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Abstract
Objective To identify whether there have been changes over time in the capacity of paediatric consultants to undertake research and if the activity differs between men and women.
Design Comparison of data from two surveys of UK paediatric consultants.
Subjects UK consultant members of the Royal College of Paediatrics and Child Health.
Interventions Surveys carried out in 2011 and 2015.
Main outcome measures The proportion of consultants with allocated time in job plans for research, academic appointments, postgraduate qualifications, publications, grant funding and supervision of PhD students.
Results The 2015 survey demonstrated 20% of consultants had one or more programmed activities (PAs) for research, but the average paid PA for research was 0.39 PA. Between the surveys, the proportion of consultants with honorary contracts had declined, and the proportion with a PhD or MDRes was 32% in 2011 compared with 26% in 2015 (p<0.001). In 2015, only 12% of consultants had at least one current grant. In 2011 and 2015, 51% and 54% respectively of consultants had not authored a publication in the preceding 2 years. In 2015, 92% of consultants were not currently supervising a PhD student, and 88% had never supervised a PhD student. In 2015, 25% of men and 12% of women had PAs for research (p<0.001). Women were less likely to hold an honorary or primary academic contract, have authored a publication or supervised a PhD student (all p<0.001).
Conclusions Research activity among paediatric consultants remains low, particularly among women.
- Research
- Child Health
- Paediatrics
- Consultant
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What is already known on this topic?
Child health research is important to improve patient outcomes and advance the science of paediatrics.
There had been a decline in the number of academic paediatricians at honorary consultant grade prior to 2011.
What this study adds?
Between 2011 and 2015, there has been a further decline in paediatric consultants with a primary academic contract.
In 2015, a minority of consultant paediatricians had programmed activities (PAs) for research.
Women consultants had fewer PAs for research and less author publications, and hold fewer grants.
Introduction
The Royal College of Paediatrics and Child Health (RCPCH) considers that involvement in and support for child health research should be embedded in the work of every paediatrician throughout their careers. As a consequence, the RCPCH has conducted reviews over time to assess such activity. In 2011, a survey was conducted of consultant and staff associate specialist and specialty doctor (SAS) paediatricians recorded in the RCPCH Medical Workforce Census of 2009.1 The response rate was 67% and highlighted a low level of research involvement.1 Furthermore, the number of paediatricians with a primary academic contract recorded in the RCPCH Medical Workforce Census had decreased year-on-year.2 In 2012, in a report, Turning the tide: harnessing the power of child health research,3 the RCPCH stressed the importance of child health research to patients and populations and emphasised the need to increase research activity in child health. It was then of concern that, with the pressures facing clinical services, the ability of the paediatric workforce to contribute to child health research was shown to be declining.4 The RCPCH has, therefore, undertaken a further survey in 2015. Our aim was to determine whether the level of paediatrician involvement in research had changed since the 2011 survey. As more than 50% of consultant paediatricians are women, an additional aim was to determine if there were any differences in research activity by sex.
Methods
In 2011, all consultants and SAS doctors recorded in the RCPCH Workforce Census 2009 were identified (n=4549). Of those, 100 were not contacted (figure 1). The remaining doctors (n=4449) were sent a survey via SurveyMonkey which included questions about their research activity (see online supplementary appendix 1). The survey was undertaken between November 2011 and January 2012. In 2015, all consultants and SAS doctors recorded in the RCPCH Workforce Census 2013 and any new CCT holders in paediatrics qualifying up to May 2015 were identified (n=4768). Of those, 435 were not contacted as they had either opted out of email or survey contact, had not provided the RCPCH with their email address, had retired or moved overseas. The others (n=4333) were sent a survey via SurveyMonkey asking about their research activity (see online supplementary appendix 2). The survey was undertaken between May and July 2015. Additional information was gathered in the 2015 survey which included asking respondents how much time (programmed activities (PAs)) they had allocated for research in their job plans and how much time they spent on research work. Consultants were asked how many PhD students they were currently supervising and how many they had successfully supervised throughout their consultant careers. In the 2015 survey, RCPCH members were also asked whether they were members of a funding board or a research committee. Data were also extracted from the RCPCH Medical Workforce Census 2013.2
Supplementary appendices
Response rates in 2011 and 2015.
Analysis
Only results from consultants were analysed as there were relatively small numbers of other grades who responded (figure 1).Respondents were divided into those who were general or community paediatricians or were in a specialty, for example, neonatology, subsequently referred to as specialists. Differences in responses to questions common to both surveys and by sex were assessed for statistical significance using the Z test.
