State of Research in Adult Hospital Medicine: Results of a National Survey

In this first survey quantifying research activities in HM, respondents from 28 programs shared important insights into research activities at their institutions. Although our sample size was small, substantial variation in the size, composition, and structure of research programs in HM among respondents was observed. For example, few respondents indicated the availability of training programs for research in HM at their institutions. Similarly, among faculty who focused mainly on research, variation in funding streams and effort protection was observed. A preponderance of midcareer faculty with a range of funding sources, including NIH, AHRQ, VHA, CMS, and CDC was reported. Collectively, these data not only provide a unique glimpse into the state of research in HM but also help establish a baseline of the status of the field at large.

Some findings of our study are intuitive given our sampling strategy and the types of programs that responded. For example, the fact that most respondents for research programs represented university-based or affiliated institutions is expected given the tripartite academic mission. However, even within our sample of highly motivated programs, some findings are surprising and merit further exploration. For example, the observation that some respondents identified HM investigators within their program with <25% in intra- or extramural funding was unexpected. On the other extreme, we were surprised to find that three programs reported >$5 million in research funding. Understanding whether specific factors, such as the availability of experienced mentors within and outside departments or assistance from support staff (eg, statisticians and project managers), are associated with success and funding within these programs are important questions to answer. By focusing on these issues, we will be well poised as a field to understand what works, what does not work, and why.

Likewise, the finding that few programs within our sample offer formal training in the form of fellowships to research investigators represents an improvement opportunity. A pipeline for growing investigators is critical for the specialty that is HM. Notably, this call is not new; rather, previous investigators have highlighted the importance of developing academically oriented hospitalists for the future of the field.⁵ The implementation of faculty scholarship development programs has improved the scholarly output, mentoring activities, and succession planning of academics within HM.^6,7 Conversely, lack of adequate mentorship and support for academic activities remains a challenge and as a factor associated with the failure to produce academic work.⁸ Without a cadre of investigators asking critical questions related to care delivery, the legitimacy of our field may be threatened.

While extrapolating to the field is difficult given the small number of our respondents, highlighting the progress that has been made is important. For example, while misalignment between funding and clinical and research mission persists, our survey found that several programs have been successful in securing extramural funding for their investigators. Additionally, internal funding for QI work appears to be increasing, with hospitalists receiving dedicated effort for much of this work. Innovation in how best to support and develop these types of efforts have also emerged. For example, the University of Michigan Specialist Hospitalist Allied Research Program offers dedicated effort and funding for hospitalists tackling projects germane to HM (eg, ordering of blood cultures for febrile inpatients) that overlap with subspecialists (eg, infectious diseases).⁹ Thus, hospitalists are linked with other specialties in the development of research agendas and academic products. Similarly, the launch of the HOMERUN network, a coalition of investigators who bridge health systems to study problems central to HM, has helped usher in a new era of research opportunities in the specialty.¹⁰ Fundamentally, the culture of HM has begun to place an emphasis on academic and scholarly productivity in addition to clinical prowess.^11-13 Increased support and funding for training programs geared toward innovation and research in HM is needed to continue this mission. The Society for General Internal Medicine, American College of Physicians, and SHM have important roles to play as the largest professional organizations for generalists in this respect. Support for research, QI, and investigators in HM remains an urgent and largely unmet need.

Our study has limitations. First, our response rate was low at 28% but is consistent with the response rates of other surveys of physician groups.¹⁴ Caution in making inferences to the field at large is necessary given the potential for selection and nonresponse bias. However, we expect that respondents are likely biased toward programs actively conducting research and engaged in QI, thus better reflecting the state of these activities in HM. Second, given that we did not ask for any identifying information, we have no way of establishing the accuracy of the data provided by respondents. However, we have no reason to believe that responses would be altered in a systematic fashion. Future studies that link our findings to publicly available data (eg, databases of active grants and funding) might be useful. Third, while our survey instrument was created and internally validated by hospitalist researchers, its lack of external validation could limit findings. Finally, our results vary on the basis of how respondents answered questions related to effort and time allocation given that these measures differ across programs.

In summary, the findings from this study highlight substantial variations in the number, training, and funding of research faculty across HM programs. Understanding the factors behind the success of some programs and the failures of others appears important in informing and growing the research in the field. Future studies that aim to expand survey participation, raise the awareness of the state of research in HM, and identify barriers and facilitators to academic success in HM are needed.