Diversity increases in kidney-focused research workforce, but other trends raise concerns
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An analysis of NIH records indicates substantial demographic changes have occurred in the physician-scientist workforce conducting kidney research in the United States during the past 30 years.
Certain demographic shifts have increased diversity in the research workforce, including a workforce that has a greater representation of women and international medical graduates.
Some of the observed trends however, such as an aging workforce that is declining in relative number, “raise serious concerns” regarding future progress in this area, Delaney C. Abood, BS, research specialist at Emory University School of Medicine, and colleagues wrote.
“Physician-scientists have made an enormous contribution not only to clinical care, but also to medical investigation, which has propelled the U.S. into its current global leadership position in biomedical research,” Abood and colleagues wrote. “These investigators are uniquely poised to make important scientific observations due to the ‘experiments of nature’ they encounter in the practice of medicine. However, this country’s biomedical research leadership status is threatened, in part, from the decline in its physician-scientist workforce ...
While we know there to be fewer [National Institute of Diabetes and Digestive and Kidney Diseases] NIDDK-funded physician scientists, what is not known is whether this workforce is also aging, which portends their further decrease in number. Also unknown is whether there have been changes in the representation of PIs doing basic science [vs.] clinical research, the representation of men [vs.] women, and the representation of investigators trained within [vs.] outside the U.S.”
Diversity
The analysis of NIH data, obtained utilizing RePORTER, revealed that while the number of physician principal investigators (PIs) trained in the United States has remained “fairly stable” in the past 30 years, the number of international graduates has increased. In addition, researchers found U.S. trained physicians now make up a smaller percentage of all physician-scientists, while international medical graduates make up a greater percentage.
Researchers observed shifts over time for international medical graduates: In 1990, they made up 28% of the R01-funded kidney-focused physician PI workforce, but by 2020 they represented 43%.
The representation of women with R01 funding has also increased, “both in total number and as a percent of all physician PIs.” When comparing specific years, researchers found women represented 8% of kidney-focused physician PIs in 1990 compared with 25% by 2020.
Clinical vs basic research
Changes were also observed in the choice to conduct basic vs. clinical research throughout the study period, with physicians doing clinical research making up 24% of total K-funded physician scientists in 2000 compared with 50% in 2020. With this increase in PIs conducting clinical research, a “reciprocal fall” was observed in basic science participation.
“Clinical research was taken to be studies of human subjects, human populations, or human databases that that use widely available measurements, such as those performed by a clinical laboratory or an institutional core facility,” the researchers explained. “Basic science was deemed to be research utilizing cell systems, animals, or human tissue that was heavily dependent on biochemistry, molecular biology, physiology techniques etc. that are available only in a basic science laboratory.”
Decline in physician-scientist workforce
Regarding the workforce overall, researchers found the percentage of all R01-funded PIs that are physicians declined from 72% in 1990 to 59% in 2020 (on the other hand, the percentage of non-physician PIs increased). In addition, researchers observed the number of years that have elapsed since physician PIs have been out of medical school (used as an age surrogate) increased from a median of 22 years in 1990 to a median of 31 years in 2020.
“Overall, the physician-scientist workforce doing kidney-related research is getting older and represents a smaller proportion of all PIs, particularly among those doing basic science,” Abood and colleagues concluded. “This trend raises serious concerns as to whether there will be a sufficient workforce to drive future progress in kidney-related research.”
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