When Doctors Turn to Research: A Win-Win or Mutual Loss?

From Shennong’s tasting of hundreds of herbs to today’s medical research, the study and exploration of medicine have never ceased throughout history.

With the rise of China’s domestic socio-economic landscape and the extensive expansion of international exchanges, the national government has continuously introduced policies to encourage medical scientific research, while providing substantial financial and resource support for the implementation of medical research projects. This has sustained a high level of enthusiasm for medical research initiatives within China.

A telling piece of data is that the number of applications for the National Natural Science Foundation of China (NSFC) projects has hit a new high this year, with major hospitals joining universities as the primary applicants. Data show that Zhongnan Hospital of Wuhan University submitted 475 project applications, representing a 14.5% increase compared to the same period in 2021; the First Affiliated Hospital of Xi’an Jiaotong University College of Medicine submitted 480 NSFC grant applications, a 10.8% increase from 2021; and Beijing Shijitan Hospital has maintained a growth trend in its application volume over the past five years...

Data indicate that medical research projects in China are flourishing; however, underlying issues are also emerging.

From the perspective of the conversion rate of scientific research achievements, it is undeniable that China has made significant progress in the field of medical innovation in recent years. From 2019 to 2022,China’s patent volume has ranked first globally for three consecutive years. However, its key commercialization rate remains below 10%, with less than 5% achieving true industrialization, marking a significant gap compared to developed countries in Europe and the United States, which boast scientific research commercialization rates of approximately 40%.。

Next, let us examine scientific research papers. According to the China Statistical Yearbook (2020) and data from Clarivate, China published 471,400 SCI-indexed papers in 2019, ranking first globally. However, significant structural issues persist regarding the quantity and output proportion of top-tier, high-quality papers from China. Moreover, in the past two years, several domestic hospitals have been involved in large-scale academic misconduct incidents.

As can be seen, issues arising from medical research projects are not uncommon. So, what exactly are the causes behind these problems? VCBeat’s Orange Bureau has conducted an in-depth analysis.

Why Do Physicians Conduct Scientific Research?

Before addressing this question, we must first understand the relationship between physicians and scientific research.

In the public perception, a physician’s primary responsibility is to diagnose and treat patients. A physician’s clinical competence is closely tied to their accumulated experience, whereas scientific research is regarded as the domain of professional researchers. At first glance, these two roles appear to be entirely separable.

However, with the advancement of science today, both the development of medical disciplines and the dissemination of specialized medical knowledge must be grounded in scientific principles and evidence. From this perspective, the relationship between clinicians and scientific research is largely complementary.

Returning to the question of why physicians should engage in scientific research, the underlying reasons ultimately boil down to two categories: internal and external factors.

Let’s begin with external factors. Whether in scientific research or the market, development trends are inevitably influenced by policy.

In terms of policy, China proposed the innovation-driven development strategy since the 18th National Congress of the Communist Party of China, and has intensified reforms of the science and technology system since the 19th National Congress, gradually introducing various supportive policies. These include the 2016 Action Plan for Promoting the Transformation of Scientific and Technological Achievements, the 2017 Plan for Deepening the Reform of the Science and Technology Award System, and the 2018 Notice on Several Measures to Optimize Research Management and Enhance Research Performance.

Robust policy support has significantly enhanced hospitals’ capacity for translating scientific research into practical applications. According to data from the “Notice on the National Monitoring and Analysis of the Performance Appraisal of Tertiary Public Hospitals in 2018,” 80.34% of tertiary public hospitals received research funding support in 2018, with 5.64% of these hospitals securing more than RMB 2 million in research funds per 100 healthcare professionals. The monetary value of translated research achievements per 100 healthcare professionals reached RMB 13.0593 million, representing a 165.96% increase compared to 2016.

Beyond policy, the strong correlation between scientific research and physicians’ career trajectories is also a significant driver for their engagement in research. In China’s professional title promotion system for clinical physicians, titles are typically linked to publication records and SCI-related metrics. Moreover, beyond title advancement, the conduct of research projects and publication output serve as critical evaluation criteria for awards, honors, and grant applications.

Having discussed the external factors, let us now examine the internal ones.

As can be seen from the aforementioned relationship between physicians and scientific research, medical research has been endowed with increasingly significant importance, whether for the purpose of enhancing individual professional competence or, on a broader scale, driving the advancement of the medical discipline. The 2021 Annual Scientific Research Report released by MedSci earlier this year also indicates thatMore than 60% of physicians hope to enhance their clinical diagnostic and treatment capabilities through scientific research.。

Moreover, for some clinicians, scientific research enables in-depth exploration of medicine and the dissemination of evidence-based medical knowledge; therefore, they have a strong willingness to engage in research activities.

Furthermore, hospitals and physicians possess extensive case records, which themselves provide a wealth of reference information for conducting scientific research.

