Allied health clinician-led research tends to reflect current problems and issues in healthcare practice and therefore produces findings that are more readily translatable into practice. When research happens within the healthcare setting, we see the increased use of research knowledge to inform health practice, and enhanced system-wide uptake of research into healthcare practice. These are just some of the known benefits of allied health clinician-led research.
One of the key barriers to allied health professionals’ (AHPs) sustained engagement in research activity is the absence of defined clinician-researcher career pathways and sufficient employment opportunities for clinician-researchers.
In this article, I will unpack the reasons why we need allied health clinician-researcher pathways, some of the enablers or existing structures that provide opportunities for allied health to develop a research career, and the challenges that remain. I conclude with some suggestions for advancing allied health clinician-researcher career pathways.
Why do we need allied health clinician-researcher career pathways?
There are various definitions of the term clinician-researcher, and exactly which clinicians and researchers meet the definition of this hybrid role. Clinician-researchers are generally understood to be health professionals who either directly provide, supervise, or otherwise support those who provide clinical care, and concurrently lead or conduct health research. Other terms are used to describe these professionals including embedded researcher, an individual with research qualifications working in health settings for at least 30% of their time, or clinician-scientist, a health professional who combines healthcare delivery and research activities.
Clinician-researchers are aptly placed to identify important research topics and questions from their clinical practice and close links to clinical service delivery. They also have access to research knowledge and evidence they can draw on to inform their own and their colleagues’ clinical practice. What is more, they can translate the knowledge and evidence they generate through their research endeavours into clinical practice within their setting, and promote scale and spread to other settings.
Clinician-researchers are integral to closing the gap between research knowledge and what happens in clinical practice. However, they can’t do this important work if there are few jobs available that support these hybrid roles.
Job security and career progression are important considerations for many AHPs. Embarking on an expensive and intensive higher education degree, with little guarantee of suitable or desirable job prospects at the end, is not at the top of all AHPs’ to-do lists. To encourage more AHPs to consider pursuing a career as a clinician-researcher, we need to create, consolidate, and make visible more employment and advancement opportunities.
Some of the markers of professionalisation for allied health clinician researchers already exist—attempts have been made to identify the tasks undertaken by clinician-researchers and the skills they need, and evidence that they practise productively within a health organisation setting. There are even examples of organised bodies to promote and advance the work of clinician-researchers. However, career pathways for allied health clinician-researchers remain underdeveloped and uncertain.
Alternative research roles for allied health
Allied health researchers occupy many roles other than typical clinician-research or embedded researcher roles, and can exert a great deal of influence in these alternative research roles. For example, AHPs can fulfill roles as managers of research or research offices for organisations including health services; they can also work in ethics officer or grants officer roles for health services and organisations.
It may be tricky for AHPs in alternative research roles to continue both clinical practice and research activities; when working these types of roles, however, they can enjoy a fulfilling and interesting career, and they also make great use of their clinical and research knowledge and experience. For example, AHPs working in alternative research roles can influence the research agenda, perform a research capacity and capability building function, and conduct their own or contribute to others’ research endeavours.
In the Australian context at least, there is an increasing expectation that clinicians recruited or promoted to senior allied health roles have a higher degree. Those with PhDs or other higher degrees by research may be looked upon favourably for one of these roles. With senior allied health clinicians with research degrees in tow, we will surely begin to see research become more embedded in clinical practice.
University department and health service conjoint roles for allied health
Allied health clinician-researchers are more likely to find stability and growth opportunities in conjoint appointments between university departments or schools and health services. These roles tend to be mutually beneficial for both organisations when there is direct alignment between a clinician or their discipline and the clinical and research work.
When occupying conjoint positions, clinician-researchers tend to follow typical academic pathways and progression: from PhD to postdoctoral researcher, and in some cases all the way through to professorship. These types of roles are relatively rare and securing one is challenging in such a competitive environment.
One of the other major challenges with conjoint university-health service roles for allied health is the need for the clinician-researchers occupying these roles to report to or meet the key performance indicators (KPIs) of two large organisations. Performance indicators for universities are typically traditional academic outputs (e.g., peer-reviewed publications, grant funding, conference presentations). Whereas health services are generally more concerned with the impact of research on healthcare delivery and practice. That is not to say that universities aren’t interested in real-world impact, or that health services do not value grant funding and tangible research outputs. However, clinician-researchers in conjointly funded roles often strive to meet KPIs that are prioritised differently by their two employing organisations.
In some cases, clinician-researchers in conjoint appointments need to choose between their health service embedded researcher position and career progression. These decisions are often made in favour of a university only appointment, given the comparatively fewer senior researcher roles (e.g., professor level) available for health service embedded clinician-researchers.
