- Email: [email protected]
Cut to the Bone
Cut to the Bone Congress Slashes NIH Investigator Salary Cap
by LEE CEARNAL Special Contributor to Annals News & Perspective
A
reduction in the salary cap for principal investigators working on grants from the National Institutes of Health (NIH) has research institutions concerned not just about covering the cut but also larger questions on the future of medical research. “I think it’s the whole landscape that’s really scaring folks,” said Heather Offhaus, MA, of the University of Michigan Medical School. Researchers already see huge increases in the number of grant applications, grants being funded at 80% or less of the requested amount, flat federal funding 4 years in a row, a biomedical research inflation rate that is that of the consumer price index, and, scariest of all, the possibility of a 7.8% whack in the NIH budget on January 1 if Congress doesn’t strike a deal in the sequestration fight. For the last 2 decades, the salary cap had been set at Executive Level 1 on the federal pay scale. But on December 23, Congress cut it to Level 2, from $199,700 to $179,700. A $20,000 reduction in 1 line item of a 6- or 7-figure grant might not seem that drastic. But the cost across multiple programs can be substantial, especially considering that physician-researchers’ compensation is already being supplemented from other institutional sources. “The old number cut into the muscle,” said Katherine Heilpern, MD, chair of the Volume , . : July
Department of Emergency Medicine at Emory University. “This number cuts through the muscle and into the bone.” At Massachusetts General Hospital, which gets more NIH funding than any other institution (about $300 million), the effect “might be somewhere between 1 and 3 million dollars” and affect “sev-
eral hundred researchers,” said Harry W. Orf, PhD, senior vice president for Research Management. At Michigan medical school, the cap reduction should cost “just over $2.5 million a year,” said Offhaus, director of the Grant Review and Analysis Office, because “base salaries are guaranteed at our institution and are not dependent on federal funding.” But Dr. Orf said it’s not just the money; it’s the message: what does the cap reduction say to young MDs considering a research career? At Mass General, he said, the ratio of MDs to PhDs is “probably 3 or 4 to 1.” Heilpern said about 80% of the research
in her department is directed by emergency physicians. (Nationwide, NIH says, about 30% of principal investigators hold an MD or an MD/PhD degree, and that proportion has been steady for 25 years.) “The clinical researchers, the physician-scientists, are the breed that really leads innovation in translational research and translational science, making new discoveries and bringing them into the health care system,” Dr. Orf said. Indeed, part of this year’s NIH budget is going to set up a new bureaucracy: the National Center for Advancing Translational Sciences. Heilpern said, “That’s why that announcement about the cutting of the salary cap really confused me because it seemed to fly in the face of a very important direction that the NIH has taken. By diminishing the cap on the salary, we have really cut off our nose to spite our face.” If making up for the salary cap were the only problem, researchers could cope with it. It’s not. “We are seeing mostly 18% cuts” in grant requests, Offhaus said. “When you get the award, NIH says to review it and make sure you can get the same amount done for the amount you are awarded.” When that happens, said John Younger, MD, MSc, associate chair for research at Michigan medical school’s Department of Emergency Medicine, you can cut people, pay them less, subcontract some work, and try to make more use of available institutional facilities and personnel. “But typically when it gets tight,” he said, “you throw your salary over first. It doesn’t mean you work less on the program; it just means you work for free on the program.” About 75% of Michigan’s research money comes from the NIH and other Annals of Emergency Medicine 19A
Top 20 NIH Rankings based on Grant Awards for the Department of Emergency Medicine. Federal Fiscal Year: 2011 NIH Data As Of: Dec 04, 2011 (Actual) Actual Rank 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
