Participant Demographics
A total of 57 clinician researchers participated in the study and their demographic data is shown in Table 1. Respondents were from four states in Australia with over 60% from Queensland. There were eight AH professions represented within the sample, with just over a third (40.4%) coming from speech pathology. Just over half of the participants had completed a PhD or Research Master’s and a further third were currently enrolled in one. Participants were mainly from public, metropolitan hospitals, which served either adults only or had mixed caseloads (adult and paediatric populations). Three quarters had worked in their professional field for > 10 years. Most participants had been employed in their current main role for less than 10 years.
Table 1
Participant characteristics
|
N (%)
|
State
|
|
Queensland
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37 (64.9)
|
New South Wales
|
10 (17.5)
|
Western Australia
|
6 (10.5)
|
Victoria
|
4 (7.0)
|
Profession
|
|
Speech Pathologist
|
23 (40.4)
|
Physiotherapist
|
16 (28.1)
|
Social Worker
|
5 (8.8)
|
Dietician
|
4 (7.0)
|
Occupational Therapist
|
4 (7.0)
|
Pharmacist
|
2 (3.5)
|
Radiation Therapist
|
2 (3.5)
|
Other
|
1 (1.8)
|
Research Higher Degree status
|
|
None
|
6 (10.5)
|
Enrolled in Research Master’s
|
2 (3.5)
|
Enrolled in a PhD
|
19 (33.3)
|
Completed Research Master’s & enrolled in PhD
|
1 (1.8)
|
Completed Research Master’s
|
1 (1.8)
|
Completed PhD
|
27 (47.4)
|
Completed Research Master’s & PhD
|
1 (1.8)
|
Type of Health Service
|
|
Public
|
52 (91.2)
|
Private
|
5 (8.8)
|
Paediatric
|
8 (14.0)
|
Adult
|
33 (57.9)
|
Mixed paediatric and adult
|
16 (28.1)
|
Metropolitan
|
52 (91.2)
|
Regional
|
5 (8.8)
|
Years in profession
1–5
6–10
11–15
16–20
21–25
More than 25
|
3 (5.3)
11 (19.3)
11 (19.3)
11 (19.3)
13 (22.8)
8 (14.0)
|
Years in current role
1–5
6–10
11–15
16–20
|
28 (49.1)
21 (36.8)
5 (8.8)
3 (5.3)
|
A subgroup of 18 participants replied to the respondent validation email. Of these, 14 confirmed that the themes as written reflected their experiences, and four offered minor clarifications or further comments. No themes were changed as a result of the respondent validation, however three of the participants’ comments resulted in additions to the descriptions of the themes, providing further information or counterpoints. These are specifically identified in the text.
Thematic analysis
The thematic analysis resulted in 6 non-hierarchical main themes with a total of 14 subthemes. The 6 main themes are represented diagrammatically in Fig. 1, and consist of: (1) Clinician researchers prefer roles which are embedded in health services; (2) Current opportunities for clinician researcher roles in health are insufficient; (3) There are deficiencies in the pathway for clinician researcher careers; (4) Clinician researchers are not always valued or incentivised by health services; (5) Consequences of the current career challenges; and (6) The clinician researcher career path has been improving and there is hope it will continue to improve. Each of these six themes and their subthemes are described in more detail below, and are supported by the exemplar quotes within Table 2.
