Physician Scientists: Leading Innovation at the Bench and the Bedside
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By Alex Strauss
Research the phrase “physician scientist” and one word comes up again and again: endangered.
These individuals work at the intersection of clinical practice and scientific inquiry, uniquely poised to bring clinical insights into the lab and vice versa. And yet, the gist of nearly every article written about physician scientists in the 21st century is that, although their work is critical to medical advancement, their numbers are steadily declining.
In 1999, Princeton microbiologist Leon Rosenberg wrote in Science, “If the country’s medical research enterprise is to make the contributions it is poised to deliver, the progressive, dangerous decline in the number of physician-scientists must be reversed.”
But the problem has only gotten worse.
A 2014 article in Evaluation and the Health Professions called the continued downward trend “alarming”. A year earlier, an article in the Journal of the Federation of American Societies for Experimental Biology found, among other things, that physicians now represent a smaller percentage of grant recipients and are less likely to take a major role in biomedical research than they were in the past.
These are just a few of the reasons why the three local physician scientists we spoke with for this story are so passionate about what they do. Despite long hours, erratic schedules and fragmented professional duties, these Sanford doctors all say they would not trade their rich professional lives of patient care and scientific inquiry.
Dr. Michael Kruer
Dr. Michael Kruer is an Associate Scientist in the Children’s Health Research Center at Sanford Research and a pediatric neurologist at Sanford Children’s Hospital. But neither role was in his sites when he started college at Arizona State.
“I didn’t really know what I wanted to do but I was studying psychology and started doing some work with kids with autism,” says Dr. Kruer. “As I became closer with these kids and their families, I realized that if there was going to be a breakthrough for autism, it would have to be a medical breakthrough. That got me interested in brain science and how it could be translated into better care for people with neurological diseases, particularly children.”
After graduation, as Kruer was struggling with whether to enter graduate school or medical school, a biochemist for whom he was working had some sage words. “He said ‘I’ll make it easy for you…Just do both!’” he recalls. In medical school at Arizona, Dr. Kruer found his niche working with children with rare movement disorders and neurodegenerative diseases and later did post-doctoral work in a neurogenomics lab.
“Some other people advised me against going into such a difficult field. They said there’s not much you can do for these people,” says Dr. Kruer. “But I was struck by how much these patients needed someone to walk with them on this difficult path and also by how grateful they are. I became very passionate very quickly.”
Today, Dr. Kruer spends two days a week in general pediatric neurology and specialty movement disorder clinics at Sanford Children’s. The other three days are spent studying the molecular mechanisms of inherited and acquired diseases of the central nervous system – specifically dystonia and juvenile parkinsonism – in his lab.
“I feel so blessed to be able to do both,” says Kruer. “My work in the clinic makes me realize how much we still don’t know and how important it is to continue with the research. My work in the lab is so much richer because I see the human faces behind what we’re doing.”
That’s not say it’s an easy life. Like most physician scientists, Dr. Kruer is often torn between these two worlds. “It’s a juggling act and it can be incredibly difficult. There are days when I am supposed to be over in the lab but things are happening with my patients and my pager is going off. There are also times when I have presentations that take me out if town and it’s tough to keep in touch with my patients. On a bad day, it makes me a little crazy. But on a good day, it’s the best career I could ever imagine.”
Dr. John Lee
Head and neck cancer surgeon and researcher John Lee, MD, spends three days a week seeing patients and performing surgery at Sanford USD Medical Center and two days a week studying the causes and treatments of tonsillar cancers that are triggered by the HPV virus. These cancers have increased by 300 percent in the last 3 to 5 years and are now the most common head and neck cancers that Dr. Lee treats.
“The great thing is that I do research on the things that I treat,” says Dr. Lee. “We have a lab that looks at how the virus changes cells, how it causes them to become cancerous. My role is to not only see the patients but to translate new information from our lab and from labs around the world into better treatments.”
After more than 20 years as both a clinician and a researcher (15 at the University of Iowa and 6 at Sanford), Dr. Lee calls himself the “old man” of the physician scientist bunch at Sanford. The Minnesota native took a job in a research lab to pay his way through Stanford and later through medical school at the University of Minnesota. His lab has produced four different cancer trials focused on tonsillar cancer and the HPV virus. When asked what attracted him to a career in both research and clinical work, he uses a music metaphor.
“You have people who can compose the music and people who perform it,” says Dr. Lee. “The problem is that surgery is like playing an instrument. It’s very technical and you’re doing the same thing over and over, hitting the keys. Doing the research is like also having the opportunity to write the music. You’re designing new ways to present things. I think that is really what keeps me interested.”
As for the challenges of time management, Dr. Lee has a simple solution – be available to everyone all the time. “You try to compartmentalize as best you can, but the bottom line is that you really have to be able to leave if something comes up. That is what makes it hard, that lack of continued focus.”
But Lee says the rewards of continued learning and seeing his research translated into real clinical benefits are worth the challenges. “Based on our research on how the virus changes the way cancer eats sugar, we developed a therapy and have found that people respond 20 to 40 percent better with this therapy. That was very exciting,” he says.
Dr. Lee worries about the future of research as fewer people choose the complexities of the physician scientist track and has this advice for medical students: “There is a point in your practice – often in your 40s – when you can start to get bored. Being a researcher, as well as a clinician, is a great way to assure that you don’t.”
Dr. Michelle Baack
Not all physician scientists pursue both tracks from the beginning. Pierre, South Dakota native and neonatologist Michelle Baack, MD, spent ten years as the only full-time pediatrician in Pierre before deciding to pursue neonatology at the University of Iowa. It was there than she was “bitten by the research bug.”
“During a pediatric fellowship, you do two years of research and then your clinical work,” says Dr. Baack. “As a pediatrician, I had seen the longer term effects of nutrition and I was thinking of ways that we could improve the outcomes of premature infants. So I started looking at the role of fatty acids and that is what I still do in my research.”
As a neonatologist, Dr. Baack manages the sickest of newborns during one week on call each month, as well as one overnight each week. On the weeks when she is not on call, she is studying the importance of fatty acids in the promotion of normal growth, brain development and vascular health in early development.
“Expectant mothers with diabetes can have very high circulating fat levels, which can actually turn genes on or off in the fetus,” explains Dr. Baack. “Our hope is to be able to fix these kinds of problems even in utero in order to prevent things like heart disease as an adult.”
Like other physician scientists, Dr Baack believes that both sides of her dual career inform and enhance each other. “Sometimes I see new medical students say ‘This is the algorithm I learned in medical school and this applies to everyone.’ But being a researcher makes me think about patients and their medical care in more innovative ways.”
“When I take the information gained from new research and apply it, it makes me a better physician. And when I take what I am learning from my patients and apply it in the lab, it makes me a better scientist.”
Although her dual career causes some colleagues to see her as a ‘half time’ physician or scientist, Dr. Baack says the reality is that physician scientists must be more than full time – and fully-committed – in both areas.
“When other doctors get done doing a night shift, they go home. When I get done, I go to the lab,” she says. “When I am not in the NICU, I am in the lab. When I am not in the lab, I am in the NICU or home writing grants and papers. So my ‘work/life balance’ is mostly work.”
Like her colleagues, Dr. Baack worries about the future of medical innovation as fewer students choose the difficulties of a dual career. She herself says she has never regretted her decision to pursue both medicine and scientific inquiry and is proud to be on the leading edge of advancement.
“New physicians are learning algorithms. And who makes those algorithms? It is the leaders in their fields. In this line of work, you are really on the cusp of everything.”