Shortages of medical academics are set to worsen, with most young doctors never considering a career in teaching and research, says the British Medical Association.
Only about 25 per cent of the 473 doctors surveyed by the BMA had considered entering academic medicine, with men more likely to have given it thought than women.
Doctors working in hospitals were more likely to have considered the academic option than their GP counterparts.
According to the study of medical graduates from 1995, medics who had not considered academe were deterred by low salaries.
One said: "I would have been taking on a research post where the pay would have been half to two-thirds of what I could earn in a modestly paid salaried GP post - it just didn't seem feasible."
Others found the "insular" and "exclusive" nature of academic medicine a turn-off. The number of academic posts was seen to be limited, highly competitive and available only to the very best.
Reduced clinical responsibilities, lack of patient contact and fears of becoming deskilled were cited by others.
"I went into medicine to work with people rather than to theorise," one commented.
Lack of career structure was an additional problem for some respondents, although a combination of factors was often involved. "Clinical medicine is a breeze compared with the politics and financial hardships of research. It is a constant battle to obtain funds, ethical approval and protected research," one commented.
But many doctors who had chosen an academic career enjoyed the teaching aspect and intellectual stimulation. Others felt that it was less stressful than a clinical career, with more flexible hours and greater autonomy.
The main reason given by those working in some form of research post was that it was a "means to an end" - a way to improve their career prospects or to obtain a national training number.
In a bid to resolve the problem, the BMA recommends that students be exposed to research and academic careers at medical school. It also suggests introducing incentives such as "seed-corn" funding for junior doctors.
Better part-time and flexible working arrangements and support would improve recruitment to the medical academic workforce, the association says.
The BMA calls on the university sector to promote academic activity in the National Health Service as well as in higher education with a coordinated recruitment policy.
Michael Rees, chairman of the BMA's medical academic staff committee, said it was a concern that so few doctors saw academic careers as a realistic or appealing option.
"The NHS needs high-calibre researchers to be able to develop the best possible treatments," Professor Rees said. "With medical school intake on the increase, the need for qualified medical lecturers and professors to teach students is increasingly important."
The Medical Academic Career Intentions report can be read at www.bma.org.uk/careerintentions