Table 2
Exemplar participant quotes for each subtheme
Theme
|
Subtheme
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Exemplar Quotes
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Theme 1: Clinician researchers prefer roles which are embedded in health services
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1.1. Clinically active researchers would prefer to maintain links to clinical practice
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“I'm a clinician first. And research for me needs to be clinical and at the forefront. ... I guess it's the patient that drives me, not the research.”- P33
“The reason that I want to stay in health is because I love seeing patients, that's what I find really motivating” -P10
|
1.2. Clinician researchers are most effective when embedded in healthcare settings
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“I feel like health has the huge advantage of you're where the action's happening, you know what the issues are and why they're an issue because either you're a clinician on the ground or you go to the meetings where they talk about the pressures of the health service.”- P1
“I really believe that the health service based researchers are in a much better position to have an impact on the people for which the research is designed to help. They are in a much better position to create change in the health system, to translate research into practice, to have a beneficial impact on the community”- P20
|
1.3. There are a variety of preferences for combining clinical and research components within a position
|
“I think having some accepted clinical time to do some research within a clinical space, I think would be sort of what I class a dream position.”-P44
“I'd happily just do a one day a week clinical role. And then a day a week considering some of that research capacity building and then three days is actually doing your hands on research”-P3
|
Theme 2: Current opportunities for clinical researcher roles in health are insufficient
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2.1 Combined clinical practice and research positions are not readily available
|
“There's pockets of research positions [in health services]. But there's so few and far between.”-P41
“Not from my discipline I don't see that… it's still quite a segregation. It's not an integration within the one role.”-P22
|
2.2 Clinician researchers often have to make their own job opportunities
|
“It's all accidental or people creating their own opportunities to be honest…It takes a lot of drive, passion and commitment from the clinician to create the opportunity.”-P30
“I think it's often people just model it together themselves, and then departments have been really flexible and accommodating the individual people, as opposed to being seen as a standard way of being professional and within the department potentially.”-P45
|
Theme 3: There are deficiencies in the pathway for clinician-researcher careers
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3.1 Research expectations of different levels are unclear
|
“People have said, just make sure it's not taking up all of your time. But how much time is too much time? Like, is an hour a week too much? Is that enough? I don't know.”-P2
“It's very specific to me as a person that there's an expectation that I continue on [with research], …but there’s not an equitable approach to that across the senior staff…. across the service, there's different expectations of that same senior level.”-P13
|
3.2 There is an absence of dedicated clinician researcher career structure in health
|
“There hasn't been a career structure to step into. You're either a researcher or you're a clinician or you're a manager. It doesn't feel at this point [Allied Health disciplines] support any other kind of role description or role type”-P15
“I can't see a pathway or structure unless you create that pathway … I don't know that there is a pathway that goes ‘We recognize you as a clinician and we also recognize you as a researcher, and we'll promote that’.”-P21
|
3.3 Opportunities for progression are limited in current awards
|
“If you are looking at career progression, I've probably progressed to the point where clinically and even from a research perspective, that's as far as it's going to go... So I guess you'd just be traveling horizontally with a greater research component.”-P39
“At the university you can progress with your career. You can apply for an associate professorship and a professorship. It's not dependent on "Oh sorry, we've already got eight professors we can't have another one". It's not dependent on roles, it's dependent on you and your achievement”-P5
|
3.4 The career pathway has gaps at some levels, particularly post-PhD
|
“You do definitely I do feel quite different post PhD, because when I was doing my PhD, it was just so much focus on this is the next goal, this is the next milestone. And then when you get your conferral, you'll just resume your normal clinical job. There is a real ‘Well What next? What next?’”-P13
“When I started my PhD, I was going in it with rose colored glasses and thinking, ‘oh, there can be all these opportunities for me with my career once I've got a PhD’ and I'm actually finding that's definitely not the case”-P28
|
Theme 4: Clinician researchers are not always valued or incentivised by health services
|
4.1 Recognition and value of research experience in recruitment is variable
|
“I think it depends on who's doing the recruiting… my feeling is that it's patchy. That in some places someone's research capability does get considered as part of a role description. But in other parts its more lip service paid to that.” -P36
“I think there's not a lot of incentive for people to do things like research higher degrees or research in terms of, for example, [senior/advanced level] job descriptions. Having a research higher degree is advertised as being desired, but it's not essential or I don't know that it's given any additional weight.”-P10
|
4.2 Clinical research opportunities are generally less well paid and less stable than clinical roles
|
“If I went into a research position, I'd have to take a downward slide. And so, for me, it's better from a career point of view as well as a financial point of view to stay where I am and do research on the side.”-P24
