What are the chances? Clinician scientist` career pathways in Germany

BACKGROUND

Germany faces a lack of clinician scientists. This problem is widely acknowledged, not just in Germany, as clinician scientists are crucial for medical translation and innovation: trained in medical practice and research they are capable of translating scientific problems into clinical application and vice versa, clinical problems into research. The implementation of nationwide clinician scientist programs (CSPs) in Germany is supposed to solve the lack of trained clinician scientists and, as consequence, to improve the translational relationship between biomedical research and clinical practice. Against the backdrop of an increasing number of CSPs, our study provides early insights into their effectiveness with a focus on what it means to become a clinician scientist and to establish a subsequent career path as a clinician scientist in Germany.

METHODS

During a research project that was conducted from 2020 to 2023 and funded by the German Federal Ministry of Education and Research, we studied thirteen CSPs. We developed a qualitative questionnaire and interviewed 36 clinician scientists in training, their program supervisors, as well as policy stakeholders. The goal of the interviews was to identify the key obstacles in establishing a career path for clinician scientists in Germany.

RESULTS

We found three types of challenges for establishing and ensuring long term career paths for clinician scientists: First, local working conditions need to allow for clinician scientists to create and perform tasks that combine research, teaching, patient care and translation synergistically. Protection from the urgency of patient care and from metrics-based performance measures both in the clinic and in research seem key here. Second, a stable career path requires new target positions besides clinic management and senior residency. Third, there is a need for cultural change within university medicine that recognizes and rewards new translation-focused practices.

CONCLUSION

We find that CSPs improve working conditions for the duration of the program and provide protected time for doing research. After the programs, however, the career paths remain unstable, mainly due to a lack of target positions for clinician scientists. CSPs support the initial development of the clinician scientist' role, but not in a sustainable way, because the separation of research and patient care is stabilized on an institutional and systemic level. The tasks clinician scientists perform in research remain separate from patient care and teaching, thus, limiting their translational potential. In order to remain a clinician scientist within this differentiated system of university medicine, clinician scientists have to do a significant amount of extra work.

Clinician-Scientists in-and-between Research and Practice: How Social Identity Shapes Brokerage

Clinician-scientists (CSs) are vital in connecting the worlds of research and practice. Yet, there is little empirical insight into how CSs perceive and act upon their in-and-between position between these socio-culturally distinct worlds. To better understand and support CSs' training and career development, this study aims to gain insight into CSs' social identity and brokerage. The authors conducted semi-structured, in-depth interviews with 17, purposively sampled, CSs to elicit information on their social identity and brokerage. The CSs differ in how they perceive their social identity. Some CSs described their social identity strongly as either a research or clinical identity (dominant research or clinical identity). Other CSs described combined research and clinical identities, which might sometimes be compartmentalised, intersected or merged (non-dominant-identity). In the types of brokerage that they employ, all CSs act as representatives. CSs with a non-dominant identity mostly act as liaison and show considerable variability in their repertoire, including representative and gatekeeper. CSs with a dominant identity have less diversity in their brokerage types. Those with a dominant research identity typically act as a gatekeeper. Combining lenses of social identity theory and brokerage types helps understand CSs who have a dual position in-and-between the worlds of clinical practice and research. Professional development programs should explicitly address CSs' professional identities and subsequent desired brokerage. Research and policy should aim to clarify and leverage the position of CSs in-and-between research and practice.