- © 2008 Canadian Medical Association
Canada must persuade more physicians to become more involved in research to ensure that bench science is being transferred to the bedside and that research protocols are properly informed by health needs, says the incoming President of the Canadian Institutes of Health Research (CIHR).
Decreased physician involvement in research, typically because of clinical demands, teaching loads or other administrative and financial pressures, is counterproductive to the health of the research enterprise because doctors are “key in the whole knowledge transfer system,” argues Dr. Alain Beaudet, who will step aside from his current duties as Fonds de la recherche en santé du Québec president to assume the CIHR helm on July 1.
The problem has been particularly acute in Quebec, where a regime governing distribution of physicians known as “regional general medicine manpower plans” has essentially punished university hospitals who allowed clinicians to become involved in research, Beaudet says.
In hopes of resolving that, the agency recently negotiated an agreement with the province to allow hospitals to calculate clinician-researchers differently in manpower plans. It also helped develop an agreement to financially compensate medical specialists for research activities and is now working on a similar arrangement for general practitioners.
As well, it will soon establish a new 5-year program aimed at encouraging and training more residents to become involved in research, Beaudet adds. “It's going to fund the first years of research during the residency, then an additional 2 years of fellowship abroad and then the first year back into an academic setting to encourage our universities to hire them back and support for a first year until they get CIHR or FRSQ [Fonds de la recherche en santé du Québec] stipends and salary support.” The financial elements of the program, including exact level of support and the number of residents to be supported, have not yet been determined.
The affable neuroscientist (CMAJ 2008;178[9]: 1128) stressed that it would be presumptuous, if not downright “incendiary,” to presuppose what sort of changes might be required at CIHR without first launching extensive consultations with the academic community and political decision-makers, including provincial health ministers, which he plans to undertake this fall.
But measures to make research more attractive to clinicians and to make CIHR collaborative programming more responsive to both provincial and national health needs appear to be personal priorities.
All too often, CIHR partnership programs take the “Canadian way of doing things,” Beaudet says. “So when CIHR partners, it's ‚we partner, so we decide. We decide on the program. We organize everything and you guys come in and part with your money.'”
Instead, Beaudet would like CIHR partnership programs to be more responsive to local needs. “I'd like to see individual provinces come up with a health problem specific to that province and this is how they would like to tackle it and how could CIHR help to tackle that problem in that their province. … Let some of the research questions come up from the clinical observations and the clinical results.”
Beaudet declined comment on many of the contentious issues that have bedeviled the council in recent years, including whether the current division of the pie between the the 4 so-called pillars (biomedical, clinical, population health, and health services and systems research) is suitable; whether there's an excessive amount of strategic, multidisciplinary, interdisciplinary and collaborative programming; and whether the CIHR's 13 so-called “virtual” institutes have appropriate roles and functions (CMAJ 2006;175[8]: 857-8).
“I want to be very prudent now to really understand what's going on before I start making any statements that could be seen or perceived as being incendiary,” Beaudet said.
“It's clear that we have to bring the individual institutes into the fray. They have a critical role to play. They've got boards that are full of really creative energy, very bright people. Let's use these people more than perhaps they've been used so far. But I really want to be prudent here. Let me first get acquainted with the beast and then I'll tell you how to tame it,” Beaudet later added.
Asked point-blank whether he's concerned that the recent devolution of financial decision-making authority from the CIHR's governing council to a Research and Knowledge Translation Committee comprised primarily of the scientific directors of the 13 institutes might severely limit the ability to affect change, Beaudet replied, “No, I don't think so. If there's good will, it's going to work and when there's a will, there's a way. What you have with the institutions, is a federation and what you want is a federation that works. We're familiar with that problem in this country, aren't we?”
Provincial counterparts describe Beaudet as extremely collegial and receptive to argument but a “bit of a bulldog” once he decides upon a course of action.