Physician scientists who choose an academic career usually come to grips early on with the fact that they must find external support for their research. Usually this means that they will apply for grants or contracts, often to parts of the National Institutes of Health (NIH), and that is a long and arduous path. Success rates are declining, and funding rates are declining as well.

Francis Collins, MD, PhD, Director of the NIH, has established several new mechanisms for funding especially promising young researchers. One of these is the Early Independence Award, designed to generously underwrite five years of research for a few lucky and talented applicants who either have within the past 12 months completed a doctoral degree or medical residency or will within the coming 12 months complete a doctoral degree or medical residency. In other words, the window is barely cracked open, and if you think you qualify you must move quickly.

Someone who qualified and moved quickly to submit an application through the Palo Alto Veterans Institute for Research at the VA Palo Alto is David C. Chan, MD, PhD,(Assistant Professor, Center for Primary Care and Outcomes Research). Chan is the one Stanford Early Independence Awardee for 2014, as announced by the NIH on October 6.

Chan’s response to a recent offer of congratulations went like this: “Thank you! I’m really excited about this.”

Chan is an internist and hospitalist at the VA, an assistant professor on the tenure track, and a young researcher who doesn’t have to worry about his salary or the funding needed to put together a team to help him pursue his research, thanks to the Early Independence Award.

“I applied for the award last year. I had just finished my PhD in Economics at MIT, which put me in the one-year period of time when I could apply for it. I was really grateful for the opportunity to apply and even more grateful that it worked out.”

The Award

“The Award is for 5 years, and it’s wonderful. The amount of funding is quite generous. It frees me from other responsibilities and allows me to build an infrastructure and a team to help me pursue my research. It’s going to be a tremendous help in making this research as impactful as possible.

“It’s not just the size of the award, it’s also the flexibility of the award that by its very nature is coming from a high risk/high reward part of NIH. It is not funding certain items or specific deliverables. In fact, when applying for the award, there is no request for a detailed budget. Basically, there’s an unusual amount of trust and expectation that I’m going to spend it in the best way.”

His Research

“My research tries to answer this question: How do you explain some health care institutions being much more productive than others? By ‘productive’ I mean much lower cost and higher quality.

“One of the basic principles of reforming health care is understanding how the Mayo Clinics and the Cleveland Clinics of our country are able to deliver health care at costs below the norm and quality above the norm. We really don’t know the answer to that. We have some idea of characteristics that are shared by these institutions, but what I want to do is bring a behavioral framework as well as quantitative tools to an understanding of what explains high productivity in health care.

“My research proposal talked about looking at information as a key driver of productivity, and finding a balance between too much information and too little information. We have to recognize that consumers of information are not robots; consumers of information are busy human beings who could be overwhelmed by information.

“Providing useful information can really help in health care. But providing too much information could basically overwhelm the cognitive bandwidth of providers. There’s a whole body of research in the laboratory showing that people can only process a certain number of things. But there is also research showing that experienced providers can remember more things by lumping certain ones together, so one unit of information is not the same for experienced providers and new providers. There is reason to believe that the optimal level of information might differ across different types of people and perhaps even by individual.

“Part of the goal of my project is to look at different types of people and at people in different types of situations – for instance, on busy days when they have little bandwidth versus on days when their patients are less complex and they are able to process more information. What I hope to do is begin mapping out some of the important characteristics that would determine where the optimal level of information might lie.”

The VA Advantage

Chan’s appointment at the VA provides yet another opportunity to take advantage of some characteristics that don’t exist in other places.

“The Veterans Administration has the single largest platform of health information technology, and it is constant in many important ways. But there is useful variation across individual health systems in the VA, such as Palo Alto versus Seattle versus Los Angeles, that I’m going to use. For instance, there are electronic reminders built into the platform. Seattle has three times the number of electronic reminders as LA, but the majority of the health care platform is held constant. That allows me to focus on the number of electronic reminders in play.

“Ideally, it will lead to opportunities to redesign health information technology in a prospective manner and change things that might make an important difference.”

Over the next several years, watch for publications and lectures where Chan will present early results of this interesting and well-funded research.