By Sumedha Gupta and Preeti Pushpalata Zanwar
Economics as a discipline has always stressed the value of causal inference. In other disciplines such as health services research, however, descriptive papers and associations are valued and published more than in economics. By working in these other disciplines, health economists have opportunities to broaden their research, collaborations, and audience. Since health economists trained in the economics style of writing may initially find writing for peer-reviewed publications in health services research costly, (health services researchers may feel the same about economics journals) requiring additional investments of time, effort and even journal publication fees – we may wonder why health economists are increasingly pursuing health services research and vice-versa. Here are some considerations for why it may be worthwhile to pursue dual identities of being a health economist and a health services researcher, and some ways to do it successfully.
Why it may be helpful to be a health economist and a health services researcher?
Shared research interests – Perhaps the most obvious reason to concurrently pursue research programs in health economics and health services research is that health economists and health services researchers are often interested in answering similar research questions, sometimes even using similar types of secondary data, and similar research methods (albeit with different terminology, for example, interrupted time series analysis and regression discontinuity designs). So, the fields are less distinct to begin with from a topical perspective. Health services research closely mirrors epidemiology and econometrics in terminology and approaches (e.g., linear regression vs. OLS, difference-in-difference vs. pre-post design).
Speed of publishing – Most health economists publishing in health services research journals appreciate the shorter peer-reviewed health-services-research journal format as compared to those in economics, which allows for faster publication timelines. Getting some ‘quicker’ publications may help establish research productivity, for instance, for promotion and tenure (P&T), if the department criteria give credit for HSR publications, which may allow health economists to continue pushing on some longer format economics studies over a longer period. The shorter HSR publication timelines may sometimes protect the researcher from getting ‘scooped’, and help the researcher establish themselves as an expert more quickly in an area of research. Since many health economists are increasingly in non-economics departments, having a longer publication list, even if with many authors, may in fact even be an expectation for P&T.
High impact of health services research journals – Several leading HSR journals have higher impact factors than many economics journals and a wide readership. Publishing in these venues may help researchers become more widely cited, improve their scholarly status among policy makers and other stake holders, and may even help the researcher buffer their P&T dossiers with metrics like ‘impact factor’, ‘citation score’, ‘h-index’, and ‘altimetric’ measures, which may more easily convey scholarly impact to non-economics school- and campus- level P&T committee members, who may otherwise not adequately appreciate economics publication norms.
Support grant activity – Peer-reviewedHSR journals, with their shorter publication timelines, and high impact factors may be ideal for health economists to publish their ‘preliminary study data’, which will significantly bolster their external grant funding applications. Additionally, the shorter-format HSR publications still leave scope for additional innovations that can be proposed for future analysis or investigation in grant applications. In contrast, the longer format economics studies are often more exhaustive and with longer publication timelines, potentially making the study findings feel ‘obsolete’ to grant reviewers or funders and leaving less scope for additional future contributions, which may negatively impact fundability.
Collaborative – Funders often also value multidisciplinary research teams, with a successful collaboration record. But collaborations with other health services researchers may occasionally require publishing in journals that may be more valued in your collaborator’s field than in health economics. It is common for HSR researchers to be physicians and other clinicians, who may prefer publishing in medical journals. Initially there may also be a bit of a learning curve in writing for a HSR, medical, or public health audience, but collaborations with HSR researchers with shared topical interests but different disciplinary training can broaden the scope of the research, sometimes help make ‘novel’ contributions to the health economics literature, and is almost always fun.
When to become a HSR along with being an economist?
Even for economists trained/based in economics departments, HSR scholarship is just another research skill, which can be learnt with practice and time. So, if health services research is for you, it is never too early to start. However, an important consideration for early-stage faculty may be department criteria, for instance, for P&T. Many economics departments do not give (equal) credit for non-economics publications. Other departments may only value first, second or last author publications when it comes to P&T, despite science being very much a team sport. Economists are seldom the sole authors on publications.
Since building a health services research program may be somewhat costly in the beginning, it is important to know whether your department will give you adequate credit for these publications, in fields outside of economics, and potentially with many co-authors. Due to other advantages (e.g., benefits for grant activity or increased overall research productivity noted above), you may still choose to concurrently pursue HSR scholarship or vice-versa; those trained as HSR/epidemiologists may purse economics scholarship. But knowing how your HSR scholarship will be valued by your institution will allow you to make informed decisions about how to best split your effort between your economics vs. HSR research program. It is not uncommon for economists to actively pursue a health services research program only after tenure.
How to be a health services researcher, while being an economist?
Culture of multidisciplinary collaborations; PI’ship in economics vs HSR – While no single discipline comprises health services research, HSR publication culture is reminiscent of that in medicine. Cultural differences may be important, especially for early-stage health economists looking to document their significant/ lead contributions in their published research. HSR studies often include a large team of co-authors (especially compared to economics, despite some recent increase in the average number of coauthors on health economics publications), and the (junior) economist may not receive the coveted lead authorship. Therefore, early conversations about effort contribution and co-authorship ordering in a study are common in HSR teams and allow researchers to appropriately allocate their effort. Agreeing on authorship ordering at the start of a study, before significant contributions and progress has been made, is atypical to economics and may feel uncomfortable, but can be important and is a common practice for health services researchers. The guidelines for order of authorship for HSR/medical journals follow ICMJE guidelines, which help protect the junior scholars and help give credit where it is due.
Academic writing for Economics vs HSR – Quick literature reviews, for instance using PubMed, can be helpful to identify HSR journals that may be interested in publishing on topics in your research area. Alternatively, following HSR publication venues of other economists in your research area may help identify suitable HSR journals for your study. Much like economics journals, HSR journals have published author guidelines. Familiarizing yourself with publication guidelines, for instance, permissible word limit (typically much smaller, like 3000 words) and number of exhibits, for your target journal will help you make critical decisions about the scope of your study and what results belong to the main manuscript versus being placed in an accompanying online appendix.
The writing style for HSR journals also differs in significant ways from academic writing in economics. In addition to tighter limits on permissible text length and the number of exhibits, sections in HSR articles, for instance – Introduction, Methods, Results, and Discussion – are much more clearly demarcated, in the sense that a study finding may not be mentioned in the Introduction or even a small data detail may not be introduced in the Results section. Reviewing published articles on related topics in your target HSR journal could be helpful for stylistic inspiration. Also, starting your HSR journey in collaboration with a helpful and experienced dual economist-health services researcher may ease the learning curve.
Attending and participating in HSR and Economics conferences is also a good way to help identify and network with journal editors and collaborators. For example, AcademyHealth hosts an annual health services research annual scientific meeting, and has had a designated session on meet/greet/ask questions with editors for Health Services Research, Health Affairs, and JAMA.
In summary, collaborations with HSR and economists is win-win as it can expand the scope of your work and also your grant portfolio, allowing more opportunities for jobs, job security, impact and innovation.