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Physician-scientists comprise a unique and valuable part of the biomedical workforce, but for decades there has been concern about the number of physicians actively engaged in research. Reports have outlined the challenges facing physician-scientists, and programs have been initiated to encourage and facilitate research careers for medically trained scientists. Many of these initiatives have demonstrated successful outcomes, but there has not been a recent summary of the impact of the past decade of effort. This report compiles available data from surveys of medical education and physician research participation to assess changes in the physician-scientist workforce from 2011-2020. Several trends are positive: rising enrollments in MD-PhD programs, greater levels of interest in research careers among matriculating medical students, more research experience during medical school and rising numbers of physicians in academic medicine, and an increase in first R01 grants to physician-scientists. However, there are now decreased levels of interest in research careers among graduating medical students, a steady decline in MDs applying for NIH loan repayment program support, an increased age at first R01 grant success for physicians, and fewer physicians reporting research as their primary work activity: all of these indicators create concern for the stability of the career path. Despite a recommendation by the Physician-Scientist Workforce in 2014 to create "real-time" reporting on NIH grants and grantees to help the public assess trends, this initiative has not been completed. Better information is still needed to fully understand the status of the physician-scientist workforce, and to assess efforts to stabilize this vulnerable career path.

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The Federation of American Societies for Experimental Biology (FASEB) was formed in 1912 to serve the needs of its four charter societies. Its growth, from these organizations with a little more than 300 members to nearly 30 societies with over 100 000 members, is a tribute to its ability to respond to the changing structure and needs of the experimental biology community. The Federation began as a loosely constructed, single-purpose organization established to facilitate the coordination of the annual meeting of its four member societies. Following World War II, the limitations of this informal structure became readily apparent, and the development of a professional staff under the leadership of Milton O. Lee ushered in the second phase of FASEB's history. Lee oversaw a period of substantial institutional growth, but when he retired in the mid-1960s the unresolved issues of governance and member autonomy loomed large. These became increasingly divisive sources of organizational friction and were not meaningfully resolved until the Williamsburg Retreat of 1989 restructured the Federation and initiated the third phase of its existence. The changes made as a result of this pivotal event gave FASEB a new raison d'etre (public affairs) and made the organization attractive to many other biomedical research societies. Membership grew rapidly in the 1990s and early years of the 21st century. This larger membership, along with changing financial relationships, present new challenges for the Federation and are precipitating another restructuring.

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After >3 decades of steady growth, the number of biological and medical science postdoctorates at doctoral degree-granting institutions recently began to decline. From 2010 through 2013, the most recent survey years, the postdoctoral population decreased from 40,970 to 38,719, a loss of 5.5%. This decline represents a notable departure from the previous long-standing increases in the number of postdoctorates in the biomedical workforce. The rate of contraction appears to be accelerating in the most recent survey years, and this has important implications for the biomedical workforce.

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Physician scientists (researchers with either M.D. or M.D.-Ph.D. degrees) have the unique potential to combine clinical perspectives with scientific insight, and their participation in biomedical research has long been an important topic for policymakers and educators. Given the recent changes in the research environment, an update and extension of earlier studies of this population was needed. Our findings show that physician scientists are less likely to take a major role in biomedical research than they were in the past. The number of physician scientists receiving postdoctoral research training and career development awards is at an all-time low. Physician scientists today, on average, receive their first major research award (R01 equivalent) at a later age than in the 1980s. The number of first-time R01-equivalent awards to physicians is at the same level as it was 30 yr ago, but physicians now represent a smaller percentage of the grant recipients. The long-term decline in the number of physicians entering research careers was temporarily halted during the period of substantial U.S. National Institutes of Health (NIH) budget growth (1998-2003). These gains are lost, however, in the subsequent years when NIH budgets failed to keep pace with rising costs.

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Has the dramatic growth in the NIH budget affected the training and production of biomedical Ph.D.s? Examination of new survey data reveals surprising findings. Despite the need for an increased workforce to carry out the expansion in biomedical research, there has not been an increase in new U.S. doctorates awarded, and time-to-degree in the biomedical sciences is no longer increasing. Furthermore, both the frequency and length of postdoctoral appointments are decreasing for U.S. biomedical science recipients. There has been, however, continued growth in the number of foreign postdoctorals. Industrial employment of biomedical scientists continues to increase, but there has been only modest growth in tenured or tenure-track academic jobs.

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