Jay Vyas: Nurturing Physician-Scientists

Physician-scientist Jay Vyas was initially surprised when he was approached about becoming director of the medical residency program at Mass General nearly a decade ago. The position is usually held by full-time clinicians, and Vyas spent most of his time working in his immunology lab to find new approaches for patients with hard-to-treat infections.

But Vyas also wanted to infuse more science into the residency program—as did his chair of medicine at the time, Katrina Armstrong, who proposed the role to him.

Vyas took the job, which he held for nine years, and was known for developing innovative programs to support the training of physician-scientists and foster scientific curiosity among residents. The programs include the Pathways Program, which gives residents two weeks of time to focus on a single patient and learn how to collaborate with scientists to find better treatment approaches, and a program that allows residents with little prior research experience to spend a year in a laboratory coupled with intense mentorship. For his work, Vyas received this year’s Distinguished Medical Educator Award from the Alliance for Academic Internal Medicine.

In October 2024 he joined Columbia University Vagelos College of Physicians and Surgeons as associate dean for academic innovation to explore new ways to support physician-scientists throughout the medical school and within the Roy and Diana Vagelos Institute for Basic Biomedical Science.

Physician-scientists are critical members of the biomedical workforce, able to combine their clinical and scientific training to identify important gaps in patient care and make discoveries to improve that care. But their numbers are declining.

“There’s an incredible desire here at Columbia to ensure our physician-scientist pipeline is fortified and remains healthy, which I think is central to the future success of medicine,” Vyas says.  “Columbia truly believes that we have a mission as an academic medical institution to care for our patients today and make the discoveries that promise a better tomorrow.”

We recently spoke with Vyas about his first six months at Columbia and his plans.

Why are physician-scientists so important, and how does the uncertainty today around federal funding of biomedical research affect them?

It's clear that physician-scientists have played an outsized role in delivering discoveries—made through research—to patient care. If you look at the leaders in the biotech and pharma industry, many are physician-scientists. In the last 35 to 40 years, 37% of all Nobel laureates in medicine or physiology have been physician-scientists.

The threat to biomedical research has a profound effect on the physician-scientist pathway.

While I worry about the loss of funding to scientists today, I worry more about what these messages are sending to our trainees.

Without exception, people training to be physician-scientists are exceptionally talented. They are going to develop the next immunotherapy that cures a certain type of cancer or figure out how to use CRISPR technology to edit genes and fix a wide variety of diseases that have a genetic basis.

If we don't have the right people to embark on this training, if we don't have individuals who are committed to that type of work, those benefits are at risk and may not be realized.

Even without considering the change in funding landscape, what needs to change about training physician-scientists?

A big challenge, I think, is that our training is long. Trainees typically do seven to eight years of an MD/PhD program, three to five years for a residency, up to three years for a fellowship, and three to five years for a postdoctoral fellowship, it adds up to 15 to 17 years of training after college.

We know trainees drop out of this pipeline for a variety of reasons. Some may be financial. Some people may realize this is going to be too long of a road. The leaks directly threaten this workforce. So, I do think that there's an opportunity for us to start to think about shortening training without removing the rigor required for developing physician-scientists.

There are ways I think we can help. There are several transitions along the path—such as switching from one type of training to another—and transitions are often inefficient. So, are there ways we can improve those transitions? Are there ways we can provide financial support to individuals who might feel that this path is too financially risky for them? As an institution, we need to address these important questions.

You’ve been spending your first months here talking to students, educators, and physicians about the various points in the training path of a physician-scientist. What are your initial thoughts about student experiences and how they can be bolstered?

At VP&S, medical students represent the largest group of trainees who may consider a research career, if their environment stimulates their intellectual curiosity. The medical school curriculum is designed to prepare students to be outstanding clinicians. With Dean Monica Lypson, we have been working on how to impart the basic science portion of the curriculum in a way that fosters intellectual curiosity in our students. Some students will see basic sciences as a necessary evil to memorize and regurgitate on an exam until they get to the  “important part” of medical school. I think it’s a mistake to interpret basic science that way, but we need to teach it in a much more compelling way, to ensure that students appreciate the direct scientific underpinnings of the pathophysiology that will manifest in the patients they are going to see in the clinic.

Regarding the MD-PhD program, which focuses on classic topics like neuroscience and immunology, we must remember that the students we bring in now won't develop their own independent research programs for another 15 to 17 years. What are the most pressing issues going to be in 15 years? So, we're starting to explore where our program should be headed. As an example, I would argue that how we adopt artificial intelligence and how we leverage our computerized records to benefit our patients, will require more integration of technology into clinical practice. And so, can we start to think about recruiting individuals who wish to pursue computer science to develop them into physician leaders in the clinical AI space?

You’ve writtenthat a lot of attrition in the physician-scientist pipeline occurs during residency, fellowship training, and the first years as a faculty member. What kind of changes can help?

We want to ensure that as physician trainees care for patients and learn how to become great doctors, we promote a culture of intellectual curiosity. Some are going to become enamored by a particular clinical problem, for instance, heart failure, that they want to understand at a molecular level. But they don't currently have the tools to do so. I would love for us to encourage these individuals to pursue their scientific interests by giving them an on-ramp to develop the necessary research skills to create their own research program.

When you're a busy resident who works typically close to 80 hours a week, it's not easy to carve out time. Residents are oftentimes surrounded by people who are amazing clinicians but do not regularly come into contact with individuals who spend a lot of their time doing research. So, we want to create opportunities for these important cross connections and give residents space and time to nurture their research interests.

This applies to any residents, not just those with PhDs, who feel a strong inclination to answer fundamental questions that manifest from their experiences with patients. We need physician-scientists of all different stripes. There are more and more opportunities for physicians to engage in different types of research beyond basic science.

The challenges don’t end when they join the faculty. Our junior faculty are focused on launching their research programs. They’re older, may have a family, and their time gets divided in a variety of ways. We’re looking at new ways to support those individuals with resources to continue their research pursuits so they don’t give up at the very end of the pipeline.

I'm a big fan of near-peer mentoring—students talking with residents, residents talking to junior faculty, junior faculty talking to senior faculty to learn more about the road ahead. A top-down approach can work in some situations, but I really do believe that a community of physician-scientists coming together and sharing best practices in an informal setting is the best way to create a supportive environment.

Any concluding thoughts?

In unsettled times, my mindset is to remain focused on the mission. Physician-scientists play a critical role in discovering new biology and developing new therapies to help our patients in the future. I will work hard to ensure that Columbia leads in the development of these talented individuals and is recognized as the vanguard destination for physician-scientists and those who wish to train to become one.