BACKGROUND The proportion of investigators applying for clinical research grants from the National Institutes of Health (NIH) who are physicians has declined from 40% 30 years ago to 25% today. OBJECTIVE To recommend NIH policy changes that might encourage physician investigators to undertake careers in clinical research, eg, patient-oriented research, epidemiologic and behavioral studies, outcomes research, and health services research. METHODS The NIH Director's Panel on Clinical Research comprised 14 physicians from academia and industry, chosen by the director. They met in numerous closed sessions and in 5 public meetings from July 1995 to November 1997. METHODS In addition to expert opinion and pertinent literature, data sources included the training characteristics of applicants to NIH who were funded or not. Topics considered included financing of clinical research, recruitment, training, and retention of future clinical investigators, conduct of clinical trials, and peer review of clinical research. Consensus was reached and recommendations were made in response to an interim report, widely circulated to the biomedical community, written by members of the panel, which contained preliminary recommendations. CONCLUSIONS The panel's final recommendations to NIH included maintaining at least the present proportion of NIH funding for clinical research; continuing mentored opportunities in clinical research for medical students; promoting clinical research training by offering didactic courses and grant opportunities in clinical research to nascent investigators emerging from specialty training programs and providing partial salary support for mentors; restructuring study sections that review patient-oriented research applications to include more physicians; encouraging clinical investigators and basic scientists to work closely together and weld collaborations between academic clinical investigators and colleagues in pharmaceutical and biotechnology companies; and developing a joint policy between academic health centers and NIH for the support of clinical research and clinical research training.