The Center for Health Outcomes in Medicine Scholarship and Service (HOMES): Fostering and Supporting Physician-Initiated Research

Abstract

Problem

The U.S. physician scholar workforce, currently comprising less than 1.5% of U.S. physicians, continues to decrease, threatening national status as a global biomedical research leader. Academic medical center (AMC) trends away from tenure-track physician faculty appointments toward clinical faculty appointments have contributed to this decrease, but AMCs have limited strategies to equip clinical faculty to conduct research. Infrastructure fostering clinical faculty research may establish new mechanisms for expanding physician scholar workforce and supporting academic goals of clinical faculty. This article presents one such model, the Center for Health Outcomes in Medicine Scholarship and Service (HOMES), from the Department of Internal Medicine, The Ohio State University College of Medicine.

Approach

Established in 2019, HOMES provides research infrastructure, support, and mentorship tailored to clinical faculty needs. Multidisciplinary core faculty support research across 5 cores: clinical networks, biostatistics and secondary data, qualitative methods, mixed methods, and research ethics. HOMES services include research consultation, mentorship, microgrants, a training toolkit, and symposia.

Outcomes

In 4 years, HOMES supported 50 faculty on 99 projects. Forty-five (90%) of these faculty have reported scholarly output, including 127 national presentations, authorship on 41 peer-reviewed articles, and 53 grant submissions. Forty HOMES-supported grant submissions have received funding, and 4 HOMES-supported physicians in training have pursued or plan to pursue AMC research careers.

Next Steps

HOMES has fostered scholarly productivity among AMC physicians, competitive grant applications, and research focus among physicians in training. As demand for HOMES services increases, HOMES will prioritize projects based on their innovation and research skill development potential. Academic medical centers can apply HOMES lessons through fostering clinical faculty collaboration with multidisciplinary research teams and increasing research training opportunities for residents and fellows. National expansion of funding opportunities dedicated to building biomedical research capacity and expertise among clinical faculty can facilitate sustainable scaling of HOMES-like models.

Problem

More than 140,000 full-time physician faculty serve within U.S. academic medical centers (AMCs), with 70% serving on clinical rather than tenure tracks (https://www.aamc.org/data-reports/faculty-institutions/data/us-medical-school-faculty-trends-counts). Although the proportion of AMC clinical track physician faculty (hereafter referred to as clinical faculty) has steadily increased during the past 4 decades, strategies for supporting their scholarly productivity and engagement have not kept pace with this increase.¹ More than 2 decades of strategic investments and programmatic innovation by organizations such as the National Institutes of Health (NIH) have failed to reverse alarming decreases in the physician scholar workforce, which currently comprises less than 1.5% of the U.S. physician workforce.² These trends have led to decreases in AMC clinical research portfolios and U.S. physicians’ capability to apply clinical expertise to biomedical research, threatening destabilization of U.S. global leadership in biomedical research.^2,3

Organizations such as the National Academy of Medicine and the Association of American Medical Colleges have also sought to reverse the drying pipeline of physician scholars.² Although biomedical research training of clinical faculty has received limited strategic attention, scalable clinician-focused innovations may provide an impactful mechanism for expanding the U.S. physician scholar workforce, especially for the conduct of clinical and community-based translational research.⁴ Recent public health crises, such as the COVID-19 pandemic, which have propelled strategic federal investments in learning health systems and community-integrated clinical translational scientific capacity, underscore the urgency of integrating clinical faculty into scientific teams.⁴

This scientific integration can also benefit individual clinical faculty during an era of intensifying academic expectations and alarming rates of physician burnout.^5,6 Clinical faculty face multiple challenges to scholarly productivity, including increasing clinical service requirements, increasingly demanding productivity benchmarks, and lack of scholarly program startup resources traditionally available to tenure-track faculty.^5,6 These pressures have intersected with clinical faculty experiencing unprecedented levels of burnout.⁵ Mechanisms for promoting scholarly productivity among clinical faculty may protect against burnout, yielding personal and patient safety benefits.⁶ The AMC structures that support scholarly output alongside clinical service may also accelerate promotion,⁵ especially among women and minoritized faculty, who often face heavier clinical responsibilities, thus potentially fostering equitable faculty advancement.⁷ Supporting clinical faculty scholarship may also promote faculty retention by fostering work satisfaction.⁶

The clinical research environment has become less hospitable to scholarship in recent years due to reductions in federal funding, increased regulatory requirements, and workforce changes.⁸ Reenvisioning scholarly support structures for clinical faculty within AMCs can have transformational potential at national, community, institutional, and individual levels. The ability of AMCs to develop scalable, sustainable strategies that allow high-impact clinical scholarship to coexist with delivery of high-quality clinical care can help address the multifaceted challenges faced within AMCs, their communities, and our broader society.

