**National Institutes of Health**

**NIH Town Hall Meeting on**

### NRSA Tuition Support 

### 

**Natcher Conference Center**

**Bethesda, Maryland**

**November 30, 2005**

**MEETING SUMMARY**

# 

# NIH Town Hall Meeting on 

# NRSA Tuition Support

National Institutes of Health

Bethesda, Maryland

November 30, 2005

# Meeting Summary

## 

## Introduction and Background

***Warren C. Jones, Ph.D.***

***Ruth L. Kirschstein, M.D.***

***Walter L. Goldschmidts, Ph.D.***

***Jeremy M. Berg, Ph.D.***

On November 30, 2005, the National Institutes of Health (NIH) held a
Town Hall meeting to hear comments and insights concerning possible
revisions to certain fiscal policies that govern the Ruth L. Kirschstein
National Research Service Award (NRSA) programs, which comprise
institutional training grants (T32, T34, and T35) and individual
fellowships (F30, F31, F32, and F33). The former are awarded to
institutions with faculty-led programs that select trainees, the latter
to individuals at a specific stage of professional development. The NRSA
programs have been operating since the mid-1970s. The open public
meeting focused primarily on the funding of costs such as tuition, fees,
and health insurance provided through institutional training grants
(T32). A videotape recording of the conference can be found at:
<http://videocast.nih.gov/PastEvents.asp>.

The need for training is self-evident, but it becomes ever more
important as the field of biomedical sciences expands and increasingly
encompasses the physical, mathematical, chemical, and behavioral
sciences. The growth rate of the biomedical sciences has been absolutely
staggering, yet the evolution of training support has not kept pace,
despite the quality of training grant programs and sustained (student
and faculty) interest. In hosting this Town Hall meeting, the NIH sought
a dialogue with stakeholders to discuss various options to sustain and
enhance training activities in a budgetary-constrained environment.

NRSA programs currently support over 17,000 pre- and postdoctoral
research training positions, and a majority of these are funded through
institutional training grants. The direct-cost funding of these grants
is segmented into four categories: (1) Stipend, which contributes to
living costs; (2) tuition/fees/health insurance (hereafter referred to
collectively as "tuition"); (3) trainee travel; and (4) training-related
expenses that are directly related to the training program such as
research supplies, administrative support, staff travel and consultant
costs. The funding levels of three of these (stipend, travel, and
training-related expenses) are stipulated by the NIH, although each can
be adjusted as fiscal circumstances and program needs evolve. However,
the funding of tuition is not prescribed by the NIH but is governed
instead by a formula tied to the amount that each institution requests
for this expense. The formula provides for each T32 trainee, annually,
the sum of \$3,000 plus 60 percent of the requested tuition in excess of
\$3,000. This level, once established for a given competing grant, is
used for the subsequent non-competing renewal awards during the project
period.

Prior to 1995, variations in tuition-reimbursement policies on NRSA
institutional research training awards existed across the NIH Institutes
and Centers (ICs). NIH made several attempts to develop a formal,
uniform tuition reimbursement policy across the ICs. A Task Force that
was assembled to consider the issue held a Town Hall meeting on June 5,
1995, to obtain opinions from stakeholders. More than 80 individuals
attended the meeting. The Task Force recommended an NRSA tuition
reimbursement policy based on a simple marginal rate mechanism paying
100 percent of education costs up to \$2,000 per trainee per year and 60
percent of costs above the \$2,000 base. On February 2, 1996, NIH
announced the NRSA Tuition Policy, which was implemented for competing
NRSA training grants in fiscal year (FY) 1996 and for competing
individual NRSA fellowships in FY1997. To partially offset additional
costs of family health insurance, on December 23, 1999, the NRSA Tuition
Policy was adjusted---beginning with the FY2000 awards---to pay 100
percent of education costs up to \$3,000 per trainee per year and 60
percent of costs above the \$3,000 base. Thus, the current tuition
reimbursement policy has been in place for 6 years and applies to
institutional training grants and individual predoctoral
fellowships.[^1]

Tuition reimbursement costs have been rising markedly, yet the available
T32 budget has been rising much less (Figure 1). In setting the T32
financial context, Dr. Berg reported that growth in training costs
mirrored the NIH doubling that ended in FY2003, but the numbers of
trainees less than doubled during this period because some of the new
funds went toward raising stipends as recommended in the 2000 National
Research Council report *Addressing the Nation's Changing Needs for
Biomedical and Behavioral Scientists
(*<http://grants.nih.gov/training/nas_report/index.htm>).

Barring other adjustments, the continuation of the trend in tuition
growth will result in a significant annual decline in the number of NRSA
trainee positions and programs supported by T32 training grants and
individual fellowships. Given the current period of limited budget
expansion, the NIH must re-examine aspects of its NRSA policies that may
not be sustainable. In the meantime, the NIH has frozen the tuition
expenses on competing renewals of T32 awards in FY2006 with new T32
applications continuing to receive funding to offset tuition, fees, and
health insurance costs utilizing the current formula. (See
<http://grants2.nih.gov/grants/guide/notice-files/NOT-OD-05-059.html>)

> Figure 1. NIH NRSA Budget Adjusted for Stipend Increases and Cost of
> T32 Tuition, Fees, and Health Insurance (T/F/HI)
>
> Note: Costs of stipends for all Fs and Ts were subtracted from the
> NRSA budgets. Stipend costs in FY2006 were assumed to be the same as
> in FY2005.

From various approaches for handling the funding of trainee tuition in
the future, NIH training officials presented three options for
consideration when the meeting was announced.[^2] Prospective
participants (and other interested parties) were invited to submit a
brief statement concerning these options by November 4, 2005:

1.  The current tuition formula could be applied in conjunction with a
    ceiling; the funds provided would be the amount dictated by the
    currently-used formula or the amount dictated by the ceiling,
    whichever is less. The magnitude of the ceiling would be based on
    the fiscal resources available as well as on applicable data. For
    the sake of discussion, those offering comments may assume the
    ceiling could be in the range of \$16,000 to \$18,000.

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1.  A fixed allowance could be provided for tuition; the same allowance
    per trainee would be provided to each grantee institution. This
    approach is employed by the National Science Foundation for its
    graduate research fellowship program. For the sake of discussion,
    those offering comments may assume the allowance could be in the
    range of \$16,000 to \$18,000. The allowance could be adjusted
    periodically by the NIH as fiscal circumstances warranted.

2.  The current tuition formula could be retained without modification.
    Those offering comments may assume that under this option the number
    of NRSA trainees and funded training grant programs will likely
    experience a series of year-to-year decreases as long as the current
    fiscal patterns prevail.

The NIH received statements from 25 individuals (20 from individuals at
academic and/or research institutions and 5 from individuals
representing associations and organizations), 17 of whom were able to
participate at the Town Hall meeting. A total of 106 individuals
attended the Town Hall meeting, including 56 participants from 35
academic institutions; 17 representing 11 foundations, associations, or
other entities; 4 representing other Federal agencies; and 29 from the
NIH. An additional eight individuals submitted comments but could not
attend, four of whom were affiliated with institutions not already
represented. See Table 1 for a summary of all statements received and
additional notes. (All submitted statements are available for review at
<http://pub.nigms.nih.gov/generic_meeting_upload/upload/supportingDoc1.pdf>).
A list of the members of the Organizing Committee is included as
Appendix 1.

