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 highly motivated and accomplished
trainees should be included in the debt relief program offered by the VA.
Snyderman R. The Debt Repayment Paradox for VA Clinical Investigators—Reply. JAMA. 2004;291(19):2316. doi:10.1001/jama.291.19.2316-b
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