The Next Step in Building Family Medicine Research Capacity: Finding the way from Fellowship

Abstract

The future of family medicine depends on a thriving research enterprise that requires a clear vision, commitment, and investment of resources. We have made great progress. A recent survey of departments identified approximately 400 family medicine faculty with external funding (not including Title VII); these faculty are making significant contributions to creating new knowledge and are publishing with increasing frequency.1 Given our success in building research capacity, ADFM believes that the most important question is no longer, “how do we get faculty interested in research? “ or “how do we obtain research fellowships?” but, instead, “how do we help young and mid-career researchers make the transition to sustained independent funding?” This is particularly important in the current context of flat NIH budgets, diminishing institutional resources, and departments’ increasing reliance on clinical income. What doesn’t work is clear. Setting up single researchers in every department—giving them the title of “research director”, a fraction of their time for scholarly activities and little else—will not drive us forward. Similarly, the days of the “lone ranger” are over. Departments of family medicine cannot afford solitary investigators conducting their own research in a vacuum. Today’s funded research is almost always done in teams. Finally, developing researchers “on the cheap” is a recipe for failure. The minimum typical outlay for developing new researchers is $300,000 and often more; even with that investment, many faculty do not gain independent R01 or equivalent funding. Substantial, ongoing departmental investment is necessary. What are the proper initial conditions necessary to make the transition from research fellow to Principal Investigator (PI) in a federal grant? Release from other obligations needs to be substantial and prolonged, but exactly how much and how it is counted is unclear and varies across departments. Borrowing the model from the basic sciences and K awards, many fellows expect up to 80% time for several years, while the Robert Wood Johnson Foundation Generalist Physician Faculty Scholars Program asked for 50% release time. Given the lack of a clear “best practice”, what should departments set as desirable goals for new research faculty? First, fellowship directors must emphasize publications and grant writing experience, including development of a career award proposal. Researchers should hit the ground running producing publications and grants. Second, we must explore models of faculty positions that provide substantial research-focused time (40 to 50% or greater), while not eliminating clinical and teaching roles. Department chairs and their research faculty must define and measure research success. This might include benchmarks for sustained grant support, publications, research leadership and mentoring. We also need to look beyond the standard 2- to 3-year period to secure funding for a researcher. Institutional or individual K awards can help. They provide up to 5 years of support for young faculty. Preparing proposals provides junior faculty with an important opportunity to identify mentors and develop a plan for pilot data, publications and grants. However, K awards are increasingly competitive and most faculty with K awards do not make the transition to obtaining R01s. Moreover, the 80% protected time model is not realistic for most of our faculty: to win 2 to 3 R01s by year 5 would be unusual! We need to look also to other models of developing young researchers. In the basic sciences, there is often an apprenticeship or post-doctoral time where the newly trained learn the basic processes needed for success. While graduate school and fellowship is a time to learn methods, the period post-fellowship is a time to learn “how to play the game.” This learning is best done under the guidance of an experienced mentor, someone who is funded and has a funded trajectory of inquiry. This approach often requires that the junior faculty member delay pursuing an independent research question and become a member of the mentor’s team.2 In this way the junior faculty member has an opportunity to benefit from available research data, co-author manuscripts and become a co-investigator. This approach allows learning the art of grant-writing through cycles of submission and resubmission with their mentor. Outsourcing mentorship is also a possibility. Good quality mentorship is critical to the development of young researchers, but mentors do not necessarily need to be members of the department of family medicine (eg, a cancer center, or a health services research center). “Lending out” our scarce future researchers in anticipation that they will gain necessary skills and return to us may be risky. One approach that has been piloted in some FM departments is to have dual mentorships both inside and outside departments of family medicine. This has helped foster an FM faculty identity while providing research training and fostering transdisciplinary relationships. We look forward to more dialogue among departments and faculty members.