|
his news of the cyberattack that recently shut down fuel supply to the eastern USA set me thinking about Neurology’s own pipeline and whether it is keeping up with the demand to create physician-scientists who will eventually evolve into leadership positions. There is a shortage of neurologists in several states, and the “graying of America,” and the rising prevalence of neurodegenerative disorders will further stress the system. In addition, surveys of “burnout” and quality of life suggest that neurology ranks amongst the least popular career choices. Women and underrepresented minorities are not entering the physician-scientist pipeline1. Figure. The physician-scientist pipeline: long and leaky1. The figure above highlights a number of issues, including career attrition at every stage and the existence of a protracted period when well-trained physicians in their 30s are serving in subordinate positions awaiting the next step in their career progression. Outcome data show that approximately 80% of MD-PhD program graduates are working in academia, industry, or research institutes — including the NIH — but not all are doing research. Data on NIH award rates, conversions from K grants to R grants, and the proportion of individuals appointed to MSTP T32 grants can be found in the PSW report2. The NIH continues to track principal investigators on grants but is just starting to track physician-scientists who play essential roles as other key personnel. Although the number of graduates from MD-PhD programs has risen over the past 10 years, women are less likely to apply to these programs than men. The number of underrepresented minority applicants to MD-PhD programs did not increase between 2010 and 2014. The extant problem in academic leadership in the USA is reflected clearly in the statistics. In 2020 of all medical department chairs in the country, out of more than 3,000 surveyed, 2,037 were occupied by white men, 63 by Asian-American women, and only 49 by Black women (AAMC statistics, 2020). Much has been written about the pipeline for physician-scientists and, appropriately, attention has been given to widening the pipeline upstream, both for learners and junior faculty. Indeed, the ANA has devoted considerable time and effort to focusing on learners, for example by encouraging attendance at our annual meetings and professional development offerings. To address the lack of diversity in the biomedical research workforce, the NIH launched a broad, trans-institutional strategy in 2014, including the Diversity Program Consortium. National efforts have focused significant resources on this through, for example, the National Mentoring Resource Network (NRM)2. NRMN resources include mentor certification, professional development webinars, a social networking platform called MyNRMN, and facilitator certification through the Center for the Improvement of Mentored Experiences in Research. As a small, resource-poor volunteer organization the ANA doesn’t have the capacity to tackle the entire pipeline issue for physician-scientists. Partnering with platforms like NRMN will amplify our organization’s capabilities. Effective mentorship early on is essential to building the pipeline of academic neurologists, and is a critical method for ensuring the recruitment and retention of those from underrepresented groups. In addition, the recently instantiated ANA IDEAS Task Force will strengthen the diversity of the leadership of the ANA and academic neurology. This focus on the pipeline downstream may stimulate allyship, strengthen mentoring, and in turn may widen the pipeline upstream by changing the face of academic neurology and making it a more attractive career choice for learners. The COVID pandemic has forced many professional activities to be conducted virtually, even those that traditionally we thought were not suitable for this medium. This shift may herald a new era of remote mentoring for academic neurologists, allowing for the “democratization” of mentoring so that all academic neurologists can have access to experienced mentors in varied research fields within neurology and neurosciences. Finally, we should remember the joy of mentoring, and seeing a mentee succeed. Arguably this is one of the greatest roles for an academic. Warm regards, Justin C. McArthur, MBBS, MPH |