The numbers of specialists who are practicing Clinical Pharmacology is declining. This raises questions about the nature of the discipline and the roles of those who practice Clinical Pharmacology. Numbers and qualifications of successful trainees in North American accredited Clinical Pharmacology training programs are presented. Questions are posed that require discussion by a forum of academic, regulatory, and industry-based scientists to enable Clinical Pharmacology training programs to meet the clinical care, drug development, and drug policy needs in Western countries in the next decade.