From improvised to intentional: re-imagining the physician-scientist career path

The physician-scientist career has historically progressed through individual persistence and improvisation, as physician-scientists have navigated the demands of clinical practice combined with biomedical research without a clearly structured path. While this approach has sustained the field for several decades, individual determination is increasingly insufficient in the current climate, given the growing complexity within both clinical and research training, as well as potential disruptions to research funding and health care reimbursement. The 2025 American Society for Clinical Investigation/Alliance for Academic Internal Medicine/Burroughs Wellcome Fund Physician-Scientist Pathways Workshop convened national leaders and faculty at all career stages to assess existing structures and envision new and more deliberate approaches. Discussions highlighted the impact of NIH initiatives in supporting early careers, institutional vulnerabilities, and need for intentional investments in physician-scientist careers. Breakout sessions emphasized the importance of dedicated funding for physician-scientist pathways, mentorship, social supports, and national benchmarks for compensation and promotion for this unique career pathway. The physician-scientist career path now stands at a crossroads. Going forward, sustained investment, longer and more flexible funding mechanisms such as the R37 and R35 Maximizing Investigators' Research Award programs, and transparent standards are required. Federal funding alone cannot ensure the stability of a physician-scientist's career; therefore, new approaches and commitments from academic health centers, philanthropy, and industry will be essential to ensure the viability of this career. With coordinated, intentional strategic planning, the physician-scientist workforce can thrive and remain a driver of America's biomedical research future.