NIH Institution
Grant Amount (Count)
EMORY UNIVERSITY UNIVERSITY OF MICHIGAN AT ANN ARBOR UNIV OF MASSACHUSETTS MED SCH WORCESTER UNIVERSITY OF PENNSYLVANIA MOUNT SINAI SCHOOL OF MEDICINE OF NYU THOMAS JEFFERSON UNIVERSITY UNIVERSITY OF CALIFORNIA DAVIS UNIVERSITY OF ARIZONA UNIVERSITY OF PITTSBURGH AT PITTSBURGH OREGON HEALTH & SCIENCE UNIVERSITY WAYNE STATE UNIVERSITY UNIVERSITY OF ALABAMA AT BIRMINGHAM VANDERBILT UNIVERSITY INDIANA UNIVERSITY SCHOOL OF MEDICINE YESHIVA UNIVERSITY UNIVERSITY OF NEBRASKA MEDICAL CENTER MEDICAL COLLEGE OF WISCONSIN UNIVERSITY OF ROCHESTER UNIVERSITY OF CINCINNATI UNIVERSITY OF MARYLAND BALTIMORE
$9,513,122 (5) $7,369,516 (5) $4,201,592 (5) $2,894,560 (9) $1,182,647 (5) $904,635 (3) $791,852 (2) $693,566 (2) $667,317 $655,113 (3) $574,117 (2) $561,301 (1) $511,540 (3) $495,306 (2) $402,003 (3) $371,250 (1) $330,617 (2) $306,416 (2) $221,358 (2) $215,992 (1)
*
Please note this list captures only NIH funding awarded to the Department of Emergency Medicine. NIH funding that is awarded to other emergency medicine divisions (eg, Department of Surgery, Pediatrics, etc) is not reflected in these numbers. ** This listing is based on NIH posted GRANT information for the federal fiscal year. NIH has not released contract amounts since 2006. Subsequent years reflect 2006 amounts in the contract column as a means of estimating the final total. Therefore, the listing including contracts should be seen as a trend for the unit. In order to address the contract timing issue, the Medical School has opted to calculate rank based on grants only.
federal agencies, so the rest has to come from hospital revenues and private donors. “We are finding it harder and harder to find the money elsewhere,” said Offhaus. “We have hundreds of projects. We can’t afford to help all of them.” Whatever money is scraped together doesn’t go as far. As measured by the biomedical research index, Offhaus said, “our dollars today have the same buying power as 2004.” NIH also is no longer giving inflationary increases, Offhaus said. “So if you get $100,000 the first year (of a $500,000 grant), you’re going to get $100,000 every one of the 5 years.” And even that’s not a sure thing: “In coming years, the awards that we have are not exactly safe.”
20A Annals of Emergency Medicine
The NIH budget has increased from $17.8 billion in 2000 to $30.8 billion in 2012. In real dollars, funding has been pretty much flat for the decade. (NIH did get an extra $10.4 billion from the 2009 stimulus—$8.2 billion of which went for research funding— but such largesse is likely a thing of the past.) So, with NIH money getting tighter, can industry take up the slack? No, said Younger, because the pharmaceutical and medical device industries “are not very likely to go wandering off into areas early in their evolution. They are not going to pursue those things. They’ve got people to answer to.” Dr. Orf agreed, “They’re only going to invest in very targeted discoveries that are immediately reducible to a commer-
cial product, whereas the real innovation is taking place at a very fundamental basis of science.” Don’t expect much help from foundations and private donors. Their contribution to the total pool is comparatively small. Younger cited one example: grants from the Emergency Medical Foundation. “All the grants it gives out in a year, in total, are going to be less than the grants that are currently operating in my lab. . .. There’s no capacity for foundations to do the amount of work that’s really required.” All the researchers interviewed were worried about what all this means going forward. “People don’t do this for the money,” Younger said. “It’s not about that. But people will quit if it’s no longer sustainable.” Dr. Orf’s view is longer, and darker. “Biosciences will have the same dramatic impact on everyone’s lives this century that the physical sciences did in the 20th century,” he said. “The question is, will the United States continue to lead in innovation? If we don’t continue to lead in investment in innovation, then we will not be the ones to reap the benefits.”