## Summary of Public Statements

The following summarizes the oral presentations made during the Town
Hall meeting in the order presented.

***Linda A. Dykstra, Ph.D., Association of American Universities***

Dr. Dykstra spoke on behalf of the Association of American Universities
(AAU). Dr. Dykstra is Dean of the Graduate School and a professor in the
Departments of Psychology, Pharmacology, and Neurobiology at the
University of North Carolina at Chapel Hill. She is also President of
the Association of Graduate Schools (AGS), which is an organization of
graduate deans from AAU universities. AAU claims as members 62 leading
public and private research universities in the United States and
Canada, with considerable firsthand experience managing NRSA training
programs. Dr. Dykstra expressed great appreciation for her own training
and the central role of the NRSA awards in educating and training future
biomedical and behavioral research scientists and in contributing to the
preeminence of U.S. biomedical research and training. She noted that the
University of North Carolina at Chapel Hill currently holds 50 NRSA
training grants, supporting 183 predoctoral and 149 postdoctoral
fellows.

The AAU considers the NIH to have primary responsibility for supporting
the training of the thousands of biomedical researchers that the
academic, industrial, and Government sectors will need in coming years.
Until there is once again a favorable funding climate for NIH-supported
research and training, the AAU believes that the NIH should maintain the
current policy and scale the size of the Kirschstein NRSA program to the
resources available, even though such a course could mean fewer training
opportunities for future biomedical researchers. Dr. Dykstra added that
offering "flexibility" to rebudget tuition funds according to
institutional needs can help cushion the impact. Her full statement can
be found at:
<http://www.aau.edu/research/AAU_NRSA_Dykstra_Test_113005.pdf>.

***Jennifer Hyde, The Miriam Hospital, Brown Medical School***

Ms. Hyde is Divisional Coordinator, Division of Infectious Diseases at
the Miriam Hospital, Brown Medical School. She administers the T32 grant
(PI: Timothy Flanigan) that supports both pre- and postdoctoral fellows
at the Miriam Hospital. Ms. Hyde highlighted the benefits of fixed
amounts in teaching trainees fiscal management of grant monies. She
contended that adoption of Options 1 or 2 would address disparities in
the tuition line between private and public universities. She also noted
that her institution would rather impose a tuition cap than cut any of
the other three direct-cost categories of the NRSA awards.

***David M. Engman, M.D., Ph.D., Northwestern University***

Dr. Engman is Associate Professor of Pathology and Director of the
Northwestern Medical Scientist Training Program (MSTP). He highlighted
his own NRSA experiences, first as an MSTP NRSA trainee (1983 to 1985)
and then as a Genetics NRSA trainee (1985 to 1988) at the University of
Iowa. He has been a member of the Basic Research Training (BRT)-A grant
review study section for NIGMS since 2003, which has given him a broad
perspective on training grants at other institutions. He also currently
mentors graduate students supported by institutional and individual
NRSAs. Dr. Engman reported that, in discussions among training grant
directors, deans, and Provost at Northwestern University, the
overwhelming conclusion was that reductions in training dollars should
be avoided if at all possible and the integrity of these outstanding
training programs must be maintained. The proposed reductions to tuition
reimbursements are contrary to recommendations by the National Academies
and other agencies, and they undermine the Roadmap-oriented goals, which
are intrinsically inter- and multidisciplinary. The Federal Government
does not regulate tuition, and the cost of training a Northwestern
student far exceeds the amount provided by the NIH tuition allocation.
He observed in his role as MSTP Director and BRT Study Section Member
that well-run training programs provide incalculable added value, with
many spillover effects that ultimately promote integrated,
interdisciplinary research training.

On behalf of Northwestern University, Dr. Engman presented as an
alternative to the current options another approach: To modify the
current formulation to support a smaller percentage of tuition.
Institutions with higher tuitions might receive a smaller percentage
than those with lower tuitions, i.e., a graduated percentage
reimbursement. If no alternatives can be considered, then Northwestern
suggests a modified version of Option 3, with across-the-board cuts in
training positions. Each institution would handle the effect its own
way, and programs with a small number of trainees (e.g., four or five)
should be "protected" in recognition of the need for a critical mass of
trainees for a training program to be considered viable. If this
modified Option 3 is not acceptable, then Northwestern prefers Option 2,
to preserve the number of training positions without the financial
consequences of Option 1, and asks that the cap amount be reconsidered.

***Robert D. Simoni, Ph.D., Stanford University***

Dr. Simoni is Professor of Biological Sciences at Stanford University
and Director of the Stanford Cellular and Molecular Biology Training
Program, now in its 30^th^ year. He served on the 1995 Task Force to
consider the NIH tuition reimbursement. He also has benefited by
NIH-supported traineeships during graduate school. He described an
extraordinary partnership between NIGMS and Stanford's training program
that has helped over 200 trainees, at least 90 percent of whom remain in
research, many as leaders in the biomedical field. Because the shortfall
in tuition reimbursement for NIH grantees must be made up by non-Federal
funds, Stanford expects that requirements for higher university
subsidies will necessitate a reduction in the number of trainee slots
unless private sources of support can be found. Dr. Simoni identified a
number of consequences of what he termed "cost shift proposals,"
including a greater proportion of trainees at low-cost providers. He
advocated retaining the current policy and adjusting the tuition
reimbursement to compensate for tighter budgets. He also noted that
categories are fungible, such that the amount set aside for supplies or
research administrative needs can be rebudgeted to cover other research
training costs as needed.

***Joseph C. LaManna, Ph.D., Federation of American Societies for
Experimental Biology (FASEB)***

Professor Joseph C. LaManna, Professor and Chair of the Anatomy
Department at the Case Western Reserve University School of Medicine,
presented on behalf of FASEB, which represents over 60,000 experimental
biologists and 23 scientific societies. FASEB opposes reducing the NRSA
compensation and benefits and views such reductions as detrimental to
the recruitment of new scholars from a diversity of backgrounds to
biomedical research. Dr. LaManna argued to maintain stipends, tuition,
and health insurance support at the current level, but to separate the
health insurance from the tuition category to ensure that health
benefits are preserved if the tuition formula changes.

***Thomas Roberts, Ph.D., Harvard Medical School***

Dr. Roberts is Faculty Dean and Chairman, Division of Medical Sciences
at Harvard University. In favoring the capping of tuition to maximize
the number of slots, Harvard reasoned that such an approach would help
the Nation benefit from the incredible explosion of new research
possibilities now open, which calls for more trainees, not fewer.
Maintaining slots also will favor diversity both in the scientific
disciplines available for study and in the composition of students, and
will maintain U.S. competitiveness as foreign nationals become a
diminishing resource.

Dr. Roberts noted that, today, many of the best American students fail
to enter science, and foreign nationals see better opportunities in
their home countries. Even a small, symbolic decrease in available NRSA
positions could send a negative message to the next generation of
American scientists.

