The elephant in the room: NIH funding of faculty-initiated award proposals.

The phrase “the elephant in the room” refers to a situation that is significant, on everyone's mind, and impossible to ignore, yet nobody wants to talk about it because they may not want to embarrass someone else in the room, or because nobody knows what to do about it. The elephant I wish to address is National Institutes of Health (NIH) funding of faculty-initiated award proposals, and how it relates to what the Association has identified as its major issues these past several years; namely, faculty recruitment, retention, and renewal (“The Three R's”).1-3 Pharmacy faculty members have been increasingly successful in obtaining NIH funding over the 7-year period, 1998-2004, garnering over 600 NIH awards in FY 2004, an increase of 59 percent from 1998. The amount of NIH funding of pharmacy faculty members increased 153% over this same period.4 The ranking of NIH funding for colleges and schools of pharmacy provided by AACP and the NIH is used by our members as evidence of their research productivity and graduate program excellence to both internal and external audiences. NIH funding not only provides financial support for equipment, supplies, and laboratory personnel (including graduate students), but the faculty salary offset and indirect costs are used for a variety of purposes to improve all of the institution's programs, including recruitment, retention, and renewal. What is it about the elephant that we don't talk about? Let me suggest it is the pervasive influence of NIH funding on some aspects of the 3 Rs. Regarding recruitment, the potential for a faculty candidate to obtain NIH funding is a major determinant in the hiring decision. The ability for faculty members to obtain funding for their research is important, but placing so much emphasis specifically on the potential for NIH support has and is changing the composition and appointment status of pharmacy faculty members. One could argue that this has been for the better as it has raised the level of scholarship of the collective faculty. However, should NIH funding potential determine the importance of an area of research to the professional degree program, the profession, or to the public's health? Colleges and schools of pharmacy need to focus their resources and cannot be involved in all disciplinary areas of research, but should potential for NIH funding be the sole criterion for that decision? Regarding faculty retention, at one time in almost every college and school of pharmacy, an NIH award along with publications during the probationary tenure-track period was sufficient to demonstrate excellence in research. At some institutions a single NIH grant is no longer sufficient for promotion and tenure. NIH research proposals are reviewed by a group of outside peers, so it appears reasonable to use the attainment of NIH awards as evidence of research excellence and development as an independent investigator. Most academics would agree that the NIH system of peer review of research ideas is better than most alternatives. But it is not the review score or comments about the research proposal that are used by college, school, and university tenure and promotion committees as the measure of research excellence; it is whether the proposal is funded. Again, this appears reasonable, for without funding it is impossible to purchase equipment and supplies or support graduate students or laboratory personnel to conduct the research. Unfortunately, the use of NIH funding as the major faculty evaluation criterion suffers from a major flaw. The decision to fund is significantly influenced by the size of the NIH budget, and even more so, by the rate at which the budget changes each year. The average increase in the NIH budget from US government fiscal years (FY) 1983 through 1998 was 8.1%, providing a slow growth in both the number and size of the grants awarded over this period.5 From 1998 through 2003, the NIH budget doubled by 14%-16% annually. The number of grants as well as the amount awarded per grant increased significantly during this period. Success rates for funding of new investigator-initiated grants (R01, R03, R15, and R21) across the agency increased from a low of 17.3% in FY 1993 to a high of 26.5% in FY 2001.6 After FY 2003, the last year of double-digit increases, Congress dramatically decreased the annual percent increase in the NIH budget. The final FY 2006 NIH appropriation, including the 1% mandated giveback, is the first yearly agency decrease in 36 years. After adjusting for inflation, NIH will have a smaller budget in 2006 than in 2003, erasing the small gains that occurred in FY 2004 and FY 2005.7 From 1998-2004, the elephant provided increased numbers of pharmacy faculty members and funding at colleges and schools to support research, graduate students, and postdoctoral fellows; construction money to improve research facilities; and large grants to improve the research infrastructure of institutions in selected states. Although the slowdown in the NIH budget increases began less than 3 years ago, significant changes in funding patterns have already occurred. Renovation and research infrastructure programs appear to have been shelved this past year. The number of grants approved and funded has also begun to drop, with success rates for new investigators dropping to 20.7% in FY 2004.6 NIH funding of pharmacy faculty in FY 2005 will not increase over FY 2004, following an 11-year run of increases from 1993-2004. This downturn in NIH funding, which is projected to continue for the near future, could have a dramatic impact on faculty retention and renewal, as faculty grant proposal scores, which would have been funded in the years of double-digit budget increases, go unfunded because of NIH budgetary issues, not merit. How will this impact faculty promotion and tenure decisions? There are no tried and true measures to deal with changes in the size and growth of the elephant, but it must be acknowledged that the creature plays an increasing role in faculty recruitment, retention, and renewal. Each college and school of pharmacy may deal with the elephant differently, but they should openly discuss its presence in the room.