RESEARCH DEVELOPMENT STORIES FROM 7 DEPARTMENTS OF FAMILY MEDICINE: 7 LESSONS FOR ALL DEPARTMENTS

The challenges to development of research capacity in departments of family medicine have been documented.¹ ADFM strives to be a learning community, where members share their challenges, opportunities, successes, and disappointments. Seven stories of family medicine departments from Boston University, Brown, Jefferson, Kansas, Minnesota, Oregon, and Wake Forest were featured at a recent annual ADFM Winter Meeting. In aggregate, these departments saw their number of funded investigator FTEs increase five-fold and research awards increase eight-fold. The areas of emphasis were varied and included prevention, chronic disease management, and access to care, and employed epidemiology studies, implementation studies, and clinical trials. These 7 stories of success and the discussions yielded important lessons.

1. Chair leadership and vision was critical to research growth and success. The vision was influenced by the assessment of local strengths, weaknesses and opportunities for research. Planning usually included identification of who might serve as potential partners in building a research enterprise and chairs supported these partnerships. The stories illustrated that there are many possible pathways to success, and that partnerships can be created within the university, the surrounding community, regional health systems, state legislatures, and even international institutions. Additionally, some considered research as opportunistic and thought chairs should guide researchers to look at the horizon of where potential research funding opportunities might hide.

2. With visionary leadership, chairs must invest in research. How did these chairs invest? First, they invested in people. One noted that you should not underestimate the costs to become successful in research– it takes $300,000 or more to get a junior investigator off the ground, $1 million to attract a mid-level investigator, and several million to attract a senior investigator. Chairs’ investments in researchers were linked to outcomes and productivity measures, especially including grant funding support. Chairs invested in more faculty time for young investigators to develop and noted that devoting at least 60% time or more to research was needed to develop sustained funding.

3. Recruitment and retention of researchers is a challenge. Two chairs invested in research fellowships but all agreed that this was not essential. Given the relative dearth of investigators in family medicine, “growing your own” is often necessary, but having a fellowship program isn’t the only way to do this, and fellows may leave following their training. With the scarcity of Title VII funds for establishing research programs, chairs looked to K awards from the National Institutes of Health to fund infrastructure and junior investigators. Even so, a significant portion of K awardees will not have a sustained research career.

4. Chairs often invested in teams of investigators to create research programs rather than isolated individuals. Many departments recognized the value of PhD investigators on the team—they don’t have competing clinical demands and usually have much deeper training in research methods. Although many research-intensive departments succeed with a relatively narrow research focus, there are several examples of those that also succeed with a group of talented investigators that are working in disparate areas, but who derive regular intellectual stimulation from their proximity and relationship with their department peers.

5. Chairs invested in physical space devoted to the research team, and sought to cluster investigators. Establishing a culture conducive to investigation was important to chairs and the proximity of researchers to clinicians was articulated as being important to family medicine.

6. Chairs invested in essential infrastructure to support the cost of doing research business. In particular, they invested in grants management and internal auditing (for finance and fraud). This may be provided by the home university, or may be internal to the department if the operations are large enough.

7. Chairs actively encouraged and supported networking. The practical power of networking was apparent in all 7 stories, with benefits for both K awardees and senior investigators. The North American Primary Care Research Group has created and sustained networking for primary care investigators since the 1970s, and family medicine investigators are now creating partnerships in content area focused meetings, as well. Although not a venue for the presentation of original work, ADFM will continue to play a key role in helping chairs, chairs to be, and department administrators learn from one another and thereby create and sustain research that will advance our discipline and practice.

Research and the creation of new knowledge to guide practice and encourage innovation is critical to our discipline and it is the role of all family medicine organizations to sustain and advance investigators and investigations. The lessons above may provide a direction for such efforts.

This Annals Commentary was produced by the Chair and Vice Chair of the ADFM Research Development Committee with review by the ADFM Executive Committee.

• © 2011 Annals of Family Medicine, Inc.