Universities are facing a medical staff crisis that could jeopardise the expansion in medical schools announced as part of government plans to save the National Health Service.
"Vice-chancellors have to wake up to the fact that some areas of clinical medicine are withering on the vine and that when current professors retire there will be no one to replace them," said John Savill, professor of medicine at Edinburgh University and author of a report on clinical academic careers published last year by the Academy of Medical Sciences.
"Universities have to resume the role in career development that they abandoned ten years ago."
The Department of Health has just announced a scheme to boost clinical academic numbers, which will complement projects announced by charities and research councils.
Professor Savill said: "The department is doing its bit, the research councils and charities are doing their bit, what about the vice-chancellors?" Roland Levinsky, head of the graduate school and vice-provost for biomedicine at University College London, and chair of a working group looking at training for the AMS, said: "Academic medicine has reached crisis point. There are some areas such as pathology, anaesthetics and certain surgical areas where we are having to kickstart the whole profession again.
"We are looking for tenure-track or longer-term security for these academics. Some vice-chancellors are happy to do this, some are not."
Sir Martin Harris, vice-chancellor of Manchester University and chairman of the Universities UK health strategy group, welcomed the DoH scheme but said that universities needed more funding.
"Proper incentives for the best doctors to take up the academic challenge need to be offered across the board. The funds to do so must be made available if the posts we need to train the additional doctors under the plan are to be filled," he said.
The DoH's National Clinician Scientist Scheme will provide a career path and funding for clinical academics. The scheme is based on the recommendation in Professor Savill's report for the immediate introduction of 50 clinician scientist posts a year.
The DoH has said it will fund eight posts a year, at £100,000 per post, over five years. This will complement posts created by the Wellcome Trust, the Medical Research Council and other bodies, bringing the total number of new posts to about 30.
"The AMS is also working with universities to encourage vice-chancellors to guarantee posts at senior lecturer or consultant level to clinical academics who have successfully completed the five years of the clinician scientist scheme," Professor Levinsky said.
Ken Fleming, head of the medical sciences division at Oxford University, said: "There is certainly a real problem in recruiting clinical academics at the moment. How posts in the new medical schools will be filled is a serious concern. It is not clear that there are sufficient suitably qualified individuals around to ensure maintenance of standards."
But he said: "This university could not guarantee a senior post to a clinical academic completing the five-year clinician scientist scheme. We hold a position in the global market and would want an open competition for such senior positions."
- The vanishing dream of a job for life
Jeremy Hughes is Wellcome Trust senior fellow in clinical science at Edinburgh University's medical school. He is based at the Medical Research Council's Centre for Inflammation Research. He does some teaching but his priority is to establish his research team.
His path to his present post, while littered with awards and scholarships, has not been straightforward. He was 37 before he got a post lasting more than five years.
"I completed my medical training in London and then went to work for the Hammersmith Hospital as senior house officer in renal and respiratory medicine," he said. "The Hammersmith had previously been the Royal Postgraduate Medical School, which gives you some idea that it was heavily research-oriented. I loved it and started to pursue a career as a clinical academic, but there was no set career path. It was rather the encouragement of professors and other senior research fellows that pushed me in this direction.
"I have had to take risks and work abroad in order to advance my career. My last job was in Seattle, and as the contract came to an end my wife was particularly anxious. I just had to hope something would come up."