Clinicians, including physicians, nurses, therapists, and other allied health professionals, form an important core of the multidisciplinary field of health services research (HSR). By operating as front-line workers in our healthcare system, clinicians bring a unique perspective to research that includes insights into policies that can advance health and anticipate potential unintended consequences. Through interactions with patients, clinicians have a direct line of sight to what patients need and want. This connection with patients is particularly important as the HSR field strives to serve all populations, including vulnerable populations whose construct of health may differ from the backgrounds and lived experiences of HSR professionals.
An analysis of the growing HSR workforce in 2016 found that approximately one third of 6,126 identified researchers had MD degrees. Researchers with PhD (40%) and masters degrees (17%) also include clinicians, such as PhD nursing scholars. In a recent study examining critical competencies for success in HSR, clinicians are well-suited to serve the demand for generalists in the field: “The kinds of people [who] are not necessarily experts in a particular area… [individuals] who can apply their knowledge base and make connections across different sectors.”
Expanding the workforce of clinicians that are also health service researchers through strengthened training pathways is essential to maintaining the quality, relevance, and dissemination of HSR. We recommend three approaches to building this workforce: early introduction to HSR for clinicians-in-training, HSR training programs tailored for clinicians, and multidisciplinary HSR training programs that bring together diverse clinical and non-clinical professionals.
Early introduction to HSR during clinical training. Early education in HSR ensures that all clinicians acquire a baseline understanding on the importance of HSR and its potential for impact on daily practice and health. Even if only a few clinicians become HSR professionals, early exposure to HSR approaches can expand the broader perspectives of clinicians and their ability to engage with HSR initiatives at the patient, provider, and system level. Basic HSR competencies can be incorporated into undergraduate and professional training programs (e.g., via lecture series or more intensive opportunities in medical and nursing school). These competencies include implementation and dissemination, which expand the toolkit of all clinicians to create meaningful impact in the delivery of health services. Examples of early HSR introduction in clinical training include the Duke-Margolis Scholars program and Bridging the Gaps. Further, career trajectory templates can be used to illustrate pathways for clinicians to advance into HSR. The AcademyHealth Education Council is working closely with members in the field to develop these trajectories for publication in 2019.
HSR training programs tailored for clinicians. For clinicians seeking to make a career in HSR, training programs can be designed to accommodate the needs of clinicians, namely the need practice clinically. Training programs can also be designed considering the evolution of clinician’s careers, from HSR training concurrent with clinical residencies or fellowships to mid-career clinicians interested in shifting their career focus to HSR. The National Clinician Scholars Program (NCSP) is a 2-year HSR training program with an interprofessional core curriculum for physicians and PhD-trained nurses tailored to their specific training needs, while also allowing continued clinical practice. Clinician scholars are trained to conduct timely research that addresses real-world, highly relevant health problems through didactics, mentorship, leadership training, and protected time to develop their own research portfolio. Academic research fellowships funded by T32 NIH awards are other options often used by clinician-HSR trainees. A regularly updated list of HSR training programs, including T32 and K12 awards, is available on the AcademyHealth website here.
Multidisciplinary training programs that attract diverse clinical and non-clinical professionals. By definition, the field of HSR flourishes at the crossroads of interdisciplinary knowledge. Clinician experts come from diverse fields, including physicians, nurses, physical therapists, dentists, social workers, nutritionists, psychologists, and pharmacists. Dynamic team learning can occur in training opportunities that bring together clinicians with non-clinical partners, such as economists, social scientists, policymakers, and attorneys. The Robert Wood Johnson Clinical Scholars provides established clinicians from diverse backgrounds leadership skills to work collaboratively on complex health issues to promote a culture of health.
While the need is clear, there are considerable challenges to training and sustaining a diverse workforce of clinically-trained health services researchers. Ultimately, these challenges may boil down to funding. Although the funding available for HSR has increased over the past decade, it remains a tiny proportion of the overall NIH budget. The challenging funding environment, particularly for recently-trained clinicians hoping to embark on a career in HSR, is an important consideration for clinicians fighting to protect time for HSR. The funding constraints may push would-be clinician health service researchers into more administrative, educational, or clinical research roles for which value may be more easily apparent to institutions, health systems, and department chairs.
Ultimately, clinicians undergo years of training to be able to provide high-quality medical care to patients. Clinicians motivated to engage in HSR realize that improving health demands cultural and health system change. We must afford clinicians the opportunity to make those changes a reality.