Sustaining Biomedical Research: A Challenge for Academic Health Centers

During the past half century, this country's biomedical research enterprise has, with few, if any, exceptions, increased in size and scope each year. Fueled to a great extent by the robust extramural research budget of the National Institutes of Health (NIH), the number of medical school faculty engaged in research has grown accordingly. Despite these trends, some believe that the size of the research enterprise may not be sustainable in the years ahead because of inadequate levels of NIH funding, even though such funding is likely to continue increasing well into the future. Be that as it may, it is important to recognize that there are other factors that may adversely affect the growth of the country's biomedical research enterprise. Among these are forces acting to produce an environment within medical schools and teaching hospitals that could become less friendly to and supportive of the conduct of research. There is no question that the environment within which biomedical research is conducted has changed rather dramatically in recent years. Some of the changes are the result of government efforts to address moral and ethical breaches by individual investigators and the failure of institutions to adequately monitor the conduct of research by members of their faculties and staffs. Other changes reflect the complexity introduced by the increase in funding by for-profit corporations. And some reflect the growing complexity of the organizational structures of academic medical centers and its impact on the relationships within the institutions. But despite all of these forces (and others), the biomedical research enterprise so far continues to thrive. This issue of the journal presents articles about additional challenges that must be met to sustain the research productivity of U.S. medical schools and teaching hospitals. The authors address various aspects of two factors that are key to carrying out biomedical research in academic medical centers—namely, the number and qualifications of those faculty whose primary responsibility in their institutions is the conduct of research. Taken as a whole, the articles suggest that the leaders of academic medical centers must consider some new approaches for managing their institutions’ biomedical research effort. In their article, Bickel and Brown raise what may prove to be one of the most important issues determining the future of the country’s biomedical enterprise: creating effective programs for mentoring young faculty. Among the points they make is that because of the growing complexity of academic medicine, mentoring young faculty is increasingly important for their career development and, therefore, for the future success of their institutions. And they maintain that one of the keys to effective mentoring is to overcome the generational differences that are now so apparent in academic institutions. In their view, if academic medical centers hope to maintain their research enterprises over time, they must find ways to bridge the generational differences that exist between current faculty members and the medical students, graduate students, and residents who will compose the research faculty of the future. Chang and colleagues describe an additional factor in the challenge of developing effective mentoring programs for young research scientists. They acknowledge the importance of mentors in guiding the career development of young scientists in the traditional postdoctoral training model. But they point out that the emerging demand for multidisciplinary investigations of research questions requires that new approaches be adopted for postdoctoral training, and describe a successful example of such an approach. They emphasize that the multidisciplinary nature of the necessary new training models makes it difficult to identify faculty who can effectively guide the development of young scientists. Needless to say, effective mentoring of trainees interested in careers in biomedical research will contribute to the future health of the country's biomedical enterprise only if the institutions where they work manage their resources to create a productive research environment. In the third article in this issue of the journal, Joiner points out that decisions regarding the allocation of scarce institutional resources for the recruitment of new faculty are among the most crucial ones that leaders of academic institutions must face. He suggests that faculty recruits should not be viewed in isolation but instead treated as “projects” that the institution is investing in with the hope of an appropriate return on the investment at some time in the future. And he goes on to propose a strategy to do this. He argues that viewing the recruitment of faculty in this way provides a more systematic approach for prioritizing resource allocation across the institution, which will result in its greater success in the long run. Finally, Bland and colleagues shed light on some of the factors affecting the research productivity of institutions. Their model, not surprisingly, points out that individual, institutional, and leadership characteristics influence the productivity of individuals and departments operating within a large, research-oriented medical school. Their analysis makes clear that the motivation of individual investigators, effective mentoring of young research faculty, protected time to conduct research, and the opportunity to interact with a network of colleagues are critical determinants of the research productivity of the institution. Leaders of academic institutions who do not focus some of their time and effort on ensuring that these conditions exist cannot expect their institutions to develop or maintain meaningful research programs. These four articles outline many of the strategies that institutional leaders must adopt if they want their institutions to have strong research programs in the future. For example, these leaders must understand the personal and career goals of individuals currently in training, since some of them must become future leaders of the country's biomedical research enterprise. They must ensure that their institutions have training programs in place that will prepare those individuals to address the kinds of multidisciplinary research questions they will face in the future. And they must ensure that those individuals are effectively mentored throughout the early years of their career development. Academic leaders must become more strategic in committing institutional resources to the recruitment of new faculty and creating conditions within their institutions to ensure that motivated and skilled individuals will be as productive as they can be. A major agenda and a major challenge for these leaders¡ Michael E. Whitcomb, MD