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Careers in Clinical Research: Obstacles and Opportunities
are, of necessity, generally well-established senior investigators. For a newly independent junior faculty member, the inability to compete successfully for NIH funding, identify a unique research niche, and develop one's research independence seem to be insurmountable obstacles (Cohen, 1991). In addition, the necessity to participate in multicenter projects that require a large team approach is unappealing. Moreover, it takes many months for scientific and human protection committees to review and approve a human study protocol before patients can be enrolled in a clinical study. The new congressional requirement for subgroup analysis of women and minorities will also increase the size and cost of each clinical trial as well as the difficulty of enrolling patients into each trial. The time required to initiate, implement, and publish a human study is thus prolonged and arduous, and the potential number of publications from these studies over a similar period of effort is perceived to be fewer than that for laboratory-based research. Therefore, junior faculty perceive that the best route to promotion is development of a laboratory-based research effort. Laboratory experiments with well-established controls often can be completed rapidly; determining the clinical correlates in a patient-based clinical study can take years. Consequently, clinical research publications are frequently case reports or descriptive reviews of patients (Cadman, 1993).
Perceptions of second-class faculty status abound in both camps of the medical school faculty. Some physicians feel that their laboratory-based Ph.D. colleagues regard them as having inferior training in scientific methods and, therefore, as being less sophisticated scientists. At the same time, the Ph.D. community sometimes feels that it is perceived as second-class faculty by its physician colleagues, particularly those with a primary appointment in a clinical department. Even Ph.D.s in clinical departments feel that they are viewed as outcasts by their Ph.D. colleagues in the preclinical departments. Although it is nearly impossible to diminish these perceptions, no empirical data exist to support the conjecture that one group is superior to or more productive than the other in conducting research. Each clearly has unique contributions to make to expanding the knowledge base of medical science.
Institutions have dealt with these issues through different means. Some institutions have established multiple career tracks for the physician faculty to recognize their different scholarly contributions (Bickel, 1991; Bickel and Whiting, 1991). For example, the Department of Internal Medicine at the University of Michigan initiated a two-track system for tenurable clinical faculty that is intended to define the expectations of departmental faculty by the department's leadership (Kelley and Stross, 1992). In addition to the nontenurable, full-time clinical faculty, tenurable faculty are divided into