Toward an adequate pool of clinical investigators.

Abstract

COMMENTARY AND DISCUSSION Toward an Adequate Pool of Clinical Investigators fOHN F. SHERMAN* A primary cause of our concern has been an alarming decrease in the number of qualified young physicians who seek training opportunities for careers in academic medicine with an emphasis on clinical research. The extent of this concern may be measured by the fact that it has been the theme of three recent presidential addresses of the American Federation for Clinical Research and the Association of American Physicians. Avoiding the temptation to add another voice to the definition of clinical investigation, I shall refer only to the necessity of assuring an adequate pool of physicians undertaking research which involves human subjects in one manner or another. I propose to address four areas of importance : The first has to do with money or funding for research, especially for clinical investigation and the training for careers in it; the second speaks to changes which are occurring in our institutions and their faculties; the third, which I have not heard mentioned during this meeting, is the influence ofthe clinical specialty boards; and the fourth is the hopeful sign of a heightened interest in research on the part of contemporary medical students. First, the level of funding for biomedical research. I seriously doubt that Swisher's prediction of a "relatively major retrenchment in biomedical research" will occur. There is no question that the rate of increase in support has diminished in recent years, but the data displayed by Bever and Whedon earlier in this volume refute some of the claims about cuts in funding levels. This is not to say that we could not effectively use more money or that we should not mount vigorous efforts to assure a reasonable rate of growth in funding for health-sciences research. Such efforts ?Vice-president, Association of American Medical Colleges, 1 Dupont Circle, N.W., Washington, D.C. 20007.© 1980 by The University of Chicago. 0031-5982/80/2322-0156$01.00 Perspectives in Biology and Medicine · Winter 1980 · Part 2 S79 must include a greater emphasis on financial support from sources other than the federal government. The probability of greater competition for federal funds for all domestic programs heightens the need for more vigorous, sophisticated, and continuing efforts on behalf of our cause. Because of preoccupations with the direct funding of research, too little attention has been paid, in my opinion, to the impact of the massive funding in recent years for health services. That revenue, which is derived from a combination of public and private sources, has resulted in increasing distractions to both faculty and institutional officials. As Skinner pointed out earlier, income from private-practice plans has become, for both individual faculty members in clinical departments and for the medical schools as a whole, a larger source of revenue than that from biomedical and behavioral research. In addition, these sources of income , particularly from Titles 18 and 19 of the Social Security Act, have brought a flood of time-consuming and costly regulations. I suggest that these circumstances cannot help but distract the institutions' staff from research and must represent a significant influence on the career decisions of young M.D.'s. As for changes within the institutions and their faculties, I find myself in mild disagreement with Swisher's generalization that the "newer, smaller, less-known, and fiscally weaker medical schools" would probably suffer more heavily from cutbacks in federal funding than the "older, prestigious schools of the East Coast where many academic people are now trained." My disagreement arises, first of all, from the fact that many of the newer schools, usually having state support, are probably fiscally stronger than some of the older schools, especially those in the private sector. Furthermore, data from the NIH show that four of the West Coast schools have been among the leaders in NIH funding in recent years. More important, the emphases on primary care and community involvement and the competition for research funds have resulted in the emergence of two types of schools within the institutional population: The first are those which have traditionally carried on a major program in biomedical and behavioral research, and the second are more oriented...