More than grit: growing and sustaining physician-scientists in obstetrics and gynecology

Abstract

Obstetricians know the statistics-1 out of every 10 babies is born premature; preeclampsia affects 1 in 25 pregnant people; the United States has the highest rate of maternal mortality in the developed world. Yet, physicians and scientists still do not fully understand the biology of normal pregnancy, let alone what causes these complications. Obstetrics and gynecologytrained physician-scientists are uniquely positioned to fill critical knowledge gaps by addressing clinically-relevant problems through fundamental research and interpreting insights from basic and translational studies in the clinical context. Within our specialty, however, physician-scientists are relatively uncommon. Inadequate guidance, lack of support and community, and structural barriers deter fellows and early stage faculty from pursuing the physician-scientist track. One approach to help cultivate the next generation of physicianscientists in obstetrics and gynecology is to demystify the process and address the common barriers that contribute to the attrition of early stage investigators. Here, we review major challenges and propose potential pathways forward in the areas of mentorship, obtaining protected research time and resources, and ensuring diversity, equity, and inclusion, from our perspective as early stage investigators in maternal-fetal medicine. We discuss the roles of early stage investigators and leaders at the institutional and national level in the collective effort to retain and grow our physician-scientist workforce. We aim to provide a framework for early stage investigators initiating their research careers and a starting point for discussion with academic stakeholders. We cannot afford to lose the valuable contributions of talented individuals due to modifiable factors or forfeit our voices as advocates for the issues that impact pregnant populations.

Optimizing team science in an academic medical center: A qualitative examination of investigator perspectives

“…Additionally, training and mentorship may improve researchers' knowledge and skills necessary to succeed in research [6,18]. Incentivizing mentors through provision of career development awards, providing salary support for mentoring activities, and rewarding outstanding mentors may encourage dedication from effective mentors, provide new mentoring opportunities, and facilitate an organizational culture of mentoring excellence [9,[19][20][21]. Additionally, having multiple mentors may be beneficial for investigators in clinical departments without robust research track records [22].…”

Reproductive Scientist Development Program: Bridging the Gap to the Physician Scientist Career

“…The background of an OBGYN physician-scientist facilitates the recognition of clinically relevant and novel research ideas and the ability to translate results from the bench to bedside. However, the physician-scientist workforce is diminishing as a result of challenges in achieving adequate funding, clinical demands, paucity of available mentorship, lack of institutional support, educational debt, lower wages compared to fully clinical colleagues, and difficulties with work-life balance [ 1 ]. As physician-scientists are becoming endangered at the national level, more comprehensive and supportive research experiences need to be available to OBGYN residents, fellows, and junior faculty so that they can develop an interest in a research-focused career early [ 1 ].…”

“…With the present waning National Institutes of Health (NIH) funding landscape and career opportunities available to support physician-scientist trainees, the OBGYN-scientist workforce has continued to diminish. This is a concerning trend that parallels global underinvestment in women’s health research and the progressively smaller pool of early-stage physician-scientists applying for NIH research support [ 1 , 2 ]. OBGYN subspecialties that have traditionally attracted OBGYN scientists, including maternal–fetal medicine, reproductive endocrine infertility, and gynecology oncology, are also experiencing decreased interest from fellowship applicants to pursue an OBGYN scientist career [ 1 , 3 , 4 ].…”

“…This is a concerning trend that parallels global underinvestment in women’s health research and the progressively smaller pool of early-stage physician-scientists applying for NIH research support [ 1 , 2 ]. OBGYN subspecialties that have traditionally attracted OBGYN scientists, including maternal–fetal medicine, reproductive endocrine infertility, and gynecology oncology, are also experiencing decreased interest from fellowship applicants to pursue an OBGYN scientist career [ 1 , 3 , 4 ]. A long-term consequence of this is a subsequent decline in OBGYN-scientist mentors that can train the next generation of physician-scientists in obstetrics and gynecology.…”

Design and Implementation of a Career Development Program for Physician-Scientists: Lessons Learned

“…There are multiple challenges that can prevent physician-scientists from transitioning to independent research careers, particularly in HSR. Common across a broad range of medical disciplines, these barriers include lack of training in research methods 1,2 and advanced statistics, 1,3,4 difficulty identifying appropriate mentors, 1,[4][5][6][7] few opportunities for collaboration, 2,6,8 and challenges accessing data. 2 The National Institutes of Health's (NIH's) R25 and T32 career development programs are intended to address these challenges.…”