It is evident that, whether driven by internal motivations or propelled by external factors, engaging in scientific research remains a choice made by many physicians. However, for doctors, opting to pursue research entails multifaceted challenges.

First,Funding and ProjectsWhether it is clinical research or research in other fields, their implementation inevitably requires substantial financial support. Meanwhile, similar to most other domains, the “Pareto principle” (80/20 rule) is also evident in the conduct of clinical research projects.

The so-called “80/20 rule” means that 20% of researchers secure 80% of scientific research funding. Although data from the actual implementation of clinical research projects do not perfectly align with this ratio, the overall trend remains consistent.

Furthermore, whether applying for national-level or provincial/ministerial-level grants, physicians face increasingly fierce competition, which further exacerbates the difficulty of securing grant approvals and funding support when conducting clinical research projects.

Second,TimeAccording to the "2020 China Physician Insight Report" released by DXY, prior to the pandemic, physicians worked an average of 8.9 hours per day. During the peak of the pandemic, this average increased to 9.6 hours, with 13% of physicians working more than 12 hours per day on average during the outbreak period.

For physicians, the demanding nature of clinical practice already consumes a substantial amount of their time and energy, making it inherently challenging to undertake scientific research projects.

Third,Research Skills. As a rigorous endeavor, scientific research requires extensive data collection, verification, and validation. Faced with massive volumes of data, researchers must fully leverage their expertise in statistics, data processing, and related skills.

Moreover, medical research must continuously stay abreast of cutting-edge developments; therefore, reviewing domestic and international literature constitutes a fundamental aspect of conducting scientific research. In addition, skills such as study protocol design and manuscript preparation are equally essential for the successful execution of research projects.

However, for most physicians, clinical practice often lacks systematic, long-term research training, leaving them ill-equipped to conduct scientific research. Nevertheless, this gap has spurred the growth of the market for research tools and scientific support platforms.

Fourth,PlatformNot all hospitals have established fully functional research platforms. Moreover, even when such platforms are in place, numerous management issues may arise during actual operation, such as prioritizing grant applications over oversight and support, and emphasizing the quantity and prestige of publications while neglecting data review. Additionally, there is a trend of excessively promoting the concept of “research-oriented hospitals,” which advocates for all hospitals to develop into research-oriented institutions regardless of their specific conditions or institutional nature.

Furthermore, physicians’ engagement in scientific research is constrained by their own perceptions of research. Despite numerous policies and promotional slogans in China, some physicians remain more focused on clinical practice, being neither familiar with nor interested in scientific research.

It appears that, for physicians, clinical practice and scientific research are akin to choosing between fish and bear’s paw—difficult to have both. Will this phenomenon persist?

In fact, China’s path of scientific research reform has been continuously advancing and has made significant progress in addressing the various challenges physicians encounter in clinical practice.

First and foremost, regarding the linkage between scientific research and professional title evaluation—a matter of greatest concern to most physicians—on December 1, 2020, the Ministry of Human Resources and Social Security, in conjunction with the National Health Commission, issued a notice soliciting public comments on the “Guiding Opinions on Deepening the Reform of the Professional Title System for Health Professionals (Draft for Comment).” The document explicitly proposed incorporating metrics such as outpatient service hours, on-site working hours, number of patients admitted, number of surgeries performed, and nursing care hours into the eligibility criteria for title applications, while also aiming to eliminate the prevailing overemphasis on publications, academic degrees, awards, and prestigious titles or honors.

In June last year, the General Office of the State Council issued the "Notice on Printing and Distributing the Key Tasks for Deepening the Reform of the Medical and Health System in 2021," which clearly stated that the evaluation mechanism for medical personnel's professional titles should emphasize practical ability and performance, encouraging health professionals to remain at the forefront of disease prevention and treatment. This also means that the reform of the evaluation mechanism for medical personnel's professional titles has officially begun to be implemented.

Overall, however, this transformation remains in its early stages, and numerous evaluation metrics require ongoing refinement; we must wait and see what changes the future will bring.

Let us now examine the issue of grant applications. As the saying goes, “Even the cleverest housewife cannot cook a meal without rice.” Regardless of how strong their research interest and capabilities may be, if physicians fail to secure research grants, the conduct of their scientific work will be directly impacted. However, national- and provincial/ministerial-level research fund programs typically have explicit requirements regarding applicants’ academic degrees and professional titles, leaving young physicians at certain institutions in a “gap period” where they are ineligible to apply.

Generally speaking, various planned projects and funds constitute the primary sources of research projects at the current stage. In recent years, the number of research projects approved by national and local authorities has been increasing rapidly; however, alongside this surge in project volume, the funding available for project implementation may become relatively fragmented.

Some experts have further stated that when a research team conducts scientific research on a relatively large scale,"To secure funding, it is necessary to split one project into several smaller projects for grant applications.", this practice has further driven the rapid growth in the number of scientific research projects.