Results
The response rate by paediatric consultants in 2011 was 72% (n=2352) and in 2015 44% (n=1924). In 2011, 44% of respondents were specialists compared with 26% of the overall workforce (p<0.001), and in 2015, 39% of respondents were specialists compared with 33% of the overall workforce (p<0.001).
The proportion of consultants spending time on research was 36% in 2011 and 49% in 2015 (p<0.001). The 2015 survey highlighted that 285 (20%) of consultants had one or more PA for research; however, 706 (49%) were spending more time on research than allocated in their job plan. Averaged across all respondents, consultants spent a mean of 0.71 PA for research per week, but were paid for 0.39 PAs. A lower proportion of women compared with men had PAs for research in their job plan (p≤0.001), and a greater proportion of men spent time on research not accounted for in their job plans (p<0.001) (table 1).
Research activity by gender in 2015
In 2011, 32% of respondents had either a PhD (n=148) or MDRes (n=602); corresponding figures for 2015 were 26% (PhD 125; MDRes 309) (p≤0.001). In 2011, 48% of respondents held honorary appointments compared with 37% in 2015. In 2011, 6% of respondents had a primary academic appointment compared with 5% in 2015 (p=0.06). In 2015, women represented 51% of consultant respondents, but only 40% of those with an honorary academic appointment and 25% of those with a primary academic appointment (p<0.001) (table 2). There were no significant differences between the proportions of women with either honorary or primary academic appointments between 2011 and 2015 (p=0.74 and 0.41, respectively).
Primary academic appointment by gender
The 2015 survey demonstrated 1448 consultants (92%) of respondents were not currently supervising a PhD student, and 88% had never supervised a PhD student; 6% of women were currently supervising a PhD student, compared with 11% of men (p≤0.001); 9% (61/703) of women had ever supervised a PhD student compared with 17% of men (p≤0.001).
The proportion of consultants authoring no publications in the 2 years prior to each survey was 51% in 2011 and 54% in 2015 (p=0.116) (table 3). The average number of publications produced per whole time equivalent consultant was lower for women in both 2011 and 2015 (p<0.001) (table 1). In 2015, 1477 respondents (88%) did not hold any grants; 12% respondents held one or more grants. Of the 198 who held one or more grants, 38% were women.
In 2015, 1573 (94%) consultants were not members of a funding board or a research ethics committee. Of those who were members, 22 sat on a charity research committee/advisory board, 19 on the National Institute for Health Research (NIHR) Scientific Advisory Board, 10 on the Medical Research Council Scientific Advisory Board, 15 on a National Research Ethics Service research ethics committee, 12 on a special interest group and 10 on a local research ethics committee. Certain respondents sat on one or more committees/boards.
Discussion
We have identified a decline in the proportion of consultant paediatricians with a primary academic appointment between 2011 and 2015. In 2015, only a minority of consultant paediatricians had allocated time in their job plan to contribute to research. Furthermore, a minority of respondents held research grants or had authored a peer reviewed publication in the 2 years prior to each survey. We found that women had significantly less evidence of research involvement compared with men. In both surveys, a greater proportion of responses were received from specialists compared with that from general paediatricians. As specialists may be more likely to be research-active, our results may have overestimated the true level of research activity and output.
The Royal College of Physicians (RCP) undertook a survey of 2000 doctors across all specialties, including medical students and career stages, in 2015.5 Their results highlighted that doctors want to be more engaged in research and, in keeping with our study, found that many do not currently have the time, funding or skills to realise their potential. They too demonstrated that men were more likely to be engaged in research. In addition, they found that women felt less confident about their research skills than men and found it harder to fit research activity with family life. Both surveys then highlight it would be important to have focused activities to ensure women achieve their full potential with regard to research.
The response rate to our later survey compared with the earlier survey was lower. In the earlier survey, the survey had a wider remit than research, although a number of questions about research were included. The later survey, however, was specifically about research, and this was indicated by the title (see online supplementary appendix 2). We, therefore, speculate that those not involved in research may have been less likely to respond to the later survey. This may explain why the proportion of consultants involved in research had apparently increased from 2011 to 2015. It may mean then that the decline in research activity among paediatric consultants overall may be even greater.
We included data on PhD students as this was collected in the 2011 survey. The numbers of PhD, not MDRes, students are returned in exercises such as the Research Excellence Framework, and hence we also thought these data would be more accessible and accurate. The number of consultants undertaking research activity, including in their own time, was much greater than the number of current PhD students. This may reflect that their research activity includes recruitment into clinical studies/trials.