Section editor: Truman J. Milling, Jr, MD Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). The author has stated that no such relationships exist. The views expressed in News and Perspective are those of the authors, and do not reflect the views and opinions of the American College of Emergency Physicians or the editorial board of Annals of Emergency Medicine. http://dx.doi.org/10.1016/j.annemergmed.2012.05.023
Volume , . : July
by LEE CEARNAL Special Contributor to Annals News & Perspective
A
reduction in the salary cap for principal investigators working on grants from the National Institutes of Health (NIH) has research institutions concerned not just about covering the cut but also larger questions on the future of medical research. “I think it’s the whole landscape that’s really scaring folks,” said Heather Offhaus, MA, of the University of Michigan Medical School. Researchers already see huge increases in the number of grant applications, grants being funded at 80% or less of the requested amount, flat federal funding 4 years in a row, a biomedical research inflation rate that is that of the consumer price index, and, scariest of all, the possibility of a 7.8% whack in the NIH budget on January 1 if Congress doesn’t strike a deal in the sequestration fight. For the last 2 decades, the salary cap had been set at Executive Level 1 on the federal pay scale. But on December 23, Congress cut it to Level 2, from $199,700 to $179,700. A $20,000 reduction in 1 line item of a 6- or 7-figure grant might not seem that drastic. But the cost across multiple programs can be substantial, especially considering that physician-researchers’ compensation is already being supplemented from other institutional sources. “The old number cut into the muscle,” said Katherine Heilpern, MD, chair of the Volume , . : July
Department of Emergency Medicine at Emory University. “This number cuts through the muscle and into the bone.” At Massachusetts General Hospital, which gets more NIH funding than any other institution (about $300 million), the effect “might be somewhere between 1 and 3 million dollars” and affect “sev-
eral hundred researchers,” said Harry W. Orf, PhD, senior vice president for Research Management. At Michigan medical school, the cap reduction should cost “just over $2.5 million a year,” said Offhaus, director of the Grant Review and Analysis Office, because “base salaries are guaranteed at our institution and are not dependent on federal funding.” But Dr. Orf said it’s not just the money; it’s the message: what does the cap reduction say to young MDs considering a research career? At Mass General, he said, the ratio of MDs to PhDs is “probably 3 or 4 to 1.” Heilpern said about 80% of the research
in her department is directed by emergency physicians. (Nationwide, NIH says, about 30% of principal investigators hold an MD or an MD/PhD degree, and that proportion has been steady for 25 years.) “The clinical researchers, the physician-scientists, are the breed that really leads innovation in translational research and translational science, making new discoveries and bringing them into the health care system,” Dr. Orf said. Indeed, part of this year’s NIH budget is going to set up a new bureaucracy: the National Center for Advancing Translational Sciences. Heilpern said, “That’s why that announcement about the cutting of the salary cap really confused me because it seemed to fly in the face of a very important direction that the NIH has taken. By diminishing the cap on the salary, we have really cut off our nose to spite our face.” If making up for the salary cap were the only problem, researchers could cope with it. It’s not. “We are seeing mostly 18% cuts” in grant requests, Offhaus said. “When you get the award, NIH says to review it and make sure you can get the same amount done for the amount you are awarded.” When that happens, said John Younger, MD, MSc, associate chair for research at Michigan medical school’s Department of Emergency Medicine, you can cut people, pay them less, subcontract some work, and try to make more use of available institutional facilities and personnel. “But typically when it gets tight,” he said, “you throw your salary over first. It doesn’t mean you work less on the program; it just means you work for free on the program.” About 75% of Michigan’s research money comes from the NIH and other Annals of Emergency Medicine 19A
Top 20 NIH Rankings based on Grant Awards for the Department of Emergency Medicine. Federal Fiscal Year: 2011 NIH Data As Of: Dec 04, 2011 (Actual) Actual Rank 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
