The Friends of VA Medical Care and
Health Research (FOVA)
Jennifer L. Strauss, Ph.D.
Center for Health Services Research
in Primary Care
Durham VA Medical Center
Assistant Professor in Psychiatry and
Duke University Medical Center
April 9, 2008
Chairman Akaka, Ranking Member Burr, and members of the Committee, on behalf of the Friends of VA Medical Care and Health Research, thank you for the opportunity to testify. FOVA is a coalition of over 90 national academic, medical and scientific societies; voluntary health and patient advocacy groups; and veteran service organizations committed to ensuring high-quality health care for our nation's veterans.
I am a clinical psychologist and health scientist at the Durham VA Medical Center and a recipient of a VA Research Career Development Award. The primary focus of my research is the treatment of post-traumatic stress disorder in women survivors of military sexual trauma. Today I have been asked to share my reasons for choosing a career as a VA clinician-researcher, and specifically, how VA research opportunities impact the Department of Veteran Affairs' ability to recruit and retain talented clinicians.
Let me say at the outset that I love my job. The opportunity to conduct research greatly enhances my job satisfaction and has played a large role in my decision to remain at the VA for seven years. From the time I applied to graduate school, my goal was to pursue training and professional opportunities that would allow me to blend my clinical and research interests. And VA provides an environment to do just that.
VA is not the only venue in which a clinician can conduct research. Academic medical centers are frequently the landing pad for individuals like me. But understand that I have come of age professionally in the post 9/11 era. I earned my doctorate in June of 2001. Shortly thereafter we were at war. I wanted to help and I had a specific skill set that could allow me to do so quite directly. The opportunity to apply my clinical and research training in support of veterans traumatized by their war experiences continues to resonate very strongly with me, as I believe it does with many of my VA colleagues.
I treat women survivors of military sexual trauma while also conducting research to make those treatments more effective. I am a small piece of a shared vision to provide the best possible care to our nation's veterans. And I am well-aware of how lucky I am to be able to say that. This war has presented numerous clinical challenges and, in many ways, we are still learning as we go. To make progress, VA must foster partnerships between research and clinical services, and must recruit clinician investigators to guide these efforts.
Towards this end, VA offers exceptional research and training opportunities for clinicians like me who are interested in research careers. Among these is the Research Career Development Program. This is a highly competitive mentored award that typically provides 3-5 years of structured research training. Clinicians who receive these awards are relieved of 75% of their clinical duties, allowing for protected time to focus on training and developing an individual program of research.
This award is specifically designed to attract, develop, and retain talented researchers in areas of particular importance to VA, and it is a powerful recruitment tool. I am currently in the second year of my Research Career Development award. For this privileged opportunity, I aim to repay VA and our nation's veterans hefty dividends on their investment in me, in the currency of high quality care and clinically-informed research to improve the care of veterans.
As a VA research career development awardee, I am in a unique and fortunate position. I benefit from truly exceptional research mentoring and training, and I have the luxury of devoting a substantial portion of my time to developing a research program at VA. At the Durham VA's Center for Health Services Research in Primary Care, I am one of 31 core investigators, half of whom are clinicians and many of whom are young investigators, who jointly attract over $10 million of research grant support annually. The Center's success is a reflection of exceptional leadership, a sophisticated research infrastructure, and a talented, collegial, multidisciplinary faculty who are unusually invested in fostering the careers of junior faculty. The common thread is a deep respect for our nations' veterans and a drive to provide them with the highest quality care and to constantly seek improved treatments. I believe my success to date is largely a reflection of the exceptional opportunities afforded to me in this environment and it is these opportunities that give me such professional satisfaction and keep me at the VA.
Despite the many advantages VA offers, it is not necessarily easy to build a career as a clinician investigator at VA. I would like to highlight several ways in which I believe VA can improve recruitment and retention of clinicians such as myself, who are interested in integrating research into their careers. I offer what follows from the perspective of a field worker. I know there are numerous constraints on implementing the ideal in the short run. But I also firmly believe that longer-term goals should be kept in mind for the good of the veterans we are all committed to serve.
To date, VA has invested in seven years of my research training. Yet what happens when my Career Development award, and the protected research time it affords, expires in two years is an open question. Unlike clinicians at most academic medical centers, VA clinicians may not fund a portion of their salaries through research grant support. If a non-clinician VA researcher is awarded research funds, those funds can be used to pay salary for time devoted to the research project. But VA clinicians cannot do this and typically must donate their time, often performing research duties early in the morning or very late into the night after a long day of seeing patients. I do not think this is in the best interest of VA or the veterans we serve. I strongly recommend that VA adopt a model that is more in line with what is available to clinician researchers working in academic medical settings. Namely, to foster recruitment of the best care providers and to encourage clinicians to conduct research by providing protected research time. The objective, of course, is to hasten development of the new and more effective treatments that are urgently needed.
There are several other ways in which I believe VA could better facilitate clinicians' involvement in research. Currently, the primary research funding mechanism for VA investigators is a merit review award. For health services researchers like myself, these are typically 3-5 year studies with relatively large budgets. Understandably, these studies are generally awarded to mature investigators who have already completed a substantial body of work in the research area. Currently missing from the VA research funding portfolio in my area of health services research is a grant mechanism that would allow individuals to conduct research on a smaller scale. I believe this type of funding mechanism, akin to the R03 program offered by the National Institutes of Health, would be particularly attractive to VA clinicians interested in taking on research without the commitment of time and resources that large scale studies demand.
Current space constraints are an additional obstacle to the clinician-researcher career path. Space is at such a premium at our facility that some of our researchers may soon be moving off-site. A geographic divide between research labs and clinics will do little to enhance the type of collaborations that I believe are essential to move VA research forward in a manner that will best inform the clinical care of veterans. Continued investment by VA in the Durham research infrastructure and a similar investment at other facilities are imperative.
The last obstacle I want to mention is data security in the context of research. Absolutely, veterans' privacy and research data must be safeguarded; that is paramount. However, while I know it is not intentional, it has become extremely difficult to share data even among VA facilities, and collaborating with non-VA organizations can be even more problematic. I urge VA to ensure that its security policies guarantee the safety of data, but still allow shared research to continue. With improvements in security technology I hope the current situation will get better. But right now, managing research data in compliance with VA policies is a significant challenge. The reasoning behind some of the obstacles is understandable; the consequences can be severe.
Finally, I think the career opportunities available at VA remain a too-well kept secret. A VA career never occurred to me until a trusted graduate school mentor encouraged me to take a closer look. Coming from a traditional academic training environment, VA simply wasn't on my radar. It is time to let this secret out of the bag. For the reasons I have described, VA is an elite venue for clinicians and researchers alike and should recruit accordingly.
Serving those who have served our country is what my colleagues and I do. And we are filled with pride by the opportunity to do so. That feeling - that attachment - is considerably deepened because of the opportunity to combine clinical care with research, to compete for Career Development awards, and to be linked with mentors willing to nurture our research interests. These are significant factors in why I came to and remain at the VA. And apparently many of my colleagues feel similarly. When surveyed by VA in 2002, 79% judged that research opportunities and support were very or extremely important for recruiting and retaining high quality clinicians in VA, and 61% of clinician respondents indicated that they would not work in VA without research opportunities.
Mr. Chairman, thank you again for inviting me today. I am happy to answer any questions that you or the other committee members may have.
Table of Contents