Letter: Research Productivity of Physicians in the Pandemic and Post-pandemic Era: A "Productive Outbreak'".

To the Editor: On March 13, 2020, the United States declared a national emergency concerning the novel coronavirus disease (COVID-19) during a time of heightened strain on the country's health care system, leading to the near shutdown of elective hospital operations. As health care systems adjusted to new protocols, physicians across many disciplines were affected by the overall reduction in clinical activities. These circumstances created a unique opportunity for clinicians to embark on academic-focused endeavors, including virtual teaching, conducting research, and participating in scholarly activities traditionally threatened by increasingly demanding clinical workloads.1,2 Conversely, in a prepandemic era marred with challenges to supporting physician-scientists, the period of shutdown during the pandemic represented a real-life experiment to examine whether reduction in clinical responsibilities for physicians, without a concurrent increase in research funding, could improve research productivity. We evaluated the research output of medical specialties in the United States between January 2018 and June 2022. We used the monthly publication count in PubMed to determine how research output changed during and postpandemic. Using the 2018 average as a baseline (Supplementary Material, https://links.lww.com/NEU/D579), we observed minimal increase in overall research output across specialties in the prepandemic era. During the COVID-19 pandemic, there was an abrupt increase in overall research output by 54% (Figure 1). The trend of research output followed a sigmoidal curve that plateaued after the shutdown period and remained elevated in 2022. This increase in output could not be explained by COVID-19–related research activities, which only accounted for up to 6.5% of research output in the same period (Figure 1). Pandemic-related growth in research productivity occurred in almost all surgical and medical specialties with a variable magnitude that ranged from 35% to 83%, with a similar rate of rise during the pandemic (Supplementary Figures 1, 2, https://links.lww.com/NEU/D579). The quality of this research output, measured by the contribution of randomized controlled trials, did not change. Research contribution from basic science, that is affected by workspace closure and decrease funding,3 demonstrated a slow decrease in relative contribution during the pandemic from 20% to 15% of monthly output (Supplementary Figures 3, 4, https://links.lww.com/NEU/D579). These findings support prior published observations on the significant increase in manuscript submission rate during the pandemic.4FIGURE 1.: Trend of monthly publication rate over time before, during, and after the pandemic. Top graph shows the sigmoid shape of the monthly publication rate among all studied specialties between January 2018 and June 2022. Monthly output is reported as the percentage of the monthly average in 2018. Black line shows the interpolated curve with dashed lines representing the 95% CI. Blue bars represent the percentage of COVID-19–related publications in each studied month (measured on right y-axis). Red line denotes March 2020, the month of official shut down proclamation release. Bottom panels show the percentage increase in monthly publication rate reported as percentage difference between prepandemic and postpandemic plateau in the publication curve. Specialty specific curves are shown in Supplementary Figure 3, https://links.lww.com/NEU/D579. The blue line in each pie represents the average increase of all specialties combined.Research output from physicians during the pandemic period could not be explained by increased overall funding which declined during the pandemic.3 Although the argument could be made that this persistent effect is related to the gap between study execution and publication, there is no observed decline in output over 18 months after the shutdown period and return of clinical activities to near normal operations. Increased research output during the pandemic is likely dependent on several factors including infrastructure, positive reinforcement, collaboration, and peer impact. Research activities, ranging from chart reviews to basic science experiments and clinical trials, require an infrastructure of administrative and team-building activities that include regulatory protocols (eg, Institutional Review Board approvals), database construction, building research teams, etc. Once established during the pandemic shutdown, these activities are not project-specific and open the door ongoing productivity. Positive reinforcement after successful publication, peer impact, and availability of mentors are additional contributing factors. As more physicians embark on research projects, such momentum is contagious for colleagues to pursue their own research ambitions, collaborate on common topics, mentor others, and replicate findings in different settings. Notably, early implementation of safe workspace protocols and safe return to work across the country played a key role in minimizing the overall negative impact of the pandemic on research workflow. Apart from this multifactorial phenomenon that could explain this postpandemic “productive outbreak” in research activities among physicians, current data support the notion that the research contribution of physicians across specialties is highly dependent on institutional support of physicians' time contribution to research activities regardless of major changes in funding strategies. We argue that physicians continue to demonstrate the drive, perseverance, and competence to contribute to advancing patient care through medical research. Continued institutional support for clinicians to pursue these activities is likely to reap exponential impact on productivity, especially for early-career faculty. The COVID-19 pandemic provided a real-life experiment to demonstrate that even without an increase in overall funding or proportion of formal physician-scientist trainees, biomedical research among clinicians is heavily influenced by institutional support. Tracking research output over the upcoming year to assess whether research output will remain at the current level will help validate this hypothesis.