Reviving a Dying Breed: The Clinician Scientist 


By Amanda Marshall, MD

With the many pressures of balancing basic science research and quality patient care, fewer and fewer surgical specialists are pursuing the career path of both clinician and scientist. This is not a brand new observation.

Even as early as 1976, academicians spoke of the unresolved conflict, “between the operating room and the
laboratory, and between the clinical pressures of care of the sick and the pursuit of science.”

Having recognized this upcoming crisis, various surgical societies attempted to curtail it; but, the crunch of dwindling practitioners contributing to the basic science knowledge base is upon us.

For the last several decades the percentage of clinicians who serve as principal investigators for all fields of medical research has dropped to less than 20 percent of the total number of principal investigators. In the field of orthopaedics in particular, fewer than 4 percent of practicing orthopaedists even consider themselves clinician-scientists. This decrease is not entirely unexpected given the major changes in health care delivery and reimbursement over the past two decades.

Surgical subspecialty task forces have documented many barriers to the budding clinician-scientist, not the least of which are economic, but some of which also reflect changes in the culture within academic departments in response to outside pressures.

Some might ask, “Why is this even a concern?” Let’s consider the specialty of orthopaedics. Historically, the
advancement of the field was largely based on a heuristic approach (trial and error) guided by practitioner intuition.

A good example is the common hip replacement designed by Sir John Charnley in England. He relied on his clinical experience to direct the material science and biomechanical testing that went on to become one of the most successful and life-changing surgeries in all of medicine – total hip arthroplasty.

Today’s medical community has witnessed a shift in the practitioner-driven research to a more laboratory-based approach. Current examples include gene therapy, “designer” drugs, growth factors and advances in joint replacement bearing surfaces such as ceramics and polyethylene.

The current state of rapidly advancing musculoskeletal therapeutics arising directly from the laboratory begs the question: who will be the liaison between the lab bench and the bedside?

Do we as patient advocates want to rely on the data eagerly supplied by various drug and implant vendor representatives?

Obviously, the speed and manner of bringing laboratory advances back to the clinic, as well as formulating research agendas based on patient care issues are critically dependent upon having clinician-scientists. As clinicians they pose the questions, and as scientists they develop sound and reliable research to answer them. The outcomes are clinically relevant, effective and safe treatment and disease-prevention strategies.

Besides bringing clinical relevance to future research, these clinically oriented researchers are often our profession’s most valued teachers and the authors of educational material for future students. They are important in setting new standards for both research and education in the various medical specialties.

In the midst of declining numbers of clinician scientists, the University of Texas Health Science Center strives to revive this dying breed. The Chairman of the Department of Orthopaedic Surgery, Daniel W. Carlisle, MD, said, “The leadership of the University and the School of Medicine continue to support our research mission through aggressive recruitment, faculty development and resource allocation.

“This has enabled the University to significantly increase the amount of grant dollars we receive each year, which allows our Department to help advance the art of orthopaedic surgery through basic science and clinical research.

“Research done today by clinician scientists such as Dr. Marshall will directly contribute to the surgical and clinical care of our patients in the future.”

In summary, the profession of medicine continues to need clinicians who understand the capabilities and limitations of new technologies, as well as the clinical and biological realities so that new science can be translated into real benefits for our patients.Learn more about being a clinical scientist.

Originally from South Texas, Dr. Marshall returned to her home state last fall to join the Department of Orthopaedics at the University of Texas Health Science Center. She specializes in minimally invasive joint replacement and complex hip and knee revisions. In addition to her clinical practice, she has earned numerous research awards in the area of joint arthroplasty.