Barriers, Enablers, and Incentives for Research Participation: A Report from the Ambulatory Care Research Network (ACRN)

Am I interested in research? I am really interested in research. Am I interested in being reimbursed for research? I am, but right now I have only 5 clinical sessions a week and one of those I precept the residents. So I only see patients 4 sessions a week. I don't think I can go down to 3 and still call myself a primary care doctor so easily, or I don't know if I am ready to go down to 3. And so, again, we wear so many hats and, yes, I would love to wear another hat. (IM)

The largest barrier is basically time. There is no time to do any of this, or it's going to be in your sleep. …it's been going on for 3 years, and it's difficult. (FM)

Coming from residency, if you haven't gone into a program that fosters research you don't have the skills in order to write grants or be the principal investigator of a research project, …unless you've had a mentor who's actually taught you how to do that, so adequate skills or training…. (IM)

We don't really understand what it entails. In terms of what do we have to put in to it really … and how much do we want to put in? Do we want to be the PIs, or do we want to be involved in projects with other people that are staying up until 3:00 in the morning so we don't have to? (FM)

And not getting reimbursed for it makes a huge difference (IM)

It's [the grant] been going on for 3 years, and it's difficult. My time is not bought out; it's in kind. So this is on top of all of the things that I'm doing. (FM)

You have to consider that when a peg is gone, there's a hole there, and how do you fill that hole? And then will it get to a critical point where there is no more leftover pegs to fill in. When you pull someone to cover that, you're pulling them from something else. There is a domino effect. You can't hire, appoint one person to cover that hole, either, even if you have the release money. And then what happens when she loses her funding? Do you throw away that person we hired? Then it becomes a budget issue. (FM)

And then we did the survey and having to get it translated, right, then we realized the survey was too complicated for our patients so we needed then to simplify and then we had to resubmit it. I mean, it was just exhausting. So we did it and we did quite a few of them, but we never did anything with it because again you need a group of people who can consistently meet. (IM)

It's just very hard to sustain things. That sustainability is one of my biggest challenges. (IM)

I can't believe how hard it was to get IRB approval for something that involved no drugs. You know, this couldn't have been more soft research. And it's just because it doesn't matter what it is, you have to go through all the steps no matter what. And it was so hard and so many back and forths in getting the consents approved and being confused about whether…oh, I was originally supposed to include kids so I needed assent and consent and kids never came, thank goodness. . . . and the grant was written for like 100 people and I got 20 at the beginning and then 10 and then 6. (IM)

I have projects and I tried to get IRB approval. And I finally found someone I thought could help me on the process. They did help me, but when I submitted it, it still got denied, and then we couldn't figure out how to overcome that barrier. So we get to a certain point. We marshal all of our time and energy and resources, and we get to a certain point and reach another hurdle, and we just drop it. (FM)

. . . Spanish was my primary language and I feel like I have a special connection with them because I speak exactly as they do, . . . they feel that you are using them sometimes. They don't trust you enough. (IM)

. . . I can speak from the African American population that there's a lot of mistrust of the medical community. . . . They don't want to be experimented on, especially after that whole Tuskegee experiment. (IM)

And so any study that helps contribute to our knowledge of what can help our patients and what is the best practice is something that this group is going to be interested in. (IM)

I have found people very open to working with things if they're brought in a way that their collaborating, inclusive, right, you don't have to do this but we think this might work, in a place that people can feel like it's incorporating things into their practice and not adding more work into their practice. Key. (IM)

I think we are all academics and that's why we're here. We're not in private practice for a reason. (IM)

One of the issues with collaborators if we're all primarily clinicians then it gets very difficult because as clinicians we tend to put the clinical first. The only reason why I actually ended up finishing was because the person I worked with was primarily a researcher and he pushed and pushed because he wanted to get this done so he gave me deadlines. . . (IM)

That's the importance of mentorship, to keep you from wasting your time on things that you should not have to be focusing on. (FM)