Building Canada’s health research capacity within the framework of the Canadian Institutes of Health Research

Abstract

The establishment of the Canadian Institutes of Health Research (CIHR) generated considerable excitement about the capacity for health research in Canada. The long term success of the CIHR will be determined, in part, by its ability to recruit, train and retain a cadre of talented researchers. During a workshop to develop the research agenda for one of the proposed institutes within the CIHR, a national, multidisciplinary group of clinical and basic science research trainees were invited to present their views about the challenges that face Canadian researchers of tomorrow. The objective of this paper is to present the challenges associated with recruiting, training and retaining health researchers, and to identify new opportunities provided by the creation of the CIHR. The present paper concludes with suggestions that may improve the success of researchers and, ultimately, the success of the CIHR.

The establishment of the Canadian Institutes of Health Research (CIHR) on June 7, 2000 generated considerable excitement about the capacity for health research in Canada (1). The CIHR, the new major federal agency responsible for funding health research, has a broad mandate. The objective of the CIHR is “to excel, according to internationally accepted standards of scientific excellence, in the creation of new knowledge and its translation into improved health for Canadians, more effective health services and products, and a strengthened Canadian health care system” (1). To this end, the CIHR is committed to creating a Canadian research environment that involves all stakeholders in health research, links research with health needs and scientific opportunity, accelerates the translation of research knowledge, coordinates research efforts of other funders and improves networking among researchers. The long term success of the CIHR will be determined, in part, by its ability to recruit, train and retain a cadre of talented health researchers.

At a workshop to develop the research agenda for one of the proposed CIHR institutes (2,3), the authors were invited to present their views about the challenges facing Canadian researchers of tomorrow. This group of 12 research trainees from medicine, epidemiology, nursing, psychology, pharmacology and biomedical sciences was selected to provide a nationally representative, multidisciplinary group of individuals at various stages in their training programs who expressed an interest in pursuing academic research careers. The objective of the present paper is to present the challenges associated with recruiting, training and retaining health researchers, and to identify new opportunities provided through the creation of the CIHR. This paper concludes with suggestions that may further improve the success of researchers of tomorrow and, ultimately, the success of the CIHR.

CURRENT CHALLENGES

Canada ranks near the bottom of G-7 nations in per capita spending on health research (4). The United States’ National Institutes of Health (NIH) spending on a per capita basis is eight times that of Canada (5). Average operating grant values in 1999 were approximately $80,000 in Canada, compared with over $260,000 in the United States (6). The creation of the CIHR will see the research budget of the former Medical Research Council double from 1998 to 2002 (7). The CIHR budget will be $402 million in 2000/01, rising to $533 million in 2001/02 (1). In the first year of operation, the CIHR budget includes more than $65 million of direct and partnered funding to train and support nearly 400 students, postdoctoral fellows and senior researchers at 22 universities across Canada (1). By 2005, CIHR’s grantee base is expected to encompass 4000 principal investigators, with 25% of these grants held by fellows and health professional researchers who are beginning their careers in health research (6). However, the increased opportunities created by the CIHR may be underused owing to a short supply of skilled personnel to conduct health research in Canada.

The projected increase in the researcher base will be met primarily by those with graduate degrees. However, the proportion of the Canadian population with a graduate degree has remained stable from 1991 to 1997 (the last year for which data from Statistics Canada are available) (8). One of the major challenges faced by the CIHR will be to recruit talented undergraduate students and health professionals to research training programs. To attract health professionals to research training, it is important to recognize the differences in career trajectories between clinical and basic science research trainees. Some clinical research trainees enter training programs after years of successful clinical practice. Research training may involve considerable economic sacrifice. A comparison of the current annual stipends, and research and travel allowances for the CIHR and the NIH are presented in Table 1 (9,10). The disparity in stipends between the CIHR and the NIH is reflected by the fact that the American awards are almost equivalent to the value of the Canadian awards, even before applying the appropriate exchange rate. (See the notation in Table 1 for the exchange rate.) The NIH has set tentative targets for 2005 of US$25,000 and US$45,000 for predoctoral and postdoctoral awards, respectively. Once the targets have been attained, the relative value of the stipends will be maintained with annual cost of living adjustments (10). While parity with American rates may not be attainable, internationally competitive funding levels are essential to increase health research capacity in Canada (6).

