Similar to individuals in other professional careers, physicians in training pursue various career paths with the expectation that they will have rewarding employment opportunities upon completion of their training. The pathway to being a successful clinical investigator is not an easy one. It requires energy, drive, ambition, devotion, initiative, entrepreneurship, individualism as well as team work, and plenty of hard work (Rahmitoola, 1990). In return, fair compensation is essential to afford adequate housing, provide for a family, and purchase a reliable automobile, particularly at the junior faculty level.

Many trainees and junior faculty, however, perceive the financial security of an academic career as ephemeral. For many who have incurred large educational debt burdens during college and medical school, the financial insecurity of an academic career serves as a disincentive for choosing this career path. Many believe that the large educational debt, the discrepancy between the incomes of academically based physicians compared with those of physicians in private practice, the difficulty of garnering competitive research funding from NIH and other sources for basic as well as clinical research, and obstacles to advancement in the academic community discourage trainees from pursuing academic career paths (Hughes et al., 1991; Institute of Medicine, 1988a). The implications of debt and career choices will be covered more thoroughly in Chapter 4.


In conclusion, the committee believes that there are numerous hurdles confronting clinical investigators at all levels of faculty career development. Recognition in the academic health center includes promotion, protected time, and financial support. The scholarship of the successful clinical investigator should be appropriately recognized in the academic setting. This includes recognition that the nature of the clinical investigator's research, the sources of the funding, and the journals in which investigators publish may differ substantially from those of fundamental investigators.

Leadership at all levels within these institutions must define their expectations of junior faculty and support them so that these young men and women can meet and exceed the expectations. Teaching and serving as role models, advisers, and mentors are important in attracting students to careers in clinical investigation. These faculty activities, therefore, must be recognized and rewarded.

In addition to well-trained and adequately funded patient-based clinical investigators, the successful execution of patient-based clinical research requires a suitable institutional infrastructure. Similar to newly independent, laboratory-based

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