***Joan M. Lakoski, Ph.D., University of Pittsburgh Schools of Health
Sciences***

Dr. Lakoski presented on behalf of the Schools of Health Sciences at the
University of Pittsburgh, including the Graduate School of Public Health
and the Schools of Dental Medicine, Health and Rehabilitation Sciences,
Medicine, Nursing, and Pharmacy. The university's predoctoral training
programs support over 260 predoctoral students, 584 medical students,
and 88 M.D./Ph.D. students. The newest initiative is the Program in
Integrative Biology (PMB), which is designed to provide rapid immersion
into a research environment combined with mentorship to promote creative
thinking and independence. The university's commitment extends to
ensuring a successful transition to independence for more than 500
postdoctoral fellows, residents, and clinical fellows. Dr. Lakoski
requested that the current tuition formula be retained without
modification.

***Lasse Lindahl, Ph.D., University of Maryland Baltimore County***

Dr. Lindahl is Professor and Chair of Biological Sciences, University of
Maryland Baltimore County, and Director of the Minority Access to
Research Careers Undergraduate Student Training in Academic Research
(MARC U\*STAR) program, an undergraduate (T34) scholarship opportunity
aimed at increasing the number of individuals from underrepresented
groups who pursue Ph.D.s and careers in biomedical research or
mathematics. Dr. Lindahl noted a number of challenges for the U.S.
scientific community: The retirement over the next decade of significant
numbers of scientists educated in the1960s and the 1970s; the decline by
almost 20 percent of Ph.D.s conferred to U.S. citizens/residents from
1995 to 2003; the dramatic change in the demography of the U.S.
population over the next few decades; and increased competition from
overseas scientific communities. These challenges support the need for
maintaining or increasing training slots and boosting recruitment of
trainees from all population groups. Dr. Lindahl argued for the
reimbursement of 100 percent of the first \$5,000 (up from \$3,000) and
then 60 percent of the remaining tuition amount up to a cap of about
\$15,000 for each trainee. He saw this approach as providing some relief
for the "poorest" institutions, which include many public and
Historically Black Colleges and Universities (HBCUs) that contribute
significantly to fostering the next generation of scientists at both the
undergraduate and graduate levels of recruiting and training.

***Glen Gaulton, Ph.D., University of Pennsylvania School of Medicine***

Dr. Gaulton, Vice Dean, University of Pennsylvania (Penn) School of
Medicine, expressed profound concern regarding possible changes to the
tuition reimbursement policy and called for greater transparency in the
detailed analysis and cost projections that underlie the changes. He
also rallied organizations and individuals to educate the public and
politicians more thoroughly on the importance of biomedical research and
the unique role of the NIH, as well as to lobby effectively within the
NIH for an appropriate distribution and management of training and
educational support funds.

With respect to the proposed tuition reimbursement options, Dr. Gaulton
argued to retain the current tuition formula and to reduce the number of
NRSA training positions so that the amount of funding per trainee will
remain unchanged. In his view, any approach will ultimately lead to a
reduction in slots unless institutions can augment reductions with
internal subsidies. He favored the head-on approach, which he perceived
as maximizing NIH influence over quality and program direction. He noted
that 63 percent of the current costs for Ph.D. students in biomedical
science at Penn are borne by the University/School of Medicine and 21
percent by the NIH or other research grants, whereas only 16 percent is
provided by training grants. Thus, a substantial portion of the tuition
costs for graduate education (\$22,038 in FY2005, having risen on
average 4.1 percent over the past 5 years) are already borne internally.
Penn currently has about 650 Ph.D. students, with more than 300
predoctoral and 200 postdoctoral trainee slots. Dr. Gaulton requested
that any cuts in slots be made during the competitive renewal or new
award period rather than across-the-board. He further requested that the
NIH request justification for annual increases in tuition costs beyond
inflation and exercise its right to deny certain expenses found to be
unreasonable.

***Roseanne Ford, Ph.D., University of Virginia***

Dr. Roseanne Ford, Associate Vice President for Research and Graduate
Studies at the University of Virginia and Professor in the School of
Engineering and Applied Science, Chemical Engineering Department,
reported that the NRSA program supports 110 graduate students at the
University of Virginia, comprising about 20 percent of the biomedical
and engineering students. She indicated that shifting more costs to
universities is unacceptable. She stated that the most notable
implication of Option 3 is the loss of slots and that it is unclear how
the reduction in slots would be allocated. Across-the-board cuts in
slots would disadvantage small programs and could lead to less diversity
within programs and undermine the critical mass needed for a program's
viability. Given the downstream effects of Option 3 of fewer slots and
less diversity, Dr. Ford favored Option 2, followed by Option 1, as
providing most flexibility for programs.

***Alyson Reed, National Postdoctoral Association (NPA)***

As Executive Director of the NPA, Ms. Reed focused her comments
primarily on the issues that concern postdoctoral trainees, with less
consideration to predoctoral trainees. She pointed out that for
postdoctoral scholars, health insurance is the primary cost, not tuition
and fees. She therefore urged that the formulas for pre- and
postdoctoral trainees be reviewed separately and that the NIH provide
disaggregated data by type of expense (e.g., tuition, fees, health
insurance), and separate reimbursement for health insurance costs (which
is more outside of the institution's control) from tuition
reimbursements. She called for flexibility for institutions to enroll
their trainees in a larger risk pool of those insured, which might
generate cost savings, and she noted the distinction between trainees
(who receive structured mentoring) and employees. The NPA favors
retaining the highlight quality experience, even if it means reducing
the number of slots. The NPA policy committee endorsed Option 1 because
it seemed to be the fairest way to motivate institutions to keep tuition
low and to help the NIH plan. The NPA rejected the allowance option
because it would ensure the maximum charges with no guarantee that the
amount would be used for postdoctoral trainees. Ms. Reed noted that
without the T32, institutions would not be obligated to train
postdoctoral trainees, although they are obligated to train predoctoral
trainees.

***Howard B. Dickler, M.D., Association of American Medical Colleges
(AAMC)***

Dr. Dickler is Director for Clinical Research at the AAMC, which
represents all 126 accredited U.S. medical schools, nearly 400 teaching
hospitals and health systems, and 94 academic and scientific societies
with 109,000 faculty. Dr. Dickler estimated that more than 70 percent of
training grants are awarded to AAMC members. The AAMC articulated four
target principles in addressing the anticipated NRSA tuition funding
shortfall: (1) Preserve as many NRSA positions as possible; (2) protect
stipend levels and health insurance allotments for trainees; (3) provide
institutions with the option of making up the shortfall with
institutional funds or reducing positions; and (4) treat public and
private institutions impartially. Options 1 and 2 were seen as
preserving positions and protecting stipend levels, but they do not
provide institutional choice, and they disproportionately affect
high-cost institutions that generally are private and research
intensive. Option 3 protects stipend levels and treats institutions
impartially (merit based) but does not preserve positions and does not
provide institutional choice because of the likely shortfall. Not
optimistic that the NIH could make up the shortfall from other sources,
Dr. Dickler proposed that the NIH maintain the current formula but fund
the shortfall with across-the-board cuts to the tuition category among
all ***new and competing*** training grants. This approach gives
institutions a choice of either making up the shortfall from
institutional funds or relinquishing slots, thus permitting stable grant
funding for all non-competing years and meeting all four of the AAMC's
target principles.

