Careers in Medicine: Research
A NextGen Pathways in Medicine Article
From an Interview with Dennis Ausiello, M.D., Massachusetts General Hospital
Dennis Ausiello, M.D.
Earlier in the twentieth century, the most respected physicians in academic medical centers practiced medicine with a tripartite mission: they allocated their time to participate in the best clinical care, the best education, and the best research. Dr. Ausiello, however, believes that current physicians can only perform optimally when they spend at least 75% of their time and energy in one of the three and allocate 25% to other roles. Many physicians have chosen to dedicate that 75% (or more) to research, the "investigatory arm of medicine," to create new knowledge instead of being passive recipients of information. "What we don't know about a problem often is more exciting to explore than just using the information that we do know about a problem."
Research in medicine covers a wide range of topics from a micro scale to a macro scale, from principles of basic science to drug trials to public health research. According to Dr. Ausiello, "biology is not a science: it is an elegant expression of chemistry, physics, and mathematics," all of which form a common language shared by researchers in various fields. Traditionally, physician-scientists focused on either basic science research, limited to non-human experimental organisms, or clinical research, focusing on human subjects. However, increased knowledge of the human genome and other advancements in our understanding of human biology has blurred the distinctions between the two disciplines. Dr. Ausiello asserts, "It's a continuum. To stratify science doesn't make a lot of sense in terms of understanding the nature of biological questions and how to solve them." Nonetheless, Dr. Ausiello emphasizes that this is an exciting time as the chasm between basic science and clinical science has narrowed to a critical point. While it may be impossible for a single physician-scientist to engage the entire spectrum, teams of researchers (M.D.'s, Ph.D.'s, and M.D.-Ph.D.'s) and clinicians can readily cooperate in translating knowledge across the continuum so that principles of basic science can be applied to the care of patients.
At this time, there are two main paths leading to careers in research that young physicians can take: the M.D.-Ph.D. path and the M.D. path. In both cases, physician-scientists train within the apprenticeship model (similar to how physicians develop their clinical skills during residency): they are guided by mentors who are established researchers. When the young physician and her mentor agree that she is prepared to become an independent researcher, she often begins her career by securing her first grant and arranging the provision of space and resources by an academic institution.
However, there are a variety of challenges to physician-scientists built into this model. Growing numbers of Ph.D.'s and M.D.-Ph.D.'s are engaging in biomedical research and are vying for a limited supply of funding for research, particularly at a time when funding from the National Institutes of Health (NIH) appears to be on a downturn ("It's happened before, and it's happening again now."). As such, there appears to be little job security given that physician-scientists must depend on funding from grants for their salaries and for conducting research. Furthermore, although there are greater numbers of M.D.-Ph.D.'s now, there are fewer M.D.'s working as researchers. According to Dr. Ausiello, there is a growing shortage of good research training for M.D.'s, particularly due to a "dilution of scientific requirements" for medical school admissions and rigorous research-directed training in medical school. "Without some added educational process [such as a mentorship or a Ph.D. training equivalent]," Dr. Ausiello states, "M.D.'s will not be as well prepared to do state-of-the-art science today as 25 years ago."
Nevertheless, despite these challenges, research in medicine is an exciting area for talented
physicians to apply their skills and energy. Dr. Ausiello suggests that future physician-scientists
must have 1) an inquisitive mind, 2) good people skills ("not just in the clinic, but also in
collegial interactions"), 3) generosity in taking the time to train younger researchers and continue
the success of the apprenticeship model, 4) patience and diligence, and 5) rigorous training to give
them the skill sets and the knowledge of how to use those skill sets to answer the key questions in
medicine today. "Science is never straight, never easy. Coupling [biological sciences] to the human
condition isn't always clear." 
Lester Leung is the Editor-in-Chief and Founder of the Next Generation and a member of the Harvard College Class of 2006.
Dennis A. Ausiello, MD is the Jackson Professor of Clinical Medicine at Harvard Medical School and the Physician-in-Chief of the Department of Medicine at Massachusetts General Hospital (MGH). Previously, Dr. Ausiello served as Chief of the MGH Renal Unit from 1983-1996 and oversaw its development into one of the most sought after research and training programs in the world. He has made a substantial contribution to knowledge of epithelial biology in the areas of membrane protein trafficking, ion channel regulation and signal transduction, and has published over 100 papers, chapters and textbooks. Dr. Ausiello currently serves as the co-editor of Cecil's Textbook of Medicine (Elsevier), now in its 22nd edition.