TABLE 1:

Current annual stipend, and research and travel allowances of the Canadian Institutes of Health Research (CIHR) compared with the National Institutes of Health (NIH)

Stipend and allowances	CIHR(CDN$)*	NIH(US$)
Predoctoral stipend	19,030	16,500
Research and travel	500	2000 to 4000
Postdoctoral fellowships†	35,000 to 45,000	28,260 to 44,412
Research and travel	3500	4000 to 5000

^*For comparison purposes, the exchange rate in effect at the time of writing (May 15, 2001) was US$1 to CDN$1.58;

^†Stipends for CIHR postdoctoral fellowships depend on training (doctoral or licenced health professional) and years of experience. NIH postdoctoral fellowships are contingent only on the number of years of experience

Programs to recruit talented research trainees need to be balanced with the capacity for research training. During the recent period of national fiscal restraint, universities have been particularly hit hard. For example, from 1990 to 1996, provincial operating grants per capita to universities were cut by 23.0% in Ontario and by 13.8% in other provinces (11). During this time, the number of university professors in 13 large Canadian universities decreased by 12.3% or almost 1300 professors (12). This corresponds to a loss of 251 full professors, 297 associate professors and 720 assistant professors (12). The massive reduction in the number of professors has had a huge impact on university teaching capacity, particularly for graduate students and postdoctoral fellows.

Not only have there been reductions in the number of university faculty due to budget cuts, but also a critical mass of experienced faculty is nearing retirement. Currently, approximately 5500 or 25% of Canada’s university faculty are between the ages of 55 and 64 years (4). In the coming decade, these professors will retire while, at the same time, the demand for researchers and research training is expected to increase (4).

The above issues are reflected in a recent report that calls for hiring more than 10,000 new faculty at Ontario universities (4). The need for new faculty in the sciences is supported by data indicating that science programs, including life sciences, experienced an increase in applications of more than 36% between 1987/88 and 1997/98 (4).

There has been considerable debate over the existence and severity of the ‘brain drain’ (13–16). Although the numbers are small (less than 0.1% of the total population), a recent Statistics Canada report (15) indicates that emigrants to the United States are over-represented among those who are better educated, earn higher incomes and are of prime working age (15). For example, from 1994 to 1999, 49% of Canadian emigrants to the United States held a university degree, compared with 12% of the Canadian population (15).

These figures are even more alarming for individuals with advanced degrees. Twelve per cent of Canadian doctoral graduates moved to the United States within two years of graduation (16). Evidence suggests that those graduates who leave Canada for the United States are more likely than nonmovers to have received scholarships or other awards during the course of their academic careers (15). The National Graduate Survey (16) indicated that almost two-thirds of Canadian graduates who moved to the United States were in health occupations or natural and applied science jobs. Relative to the supply of new graduates, the annual loss of physicians and nurses in recent years has been large (15). For example, in 1996 alone, 513 physicians left Canada, equalling the annual output of five Canadian medical schools (17). When emigrants from Canada were asked to provide a reason for leaving, the vast majority, particularly those in health-related fields, cited better job opportunities, not higher salaries or lower taxes (12,16). Canada has the highest post-secondary participation rate in the Organisation of Economic Co-operation and Development (15) and has been consistently ranked as the ‘best’ country in the world, according to the United Nations Human Development Index (18). Yet, many of Canada’s ‘best and brightest’ leave the country.

THE CIHR RESPONSE

It is evident that the CIHR is concerned with recruiting, training and retaining Canada’s ‘best and brightest’ for health research careers in Canada (1). CIHR recruitment strategies include programs designed to raise awareness of health research opportunities among undergraduate students. For example, a joint $1.2 million dollar partnership between CIHR and the Burroughs Wellcome Fund will support 309 undergraduate studentships for three months to one year at 16 research institutions across Canada (9). For graduate students, the CIHR Doctoral Research Award provides an annual stipend of $19,030, with a research and travel allowance of $500 for full-time students who have completed at least 12 months of graduate study. There is no specific program for the provision of individual fellowships at the Master’s level or the first year doctoral level. However, there are expanded opportunities for research training available through the Interdisciplinary Health Research Teams and Community Alliances in Health Research, and through the Health Research Partnership Fund, which provides support for training in specific areas of interest to partners. As announced in May 2001, the CIHR anticipates the launch of a new funding mechanism for health research training (19). The CIHR Training Program Grant will provide block funding to groups of educators or researchers who formulate proposals for an innovative research training program. Under this program, funds can be allocated for stipend support of outstanding students recruited to the training programs and to the training of postdoctoral fellows, health professionals and researchers who are beginning their careers. Additionally, the CIHR has increased the value of the Postdoctoral Fellowship to $35,000 for the holders of a doctoral degree, and $45,000 for applicants with a health professional degree. The research allowance has been increased to $3,500 in each year (9).