Fortunately, in recent years, an increasing number of qualified institutions have begun to establish project-based initiatives aimed at incubating projects, along with corresponding regulations for the management of research funding.

Finally, let us examine research capabilities. For most physicians, difficulties in data analysis and academic writing are common challenges. This pain point has given rise to numerous third-party research support platforms, tools, and training institutions. These platforms can address needs ranging from early-stage grant application guidance and research knowledge acquisition to later-stage data analysis, processing, and manuscript preparation support.

Overall, although numerous challenges persist in the research environment for physicians, continuous changes and optimizations are taking place across all aspects.

In the global landscape of medical research, there is no shortage of high-quality success stories; from these examples, we may well discern the key to balancing clinical practice and scientific research.

Ranked No. 1 in the United States for 23 Consecutive YearsJohns Hopkins HospitalTake, for example, Johns Hopkins Hospital, a medical institution with world-leading clinical expertise. The hospital places great emphasis on the research endeavors of its clinicians. It is commonplace there for physicians to simultaneously manage their clinical duties and advance ongoing research projects, resulting in the publication of numerous academic papers.

The emergence of such a strong research culture is closely tied to the institutional framework at Johns Hopkins Hospital. As the pioneer of residency training, Johns Hopkins Hospital mandates that junior physicians engage in scientific research, ensuring that residents integrate both clinical practice and research throughout their training.

Taking the neurosurgery residency program at Johns Hopkins Hospital as an example, it is understood that residents are required to undergo seven years of standardized training, including two years dedicated to scientific research. This stands in marked contrast to the standardized residency training for neurosurgeons in China.

In China, the content and standards for standardized residency training in neurosurgery generally place greater emphasis on residents’ acquisition of professional theoretical knowledge and clinical practice, while training in research capabilities remains relatively weak.

Although this training model at Johns Hopkins Hospital is not actually a uniform mandate across U.S. hospitals, this does not mean that the United States undervalues physicians’ engagement in scientific research. On the contrary, the U.S. has a clearly defined career pathway for cultivating “physician-scientists,” while placing greater emphasis on the principle that professionals should focus on their respective areas of expertise.

As early as 1960, the United States initiated the training of “physician-scientists,” establishing the Medical Scientist Training Program (MSTP) under the auspices of the National Institutes of Health (NIH) to cultivate interdisciplinary professionals holding dual degrees: an M.D. (Doctor of Medicine) and a Ph.D. (Doctor of Philosophy).

The entire training process can be broadly characterized as a “2+4+2” model: the first two years are dedicated to systematic study of foundational medical courses at the medical school; the subsequent four years are spent conducting research in laboratories; and the final two years focus on further developing clinical skills and knowledge. Although this pathway is time-consuming and demanding, it produces physicians who excel in both clinical practice and scientific research.

In terms of research management, most top-tier medical centers in the United States have established specialized research institutes to focus on advancing scientific research and translational innovation. For instance, the Cleveland Clinic, ranked among the top 10 globally, has set up the Lerner Research Institute, which is dedicated to basic medical research, and the Cleveland Clinic Innovations department, which is responsible for commercial translation. This approach enables physicians to devote greater attention to their research activities.

In addition, to facilitate the effective translation of scientific research achievements and their smooth entry into the market, most of these hospitals have established Technology Transfer Offices (TTOs), such as the PACTT (Technology Transfer Office) founded by the Lausanne University Hospital. They also boast a large team of professional technology transfer managers who serve as a bridge between research institutes and enterprises. This linkage plays a pivotal role in the commercialization of scientific and technological achievements, thereby alleviating concerns for physicians conducting research projects.

Objectively speaking, China has made significant progress in the reform of scientific research for physicians.

However, given the current reality, conducting scientific research remains an “excruciatingly painful” endeavor for physicians.The Question of Whether Doctors Should Engage in Scientific Research Must Be Viewed Through a Dialectical Lens。

On the one hand, not all physicians are required to engage in scientific research. The primary duty of a physician is to diagnose and treat patients; therefore, a physician’s competence should not be judged solely by their research capabilities. Those who remain dedicated to their posts and strive wholeheartedly to save lives and heal the wounded can be regarded as exemplary physicians serving the public, even in the absence of academic publications or research achievements.

But on the other hand, physicians are required to conduct scientific research. Someone once made this analogy: “NoClinical services without scientific research are like a “lame person,” able to walk but not far; scientific research without clinical guidance is like a “blind person,” whose direction may be wrong from the very beginning..” Scientific research is a complex endeavor; only by integrating the efforts of clinicians and medical scientists can high-quality research be achieved.

Therefore, much like entrepreneurship, we should only encourage physicians who are genuinely willing and capable of conducting scientific research, providing them with the best resources to support their growth. Blindly pursuing scale and foreign models will only be counterproductive.