The Reply

Cook, David A.; Dyrbye, Liselotte N.

doi:10.1016/j.amjmed.2009.02.018

« Previous Next »The American Journal of Medicine
Volume 122, Issue 7 , Page e11, July 2009

The Reply

Office of Education Research and Department of Medicine, College of Medicine, Mayo Clinic, Rochester, Minn

Article Outline

References
Copyright

We thank Kumar for his interest in the career trajectory of physician-scientists. In response to his comment on the productivity plateau of MD-PhD graduates, we clarify that in our study comparing 3 physician-scientist training programs¹ we did not report changes in graduates' productivity over time. The Kaplan-Meier curves in the Figure represent time to first grant, and indicate that MD-PhDs who had not received a grant within 12 years of medical school graduation did not receive a grant during the period of this study. However, these analyses do not indicate the level of continued productivity among grant recipients, nor did we report publication productivity over time. We considered reanalyzing our data to explore changes over time, but believe such analyses would be misleading because of small samples and ambiguity in the determination of causality.

Nonetheless, the questions regarding possible burnout merit thoughtful consideration. Burnout is prevalent in both academic and private practice physicians,², ³ and distress among physicians is associated with job turnover and intent to leave practice.⁴ We are unaware of any study that has explored the prevalence or consequences of burnout among physician-scientists; however, given the already-tenuous state of the physician-scientist pipeline, this is clearly an area worthy of future research.

We share Kumar's expectation that improving the organization and content of physician-scientist training programs could enhance the productivity of program graduates. Unfortunately, the evidence thus far is limited to observational studies such as ours which incompletely clarify how to accomplish this goal.

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References

Dyrbye LN, Lindor KD, LaRusso NF, Cook DA. Research productivity of graduates from 3 physician-scientist training programs. Am J Med. 2008;121:1107–1113

Spickard A, Gabbe SG, Christensen JF. Mid-career burnout in generalist and specialist physicians. JAMA. 2002;288:1447–1450

Shanafelt TD, Sloan JA, Habermann TM. The well-being of physicians. Am J Med. 2003;114:513–519

Campbell DA, Sonnad SS, Eckhauser FE, et al. Burnout among American surgeons. Surgery. 2001;130:696–702

Funding: None.

Conflict of Interest: None.

Authorship: All authors had access to the study data (there were no new data analyses in this manuscript). Both authors were involved in drafting and revising the manuscript.

PII: S0002-9343(09)00328-3

doi:10.1016/j.amjmed.2009.02.018