The Q&A: Dianna Milewicz

With each issue, Trib+Health brings you an interview with experts on issues related to health care. Here is this week's subject:

Dianna Milewicz is the director of the Division of Medical Genetics at the University of Texas Medical School at Houston. She is one of the authors of a recently published article in Journal of Clinical Investigation about the number of physician scientists – physicians who mainly conduct research – in the workforce, and the value of increasing the number of physicians in the field.

Editor's note: This interview has been edited for length and clarity.

Trib+Health:  Could you explain this trend of less physicians doing research?

Dianna Milewicz: The head of the [National Institutes of Health], Francis Collins, commissioned a committee to look at the physician scientist workforce in the United States. In other words, how many physicians are actually spending the majority of their time doing research?

And what they found is that the physician scientist workforce, although the numbers haven’t changed over the past few years, what the data seems to suggest is that the older physician scientists are working to an older age, and that there’s fewer and fewer physician scientists coming in at the beginning of their career. Although the numbers have not diminished, the age of the physician scientist workforce has gotten older.

Trib+Health: What do you think are the potential consequences of this trend?

Milewicz: I think that over time, the number of MDs and MD-Ph.D.s, or the number of physician scientists, is going to decrease as the older physician scientists retire… It’s going to slow the pace that we make new discoveries and our understanding of new diseases.

Trib+Health: What do you think is causing this trend of less people entering the workforce becoming physician scientists?

Milewicz: I think there are many issues, and we definitely need better data to understand why so few people are choosing to become physician scientists.

I think it’s a number of issues. The training is taking longer and longer, both the clinical and the research training. Number two, I think that the way the NIH treats research makes it difficult to pursue research as a career. It has sort of that boom and bust sort of funding, that same sort of funding that you see in the oil industry.

So when the NIH is awarding a lot of research grants it can be attractive, exciting to be able to get those grants and pursue research. But once it becomes difficult, then people will decide just to practice medicine. There’s always a need for doctors out there, so as research gets more difficult to fund and more difficult to pursue, it just becomes easier and easier for physician scientists to decide just to practice medicine.

Just like in the oil industry, when the price of oil goes down and they start firing people, then those individuals may choose to pursue a different career, and they lose some of those people in the oil industry because of that. Well, the same thing happens with the NIH funding.

Finally, I think there are issues in the way we train physician scientists. In the article in the Journal of Clinical Investigation, part of it was focused on how do we better move them through the training and get them into an individual, independent career as quickly as possible.

For instance, when I trained, I did the MD-Ph.D. I did my residency, then fellowship and then did some more research at the end, then I started on faculty and began my independent career. I was completed with all that and in a faculty position with my research lab by my mid-30s. Now the data says it takes people until their mid-40s to get in that independent research position, so we made suggestions on how to decrease that time back to something more reasonable like it was when I trained.

Trib+Health: What are some potential solutions to offset this trend?

Milewicz: We’re good at getting people through medical school, and we’re good at getting trainees through the MD-Ph.D. programs. So we really focused on what happens between the time they leave the medical school with either their MD or their Ph.D., and made a series of recommendations as to how to decrease that time and how to provide oversight for those individuals during that training period.

The recommendations were to first provide oversight of that training by initiating offices of physician scientist training at institutions that could keep track through the clinical and research part of the training. And then, No. 2, to have the NIH alter the way that they fund beginning physician scientists. Right now, when you start on faculty as a physician scientist, the expectation is that you would get five years of a mentored grant, somebody working with you to help you get established. We did not think that many of the physician scientists needed another five years of a mentored grant, and that transition should be more rapid into their own independent grant. Those were the two major recommendations.

Trib+Health: What do you think is the value of having more people doing research in the medical field?

Milewicz: It’s a wonderful time to be a physician scientist. We have so many tools and techniques to really take the disease and the patient and take it into the lab and understand what’s going on at the molecular level. That’s the first step to developing better therapies, better ways to diagnose and better outcomes of diseases. If we don’t have physician scientists in the workforce, it will hurt the progress that we are making with understanding and treating diseases.