A Snapshot of the Current Research and Grant Output by Family Physicians in Family Medicine Residencies

Richard Young, M.D., Joane Baumer, M.D., Karen Smith, M.D.
John Peter Smith Family Medicine Residency Program

Cindy Passmore, M.A.
Waco Faculty Development Center

Mark DeHaven, Ph.D.
UT-Southwestern Medical Center

Introduction

The Future of Family Medicine Project concluded: “The ongoing development of the specialty and its need to contribute more substantially to the body of medical and health systems knowledge will depend on the growth of research and a greater commitment to a culture of ongoing inquiry in family medicine.” The purpose of this study was to take a snapshot of the current state of research in family medicine residencies to get a sense of what is working and what is not.

Methods
We surveyed all program directors in family medicine residencies in the U.S. A two-page survey was mailed three different times during the Spring/Summer of 2004. The survey asked about research and grant production over the last three years. Questions were both open- and close-ended. Some responses were styled in a yes-or-no format, others were on a Likert scale. Specifically, we wanted to answer the following questions:

• How many programs have any research output and what is that output?
• How much time do family physician faculty have to produce research?
• What sources of funding pay for these research efforts, and more specifically how much do grants fund these efforts and which grants are utilized?
• How useful are current funding mechanisms for research time and training (i.e., NIH K awards and the Robert Wood Johnson Generalist Faculty Physician award) to family physician residency faculty?
• What specific barriers must be overcome to increase research output in their family medicine residencies?

Residencies that had closed or were about to close were excluded, as were programs that are listed as separate entities by the AAFP guide but which are extensions of a home program, like a rural track, for instance.

Results
298 out of 453 eligible programs responded (66 percent). The majority of programs (84 percent) reported some participation in research. A minority of community-based (CB) programs have published original papers in peer-reviewed journals (44 percent), but a majority of the medical school-based (MSB) programs have (81 percent). The MSB programs have produced many more papers per program in the last three years (13 versus 1.5). The output of poster presentations at national meetings is similar between the CB and MSB programs on the question of whether any posters have been produced (45 percent versus 63 percent), but the MSB programs have produced many more in total (10 versus 5).

Family physician faculty in residencies have very little time protected for research. In CB programs, almost no faculty have significant protected time: 7 percent of programs report at least one faculty member with 25 percent or more protected time. The situation is better in the MSB programs, though only about half of those have any faculty with greater than 25 percent protected time (47 percent).

A minority of CB programs, but a majority of MSB programs report any grants that funded faculty time in the last three years (36 versus 76 percent). The NIH was the most commonly listed source of funds for the MSB programs (56 percent versus 7 percent of CSB programs); state and local foundations were the most common responses for the CB programs (15 percent). AAFP and state family medicine association grants were less frequently reported. When the CB programs were asked, “…what funding sources subsidize [faculty] research time,” the most common response was: “There is no funding for research time; they do it on their own time.”

A minority of MSB programs responded that they could meet the minimum eligibility requirements for the NIH K-type investigator awards (about 29 percent). Almost none of the CB programs could meet the requirements (about 3 percent).

When asked about what barriers were needed to increase their research capacity, there was no difference between the CB and MSB programs. By far the most common response was time, money and more faculty (about 90 percent). Research expertise was listed in about 25 percent of programs. A lack of interest was rarely reported.

Conclusions
Research in family medicine has a long way to go. Only about half of the family medicine residencies have produced any posters or papers by the family physician faculty in the last three years. Family medicine faculty in MSB programs are more successful at producing research, especially publications, than their CB program counterparts because they have more faculty with protected time, though a surprising number of MSB programs have few to no faculty with protected time for research. Most of the faculty in CB programs that report some degree of research participation do this with less than 10 percent protected time.

The vast majority of programs have not received grant support for research in the last three years. The current sources for funding faculty time and training (NIH K-type awards) are not useful to most family medicine residencies. On a related note, the Robert Wood Johnson Generalist Faculty Scholar program, another potential source of training funds, is no longer funding new applicants.

Limitations of this study include less than 100 percent response rate (though 66 percent is very acceptable) and a lack of questions about the contributions made by the behavioral science faculty. We also did not ask about the amount of grant money received. We made no attempt to judge the quality of research produced.

Our study found that research in family medicine is still struggling and that the reported barriers to research have not changed much over the last two decades. An assumption underlying this study was that if family medicine is going to develop a “culture of ongoing inquiry,” then research has to happen where most young physicians become family physicians — the community-based family medicine residencies. If this is to happen, than we believe a clear implication of this study is that a major restructuring of the funding of family medicine residencies must occur to create reliable funding streams to support protected time for research by academic family physicians in residencies, particularly community-based residencies. We realize this will be an arduous task.

This report is intended to be an executive summary only. We will submit a more detailed draft to one of the major family medicine journals in hopes of it being published.

This study was funded in part by a research grant from the Texas Academy of Family Physicians Foundation.