Tactics for Institutional Advocacy to Increase Research Capacity in a Family Medicine Department

Increased Funding from Institutional Leadership

Negotiating before hiring offered the best opportunity to secure institutional support. MJ consulted with other chairs and focused on recruiting young promising clinician scientists and providing appropriate time and staff support and mentoring, rather than senior clinical research faculty, whose focus on patient- and community-based research precludes an easy relocation as opposed to basic scientists who could more readily move their laboratories. Estimating a start-up package of $500,000 for the first 3 years of an assistant professor until independent funding could be obtained, MJ requested $1.5 million over 5 years from the Dean and received $1 million of support. He also received $100,000 per year of support for 5 years to start an internal research funding program for clinical nontenured faculty. Finally, he received $50,000 per year for 4 years to support his own research program and another $100,000 support for feasibility studies for a large program or center development.

Identify and Promote Promising Practices

To create a vision that resonates with all faculty, once hired MJ met with all faculty to establish the goal of strengthening research and scholarship during the first 5 years of tenure. He also established monthly research meetings, open to any faculty interested in research, with themes ranging broadly from strategic planning to informal presentation of research idea. He consulted with Building Research Capacity (BRC), an initiative by the Association of Departments of Family Medicine and North American Primary Care Research Group to help increase the research capacity among the US family medicine departments, leading to 2 themes: increase the research capacity through greater external funding and increase scholarship output from all faculty.⁴

Another approach was to identify senior collaborators as faculty mentors and sponsors. MJ’s expertise in cancer communications research led to meetings with the institutional experts in cancer and health services research before hiring. This facilitated the discussion for collaboration soon after hiring, leading to the directors of the Cancer Center and the NIH-funded Building Interdisciplinary Research Careers in Women's Health (BIRCWH) to offer funding support for junior faculty with relevant research interest. MJ was also tapped for a multiple principal investigator role in a multi-institutional cancer equity collaborative funded by the National Cancer Institute.⁵ This led to additional connections with senior cancer research faculty.

The search committee for research faculty was charged to ensure the applicant’s research theme aligned with that of the department to have synergy among the research faculty and the right mentorship. The applicant’s potential was determined by the clarity of the research question and approach to address them and the track record that supported success. Over 3 years, the department has successfully recruited 2 early career faculty with an interest in cancer research and a midcareer faculty with independent funding in perinatal equity. While the department did not have established research in perinatal care, many faculty members had clinical expertise in obstetrics, and the institution had an established group of senior perinatal researchers. The combination of independent funding and the funding from the Dean, Cancer Center, and BIRWCH was enough to support 75% time for research for all 3 faculty.

Outcomes So Far

As MJ completed the first 3 years as the chair, the department has doubled the number of research faculty. Internally funded research time and staff support were ensured for the existing research faculty. One faculty obtained the department’s first R01 grant. The department is now approaching RCS level 2.

Increased Funding from Institutional Leadership

An important strategy for enhancing research capacity involved advocating internally for additional state-funded faculty positions, also known as “tenure lines.” Special campus initiatives often involved establishment of new tenure lines, such as precision medicine and those aimed to enhance diversity, aligning well with the department’s focus on improving community health and health equity. A key tactic to build research capacity was advocating to include family physicians in the existing primary care research fellowships in other departments, such as the National Research Service Award T32 primary care research fellowship and the National Clinician Scholars Program (NCSP). Demonstrating institutional commitment, the Dean supported family medicine with over $110,000 annually for 1 fellow through June 2027, underpinning the department chair's efforts to establish pathways for family physician researchers.

Identify and Promote Promising Practices

First, goal-oriented salary incentives for the research faculty are crucial to pursue NIH and other extramural grants. Second, internal advocacy to include family medicine in CTSA is vital to improve access to institutional resources and bolster research capacity. CTSAs frequently incorporate community or population health cores and benefit from expertise of family medicine researchers. CTSA provides opportunities such as pilot grants and career development awards for junior faculty and leadership roles for midlevel and senior faculty. Finally, family medicine can make significant contributions to research on improving community health, population health, vulnerable populations, and health equity. In addition, P30 or U grant-funded centers within other departments frequently seek diverse junior faculty engaged in health equity research. Given family medicine's focus on community and practice-based research, it naturally aligns with the objectives of these centers, often leading to collaborations and access to center pilot grants. The department has established a new HRSA Center of Excellence focused on underrepresented minorities in medicine, synergized with ongoing health equity research initiatives.

Outcome So Far

In 2023, the department’s BRIMR Rankings of NIH family medicine funding rose to #4. Two locally fellowship trained family medicine researchers joined the faculty in 2024, while 2 more family physicians are research fellows. They represent a diverse cohort, including underrepresented minority investigators, all benefiting from over 75% funded research time. Faculty have obtained pilot research funds from NIH funded (Institute of Aging and National Institute of Diabetes and Digestive and Kidney Diseases) school of medicine centers, Dean’s Office research and diversity initiatives, and CTSA bridge funding. The objective is to build on these research connections with diversity supplements and career development awards. Furthermore, 3 active searches for additional state faculty lines focusing on health equity are underway, promising to further bolster the department’s research capacity and impact.