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BRIEF COMMUNICATIONS: M. J. Doherty, A. T. Schneider, and D. L. Tirschwell Will neurology residents with large student loan debts become academicians? Neurology 2002; 58: 495-497 [Abstract] [Full text] [PDF]

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Reply to Letter to the Editor

Michael Doherty, A T Schneider and D L Tirschwell   (26 April 2002)

Will neurology residents with large student loan debts become academicians?

Daniel M Feinberg   (26 April 2002)

Reply to Letter to the Editor 26 April 2002
Michael Doherty University of Washington Seattle WA, A T Schneider and D L Tirschwell Send Correspondence to journal: Re: Reply to Letter to the Editor mdoherty{at}u.washington.edu Michael Doherty, et al.	We thank Dr. Feinberg for his comments on student debt and becoming a clinical investigator. Dr. Feinberg suggests the academic neurology community rethink its strategy of training and retaining academicians. Although our study focused within the neurology community, this problem is faced by all of academic medicine. Recent legislation has structured some debt relief for NIH grants awardees. [2, 3] Debt relief of NIH grants holders are a welcome attempt at retaining physicians in research careers. However, it may have little effect on whether residents or fellows choose an academic career. In our survey, many residents intended to become academicians; prior studies suggest a discordance between intent and action.[1,4] This switch seems to occur either very late in residency or during the one or two years of neurology fellowship, a time in which the gulf between the competency seen at the end of residency (and perhaps, as Feinberg suggests, at the end of fellowship) and the scientific wherewithal needed to write a fundable NIH grant, is daunting. Feinberg suggests changing fellowship salary structures. This would no doubt thrill fellows and residents, but do little to smooth the transition to competent investigator. Although we did not specifically assess whether salary was a disincentive to entering academic work, we know that debt is.[1] Debt reduction combined with a first-rate fellowship may be the most appropriate lure to a resident with academic promise. While the NIH already offers such programs, they are restricted in terms of number, geography and affiliation. Debt relief during a competitive academic fellowship that directly follows residency training at any institution, regardless of NIH affiliation, might harness academic intent and action. Clinical or basic science training, instruction in grants writing, epidemiology, biostatistics, and medical ethics would provide core skills to supplement any potential investigator. [5] This would bridge residency, fellowship and junior faculty without losing financial or academic ground. References: (1) Doherty MJ, Schneider AT, Tirschwell DL. Will Neurology Residents with Large Student Loan Debts Become Academicians? Neurology. 2002;58:495- 497. (2) Ley TJ, Rosenberg LE. Removing career obstacles for young physician-scientists -- loan-repayment programs. N Engl J Med. 2002;346:368-372. (3) Nathan DG. Educational-debt relief for clinical investigators- a vote of confidence. N Engl J Med. 2002;346:372-374. (4) Holloway RG, Vickrey BG, Keran CM, Lesser E, Iverson D, Larson W, Swarztrauber K. US neurologists in the 1990’s: trends in practice characteristics. Neurology . 1999; 52: 1354–1358. (5) Ringel SP, Steiner JF, Vickrey BG, Spencer SS.Training clinical researchers in neurology: We must do better. Neurology 2001; 57: 388-392.
Will neurology residents with large student loan debts become academicians? 26 April 2002
Daniel M Feinberg University of Pensylvania School of Medicine Send Correspondence to journal: Re: Will neurology residents with large student loan debts become academicians? sandi_moriarity{at}urmc.rochester.edu Daniel M Feinberg	Doherty et al. [1] addressed the critical issue of student loan burden and choice of academic neurology. In 1996, Spencer [2]addressed the number of years of fellowship necessary to adequately prepare one for a clinical academic career. As a then clinical fellow, I suggested that student loan would affect the choice of multiple-year clinical fellowship training programs. [3] Five years later, after working as a full-time clinician/teacher in a neurology-training program, I have only stronger concerns about this issue. The average student loan debt is increasing dramatically and starting academic salaries and fellowship stipends are not keeping pace. Doherty's data points out a very disturbing trend: Young people with large student loan debts are less likely to enter academic neurology. As a result of lengthening fellowships and continuing to pay PGY-4 or 5 level salaries, more residents choose private practice or one-year fellowships instead of more comprehensive clinical research training. The one-year programs largely focus on clinical or procedure oriented training but provide less opportunity to grow as clinical investigators. With academic departments and teaching hospitals facing serious financial challenges, increasing fellows' salaries is undoubtedly low on priority lists. The academic neurology community must rethink how it funds fellowships and try to make it more attractive financially to train in multiple-year training programs. Otherwise, the current trend of not choosing academic training or practice will only worsen as debt increases and the quality of clinical research will suffer as a result. References: 1. Doherty MJ, Schneider AT, Tirschwell DL. Will neurology residents with large student loan debts become academicians? Neurology 2002; 58:495-97. 2. Spencer SS. Careers in academic neurology. Ann Neurol 1996;40:123-127. 3. Feinberg DM. Financial influences on career choices in neurology. Ann Neurol 1997; 41(2): 283-284.