***Lynn Cooley, Ph.D., Yale University***

Dr. Cooley is Professor of Genetics, Cell Biology, and Molecular,
Cellular, and Developmental Biology (MCDB) at Yale University. She is
also Director of the Cellular and Molecular Biology (CMB) Training
Program (T32), a long-standing and one of the largest training programs
at Yale University, as well as Director of the Combined Program in the
Biological and Biomedical Sciences Program. Dr. Cooley reinforced the
importance of the NRSA for science nationwide and on the Yale campus.
Yale University believes strongly in the importance of maintaining the
link to real costs, especially because costs are expected to continue to
rise, and endorses an overriding principle of preserving trainee slots.
A loss of slots would harm established and particularly new graduate
programs and would weaken Yale's training environment. Dr. Cooley
affirmed that Yale would support a ***temporary*** cap on tuition of
\$18,000 (Option 1) and expressed interest in the AAMC proposal for an
across-the-board percent cut on competing applications.

***Ann Bonham, Ph.D., University of California, Davis, School of
Medicine***

Dr. Bonham is Executive Associate Dean, Research and Education, School
of Medicine, at the University of California, Davis. She began with
three observations: (1) Training and research activities are
inseparable; (2) the NIH recognizes the urgent need for
multidisciplinary teams of investigators to conduct translational
research; and (3) training is the foundation for building "academic
homes for clinical research" envisioned by the Roadmap and the
Institutional Clinical and Translational Science Award (CTSA)
initiative. She presented Option 3 as perpetuating the erosion of the
Nation's overall training activities, reducing the quality of the U.S.
research enterprise, at a time when the hope is for "transformation" of
our research enterprise through the Roadmap. She saw Options 1 and 2 as
averting a decline in slots. Although Options 1 and 2 are likely to
disadvantage higher-tuition institutions, she believed that these
options were in the greater national interest to avert a national
decline in trainee slots and programs and to facilitate the vigorous,
diverse research enterprise envisioned by the NIH.

***Donna M. Paulnock, Ph.D., University of Wisconsin, Madison***

Dr. Paulnock, Professor of Medical Microbiology and Immunology, spoke on
behalf of the Graduate School at the University of Wisconsin,
acknowledging that there are a diversity of opinions on campus. The
university currently has 47 institutional training grants that support
nearly 300 graduate trainees. She reiterated the critical role that the
T32 institutional training grants have played in research training for
graduate students on campus. It is critical to offer competitive
stipends and fringe benefits in order to recruit successfully the
highest caliber of student. She noted that the actual cost of the total
graduate student financial package (sum of tuition, health insurance,
and stipend) is borne by the funding agency (e.g., NIH), the university,
the degree-granting department or program, and the Principal
Investigator (PI) who mentors the student. The "shortfall" in trainee
costs at the University of Wisconsin is covered by the university at a
cost of nearly \$2 million per year, resulting in considerable financial
strain. Dr. Paulnock expressed the university's preference to maintain
the number of grants and trainees supported through the NRSA program at
approximately the current level. At this point in time, the university
favors future funding options that would provide a fixed allowance for
tuition for each trainee (i.e., Option 2). However, rather than
stipulating a dollar amount, she proposed that the funding level be
adjusted using a model similar to that used for calculating the total
compensation for graduate students on R01 grants or pegged to NRSA
postdoctoral zero-year stipend amounts, thus allowing tuition
adjustments to parallel increasing costs. Dr. Paulnock further proposed
revising current regulations to allow supplementation of trainee
compensation packages using Federal research dollars. NIH staff
clarified that it is inappropriate to supplement NRSA support with
research project funds to conduct the same activities since: NRSA funds
are intended to support 100 percent of the candidate's training-related
effort and was not feasible based on generally accepted accounting
principles; the inability to commingle research and NRSA training
funding authorities; and the fact that NRSA trainees are not considered
to be in an employment status.

***W. James Waldman, Ph.D., Ohio State University School of Biomedical
Sciences***

Dr. Waldman is Associate Professor, Department of Pathology, Department
of Molecular Virology, Immunology, and Medical Genetics, at the Ohio
State University (OSU) College of Medicine. He is one of the founding
members of the integrated biomedical sciences graduate program launched
in 2001 that has been successful beyond expectations, involving over 200
faculty members. He contrasted a low-cost university such as OSU, which
charges about \$12,000 in tuition (tuition subsidy of \$8,400 per
trainee per year) with a high-cost institution charging about \$30,000
per year in tuition (tuition subsidy of \$19,200 per student per year).
He noted that state funding for public universities is on the decline.
OSU currently receives only 18 percent of the costs of graduate
education from the state of Ohio. The OSU College of Medicine favors
fixed equal tuition subsidies for all trainees, regardless of the
institution in which training programs are based (Option 2), and then
Option 1.

***Peter C. Maloney, Ph.D., Council on Governmental Relations***

Presenting on behalf of the Council on Governmental Relations (COGR),
Dr. Maloney is Professor and Associate Dean, Johns Hopkins Medical
School. COGR is a consortium of 165 research-intensive institutions,
both public and private. Members demonstrate a commitment to graduate
education and training and hold a substantial fraction of all NRSA
grants and awards. In FY2006, the tuition/fee subsidy contributed by the
Johns Hopkins School of Medicine will be about \$12,500 per student. The
university has also provided an institutional subsidy of \$3,800 toward
the stipend of \$24,600. The aggregate institutional subsidy has been on
the order of \$3.4 to \$3.8 million per year. The abrupt and unplanned
proposed cost shifting will mean new costs for the university
approaching \$1 million per year. Dr. Maloney identified a number of
unintended consequences: Institutions must balance competing demands
with limited resources; some (smaller) institutions may forego NRSA
awards if alternative resources are not available; and high- and
low-tuition institutions will experience differential strain. Option 3
will lead to reduced numbers of trainee slots under most scenarios, but
institutions have variable resources and the AAMC points out a potential
role for the individual institution. COGR therefore recommends that the
NIH adopt Option 3 because it equitably distributes increased costs
throughout the community; allows each institution to set tuition and
fees that fairly reflect its own real costs of education; provides
institutions with a reliable metric in planning realistically for future
cost recovery; and avoids an abrupt, unforeseen increase in educational
costs that some institutions could not absorb in the long term.

