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Careers in Clinical Research: Obstacles and Opportunities
university-based research has been attributed to the wisdom and foresight of Vannevar Bush (Bush, 1945). Resources were not only plentiful for supporting research but numerous programs were also initiated to build the physical research infrastructure and train more highly talented scientists (Institute of Medicine, 1990). The biomedical research community responded, and the nation's health research capacity expanded significantly. During this period research that involved interactions with human subjects, possibly with the exception of psychological studies, was primarily the domain of physician-scientists. Many of these physician-scientists were motivated to pursue research careers because of the rapid advances in biomedicine and the potential to become critical players in medical discovery. Others may have pursued research to avoid military service in an unpopular war in Southeast Asia. Nonetheless, after completing their clinical training residencies, many physicians sought fellowships at the National Institutes of Health (NIH) and subsequently moved into academic and research positions around the country. Whatever their motivation, most of these scientists have contributed to the fount of knowledge that serves as the basis of modern health care.
In the late 1970s and early 1980s, many leaders in the medical research community expressed concern about a perceived decline in the participation rates of physicians engaged in all aspects of biomedical research (DiBona, 1979; Gill, 1984; Kelley, 1980 and 1985; Thier et al., 1980; Wyngaarden, 1979). This perception was supported by data demonstrating that the ratio of M.D.s to Ph.D.s successfully obtaining research grant awards from NIH was declining. More alarming was the notion that individuals who were highly trained in patient care and who were considered the technology transfer agents were not seeking rigorous scientific training, which widened the gap between basic research discoveries and application of these advances to improved health care (Glickman 1985; Healy, 1988). Furthermore, although some physicians were seeking training in the basic biological sciences, there was a perception that few were being trained to develop and test hypotheses in human subjects or populations (Forrest, 1980). Ironically, data show that the number of full-time faculty in medical schools has grown by more than 20,000 over the past decade, to nearly 65,000. (Data from the Association of American Medical Schools report that medical school faculty totaled 65,000 in 1990, whereas data collected for the Liaison Committee for Medical Education reports that faculty totals were nearly 80,000.) It has been hypothesized that this growth reflects a growing dependence on medical center profits to offset increasing constraints on research funds and shrinking subsidies for graduate medical education (Chin, 1985; Hughes et al., 1991). Although faculty members are required to perform scholarly activity, there appears to be an increasing demand on the clinical faculty to derive revenue through patient care. Furthermore, the growth in clinical faculty may have increased tensions between the faculty in basic science departments and those in the clinical departments. These tensions may arise because basic science faculty fear that their research