Hard times for Swedish physician–researchers
Physician-researchers form an important link between pre-clinical and clinical medicine. They often put research findings into practice and they play a crucial role in maintaining high standards in health care. They often teach and encourage medical students to do research. So it is important for them to strike a balance between medicine and research.
This isn't always easy, as a 2003 Swedish research council survey indicated. Many of the 425 medical students and 182 junior doctors cited bad pay and a heavy workload as reasons to abstain from research.
The situation is like that in North America: only one in five Swedish physicians with a PhD plans to become a senior lecturer. The number of researchers with MDs is declining, for several reasons.
Getting a PhD involves a huge effort, especially for MDs, who often have to work full-time in a clinical setting while doing their PhD. The average age for MDs at the Karolinska Institute to attain a PhD increased from 38.5 in 1991 to 40.8 in 1997. Sweden's healthcare system is constantly slashing costs and increasing patient numbers. MDs find it hard to allocate time for research, and the pace has made supervisors less keen to take on new recruits.
To become a specialist in Sweden, an MD has to complete a two-year internship and another five years of specialization. Their salary increases by US$1,000 a month when they qualify, but that pay rise is often delayed for physician-researchers by the number of months they spent on research.
A PhD is no longer a prerequisite for top clinical positions at university and teaching hospitals. And funding for medical research is declining.
To encourage more physician-scientists, economic incentives need to be created. Norway sets an example: junior doctors are allowed to include 12 months' research towards their specialization requirement. This would reduce the salary gap with colleagues who are not doing research. Healthcare providers should reward research and create an atmosphere where it is an integrated part of clinical work. This means creating positions for young physician-scientists and remedying the shortage of supervisors needed to keep Nordic medical research at a world-class level.
Finally, the state should increase funding for clinical research. If it doesn't, young physician-scientists may soon be another species menaced by extinction.
About this article
A qualitative study of the perspectives of key stakeholders on the delivery of clinical academic training in the East Midlands
JRSM Open (2018)
The Lancet (2007)
Journal of Investigative Medicine (2006)
The Lancet (2006)