I attended an overseas panel review for health research professorships recently where the issue of declining rates of applications from “non-doctor clinicians” (nurses, pharmacists, other allied health professionals) was discussed.

The funding body had already set in place measures to promote gender equality (if two candidates were nominated by an institute for the professorship, at least one had to be a woman), but it also wished to promote translational/clinical/healthcare research opportunities to clinicians who were not doctors.

I was very impressed.

In Singapore, many people – including doctors – equate clinicians with doctors. This view is slowly changing as more clinical roles are taken up by other healthcare professionals (i.e. nurse clinicians, advance practice nurses, pharmacist specialists, etc.), including prescribing.

The national drive to train more clinician-scientists (clinicians who also do significant research) has focused primarily on doctors, and has largely left other healthcare professionals by the wayside. One can clearly see this from the language of the National Medical Research Council’s description of the clinician-scientist award (compiled screenshot below – non-doctors require PhD at a minimum and will be considered an “exception”). The recently established College of Clinician Scientists is also sited within the Academy of Medicine, Singapore – non-medical specialists can join but can only be associate members.

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This may have been necessary at the start, but is not necessarily a good thing in the long run. Other healthcare professionals have different perspectives of healthcare compared to us doctors, and may identify and solve problems that entirely escape doctors but are nonetheless very important for patients or the healthcare system.

Yet in some ways the barriers may be even higher today for a nurse, physiotherapist or pharmacist who wishes to become a clinician-scientist in Singapore. The competition for clinical/translational grants and awards is stacked against non-doctors and those who are not in academia full time. Opportunities are also limited – local hospitals, for example, provide far more support to doctors for conference attendance and research training. Research applications written by non-doctors would fare poorly on average against those written by doctor-scientists – a fundamental issue of the system and not reflective of the true merit of the applicants.

Locally, in the field of infectious diseases, I have only known one non-doctor clinician who has overcome the odds and achieved international recognition for her research, which has also translated into clinical practice. I cannot imagine the challenges Dr Andrea Kwa has faced, and still continues to face. She is trying to support other pharmacists in her team at Singapore General Hospital to achieve the same or better in terms of research – but there is a sizeable number of infectious disease physicians who also aspire to succeed in research today and who are better supported by the local system. Likewise, in other medical fields, people like Andrea are the exception rather than the norm.

Nonetheless, I am glad to see that there is increasing recognition of the importance of “non-doctor clinicians” in research, and several institutions in Singapore do attempt to pave the way for other healthcare professionals to perform research. But an overall re-think at a systems level may be required in order to nurture clinician-scientists who are not doctors.

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