Mel Silverman is professor of medicine at the University of Toronto and senior staff nephrologist at Toronto General Hospital
In mid-June, Canada's medical community was shocked to learn that the Canadian Institutes of Health Research, the federal agency for health-research funding, has unexpectedly cancelled its support of funding for students in combined MD/PhD programs.
CIHR acted without consultation and contrary to a 2013 report of its own advisory committee on training that recommended enhancing these studentships. In cutting this funding, the agency has dealt a mortal blow to training programs that faculties of medicine across Canada recognize are critical to research and innovation in Canadian health care.
The annual budget of CIHR is $1.2-billion. Cancelling the MD/PhD studentships will save $1.8-million, effectively representing a paltry 0.15 per cent of its expenditures. Ceasing to fund this program can hardly be justified on grounds of "fiscal constraints."
This decision is shortsighted. If not reversed, it will have a long-term negative impact on Canadian medical education and research.
As the founding director of the University of Toronto's MD/PhD program, I have witnessed the impact and importance of clinician-scientist training first-hand. Initiated in 1984, Toronto's program was the first of its kind in Canada. Serving as its director for the 24 years, I witnessed the national expansion of the MD/PhD Programs at the University of British Columbia, McGill University, the University of Calgary, the University of Western Ontario, and Memorial University.
MD/PhD programs were developed to train "clinician scientists." Clinician scientists are MDs who have undergone rigorous training programs, which ultimately prepare them to be competent in patient care and teaching, and competitive for obtaining research grants. Admitting only students with both curiosity for research and aptitude for medical practice, the programs are highly selective. Completing the training typically takes about 15 years (approximately eight years for MD and PhD degrees, then about seven years for postgraduate clinical and research postdoctoral training). Such individuals are uniquely placed to lead activities that bridge the divides from the "bedside to the bench" (taking clinical problems and trying to find solutions in the laboratory) and from the "bench to the bedside" (taking advances from research and applying them to patient care).
The growth of the Canadian MD/PhD programs was strongly supported and prioritized by Canada's academic medical leadership (that is, deans of medical schools and clinical department heads). Since their inception, MD/PhD studentships have been funded in partnership between the medical schools and the federal granting council (initially the Medical Research Council, followed by the CIHR as successor).
Until the unilateral cancellation announcement by CIHR, the broad consensus was that MD/PhD programs were essential for sustaining Canada's manpower in patient care, clinical instruction and health research.
An MD/PhD program is not the only route to becoming a clinician scientist, but the programs are targeted and tailored, integrating the medical curriculum and doctoral studies. Perhaps the best analogy for the special quality of MD/PhD programs is the process for selecting and cultivating top athletes: MD/PhD programs provide early identification of talent, ambition and leadership potential to ensure that Canada can "own the podium" in health research.
Followup assessments have demonstrated and documented the enormous success of such programs. For example, the U.S. National Institutes of Health has provided MD/PhD funding since the late 1960s. For a half-century, graduates of these programs have been at the forefront of medical research, discovery and innovation. In addition, they have taken on leadership roles within the basic science and clinical departments of faculties of medicine across the U.S., providing a bedrock of research talent that propels medical discovery and clinical innovation.
When a training program is summarily discontinued, the usual two assumptions are that there are insufficient applicants, or that the graduates are somehow not competitive and can't find work.
However, the number of applicants to Canada's MD/PhD programs has been increasing, not decreasing, and over the years, programs have expanded. Indeed, graduates of MD/PhD programs are continuing to be actively recruited to highly competitive faculty positions. CIHR is cutting supply in the face of increasing demand for such individuals.
In summary, there is no evident justification for CIHR to have cancelled MD/PhD studentships, and CIHR has failed to coherently explain its rationale. This surprise announcement reflects a major disconnect between the manpower needs and priorities of faculties of medicine, and decision making by CIHR.
If Canada wants to compete internationally in medical research and innovation, changes with such impact require consultation. If Canada wants to attract the best and brightest to its medical faculties, this particular decision must be reversed.