Planning for the Research Mission of Public Universities in the Twenty-first Century
no. 101 - June 1997

The State of Research Endeavors: View from the Administrative Level

Deborah Powell
Executive Dean, Vice-Chancellor for Clinical Affairs
School of Medicine, University of Kansas Medical Center

As a medical school dean, I would like to comment briefly on several areas which I believe must be addressed if the research enterprise in our state university academic medical centers is to survive in the 21st century. The order in which these are presented does not reflect necessarily the order of their importance.

Payment for Non-Funded Research

Research for faculty in academic medical centers is important for several reasons. Research by clinical faculty is important to advance our knowledge of disease as well as to advance the academic careers of the faculty. For many clinical faculty in academic medical centers however, the opportunities to develop significant extramural funding for research programs is limited. This is due to a variety of factors but a major determinant is that clinical faculty time is becoming increasingly directed toward patient care activities. Thus both teaching of medical students and residents and research activities are short changed. Many faculty however, still manage to remain academically productive in terms of publications and presentations.

Much of the funding for research activities resulting in these scholarly products has traditionally come from clinical income. Recently however, the advent of managed care as well as cuts in federally funded program reimbursements (i.e., Medicare) has resulted in somewhat traumatic decreases in clinical revenues. This has already been demonstrated to decrease the academic research productivity in areas of high managed care penetration.

The issue of how we are to maintain the non-funded research activities (particularly of our clinical faculty) which are vital to academic advancement and to their satisfaction with their careers in academic medical centers, is a critical problem that faces us today and I believe will continue to plague us in the 21st century. I do not believe that it is an option to relegate research to basic science departments and to a few basic scientists housed within clinical departments. We must address the issue of critical numbers of faculty and funding for clinical research, recognizing the need to keep our clinical faculty academically productive.

Maximizing Scarce Resources

Even extramurally funded research programs are feeling constraints due to the limitations of resources. It is important in academic medical centers that resources be maximized to further the research enterprise into the next century. Core facilities are important in this process since they can be shared by multiple users and can make expensive technology available to a large number of scientists. Core facilities which support a school or an entire medical center require not only major equipment but personnel and adequate oversight to run the facility. It is important that these facilities be of high quality and most importantly that they be centralized with the school or medical center so that we avoid duplication of costly services and technologies.

Centers of Excellence are another way of maximizing resources. Centers of Excellence allow mechanisms for clustering of faculty from diverse academic units around themes or programs of research interest. This can be valuable in maintaining the traditional departmental or other academic unit structure so vital for the advancement and mentoring of faculty, while allowing research collaboration to take place around a common theme of interest. If possible, it is important that centers be created so that scientists within the centers can share facilities, in close proximity, which allows for dynamic interactions. The concepts of centers bringing together investigators interested in a theme or subject from diverse academic backgrounds is important in developing multidisciplinary programs or projects, particularly where extramural funding sources are looking for a variety of approaches to a single disease related problem.

Introduction of New Paradigms for Research and Education

An important mechanism for expanding the research enterprise in the next century will be development of new multidisciplinary programmatic areas which will allow us to accept new paradigms for education and research, particularly in the basic sciences. We must recognize that while the academic disciplines of the sciences basic to medicine may remain separate, much of the scientific technology has blurred. Departments of Physiology, Biochemistry and Cell Biology, now and in the next century, are and will be composed of scientists utilizing similar technologies. This was not true twenty or thirty years ago. Because of the similarity of research technologies it is appropriate to reconsider traditional structures and develop multidisciplinary programs which allow us to consider new paradigms both for research and for education. It is important in this process to maintain some structural integrity of units which will allow for faculty growth and development as well as advancement and it is important also to recognize the separate nature of the academic disciplines. I believe that institutions that are able to develop acceptance of these new paradigms will be the most competitive for increasingly scarce extramural funding dollars.

Blending of the Teaching and Research Programs

It is important for the research enterprise to succeed in the next century that we consider the focus and purpose of both our teaching and research programs and the products they produce. Currently, in the basic biomedical sciences much of the research enterprise is intertwined with and in many instances dependent upon the graduate training programs. Many laboratories are run by graduate students and post-doctoral fellows who carry out much of the productive work of the laboratory. Nevertheless, it is becoming apparent that we may have been training too many Ph.D. graduates in the biomedical sciences and that these young professionals are having more and more difficulty in finding satisfying careers.

We must focus not only on the conduct of research but also on our role both as scientists and as teachers. It is important that in our graduate training programs we remember that our students are there to develop their own careers, to learn by doing, but not to have doing as their sole function for existence. We must concentrate on preparing our graduate students for successful careers whether in industry or academia. We must focus on training them both to be excellent technical research scientists and also to be independent thinkers, exhibiting scientific curiosity as well as to become able teachers of the next generation of scientists.

It is important for us to focus on separating the conduct of our research from the training of our students. We must continue to train outstanding basic scientists to follow in our footsteps and we must continue to run productive research laboratories, but we must have clearly in mind the goals and the conduct of each. We must staff our laboratories appropriately so that the research is done and we must train our students with the goals of our training programs clearly in mind. This will be an increasing challenge for us in the next century as we make sure that the supply of students emanating for our program is appropriate for the needs of the country as a whole.

Faculty Advancement

The research enterprise of the next century is dependent on our faculty. I have already mentioned briefly the demands on the time of clinical faculty for clinical patient care and teaching as well as research. At the very time that these demands are being increased, the need for disease related research both in the basic sciences and in the study of the outcomes of different interventions, therapies and health economics are critically important to the health of the nation and rightly should be the research portfolio of our academic faculty.

In the face of all this we are still, in many instances, enmeshed in traditional structures of promotion and tenure for faculty which were developed decades previously. We must question whether these remain appropriate for our faculty in the 21st century. For clinical faculty in medical schools, it is the security and structure of tenure, particularly the latter rather than economic issues, which continue to make non-tenure track faculty consider themselves as second-class citizens. In the systems in which we find ourselves currently, many young faculty members, particularly young women faculty are disadvantaged by the time of probationary periods. Consider the case of a young woman faculty member, a physician, who wishes to pursue an academic career with a research program. By the time this faculty member finishes residency training, say in internal medicine or pediatrics, she is on average between 26 and 28 years of age. This is presuming that she has also taken subspecialty training in a specific area of her chosen specialty. If she wishes to pursue an academic career and is accepted as an assistant professor, she will have six years to demonstrate her academic prowess before she must be either promoted or told she can not advance at her chosen institution. At the same time, if she desires to have children, this is precisely the time when she must begin her child rearing since there are compelling biological reasons why delaying child rearing into one's mid-thirties is less advantageous. For many young women faculty, the pressures of trying to deal with a young family and the demands of beginning a career in academic medicine with pressures to see patients, teach and develop a research program become overwhelming and they choose to leave academic careers where they may have shown great promise or to opt for non-tenure track clinical positions where they are able to maintain a more balanced life style. Clearly, we cannot afford to lose young academic scientists in this way. We must address some of the problems attendant upon traditional pathways to promotion and tenure, if we are to maintain and develop the careers of young faculty and maintain the excellence of our academic programs.