***Roger G. Chalkley, Ph.D., Vanderbilt University***

Dr. Chalkley, Senior Associate Dean for Biomedical Research, Education,
and Training at the Vanderbilt University School of Medicine, has been
involved with all of Vanderbilt's creative activities in biomedical
graduate education over the last 15 years. He noted recent advances in
graduate education and postdoctoral training and reported how tuition
monies have gone to support a wide variety of activities at Vanderbilt
that have beneficial spillover effects. These include developing
emerging areas of new focus, career advising, improving teaching
opportunities, offering responsible conduct of research and survival
courses, developing a culture of mentoring, increasing diversity,
offering graduate-student-specific psychology services, supporting
outcomes research and analysis, and providing vastly improved IT
resources. Dr. Chalkley proposed a moratorium on additional training
slots for one year and on additional slots awarded to competitive
renewals for one year. He further proposed that tuition levels for each
university be frozen at the current levels (or if necessary at \$18,000)
for one year, although the preference is not to have a uniform, set
tuition level for all students, as there are clearly some schools that
can draw upon other mechanisms of taxpayer support (e.g., state taxes)
and this would tend to make the private schools inherently less
competitive. He recommended that a review be conducted after one year.
If there is continuing shortfall, he proposed that tuition levels be
reduced by 10 percent, and only then should the numbers of total slots
be reduced if necessary to meet additional fiscal restraint
requirements.

## Summary of Main Themes From Remarks and Discussion

Participants praised the support provided by the Ruth L. Kirschstein
NRSA Program, which has benefited over 17,000 trainees per year, many of
whom are now training directors and leaders at their respective
institutions. A number of speakers offered personal testimonials about
the benefits bestowed upon NRSA trainees. Many credited the NRSA
programs for contributing to the preeminence of U.S. biomedical science
and considered a competitive NRSA program as key to maintaining U.S.
competitiveness in biomedical research. Others noted that NRSA programs
encourage diversity in the scientific disciplines available for study
and in the composition of the scientific workforce. Institutions were
cognizant that strong NRSA programs help in recruitment of trainees and
faculty. With less plentiful research funds, young faculty depend in
part on trainees to establish research groups. Several participants also
noted that well-run training programs are considered to provide
incalculable added value with significant spillover effects that
ultimately promote integrated, interdisciplinary research training.
Cutting available training program positions sends a signal that can
discourage undergraduates and faculty from pursuing biomedical research
at a time when the country should be increasing its investment in
training.

None of the proposed NIH options to reduce tuition, fees, and health
insurance reimbursements was seen as optimal. Participants expressed
strong concerns that proposed reductions may seriously hinder
institutional training programs and threaten future U.S. leadership in
biomedical research. A number of participants also expressed concern
that any change may be difficult to reverse, even when the funding
picture improves. Past experience suggests that caps imposed during
times of fiscal restraint can persist even when conditions improve.
Several participants urged that any tuition reimbursement reduction be
considered a temporary measure, and they endorsed the idea of an
explicit sunset clause that would force a review within a certain time
period to assess whether continued restraints are justified. For many,
hard-won slots must be preserved at all costs, as there was a sense that
funding reductions can be overcome but that lost trainee slots would be
permanent.

All sought an equitable way to share the burden, but there was no
consensus on how best to achieve this end. Many expressed that the
options proposed by the NIH may be more or less attractive to a specific
institution depending on the scale of its training operation, tuition
rates, and how close the tuition rates are to the proposed ceilings or
caps. In general, participants primarily concerned with preserving
trainee slots rejected Option 3, acknowledging that Options 1 and 2 were
viewed as disproportionately disadvantageous to medical schools and
private graduate schools and more advantageous to lower-tuition
institutions. Although private school tuition is generally higher than
that for public schools, state schools have seen greater increases in
tuition costs in recent years, with fewer resources available from state
legislators. It is therefore difficult to generalize about private
versus public schools concerning this topic. Some saw the distinction
between public and private as unwarranted, as both institutions are
likely to suffer equally \[Lichtenberg\]. Perhaps a more accurate
distinction is between "lower-tuition" and "higher-tuition"
institutions.

Some of the large advocacy groups (COGR, AAU) favored Option 3, as did
Stanford, Pittsburgh, and Penn, but some high-tuition schools (Brown
Medical School, Harvard Medical School, Yale University) selected Option
1 over Option 3. Dr. Goldschmidts clarified that broadly across the NIH,
it is already the case that T32s may not be fully funded for all slots
recommended by study sections. If the status quo were to prevail, there
were a number of requests for greater clarity on how reductions in slots
would be determined. Many who offered comments recommended that
reductions be made to new and competing awards, not to continuing
training grants. One participant suggested a one-year moratorium on new
slots, either on continuing awards or new awards.

Participants wanted NIH to try to protect smaller programs, recognizing
that at least four trainees every year are needed to constitute a
critical mass for a viable program. It was noted by several participants
that new research areas are often nurtured through small training
programs, and cutting the number of NRSA programs would likely
disproportionately impact cutting-edge areas of innovation and
interdisciplinary research.

In response to Dr. Jones' question about whether tuition levels are
influenced by NIH training grants, Dr. John Godfrey from the University
of Michigan (UM) stated that NIH actions have no effect on how UM sets
tuition. UM has roughly 75 T32s; some T32s are put forward by more
junior faculty who are truly on the cutting edge but are probably more
vulnerable to slot reductions. For predoctoral trainees, institutions
look at other institutions to stay competitive and do not reference NIH
levels. The link is more important for postdoctoral fellows, since the
NRSA levels are the minimal levels offered by institutions.

In general, postdoctoral fellows do not have the same level of tuition
costs as predoctoral fellows. However, with increasing emphasis on
multi- and interdisciplinary training, it is important to plan for the
likelihood that more formal didactic training will become an expected
component of some postdoctoral training. The more rapid increase in the
postdoctoral tuition pool was attributed, in part, to the encouragement
of NIH for clinical and translational research training.

Given the rising cost of tuition and fees, a number of non-Federal
participants sought to unbundle health insurance costs from tuition and
fees in order to ensure health benefits coverage should the tuition
formula change. The AAMC suggested transferring health insurance costs
into the institution's campus-wide fringe benefit pool.

Many expressed the opinion that it is important to have this type of
public dialogue more often---certainly more frequently than every 10
years. Participants requested that the submitted statements and
presentations be posted on the NIH Web site.

## Next Steps

Dr. Norka Ruiz Bravo stated that the NIH will issue a summary report of
the Town Hall meeting and in subsequent months, the NIH will carefully
evaluate and model a variety of policy options, consider stakeholder
opinions, and draft a new NRSA tuition policy. The draft NRSA tuition
policy will be reviewed by appropriate NIH governance bodies, and a
final policy will be presented to the NIH Director. A new NRSA tuition
policy is expected to be announced in the *NIH Guide for Grants and
Contracts* and the *Federal Register* in Spring 2006. One participant
urged that the final policy be in place by October 1, 2006, so that
institutions are not put in the position of recruiting students and then
falling short on available trainee support.

In response to a request for an analysis of tuition costs in conjunction
with other categories \[Schwartz, University of Chicago\], Dr.
Goldschmidts clarified that the other direct-cost categories are fairly
modest in amount relative to the tuition and stipend categories.
Although some participants from academic institutions emphasized that
tuition costs were real costs that must be paid, one participant at a
state research university \[University of Wisconsin\] contended that
institutions need to do a better job accounting for tuition costs and
increases and aligning tuition charges with true costs.

