An analysis of academic neurology reveals several important trends. First, despite the substantial expansion of neuroscience over the past decades, the number of MD–PhDs remains flat. Also, the average age of both those in academic departments and principal investigators on NIH major grants has increased substantially over the past two decades. When I have had the opportunity to meet with neurologists just finishing training, a frequent complaint is that the barriers to an academic career are insurmountable. It is the view of many that researchers— be they bench, translational, or clinical—benefit from clinical training in terms of the focus of research and even productivity.
A year ago, the AAN appointed a task force to look at the barriers to a research career and potential interventions to lower the barriers. Recognizing that this issue transcends any one neurologic organization, leaders of the American Neurological Association, the Child Neurology Society, and the Association for University Professors of Neurology were included in the task force. The AAN Board of Directors will review the analysis and recommendations this month.
The barriers are substantial. Success in a research career has always presented substantial challenges. However, with the evolution of academic careers, the challenges are substantially increased. For those with a PhD, clinical training time is long—five to six years—typically without meaningful exposure to research opportunities. Trainees often express regret at the atrophy of research careers during clinical training and the loss of clinical skills during fellowship. Those MDs interested in a clinical research career confront often–haphazard training and a lack of clarity for the development of appropriate career tracks. Perhaps the major barrier is the debt most carry on completion of medical school. Currently the average is over $150,000. The payments become due during fellowship. Since salaries for those early in an academic career are substantially less than practice, that debt represents a major disincentive. The last major barrier is the continued decline in the ability of the National Institutes of Health to fund deserving requests. Finally, there are other less major barriers that cumulatively add to the disincentive, such as Medicare not paying graduate medical education for time spent in research or the difficulty finding a mentor or even an effective role model.
Solutions will not come easily. There are modifications to training programs that potentially will permit exposure and participation in research. Programs that provide career track advice and guidance as well as grant writing expertise, while already excellent, need to be expanded. Finally, the debt burden needs to be effectively addressed at the medical school level and programs need to be developed to decrease the burden for those committed to a research career.
Going forward, we, the neurologic community, need to find a solution to these barriers. Neuroscience has made notable gains over the past three decades and continues to identify and characterize the mechanisms of disease and potential treatment targets. Effective translational and clinical research is necessary to bring these observations to the bedside. While the choice of a research career has never been easy, it is critical that those with the talent and commitment be supported and nurtured. Future treatments for the devastating neurologic diseases we all care for depend on it.
Bruce Sigsbee, MD, FAAN