A new doctorate for doctors

As medicine seeks new ways to speed basic discoveries from the laboratory to bedside, there is growing concern that the investigators ideally equipped to guide that translation are becoming an endangered species. Three decades ago, nearly half of all NIH research-project grants went to physician-scientists with M.D. or M.D./Ph.D. credentials. Today that fraction is closer to a quarter and dropping as the number of Ph.D. investigators in the life sciences increases.

Now there’s a new route at Yale for physicians who are interested in research careers to get their Ph.D.’s. This summer the Graduate School of Arts and Sciences approved a new doctoral degree in investigative medicine — the first anywhere in which a Ph.D. program is administered by a clinical department. The new degree program grew from a proposal by the Department of Internal Medicine to create an alternative route for physicians who wish to combine careers in clinical medicine and research. Unlike the existing M.D./Ph.D. Medical Scientist Training Program, which trains an average of six physician-scientists each year, the new program is open only to physicians who have already earned their medical degrees and completed two years of their clinical training.

“The fundamental difference is that in this program the candidates have decided substantially later in their careers to become physician-scientists,” said program director Keith Joiner, M.D., chief of the section of infectious diseases in the Department of Internal Medicine. “They want the same rigorous training that an M.D./Ph.D. student would want, but they’ve had a portion of their clinical training already and poured their heart and soul into patient care for three or four years. Here, they can be sure that their clinical interests are not dissociated from the rest of their advanced training.”

Joiner anticipates that the program, which is accepting applications now for July 2000, 2001 and 2002, will grow to 10 slots each year for candidates interested in disease-oriented laboratory research, patient-focused clinical research, outcomes studies and epidemiological research. Geriatrician Sharon Inouye, M.D., and biostatistician Theodore Holford, Ph.D., will run the program along with Joiner.

Convincing members of the Graduate School faculty that the new doctoral program would be sufficiently rigorous to merit the granting of a Yale Ph.D. required many months of discussion. “We really wrestled with it for a whole year,” said immunobiologist Kim Bottomly, Ph.D., chair of the basic science advisory committee that was asked to review the proposal. The committee made suggestions and the original proposal was modified. Then two high-profile external advisors — then-New England Journal of Medicine editor Jerome Kassirer, M.D., and Kenneth Shine, M.D., president of the Institute of Medicine — were asked to evaluate the plan. After a few more changes, it was forwarded to the faculty for approval with a unanimous endorsement from the advisory committee. “This is a chance to apply science to health,” said Bottomly, “not only by cloning a gene that may someday play a part, but by really asking questions about human disease, forming hypotheses about care and following up to see the outcomes.”

“It’s phenomenal that it happened at Yale and testimony to the foresight of the basic science faculty and their willingness to think outside the box,” said Joiner. “The program’s goal is to create an environment that constantly interfaces clinical science and investigation of disease. I think we’re well on our way.”