We present one such model, a health outcomes research center in the Department of Internal Medicine (DOIM) at The Ohio State University (OSU) College of Medicine, the Center for Health Outcomes in Medicine Scholarship and Service (HOMES), that seeks to support clinical faculty–initiated and clinical faculty–integrated biomedical research. The HOMES model can be applied and contextualized to a range of AMCs that seek to enhance environments supporting scholarly productivity of clinical faculty.

Approach

Launched in July 2019, HOMES was established to provide tailored research support, infrastructure, mentoring, and professional development to clinical faculty to facilitate physician-initiated and physician-informed health outcomes research. Any DOIM clinical faculty member pursuing health outcomes research can access HOMES services after completing a HOMES project consultation meeting and reviewing HOMES research preparatory resources. HOMES has refined its services over time. Although some HOMES services, such as project design, are also available within other research centers and institutes within the organization, HOMES services do not require clinical faculty to personally fund use of these services. HOMES delivers services via processes compatible with practicing physician schedules and workload. Supplemental Digital Appendix 1 (at http://links.lww.com/ACADMED/B648) offers a timeline of HOMES achievements.

HOMES, which has an annual operating budget of approximately $175,000, uses a consulting core model to provide clinical faculty with research support (Figure 1). Multidisciplinary core faculty, mostly external to the DOIM (such as the College of Public Health, the College of Nursing, and the Department of Biomedical Informatics), support research across 5 cores: clinical networks, biostatistics and secondary data, qualitative methods, mixed methods, and research ethics. Core faculty dedicate 0.05 to 0.20 full-time equivalent hours to HOMES efforts. HOMES research cores support activities such as team-based study design, professional development sessions, and grant consultation. Grant consultation support spans the project lifecycle from proposal development to postaward study implementation. HOMES provides one-on-one consultations, monthly small group project pitches, and works-in-progress sessions, allowing clinical faculty to develop projects and receive feedback.

Figure 1.

The Center for Health Outcomes in Medicine Scholarship and Service (HOMES) operates on a consulting core model that delivers research support to clinical faculty. Multidisciplinary faculty support clinical research across 5 cores (listed inside the black circle). These areas provide expertise that helps HOMES fulfill 6 primary activities (listed outside the black circle).

HOMES issues 2 to 3 microgrants annually ($500–$2,500) to support emerging research projects developed by clinical faculty, with first awards issued in June 2020. Faculty seeking microgrants submit a 1-page application for competitive merit review (see Supplemental Digital Appendix 2 at http://links.lww.com/ACADMED/B649). This process was established to streamline application barriers while ensuring proposal rigor. Microgrant award conditions include project check-ins with core faculty and progress updates. A key microgrant deliverable centers on submitting a national meeting abstract or a manuscript to a peer-reviewed journal within 1 year of microgrant completion. Faculty are encouraged, but not required, to use microgrant pilot data to submit internal and extramural grant applications.

HOMES launched a training toolkit in July 2021, with synchronous and asynchronous components, to provide faculty with basic research competency training. Asynchronous training includes a curated collection of methodological resource articles, websites, and recorded lectures (< 20 minutes) suited for consumption within small time frames, such as a canceled clinical appointment. Synchronous training, also later accessible as asynchronous recordings, consists of a lunch-hour didactic series highlighting institutional research resources, research tools, and exemplar projects. The HOMES annual symposium, inaugurated in September 2021, features lectures by clinical faculty and microgrant awardees, along with workshops exploring topics such as clinical program evaluation and implementation science. The symposium also facilitates interdisciplinary networking between clinical faculty and PhD researchers to foster interdisciplinary, clinician-integrated research teams.

