Is Academic Rheumatology Research on the Brink of Vanishing?

November 4, 2015

Does rheumatology research have a future in academia? Researchers say the road is littered with obstacles and challenges never before seen.

The value of academic research cannot be underscored enough. This is where new discoveries largely take place, but a lack of federal funding and resources has stymied research. Young investigators are having a difficult time launching research programs, experienced investigators have less time to mentor new researchers and institutional policies can be rigorous. So, where does the future of rheumatology research lie? Anne Davidson, MBBS, of the Feinstein Institute for Medical Research in New York and David Polsky, MD, PhD, of New York University School of Medicine, say the field is due for some revisions, which they highlight in an editorial written in response to a study published in the September issue of Arthritis Care and Research. The study is based on a survey of 430 fellows, young investigators, established investigators, mentors, clinicians and academics who previously pursued a research career but chose a different career path. The barriers to research largely came down to the lack of funding and mentoring. Other reasons included protected research time and protection from clinical and administrative duties, institutional support and personal reasons.  “The physician-scientist workforce is aging, fewer young investigators are entering the work-force, and maintaining a career in research is challenging,” wrote the authors of the study which was led by Alexis Ogdie, MD, of the University of Pennsylvania in Philadelphia, on behalf of the American College of Rheumatology. The environment for launching a research career has changed dramatically in recent years and academia hasn’t kept pace with the changes. When one element of the research enterprise is missing, the entire structure is subject to collapse, one survey respondent wrote: “A successful young investigator needs to have ALL (funding, time, mentorship, work ethic/passion, family support) of the things listed above. If a young investigator is missing ANY of them, then they will fail.” Dr. Ogdie and the authors of the editorial highlighted some reasons for a waning research enterprise: Insufficient funding strangling the academic research pipeline:  NIH research funding for RO1 research grants awarded to ACR members decreased 30% between 2010-2014.  No mentors for young investigators:  “Current conditions place extra stresses on mentors who are competing for their own research funding and face increasing administrative responsibilities. In addition, experienced mentors are increasingly in short supply,” write the authors of the editorial. Organizational and cultural barriers:  “Today’s research success is frequently the work of large groups, most often led by highly seasoned and successful investigators. These structures can inhibit the meaningful entry and contribution of young physician scientists, whose success is essential to the sustainability of the research enterprise.” In an interview with Rheumatology Network, Dr. Davidson, addressed some solutions, which included increasing research funding from all sources, the availability of mentors and changing the metrics for success. Q:  In the editorial you write, “Today’s NIH budget, when adjusted for inflation, is greater than 20 percent lower than it was in 2003. From 2010 to 2014 there was a 30 percent decrease in the number of individual investigator R01 grants awarded to American College of Rheumatology members.” Are these cuts across the board? A:  Yes, it’s been across the board, but the lack of NIH-funding is affecting rheumatology more. We are a small community to begin with. If a cancer group of 20 researchers loses three people, it may not affect the work. But a rheumatology division may only have two researchers, so if they lose one, it can be disastrous.  Q:  You write a lot about the importance of the mentor/mentee relationship in rheumatology re-search groups. Why is that dynamic important in rheumatology research? A:  There are plenty of young people who want to work in rheumatology. We don’t see a drop off in fellowship applications each year, in fact, we have seen a slight increase. So eager young people are not the problem. The problem is that those people need qualified mentors to help them grow as physician-scientists. Mentors are in short supply because of the lack of funding, some attrition to the pharmaceutical industry and all are busy. Researchers today have more on their plates, more grants, more data, more regulatory requirements and more teaching duties. There’s less time to sit and talk and think, and that’s diminished mentorship.  Q:  How does research suffer if you don’t have a mentor? A:  Just getting someone to read your grant is more difficult than it used to be. This shows in the grant application quality we see coming into the Rheumatology Research Foundation (Davidson chairs the scientific advisory council for the Rheumatology Research Foundation.) Young investigators need help to mature their work into good grants. If your mentor doesn't improve your grant, then your improvement is slower and more painful. Q:  Your editorial addressed women in rheumatology researcher. Can you address developments unique to this group? A:  There is a major demographic shift happening that we’re not talking about. Currently, 40 percent of practicing rheumatologists are women, but 60 percent of rheumatology fellows are women. That means in 10 years, women will be more predominant in the field.  If women choose to have families, they will also bear the brunt of child-rearing and care in the early years, the same years when there is tremendous workload if you want to be an independent investigator.  We see more women and men who want a work-life balance, and when they look at independ-ent research they say, “No, I don’t want that.” So we see them moving into clinical work and patient care because that looks more manageable than basic science research based on grant funding. Q.  Moving forward, what should rheumatology researchers and departments be looking at to solve some of these problems? A:  Money is the major issue. We need to convince philanthropic donors and the government that their investment is part of the medical enterprise. The second thing we need is more structure in mentorship; often mentors take on people and have no structure. The Rheumatology Research Foundation does this well. It helps hold mentors feet to the flames and supports young, middle and older investigators. Lastly, there needs to be conversations about the role of women researchers and how to encourage them in the field. But without money, things will not improve a whole lot.   

References:

Anne Davidson and David Polsky.

"Sustaining the Rheumatology Research Enterprise," 

Arthritis Care & Research.

September 2015. DOI 10.1002/acr.22570 Ogdie A., Shah AA., et al.

"Barriers to and Facilitators of a Career as a Physician-Scientist Among Rheumatologists in the US,"

Arthritis Care & Research

, Vol. 67, No. 9, September 2015, pp 1191–1201, DOI 10.1002/acr.22569.