A recent ‘Days of Molecular Medicine’Conference in La Jolla sponsored by the UCSD Institute for Molecular Medicine, the Salk Institute and Nature Medicine included a forum for discussion of the current status of physicianscientist career pathways—with a particular focus on the pipeline of new recruits. Forum participants included representatives from academia, private foundations, medical research societies and the pharmaceutical industry. Comments by participants from Asia and Europe also served to highlight the international significance of this issue. Who are physician-scientists, and why do we need them? They are individuals with medical training who spend most or all of their time engaged in basic, disease-oriented or patientoriented research. Much has been written over the past two decades regarding the importance of physician-scientists, and the problems faced by those entering this career track1–3. Physician-scientists are vital members of the medical research enterprise, because the scientific questions they ask reflect the experiences they gain from taking care of sick people. This generalization can be illustrated by listing some of their notable achievements, such as the discovery of oncogenes, the low-density lipoprotein receptor, prions, HIV, pulmonary surfactant, and the defective genes in many inherited disorders; the eradication of smallpox and the near-eradication of polio; cures for childhood leukemia, Hodgkin disease, and testicular cancer; the development of open-heart surgery, of organ and bone-marrow transplantation, and of approaches to decrease mortality after heart attacks and strokes. The kinds of questions that physicianscientists tend to ask will become even more important as information about the human genome swells in this ‘post-genomic’era. They are also in an ideal position to communicate and collaborate, both with PhD scientists and with health-care providers. Finally, physician-scientists can make the strongest case for the medical relevance of basic research to legislators, advocates and health agencies4.

Unfortunately, the number of physician-scientists has been declining for the last two decades. In 1983, there were 18,535 physician-scientists nation-wide. By 1998, this number had fallen to 14,479, a 22% decline5. This gradual but definite decrease in the face of an expanding need has been the subject of much concern and pessimism3, 6, including grave warnings of the possible loss in preeminence of American academic medicine7. We are therefore pleased to report that the warnings of the past two decades and the advocacy efforts of a growing number of national organizations (Box 1) have resulted in many new initiatives by public and private funding organizations aimed at revitalizing the pathway (Box 2). We applaud all these efforts, but suggest that most need to be expanded further. For example, the recently established loan repayment program of the National Institutes of Health (NIH), which limits eligibility to individuals being trained in clinical research, needs to be expanded to include physicians training in basic and translational research as well5. Furthermore, the impressive efforts of nonprofit foundations should be more widely publicized, and enhanced to focus on other critical weaknesses in the pipeline, such as the need to encourage more extended research opportu-