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soon as possible. Maybe that is why we are getting more gastroenterologists and dermatologists these days. Since interns are calculating the work/pay ratio for potential specialties, the student perceives that requirements of the academic world are very tough. He sees that the number ofcommittees, boards, reports have proliferated tremendously. Everyone has the same kind of requirements for accountability. It is not just the federal government. It is the university, the medical school, the state, the medical specialty network, the Social Security Administration, the foundation. Ifyou actually do what you are required to do, you make a lie out of the questionnaire in which you said you would give 10 or 15 percent of your time to teaching and certainly some small percentage to research. This type of dilemma affects the perception of the young person who sees clinical research abused in this way. The people being selected at Harvard are no different now than they were 10 years ago; they may even be better or smarter. Yet a smaller percentage of them is opting to go into academic medicine. That does not mean that they will not do some form of clinical investigation, or that they will not learn, or that they do not have inquiring minds. A well-trained, philosophical person will use the resources at hand in the most efficient way that he can. Beeson has shown us one way, and I think many clinicians of this generation will follow it. It does not mean the grant process is wrong, and I do not think we need to be quite so pessimistic. If the senior investigators peel offafter 10 years, that may be a very, very good thing. Survey of Career Choices in Surgery DAVIDB. SKINNER* Are we faced in this conference with a real problem or only a perceived problem? I have been increasingly concerned over the last several years with the shifts that are occurring in the bases of support for academic medical centers. I am also concerned that the perceived attrition of faculty across the country is indeed a real problem. Earlier this year we set out to get some data on this subject as it relates to surgery. The basis for the concern, I think, is well documented. Data generated by the RAND Corporation for the President's Biomedical Research Panel indicate that funding ofour academic medical centers has indeed ""Chairman, Department of Surgery, University of Chicago Pritzker School of Medicine, 950 East 59th Street, Chicago, Illinois 60637. S54 J George E. Schreiner The Independent Researcher shifted away from research—from 41 percent of the total in 1965 to only 23 percent 10 years later. The difference was made up by an increase in the professional fee contributions of the faculties to the academic medical centers. Tuition, endowments, gifts, indirect costs, and everything else stayed absolutely steady as a percentage of total funding during that decade. This has necessarily had a large impact on the clinical faculties who do the clinical investigation and are the focus for our discussions here. Last fall I went back to the three institutions with which I have been associated over the past 20 years—Massachusetts General Hospital, Johns Hopkins Hospital, and the University of Chicago—and surveyed the graduates of their surgical training programs to see what had happened and what changes had taken place. All together, 109 chief residents completed the three surgical programs between 1966 and 1978. All three of these institutions have stressed the training of academic surgeons and clinical investigators. All three have selected their house staff on the basis of potential to become clinical investigators. AU three have been supported by NIH academic surgery training grants. All three have a strong heritage of producing professors, investigators, and academic surgeons. It pleased me that there was a very high response rate of 86 percent of the total group to a 64-part multifactorial questionnaire. It covered their activities and the factors bearing on their decision to enter private practice or academic medicine. The first striking finding was a statistically significant decrease in the number of graduates entering academic surgery from these three institutions . Seventy-five percent ofthose who received their M.D.'s...


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