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Academia and the Profession |

The Academic Physician-Investigator: A Crisis Not To Be Ignored

Edwin C. Cadman, MD
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From Yale University School of Medicine, New Haven, Connecticut. Requests for Reprints: Edwin C. Cadman, Yale University School of Medicine, Yale-New Haven Hospital, 20 York Street, New Haven, CT 06504.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1994;120(5):401-410. doi:10.7326/0003-4819-120-5-199403010-00009
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The academic physician-investigator faces many challenges. Obtaining funding to support research is the greatest impediment. The National Institutes of Health, the single largest source of grants for the academic physician-investigator, approved only 14.2% of new investigator grant applications in 1990, compared with 40% in 1965 and 1975. Physicians submitted 25% of all applications, and they have priority scores similar to those applications submitted by investigators with PhD degrees. The 14.2% funding rate for new investigator-initiated grants is considerably less than the 56% success rate of amended renewal investigator-initiated grants. These trends in funding can be discouraging to the new physician-investigator. In addition, more emphasis is placed on clinical practice to generate money to support the new academic physician. 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 physicians for academic careers has been poor, with no attention given to the projected needs of the academic centers or the nation. This article describes the dilemma facing young physician-investigators and provides recommendations for improvement to the leaders of American medicine.


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Figure 3.
Outcome of resubmitted and amended investigator-initiated grant applications (R01s) that were previously funded from 1980 through 1990[2].
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Figure 4.
National financial support for research and development in health from 1981 through 1990 categorized by private nonprofit, industry, state and local governments, non-National Institutes of Health federal, and National Institutes of Health (NIH)[2]


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Figure 2.
Grants funded by the National Institutes of Health by type of grant: investigator-initiated (R01), Program Project Grant (PO1), and others from 1981 through 1990.

In 1990 there were 25 725 total, 15 888 R01s, 9066 other, and 771 PO1s. Only 4845 of the R01s were newly funded in 1990.

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Figure 1.
New and renewal investigator-initiated research grant applications (R01) to the National Institutes of Health (U.S. Dept. of Health and Human Services). By outcome: disapproved, unfunded, and funded from 1965 through 1990[2]


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Figure 5.
Training grants provided by the National Institutes of Health by recipient, predoctoral students, PhDs, and MDs from 1981 through 1990[2]


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Figure 6.
Physicians in research compared with the number of physicians from 1975 through 1990 in the United States[12].
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