Why investing in early-career clinician-scientists is investing in the future of healthcare in Canada

By Dr. Ana Nikolic, MOHCCN Clinician-Scientist Award Winner*

Clinician-scientists play a pivotal role in our healthcare systems. As physicians who also do research, we bridge the gap between the lab and the clinic, using our clinical experience to inform scientific inquiry and the findings from our research to try to improve the lives of patients. 

Given this unique role, you’d think there’d be plenty of us around. But sadly, that’s not the case. In fact, a report from the Royal College of Physicians and Surgeons of Canada estimates that the number is likely not more than 5000, prompting one of my colleagues to compare us to the dodo bird and suggest that we were heading towards extinction.

This scarcity has many reasons. For one, there are shortages in dedicated training opportunities for young clinician-scientists. Medical schools tend to advertise their commitment to research, and many prospective clinicians enrol with the intention to spend time in the lab. However, anyone who has gone through medical school knows that opportunities for students to engage in meaningful research are few and far between.

There are, of course, some research training programs for physicians in training, such as MD/PhD s and clinician- or surgeon-scientist training programs. However, funding for these programs is declining, limiting their reach. For example, a long-standing federal funding program for MD/PhD students was cut in 2016 after 30 years. In Alberta, where I am based, another program that used to offer studentships specific to MD/PhD students or MD-holding clinician-scientists was also eliminated. Existing programs often provide guaranteed funding only for two years, an insufficient amount of research training time for many translational or basic science fields.

In addition to the funding gap, the reality of our healthcare systems means that clinician and surgeon scientist programs are under constant pressure from clinical services, especially in the post-pandemic world. The pressure on clinician-scientists is also apparent at the faculty level, where positions dedicated to academic medical faculty are rare, making it difficult for young clinician-scientists to start research positions. Many departments are short-staffed, and negotiating protected research time for clinician-scientists often seems an unappealing proposition. Additionally, there is a lack of transitional awards at the early faculty level to help these scientists start their work.

I am one of the lucky ones. I was able to pursue clinician-scientist training through the Royal College Clinician Investigator Program and obtained my PhD. Early in my career, I was also fortunate to be selected as a recipient of the Marathon of Hope Cancer Centres Network Clinician-Scientist award, which has provided funding for my lab and helped me secure a faculty position with time for independent research, helping me further my studies into tumour evolution in glioblastoma, the most common malignant brain tumour.

Programs like these not only help early-career clinician-scientists like myself establish our labs and launch our careers—they are pivotal investments in the future of healthcare in Canada.

Clinical medicine is growing increasingly complex across many fields, including microbiology, clinical neuroscience and oncology. Advancements in areas such as genomics, next-generation sequencing, artificial intelligence and imaging are rapidly entering the clinical sphere. Given the complexity of modern science, the gap between basic science and clinical practice grows ever wider, and the science becomes more challenging for many clinicians to understand. For example, in neuropathology, which is my area of expertise, many brain tumour diagnoses are now dependent on genomic information.

As a clinician-scientist, I am better able to interpret this information and integrate the basic science underlying some of these diagnoses into the clinical realm. On the flip side, I can apply my understanding of the clinical problems to guide interpretation of basic science data and drive research projects in the lab. 

In a landscape increasingly reliant on interdisciplinary team science, clinician-scientists make valuable team members, not only as collaborators but also as leaders with a strong understanding of both the clinical and basic science aspects of disease. An investment in clinician-scientists is an investment in improving the quality and the future of clinical medicine, in moving from just getting by to being at the cutting edge of what medical practice could be.

In this sense, we are the future, not the past. We are not the dodo.

*Dr. Nikolic is recipient of the MOHCCN Clinicians Scientist Award. She is a neuropathologist with an interest in the molecular biology of brain tumours. She completed medical school at the University in Toronto, neuropathology residency at the University of Calgary, and a doctorate in brain tumour epigenetics at the University of Calgary in the lab of Dr. Marco Gallo.