Dr. Kirschstein recalled that funding for research and training since
the early 1960s was in existence in almost every state, at both private
and public institutions. At that time, funds were more fungible between
research and training uses, but there always will be some segment of the
public who object to covering the entire training cost of trainees
because some may eventually leave research for higher-paying private
sector opportunities. The pay-back provision in the original NRSA
program was established to address this concern and to encourage
trainees to remain in research. Nevertheless, non-Federal participants
encouraged the AAMC and FASEB to educate Congress about the value of
research training and education. The AAU pledged that it will continue
to urge Congress and the Administration and others to reexamine current
NIH funding appropriations so that gains made possible by the NIH
doubling are not reversed and the United States can maintain its
competitiveness and preeminence in the biomedical research arena.

**Table 1. Opinions Submitted to the NIH**

**by Name of Stakeholder, Presenter, Participation at Town Hall Meeting,
and Option Selection**

+---------+------------+---+---+---+---+---------------------------------------+
| *       | **Author   | > | > | > | > | **Notes**                             |
| *Stakeh | of         |   |   |   |   |                                       |
| older** | Statement  | * | * | * | * | Submitted statements are posted at    |
|         | and/or     | * | * | * | * | http://pub.nigms.nih.gov/generic_mee  |
|         | Speaker if | O | O | O | O | ting_upload/upload/supportingDoc1.pdf |
|         | Present at | p | p | p | t |                                       |
|         | Town Hall  | t | t | t | h |                                       |
|         | Meeting**  | i | i | i | e |                                       |
|         |            | o | o | o | r |                                       |
|         |            | n | n | n | * |                                       |
|         |            | > | > | > | * |                                       |
|         |            |   |   |   |   |                                       |
|         |            | 1 | 2 | 3 |   |                                       |
|         |            | * | * | * |   |                                       |
|         |            | * | * | * |   |                                       |
+=========+============+===+===+===+===+=======================================+
| **Assoc |            |   |   |   |   |                                       |
| iations |            |   |   |   |   |                                       |
| and     |            |   |   |   |   |                                       |
| O       |            |   |   |   |   |                                       |
| rganiza |            |   |   |   |   |                                       |
| tions** |            |   |   |   |   |                                       |
+---------+------------+---+---+---+---+---------------------------------------+
| A       | \*Douglas  |   |   | X | X | Favors separating funds for tuition   |
| merican | C. Eaton,  |   |   |   |   | and health insurance. Statement also  |
| Physio  | Ph.D.      |   |   |   |   | posted at:                            |
| logical |            |   |   |   |   | http://ww                             |
| Society |            |   |   |   |   | w.the-aps.org/pa/action/news/NRSA.pdf |
+---------+------------+---+---+---+---+---------------------------------------+
| Asso    | \*Jordan   |   |   | X | X | NIH should address shortfalls with    |
| ciation | J. Cohen,  |   |   |   |   | funds from elsewhere in the NIH       |
| of      | M.D.,      |   |   |   |   | budget. If not viable, advocate       |
| A       | AAMC;      |   |   |   |   | Option 3 and address the shortfall    |
| merican | Presenter: |   |   |   |   | each year with across-the-board cuts  |
| Medical | Howard B.  |   |   |   |   | to all new and competing training     |
| C       | Dickler,   |   |   |   |   | grants, and give grantees the option  |
| olleges | M.D.       |   |   |   |   | of making up the shortfall with       |
|         |            |   |   |   |   | institutional funds or cutting slots. |
|         |            |   |   |   |   | Statement also posted at:             |
|         |            |   |   |   |   | http://www.aamc.org/advocacy/li       |
|         |            |   |   |   |   | brary/research/corres/2005/110405.pdf |
+---------+------------+---+---+---+---+---------------------------------------+
| Asso    | Linda A.   |   |   | X |   | Dr. Dykstra's full testimony can be   |
| ciation | Dykstra,   |   |   |   |   | found at:                             |
| of      | Ph.D.,     |   |   |   |   | http://www.aau.edu/rese               |
| A       | UNC-Chapel |   |   |   |   | arch/AAU_NRSA_Dykstra_Test_113005.pdf |
| merican | Hill       |   |   |   |   |                                       |
| Unive   |            |   |   |   |   |                                       |
| rsities |            |   |   |   |   |                                       |
+---------+------------+---+---+---+---+---------------------------------------+
| Council | \*Anthony  |   |   | X |   | Statement also posted at:             |
| on      | DeCrappeo; |   |   |   |   | http://                               |
| Gover   | Presenter: |   |   |   |   | 206.151.87.67/docs/TuitionCapNRSA.doc |
| nmental | Peter C.   |   |   |   |   |                                       |
| Re      | Maloney,   |   |   |   |   |                                       |
| lations | Ph.D.      |   |   |   |   |                                       |
+---------+------------+---+---+---+---+---------------------------------------+
| Council | Patricia   |   | X | X | X | Some support for Option 2; some for   |
| of      | H.         |   |   |   |   | Option 3 but with some protection for |
| G       | McAllister |   |   |   |   | smaller programs.                     |
| raduate |            |   |   |   |   |                                       |
| Schools |            |   |   |   |   |                                       |
+---------+------------+---+---+---+---+---------------------------------------+
| Fed     | Bruce R.   |   |   | X |   | Separate health insurance costs from  |
| eration | Bistrian,  |   |   |   |   | the "tuition" category to ensure that |
| of      | M.D.,      |   |   |   |   | health insurance benefits would not   |
| A       | Ph.D.,     |   |   |   |   | be compromised by any new constraints |
| merican | FASEB;     |   |   |   |   | placed on tuition reimbursement       |
| So      | Presenter: |   |   |   |   | amounts.                              |
| cieties | Joseph C.  |   |   |   |   |                                       |
| for     | LaManna,   |   |   |   |   | Statement also posted at:             |
| Exper   | Ph.D.,     |   |   |   |   | http:                                 |
| imental | Case       |   |   |   |   | //www.faseb.org/opa/pdf/FASEBNRSA.pdf |
| Biology | Western    |   |   |   |   |                                       |
|         | Reserve    |   |   |   |   |                                       |
|         | University |   |   |   |   |                                       |
+---------+------------+---+---+---+---+---------------------------------------+
| N       | Alyson     | X |   |   |   | Statement also posted at:             |
| ational | Reed,      |   |   |   |   | <http                                 |
| Postd   | M.P.P.     |   |   |   |   | ://www.nationalpostdoc.org/committees |
| octoral |            |   |   |   |   | /policy_committee/NRSA_Town_Hall.pdf> |
| Asso    |            |   |   |   |   |                                       |
| ciation |            |   |   |   |   |                                       |
+---------+------------+---+---+---+---+---------------------------------------+
| **A     |            |   |   |   |   |                                       |
| cademic |            |   |   |   |   |                                       |
| and/or  |            |   |   |   |   |                                       |
| R       |            |   |   |   |   |                                       |
| esearch |            |   |   |   |   |                                       |
| Institu |            |   |   |   |   |                                       |
| tions** |            |   |   |   |   |                                       |
+---------+------------+---+---+---+---+---------------------------------------+
| The     | \*Timothy  | X | X |   |   |                                       |
| Miriam  | P.         |   |   |   |   |                                       |
| Ho      | Flanigan,  |   |   |   |   |                                       |
| spital, | M.D. and   |   |   |   |   |                                       |
| Brown   | Jennifer   |   |   |   |   |                                       |
| Medical | Hyde       |   |   |   |   |                                       |
| School  |            |   |   |   |   |                                       |
+---------+------------+---+---+---+---+---------------------------------------+
| Harvard | Thomas     | X |   |   |   |                                       |
| Medical | Roberts,   |   |   |   |   |                                       |
| School  | Ph.D., Tom |   |   |   |   |                                       |
|         | Fox,       |   |   |   |   |                                       |
|         | Ph.D., and |   |   |   |   |                                       |
|         | Vivian     |   |   |   |   |                                       |
|         | Holmes     |   |   |   |   |                                       |
+---------+------------+---+---+---+---+---------------------------------------+
| Medical | \*John D.  | X |   |   |   | Preferred Option 1 for flexibility.   |
| College | Catravas,  |   |   |   |   | Against reducing number of slots.     |
| of      | Ph.D., and |   |   |   |   | Considered Option 3 as least          |
| Georgia | \*David M. |   |   |   |   | desirable.                            |
|         | Pollock,   |   |   |   |   |                                       |
|         | Ph.D.      |   |   |   |   |                                       |
+---------+------------+---+---+---+---+---------------------------------------+
| North   | \*Lawrence |   |   |   | X | Favored in the following order: (1)   |
| western | B. Dumas   |   |   |   |   | Graduated tuition reimbursement       |
| Uni     | and \*C.   |   |   |   |   | pegged to tuition amount; (2) Option  |
| versity | Bradley    |   |   |   |   | 3, but with across-the-board cuts in  |
|         | Moore;     |   |   |   |   | slots; smaller programs protected;    |
|         | Presenter: |   |   |   |   | (3) Option 2, but reconsider cap      |
|         | David      |   |   |   |   | amount.                               |
|         | Engman,    |   |   |   |   |                                       |
|         | M.D.,      |   |   |   |   |                                       |
|         | Ph.D.      |   |   |   |   |                                       |
+---------+------------+---+---+---+---+---------------------------------------+
| Ohio    | W. James   |   | X |   |   | Favored Option 2, followed by Option  |
| State   | Waldman,   |   |   |   |   | 1.                                    |
| Uni     | Ph.D.      |   |   |   |   |                                       |
| versity |            |   |   |   |   |                                       |
+---------+------------+---+---+---+---+---------------------------------------+
