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Reflections on the current and future roles of clinician-scientists.

"Clinician-scientists" is an all-inclusive term for board-certified specialists who engage in patient care and laboratory-based (biomedical) research, patient-based (clinical) research, or population-based (epidemiological) research. In recent years, the number of medical graduates who choose to combine patient care and research has declined, generating concerns about the future of medical research. This paper reviews: a) the various current categories of clinician-scientists, b) the reasons proposed for the declining number of medical graduates who opt for a career as clinician-scientists, c) the various interventions aimed at reversing this trend, and d) the projections for the future role of clinician-scientists. Efforts to encourage students to combine patient care and research include providing financial and institutional support, and reducing the duration of the training of clinician-scientists. However, recent advances in clinical and biomedical knowledge have increased the difficulties in maintaining the dual role of care-providers and scientists. It was therefore suggested that rather than expecting clinician-scientists to compete with full-time clinicians in providing patient care, and with full-time investigators in performing research, clinician-scientists will increasingly assume the role of leading/coordinating interdisciplinary teams. Such teams would focus either on patient-based research or on the clinical, biomedical and epidemiological aspects of specific clinical disorders, such as hypertension and diabetes.