“There are few research positions I'm aware of in Queensland Health that are substantive, full time, not defined by a three year grant or a three year contract.”-P5
|
4.3 The role of clinician researchers is not always valued and enabled in health services
|
“I'm not entirely convinced [research is valued]. But the health service is always happy to take the glory of the number of papers published and the number of posters …So they're happy to take the glory, but not always happy to support it.”-P34
“There are the exhausting, ongoing issues within the system of health, that really are barriers to research … one example is the issues around restricting travel for researchers…That results in that perception of researchers not being valued. So the work that they're doing is not valued.”-P20
|
Theme 5: The current career challenges impair the viability of clinician researcher careers
|
5.1 Clinician researchers either leave health services to work in academia or become clinicians with little opportunity to do research
|
“They end up universities and I know a couple, maybe one person, has gone back to clinical work because they didn't like research. So I guess that kind of defeats the purpose of having someone have it PhD in hindsight.”-P40
“If I'm going to want to continue my career in research, I either have to go back to being a clinician and do it in my own time or leave and go to a university.”-P28
|
5.2 Clinician researchers are unable to use their full skillsets, negatively impacting both research and patient care
|
“I spent 20 years doing clinical before I then started on my research career. And unless I'm still in clinical I feel as though 20 years worth of clinical expertise sort of gets wasted to some extent … if you're faced with having to choose between a research career or clinical career then one or the other is gonna lose out, you're not using the full array of your of your skill set.”-P15
“There is a lack of where do you go from here? Do I want to totally just lose the clinical skills that I've got and all the expertise in my allied health discipline, and become a researcher, or do I want to just have the title doctor and be a highly specialist clinician who uses evidence based practice but doesn't do any research. It's a bit of a tension.”-P15
|
Theme 6: The clinician researcher career path has been improving and there is hope it will continue to improve
|
|
“Five years ago, I don't feel that if I wanted to do research, I would be supported. I do feel like when I finish my PhD, I would be supported to do clinical research.”-P12
“I think things are progressing fairly quickly. So, I'm optimistic that I might get my dream job one day.”-P9
“I have started to see the trajectory go up over the last five years, and I'm aware of different strategies and plans that are in progress…it takes time for things to change and opportunities to develop. Its not like there's going be a huge amount of positions in five years, but I think there will be more opportunities over time.”-P7
“I think that culture is changing, these positions are starting to emerge. And they're starting to be developed to acknowledge the connection between research and clinical practice and to acknowledge those types of options as being really important. But I don't think it's easy. I don't think it's clear.”-P48
|
Theme 1: Clinician researchers prefer roles which are embedded in health services
The participants in this study, all of whom worked at least partially in a healthcare delivery setting, expressed a preference to continue to work in this type of setting. As P6 stated “I don't think I would look outside of health. That's where I am and that's where I'm going to keep going”. Within this theme there were 3 identified subthemes, explained further below and supported by exemplar quotes in Table 2. The first two pertain to the reasons for this preference to remain in these roles and the third describes the nature of the preferred roles.
Subtheme 1.1: Clinically active researchers would prefer to maintain links to clinical practice
When discussing their preference to stay within health services, participants who were clinically active spoke about the personal fulfillment of working with patients and engaging their clinical skills. Many identified strongly with being a clinician and did not want to lose that identity or feel they were wasting their skills by leaving their clinical role. They spoke about the joy they found in their clinical work, and that their interest in research was often secondary to, or driven by, their patient work. As a consequence, many stated they would not consider working in another setting such as a university. For others, they stated they would consider working in a university setting, but this was either not preferred, or would need to be combined with a part-time role in healthcare. It was also noted by a few participants that roles in health other than direct patient contact, like clinical education or applied research, could be sufficient to help maintain their feeling of connection to clinical care. As P21 described “Even if it's not specifically clinical practice, it would be very close proximity to clinical practice, so you really understood what happens on the ground.”
Subtheme 1.2: Clinician researchers are most effective when embedded in healthcare settings
A complementary reason for the preference to work within health services was the value that clinician researchers felt being embedded in a healthcare delivery setting brings to their research, patients and the community. P21 asserted that “having a proximity to patients and clinical care, and the value that has in research and that translation of knowledge is really important.” Participants felt that by being embedded in the healthcare setting they were able to identify research questions which were most important to practice. Most importantly, they emphasised the value that having a clinician researcher role brought to translating research into practice.
Participants also stated that their knowledge of the health service meant they were able to design research which was more practical to conduct in this setting, which some felt was lacking in academia-generated research. Some participants, like P40, also felt their role as a researcher also enhanced their role as a clinician- “I think doing research makes me a better clinician as well”.