| Penns   | \*Gordon   |   | X |   |   | Favored Option 2 because it enhances  |
| ylvania | F. De      |   |   |   |   | rational planning and institutional   |
| State   | Jong,      |   |   |   |   | matches needed as well as student     |
| Uni     | Ph.D.      |   |   |   |   | program planning scheduling. The NIH  |
| versity |            |   |   |   |   | would need to periodically (even      |
|         |            |   |   |   |   | annually) adjust the fixed allowance  |
|         |            |   |   |   |   | amount in accordance with prudent     |
|         |            |   |   |   |   | cost-of-tuition and health-care       |
|         |            |   |   |   |   | increases.                            |
+---------+------------+---+---+---+---+---------------------------------------+
| S       | Robert D.  |   |   | X |   | Favored Option 3 with an adjustment   |
| tanford | Simoni,    |   |   |   |   | to awards to compensate for budget    |
| Uni     | Ph.D.      |   |   |   |   | constraint.                           |
| versity |            |   |   |   |   |                                       |
+---------+------------+---+---+---+---+---------------------------------------+
| Uni     | Ann        | X | X |   |   | Least preferred Option 3 because it   |
| versity | Bonham,    |   |   |   |   | would reduce the number of trainee    |
| of      | Ph.D.      |   |   |   |   | slots.                                |
| Cali    |            |   |   |   |   |                                       |
| fornia, |            |   |   |   |   |                                       |
| Davis   |            |   |   |   |   |                                       |
+---------+------------+---+---+---+---+---------------------------------------+
| Uni     | Charles S. | X | X |   |   | Favored less money with more slots.   |
| versity | Craik,     |   |   |   |   | Co-funding at whatever level from the |
| of      | Ph.D.      |   |   |   |   | NIH helps to leverage other funds to  |
| Cali    |            |   |   |   |   | help build new programs.              |
| fornia, |            |   |   |   |   |                                       |
| San     |            |   |   |   |   |                                       |
| Fr      |            |   |   |   |   |                                       |
| ancisco |            |   |   |   |   |                                       |
+---------+------------+---+---+---+---+---------------------------------------+
|         | \*A.       |   |   |   | X | Opposed fixed ceiling on T32 awards;  |
|         | Eugene     |   |   |   |   | opposed reducing the number of        |
|         | W          |   |   |   |   | awards.                               |
|         | ashington, |   |   |   |   |                                       |
|         | M.D.       |   |   |   |   |                                       |
+---------+------------+---+---+---+---+---------------------------------------+
| Uni     | Lasse      |   |   |   | X | Proposed a combination of Options 1   |
| versity | Lindahl,   |   |   |   |   | and 3, with 100 percent reimbursed up |
| of      | Ph.D.      |   |   |   |   | to \$5,000 and then 60 percent of the |
| M       |            |   |   |   |   | remainder up to a cap of about        |
| aryland |            |   |   |   |   | \$15,000 for each trainee.            |
| Ba      |            |   |   |   |   |                                       |
| ltimore |            |   |   |   |   |                                       |
| County  |            |   |   |   |   |                                       |
+---------+------------+---+---+---+---+---------------------------------------+
| Uni     | \*George   |   | X |   |   | Advocated to maintain number of       |
| versity | B.         |   |   |   |   | trainees at the current level.        |
| of      | Whitman,   |   |   |   |   |                                       |
| Massac  | Ph.D.      |   |   |   |   |                                       |
| husetts |            |   |   |   |   |                                       |
+---------+------------+---+---+---+---+---------------------------------------+
| Uni     | \*Robert   | X |   |   |   | Rejected Option 3. Favored Option 1,  |
| versity | T.         |   |   |   |   | but suggested raising the base above  |
| of      | T          |   |   |   |   | \$3,000 and using a lower percentage  |
| Mi      | ranquillo, |   |   |   |   | up to the ceiling so that total funds |
| nnesota | Ph.D.      |   |   |   |   | are not as biased to the high-tuition |
|         |            |   |   |   |   | institutions.                         |
+---------+------------+---+---+---+---+---------------------------------------+
| Uni     | \*Barry R. | X |   |   |   | Favored Option 1 to maintain a        |
| versity | Lentz,     |   |   |   |   | diverse portfolio of training         |
| of      | Ph.D.      |   |   |   |   | efforts. Losing slots will impact     |
| North   |            |   |   |   |   | disproportionately smaller programs.  |
| C       |            |   |   |   |   | Option 2 seen as less savings for the |
| arolina |            |   |   |   |   | NIH. Caps are needed so that          |
| at      |            |   |   |   |   | high-cost institutions do not drain   |
| Chapel  |            |   |   |   |   | funds from smaller, state-supported   |
| Hill    |            |   |   |   |   | programs. Rejected Option 3.          |
+---------+------------+---+---+---+---+---------------------------------------+
| Uni     | Glen       |   |   | X |   | Requested that cuts in slots be made  |
| versity | Gaulton,   |   |   |   |   | at the time of competitive renewal or |
| of      | Ph.D.      |   |   |   |   | new award rather than imposing        |
| Penns   |            |   |   |   |   | across-the-board cuts. Advocated that |
| ylvania |            |   |   |   |   | NIH request justification for annual  |
| School  |            |   |   |   |   | increases in tuition costs beyond     |
| of      |            |   |   |   |   | inflation and deny certain expenses   |
| M       |            |   |   |   |   | found to be unreasonable.             |
| edicine |            |   |   |   |   |                                       |
+---------+------------+---+---+---+---+---------------------------------------+
| Uni     | Joan M.    |   |   | X |   |                                       |
| versity | Lakoski,   |   |   |   |   |                                       |
| of      | Ph.D.      |   |   |   |   |                                       |
| Pit     |            |   |   |   |   |                                       |
| tsburgh |            |   |   |   |   |                                       |
| Schools |            |   |   |   |   |                                       |
| of      |            |   |   |   |   |                                       |
| Health  |            |   |   |   |   |                                       |
| S       |            |   |   |   |   |                                       |
| ciences |            |   |   |   |   |                                       |
+---------+------------+---+---+---+---+---------------------------------------+
| Uni     | \*Mohammad |   | X |   |   | Option 2 is simpler and more uniform, |
| versity | M. Ataai,  |   |   |   |   | although Option 1 also will work from |
| of      | Ph.D.      |   |   |   |   | budgetary standpoint.                 |
| Pit     |            |   |   |   |   |                                       |
| tsburgh |            |   |   |   |   |                                       |
| Center  |            |   |   |   |   |                                       |
| for     |            |   |   |   |   |                                       |
| Biotec  |            |   |   |   |   |                                       |
| hnology |            |   |   |   |   |                                       |
| &       |            |   |   |   |   |                                       |
| Bioengi |            |   |   |   |   |                                       |
| neering |            |   |   |   |   |                                       |
+---------+------------+---+---+---+---+---------------------------------------+
| Uni     | \*Rueben   |   | X |   |   | Favored Option 2 because provides     |
| versity | Gonzales,  |   |   |   |   | needed support as well as clarity and |
| of      | Ph.D.      |   |   |   |   | ease of administration.               |
| Texas   |            |   |   |   |   |                                       |
| at      |            |   |   |   |   |                                       |
| Austin  |            |   |   |   |   |                                       |
+---------+------------+---+---+---+---+---------------------------------------+
| Uni     | \*R. Ariel | X | X |   |   | Favored Option 2, then Option 1.      |
| versity | Gomez,     |   |   |   |   |                                       |
| of      | M.D.;      |   |   |   |   |                                       |
| V       | Presenter: |   |   |   |   |                                       |
| irginia | Roseanne   |   |   |   |   |                                       |
|         | Ford,      |   |   |   |   |                                       |
|         | Ph.D.      |   |   |   |   |                                       |
+---------+------------+---+---+---+---+---------------------------------------+
| Uni     | Donna M.   |   | X |   |   | Favored Option 2, but without         |
| versity | Paulnock,  |   |   |   |   | stipulating a dollar amount, instead  |
| of      | Ph.D.      |   |   |   |   | pegging the amount to a set scale     |
| Wis     |            |   |   |   |   | that parallels increases in costs;    |
| consin, |            |   |   |   |   | also proposed using R01 grants to     |
| Madison |            |   |   |   |   | complement trainee amounts.           |
+---------+------------+---+---+---+---+---------------------------------------+
| Van     | Roger G.   |   |   |   | X | Proposed moratorium for 1 year on     |
| derbilt | Chalkley,  |   |   |   |   | additional training slots and slots   |
| Uni     | Ph.D.      |   |   |   |   | awarded to competitive renewals. If   |
| versity |            |   |   |   |   | shortfall persists after 1 year,      |
|         |            |   |   |   |   | reduce tuition level by 10 percent,   |
|         |            |   |   |   |   | and only then reduce number of        |
|         |            |   |   |   |   | trainee slots if necessary.           |
+---------+------------+---+---+---+---+---------------------------------------+
| Wayne   | \*Sam C.   |   | X |   |   |                                       |
| State   | Brooks,    |   |   |   |   |                                       |
| Uni     | Ph.D., and |   |   |   |   |                                       |
| versity | \*Larry H. |   |   |   |   |                                       |
|         | Matherly,  |   |   |   |   |                                       |
|         | Ph.D.      |   |   |   |   |                                       |
+---------+------------+---+---+---+---+---------------------------------------+
| Yale    | Richard    | X |   |   |   | Proposed ***temporary*** cap on       |
| Uni     | Jacob;     |   |   |   |   | tuition of \$18,000; urged            |
| versity | Presenter: |   |   |   |   | exploration of AAMC proposal for      |
|         | Lynn       |   |   |   |   | across-the-board percent cut on       |
|         | Cooley,    |   |   |   |   | ***new and competing*** applications. |
|         | Ph.D.      |   |   |   |   |                                       |
+---------+------------+---+---+---+---+---------------------------------------+

