THE ACADEMIC PHYSICIAN-INVESTIGATOR - A CRISIS NOT TO BE IGNORED

The academic physician-investigator faces many challenges. Obtaining f unding to support research is the greatest impediment. The National In stitutes of Health, the single largest source of grants for the academ ic physician-investigator, approved only 14.2% of new investigator gra nt applications in 1990, compared with 40% in 1965 and 1975. Physician s submitted 25% of all applications, and they have priority scores sim ilar to those applications submitted by investigators with PhD degrees . The 14.2% funding rate for new investigator-initiated grants is cons iderably less than the 56% success rate of amended renewal investigato r-initiated grants. These trends in funding can be discouraging to the new physician-investigator. In addition, more emphasis is placed on c linical practice to generate money to support the new academic physici an. These two facts, reduced probability of obtaining a grant and the perceived need to see more patients for salary support, may jeopardize retention of young faculty members. Moreover, training to prepare phy sicians for academic careers has been poor, with no attention given to the projected needs of the academic centers or the nation. This artic le describes the dilemma facing young physician-investigators and prov ides recommendations for improvement to the leaders of American medici ne.