The Future of the Orthopaedic Clinician-Scientist

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Abstract
Background: There is currently a severe shortage of clinician-scientists, who fill a vital role in musculoskeletal care. One way to address this shortage is to recruit more MD-PhD students into orthopaedics. We analyzed data from a national survey of MD-PhD students to assess this potential. Methods: A total of 868 students from thirteen MD-PhD training programs were requested to fill out a multiple-choice online survey concerning their education and future goals. Results: We achieved a response rate of 56.7% (492 of 868). Seven (1.4%) of the 492 respondents listed orthopaedics as their primary clinical interest, and thirty (6.1%) listed it as one of their three strongest clinical interests. Among the thirty respondents, seven (23%) were senior students, five (17%) were women, and none were minorities. In comparison, 33% of the 462 respondents in the nonorthopaedic cohort were women and 12.1% were a member of a minority group (p < 0.05). Among twenty-three students who had a secondary orthopaedic interest, only one-third had a primary surgical interest. Both the thirty with a strong clinical interest in orthopaedics and the others without a strong interest in orthopaedics showed similar intent on becoming physician-scientists (a score of 2.73 and 3.30, respectively) and an interest in an academic career (90.0% and 90.3%, respectively) (p > 0.05 for both). The orthopaedic group showed significantly greater interest in clinical care as a primary activity than did the nonorthopaedic group (63.3% compared with 30.7%; p < 0.0005). Eighty-seven percent of those in the orthopaedic group reported research as their most likely primary or secondary activity. Conclusions: This study suggests that there is a relatively strong interest in orthopaedic surgery (patient care and research) among MD-PhD students nationally, creating the potential to recruit approximately 100 new orthopaedic clinician-scientists every eight years (the average MD-PhD training period). Extrapolation indicates that there is the ability to double the number of orthopaedic clinician-scientists in the United States over the next fifty years. Therefore, efforts should be made to attract these students (especially women and those in underrepresented minority groups) to orthopaedic surgery. The study further suggests recruiting broadly—we should not be biased toward students late in training and just those with surgical interests.

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