Perhaps because I am a veteran of the “good old days”(they were really quite bad), young physicians who hope to become clinical investigators often ask me how they might establish their careers. Many are more than a little worried about their futures and often have trouble envisioning a career path that is financially secure for themselves and their families. The grumbling of clinical investigators a few years their senior enhances their angst. So I try to encourage these young physicians because I know the great intellectual (if not monetary) rewards of the field and because I know that the future of medicine absolutely depends on clinical investigators. The following is what I try to say to them.

First I try to point out that the definition of clinical research is very broad. It encompasses clinical trials, outcomes, health delivery, epidemiological, and psychosocial research (1). Though many experts seem to believe that the term “clinical research” is restricted to those areas, nothing could be further from the truth. One of the most important, and most difficult, areas of clinical research is currently called (for want of a better term) translational clinical research. Translational clinical research focuses on the bench-to-bedside interface and requires a physician-investigator schooled in the clinical aspects of a subspecialty, skilled in biomedical science and its methodologies, and endowed with enough intuition to recognize the patients who can, if carefully investigated in the laboratory, reveal the nature and/or appropriate treatment of their diseases. During this process the investigator may uncover fundamental rules of biology (2). It is this class of clinical investigator that has seemed most endangered since James Wyngaarden, a former director of the NIH, first called attention to its fragility (3).