The process of integrating medical scientific break-throughs into improved clinical practice requires talented and dedicated clinical investigators. Unfortunately, substantial impediments deter gifted physicians from clinical research. The experience of "Dr. Ross," an aspiring (fictional) clinical investigator, is presented in this report. The factors that ultimately contribute to Dr. Ross' choice to abandon an academic clinical research career are explored. Issues relating to research training, mentoring, funding, and academic promotion standards are analyzed from his individual perspective. Special emphasis is given to the intense financial pressure trainees face. Finally, potential solutions are presented. These include a description of the National Institutes of Health K23, K24, and K30 programs and its new extramural Loan Repayment Program for clinical researchers. These important advances provide much-needed support, but additional work must be done. In the absence of further reform, academic medicine's mission to train tomorrow's clinical investigators will erode further.
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