Role of Partnerships: Second Annual Meeting of Child Health Services R
Starting Your Career in Child Health Services Research (CHSR)
Starting Your Career in Child Health Services Research (CHSR)
Lisa A. Simpson, M.B., B.Ch., M.P.H.
Denise Dougherty, Ph.D.
Ms. Simpson did not attend, but organized the session; Ms. Dougherty substituted for Ms. Simpson.
Anne Beal, M.D.
Neal Halfon, M.D.
Alan Monheit, Ph.D.
Andrew Nelson, M.P.H.
This session brought together individuals from a variety of disciplines who have taken various paths to becoming child health services researchers, and was aimed at identifying promising opportunities and providing career advice to those interested in such research positions.
A variety of paths, settings and a diversity of perspectives is available to young researchers interested in beginning a career in child health services research. AHRQ is just one of the many places for junior researchers to start their careers. AHRQ provides many sources of data relevant to child health research, such as the Medical Expenditure Panel Survey (MEPS), and the Agency is creating the MEPS Data Center. For the AHRQ Fiscal Year(FY) 2001 budget, more money has been requested to fund minority health researchers and to attempt to fill geographic and disciplinary research gaps. There are also many opportunities at AHRQ for dissertations, training awards, fellowships, and other minority student awards. All of these opportunities and awards, as well as job opportunities, can be found on the AHRQ web site (www.ahrq.gov).
Unique Challenges Faced by Physician Researchers
Anne Beal, M.D. spoke about her perspectives as a junior researcher and her experiences as a physician researcher and an African-American in the field of child health services research.
Physicians face unique challenges when they choose to undertake a career in health services research because most of their professional training involves clinical and not research training. Once their medical training is complete, physicians must train further to develop the necessary skills for a research career. There is a major expense incurred when undergoing research training, and many physicians have a large amount of debt from their clinical training. Lack of ability to incur additional debt by many physicians creates a socioeconomic gap among physician researchers.
Physicians also face challenges when entering the job market because they are better able to generate funds for their institutions through patient care rather than research. The physician researcher needs time to build/create a research reputation and, therefore, be able to bring in money for research. Also, there is pressure on junior researchers to devote time to clinical work, and junior researchers must learn to demand at least 50 percent of their time from supervisors to devote to research.
One of the ways to improve research skills is to seek out mentors, but most physicians have to look outside the physician profession because there are few physician role models who are health services researchers. Finding a mentor is crucial, first to provide a model of a health services researcher, and second to provide guidance regarding professional opportunities for training and employment.
Minority health services researchers face unique barriers related to the costs of training, lack of mentors, and competing professional demands. The lack of available minority mentors is evident when examining the lack of racial/cultural diversity among health services researchers in general. Also, because academic medical centers are often located in inner city or minority communities, minority physicians are viewed as significant resources to provide medical care to minorities in these communities, and thus removed from roles as researchers.
Senior researchers can attest to the so-called "Black Tax", which places pressure on African-Americans to do it all (i.e., provide clinical services in underserved areas, work on a variety of committees, teach, and serve as mentors to students of color—all while trying to start a research career.
In addition to these challenges, health services researchers interested in studying pediatric populations face another set of challenges, including:
- Most previous research has studied adult populations.
- Outcomes in children are hard to measure because they may take years to manifest.
- Access to children as research subjects can be difficult.
- Chronic and/or index conditions are relatively rare in children.
Strategies for Successful Career Development
Neal Halfon, M.D., has served 20 years as a pediatrician and spoke about his experience in becoming a senior researcher. Health services researchers face a constant tension between addressing big picture health care system issues (e.g., poor access to health care, poor quality health care) and trying to focus on one particular research area. Dr. Halfon concurred that an important step a junior researcher can make is to find a mentor(s), both methodological and inspirational. A mentor can help make the big picture issues relevant to policy, can help a junior researcher to create a research focus, and can help create a "bags of tricks" that the researcher can call on to improve his/her research methods. Also, junior researchers need to develop collegial relationships to help create ideas, further research, and explore their own ideas.
As a researcher, it is very important to choose a good population to study so that a depth of research can be created (e.g., children on welfare). By doing in-depth research on one population, models can be created that can be carried over to other populations. It is also important for those getting started to learn to balance primary data collection with secondary data collection. Primary data collection is extremely expensive and it may be better to start small with a good secondary data set to develop research skills.
Finally, it is of utmost importance that new researchers attempt to look into the future to develop a set of strategic research techniques, and think about the future of health systems in order to be on the cutting edge of research.
As an individual with a background in economics and no medical training, Alan Monheit, Ph.D. addressed research career strategies from the perspective of one who understands research techniques. Doctoral training provides a rigorous set of research techniques, and doctoral research training allows the researcher to know how research technique choices are going to affect the ability to study a particular question (e.g., population, research design). Following are a list of tips to help improve a career as a researcher:
- A researcher needs good mentors and colleagues (who will react critically to research).
- A researcher needs to understand the environment that he/she is working in, and evaluate the potential for doing quality research at the institution.
- The researcher must understand personal values and biases when doing research.
- The researcher must avoid disciplinary chauvinism and be sensitive to strengths of research disciplines other than the researcher's field.
- The researcher must be patient and persistent.
- There must be an understanding that there is a trade-off when choosing between quantity and quality of research produced.
- The researcher must recognize the value of common sense and use it when evaluating research.
Research in the Managed Care Environment
Speaking from the context of a managed care environment, Andrew Nelson, M.P.H. discussed his experience doing health services research. There are many opportunities for health services research within managed care organizations (MCOs). In 1995, for example, there were 24 research organizations within 1,315 registered MCOs. Nineteen percent of MCO enrollment is covered by MCOs with research organizations and most of the funding comes from external sources (primarily NIH), but industry research funding is rapidly increasing.
In the managed care world a researcher can work with a population instead of purely with datasets. Research within an MCO allows a researcher to have more of an immediate impact, as opposed to within a university or Federal agency setting, where there may be a long wait for publication or for papers to go through Federal bureaucracy.
Tips for New Researchers
The following questions posed by participants allowed the presenters to identify additional helpful strategies for career development:
How do junior researchers find mentors?
- Attend conferences to meet people and begin cultivating relationships.
- Consider working with more than one mentor for different areas in your professional life.
- Choose the right work/research setting for you, and ideally one that can provide access to a range of professionals.
- Be concrete and specific with your needs when approaching a potential mentor.
- Be creative.
- Think through what you want to do, understand what you=re bringing to the mentor relationship, and be confident.
What are the key issues and topics that young researchers in training should look at in regards to CHSR?
- The impact of medical care on children.
- Community and school health systems.
- Measuring quality of health care.
- How to develop health promotion organizations instead of health care organizations.
- Socioeconomic status and family systems and how they affect children's health.
- How to start within your own community and work up to "breaking new ground."
- The popularity behind "All the rage!" systems.
Suggested publications to read (although you cannot read everything):
- Health Affairs.
- Journal of the American Medical Association.
- New England Journal of Medicine.
- Future of Children.
- British Medical Journal.
- Social Science in Medicine.
- Child Development.
- Health Services Research.
- Ambulatory Pediatric Association Journal (now Ambulatory Pediatrics).
Current as of June 2000
Starting Your Career in Child Health Services Research (CHSR). Role of Partnerships: Second Annual Meeting of Child Health Services Researchers. June 27, 2000. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/chsr2car.htm