\* Did not attend Town Hall Meeting

**APPENDIX 1**

**NIH Town Hall Meeting on NRSA Tuition Support**

**Organizing Committee**

Jeremy M. Berg, Ph.D., Chair

Director, National Institute of General Medical Sciences

Warren C. Jones, Ph.D., Co-Chair

Chief, Biochemistry and Biorelated Chemistry Branch

National Institute of General Medical Sciences

Robin A. Barr, D. Phil.

Deputy Associate Director and Training Officer

National Institute on Aging

Walter L. Goldschmidts, Ph.D.

Acting NIH Research Training Officer

Office of Extramural Research

Yvonne T. Maddox, Ph.D.

Deputy Director

National Institute of Child Health and Human Development

Teresa Farris Marquette

Section Chief, Grants Operations Branch, Division of Extramural Affairs

National Heart, Lung, and Blood Institute

Ernest D. Marquez, Ph.D.

Associate Director for Special Populations

National Institute of Mental Health

John C. Norvell, Ph.D.

Assistant Director (for Research Training)

National Institute of General Medical Sciences

Walter T. Schaffer, Ph.D.

Senior Scientific Advisor for Extramural Research

Office of Extramural Research

[^1]: On January 10, 1997, the NIH announced that, beginning with
    competing individual postdoctoral fellowship awards made in FY1997,
    support for health insurance would be provided under institutional
    allowance. This adjustment was made because few postdoctoral fellows
    incurred educational costs and health insurance costs were more
    reasonably predictable.

[^2]: See
    <http://grants.nih.gov/grants/guide/notice-files/NOT-OD-06-003.html>
    for the October 12, 2005, notice announcing the NIH Town Hall
    meeting and inviting statements regarding the Ruth L. Kirschstein
    NRSA Tuition, Fees, and Health Insurance Policies.