Context.— The proportion of investigators applying for clinical research grants
from the National Institutes of Health (NIH) who are physicians has declined
from 40% 30 years ago to 25% today.
Objective.— To recommend NIH policy changes that might encourage physician investigators
to undertake careers in clinical research, eg, patient-oriented research,
epidemiologic and behavioral studies, outcomes research, and health services
Participants.— The NIH Director's Panel on Clinical Research comprised 14 physicians
from academia and industry, chosen by the director. They met in numerous closed
sessions and in 5 public meetings from July 1995 to November 1997.
Consensus Process.— In addition to expert opinion and pertinent literature, data sources
included the training characteristics of applicants to NIH who were funded
or not. Topics considered included financing of clinical research, recruitment,
training, and retention of future clinical investigators, conduct of clinical
trials, and peer review of clinical research. Consensus was reached and recommendations
were made in response to an interim report, widely circulated to the biomedical
community, written by members of the panel, which contained preliminary recommendations.
Conclusions.— The panel's final recommendations to NIH included maintaining at least
the present proportion of NIH funding for clinical research; continuing mentored
opportunities in clinical research for medical students; promoting clinical
research training by offering didactic courses and grant opportunities in
clinical research to nascent investigators emerging from specialty training
programs and providing partial salary support for mentors; restructuring study
sections that review patient-oriented research applications to include more
physicians; encouraging clinical investigators and basic scientists to work
closely together and weld collaborations between academic clinical investigators
and colleagues in pharmaceutical and biotechnology companies; and developing
a joint policy between academic health centers and NIH for the support of
clinical research and clinical research training.