Psychiatric disorders are prevalent and disabling. Despite investment over the past 2 decades, few new treatments emerged, and drug trials repeatedly ended in disappointment. 1 In 2014, the National Institute of Mental Health (NIMH) announced a new vision for treatment development, requiring investigators to establish mechanistic targets of interventions before testing efficacy in clinical trials. 1 Proponents maintain this approach focuses investment towards the most promising treatments and ensures even failed trials improve mechanistic understanding. Critics argue it impedes studying interventions that could help patients today. 2 The debate's outcome notwithstanding, developing new interventions requires patient-oriented researchers (PORs)totestthem.ExpandingthepoolofPORswithclinical trials experience will be critical in reversing the 90% decline in NIMH-funded treatment research observed between 2003-2019. 2 Here, we consider current challenges to developing PORs, particularly physician-scientists who can run clinical trials. We offer strategies to support and strengthen this essential pipeline at key career stages.Physician-scientists are declining across all specialties, including psychiatry. 3 Along with gender, racial and ethnic minority status, and academic debt, limited protected time, mentorship/training, and funding are major barriers to pursuing psychiatric research. 3 The National Institute of Health's (NIH's) Medical Scientist Training Program (MSTP) combines MD/PhD training to expand the physician-scientist workforce. MSTP graduates received more than 600 NIMH grants between 1975 and 2014, but most pursue basic research: more than 40% surveyed in 2014 worked with humans, and 3% conducted clinical trials. 4 Offered by one-quarter of psychiatry residencies, research track programs (RTPs) also train physicianscientists. 5 Physicians without PhDs, who pursue patient-orientedresearchmorefrequentlythanMD/PhDs,particu-larlybenefitfromRTPs. 6 ToimprovePORrecruitment,NIH could expand clinical research opportunities for undergraduates or high school students, require MD/PhD curricula to include clinical research and/or trials rotations, and support more integrated residency/PhD programs (delivering scientific training when clinical interests are more developed). 5 Further, NIH could make the MD/PhD tuition waivers more widely available (eg, to MDs pursuing a clini-calresearchMS),andincreaseLoanRepaymentfundingfor PORs.Foundations can also play a role. For example, the Doris Duke Foundation supports clinical research during medical school, and recently expanded to include postresidency fellowship training. At Columbia University, the Leon Levy Foundation funds PORs during psy-