Impact of Financial Incentives and Department Size on Scholarly Activity Output

We appreciate the work of Munroe et al. in investigating the impact of financial incentives and department size on scholarly activity in family medicine (1). The study provides valuable descriptive insights into the current state of scholarly productivity in family medicine departments. Notably, the finding that 62% of programs do not offer any form of financial incentive highlights the limited institutional support for scholarly work. Additionally, the fact that 16% of programs reported no scholarly output at all underscores the ongoing challenges in fostering research productivity in family medicine. These findings contribute meaningfully to the discourse on research capacity building in primary care.

However, we would like to raise three points that could further strengthen the study:

Potential inconsistency between Table 2 and the main text
The study states that larger faculty sizes are associated with increased scholarly productivity. However, in Table 2, the adjusted odds ratio for producing six or more poster presentations is 0.199 (95% CI: 0.054-0.739) for programs with more than 25 full-time equivalent (FTE) faculty, suggesting that larger departments have fewer poster presentations. This appears contradictory to the main text’s argument. If this is not a typographical error, further clarification on this unexpected result would be valuable.

Potential instability of the logistic regression model
The study uses a logistic regression model with nine variables, despite having a relatively small number of positive outcome cases (approximately 50 at most per outcome category). Given that logistic regression models are prone to instability when the number of predictors is high relative to the number of outcome events, the inclusion of multiple adjustment variables may lead to overfitting and reduced reliability of the estimates. A sensitivity analysis with a reduced number of predictors could strengthen the robustness of the findings.

Appropriateness of the uniform outcome cutoff across programs of different sizes
The study defines "high scholarly output" as producing six or more products in a given category, applied uniformly across all programs. However, it is natural that smaller programs will have lower absolute scholarly output simply due to fewer faculty members. A relative metric, such as scholarly output per faculty member, may provide a more nuanced and fair comparison of research productivity across departments of different sizes.

We commend the authors for addressing an important issue in family medicine research. Clarifying these points could further enhance the study's impact and its implications for academic institutions seeking to improve research productivity.

Reference
1. Munroe DD, Villalon-Gomez J, Seehusen DA, Moore MA. Impact of Financial Incentives and Department Size on Scholarly Activity Output. Ann Fam Med. 2025 Jan 27;23(1):66-72.

* Note from Annals of Family Medicine: We’re grateful to Dr. Kaneko for this thoughtful and detailed response. We have reviewed the points raised, and a few corrections to the study are currently in progress. These will be reflected in a revised version of the article soon.