Health and medical researchers for the future - what does Australia need?

Right now, thousands of health and medical researchers across Australia are at their desks, developing applications to the NHMRC. At the same time, new and continuing PhD students are considering their future careers.

Australia has never before had a policy discussion on the nation’s  needs for health and medical researchers, but the time has come to think seriously about how best to use Australia’s talent.  This a personal perspective on the role of Australia’s health and medical research workforce  and is a precursor to NHMRC discussions, and broad consultation, on the future of our fellowship schemes.

What are Australia’s needs?

To begin to address this question, we must first understand the wide range of ways people trained in health and medical research can contribute to Australian society. This goes well beyond creating new knowledge (crucial though that is) and includes contributions to health policy development, teaching future generations of researchers, leadership in academia, industry and hospitals, and the application of critical, evidence-focussed and inquisitive ways of thinking to a range of jobs in public and private sectors.

These needs are outlined below, starting with the needs for a nation capable of producing and assessing evidence across all sectors.

1. Many more people with training and expertise in health and medical research in the public and private sectors

The largest cohort will be people who have training in research and who have undertaken research of high scientific quality, but who are no longer active researchers.  They will instead work in the private sector, in government, in civil society. But their scientific training, and the open minds that research training brings, will help them better plan and tackle the many challenges that come with 21st century work in the public and private spheres.

As a nation, we need to value these people much more and actively promote these careers more strongly. Australia would benefit immensely from more research trained people throughout our society, including in NGOs, in government service at Commonwealth and State levels, in politics, the courts, and so on. The approach to the evaluation of evidence, to designing and completing successfully projects, are skills that the country needs in:

  • The private sector, so that our innovative industry and service sectors, the future growth engines for Australia, have the talents and training that research training and skills can bring.
  • Civil society, so that NGOs, community organisations, the courts and parliaments, can benefit from the skills of people trained and experienced in research. This includes in community leadership, especially those working in complex multidimensional community projects.
  • Health policy development at Commonwealth, State and local health authorities, and for all the many other governmental policy areas that directly or indirectly impinge on health nationally and internationally such as foreign affairs, treasury, social services, defence, biosecurity and many more.

People with doctoral training and even years of postdoctoral research already shine out in our public and private sectors.  For example, the Chair of NHMRC’s Council, Justice Annabelle Bennett is a Federal Court judge who also has a PhD in the medical sciences.  Many of the most impressive senior public servants here in Canberra have PhDs (though too few, and not overtly enough!)

There is a special Australian problem however regarding the private sector1. Compared to similar developed countries, we have fewer PhDs in business generally. Less than one in three Australian researchers work in industry; half the OECD average of 60 per cent and substantially less than the US, where some two in three researchers are in the business sector .This may be changing in biomedicine though; the growing Australian biotech industry is reported to employ around 13,000 people, many of whom are research trained and indeed conducting research in these companies. CSL alone has reported that it employed 1,851 people directly, and supported another 7,819 jobs in other industries.

There are many reasons for this low proportion in the private sector, but one important one is the culture within health and medical research itself. As just one indicator of this culture, NHMRC has offered Industry Career Development Fellowships for more than a decade. Awardees are offered NHMRC support for two years in industry, two years back in Australian research. There have been remarkably few applicants over the years – for example last year, there were just eight applications, compared to 249 applicants for the biomedical research stream of Career Development Fellowships.

We all need to work to change the practices of industry in Australia, and the culture in biomedical science in particular, to overcome the deficit so starkly revealed in the OECD figures.

2. High quality, active researchers employed by universities, hospitals, industry or civil society and government that entail research, but other duties too

Australia needs research-trained and active people in jobs such as teaching medical and health professionals so that we have:

  • Research-strong university faculties of medicine, health and science, so that the medical and health professionals and the scientists of the future are educated, trained and inspired by research active and enthusiastic teachers.
  • Research strong hospitals and health care providers, so that there is leadership in our teaching hospitals in introducing better research based practices, and acting as exemplars for the whole health care system.
  • Research leadership in primary care (medical and allied health) for extended and strengthened evidence based primary care.

The clinicians of tomorrow will face many challenges, not the least will be the need to provide care based on knowledge and evidence, not tradition.  There is a special need to make sure that university students in medicine, nursing, allied health, biomedical and life sciences and  the social sciences are taught by researchers and introduced to the concepts and practices of scientific research. This is especially crucial if we are to be able to have an agile, efficient and cost effective health system, meeting tomorrow’s health and funding challenges.

