Medical

Wearing Many Hats as a Research Clinician-Scientist: Why and How

Clinicians in all disciplines, from medicine to psychology to physical therapy, need to understand how research works. Though some aspiring doctors grit their teeth through required research methods and statistics courses, others discover a new passion for science. Those whose interest in research goes beyond applying findings to evidence-based practice should consider the dual role of clinician-scientist. Though the role is most established in medicine as the MD/PhD, other health professions also need clinician-scientists. Is an MD/PhD, DNP/PhD, Clinical PhD in psychology, or another dual-focus doctoral program right for you?

Why Choose the Clinician-Scientist Path?

When I was early in my nurse practitioner clinical training, I found that I was especially interested in the state of the science of cardiovascular disease. Why were there so many gaps in the evidence? I had assumed that there were high-quality studies supporting the interventions routinely used in practice but was surprised to find how often this was not the case. I was especially troubled to find out how much foundational medical research excluded women. I began working with a senior researcher who studied women’s cardiovascular health, and decided I wanted to pursue a PhD focusing on women’s cardiovascular symptoms in addition to my clinical doctorate (the doctor of nursing practice, or DNP). Some people questioned my decision: why did I want to stay in school even longer? Though earning dual clinical and research doctorates extended the time it took me to finish my degrees, it was worth it. This decision led to my current role as a junior faculty member. I have a clinical practice two days per week and I am part of several research studies and scholarship teams focusing on women’s cardiovascular health. My skill set is in demand, and I enjoy the variety of my professional activities. For me, it’s enormously rewarding work.

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I asked two MD/PhD colleagues what the rewards are for them. Both felt that science and clinical practice balance each other well. One described how seeing patients is a reminder of the ultimate reason for clinical research, and seeing the ways that research findings impact patients is the motivation for further discovery. The other said that participating in research combats the tendency to feel like a “cog in the machine” of medicine, and conversely, clinical practice combats the loneliness of lab life. These kinds of personal rewards make the clinician-scientist path attractive to people wrestling with such ideas.

Fixing the Research-Practice Gap

In addition to the personal reasons outlined above, there are philosophical reasons to become a clinician-scientist. The gulf between new research findings and practice change is wide: it takes an average of seventeen years for new discoveries to be translated into routine clinical practice. This is partly because the research community doesn’t do a good job disseminating findings efficiently, partly because clinicians are appropriately cautious when implementing new findings, and partly because of “clinical inertia,” or the tendency to continue current practices despite new evidence. The crux of the problem, however, is further upstream: a lot of clinical research was not designed with translation to practice in mind, so the findings aren’t readily applicable to real-world situations. Often, there are significant logistical barriers to implementation. Clinician-scientists can address these problems by conducting high-quality translational research: asking pertinent research questions, designing studies with clinically relevant outcomes, and publishing papers that speak directly to clinician’s concerns. They can also facilitate research translation by serving as hubs of disseminated learning in clinical contexts. Many clinician-scientists find satisfaction in serving as boundary-crossing “brokers” to connect clinical care and basic science.

What’s the Catch?

Not everyone is cut out to be a clinician-scientist. It can be tricky to meet the expectations of two demanding roles, especially early in one’s career. Becoming a competent clinician and establishing a robust research program both take enormous amounts of work. For some, splitting time and focus doesn’t come naturally. Another potential drawback is financial. More time in training means more financial investment. Additionally, many clinical jobs require the clinician to generate a certain amount of revenue, and many research jobs require the scientist to secure grant funding. These competing pressures are one reason some clinician-scientists drop one part of their role.

I’m Intrigued: What Should I Do Next?

Does the clinician-scientist dual role sound like it’s for you? How can you balance practice and research so they complement each other rather than compete? What should you keep in mind as you explore this idea? Here are some tips to help guide your next steps:

  1. Focus. Clinical training often starts out very general, but launching a research career requires identifying a unique area to study. What’s your niche? If you’re considering a research career, spend some time honing your interests and identifying a specific area of need that you’d like to work on.
  2. Align. If you want a clinical practice in aesthetic dermatology but a research program in heart failure, you will struggle to find time, opportunities, and meaning in your work. Think about how your clinical interests might inform your research work and vice versa. Look for areas of overlap.
  3. Find good mentors. Talk to people in your field who work as clinician-scientists. Even if their substantive interests are different from yours, they will likely have a valuable career advice for you. They’ll know the funding sources, training programs, and institutions that will help you pursue your clinician-scientist dreams.
  4. Choose an institution that supports the role of the clinician-scientist. It’s tough (but not impossible) to go it alone, so look for programs that produce successful graduates. Find out how the program works: do you need to apply to a dual-track, or can you add one later? Do you do clinical and research training simultaneously or sequentially? Talk to students in different training programs and find out what their experience is like. Look at faculty web pages and publications to get a feel for their work. Find out how faculty appointments in your field account for both research and clinical roles.
  5. Embrace teamwork! Health-related research, even at the basic science level, benefits from a clinical perspective. Some aspiring clinician-scientists get discouraged when comparing themselves to peers with dedicated research careers. You don’t necessarily need to be the principal investigator on an NIH R-01 grant to excel in research. Consider other ways to incorporate research into your career path. You might find that you are a sought-after consultant or co-investigator for basic science studies.

Combining interests in clinical practice and research is a challenging but rewarding career path. If it’s a good fit for you, you can find personal fulfillment and make much-needed professional contributions. Good luck with your education!

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