The Plight of the Academic Clinician Researcher

Why me? Thirty six years in academic medicine at a community medical school provides me some credentials.  As an emeritus professor since 2007, my part time role is occupied almost entirely by mentoring junior faculty.  In the last year I have interacted with 28 faculty and post-docs all with one intention on my mind….to help them with their academic goals.

The plight of the clinical research scientist. In my view, the only productive clinical researchers are those who do not depend upon their clinical practice to support their academic careers.  Of course, there are some exceptions to this notion but after all, this is just common sense. Clinically based faculty are simply too busy, too distracted by real-time decisions regarding human life and care.  And they are too tired or always in a hurry to catch up with other duties and chores that demand their remaining time and energy.  Teaching students, residents, and fellows, attending university and hospital meetings, fulfilling other hospital duties (CME’s, certifications and compliance courses), attending regional and/or national meetings to keep abreast with one’s field, and social gatherings to promote team work and spirit are just some, but not all of the potential intruders. 

Without grant funds to support research time, without medical school institutional support, without the ability to share clinical responsibilities with other faculty, the clinician scientist is left stranded in the land of the research want-to-be.  How does any mentor, department chair, Dean or Director or anyone else in academia approach the counseling of junior faculty who truly express an interest in academics?  Do they apply the standards of the past, drawn from their experience decades before to apply to the present situation? Do they truly listen to the plight of the burgeoning clinical researcher, or do they attempt to bludgeon the faculty member with formulas and solutions that are no longer plausible in the new real world of medicine?

Hospitals and medical centers are much more focused on efficiency and cost containment.  The flexibility and autonomy of scheduling MD’s for clinical duty by supervisors has been replaced or at least scrutinized by computer generated algorithms that tract every moment of a physician’s day.  There is no down time.  There is no time for idle talk.  There is barely enough time to eat lunch and use the rest room. In this environment, it is unreasonable to think that physicians have enough time to conduct meaningful research.  Is there even time to write a retrospective chart review paper or to engage in quality improvement research?  To be sure, activities that should take days to weeks are stalled by the priority of clinical duty to the point where their completion is delayed by months to years.  Having to rediscover your paper each time you open the file is frustrating at the very least and an unproductive way of conducting scientific inquiry and scholarly pursuit.

How do MD’s cope?  For those who are outpatient doctors, I regularly observe work being done very early in the morning, or late at night, or during weekends and holidays.   After the children go to bed, before the spouse wakes up, any moment that is free.  For those who have night call duties as part of their responsibilities, productivity in research is more dependent upon how punishing the schedule of call is and those periods of time that the physician is between clinical rotations.  The trouble is that during these periods, there is so much to catch up on that it is exhausting and maddening to consider having to complete a project that rightfully requires the full attention of the clinician researcher.  

 

More than one clinician researcher has either talked about or has already cut back their time from full to 80% to free up time to conduct their clinical research.  This is demonstration of how serious their interest in research is, that they voluntarily accept a pay cut to be able to solve their time crunch dilemma and remain sane in the process.  This indeed may serve as the model for modern day MD’s who are infected with the academic bug to conduct meaningful research.  With time and anticipating success, funds would open up to provide them support from the institution leveraging grant funding success that rewards their focused effort.

This entire discussion begs the question of how Department Chairs, Deans and Directors, and the University at large can expect full time clinical faculty members to conduct meaningful research without some appreciation for their situation and a feasible and effective plan.   Suggestions that are described below do NOT place the burden of increasing costs to the institution.

Each department has G (General Funds) from the University of Hawaii.  Perhaps a certain proportion of these funds can be dedicated to support clinical research efforts.  Instead of providing these funds as an entitlement to certain individuals and for life, portions can be dolled out for say – 25% effort for a three-year period.  This would be awarded after a competitive application is selected, open to all faculty members in that particular department.  The research goals and deliverables would be clearly demarcated in the application, a mentor or mentors would be included as well as their support of the application, and the research and career development activity would be described in detail.  It would be expected that in addition to a certain number of publications, grant applications would be prepared and submitted as one expected outcome.

A hybrid of the previous two concepts would recruit 5 members of a division who would cut their time back from full to 80%.  A new specialist would accordingly be hired to fill in the clinical gap.  Specialties like in hospital intensive and emergency care physicians would make the most sense to consider this model.  In this scenario, each of these members would gain 20% of their time at the price of making less in salary.  To many, money is less of an issue than time especially in highly paid specialties. To me, this model may make more sense, a solution to more than just considering the needs of promoting research.  Indeed, some specialties are so overloaded with clinical duties, as one physician recently admitted, there is barely enough time to brush your teeth.

There are other potential scenarios that should be considered.  With so many physicians expected to dabble in research as part of their academic responsibilities, it may be that a concentrated period of say 2 weeks with no clinical, teaching or administrative duties may produce a good first draft of a paper which would be the expected outcome.  Funding for this effort might come from grant funds that are directed to fund such “individual research retreats”, institutional funds, funds from RTRF, or all of the above.

Clinicians are destined for failure in Academics without a plausible plan from leaders of the medical school.  We all need to think creatively for how best to utilize the resources of the medical school, grant funds intended to foster clinical research productivity, and funds from our medical school partner hospital institutions to support our medical school clinical faculty.