by Holly Korschun fter receiving his dual degree from Emory, Dr. Clapham went on to a residency at Harvard and later joined the Mayo Foundation, where he climbed quickly through the research ranks. While becoming a world expert in G protein regulation of ion channels and calcium signaling, he also achieved the rank of full professor of pharmacology, physiology, and biophysics by the age of 41. Today, he is director of basic cardiovascular research at Boston Children's Hospital, professor of neurobiology and pediatrics at Harvard, and a Howard Hughes Medical Institute investigator. He holds two NIH RO1 grants and directs a laboratory staffed by 25 researchers and technicians. Dr. Clapham is among more than 60 graduates of Emory's NIH-supported MD/PhD Medical Scientist Training Program (MSTP), one of 32 such programs nationwide. The MSTPs attract the best and brightest students pursuing careers as physician/scientists in academic medicine. Last year the NIH announced a 14% increase in funding for Emory's program through a new five-year grant, prompting Dean Thomas J. Lawley to expand the number of entering MD/PhD students from five to six this academic year, for an eventual total of 41. The funding increase, which followed an NIH review for competitive renewal in 1996, is a strong sign of approval. "It reflects the stature of our program, the quality of the students we are recruiting, the expansion of our program to include Georgia Tech, and our outstanding minority recruitment," says Dr. Robert Gunn, who was principal investigator on the grant and served as program director for the past 15 years. (Dr. Gunn recently stepped down as director after 15 years, and neurologist Allan Levey was named as the new program director.) Emory's goal is to increase the number of MD/PhD students to 15% of the graduating medical school class, says Dr. Gunn. Using a "vigorous" approach of adding one or two new students each year, that goal might be met by 2007. Adding students will depend entirely on Emory's ability to fund the program, which currently costs $1,290,000. MD/PhD students receive full tuition and an annual stipend. With its recent increase, the NIH now funds 16 of the 41 total positions, with the grant paying 70% of tuition and about 65% of stipends. The remainder of the funding comes from the dean's office, mentors' research grants, individual fellowships, and various other endowment funds. MD/PhD training is rigorous and extensive, requiring a minimum of seven years to complete both the MD and PhD degrees, followed by additional years of residency and fellowship training. At Emory, students may choose to pursue their PhD through the graduate school or through a joint Emory-Georgia Tech MD/PhD in bioengineering. The NIH support is not designed to lure students into scientific careers, but to relieve them of the significant levels of debt most graduating medical students bear, says Dr. Gunn. That kind of debt might drive graduates to more lucrative careers in patient care, preventing them from developing scientific careers. While some graduates do abandon the laboratory and pursue strictly clinical practices, that is clearly not the program's intent. MD/PhD students are motivated by payoffs of a different kind. Graduates have much higher percentages of funding on NIH grants the first time they apply, and those who pursue scientific careers have the added benefit of the broad medical training needed to understand the relevance of research to patient care. Graduates often receive appointments to the nation's top postdoctoral training programs and become scientific and academic leaders. Also, Dr. Gunn believes, some future physicians see the current practice of medicine as constrained and compartmentalized. An academic setting offers more freedom for intellectual pursuits than does private practice, where managed care may dictate how physicians practice medicine. Dr. Clapham, who has advised many MD/PhD students, sees the programs as a way to retain people in the world of discovery. "Peer and parent pressure to become an MD is so intense," he says. "But once these students figure out that they're going to be successful and once they have the security of the MD degree, many of the best people come back into research. The MD/PhD gives them the time and experience to make a rational decision." "The medical school sees its role as an educator of not only excellent physicians but also physician-scientists of the future," says Dr. Gunn. "Emory is moving from being an excellent trainer of physicians for the Southeast to being a contributor to the national pool of educators and scientists."

David Clapham, 81M, is among more than 60 graduates of Emory's MD/PhD Medical Scientist Training Program. Supported by the NIH, it is one of only 32 such programs nationwide. Recent graduates of the MD/PhD program with their mentors (l to r): Albert Jun, genetics professor Doug Wallace, Steven Hoyd, and former program director Robert Gunn.

Holly Korschun is managing science editor in
the office of Health Sciences Communications.