The clinician-scientist: a rare breed under threat in a hostile environment.

Nick Lemoine is at the Institute of Cancer, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK. It is evident that clinician-scientists are high-fliers, but also increasingly obvious that they are rare and endangered Translation requires individuals who are fluent in two languages, and this is equally true of translational medicine, for which clinician-scientists are the essential conduit between laboratory and clinic. Without individuals who lead active laboratory research programmes and possess an understanding of the needs and practical realities of clinical medicine, our hopes of exploiting our burgeoning understanding of disease models and mechanisms to develop new approaches to diagnosis and therapy will founder. The pressure on these professionals is immense as they cope with the demands of literally two jobs in one, and throughout the developed world it is becoming increasingly recognised that they must be more carefully nurtured if the increasing popularity of translational medicine is to generate genuine advances in health care. The landscape in the UK reflects that of other nations with established clinical academic cultures, and highlights the challenges and opportunities that those with both clinical and academic aspirations face. Clinician-scientist programmes were established in the UK in the mid-1980s with a similar aim to the US NIH K08 funding stream, which provides mentored early career awards to support clinically orientated individuals performing basic or translational research. A major initiative was launched to allow clinicians to develop postdoctoral research programmes under the wing of established investigators while simultaneously engaged in clinical practice to complete their higher specialist training. Key agencies that had the vision to see the potential of such schemes to deliver their mission and were early investors were the Medical Research Council, the Wellcome Trust and Cancer Research UK (I declare an interest here – I received funding from the latter as their first such appointment; whether their investment returned a dividend is for others to judge...). Analysis of their impact is complicated as tracking of career progression was neglected until recently, but an analysis of the individuals appointed by the MRC in the first phase (1988-1993) revealed that over 95% of the awardees headed a research group 20 years later; the awardees spent typically over 50% of their time on research; and the majority of those who had been clinician-scientists now generated over £500,000 per annum research funding, compared with between £100,000 and £500,000 for the majority of non-clinical scientists appointed to the parallel career development awards in the same period. It was found that 80% of the clinician-scientists had gone on to hold full Professorships, compared with just 35% of their non-clinical peers of the same period. It is evident that clinician-scientists are high-fliers, but also increasingly obvious that they are rare and endangered.