immunology, and developmental biology have created opportunities in the reproductive sciences. In addition, novel approaches to the prevention, diagnosis, and treatment of reproductive diseases are appearing.

Despite conceptual and technological developments, however, there exists a crisis in academic obstetrics and gynecology in both research and in research training. In part, this is due to forces external to the specialty–economic, ethical, political, and social. But there is also a dearth of physician-scientists and clinical investigators who can contribute to advances in the reproductive sciences and serve as role models for students, house staff, and others. In sum, too few obstetricians and gynecologist are being adequately trained to pursue research opportunities.

Thus, for academic obstetrics and gynecology, current circumstances present a paradox. Never before have the opportunities been so great–and the resources so limited (Martin, 1991). Departments of obstetrics and gynecology are increasingly confronted by the need to provide highly technical clinical care, to perform manifold social functions, and to maintain large, private practices to generate income. Biomedical scientists in these departments are coming under growing pressure to justify their research. As obstetrics and gynecology approach the twenty-first century, the clinical investigator, particularly the physician-scientist, is seriously threatened by an increasingly sophisticated research enterprise, decreased time for careful thought and work, and diminishing federal and private resources for support.

In the coming years, the future of obstetrics and gynecology as a whole will depend, in great part, on the health and well-being of its academic departments. In turn, the state of these departments depends, in considerable measure, on their role in research in the reproductive sciences. As Jack Masur, former director of the Clinical Center at the National Institutes of Health, (NIH) observed, "Hospitals with long traditions of excellence have demonstrated abundantly that Research enhances the vitality of teaching. Teaching lifts the standards of service, and Service opens new avenues of investigation." (This statement appears at the entrance to the main auditorium in the NIH Clinical Center.)

This paper explores the roles of the private sector and more briefly those of the National Institutes of Health in helping to produce research leaders in obstetrics and gynecology.



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