The physician scientist: an endangered breed?

Even if we lived in a world with no resource limitations for health care, cures would still not be available for many of our patients. For this reason it has long been recognised that the complete physician will have a role in increasing the knowledge base of his or her profession as well as in teaching and in clinical practice. We are currently in a golden age of medical research with spectacular advances in our understanding of disease pathophysiology on almost every front. In medical science terms, the era is as exciting as that which occurred in planetary exploration, when Magellan rounded Cape Horn and in human artistic creativity at the height of the Italian Renaissance. The key difference, however, is that those earlier ages of exponential advance in human knowledge and creativity were centred around a small number of individuals with little communication to the world at large, whereas in our own age, the wonders of electronic communication in the global village give us all the opportunity to take part in the excitements of new discovery. In the early stages of the evolution of western medicine, most of the key scientific advances were made by medical graduates and were based directly on their study of patients. In more recent times, the complexities of frontier research have increased enormously, with the need for scientific inputs from a number of disciplines supported by a range of technologies to be on the crest of the wave. We will never return to the days where the isolated physician scientist is likely to make a major research breakthrough simply on the basis of careful clinical observation but we are now in an era where the clinical scientist is more important than ever. The opportunities for the physician to engage in medical research are enormous. Medical and physician training gives a unique perspective on disease pathophysiology that brings a focus to a large research group that the non-medical researcher may lack. Physicians who are skilled in molecular biology and biochemistry will continue to have a major role in leading basic laboratory programs and in focusing the efforts of their teams in the translational or preclinical area. The need for highly skilled clinical researchers is greater than ever, with opportunities available in several areas, including new technologies to investigate disease pathophysiology in life non-invasively, an increasing range of new therapeutic targets and new compounds to be taken through the clinical trial process, and a central role in health economics in acquiring the skills to evaluate the cost−benefit of partially efficacious treatments with a finite health budget. The exponential increase in the knowledge base has increased the complexity of physician practice and meant that it is often more than a full-time job to keep up-to-date with one's own discipline and to manage patients in the best possible way. In all of this, how does the physician find time to continue research? The scope of individual involvement will differ as it always has. All physicians should be aware of the research effort and encourage their colleagues who are making it a major part of their professional life. All physicians have the opportunity to contribute interesting and unique clinical observations to the literature and many have the opportunities to become involved in clinical trials and in clinical research more broadly. Only a smaller set of physicians will split their career between basic laboratory research and patient care. It is important, however, that where colleagues have a bent in this direction they are encouraged at an early stage so that the unique contribution that the physician scientist has to make to early discovery is not diminished. In recent issues of the Journal, we have published a series of personal viewpoint articles from a series of outstanding Australasian scientists, each of whom has made a significant intellectual contribution to medical knowledge. They differ to some degree as one would expect in the personal factors that have led them into medical research. But one thing they all share is a sense of joy in the new knowledge that they have been able to contribute and, on reading their accounts, one is left with the impression that there can be few career pathways that give such immense personal satisfaction. There is a message here for physicians young and old: we must all continue to look for opportunities to expand medical knowledge. We all have something to contribute!