Training and supporting psychiatrist-scientists is critical to accelerating progress in our field.¹ However, less than 2% of psychiatrists identified research as their dominant activity in the early 2000s,² and there is no indication this has changed. The National Institute of Mental Health (NIMH), recognizing a need for more psychiatrist-scientists, currently funds 13 programs within residencies to prepare psychiatrists for careers as scientific leaders.³ Many residencies beyond those with dedicated NIMH funding also consider engagement in research essential to their missions. About a quarter of US residencies have a formal research track.⁴

Despite this, many who enter residency with strong scientific records do not pursue academic careers. Often, this reflects a deliberate choice rather than a lack of opportunity. In a survey of Canadian psychiatry residents, interest in a research career decreased from 49% to 19% over the course of training.⁵ In one program, the most common 鈥渂arrier鈥� to a research career was 鈥減reference for direct patient care as a clinician,鈥� endorsed by 46% of alumni.⁶

A serious consideration of potential negative consequences of programs seeking to prepare psychiatry residents to become scientific leaders is valuable for those of us who hope to see more talented trainees pursue this path. The most direct cost is the potential impact on access to care. The relative dearth of psychiatrists means there is a social cost in using residency slots to train people who aspire to spend little time seeing patients. Additionally, protecting substantial time during residency for research means less time on patient care during training, which leads to graduates who are less clinically experienced. Potential detrimental impacts on clinical competencies include not just knowledge and skill acquisition, but also attitudinal components of being a physician. Cultivating an attitude consistent with clinical excellence can be challenging if a resident is receiving messages that success hinges more on research productivity than on clinical competence and effort. Reducing expected investment in clinical work can also deprive research-oriented residents of the opportunity to discover the rewards and sense of purpose that comes from clinical expertise and commitment. Finally, just as achieving clinical excellence requires a deep commitment of time and effort, so too does becoming an effective scientific leader. Some physicians with scientific ambition experience their clinical obligations as causing them to fall behind their nonclinical scientific colleagues. For those whose chief ambition is to run a research enterprise, it is not clear we are benefiting them or our field when encouraging them to pursue residency training. In sum, there are several potential costs to training psychiatrists to become scientific leaders, and it is important not to minimize them.

While acknowledging these costs, we believe preparing psychiatrists for scientific leadership is crucial. A common assumption underlying the following reasons why is that the psychiatrist-scientist not only has the credential of a residency, but has achieved a degree of superior clinical acumen: (1) Psychiatrist-scientists are uniquely positioned to lead efforts to translate scientific findings into benefits for patients. (2) Well-trained psychiatrist-scientists improve scientific rigor in clinical research. (3) Clinical knowledge and expertise are valuable for patient selection and phenotypic measurement in research. (4) Psychiatrist-scientists whose work bears directly on interventions and patient outcomes are well equipped to help develop and improve clinical guidelines. (5) The habits of mind taught by scientific training and clinical psychiatry can be mutually reinforcing. (6) Expertise in both research and clinical work can position individuals to identify flaws in conceptual frameworks used in each endeavor. (7) Psychiatry should be attractive to intellectually gifted, ambitious people, and having a possible career path that combines psychiatric practice with pursuing answers to fundamental questions about brain and mind leads some to become psychiatrists who would not otherwise. (8) Proximity to the clinical enterprise may motivate and inspire scientists whose work will benefit patients. (9) Clinical and research training are both beneficial for leaders in academic medicine and having substantial experience in both areas can provide the broad view needed to lead psychiatry departments.

Stevenson et al⁷ identified metrics of success used to evaluate interventions aimed at increasing research careers among residents. These include participation in research, number of publications and presentations, grants, and fellowship and faculty positions. These are similar to the goals of the NIMH R25: 鈥渢o increase the number of psychiatry residents pursuing research careers鈥�and to reduce the length of time it takes鈥�to achieve research independence.鈥�⁸ These metrics, though important, provide an incomplete picture of what we should look for in the development of psychiatrist-scientists. A fuller picture would also focus on the impact on clinical acumen and attitudes toward clinical work. It would also be useful to understand the impact on academic contributions that particularly make use of clinical training. An emphasis on research productivity as the singular measure of success risks incentivizing programs to degrade the quantity and quality of clinical training. It would be valuable to align metrics of success with the objective of training clinically excellent psychiatrist-scientists, not just productive scientists with a clinical credential.

Consideration of these issues leads to several principles that should guide those interested in promoting psychiatrist-scientist careers among trainees. First, residency programs seeking to train scientific leaders should still unambiguously prioritize clinical work, especially during the first 3 years. By ensuring residents receive a solid clinical foundation, programs set the stage for them to excel both as clinicians and scientists. Central to this approach is correctly calibrating expectations regarding scholarly output during residency. Those with clear aptitude for scientific work and a realistic vision for an impactful scientific trajectory should not need an extensive publication record during residency to secure bridging funding post-residency. Second, simply connecting a scientifically ambitious trainee with scientific mentorship is often inadequate to promote a career that makes best use of clinical expertise. Individuals also need mentorship and didactic training to make explicit how they can best use their clinical training as scientists. Third, departments and funders should push back against cultural and financial incentives that lead trainees to determine they must pick one domain or the other to advance their careers. Such incentives likely waste scientific talent. Fourth, while individuals鈥� ambitions often change during training, medical graduates who are certain they want to become full-time scientists and forego clinical work should be encouraged to consider alternatives to residency training. Finally, while psychiatrist-scientists are uniquely positioned to bring the clinical perspective to research, we should also facilitate other ways of accomplishing this. These include initiatives introducing nonclinical scientific trainees to principles and insights from clinical practice. For example, the Stanley Center for Psychiatric Research at the Broad Institute has worked with psychiatrists at McLean Hospital to allow nonclinical scientific trainees to have structured experiences shadowing psychiatrists on inpatient units, followed by psychiatrist-led didactics on common clinical problems. The Mind the Gap program at Johns Hopkins paired PhD scientists with psychiatrists to jointly explore clinical issues.⁹ Such experiences might help scientists make their work more impactful for patients.

Despite the challenges and trade-offs, it is imperative that psychiatry residency programs continue to prioritize the training of psychiatrist-scientists. By aligning the goals of clinical excellence and scientific achievement, we can ensure future academic leaders in psychiatry are equipped to drive progress that will enable greater prevention and alleviation of suffering caused by psychiatric illness.

Corresponding Author: Jacob L. Taylor, MD, MPH, Johns Hopkins Hospital, 600 N Wolfe St, Meyer 4-181, Baltimore, MD 21287 (jacob.taylor@jhmi.edu).

Published Online: August 7, 2024. doi:10.1001/jamapsychiatry.2024.2255

Conflict of Interest Disclosures: Dr Taylor is supported by the National Institute of Mental Health (grant MH130673). Dr Potash is supported by gifts to the Stanley and Elizabeth Star Precision Medicine Center of Excellence in Mood Disorders.