Toward a Unified and Collaborative Future: Creating a Strategic Plan for Family Medicine Research

Context

Family medicine has been grappling with its role as an academic discipline since its founding.¹ At its roots, the family medicine specialty was founded as a counterculture movement to bring medicine back into the community. As a discipline that prides itself on using the best evidence, family medicine must support the concept of being “a clinical discipline with academic rigor that includes research as a key intellectual underpinning.”² Despite progress in growing research capacity³ measured as extramural funding^4-6 (NIH funding has increased from $59M in 2016⁷ to $103M in 2021⁸—great news!), or outputs such as publications,⁹ the total NIH funding to the entire discipline in 2021 was only twice the mean funding to one department of internal medicine, leaving room for growth.⁸

ADFM and NAPCRG are leading a process to develop a roadmap and strategic plan with action steps and metrics to move research in the discipline forward by 2030. The plan encompasses the whole spectrum of research,¹⁰ from those who engage in critical appraisal of evidence to career researchers. Family physicians are engaged in all stages of research with particular emphasis on patients, populations, and communities.

Why Now?

The idea for strengthening research in family medicine is not new. In 2002, for example, a group of leaders generated a series of recommendations for building research capacity.¹¹ However, the environment is ripe for taking on this effort now for 3 key reasons.

First, progress is slow. Despite the growth in funding in the past 5 years noted above, the 10+ years before that were nearly stagnant, and we are seeing some other concerning trends. Many departments with research fellowships have reported challenges in finding interested family physician candidates, and pilot programs like the physician scientist pathway¹² have struggled to take off.

Second, we have some exceptional partners and thought leaders both within and outside family medicine in the United States. We have excellent and growing programs and opportunities, such as the Building Research Capacity initiative’s fellowship and consultation services,¹³ the CAFM Educational Research Alliance infrastructure,¹⁴ the Family Medicine Discovers Rapid Cycle Scientific Discovery and Innovation program,¹⁵ NAPCRG’s Patient and Clinician Engagement Committee,¹⁶ the PRIME registry,¹⁷ new funding for building artificial intelligence and machine learning research,¹⁸ many PBRNs, numerous fellowships and visiting scholars programs, and robust journals. We have opportunities to learn from our colleagues in other countries, like Canada with their TUTOR-PHC program¹⁹ and the Netherlands with their primary care PhD-during-residency program,²⁰ and we have partners in other specialties, like emergency medicine, who are growing their research discipline-wide in creative ways with their own strategic plan²¹ from whom we can learn.

Finally, we are in an opportune moment to push together as a discipline, with high energy for research among the current leadership across the family medicine organizations and a unique opportunity with ADFM and NAPCRG cohosting the twice-annual meetings of the 8 major family medicine organization’s elected and executive leadership (the Family Medicine Leadership Consortium [FMLC]) this year. We are particularly grateful to the ABFM Foundation for supporting this work.

Outlining the Process

The effort to create an action-oriented discipline-wide research agenda began in early 2020, with 10 key themes identified: (1) Research foci; (2) Infrastructure; (3) Advocacy; (4) Funding; (5) Pathways; (6) Mentorship; (7) Chair & Faculty development; (8) Partnerships; (9) Data; and (10) Communication. In fall of 2022, funding was received from the ABFM Foundation for a yearlong process culminating in a research summit in October 2023 in conjunction with the NAPCRG Annual Meeting.

In February, we convened the 8 national family medicine organizations as part of the FMLC to establish the process and vision, clarify the timeline, review the intended final product, and evaluate the current state of research efforts. We also featured “innovative inspirations” speakers who presented possibilities and participated in visioning exercises with consultants. The input gathered from these discussions will inform the data analysis and guide the development of potential strategies and next steps.

While planning for this FMLC kickoff, we started the process of capturing as many voices as possible for input via a visioning survey and have engaged a consulting group, Clarus Consulting, to assist with constituent interviews and focus groups for deeper input across a breadth of audiences. These data will be synthesized into themes to drive the strategic planning process. In parallel to this process, we are planning to generate a “special issue” of a journal with articles highlighting the needs and opportunities in each of our key themes.

After the FMLC organizations have reviewed the draft strategic plan in August 2023, it will be used to drive the Research Summit in October. This will include structured groupthink on action planning, measures, and advocacy to move the plan forward. Success will be measured by becoming unified as a discipline on the role of each family medicine organization in research, developing infrastructure and a broad strategic communication plan for research, and making headway in our efforts for an NIH Center for Primary Care.

A Collaborative Approach

In conclusion, we are excited about the potential of this initiative to transform research in family medicine. By bringing together key constituents from across the discipline, we can identify areas of shared interest and work collaboratively to achieve our goals. We look forward to working with all the participating organizations and individuals to develop a strategic plan that will guide our efforts over the coming years, and we are confident that, by working together, we can advance the field of family medicine research and improve health outcomes for patients and communities across the country.