The transition from research trainee to new investigator can be a long and difficult process if adequate supports are not in place. To this end, the eligibility period for the CIHR New Investigator Award has been extended to include investigators who have held an independent research position for five years or less. The CIHR portion of the salary is $50,000 with eligibility to obtain peerreviewed operating funds of $50,000/year for up to five years (9). Additionally, the Canadian Foundation for Innovation will continue to provide infrastructure support to provide top quality resources to retain researchers in Canada. The establishment of the Canada Research Chairs, Millennium Scholarships, Canadian Health Services Research Foundation, Network Centres of Excellence and Technology Partnerships Canada are important steps in creating a supportive environment for high quality education and research.

TOWARDS A BRIGHTER FUTURE FOR HEALTH RESEARCH IN CANADA

Since its inception, the CIHR has been responsive to the challenges of the researchers of tomorrow. However, more needs to be done. Opportunities for multidisciplinary collaboration, the valuing of mentorship, and a strong commitment by the CIHR to support research trainees and new investigators throughout their development are essential to the future success of Canada as a recognized leader in health research. The issues of appropriate support and resources for research trainee development and transition to new investigator will be of critical importance to the researchers of tomorrow. The strategic plan for the CIHR has clearly addressed some of the issues associated with recruiting, training and retaining a cadre of Canadian researchers. However, the CIHR needs to explore ways to provide individual fellowships at the Master’s level and the first-year doctoral level.

The increased emphasis on multidisciplinary, cross-sectoral approaches to health research is challenging for research trainees and new investigators in terms of resources and access to networks of potential collaborating partners. A clear framework within the CIHR to facilitate multidisciplinary research is needed. The additional time and resources required to establish and maintain multidisciplinary partnerships need to be acknowledged by granting agencies. National workshops would facilitate the development of professionally enhancing partnerships among trainees, new investigators and senior scientists. A national registry for health researchers could serve as an important tool to identify potential collaborators. Opportunities for networking and career development, such as regular national multidisciplinary, cross-sectoral workshops to ‘learn the business of science’, are also important. General topics such as grantsmanship and publication would be of tremendous benefit to research trainees and new investigators. These workshops could also serve as forums for research presentations.

It is recognized that the mentorship of research trainees and new investigators is critical for launching productive careers (20–22). Formal and informal mentorship programs can facilitate entry into the research field, strengthen the research trainees’ interest in their chosen fields, assist in the development of new skills, and facilitate the growth and retention of strong and committed researchers. Effective mentors show their students ‘the ropes’ and how to avoid the ‘pitfalls’ that may be encountered. Mentors help new investigators to protect time for research activities, and provide career guidance and opportunities for multidisciplinary collaboration. Researchers who have been well mentored appear to continue mentoring other researchers throughout their careers (20–22). The value of this important work needs to be formally recognized. While the importance of mentoring in all health-related fields is highlighted in the literature, there appears to be an especially significant need for mentoring among women who choose health research careers (23,24).

As Canada shifts from a resource-based to a more knowledge-based economy, investment in life sciences research is one of Canada’s most promising avenues for rapid growth and job creation. In 1996, life sciences research employed 70,000 people (including 15,000 jobs in academic health research) compared with 60,000 people employed in the aerospace sector (5). Investment in health research creates employment, improves the health of Canadians, preserves our health care system, strengthens the economic backbone of the country, reduces the debt through increased productivity, trains tomorrow’s health specialists and scientists, and retains them in Canada. The authors, who have faced first-hand the challenges of pursuing health research training in Canada, support the CIHR objective to see 1% of Canadian health care spending reinvested in research by 2005 (6). In other words, the Government of Canada’s commitment to double its investment in health research funding from 1998 to 2002 needs to be doubled again by 2005 to $1 billion. This would provide 3000 training awards and 20,000 directly funded research positions by 2005 (6).

CONCLUSIONS

The creation of the CIHR brings with it new opportunities to improve the health of all Canadians through the transformation of research knowledge to more effective health services, products and delivery systems. Furthermore, with continued forward thinking and consultation with stakeholders, the CIHR can reach its goal to excel as an international leader in health research. To make this goal a reality, the CIHR must continue to focus its efforts on building health research capacity by recruiting, training and retaining Canada’s most talented future health researchers. Not only will this benefit the health and well-being of all Canadians, but it is a sound investment to ensure that Canada will continue to be a leader in the global, knowledge-based economy of the future.