Subtheme 1.3: There are a variety of preferences for combining clinical and research components within a position
While participants expressed a clear preference for continuing to work in clinical research roles in healthcare in Subthemes 1 and 2, they had a wide variety of preferences of what their ideal position would look like. When asked specifically to identify a “dream role”, a common pattern of response was for a balance between research and practice, ranging from primarily clinical roles with a small amount of dedicated research time embedded, through to majority research roles with an opportunity to keep up clinical skills. Some participants felt an ideal position would include other roles like research capacity building, clinical education, teaching, and management. There were mixed opinions of whether each component should be flexible or should have a dedicated FTE associated with it (e.g. 0.4FTE research, 0.6FTE clinical). On the whole, participants emphasised the importance of having some level of university linkage within positions, but did not have a strong preference for the level of this linkage (e.g. conjoint, adjunct, informal links).
Theme 2: Current opportunities for clinician researcher roles in health are insufficient
In Theme 2, participants spoke about how current opportunities for clinician researcher roles in health are insufficient, especially in light of the demand described in Theme 1. As P1 stated “There's just not many opportunities in health to have a position where research is your job”. Under this theme, the lack of available roles forms the first key subtheme, and the resulting need for clinician researchers to make their own job opportunities is the second subtheme. Further quotes supporting these subthemes can be found in Table 2.
Subtheme 2.1: Combined clinical practice and research positions are not readily available
In this subtheme, participants felt that integrated clinical practice and research positions were very rare, and some stated that their preferred role did not currently exist. Many also felt the availability of positions was better in some states (i.e. Queensland), in urban regions, or within specific departments of their own health service. For example P53 said "I don’t think such a job exists in Western Australia", and P17 noted during respondent validation that finding such positions was “impossible” in rural and remote areas. Some clinician researchers also felt that the positions that were available were not always desirable to them, as they were often focused on research capacity building or joining an established project. P23 said “I don't know of any roles like that…where you can do your own research ideas…I would only want to do research if it's something that I'm interested in, and I can see a benefit from.”
Subtheme 2.2: Clinician researchers often have to make their own job opportunities
Clinician researchers also felt that because combined roles were not readily available, as outlined in subtheme 2.1, it was left to individuals to create their own opportunities. Most clinician researchers “cobbled together” (P11) their roles informally through multiple part-time positions or acquisition of highly competitive grant funding. Participants noted that individuals had to be highly driven and self-motivated to achieve this. As P19 noted “if a clinician does want to do research, it has to be working extra hours in their own time to submit grant applications. There's certainly management support for once a grant application is approved…but in that preparation phase there's no support.”. P5 noted that the constant need to both negotiate release from clinical duties and seek out funding to support their own research position “take(s) away from delivering on actual research”.
Even where true combined clinician research positions existed, participants felt that they were often created ad hoc simply because of the passion of one individual, enabled by interest from their manager. This had negative implications for sustainability and succession planning, as P33 noted “Because people themselves have made them … [the positions] are there because of the person who's in them, more than they're there for someone to work their way into”. Furthermore, when clinician researchers are unable to secure their own opportunities, they often ended up pursuing research in their own, unpaid time. As P4 said (with a sarcastic tone) “[Opportunities exist] if you don't like sleep, and you are happy working nights and weekends, which is how people do it at the moment”.
Theme 3: There are deficiencies in the pathway for clinician researcher careers
In the third main theme, clinician researchers discussed the lack of clear career structure and pathway for progression for research in health services- “I wouldn't have said at the start that I felt there was a structure that I could aim for” (P14). This had negative implications for career outcomes, as P28 outlined “I actually feel like [reducing clinical load to do research] almost hindered my career progression, because there is not yet that clear research pathway.” There were four different issues which contributed to the perception of an unsatisfactory career pathway, detailed in the subthemes below, and further supported by quotes in Table 2.
Subtheme 3.1: Research expectations of different levels are unclear
One of the ways in which the interviewees perceived the career pathway as deficient was a lack of shared understanding of what is expected of different levels of the existing pay structures in health. This applied to both determining the level of pay for research-focused positions, but also research expectations for primarily clinical roles. These expectations were sometimes linked to the person who occupied the role, rather than being a consistent expectation of clinicians at that level.
Subtheme 3.2: There is an absence of dedicated clinician researcher career structure in health
Participants noted there was an absence of shared understanding of career structure for clinician researchers in health services to help guide their progress and career planning. They noted that there is a clear structure for clinicians (e.g. graduate, junior, senior, advanced, leadership), and for researchers in university settings (e.g. Research Fellow, Senior Research Fellow, Associate Professor, Professor). Participants noted that neither structure maps directly to clinician researchers, who might have less clinical and research experience at each level as a consequence of pursuing both skillsets.
