Preserving Future Generations of Pediatric Researchers

It is important to invest in retention, success, and satisfaction of pediatric physician scientists to further advance and ensure the future of pediatric research. Research focused on childhood health and disease plays a critical role in understanding normal development and disease prevention, and in promoting a healthy lifestyle and long-term adult health.

Although the National Institutes of Health (NIH) was founded in 1887,¹ it was not until 1962 that the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) was founded,² establishing a dedicated funding stream for pediatric physician-scientists through career development awards. According to the NIH, the physician-scientist workforce has declined from 14 321 in 2003 to 12 717 in 2012, and in 2012, physician-scientists composed only 1.5% of the total physician workforce.³ Pediatricians make up an even smaller percentage of this workforce.⁴ This decline in the work-force has been accompanied by a decline in federal funding for biomedical research.^5,6

To address the small number of pediatric physician scientists, the NICHD has supported Child Health Research Centers/K12 programs to promote careers of junior faculty interested in research.^6,7 At the University of Michigan, we have a longstanding K12 career development program to support pediatric junior research faculty in the basic sciences.⁸ There are also robust faculty development programs at the Medical School and within our department focused on tracks in research, clinical care, and education as well as a broad variety of topics, including but not limited to time management, grant writing, clinical research, research team leadership, leadership, and presentations. One initiative is a peer group mentoring program. Peer mentoring programs have been used in academia over the last decade to foster collaboration and as a support network for decision making, work-life discussions, and career development.^9–11 This initiative led us to form the junior faculty in basic sciences peer group to support one another in the early stages of our careers. The group meets every 1–2 months to discuss such topics as publications, grant submissions, negotiations, use of startup funds, and balancing clinical and laboratory work. We also meet whenever an individual in the group has a specific need, such as laboratory management, career trajectory, or grant advice.

As a group, we have hypothesized that there are factors besides the decline in research funding that inhibit successful advancement of junior faculty physician-scientists into independent researchers. Based on our discussions and established surveys,^12,13 we sought to identify some of the factors contributing to success in pediatric research careers. We designed a survey in the University of Michigan Health Systems Qualtrics Survey Platform (version May 2016–January 2017; Qualtrics, Provo, Utah) that included questions about demographics, hiring processes, support, promotion processes, mentoring, funding, burnout, and career satisfaction. The survey was approved by the University of Michigan’s Institutional Review Board.

An anonymous link to this online survey was distributed via e-mail to the members of the 3 national societies of our specialties. The questions were answered voluntarily with no compensation. We received 453 complete responses (174 members of the Pediatric Endocrine Society, 155 members of the Pediatric Infectious Diseases Society, and 124 members of the American Academy of Pediatrics Section on Neonatal-Perinatal Medicine). The majority of respondents were aged 35 to 44 years (40.2%; n = 182) and female (53.2%; n = 241). Race/ethnicity, postgraduate degrees, institutional affiliation, and current appointment are shown in the Figure. The respondents ranged in age from 30 to 75 years of age, and the majority of responses were from individuals from public and private institutions with medical school affiliations (87%; n = 395). Within the wide age range of the respondents, 33% of participants were not yet eligible for promotion, 21% were not on a promotion track, 38% had been promoted, and 8% had not been promoted. Ninety-three of the respondents had received K funding, 85 had received a first R01 grant, and 42 had received a second R01 grant.

Figure.

Characteristics of the respondents to the Qualtrics survey.

Overall, there were no significant sex- or subspecialty-related differences in our combined results for grant funding, promotion, burnout, or career satisfaction. However, in endocrinology, women were more likely than men to experience burnout (70% vs 46%, respectively; P = .004), and women were less likely than men to be promoted from assistant professor to associate professor (71% vs 97%, P = .003). We asked about factors that contributed to success for grants and promotion, and found that having a clear outline of laboratory space (36% for those who were promoted vs 14% of those who were not; P = .009), startup funding (42% for those who were promoted vs 19% who were not; P = .01), and protected clinical effort (73% of those with funding vs 58% in those without; P = .02) were significantly associated with successful promotion and research funding. Importantly, only 266 respondents (59%) felt that the protected research effort assigned was possible with clinical assignments (Pediatric Endocrine Society, n = 108; Pediatric Infectious Diseases Society, n = 94; American Academy of Pediatrics, n = 64), and only 181 respondents (40%) reported receiving protected research effort from their institutions (71 Pediatric Endocrine Society, n = 71; Pediatric Infectious Diseases Society, n = 61; American Academy of Pediatrics, n = 49).

Among our respondents, some physician scientists had considered changing promotion tracks (14.8%; n = 67), but few had actually left the tenure track (9.7%; n = 44). Burnout might be a likely cause of these decisions, and it is important to consider it, given the association of physician wellness with enhanced productivity and patient care.¹⁴ According to the Maslach Burnout Inventory definition,¹⁵ 195 respondents (43%) reported feeling burnout during their early career (Pediatric Endocrine Society, n = 83; Pediatric Infectious Diseases Society, n = 61; American Academy of Pediatrics, n = 51). We provided some common causes for responders to choose from, as well as the option to write in “other” factors. The most common factors leading to this burnout were too many bureaucratic tasks, too many hours at work, family obligations, feelings of dissatisfaction, feeling stuck, income, and feeling a failure (listed in order of prevalence). The impossibility of a protected effort with clinical assignments was reported as the sole statistically significant contributing factor (35% of those who had burnout vs 22% of those who did not; P = .0076, χ² analysis). We then asked about areas where additional support early in one’s academic career would have been helpful; the top answers were institutional support (funding, time, administrative support), mentoring, and time management and leadership training.

Although there are many external factors causing the decline in pursuit of a physician-scientist career path, what is clear from our survey responses and comments, as well as discussions within our peer group, is that there are many ways in which institutions can encourage pediatricians to remain in research fields. One of the most frequently identified solutions was providing transparent and clear offer letters outlining startup funding, protected time, and dedicated space for research. These responses highlight how cementing these critical factors early in one’s career can contribute to a successful trajectory. Research mentorship is also key; however, additional mentorship is needed to navigate promotion and tenure, work-life integration, and maintaining the balance between clinical and research work. Part of this mentoring could be provided in peer groups such as our own, as many of those surveyed discussed that they learned about these topics from peers.

Overall, consistent with Cornfield,¹⁶ our study demonstrates that there is a significant need for institutional support with administrative resources, mentorship, and respect for work-life integration. Some of this could be achieved through a support system for peer group initiatives while emphasizing the positives of a career in pediatric research. With all of the difficulties inherent in this career choice, there are several reasons why people continue to choose the path of the pediatric physician scientist. The top 5 reasons for career satisfaction selected by our respondents were (1) clinical work, (2) sharing of data (talks/meetings/presentations), (3) mentoring, (4) collaboration/being part of a research team, and (5) the opportunity to advance science. Based on free response comments, clinical work brings satisfaction through working with students/trainees and patient care. Although clinical work is a motivator for this career path, as discussed above, it is important to have clear delineated time for both research and clinical work to ensure success.

It is now clear that many adult diseases have childhood origins, creating the potential for interventions in the pediatric years.⁶ Thus, the need to discover novel innovative therapies and management strategies for pediatric health care is increasing. Launching new faculty with mentorship (peer and senior faculty); providing clear support in protected time, space, and finances; and highlighting the factors for satisfaction are ways that institutions can foster development of their junior faculty. We are hopeful that there will be strong societal support and institutional recognition of the need for pediatric physician scientists. Items in this survey have identified opportunities for institutions to improve support of pediatric investigators and in return ensure the future of pediatric research. ■