The origin of the full-time faculty system. Implications for clinical research

Clinical research has long been viewed as a fragile pursuit requiring special nurturing. The full-time clinical faculty system was introduced in the early 20th century to provide a milieu that would foster clinical investigation. This article, based on extensive archival research, will show that the main goal of the architects of the full-time system was to stimulate research by removing the incentive for medical professors to devote their main energy to practice. The plan was developed by preclinical scientists at The Johns Hopkins Medical School (Baltimore, Md) and was inaugurated there in 1913 with the financial assistance of the Rockefeller General Education Board. As other medical schools adopted traditional academic criteria for appointment and advancement, there were additional incentives for faculty members to undertake research. In the 1920s, the General Education Board yielded to pressure to liberalize its definition of full time and began to support medical schools that implemented what came to be known as the "geographic full-time plan." Increased government support and other factors encouraged the expansion of full-time plans and led to an impressive increase in the output of research. Today, growing pressure on full-time clinical faculty members to generate income from practice for themselves and their institutions threatens the future of clinical research in this country.