Not the End of the Physician-Scientist

In 1984 Gordon N. Gill, professor of medicine at the University of California at San Diego, published an essay entitled “The End of the Physician-Scientist?’ He described how from the mid1960s to the early 1980s the biomedical research enterprise in the United States passed largely out of the realm of clinical investigators and into that of Ph.D. scientists working at the molecular level. He also noted that in the United Kingdom and Europe the split between basic science and clinical medicine had been completed by the early 1970s. The clinician-scientist had become the “clinician-applier of basic science.” (American Scholar, vol. 53,1984, p. 360.) “Like it or not;’ Gill concluded, “the separation of physicians and scientists is well advanced .... Partial attention to either science or medicine is no longer enough” (p. 368). Gill, while astutely describing a genuine and broad historic shift, I think too quickly closed the curtain on the potential contributions of clinical investigators or physicianscientists. Although the participation of M.D.s in biomedical research declined sharply during the 1970s, there are now signs of improvement. James B. Wyngaarden, the current director of the National Institutes of Health, has attributed the decline in the 1970s to, among other factors, the instability of federal support; society’s emphasis on the importance of patient care, particularly among underserved segments of the population; and certain economic obstacles, such as the payback provision of the National Research Service Awards (NRSA). The last scared off many newly minted M.D.s who did not wish to risk incurring a large debt if the life of a researcher turned out to be unsatisfying. Moreover, the modest stipends for postdoctoral fellows made the salary of beginning private practitioners (roughly double a resident’s salary) as irresistible as the siren’s song-especially to those with family responsibilities. (“The Clinical Investigator as an Endangered Species.” New England .Journal ofkfedicine, vol. 301,1979, pp. 1294-9). But in this decade the picture has brightened. The payback provision of the NRSA was eliminated in 1983. Research stipends have been raised significantly. Moreover, medical school faculty salaries are gaining ground on those of physicians in private practice: the average salary for academic