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In Reply: I fully agree with Dr Bean-Mayberry and colleagues. In my Editorial, I argued that the transformation of health care to a rational prospective model requires the contribution of well trained clinical researchers. These individuals are a scarce resource and many more need to be trained and supported. However, educational loan debt is a strong disincentive to the choice of a clinical research career, and this has been recognized by the NIH and the VA through debt reduction programs. Unfortunately, there is a gap in the coverage, likely an unintended consequence of a VA policy, which identifies young physicians in career development positions as temporary employees. The general goal of the Career Development Program funded by the VA is for many of these individuals to progress to permanent staff/faculty appointments within the VA and their affiliated medical schools. To accomplish this laudatory goal, I firmly believe this group of . . . [Full Text of this Article]

Ralph Snyderman, MD
snyde001@mc.duke.edu
Chancellor for Health Affairs
Duke University Health System
Durham, NC

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