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private practitioner, and yet these academic people are expected to maintain their research and teaching as well. This is a part of the problem that has to be addressed. We looked at factors that were sources of dissatisfaction and satisfaction . The academic surgeons were most dissatisfied with their research funding and achievement. The lower personal income was a lesser source of dissatisfaction than the research situation which had led many of them to enter academic surgery. They appreciated the research facilities provided by the medical centers and considered these excellent. Teaching students and residents was a very important additional source of satisfaction. The private practitioner missed significantly the opportunity to teach. He consoled himself with his income as his principal source of satisfaction. None of the numerous other factors investigated showed differences in terms of the satisfaction between the two groups. Finally we did a small, amateur, predictive study. Respondents were asked to look ahead 1 0 years and to state whether they thought academic surgery would be more desirable then than now. We also asked how academic life now compared with when they had entered their careers. Both groups felt that academic life today is less satisfactory and desirable than it was when they started. The principal reasons given were that academic life has become too similar to private practice, that the academic surgeon does everything the private practitioner does but without the income, and that research funding and opportunities have decreased. However, both groups overwhelmingly felt that 10 years from now the situation would be different and that being an investigator in an academic setting would be far preferable. The reason was the expectation that National Health Insurance will come in force—that the income differential will disappear and the resources will be concentrated in the university medical centers, which is where the action will be and where they all want to be in 10 years. These data come from only three selected institutions. They obviously cannot be extrapolated too far, but they do give us a little grassroots basis for the nature of this conference and for how these problems affect one subset of clinical investigators. Research Careers and Research Funding: Notesfrom the Discussion There has been a great drop in interest in research as a career among students and house staff. Private practice is glorified, and the clinical teacher, not the investigator, has become more the role model of the Perspectives in Biology and Medicine ¦ Winter 1980 ¦ Part 2 S57 young. Medical school admission committees give preference to familypractice ambitions where previously academic medicine was favored. Medical students are not much exposed to research; the 6-8 weeks they are given in some schools to "try their hand" may in fact be counterproductive . A key problem is curriculum planning; the huge increase in knowledge in recent years may be the greatest enemy of research because it hides what is unknown in the desire to impart what is known. The inquiring student may well be drawn to the social sciences, which stress the unknown. A number of factors which contribute to the declining interest of medical students and young physicians in a clinical research career were noted: (1) The attitude of some elements of society toward clinical research may make it appear unethical or even socially hazardous to study human subjects; (2) clinical research progresses much more slowly than laboratory research, making it impossible for the clinical researcher to pile up as lengthy a bibliography as the equally busy laboratory scientist; (3) clinical research is often discredited by "basic scientists" and sometimes by clinical academicians as well—it is not "basic"; (4) promotions may be easier to obtain as a result of laboratory and small-animal research ; (5) there is a strong feeling that NIH panels are prejudiced against clinical research grant applications; (6) the necessity for formal protocols to be approved prior to starting clinical studies discourages innovative dabbling; (7) many medical schools are unable to provide beds or funds for clinical investigation, the "free bed" has disappeared, and third parties cannot be honestly charged for many clinical studies; and (8) the financial future ofthe less competitive private practice career remains attractive to young persons as...


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pp. S57-S61
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