Finally, since July 2020, HOMES has strategically supported approximately 1 physician in training per year who is identified by key DOIM residency and fellowship leaders as having strong research aptitude or interest. HOMES supports physicians in training with center services, while pairing them with interest-aligned DOIM clinical faculty and HOMES core faculty mentors. To date, HOMES has accommodated all referred physicians in training, precluding need for a competitive selection process. HOMES physician-in-training support ultimately aims to cultivate a pipeline of academic physicians capable of leading and collaborating on multidisciplinary health outcomes research projects. HOMES collates programmatic outcomes at the end of each academic year. Programmatic outcomes spanning July 2019 to June 2023 are reported below.

Outcomes

In its initial 4 years, HOMES has supported 50 faculty and 4 physicians in training across 6 OSU DOIM divisions, contributing to 99 projects in total (Supplemental Digital Appendix 3 at http://links.lww.com/ACADMED/B649). HOMES support for preliminary data generation, study design, and mobilization of multidisciplinary research teams has proved instrumental in the submission of 53 grants involving clinical faculty, of which 40 were successfully funded. These submissions targeted institutional opportunities, major foundations, state agencies, and federal mechanisms spanning K-, R-, and U-levels, translating into $19,166,304.45 in grant funding. Funding sources include the Ohio Department of Medicaid Care Innovation and Community Improvement Program, the NIH, the Patient Centered Outcomes Research Institute, and the March of Dimes. Furthermore, HOMES faculty gave 127 presentations at conferences for organizations such as the Society of General Internal Medicine, North American Primary Care Research Group, and AcademyHealth. Projects supported by HOMES have yielded 41 publications in peer-reviewed journals, including the New England Journal of Medicine, JAMA Network Open, and Applied Clinical Informatics. To date, all 4 residents and fellows supported by HOMES have demonstrated ongoing commitment to academic careers, including participating in clinical research fellowships and pursuing AMC faculty careers that involve clinical research. Table 1 provides a list of exemplar HOMES outputs.

Table 1.

Outcomes of the Ohio State University College of Medicine HOMES Program, 2019–2023

Area	Outcome
Engagement	• Supported 50 faculty from 6 divisions in DOIM on 99 health outcomes–focused projects
Curricular development	• Established monthly journal clubs, research in progress, and career development mentorship (K Club)
Funding	• Supported 53 grant submissions: major foundation (Greenwall, RWJF, Cambia Health Sojourns Scholar), K, R01, and U submissions • Secured funding for 40 grants (total, $19,166,304.45; median, $215,317.00; range, $1,500.00–$3,326,977.00) • Supported faculty in securing an additional $2.6 million in internal and extramural awards (CICIP, NIDA, and MOD) • 11 Clinical faculty cumulatively acquired > 1.7 FTE hours of clinical release time in the 2023–2024 academic year distributed across 13 distinct HOMES-funded projects
Dissemination	• 127 Faculty presentations, including at meetings of the SGIM, NAPCRG, and AcademyHealth • 41 Articles published by HOMES faculty in journals such as New England Journal of Medicine, JAMA Network Open, Medical Care, American Journal of Hospice & Palliative Medicine, and Applied Clinical Informatics
Pipeline development	• Paired residents, fellows, and graduate students interested in health outcomes research with faculty • Supported external recruitment of faculty with strong research track records • Built productive partnerships with other departments and colleges (e.g., Department of Biomedical Informatics, College of Public Health, and School of Nursing)

Abbreviations: CICIP, Care Innovation and Community Improvement Program; DOIM, Department of Internal Medicine; FTE, full-time equivalent; HOMES, Center for Health Outcomes in Medicine Scholarship and Service; MOD, March of Dimes; NIDA, National Institute on Drug Abuse; RWJF, Robert Wood Johnson Foundation; SGIM, Society of General Internal Medicine; NAPCRG, North American Primary Care Research Group.

Among the 50 total faculty supported by HOMES, 45 distinct faculty (90%) have demonstrated HOMES-related scholarly output, 34 (68%) have served as lead or coinvestigator on a grant submission, 34 (68%) have presented at regional or national meetings, 26 (52%) have served as lead author or coauthor on a peer-reviewed publication, and 5 (10%) have secured funding to lead innovative clinical demonstration programs.