Subtheme 3.3: Opportunities for progression are limited in current awards
Some noted that current awards in health services typically do not allow progression through promotion, and instead rely on positions becoming vacant. This was highlighted by P35, who expressed frustration that “there's no way for me to go to a [higher level position] in the future, without those positions becoming vacant”. This was expressed as a limitation in the career structure for research, especially contrasted with university systems which often allow staff to apply for a change in level based on experience. This barrier to career progression is compounded by the fact that many participants were already in senior or advanced roles, and a ceiling effect in Allied Health in general.
Subtheme 3.4: The career pathway has gaps at some levels, particularly post-PhD
A common issue raised by participants was a gap in the career pathway for clinician researchers directly after completing a PhD, when there was limited direction or opportunities. P13 captured this by saying that after PhD conferral “there is a real ‘Well what next? What next?’”. There was a strong feeling that many get “lost” from a clinician researcher career at this point due to this gap. Participants pointed to a lack of postdoctoral type roles within health services, and a lack of suitability of postdoctoral roles available in universities for people who want to maintain a clinical or health service role. This was despite the fact that more AH clinicians are undertaking PhDs.
Gaps were also identified at other levels. Some participants felt that while there were currently reasonable opportunities to get involved in research for entry level clinicians, there were very few actual positions with a substantial research component at this level in health services. P33 referred to entry level roles, saying “even from the beginning, the pathway is not there”. Participants also occasionally noted a lack of higher level roles in the health service, for example between senior research fellow and Professorial level.
Theme 4: Clinician researchers are not always valued or incentivised by health services
The fourth theme identified was that clinician researchers felt that their career path was not always incentivized or valued in health services in terms of career opportunities, support and progression. While some participants noted that they were incentivised and valued in specific teams and by specific managers, they usually did not feel that this was the norm across health services. P1 outlined this by stating “I think it is [valued]. But again, I think it that depends on who's in [the position] at the moment, and also who the manager is at the moment…If someone else came into my manager's job and said “I don't really care about research”, I wouldn't really have the opportunity”. This theme had 3 subthemes, with additional quotes supporting these found in Table 2.
Subtheme 4.1: Recognition and value of research experience in recruitment is variable
As noted in Theme 3, participants expressed the opinion that the only way to progress a career in health services is to apply for higher level roles. Clinician researchers felt that the value of their research experience in the recruitment process varied between health services, and often “depends on the manager, what they value the most” (P40). In some settings, research experience was not considered relevant to career progression in health. In other settings, research experience was considered valuable for progression to higher levels, but was nevertheless rarely considered necessary. As P12 said “People value [PhDs] in academic worlds, but not in the hospital system. It doesn't help you get a job.”
However, there were other less traditional benefits to having research experience for jobseeking. Clinician researchers often felt that their research experience had opened up alternate career pathways, often in terms of lateral moves rather than progression. P32 said “I definitely feel that the research skills have been the big selling point for me to leverage off to be able to move laterally”. A key driver of these opportunities was that research often enabled networking with high level staff in health services. Participants also believed the transferable skills (e.g. project management and critical thinking) they had gained would be valuable in a range of positions, but also felt that this was not always recognised in the hiring process.
Subtheme 4.2: Clinical research opportunities are generally less well paid and less stable than clinical roles
Another factor contributing to Theme 4 was the fact that in general, clinical research positions were considered less desirable than clinical roles. Pay was considered to be sometimes inferior, especially for university administered roles. While roles administered through the health service were generally in line with clinical salaries, many of the positions or options for combining research with clinical practice were less stable (i.e. grant funding, contract positions). Some participants felt that the unique skill mix of clinician researchers was not reflected in pay level, as their amount of experience was compared unfavourably to either full-time clinicians or researchers. As P10 outlined “You almost shoot yourself in the foot in both camps, because you're not doing either one full time.”
In particular, participants noted the significantly reduced income from a clinician salary to a PhD stipend as a disincentive for pursuing research. Research degrees were not seen as a sound financial investment as there was not a corresponding pay increase in line with the skills gained. Many participants mentioned that although they didn’t pursue research for financial reward, they often felt disappointed in the lack of financial incentives. P12 said “We don't do things for the money, but it actually is still nice to see career progression and just move and progress, that whole idea of just building and moving and not being stuck.”
