The role of the clinician scientist in the Academic Medical Center appears to be under siege. Increasing clinical demands due to reduced clinical income from managed care contracts and increased documentation requirements coupled with the uncertainties in obtaining a continued stream of grant support result in a stressful existence even for the most seasoned clinician scientist. Fellows and junior faculty with young families, debt loads from college and medical school, insecure positions, and spotty mentoring are reluctant to pursue a research career. Students facing long periods of training and lack of role models find the academic track less and less attractive. The result is a declining number of clinician scientists competing successfully for federal funding of their research efforts. Does this scenario apply at UCSF? A survey of the success rate of Assistant Professors in clinical departments of the School of Medicine in achieving promotion in their initial series (ladder rank and in residence) over the past 5 years indicated that only 40% of the in residence Assistant Professors were promoted; most either changed series or left the University. The much smaller number of ladder rank assistant professors were more successful. Data regarding our success rate in placing our fellows and students in academic positions have not been systematically compiled, but anecdotal evidence suggests that the record is not stellar. As UCSF struggles to meet the fiscal challenge of its clinical enterprise and as the campus bifurcates its clinical and basic scientists between Parnassus Heights and Mission Bay, the challenge to support the role of the clinician scientist on this campus increases.
The Task Force defines a clinician scientist as a faculty person who by training, desire, performance, and academic responsibilities pursues a career which includes both clinical responsibilities and research. While the Task Force acknowledges the importance of national forces which impact on the career of the clinician scientist, the focus of the Task Force will be on UCSF policies and practices which can be modified to enhance the success of the clinician scientist on this campus.
The approach to be used by the Task Force will divided into 2 stages with goals to be pursued sequentially.
- The first goal is to determine the extent to which faculty recruited into a clinical scientist position are successful in pursing such a career, identify obstacles that handicap the successful pursuit of such a career, and recommend changes in policy and culture to improve success in this career path. Specific questions to be explored include:
- What is the success rate with respect to promotion for clinician scientists? Has this rate changed over the past 10-15 years?
- What are the barriers to attaining and maintaining a successful career as a clinician scientist?
- What support structures exist at UCSF and within departments to help young faculty initiate a research career? This includes issues of assigned space, technical support, access to necessary equipment and supplies, administrative support? Should there be a minimum starter package (University supported) required for appointments in clinical scientist tracks?
- What are the policies in the various departments regarding protected time for research activities? Does protected time to do research come at the expense of decreased salary? Should there be University wide guidelines with respect to amounts of protected time for clinician scientists?
- What are the policies in the various departments regarding bridge funding? If an investigator loses grant support, how much time does he/she have until salary is reduced and/or the individual is released?
- How are junior faculty mentored? Are there mechanisms within departments to ensure this takes place? Should there be a University wide policy regarding mentoring?
- To what extent and by what mechanisms are the expectations of department chairs and the University for junior faculty transmitted at the time of hire and during the first several years?
- What mechanisms exist to encourage collaboration between clinical and bench oriented scientists?
- The second goal is to determine the interest of and opportunities for our health science students, housestaff, and fellows to pursue a clinical scientist career, identify reasons why such career interests are either not kindled or abandoned, and recommend changes in policy and culture to enhance interest in pursuing such a career path. Specific questions to be explored include:
- What percentage of our students, housestaff, and fellows pursue a clinical scientist career in academia or industry? Has this percentage changed over the past 10-15 years.
- To what extent do admission or acceptance criteria for students, housestaff, and fellows include a stated interest in research?
- To what extent and by what mechanisms are our students and housestaff encouraged to become involved in research projects? Is there financial support for this?
- Is at least one year of research mandatory for our fellowship training programs, and if so how is this supported?
- To what extent are clinician scientists involved in the teaching or mentoring of our students, housestaff, and fellows?
- What are the mechanisms by which promising fellows can be recruited into faculty positions?