Canada's medical research community is reacting with shock and disappointment to the cancellation of a 30-year program to train doctors who see patients and work as scientists searching for new treatments.
The Canadian Institutes of Health Research is the federal government's major health science research organization. Its MD/PhD program was launched in the 1980s out of concern over the lack of specialists who could move easily between the lab and hospital.
Kevin Wang is a MD/PhD student at the University of Toronto. The program pays his tuition and living expenses while he pursues both arduous degrees.
"I really think the MD/PhD program is a mainstay in the training of the future of our health-care system," Wang said. "By cutting funding we're essentially pulling the plug on training the next generation of health research innovators."
Wang said the funding allowed him to spend eight to 12 hours in the lab a day. Without the support, he'd likely have to work two or three part-time jobs to support his studies.
"My younger brother was diagnosed with childhood cancer," Wang said of his inspiration.
"Seeing the very individual that was saving my brother's life was also leading laboratories and trying to find new discoveries, new therapies … made me realize this program was what I wanted," said Wang, who is also the president of the Clinician Investigator Trainee Association of Canada, which represents more than 400 students nationally.
'Reaction was horror'
Dr. Norman Rosenblum is associate dean of physician scientist training at the University of Toronto. Two years ago, Rosenblum was asked by the Canadian Institutes of Health Research to chair an expert committee to study patient-oriented researchers in Canada.
The expert report concluded Canada needs a major increase in the number of health clinician scientists, because the country is missing key expertise needed to address urgent health-care questions.
Rosenblum was surprised and dismayed to receive a letter from the Canadian Institutes of Health Research in June announcing the end of funding for the MD/PhD program.
"The reaction has been horror, to be honest," Rosenblum said. "My colleagues across the country have been mystified as to how this decision would be taken when they were not specifically consulted."
The letter stated "budgetary constraints" as the reason.
Physician-scientists were already an "endangered species" in Canada, representing just three or four per cent of all doctors, he said.
"I think it is a mixed message," Rosenblum said. "On the one hand, we are hearing that patient-oriented research and solutions is top drawer in terms of goals for health research, and then we are also hearing that the very people who would be in the centre of the whole enterprise are not a priority, and so we're confused."
Cancelling the program will save about $1.8 million a year. The concern is that without a replacement program Canada will lose critical expertise and leadership.
The Canadian Institutes of Health Research invests $1.2 billion a year from Ottawa to support the training of health researchers. Funding under the MD/PhD program will continue for the next six years until 2021, a spokesman said in an email.
Loss of an elite career path
Dr. Bryan Coburn, who has just completed the program, said the support was integral to his efforts to study microbes that live on and interact with us. His goal is to use the information gleaned from observing bacteria to improve patient care.
The security and consistency of support offered by the program was critical in helping candidates make the decision to pursue the elite career path between the hospital, where they can identify medical gaps that require scientific research, and the lab, where they can look for solutions.
"It means deferring the day you start your first job, deferring income, deferring the security of starting your life," Coburn said.
Coburn sees a lot of uncertainty surrounding scientific funding in Canada, which he said weighs heavily on the community.
"This is a program whose focus is solely providing benefit to Canadian health, and disease treatment and research, through scientific discovery. If we lose even a small element of that, we've lost a great deal of ability to produce that kind of translational knowledge."