These people are a major driver in improving health care too. They provide leadership in evidence based care, they bring the key research questions back to the laboratories for solutions, they train and mentor the next generation on doctors, nurses and allied health professionals who will without doubt work in a more evidence-informed sector.

Similarly, the academics in public health, health services and clinical research are essential to the work of Commonwealth and State health departments and international bodies such as the World Health Organisation.  Australian public policy could not provide such safety and quality for patients, and deal with protracted and acute public health problems, without being able to call on the expertise of these academics and researchers. For example, Australia’s responses to SARS, H5N1, H1N1, and the Ebola scare relied heavily on the Commonwealth and State health departments’ advice from hundreds of health researchers and academics.

Australia has outstanding researchers in this category such as Chief Investigators on NHMRC Project and Program Grants, NHMRC’s Practitioner Fellows (think the winners of this year’s Prime Minister’s Prize for Science, Drs Ingrid Scheffer and Sam Berkovic, and the recipients of the clinical and population health streams of our Career Development and Research fellowships schemes. 

Despite NHMRC’s decade-long efforts to increase the number of clinical early career and career development fellows, Australia may soon be facing an undersupply of new clinical researchers. Many universities have had  trouble filling academic clinical jobs with research clinicians. There are, no doubt, many reasons for this - salary,  introduction of graduate entry medical degrees,  college’s requirements for training, etc. – but we need to ensure that researchers continue to lead our clinical departments and their training of health professionals of the future, when the role of evidence will play an ever increasing role.

3. Full time researchers - tackling the most important health and scientific problems and funded through national competitive mechanisms

We need to support outstanding researchers in all fields, so that they are able to undertake breakthrough research that advances and changes a field, so that they can bring about medical and commercial breakthroughs, be internationally connected and engaged, and inspire and train the next generation of researchers.

In my view, nothing is more rewarding than working in medical research. It is deeply satisfying to feel that you are working on a project that is deeply challenging mentally, and with the potential to benefit humankind
But, a full time, lifelong career in research can only ever be available to a few.

It will also involve lifelong competition for funding. Since funds for research are always limited, a career in research is necessarily a very competitive existence, pitting your ideas and achievement against others through peer review for the limited funds. 

One of the difficult issues we face right now is an oversupply of bright, emerging biomedical researchers wishing to have a career in research, relative to the number of full time fellowships that are available. PhDs in biology and biomedicine greatly outnumber the places available, even on the most optimistic view of the future. But I would argue that, though this is rough on individual aspiring researchers, this training is far from a waste from a national perspective. We just need to be able to better ensure that this group of highly talented, highly trained people can benefit Australia more widely, outside a full time research fellowship-based career, and working in all of the wide range of areas of need in the document above.

This “oversupply” of biomedical researchers is not restricted to Australia. In an influential paper analysing the US situation last year, Alberts, Kirschner, Tilghman and Varmus2  commented that the “longstanding assumption that the biomedical research enterprise will expand indefinitely at a substantial rate’ has led to an “unsustainable” situation. In particular, “the mismatch in supply and demand (for researchers) can be partly laid at the discipline’s Malthusian traditions. …most successful biomedical scientists tarn far more scientists than are needed to replace him- or herself. Fundamentally, the current system is in perpetual disequilibrium, because it will inevitable generate an ever-increasing supply of scientists vying for a finite set of research resources…”

This situation in Australia has, as in the US, followed more than a decade of substantial increase in competitive (NHMRC and NIH) funding.  But the amount of NHMRC funding available for fellowships is not a substitute for a national training strategy. Regrettably, it does appear to be the basis upon which too many institutions base their postdoctoral employment strategy. 

NHMRC’s role

NHMRC has long played a major role in developing Australia’s research capabilities but there are many other important players, such as universities, hospitals, institutes, professional colleges, and the wider public and private sectors.

NHMRC recognises that, as the largest Australian funder of competitive fellowships and research grants in health and medical research, our policies and actions have a large effect on the policies and practices in the sector.

But, central and crucial to the future, are the universities who attract, teach and train researchers, the clinical colleges who influence health professional decisions around research, the charitable funding sector that also provides research support, the employers of researchers including the medical research institutes and the biotech and private sector generally. 

