From training to sustainability: Supporting clinician-scientist career pathways

describing the clinician-scientist pathways developed at the University of the Witwatersrand (Wits).Their experience offers more than an institutional model for South Africa; it highlights a wider challenge confronting academic medicine internationally: how to convert research training into sustainable careers that preserve clinical engagement, scientific independence and long-term academic contribution.The clinician-scientist occupies a distinct position between patient care and scientific enquiry, translating clinical observations into research questions and returning new knowledge to practice.[1,2] Yet this workforce remains vulnerable across both high-income and resource-constrained settings.Prolonged training, service-delivery pressures, limited protected research time, salary disparities, insecure grant-dependent funding and poorly defined career structures continue to discourage recruitment and retention.[1,3-5] These pressures are particularly consequential where locally generated evidence is essential to address disease burdens, health-system constraints and population priorities that may not be adequately represented by research conducted elsewhere.The Wits model is valuable because it addresses several stages of the career continuum rather than relying on isolated research opportunities.Undergraduate research exposure, the intercalated MB BCh-PhD programme, clinician PhD support and dedicated clinician-scientist posts with substantial protected research time illustrate how institutions can deliberately create structured career pathways rather than leave career development to individual persistence.[1] However, training itself should not be regarded as the endpoint.The true test of a clinician-scientist pathway is whether trained individuals remain in academic medicine and are able to build durable, clinically grounded research careers.For this reason, future evaluation of programmes such as Wits should extend beyond enrolment, degree completion, or short-term publication output.Longitudinal outcomes should include retention in academic medicine, sustained protected research time, acquisition of independent funding, first-and senior-author publications, postgraduate supervision, mentorship of younger clinicians, continued clinical activity and contribution to research addressing relevant health priorities.Such measures would help to determine whether institutional investment produces a lasting clinician-scientist workforce rather than a temporary increase in research qualifications.They would also capture whether programmes generate the mentorship capacity and visible role models needed to sustain the next generation of clinician-scientists.A second challenge is scalability.Models that depend on dedicated posts, salary support, protected time and institutional research infrastructure may not be directly transferable to every setting.Adaptation will require collaboration among universities, health services, governments and funding agencies, with protected research time recognised as a legitimate component of academic clinical work rather than an optional activity.[1,3,4] The principle, however, is broadly applicable: sustainable clinician-scientist careers require structures that align clinical service, research opportunity, mentorship and financial security.The Wits experience demonstrates that clinician-scientist development can be deliberately supported rather than left to individual resilience.Its broader significance lies in showing that the global clinician-scientist workforce should be judged not only by how many researchers are trained, but by whether academic systems enable them to remain clinically grounded, scientifically productive and professionally sustainable over time.