HOMES clinical faculty have articulated 3 key challenges within strategic planning sessions and project-based feedback. First, increased after-hours clinical responsibilities, which have persisted since the onset of the COVID-19 pandemic, have reduced time that faculty have to work on research projects, impeding progress, especially on peer-reviewed publications.⁹ Second, lack of clinical release time to work on HOMES-supported research projects has served as a barrier to achieving project goals. Third, most clinical faculty served by HOMES would prefer to participate in research as collaborators, instead of project leaders, because of limited research time and expertise.

In response to faculty-reported barriers, HOMES has strategically paired clinical faculty leading research projects with nonclinical researchers to accelerate progress, while also matching clinical faculty desiring research collaboration with interest-aligned research teams. These strategies have facilitated competitive grant submissions, which in turn support clinical release time when funded for ongoing clinical faculty research participation. Among HOMES clinical faculty with more than 0.75 full-time equivalent clinical appointments before engagement with HOMES, 11 faculty cumulatively acquired more than 1.7 full-time equivalent hours of clinical release time in the 2023 to 2024 academic year distributed across 13 distinct projects. When applicable, these faculty received institutional support for salary above federal salary caps. This partnering approach has also expanded rigorous multidisciplinary clinical research programs and supported dissemination of novel clinical demonstration projects, activities critical to translation of evidence-based clinical guidelines to practice.

These early outcomes, including national presentations, extramurally supported grants, and peer-reviewed publications, demonstrate that HOMES has advanced its core goal of establishing a program that generates clinical faculty–informed scholarship. Furthermore, HOMES research mentorship and resourcing of physicians in training during residency and fellowship have fostered their sustained scholarly productivity, pursuit of dedicated research training, and interest in clinical research-centric AMC faculty careers. The ability of HOMES to mobilize large numbers of clinical faculty and select physicians in training to participate in research within a relatively short time frame can inform broader policy and academic strategies seeking to innovatively expand physician investigator workforce and pipelines within AMCs. These broader strategies must establish individual- and systems-level solutions capable of mitigating barriers to clinical faculty research participation as investigators, collaborators, and mentors.

Next Steps

These early lessons and outcomes from HOMES can inform next steps locally, across AMCs, and nationally. At a local level, HOMES will build on partnerships with the OSU Clinical and Translational Science Institute to expand research capacity among clinical faculty. HOMES plans to initiate prioritization of resource allocation based on criteria such as clinical innovation potential, physician-in-training development potential, and faculty members’ prior project completion record. This prioritization will allow HOMES to shift additional resources toward its promising programmatic support of residents and fellows with clinical research interests. Finally, HOMES continues to seek support for future research focused on evaluating the effect of its services on faculty-level outcomes, such as burnout and retention.

Although the HOMES model may not generalize to all AMCs, its early implementation lessons have broad AMC applications. First, connecting research-interested clinical faculty with discipline-aligned investigators across fields and specialities can promote development of grant-funded research programs to support ongoing clinical faculty research involvement. Second, individual, mentored investments to support select clinical faculty-initiated research projects that align with organizational clinical priorities can simultaneously advance AMC clinical and research missions. Third, graduate medical education–based programs that promote early research exposure for residents and fellows, as well as mentored support for those with deeper levels of research interest, may help revitalize clinician investigator pipelines.

Nationally, expansion of federal funding opportunities, focused on promoting research capacity among practicing clinical faculty and physicians in training, may support AMC scaling of HOMES-like models by reducing reliance on institutional investments. Furthermore, state and federal agency health care innovation models and collaboratives (https://www.cms.gov/priorities/innovation/models), which currently have wide AMC health system participation, can also help resource physician faculty–supported evaluation of these initiatives (https://nap.nationalacademies.org/catalog/26744/national-plan-for-health-workforce-well-being). This strategy can simultaneously advance national health priorities and develop physician scholarly capacity. Cumulatively, these steps can equip AMC responses to national strategic priorities, including National Academy of Medicine calls to establish clinical “cultures of continuous learning and improvement” and NIH goals of advancing clinical research equity by resourcing physicians to conduct clinical research in real-world settings.¹⁰