NIH Institution
Grant Amount (Count)
EMORY UNIVERSITY UNIVERSITY OF MICHIGAN AT ANN ARBOR UNIV OF MASSACHUSETTS MED SCH WORCESTER UNIVERSITY OF PENNSYLVANIA MOUNT SINAI SCHOOL OF MEDICINE OF NYU THOMAS JEFFERSON UNIVERSITY UNIVERSITY OF CALIFORNIA DAVIS UNIVERSITY OF ARIZONA UNIVERSITY OF PITTSBURGH AT PITTSBURGH OREGON HEALTH & SCIENCE UNIVERSITY WAYNE STATE UNIVERSITY UNIVERSITY OF ALABAMA AT BIRMINGHAM VANDERBILT UNIVERSITY INDIANA UNIVERSITY SCHOOL OF MEDICINE YESHIVA UNIVERSITY UNIVERSITY OF NEBRASKA MEDICAL CENTER MEDICAL COLLEGE OF WISCONSIN UNIVERSITY OF ROCHESTER UNIVERSITY OF CINCINNATI UNIVERSITY OF MARYLAND BALTIMORE
$9,513,122 (5) $7,369,516 (5) $4,201,592 (5) $2,894,560 (9) $1,182,647 (5) $904,635 (3) $791,852 (2) $693,566 (2) $667,317 $655,113 (3) $574,117 (2) $561,301 (1) $511,540 (3) $495,306 (2) $402,003 (3) $371,250 (1) $330,617 (2) $306,416 (2) $221,358 (2) $215,992 (1)
*
Please note this list captures only NIH funding awarded to the Department of Emergency Medicine. NIH funding that is awarded to other emergency medicine divisions (eg, Department of Surgery, Pediatrics, etc) is not reflected in these numbers. ** This listing is based on NIH posted GRANT information for the federal fiscal year. NIH has not released contract amounts since 2006. Subsequent years reflect 2006 amounts in the contract column as a means of estimating the final total. Therefore, the listing including contracts should be seen as a trend for the unit. In order to address the contract timing issue, the Medical School has opted to calculate rank based on grants only.
federal agencies, so the rest has to come from hospital revenues and private donors. “We are finding it harder and harder to find the money elsewhere,” said Offhaus. “We have hundreds of projects. We can’t afford to help all of them.” Whatever money is scraped together doesn’t go as far. As measured by the biomedical research index, Offhaus said, “our dollars today have the same buying power as 2004.” NIH also is no longer giving inflationary increases, Offhaus said. “So if you get $100,000 the first year (of a $500,000 grant), you’re going to get $100,000 every one of the 5 years.” And even that’s not a sure thing: “In coming years, the awards that we have are not exactly safe.”
20A Annals of Emergency Medicine
The NIH budget has increased from $17.8 billion in 2000 to $30.8 billion in 2012. In real dollars, funding has been pretty much flat for the decade. (NIH did get an extra $10.4 billion from the 2009 stimulus—$8.2 billion of which went for research funding— but such largesse is likely a thing of the past.) So, with NIH money getting tighter, can industry take up the slack? No, said Younger, because the pharmaceutical and medical device industries “are not very likely to go wandering off into areas early in their evolution. They are not going to pursue those things. They’ve got people to answer to.” Dr. Orf agreed, “They’re only going to invest in very targeted discoveries that are immediately reducible to a commer-
cial product, whereas the real innovation is taking place at a very fundamental basis of science.” Don’t expect much help from foundations and private donors. Their contribution to the total pool is comparatively small. Younger cited one example: grants from the Emergency Medical Foundation. “All the grants it gives out in a year, in total, are going to be less than the grants that are currently operating in my lab. . .. There’s no capacity for foundations to do the amount of work that’s really required.” All the researchers interviewed were worried about what all this means going forward. “People don’t do this for the money,” Younger said. “It’s not about that. But people will quit if it’s no longer sustainable.” Dr. Orf’s view is longer, and darker. “Biosciences will have the same dramatic impact on everyone’s lives this century that the physical sciences did in the 20th century,” he said. “The question is, will the United States continue to lead in innovation? If we don’t continue to lead in investment in innovation, then we will not be the ones to reap the benefits.”
Section editor: Truman J. Milling, Jr, MD Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). The author has stated that no such relationships exist. The views expressed in News and Perspective are those of the authors, and do not reflect the views and opinions of the American College of Emergency Physicians or the editorial board of Annals of Emergency Medicine. http://dx.doi.org/10.1016/j.annemergmed.2012.05.023
Volume , . : July