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Young Physician-Scientists: Internal Medicine's Challenge
In the past decade, many individuals and organizations have expressed concern about the future of clinical research (1-5) and about those principally concerned with leading it: physician-scientists (6-9). Some believe that there is a “crisis” in clinical research or that physician-scientists are an “endangered species.” All agree that the problems are serious and will get worse if they go unattended. To find this much accord among such organizations as the Institute of Medicine, the National Institutes of Health (NIH), the Federation of American Societies for Experimental Biology (FASEB), the Association of American Medical Colleges, and the American Medical Association is, in itself, remarkable. That substantial agreement exists about the proposed remedies is also notable and encouraging.
The litany of problems in the clinical research enterprise, however long, bears repeating. Too small a fraction of the NIH budget is devoted to patient-oriented research; too few MDs are included on NIH study sections and institute review groups; too few career development programs are sponsored by the NIH, the Howard Hughes Medical Institute, voluntary health agencies, and foundations; too little emphasis on research in clinical departments in academia; and, most important, too little appreciation that sustaining the national investment in medical research depends on demonstrating to the public a commensurate return in terms of extending and enhancing life, reducing disability, and preventing, treating, and curing disease.
The warning signs that the physician-scientist career path is in danger are a decade-long decline in the stated intention of …
