BUILDING THE BUILDING THE RESEARCH RESEARCH

ENTERPRISEENTERPRISE

John R. Feussner, MD, MPHJohn R. Feussner, MD, MPH

Medical University of South Medical University of South CarolinaCarolina

CHALLENGES FOR CHALLENGES FOR RESEARCHRESEARCHTHINK CHANGE BE THINK CHANGE BE DYNAMICDYNAMIC• Expand spectrum of researchExpand spectrum of research

• Embrace patient-centered researchEmbrace patient-centered research

• Invest in a diversified research Invest in a diversified research workforce workforce

• Foster interdisciplinary research Foster interdisciplinary research teamsteams

• Protect productive research timeProtect productive research time

CHALLENGES FOR CHALLENGES FOR RESEARCHRESEARCHTHINK CHANGE BE THINK CHANGE BE DYNAMICDYNAMIC• Save endangered clinical Save endangered clinical

investigators investigators

• Recruit and train new investigatorsRecruit and train new investigators

• Implement systems thinking, doingImplement systems thinking, doing

• Apply research discoveriesApply research discoveries

WHERE TO START, NOWWHERE TO START, NOW??

• Vision Vision or strategic goals or strategic goals – College, Department College, Department

• TacticsTactics and and resourcesresources– Who, what, how, when?Who, what, how, when?

• Define Define base statebase state– How much can you afford?How much can you afford?

WHAT IS CLINCIAL WHAT IS CLINCIAL RESEARCHRESEARCH• EpidemiologyEpidemiology

– Clinical—patient focused as in clinical trialsClinical—patient focused as in clinical trials– Public Health—population focusedPublic Health—population focused

• Health Services ResearchHealth Services Research– Systems focused—patient, provider, delivery Systems focused—patient, provider, delivery

systemsystem– Patient safetyPatient safety

• Quality ImprovementQuality Improvement– Not research but uses similar methodsNot research but uses similar methods

• Health Policy ResearchHealth Policy Research– Econometric modeling—Cost minimization, CEA, Econometric modeling—Cost minimization, CEA,

CBACBA

WHAT IS CLINICAL WHAT IS CLINICAL RESEARCHRESEARCH

““Research is clinical when the smallest Research is clinical when the smallest unit of investigation is an intact unit of investigation is an intact human being”human being”

WHERE TO STARTWHERE TO START

CHALLENGES FOR CHALLENGES FOR RESEARCHRESEARCHTHINK CHANGE BE THINK CHANGE BE DYNAMICDYNAMIC• Value Value clinical researchclinical research

– Embrace patient-centered researchEmbrace patient-centered research

• Invest Invest in faculty expertisein faculty expertise– Physician investigators—department/divisionPhysician investigators—department/division– PhD expertise—Biostats, Epi MethodsPhD expertise—Biostats, Epi Methods– Formal clinical research trainingFormal clinical research training– Infrastructure—Grants management, IRBInfrastructure—Grants management, IRB

• ProtectProtect productive research time productive research time

STRATEGIC GOALSTRATEGIC GOAL

Increase Research Increase Research FundingFunding

KEY DELIVERABLESKEY DELIVERABLES

• Recruit & retainRecruit & retain productive productive researchers researchers

• TrainTrain research-oriented clinicians research-oriented clinicians– MSCR opportunities MSCR opportunities – Increase RCDA’s Increase RCDA’s

• Focus on Focus on junior facultyjunior faculty development development

• Create template for K awardsCreate template for K awards

MILESTONES/METRICSMILESTONES/METRICS

• Overall level of research fundingOverall level of research funding– Department/division based performanceDepartment/division based performance– Investigator initiated, industry participation Investigator initiated, industry participation

• Research faculty recruitment & retentionResearch faculty recruitment & retention

• Participation in clinical research trainingParticipation in clinical research training

• Number of career development awardsNumber of career development awards

TACTICS AND TACTICS AND RESOURCESRESOURCES

• Identify Department/College assetsIdentify Department/College assets• Promote areas of strengthPromote areas of strength• Targets of improvementTargets of improvement• Facilitate collaboration (college wide)Facilitate collaboration (college wide)• Organizational expertise—CTSA, CRO, CTUOrganizational expertise—CTSA, CRO, CTU• Faculty expertise, e.g., biostats, epi methodsFaculty expertise, e.g., biostats, epi methods• Research infrastructure Research infrastructure

– statistical computing/data managementstatistical computing/data management– Research regulatory and managementResearch regulatory and management

TACTICS AND TACTICS AND RESOURCESRESOURCES

• FacultyFaculty• MentorsMentors

– Individual/teamIndividual/team– Trainees/facultyTrainees/faculty

• Skilled Phd facultySkilled Phd faculty– Clinical research trainingClinical research training

• Career developmentCareer development– Training grantsTraining grants– Individual RCDA’sIndividual RCDA’s

TACTICS AND TACTICS AND RESOURCESRESOURCES

• Targeted recruitingTargeted recruiting

• Small wins—Trials, RCDA’sSmall wins—Trials, RCDA’s

• Big wins—CentersBig wins—Centers

• NIH funded CTSA as assetNIH funded CTSA as asset

• VA wild card—asset or not??VA wild card—asset or not??

VA RESEARCH AS ASSET?VA RESEARCH AS ASSET?

