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Should the next NIH director hold a medical degree?

As the search for the next director of the U.S. National Institutes of Health (NIH) gears up, observers are wondering: Is it time for the White House to abandon tradition and choose a biomedical scientist who does not hold a medical degree?

It’s been a topic of discussion since NIH Director Francis Collins announced on 5 October he will step down by the end of the year—and urged that a woman succeed him. The question may be especially relevant this time because insisting on a physician at the helm of NIH could complicate efforts to recruit a woman or a person of color (POC). Among potential candidates whose names quickly popped up was University of California, Berkeley, biochemist Jennifer Doudna, who won a Nobel Prize in 2020 for co-discovering the CRISPR gene-editing tool but does not hold an M.D. 

There is no legal requirement that the NIH director be a physician, but all 16 directors in the agency’s 134-year history have had a medical degree. Collins himself, an M.D. and geneticist with a chemistry Ph.D., has an active medical license. He has occasionally seen patients at the NIH Clinical Center, which treats thousands of people each year, although not as part of patients’ official care teams, an NIH spokesperson says.

Jeremy Berg, former director of the National Institute of General Medical Sciences (and former editor-in-chief of Science), argued on Twitter that “medical training matters” because the NIH director oversees clinical programs and the Clinical Center. In addition, not having the M.D. title after the NIH director’s name “could be a political liability as issues arise,” he wrote. Others disagreed: An M.D. requirement “holds back on the NIHs[sic] evolving mission,” which includes areas such as public health and bioengineering, tweeted Georgia Institute of Technology biomedical engineer Krishnendu Roy. “The right, politically savvy person can be an asset.”

One former NIH director sees it both ways. Cancer biologist Harold Varmus, an M.D. who stopped practicing medicine in the early 1970s and let his license lapse in the late ’80s, a few years before he became NIH director in 1993, says an M.D. is not needed to oversee grantmaking or set up research programs. “The vast majority of the work can be done perfectly well by someone with a Ph.D.”

But Varmus says knowing “the vocabulary of medicine” can be “useful.” Members of Congress might expect an NIH director to have an M.D., he adds. It could make it “easier” to persuade lawmakers that NIH needs more funding “not just to pursue a basic understanding of science, but to improve health,” Varmus says. The degree can also be relevant when members of Congress ask NIH for medical advice for themselves or a family member, Kathy Hudson, a former NIH deputy director, told STAT.

Yet others suggest times have changed. “The tradition seems dated,” says longtime NIH observer Tony Mazzaschi, chief advocacy officer of the Association of Schools and Programs of Public Health. With NIH’s budget now pushing past $41 billion, he thinks management and communication skills “are more essential than ever. Perhaps those skills need to be considered on par with scientific expertise.”

Mary Woolley, president of the group Research!America, which advocates for biomedical research funding, agrees that an NIH director’s administrative skills should carry a lot of weight. She notes that hospital CEOs were once expected to have medical degree, but that is no longer the case. “I just think it’s time to think more broadly,” Woolley says.

Woolley and Varmus both served on a committee of biomedical research leaders that recently pondered the M.D. question. The panel, which included past NIH Director Elias Zerhouni and two other former NIH officials, noted in a report last year: “It is essential that the Director has wide knowledge about medicine. However, we do not view the MD degree as an essential attribute.”

An M.D. requirement could shrink the pool of high-profile POC and women researchers—ruling out not just Doudna, but also others, including biochemist Erin O’Shea, president of the Howard Hughes Medical Institute, one of the largest private funders of biomedical research in the United States, and neurobiologist Cori Bargmann, head of science at the Chan Zuckerberg Initiative, another large funding philanthropy. (NIH has had just one woman as a director, Bernadine Healy.)

The White House has said it expects to nominate an NIH director before Collins steps down. The post requires approval by the Senate health committee, which could take time because of other pressing business, including the expected nomination of a Food and Drug Administration chief. Confirmation also requires approval by the full Senate. But the NIH candidate could begin to learn the ropes as soon as they are named, Varmus says. “If we had a nominee by the end of the year, that would be a triumph.”