August 1999 Bulletin

Ready action plans to increase number of clinical scientists

Douglas W. Jackson, MD, moderator of a meeting on the future of orthopaedic sciences, meets with Linda Sandell, PhD, president of Orthopaedic Research Society

The future of the orthopaedic scientist seems in doubt, but action plans being developed by a broad-based steering committee may change that outlook.

A "summit" meeting of the key organizations in orthopaedic research and education has proposed a series of actions ranging from developing a research fellowship to formulating models for orthopaedic clinical careers.

The problem: The number of first-time MD applicants for NIH research project grants plummeted 31 percent from 1994 to 1997. If this progression were to continue linearly, there would be no first time MD applicants by 2003. With this sobering assessment, Douglas W. Jackson, MD, opened a meeting of the Future Orthopaedic Scientist Steering Committee in June.

The decline in the clinical scientist, who, historically, has been responsible for major advances in orthopaedic surgery, has been a worrisome problem for years. The orthopaedic scientist is considered a vital link between biomedical research and the patient. The clinician scientist has the unique ability to identify problems and apply new research in the clinical setting.

Other orthopaedic meetings have tackled the problem, but it continues to worsen. The Academy's department of research and scientific affairs reports that the number of orthopaedic clinical research investigators declined 9 percent between 1990 and 1996.

"Only bold, concerted action can avert the threat (of the disappearing orthopaedic scientist)," Dr. Jackson, 1997 Academy president, told the steering committee representating the American Orthopaedic Association (AOA), Academic Orthopaedic Society, Orthopaedic Research Society (ORS), Orthopaedic Research and Education Foundation and the Canadian Orthopaedic Research Society.

Peeling back the layers of the complex problem, the committee uncovered:

"Young people are not choosing research because of the length of training, the burden of debt and they don't see the opportunities in a future as far as security and income that they forego," said Dr. Jackson.

"It's a problem of the chicken and the egg, the interaction between research workforce and research funding."

Gunnar Andersson, MD, a representative of ORS, views the problem as a matter of financial rewards. "Many scientists do quite well, but not as well as others (clinicians)," he said. "We will not see a large number of researchers until we change the reward system." Other rewards such as recognition and awards are needed, too, said Thomas Einhorn, MD, of AOA.

The committee also zeroed in on the medical school, which they said "poorly presented" the advantages of careers in research. A breakout group suggested changing the medical school curriculum to give more time to what is orthopaedics and orthopaedic research and "enhancing and enlightening the potential pool of talent in medical students."

Focusing on how to reverse the downward trend line in clinical researchers, the committee agreed there is a need for the creation and funding of a two- or three-year fellowship which would allow an orthopaedist to improve his/her research skills and develop research work for a lifetime. A breakout group suggested the fellowship could be 50 percent clinical and 50 percent laboratory with funding and a competitive salary.

The task force agreed on next steps for the Academy, ORS and AOS. The Academy will investigate the creation and funding of a combined clinical fellowship and develop models for orthopaedic clinical scientist careers. ORS will develop a meeting of successful research program chairs to discuss their programs, convene a meeting of young orthopaedic scientists to discuss their needs and expectations, and reach out to nonorthopaedic groups to discuss common issues and possible solutions. AOS will discuss taking a leadership role in developing strategies for increasing the number of orthopaedic clinical scientists.

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