Prof. Dr. Tanvir Fittin Abir
Daffodil University
A country may be able to create larger hospitals, purchase extra advanced equipment and hire extra doctors. However, progress towards the betterment of health will be sustained only if people bridge the gap between caring for patients and scientific research. Physician-scientists are physicians and scientists. They transform the request of information at the bedside into research that will enhance diagnosis, treatment, service delivery and health policy.
This is the more important for Bangladesh, where the hospitals and medical colleges are still growing. The capacity to create local evidence can’t be imported, building capacity can. Until the doctors who know us learn more about us, our health system will continue to use evidence generated in very different contexts.
This is the first in a two-part series about the challenges for physician-scientists. Part 1 explores the international evidence and hidden costs to patients; Part 2 offers practical suggestions for Bangladesh.
The signs of the warning are not to be overlooked. Many recent studies indicate that inadequate career support, uncertain funding, insufficient protected research time and lower wages are contributing to the loss of doctors from academic research (Farhat et al., 2025; Catenaccio et al., 2024). This is the core of the question of whether or not health systems can provide evidence and improve care.
In the United States, researchers have reported a drop in interest in a research career among graduating medical students (Farhat et al., 2025) and increasing numbers of physicians leaving a research career as their primary professional activity. In Japan, physician-scientists have dropped from 2.1 per cent of all physicians in 1996 to 1.6 per cent in 2016, and the proportion aged 39 or below has decreased 48 per cent (Ishikawa, 2019).
These are from various countries, time periods and definitions, and should not be aggregated to provide a global estimate. As a group, they are all talking about the same problem – how to keep a new generation of physicians, both to treat patients and to study the workings of health and why they do not.
The lessons to be learned from South Korea are how quickly clinical pressures can disrupt research. In 2024, many resident doctors left the hospital, leaving doctors who conducted research to shift their focus to clinical work, and the volume of medical research in the country dropped significantly (Yoo et al., 2025). Bangladesh, where doctors already have a heavy burden in their hands, should look to this.
What makes doctors reluctant to do research? Incentives are against them. MD-PhD trained academic physicians earn less in their lifetime than MD trained academic physicians in the same specialty (Catenaccio et al., 2024). According to a UK study, half of doctors were not contractually obliged to participate in research (Peckham et al., 2023). Staffing is a problem and emergencies can take their toll on protected time.
Early-career doctors face added uncertainty: 49 per cent of US physician-scientists considered leaving academic medicine within two years (Farhat et al., 2025). Chinese studies show mentoring and a supportive climate shape careers (Liao et al., 2023). These choices reflect institutional structure and reward, not weak commitment.
Late diagnosis and avoidable complications ultimately harm patients. A nephrologist in Dhaka who repeatedly sees chronic kidney disease caught late, given time and support, could examine clinical risk factors, patient behaviour, access barriers and referral gaps. Likewise, a clinician providing prenatal care may spot avoidable complications. Without research opportunities, such observations rarely become evidence that changes practice. My experience in healthcare management, patient behaviour and applied statistics has taught me that health problems are multidimensional. Epidemiology, biostatistics, health economics and management research strengthen clinical knowledge, so physician-scientists should collaborate with these specialists rather than work alone.
The capacity to conduct research can also influence the response of a hospital to new threats and technologies. Hospitals can be learning organisations when they can collect data, look at outcomes and test improvements. Relying on a new technology isn’t proof patients are safer or that care is more equitable; it takes careful evaluation from those who have knowledge of the clinical setting and sound research methods.
It’s not just a loss of researchers or publications that’s causing the decline of physician-scientists. It is a failure of a health system’s learning ability from its patients. In Part 2, I will move to Bangladesh where enthusiasm for doing research coexists alongside heavy workloads in the clinic and explore how government, hospitals and universities can create a sustainable career path in clinical research.
References
Catenaccio, E., Rochlin, J. M., Akabas, M. H., Brass, L. F., & Simon, H. K. (2024). The financial impact of MD-PhD training compared with MD training for academic physicians. JCI Insight, 9(24), e183476. https://doi.org/10.1172/jci.insight.183476
Farhat, K., Obradović, A., Siebert, A. L., Tun, H. N., Noch, E., & Kwan, J. M. (2025). Evaluating factors impacting early career physician-scientists’ decisions to continue research careers in the United States of America. BMC Medical Education, 25(1), 564. https://doi.org/10.1186/s12909-025-07144-4
Ishikawa, M. (2019). Distribution and retention trends of physician-scientists in Japan: A longitudinal study. BMC Medical Education, 19(1), 394. https://doi.org/10.1186/s12909-019-1840-3
Liao, S., Lavender, C., Zhai, H., & Zhou, X. (2023). Predictors of academic career progression among early career physician-scientists via an intensive research training program abroad: A case study. BMC Medical Education, 23(1), 94. https://doi.org/10.1186/s12909-023-04069-8
Peckham, S., Zhang, W., Eida, T., Hashem, F., & Kendall, S. (2023). Research engagement and research capacity building: A priority for healthcare organisations in the UK. Journal of Health Organization and Management, 37(3), 343–359. https://doi.org/10.1108/JHOM-12-2021-0436
Yoo, J., Choi, H. B., Kim, Y. S., & Kim, S. G. (2025). Korea’s 2024 reduction in medical research output amid physician residents’ resignation. Ewha Medical Journal, 48(2). https://doi.org/10.12771/emj.2025.00381
Professor Dr Tanvir Fittin Abir is Professor and Campus Director at Daffodil International University, Ras Al Khaimah Campus, UAE. His research focuses on healthcare management, patient behaviour and applied statistics.
Conflict of interest: The author declares no conflicts of interest. This article received no specific funding.
