The Next Generation of Physician-Scientists: Adapting to Academic Cardiology in the 21^st Century

More than 3 decades ago, Wyngaarden and Gill first warned of the challenges facing physician-scientists in their seminal papers “The Clinical Investigator as an Endangered Species” and “The End of the Physician-Scientist.” In the years since these papers were published, there has been expansion of stage I-II preclinical research focusing on discovery and exploratory studies. Expansion has often come at the expense of physician-scientists whose traditional role has been to bridge the gap between early preclinical research (stage I-II) and clinical trials (stage IV). Consequently, a paradigm shift has occurred, and increasing pressure has been placed on physician-scientists to choose between clinical practice and fundamental research. This shift is particularly concerning in the field of cardiovascular medicine, where the ubiquitous nature and clinical significance of cardiovascular disease make the role of the translational scientist essential. The challenges facing academic cardiologists have then further been amplified by the necessity not only to maintain clinical competence but also to maintain competence in highly technical fields with rapidly advancing technology. Potential solutions to these problems include increasing support from postgraduate training programs, increased participation of trainees in physician-scientist development programs, and recognition of the pivotal role physician-scientists play in translational research by funding agencies. Although the physician-scientist remains an endangered species, multifaceted solutions with a focus on collaboration among institutions, training programs, and funding agencies have the potential to maximize efficiency in biomedical research and successfully translate scientific discoveries from bench to bedside.