The Medical Schools Council (MSC) reported a survey of staffing levels of medical clinical academics at UK medical schools as of July 2015.6 They reported that the workforce for academic medicine as a whole was at best stable compared with the year-on-year growth of National Health Service (NHS) staff. In child health, we have also seen growth in NHS staff, but sadly have highlighted a marked decline in the academic workforce.7 The MSC further emphasised the substantial impact of NIHR funding in England, and that work is actively being pursued to support early-stage clinical academics. Child health has particularly benefited from NIHR support with a large number of integrated academic trainees. The MSC report demonstrated that female representation in the academic workforce was slowly increasing with greater growth at the more junior grades, although there were major differences between specialties. Indeed, we report that females fared worse in all aspects of research including a lower number of dedicated PAs, fewer have an honorary or substantial academic contract and a lower proportion had publications or grants. Athena Swan has resulted in important changes in UK Medical Schools in appropriately supporting female academics. It is important to understand why there appears to be an ongoing gender effect, and hence how the RCPCH can reverse it.
The MSC 2015 survey6 demonstrated a 3% decline in Reader/Senior Lecturer numbers, but the professorial numbers continued to increase, but at a slower rate than in the previous 6 years. The NHS, including the NIHR, funds 44% of all clinical academic posts with a 43% contribution from the Higher Education Funding Councils. The contribution of NHS funding has increased by 20% since 2006, with the majority of this funding allocated to Lecturer posts. More than half of the medical schools in the survey6 reported difficulties in recruitment to particular specialties, including paediatrics and child health.6 Reasons given included a small pool of suitable candidates, a shortage of trainees and concerns about roles not contributing to the Research Excellence Framework due to the intensity of clinical work. Unfortunately, in paediatrics, we have a shortage of trainees.8 This may lead to an increased workload for consultants and their reduced capacity to undertake research. The UK Child Health Research Collaboration (UKCHRC) is a partnership of child health research funders supporting increasing research capacity which will hopefully help to address the problem. The RCPCH is undertaking a number of initiatives to assist paediatricians who would like to contribute to research. This is essential, as a strong independent association between survival and participation in interventional clinical studies has been shown.9 The initiatives include advocating for appropriate job plans to undertake teaching and research, as well as clinical care. The RCP have recommended that trusts should take steps to ensure doctors have protected time for research and can make efficient use of that time.5 The RCPCH highlights and promotes key research successes by paediatricians and demonstrates where research has led to change and produced better outcomes for children. As part of the Future Hospital project, the RCP has published case studies of increased research capacity and improved patient participation at a local level.10 ,11 The RCPCH considers that all doctors should be able to understand and interpret research in order to incorporate best evidence into their clinical decision-making. Child health research requires specific competences including the ability to communicate effectively and engage with parents, carers and children and young people. The RCP has recommended that more is needed to enable doctors to acquire essential research skills. Following the publication of the Shape of Training report,12 the RCPCH has commenced a review of the training pathway and curriculum to widen opportunities for trainees to be involved in research. A research training day led by British Association of Perinatal Medicine and supported by the RCPCH has been held13 with the intention of extending this to trainees in other specialties.
The RCPCH established and provides support to the UK Child Health Research Collaboration of more than 40 charities which fund child health research. It was formed to foster collaboration in growing research.14 The RCPCH has also established an information hub providing details of grant calls, closing dates and eligibility criteria with the assistance of UKCHRC available on the RCPCH website.15 The RCPCH has launched a Children's Health Research Capacity Development Fund16 to support the next generation of child health research leaders. The RCPCH & Us network provides a platform for facilitating the involvement of children, young people and their parents and carers in child health research.17 In addition, the RCPCH has developed an Infant's, Children's and Young People's Research Charter to support children, young people, families and health professionals in discussions about research.18 It provides guiding principles for those who seek to involve children and young people and their families in research and signposts relevant resources.
The RCPCH Medical Workforce Census demonstrated that paediatricians increasingly wish to work less than full time, and many are already doing so.2 Academic paediatric trainees, however, feel that flexible working would be negatively viewed by funding bodies.19 We hope working within UKCHRC, we will be able to reassure trainees and funders that less than full-time working is productive and should be supported.
In conclusion, we have demonstrated that research capacity among paediatric consultants remains low with women less active than men. The RCPCH remains committed to increasing the involvement of all paediatricians in research.
Footnotes
Contributors All authors were involved in the development of the surveys (NM in 2011 and AG in 2015). RW, MM and AG undertook the analysis of the data. All authors were involved in the production of the final manuscript.
Funding AG's research is supported by the National Institute for Health Research (NIHR) Clinical Research Facility at Guy's & St Thomas' NHS Foundation Trust and NIHR Biomedical Research Centre based at Guy's and St Thomas' NHS Foundation Trust and King's College London.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement We agree to the data sharing statement.