Family Medicine: Finding Its Way on the Federal Research Roadmap

Discussion

Funding to DFMs over the past decade has not deviated substantially from levels reported in 2008 or 2016, with Family Medicine still receiving far less than 1% of total funding, or total awards, from NIH and other common federal sources of research funding. However, overall funding levels, the percentage of funding, and the percentage of awards, are all increasing. Whether this is the result of concerted efforts on the part of FM organizations, initiatives, and advocacy, or whether it is attributable to other contextual factors, is not answerable by this study, but the increasing trend does run parallel to temporally associated efforts to improve the funding profile of the FM research enterprise. For comparison, funding to DFMs is far lower than other primary care disciplines. Pediatrics departments received roughly 8 to 10 times as much funding, and Internal Medicine 36–48 times the funding, that goes to DFMs. While both Internal Medicine and Pediatrics departments tend to be much larger than DFMs, anecdotally, the fact remains that funding to those specialties is measured in billions, as opposed to millions.

In addition, departmental multidisciplinarity (as determined by name) seems to be a factor in many cases of research funding success. We believe this report adds to findings, observed through very different methods, that DFMs benefit when their faculty researchers collaborate with other disciplines. In many cases, this may require reaching outside of the DFM to establish such collaborations, but the fact that DFMs that include other disciplines within their departmental borders tend to see more success in obtaining research funding, combined with observations by Jiang²⁵ and Liaw,²² suggests that DFMs interested in increasing their own research portfolio should incorporate dedicated researchers into their own faculty, potentially alongside development of metrics to track the success rate of manuscripts becoming publications.²⁷

Notably, there is clearly a large range of funding across institutions, with 5 institutions accounting for over 40% of the total funding to DFMs across the 10 year period, and a wide dispersion in total funding across the 73 institutions included in our analysis. A possible intervention point could be to enhance the ability of DFMs who are on the low end of funding; these departments may have some intrinsic and existing capacity to pursue federal funding that could lend a foundation for growth.

There are a number of limitations to this study. The first is that we have only used data available in NIH RePORTER, which is nonexhaustive. Funding from nonprofit organizations, such as PCORI, Robert Wood Johnson Foundation, or other health foundations, state or local grants, or philanthropic gifts and endowments, are not included. In addition, we did not have access to the number of submissions, nor to the quality of submissions, so this study cannot answer whether the increase in funding is due to increased or better-quality submissions over time, nor can we directly tie our observed results to specific initiatives or programs. We also cannot account for departments that are not recorded as “Family Medicine” departments in NIH RePORTER, and so could not include primary care centers, departments that include but do not center around Family Medicine, or other iterations of Family Medicine units, that were not clearly recorded as DFMs in LCME-accredited institutions. We also have not explored whether the teams or the proposals that were funded would meet any definition of multidisciplinarity. The current study looked only at the department level, and only determined multidisciplinarity at the potentially superficial level of departmental name. A deeper, more intensive phenomenological study of departmental interdisciplinarity would be warranted, but this was beyond the scope of the current resource-limited project.

There are a number of areas for future research that would augment this study, as well as the rest of the existing literature. A true examination of research team composition would be informative. In addition, examining the clustering of research within regions, institutions, diseases or topics, and from specific funding sources, would all be useful additional studies that were beyond the scope and resources available for the current study.

Despite these limitations, we have used similar methods as employed in prior decades⁴ to offer an update to the field on trends in federal funding to NIH, and can report that there is an upward trend. However, given that the overall percentages of funding and awards made to DFMs out of the total NIH RePORTER database are only slightly higher, and roughly similar, to what they have been for decades, current advocacy and programmatic efforts should continue, if Family Medicine hopes to continue the mild upward trend we have reported here. The new NIH Director has expressed interest in supporting primary care research, including creating a new funding opportunity for research networks in primary care settings;^28,29 this holds promise for moving the needle on DFM engagement in NIH funding mechanisms and DFMs should be ready to position themselves to participate when these opportunities arise. In addition, DFMs should fully embrace multi-disciplinarity, particularly within their own departmental borders, if we hope to see strong improvements in the Family Medicine research enterprise going forward. This suggests a specific opportunity for peer sharing among ADFM members about what has worked well and what opportunities may exist for other DFMs in multi-disciplinary partnerships.