Subtheme 4.3: The role of clinician researchers is not always valued and enabled in health services
The final element that contributed to Theme 4 was that some participants had the perception that there were considerable barriers to succeeding in their clinician researcher roles in health services, linked to a perceived lack of value by the health service. Some participants felt research was greatly valued in their department, some felt it wasn’t valued at all, and some felt it was given a superficial value but true support was lacking. This had significant impact on career satisfaction and incentivisation to continue a research career in health services. Barriers as straightforward as not being able to travel internationally (without substantial paperwork and processes) to present research, or not being allowed to use grant money due to lack of backfill were frustrations that contributed to a general feeling of their role not being valued or supported. A few clinician researchers even described feeling “guilty” for taking time to do research, and that colleagues saw this as failing to help with clinical loads.
Theme 5: The current career challenges impair the viability of clinician researcher careers
Despite a desire for clinician researcher careers, the lack of extrinsic drivers outlined in the Themes above (i.e. lack of jobs, unclear career structure and lack of career incentives) meant that many participants felt that maintaining a clinician researcher career was difficult. As P3 stated “I just really value doing research at a clinical site. But how long I can do that in the current environment is a constant unknown”. The outcome of this was that clinician researchers often had to divert towards either academia or clinical practice (Subtheme 5.1), which was seen as a waste of their skillset and a loss for health services (Subtheme 5.2) (see Table 2 for further supporting quotes).
Subtheme 5.1: Clinician researchers either leave health services to work in academia or become clinicians with little opportunity to do research
While all participants were currently engaged in research in a health service, they often spoke about the difficulty of maintaining this dual role. Participants described seeing other clinician researchers leave their health service or stop engaging in research, and felt this was a possible outcome for them. As P10 stated “You're either a clinician or you leave to go work at a university”. They spoke about colleagues who had left the health service for a university setting, as it was the only viable way for them to engage significantly in engage in research. Other colleagues, even those who had completed a PhD, went back to entirely clinical roles, sometimes attempting to pursue research in their own time, which was associated with reduced morale. In the respondent validation, P5 noted that she had already left health services for a university role since her interview, primarily because of the lack of stability of her position.
In a few cases, participants spoke of more positive outcomes, but acknowledged this was rare. For example P55 mentioned “In the hospital network I work in, most of them do come back [after PhD], and most of them are clinicians as well. Which is why I think I'm really lucky because, for me, that is my ideal. But majority of the time, I don't know that that happens”.
Subtheme 5.2: Clinician researchers are unable to use their full skillsets, negatively impacting both research and patient care
As a result of Subtheme 5.1, participants felt that the unique combined skillset of clinician researchers was being lost, as P15 outlined “if you're faced with having to choose between a research career or clinical career then one or the other is going to lose out, you're not using the full array of your skill set”. This was seen as a negative outcome for both research and patient care. It was felt that moving into a full time research position was a waste of clinical skill that was often quite advanced, while returning to a full time clinical role was seen as not utilizing research skills that were often quite demanding to acquire in the first place.
Theme 6: The clinician researcher career path has been improving and there is hope it will continue to improve
The final theme was a singular issue, re-occurring through many interviews, and related to hope for the future. While many participants felt that the current situation for clinician researcher careers was poor, they also felt this was improving. Many participants stated that they had personally seen the situation improve, especially in the past 5 years. They felt that in this time, more jobs had become available, research had begun to become an accepted part of clinical roles, and research skills were more valued in the career structure. Participants were cautiously hopeful this positive trend would continue into the future, but acknowledged the pace of change was likely to be slow, especially when it came to formation of new positions.
On the other hand, some participants also expressed skepticism and frustration at the slow pace of change, like P51 who said “I can't help but have that pessimistic voice on my shoulders saying…I've seen this go in a cycle, both in Australia and New Zealand, and not a lot of change occurring.” During respondent validation, P17 also noted that sense of hope may be affected by location, saying “I have not seen evidence of [hope] in rural and remote health services.” A sense that things will improve was seen as vital for current clinician researchers’ morale, as P7 said “I think you need that little sense of hope of a good outcome. Otherwise, some of us would just drop the whole research thing and look for a different career altogether.”