• Research resourcesResearch resources– Biomedical Biomedical – Health services and epidemiologyHealth services and epidemiology– Clinical trials network (large scale)Clinical trials network (large scale)

• RCD opportunities (100% VA salary)RCD opportunities (100% VA salary)• Stable infrastructureStable infrastructure• Electronic medical record Electronic medical record • National health care networkNational health care network

FUNDING FOR MEDICAL RESEARCHFUNDING FOR MEDICAL RESEARCH

• NIH BudgetNIH Budget $29.5 Billion$29.5 Billion

• NSF BudgetNSF Budget $ 6.4 Billion$ 6.4 Billion

• VA Research BudgetVA Research Budget $ .9 Billion$ .9 Billion

FUNDING FOR MEDICAL RESEARCHFUNDING FOR MEDICAL RESEARCH

• NCI (FY 2008)NCI (FY 2008) $4.8 B$4.8 B• NIAIDNIAID $4.6 B$4.6 B• NHLBINHLBI $2.9 B$2.9 B• NIDDKNIDDK $1.6 B$1.6 B• NINDSNINDS $1.5 B$1.5 B• NIMHNIMH $1.4 B$1.4 B• NICHDNICHD $1.3 B$1.3 B• NIANIA $1.0 B$1.0 B• NIDANIDA $1.0 B$1.0 B• DVADVA $0.9 B$0.9 B

TACTICS AND TACTICS AND RESOURCESRESOURCES

• Allocation methods for scare resourcesAllocation methods for scare resources– Strategic goalsStrategic goals– Productivity drivenProductivity driven

• Business model facilitates decision Business model facilitates decision makingmaking– No exceptions—see the financialsNo exceptions—see the financials

• Under-estimate available (external) assetsUnder-estimate available (external) assets• Over-estimate time to acquire new Over-estimate time to acquire new

resources/assetsresources/assets

DEFINE THE BASE STATEDEFINE THE BASE STATE

• Successful departmentsSuccessful departments

• Successful facultySuccessful faculty

• Funding metrics/productivityFunding metrics/productivity

• All money facilitates successAll money facilitates success

July 2009FACULTY GROWTH

253235

199187

231

*expected

CLINICAL RESEARCH FACULTY SALARYCLINICAL RESEARCH FACULTY SALARY

80% 80% ClinicalClinical

70% Clinical70% Clinical 70% 70% ClinicalClinical

0% 0% ResearchResearch

10% 10% ResearchResearch

20% 20% ResearchResearch

Base SalaryBase Salary

ClinicalClinical 105,000105,000 91,00091,000 91,00091,000

ResearchResearch 00 16,00016,000 32,00032,000

IncentiveIncentive

ClinicalClinical 55,00055,000 50,00050,000 50,00050,000

ResearchResearch 00 4,0004,000 8,0008,000

Total CompensationTotal Compensation 160,000160,000 161,000161,000 181,000181,000

% of Salary at Risk% of Salary at Risk 34%34% 34%34% 32%32%

Clinical CollectionsClinical Collections 220,000220,000 200,000200,000 200,000200,000

Clinical IncentiveClinical Incentive 55,00055,000 50,00050,000 50,00050,000

Salary on GrantSalary on Grant 16,00016,000 32,00032,000

Research IncentiveResearch Incentive 4,0004,000 8,0008,000

ResearchRESEARCH AWARDS

Overall, a 43.3% increase in Research Award $’s over FY08A 30% increase in Federal and 58% increase in Corporate Awards

BARRIERS TO SUCCESSBARRIERS TO SUCCESS

• Unengaged department/division leadershipUnengaged department/division leadership• Faculty below critical massFaculty below critical mass

– Faculty expertiseFaculty expertise• Finances--dollars to recruit/buildFinances--dollars to recruit/build• InfrastructureInfrastructure

– Organization, facilities, equipmentOrganization, facilities, equipment– Information technology and data systemsInformation technology and data systems– Administration and regulatoryAdministration and regulatory

• Research cultureResearch culture• Flat federal/private research fundingFlat federal/private research funding

FUTURE PLANNINGFUTURE PLANNING

When Alice met the Cheshire cat, she asked, When Alice met the Cheshire cat, she asked, ““would you please tell me which way I would you please tell me which way I ought to go from hereought to go from here?”?”

Said the cat, “Said the cat, “That depends on where you That depends on where you want to get to.”want to get to.”

Charles Lutwidge DodgsonCharles Lutwidge Dodgson

Alice’s Adventures in Alice’s Adventures in WonderlandWonderland

““Each success only buys Each success only buys an admission ticket to a an admission ticket to a more difficult problemmore difficult problem.”.”

Henry A. KissingerHenry A. Kissinger

THE THE RED QUEENRED QUEEN EFFECTEFFECT . . . “well in . . . “well in ourour country”, said country”, said AliceAlice, still , still

panting a little, “you’d generally get to panting a little, “you’d generally get to somewhere else—if you ran very fast for a somewhere else—if you ran very fast for a very long time as we’ve been doing.”very long time as we’ve been doing.”

“ “A slow sort of country”, said A slow sort of country”, said the Queenthe Queen. . “Now “Now herehere, you see, it takes all the , you see, it takes all the running running youyou can do, to keep in the same can do, to keep in the same place. If you want to get to somewhere place. If you want to get to somewhere else you must run at least twice as fast as else you must run at least twice as fast as that!”that!”

Louis CarrollLouis Carroll

Through the Looking Through the Looking GlassGlass