Reviving a Dying Breed:
The Clinican Scientist
By Amanda Marshall, MD
With the many pressures of balancing
basic science research and quality
patient care, fewer and fewer surgical
specialists are pursuing the career path
of both clinician and scientist. This is
not a brand new observation.
Even as early as 1976, academicians
spoke of the unresolved conflict, “between the operating room and the
laboratory, and between the clinical
pressures of care of the sick and the
pursuit of science.”
Having recognized this upcoming
crisis, various surgical societies attempted
to curtail it; but, the crunch of
dwindling practitioners contributing
to the basic science knowledge base
is upon us.
For the last several decades the percentage
of clinicians who serve as
principal investigators for all fields of
medical research has dropped to less
than 20 percent of the total number of
principal investigators. In the field of
orthopaedics in particular, fewer than
4 percent of practicing orthopaedists
even consider themselves clinician-scientists.
This decrease is not entirely
unexpected given the major changes in
health care delivery and reimbursement
over the past two decades.
Surgical subspecialty task forces
have documented many barriers to the
budding clinician-scientist, not the
least of which are economic, but some
of which also reflect changes in the
culture within academic departments
in response to outside pressures.
Some might ask, “Why is this even
a concern?” Let’s consider the specialty
of orthopaedics. Historically, the
advancement of the field was largely
based on a heuristic approach (trial
and error) guided by practitioner
intuition.
A good example is the common hip
replacement designed by Sir John
Charnley in England. He relied on his
clinical experience to direct the material
science and biomechanical testing
that went on to become one of the
most successful and life-changing surgeries
in all of medicine – total hip
arthroplasty.
Today’s medical community has witnessed
a shift in the practitioner-driven
research to a more laboratory-based
approach. Current examples include
gene therapy, “designer” drugs, growth
factors and advances in joint replacement
bearing surfaces such as ceramics
and polyethylene.
The current state of rapidly advancing
musculoskeletal therapeutics arising
directly from the laboratory begs
the question: who will be the liaison
between the lab bench and the bedside?
Do we as patient advocates want to
rely on the data eagerly supplied by
various drug and implant vendor representatives?
Obviously, the speed and manner of
bringing laboratory advances back to
the clinic, as well as formulating
research agendas based on patient care
issues are critically dependent upon
having clinician-scientists. As clinicians
they pose the questions, and as scientists
they develop sound and reliable
research to answer them. The outcomes
are clinically relevant, effective
and safe treatment and disease-prevention
strategies.
Besides bringing clinical relevance
to future research, these clinically oriented
researchers are often our profession’s
most valued teachers and the
authors of educational material for
future students. They are important in
setting new standards for both research
and education in the various medical
specialties.
In the midst of declining numbers
of clinician scientists, the University of
Texas Health Science Center strives to
revive this dying breed. The Chairman
of the Department of Orthopaedic
Surgery, Daniel W. Carlisle, MD, said, “The leadership of the University and
the School of Medicine continue to
support our research mission through
aggressive recruitment, faculty development
and resource allocation.
“This has enabled the University to
significantly increase the amount of
grant dollars we receive each year,
which allows our Department to help
advance the art of orthopaedic surgery
through basic science and clinical
research.
“Research done today by clinician
scientists such as Dr. Marshall will
directly contribute to the surgical and
clinical care of our patients in the
future.”
In summary, the profession of medicine
continues to need clinicians who
understand the capabilities and limitations
of new technologies, as well as
the clinical and biological realities so
that new science can be translated into
real benefits for our patients.
Originally from South Texas, Dr. Marshall
returned to her home state last fall to join
the Department of Orthopaedics at the
University of Texas Health Science Center.
She specializes in minimally invasive joint
replacement and complex hip and knee
revisions. In addition to her clinical practice,
she has earned numerous research
awards in the area of joint arthroplasty.
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