforce can spend one to two decades in training to acquire distinct expertise. Yet, when they’ve completed this training they can be left without the financial support (such as grants) required to continue their research. This usually means that the research is given up in lieu of taking on more patient care. This is because when research goes unfunded, physician-scientists are only being paid for their clinical duties and not for their research efforts. This puts physician-scientist research at threat at each career stage and physician-scientists at threat for leaving research altogether. They need a species survival plan.
Physician-scientists work predominantly in academic health centers where their research depends heavily on external federal support, often from the U.S. National Institutes of Health (NIH). Over the last 30 years, applications by physician-scientists for early career funding have more than tripled but the number being funded has been stagnant. In the 1990s, rates for successful early career grant support were near 50 percent, now it’s nearly half of that. In 2020, near 50 percent of all applications that the NIH gave strong scores were not funded due to low funding availability. Funding to support early career physician-scientists has failed to keep up when the need for them is greater than ever to address COVID-19 related health consequences and other chronic diseases.
The pandemic has threatened physician-scientists further. Due to COVID-19, there has been an unprecedented delay and drop in research productivity due to halted studies, delegating research time to cover COVID-19-related clinical duties, and reduction of funding opportunities by specialty foundations as a result of revenue loss due to the pandemic. Additionally, due to stalled research because of the pandemic, progress in addressing other diseases has been interrupted. This means that if your family member develops a heart attack or gets diagnosed with cancer, there may be fewer treatment options for them.
As President Biden mentioned in his 100 day speech to Congress, “Scientific breakthroughs took us to the moon, discovered vaccines, gave us the internet … These are investments we made as a country and investments that only the government is in a position to make.”
Investing in our physician-scientists today is an urgent matter of safeguarding public health, national security and staying competitive on the international front. The U.S. spends less than 1 percent of its GDP on research and development compared to more than 2 percent several decades ago, while at the same time, other countries, like China have significantly increased their R&D spending. Thus, the next breakthrough technologies and cures that drive economies may ever increasingly come from outside the U.S. This means that more jobs and a stronger economy will go to other countries and not to people in the U.S. Physician-scientists are key to these research efforts and need more support to keep the U.S. competitive.
There are two potential opportunities, proposed by the American Physician Scientists Association (APSA), to tackle this problem. In the RISE Act, we can add physician-scientist specific support that provides three years of bridge funding to enable them to build on research and/or get their first grant and increase grants such as career development awards and major research grant mechanisms by at least 30 percent to enable them to sustain their work. For more longitudinal support, these support mechanisms should be incorporated into CURES act 2.0.
As Sahin said in an interview with The Times of London about potential future viral outbreaks: “This pandemic teaches us that we need to be prepared even better.” Hopefully, we can save the physician-scientists who enable us to not only provide lifesaving innovations, address long COVID and bring new therapies for society, but arm us with this biomedical workforce for the inevitable future outbreaks.
Jennifer M Kwan MD PhD, is a clinical cardiology fellow at the Yale School of Medicine and sits on the American Physician Scientist Association board of directors. Eric J. Brandt, MD, MHS., is a clinical lecturer for the Division of Cardiovascular Medicine and the University of Michigan Medical School.