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The academic physician-investigator faces many challenges. Obtaining funding to support research is the greatest impediment. The National Institutes of Health, the single largest source of grants for the academic physician-investigator, approved only 14.2% of new investigator grant applications in 1990, compared with 40% in 1965 and 1975. Physicians submitted 25% of all applications, and they have priority scores similar to those applications submitted by investigators with PhD degrees. The 14.2% funding rate for new investigator-initiated grants is considerably less than the 56% success rate of amended renewal investigator-initiated grants. These trends in funding can be discouraging to the new physician-investigator. In addition, more emphasis is placed on clinical practice to generate money to support the new academic physician. These two facts, reduced probability of obtaining a grant and the perceived need to see more patients for salary support, may jeopardize retention of young faculty members. Moreover, training to prepare physicians for academic careers has been poor, with no attention given to the projected needs of the academic centers or the nation. This article describes the dilemma facing young physician-investigators and provides recommendations for improvement to the leaders of American medicine. [ABSTRACT FROM AUTHOR]