Why the World Is Losing Physician-Scientists—and How to Rebuild the Workforce

Physicians who also conduct research are becoming increasingly rare. In the 1980s, physician-scientists made up nearly 5% of the U.S. health-care workforce. Today, that figure is closer to 1.5%.¹

The decline is also evident in other countries. In the UK, the proportion of senior doctors working as academics fell from around 5% in 2009 to around 3% in 2025. The number of doctor-scientists under the age of 36 also fell by 25% between 2024 and 2025 (see “Doctor-scientists in distress”). go.nature.com/4ygjfev

In Japan, physician-scientists accounted for 2.1% of all physicians in 1996, but just 1.6% in 2016. Over the same period, the number of physician-scientists under the age of 39 halved.²

Underlying the decline is the inability to retain young physician-scientists at a sufficient rate to replace retiring senior professionals. Clinical academics around the world say that funding instability and a lack of career support are major barriers to staying in post.^3–6

In the United States, more than half of early-career physician-scientists are considering leaving academia for a purely clinical career, according to a study posted on the preprint website medRxiv.⁷ This is higher than the 31% of U.S. physicians who say they are considering leaving their current job within the next two years.

Why physician-scientists matter to medicine

The decline is alarming because physician-scientists are invaluable to health-care research. Their combined expertise positions them to pioneer advances in translational medicine, develop and conduct clinical trials, improve clinical practice and drive economic growth. More than a third of Nobel Prizes in Physiology or Medicine and Lasker Prizes in basic science are awarded to physician-scientists.⁸

South Korea offers a glimpse of what is at stake. Medical research publications were already declining in 2024, probably because of funding cuts, when the mass retirement of medical trainees forced physician-scientists to abandon research to cover clinical work.⁹ Publications fell by 12% that year, nearly twice the decline recorded in the previous year, likely due in part to the reduced contribution of physician-scientists.

Training physician-scientists delivers long-term benefits

Our own experiences have further convinced us of the value of this group. Two of us, RM and RB, currently lead the University College London MB-PhD programme, which has been running since 1994. The programme allows medical students to earn a PhD in scientific research, typically during their fourth or fifth year. It is one of several routes to becoming a physician-scientist.

Papers authored by 131 graduates of the programme between 1994 and 2026 received nearly three times as many annual citations as comparable papers in related fields.¹⁰

These results are only a snapshot from a small group, and many factors may contribute to the high performance of the cohort. However, they highlight the importance of the combination of expertise that defines physician-scientists.

That expertise is now being lost around the world. Governments, funders, universities and other organizations must take urgent action to halt the decline.

Why physician-scientists leave research

In many countries, centralized algorithmic systems help medical graduates secure their first postgraduate job. These systems do not always take research opportunities into account. In the UK, for example, two-thirds of posts historically reserved for aspiring physician-scientists are now allocated through algorithms that do not consider publication records.¹¹ When research is considered in hiring, the quantity rather than the quality of a candidate’s research output is often evaluated.

There is also no guarantee that a faculty department in a physician-scientist’s research field will be located near their new post. Systems in countries such as the UK, Australia and Canada intentionally place doctors in underserved areas. Although this is a sensible response to genuine workforce shortages, it can unintentionally move physician-scientists away from the infrastructure their research requires.

Insufficient protected research time and mentoring

Career support is another major problem. Once physician-scientists take up a post, health systems often provide less time and support for research. Although protected research time may be included in work plans, doctors can end up using it to cover rota gaps or manage a heavy clinical workload. A UK survey found that more than 50% of doctors reported a lack of protected research time in their work plans.¹²

Mentoring is often lacking.¹³ When it is available, mentors may not understand both the clinical and scientific aspects of the work.

Lower salaries and unstable research funding

Salaries for physician-scientists are often lower than those for comparable purely clinical positions. In the United States, academic physicians earn, on average, about USD 50,000 less per year than traditional hospital physicians (see go.nature.com/4y9anls). The same problem is occurring across Europe.³

The UK allows doctors who combine research and clinical training to receive a salary premium, but some people—particularly those who completed a doctorate before graduating from medical school—are not eligible.

At the root of these challenges is instability in health-care and research funding. In 2025, cuts to U.S. federal funding forced universities to rescind offers already made to new MD-Doctoral students. In 2015, the Canadian Health Research Agency announced that it would cancel funding for MD-PhD training programmes across the country and has yet to replace it. In recent years, research funding has also been cut in countries including Argentina and the Netherlands.¹⁴ The result will be fewer grants and fewer researchers.

How to rebuild the physician-scientist workforce

Retaining more people in the profession will require a coordinated effort from governments, funders, health systems, universities and physician-scientists.

Ministries of health and science should track how many doctors at each career stage enter, remain in or leave basic and clinical research. They should also make public where and why layoffs have taken place. This information would allow ministries to target interventions at the point where talent is being lost and assess whether reforms are working.