The Orthopaedic Clinician-Scientist

Most applicants for orthopaedic residencies and fellowships state that they wish to do some teaching and research when they finish their training. However, this initial interest in research is not sufficiently maintained to replenish the pool of clinician-scientists in orthopaedics. This problem is not unique to our field; clinician-scientists are an endangered species in many other specialties as well. From 1994 to 1997, the actual number of all first-time physician applicants for National Institutes of Health research grants plummeted 31%. If this progression were to continue linearly, there would be no first-time physician applicants by 20031. While support from the National Institutes of Health is not the only way to sustain a research career, it is a bellwether of clinician-scientists doing work at that recognized high level. James Wyngaarden, former director of the National Institutes of Health, called attention to this developing trend in 1979 in an article entitled The Clinical Investigator as an Endangered Species.2 This progressive shift away from scientific investigation and toward large clinical series and case reports has been noted by others3. Francis Moore, in 1976, spoke of the unresolved conflict the operating room and the laboratory . . . between the clinical pressures of care of the sick and the pursuit of science.4 Many people in the research community believe that the small number of orthopaedic clinician-scientists capable of doing rigorous and meaningful research is the result of increasing conflict within the system5. Time and financial considerations are the major reasons for the diminishing numbers of clinician-applicants who are competing successfully for major federal funding. We all should recognize the need in our specialty for a cadre of orthopaedic clinician-scientists involved in basic, disease-oriented, patient-oriented, and prevention-oriented research. These unique individuals are necessary to create a …