I shall introduce to you this morning some ofthe most distinguished aca- demic physicians of our day. Their task today is certainly not to talk to other.
413
INTRODUCTORY REMARKS* MARIANNE J. LEGATO, M.D. Associate Professor of Clinical Medicine Columbia University College of Physicians and Surgeons New York, New York
N inety years ago Oliver Wendell Holmes addressed an audience in this hall and talked about the New York Academy of Medicine, then in its 44th year: "It deals with living subjects, it handles unsettled questions." Both of these statements describe today's symposium. There are few subjects more relevant to the quality of American medical care than the state of the academic physician: the physician-scientist who does original research, teaches, and cares for patients in a university setting. Traditionally, only about 3% of all physicians in the United States, clinical investigators, as they are called, generate new information about the normal and diseased human organism. This important function differentiates them from other members of their departments who may also teach but whose careers do not include a major commitment to research and who spend their medical lives largely in the care of patients in the hospital or in their offices. The clinical investigator is the subject of today's symposium. Convincing data support the idea that he is an endangered species. This idea may be particularly confusing to the public in view of the prevalent notion that we shall soon be faced with a superabundance of doctors, and in particular of specialists. Sentiment has been growing that we need more physicians involved in primary or family care, and that the production of specialists by American medical institutions is outrunning our need for them. It is our perception that the public is largely unaware of who the clinical investigator is, what he does, and why. Although he represents a very small proportion of the medical body, his function is essential to keep the state of the American medical art where it currently stands: second to none in the world. Valid or not, this perception is one of the complicated reasons our *Presented as part of a Symposium on The Academic Physician: An Endangered Species held by the Committee on Medical Education of the New York Academy of Medicine October 10, 1980.
Vol. 57, No. 6, July-August 1981
414
414 M
M.J. LEGATO
.J.~~~~~~~~~ LEAT
students are not choosing careers in medical research and teaching, and why the mood of the Congress is to curtail the systems that have in the past produced a flourishing body of medical researchers. How many specialists we need and whether we shall have enough doctors is not our subject today. We might point out, however, that to lose the 3 or 4 % of physicians who traditionally spend their medical lives in research or teaching will not make more doctors available for the care of the public and, in fact, will be, sooner or later, a near mortal blow to the quality of that care. I shall introduce to you this morning some of the most distinguished academic physicians of our day. Their task today is certainly not to talk to other clinical investigators. This symposium is for the public and for the medical community at large. Our task today is to set for them the nature of the physician-scientist's role, to explain the problems he faces, and to ask for help in our search to recruit and train young physicians to take our places and to make the quality of our own lives as physician-scientists acceptable. We have assembled a group of speakers today who are among the best of the breed of academic physicians. The curriculum vitae of each is a treatise on personal achievement. Interestingly, and probably predictably, each record is unique. Each man has taken his own individual track and made his own individual mark. No two careers are the same, as a consequence, I think, of the creativity and innovativeness that are part of the equipment of a good clinical investigator. You will hear different opinions today, and you will view the problem from different vantage points. But listen with the assurance that we could have found no more competent or accomplished spokesmen.
Bull. N.Y. Acad. Med.
