To The Editor:
I am writing in response to the Orthopaedic Forum entitled "The
Orthopaedic Clinician-Scientist" (2001;83:131-5), by Jackson.
Dr. Jackson has eloquently stated the importance of the clinician-scientist
to the specialty of orthopaedics and to musculoskeletal research
in general. He has provided a detailed description of the problems
associated with the decline of the clinician-scientist and possible
solutions. Among the many excellent suggestions, I question only one
of his assumptions. He states: "The clinician-scientist
must realize that his or her income will be less than that of a full-time
clinician working within an orthopaedic department. Nonmonetary rewards
and support as well as intellectual satisfaction should be as important to
the potential clinician-scientist as income is."
Many orthopaedic surgeons working in academic environments are
not driven solely by the desire for financial gain. However, if
surgeon-scientists suffer financially from their commitment,
I believe that it is only a matter of time before such pressures
drive them away from research. I suggest that the goal for academic
health sciences centers is that equal work should have equal value.
Although this may pose a challenge for departmental heads, surgeon-scientists
should not be penalized but should receive compensation comparable
with that of their academic peers who are committed to clinical activities.
Only under these conditions can we realistically expect surgeon-scientists
to continue to devote the necessary effort toward their research
and ensure their continued success.
D.W. Jackson replies:
Dr. Wright’s suggestion concerning compensation was
expressed and discussed during the consensus-building stage of the
ideas that I summarized in my article. We all agreed that there
are many financial deterrents to becoming and remaining an orthopaedic
clinician-scientist. It was felt that a reasonable initiative for
academic centers to consider would be providing compensation based
on 60% of a clinician’s salary and 40% of
a scientist’s salary in the respective departments.
It was felt that other significant financial incentives may include
the opportunity for additional training (two to five years), at
no cost to the clinician-scientist, working in a mentoring and professionally
nurturing environment, access to research facilities, and initial financial
support for pilot studies. In addition, some relief from the overhead expenses
of a full-time clinician, an important financial issue for the clinician-scientist,
would be an incentive and would compensate for 40% of the time
being spent away from patient-care responsibilities. The considerations
above are probably just as important to this unique individual (the
future orthopaedic clinician-scientist) as is salary alone.
During our discussions, we did have limited input from the Canadian
orthopaedic research community. The consensus of ideas and suggestions
that I presented was based heavily on the current medical reimbursement
and practice system in the United States. Certain modifications
may be necessary in order to apply these ideas to the Canadian system.
I agree with Dr. Wright that the marketplace will ultimately
determine the solutions. Working together, we hope to nurture and
support a few of these budding clinician-scientists each year. It
is also important to assist the currently productive clinician-scientists
in maintaining their careers. We are trying to establish an array
of choices with the cooperation of the Orthopaedic Research and
Education Foundation, the American Academy of Orthopaedic Surgeons,
the Orthopaedic Research Society, government agencies, industry, and
foundations outside of our profession.
Hopefully, Dr. Wright and others will contribute their ideas
both to their own academic centers and to our wider effort. It is
my opinion that we can make a difference with regard to this issue
of actively supporting the development of clinician-scientists in
our profession through both individual and concerted efforts.