The committee recommends that new mechanisms for supporting newly independent clinical investigators be developed.
Funding must be available to support newly independent clinical investigators who are just initiating their investigative careers. This segment of one's career development often becomes the most critical and the time when so many of the disincentives converge to dissuade newly trained clinical investigators from continuing to pursue clinical research career paths. Many believe that First Investigator Research Support and Transition (FIRST) awards have been highly successful in nurturing the careers of newly independent investigators. Indeed, FIRST awards could also be an avenue for launching a career in clinical investigation, but the structure of the awards and the ceiling on costs are more suited for bench-type research rather than human subject research. Stabilization of funding could well represent the single most important factor to the individual clinical investigator. This support has come from many sources in the past, perhaps most importantly from the academic health center. As noted later, this type of support is in jeopardy because of the changing health care system.
The committee strongly supports the efforts by NIH to develop centers and program projects to support research and infrastructure in exciting new areas of multidisciplinary, crosscutting research.
Not only is the development of these programs critical to the support of clinical research but they also provide one of the few mechanisms available for the development and support of core facilities. Such core facilities are essential to individual clinical investigators attempting to overcome obstacles in the progress of their own research. Centers not only provide physical infrastructure but also serve as a locus of intellectual capital and collaboration necessary for conducting human research. The availability of small feasibility grants as part of larger center grants often stimulates investigators to extend their expertise to new areas beyond their current levels of interest.