Demonstrating the value of allied health clinician-researchers
When it comes to developing and expanding allied health clinician-researcher pathways, there is clearly a need for financial investment from health organisations or government health departments, as well as universities or research institutions. Ongoing investment in clinician-researcher roles relies on evidence demonstrating and reinforcing the value of clinician-researchers working in health services.
Demonstrating the value for money for universities and research organisations is more straight forward as the outcomes and gains for these organisations are easier to measure (i.e., research outputs, research grant funding opportunities, etc.). For health organisations, although the benefits to increasing research activity are well-known (e.g., more relevant research that is more readily translated into practice); measuring and demonstrating improved research culture, the increased use of research in clinical practice, and ultimately improved healthcare delivery and health outcomes, are all difficult to demonstrate. These types of outcomes take time to achieve and are difficult to measure objectively or quantitatively. This makes it challenging to convince fiscally constrained health organisations to invest time and monetary resources into research and clinician-researchers.
This is not to say that health organisation executives do not see the value in research and recognise the need to invest in human resources and infrastructure to support research activity and the use of research in practice. This type of investment has been made by governments in Australia (Victoria and Queensland) and in the United Kingdom.
Higher degrees by research for allied health clinicians
Completing higher degree research is often the first step on the typical researcher career pathway, and can open many career advancement opportunities. More examples of industry-supported PhDs are being implemented in health settings. These types of initiatives provide opportunities for emerging clinician-researchers to retain their clinical roles while completing a clinically relevant higher degree research program.
PhDs and other higher degrees by research that are actively supported by and undertaken within health services benefit both the candidates and the host health services. Candidates can continue to work in their clinical role while undertaking their higher degree and health services benefit from the knowledge they are generating and the skills they are garnering. This knowledge and their skills can be used to improve healthcare practice and may inspire others within the health service to develop their own research or evidence-based practice knowledge and skills.
The next step of course, is identifying and developing further opportunities for those who complete their research qualification to retain them in the health service.
AHPs working in non-metropolitan settings (e.g., rural, regional, or remote areas) have even fewer clinician-researcher career opportunities. This reinforces the health inequities experienced in these geographical areas. There are many factors at play here, such as a lack of research funding and investment in rural health research, general health workforce shortages experienced in these areas, and a preference for health researchers to work in more city-centric areas to avoid or reduce professional isolation.
With greater need for rural health research to inform practice, there needs to be even greater monetary and strategic investment in building clinician-researcher pathways for allied health and indeed other healthcare professionals in non-metropolitan settings. This is particularly challenging, given the general workforce shortages, however there is some evidence to suggest that health services who are actively engaged in research are better able to recruit senior clinicians. We have seen examples of smaller rural health services highlighting their research infrastructure and opportunities on their websites as a means to attract research-interested staff.
Allied health clinician-researcher: if you can see it, you can be it
We are seeing more and more allied health clinicians embark on research careers even though the pathway is not always completely clear for early career clinician-researchers.
The carving out, consolidation, and advancing of allied health career pathways have always been hard-earned. Concerted efforts and the persistent advocacy of multiple stakeholder groups with shared goals are required to achieve and maintain career opportunities for allied health. Clearly, clinician-researcher pathways are no exception.
Strengthening the relationships between clinician-researchers and other key stakeholders (e.g., academic researchers, health service leaders, educators, policymakers) nationally and internationally to expand and advance the career opportunities for this group of professionals is a priority.
Professional networks, formal mentoring, and communities of practice can be instrumental in addressing the challenges and sharing ways to advance career opportunities and pathways for allied health clinician-researchers. We also need to make visible and celebrate clinician-researchers in all their different forms to bring attention to the various ways they can carve out their own careers and make valuable contributions to healthcare evidence and practice.
Summary / recommendations
Clinician-researchers are critical to generating research evidence to address problems and issues in healthcare practice and service delivery. To help develop and consolidate allied health clinician-researcher pathways, we need to:
- Encourage allied health clinician-researchers to think more broadly about how they can develop and progress their careers creatively and fill a range of different roles to influence the health research agenda and clinical practice.
- Create better and stronger links between university departments and schools and health services and allied health teams, but be careful to retain clinician-researchers in health settings
- Demonstrate the value and impact of allied health clinician-researchers beyond the traditional academic key performance indicators, to promote further investment in health service-embedded clinician-researchers and their career opportunities
- Support rural, regional, remote health services to attract and retain clinician-researchers by creating research opportunities
- Create networks and communities of practice to advance the opportunities and reach of clinician-researchers.
- Series of Allied Health Insights articles on Research Capacity Building
- Investigating clinician researcher career pathways | NHMRC
- Life as a Clinician-Scientist – AAHMS
- Professional identity in clinician‐scientists: brokers between care and science (wiley.com)
- Embedding researchers in health service organizations improves research translation and health service performance: the Australian Hunter New England Population Health example (jclinepi.com)
To share your thoughts and experiences of allied health research and capacity building, please leave a comment below.
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