Family Medicine, the NIH, and the Medical-Research Roadmap

Perspectives From Inside the NIH

While officials of the National Institutes of Health (NIH) generally respect the clinical role of family medicine physicians, they remain uncertain of family medicine’s research capacity and, therefore, uncertain of the role family medicine can play in NIH’s work. Some at NIH believe the recent NIH Roadmap for Medical Research reflects a substantive effort to connect investigation more effectively to clinical practice and patients; this may suggest there is a larger NIH role for family practitioners now than in the past.

As the predominant supporter of biomedical research in the U.S., NIH historically has been focused on basic science and organized into disease-specific or specialty-based institutes and centers (ICs). Consequently, there has been little involvement by family doctors. In recent years, however, NIH has initiated efforts to focus on more multidisciplinary research that could bring “new scientific advances to real world practice,” specifically through the Clinical and Translational Science Awards (CTSAs). This study, based on 13 interviews with key officials spread across NIH ICs, is an attempt to examine whether NIH insiders think there soon can be a better link to family medicine.

Key Findings:

  • NIH officials generally appreciate the clinical impact of family doctors, including their relationships with patients and ability to work across disciplines and to treat a patient holistically.
  • There is consensus, though, that family practitioners do little research and do not have the experience or access to infrastructure to conduct high-quality research.
  • Most officials think NIH remains focused on basic science, not clinical questions, and regard the success of initiatives to reorient the institution with skepticism. Recent NIH hires are more optimistic.
  • Perspectives on whether family physicians could play a significant role in NIH ranged from guarded optimism to outright pessimism; but all interviewees saw a need for family doctors to have more formal training and experience in research for this to occur.

The authors note that both NIH and the practice specialty itself have much work to do to make NIH more relevant to family practice and the treatment of patients. The authors urge both entities to “tread boldly” and do what they need to do to take advantage of the opportunities through the recent NIH Roadmap and CTSAs.