NHMRC is working with its Research Committee to  review the breadth and focus of its fellowship schemes. Research changes constantly. The nature of health research forty years ago when NHMRC first developed its fulltime research fellowships was very different to that of today.  Research technology, methodology, breadth, international connectedness, and the range of disciplines needed in health and medical research are all changing rapidly. There is much more emphasis on team approaches, the teams are much more multidisciplinary and there has been large growth in the number of women working in health and medical research.
There is now an increasing need for smart, motivated students from mathematics and statistics, from engineering, behavioural sciences, policy sciences and economics, to work in health and medical research. And at least a fair portion of researchers should have entrepreneurial and investment knowledge and skills.

Internationally and nationally, societies’ wishes for more specific benefits from their investment in research are increasing.

NHMRC is currently particularly focused on our earlier career fellowships. Many researchers are most creative early in their careers - think of our Nobel Prize winners and the researchers whose key findings led to Australian wealth generation in biotech3. Some researchers maintain their high level of achievement in research for many years but it is also good  (and necessary) that others move from full time NHMRC Fellowships into the broader roles discussed above, including leadership roles in universities (Deans, Heads of Schools, DVC’s), public service, administration and the private and community sectors.  

As discussed above, one issue to be faced right now comes from the great increases in biomedical and biological science PhDs that are being produced. As an indicator, the number of applicants for NHMRC’s Early Career Fellowships has grown from 393 in 2009 to 567 in 2014, just 5 years later. The number of fellowships available in contrast increased from 129 to just 135.

PhDs and emerging postdocs should never be regarded as just a ‘cheap pair of hands’. It is irresponsible for research  institutions to take on board postdocs for example and then offer them no security if they fail to gain a competitive fellowship.

Following Research Committee discussion, NHMRC will soon consult with the sector on potential changes to the fellowships schemes. The key suggestions are to reduce the numbers of levels to promote the potential of more rapid rise for the very best, to increase the duration of some fellowships (but this would concomitantly reduce the numbers available), and to limit the number of times researchers can hold a fellowship (to promote great through put and opportunities for next generations). We are also considering whether to adopt obligations similar to those for ARC’s Future Fellowships; that is, the expectation that institutions provide ongoing support beyond the end of an NHMRC Fellowship. 

Final thoughts towards a national strategy

In the rapidly changing world of research, identification and prediction of the sets of skills needed for the future will always be difficult. It will be reliant on wise and knowledgeable leadership, cognisant of the changes and trends in research internationally. National strategies should be broad and the means must be flexible.

Given the diversity of needs in research and the inherent unpredictability, it follows that the approach needed is ’no one size fits all’. The pathways to develop and support clinical researchers will be different to those for laboratory scientists. A researcher headed for industry or the public service likewise will need different approaches and greater flexibility will be required by all parties.

Similarly, we need to work out how best to build our capacity in policy and decision making research in health, and to build our numbers of Indigenous Australian undertaking research. Special approaches will be needed to assist women with young children, to recruit and train many more bioinformaticians in biology, to ensure we exchange our researchers with other countries, and to participate in global health initiatives. 

The decisions on building our researcher capacity will be made in many different settings but universities will play the major role through their recruitment and training of undergraduate and postgraduate students, and their essential roles of equipping the country with the skills and talents it needs.

Change should be gradual and planned and introduced in ways that allow individual researchers and institutions to plan their futures.

But it’s now time to better plan and act to ensure that the country has the researchers it needs for the future. Everyone has a stake in this discussion; research institutions, public and private sector employers, the taxpayers of Australia, the entire community.  It would be great if the discussion was led actively, and not defensively, by researchers themselves. Change will come; researchers have an inherent interest in leading and shaping the changes.

As always, if you have any feedback on the ideas I have raised here, please let me know at ceo@nhmrc.gov.au

Professor Warwick Anderson AM
Chief Executive Officer, NHMRC


  1. OECD, 2014. Research and Development Statistics. Available: http://www.oecd.org/innovation/inno/researchanddevelopmentstatisticsrds.htm

  2. Alberts, B., Kirschner, M.,  Tilgham, S. and Varmus, H. 2014. “Rescuing US biomedical research from its systemic flaws” Proceedings of the National Academy of Sciences of the United States of America, vol. 111 no. 16, 5773-5777, DOI 10.1073/pnas.1404402111. Available: http://www.pnas.org/content/111/16/5773.long

  3. Anderson, W.  2014. Transcript: Healthy, wealthy and affordable: How research can improve Australia’s health system. Available: http://www.nhmrc.gov.au/media/newsletters/ceo/2014/healthy-wealthy-and-affordable-how-research-can-improve-australia-s-healt