NIH Funding in Family Medicine: An Analysis of 2003 Awards

Howard K. Rabinowitz; Julie A. Becker; Naomi D. Gregory; Richard C. Wender

doi:10.1370/afm.555

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Why core matters
Howard K. Rabinowitz

Published on: 15 December 2006
What is core, and does it matter?
Thomas L. Schwenk

Published on: 05 December 2006
Family Medicine Research Funding
doug campos-outcalt

Published on: 10 October 2006

Published on: (15 December 2006)
Page navigation anchor for Why core matters
Why core matters
Howard K. Rabinowitz, Philadelphia, PA, USA
Other Contributors:
We appreciate Dr. Schwenk’s thoughtful comments and certainly agree that the contribution that research makes to the academic base of family medicine is what is important – not whether or not researchers are family physicians, nor the type of structural area of a family medicine department where the research is carried out. We also agree that research by non-family physicians in non-core areas can have an important impac...
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We appreciate Dr. Schwenk’s thoughtful comments and certainly agree that the contribution that research makes to the academic base of family medicine is what is important – not whether or not researchers are family physicians, nor the type of structural area of a family medicine department where the research is carried out. We also agree that research by non-family physicians in non-core areas can have an important impact on a Department’s growth, political influence, and indirect cost recovery. We do not agree, however, that dichotomizing family medicine NIH awards into whether or not the PI was primarily working in what we defined as a core or non-core area is either arbitrary (defined as “random” or “capricious”) or without value.
We undertook this analysis for 2 reasons: first, to increase the understanding of what the NIH list of awards to family medicine departments represented – until now a black box that was used widely, but without much knowledge as to what it included; and second, to identify current patterns or models which might be useful to other departments considering to expand their research activities. After obtaining the data regarding individual NIH awards, it quickly became apparent that the majority of NIH awards going to family medicine departments went to PIs who were working in organizational entities that seemed to have little connection to what is usually considered to be a part of the discipline of family medicine – even though they were administratively located within the family medicine departmental structure at one medical school. To be clear, this did not represent a non-family physician in an atypical unit who was doing research related to family medicine care. Instead in most instances this represented entire medical school units composed of researchers – almost entirely non-physicians, and physicians who specialized in internal medicine or preventive medicine (and not family medicine) – who were doing research in specialized areas that are not generally considered to be related to family medical care or the academic discipline of family medicine (e.g. grant titles including “Impact of Micronutrients on Progression of SIV”; “Cocaine and Mesolimbic Dopamine Electrophysiology”; Targeting K+ Channels to Caveolae: Cardiovascular System”).
Far from being arbitrary or random, we believe that identifying this group of administrative structures represents a defined and uniquely different group of entities which do not exist in the vast majority of family medicine departments. As such, we felt that it was valuable to analyze the NIH list of awards according to this methodology and to identify this pattern of atypical administrative structures – which to our knowledge has never been described in the literature – so as to increase the understanding of NIH funding awards, and to share this model with other Departments.
Competing interests: None declared
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Competing Interests: None declared.
Published on: (5 December 2006)
Page navigation anchor for What is core, and does it matter?
What is core, and does it matter?
Thomas L. Schwenk, Ann Arbor, MI USA
My comment is in the form of a question to the authors, which I actually posed to Dr. Wender when this study was presented at a recent meeting. What is the value of making arbitrary definitions of what is core to a department of family medicine and what is not? What is the value of an arbitrary distinction between family physicians vs. non-family physicians regarding the specialty of a grant's PI? My concern is that...
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My comment is in the form of a question to the authors, which I actually posed to Dr. Wender when this study was presented at a recent meeting. What is the value of making arbitrary definitions of what is core to a department of family medicine and what is not? What is the value of an arbitrary distinction between family physicians vs. non-family physicians regarding the specialty of a grant's PI? My concern is that such distinctions may not reflect the actual impact of grants on a department's growth, success and political influence within its institution. More importantly, such distinctions seem to reflect certain biases on the part of the authors regarding what they consider to be important organizational or governance issues related to family medicine research, rather than focusing on the quality and impact of the science. Is the point whether research is being done by family physicians, or whether important research is being done about family medical care by someone, somewhere within a department of family medicine? I could easily imagine grants that seem to arise from a "non-core" unit of a department, for which the PI is a non-family physician or non-physician, but that contribute substantially to the academic base of family medicine, contribute to the research infrastructure of the department, contribute to indirect cost recovery, and reflect well on the department's contribution to its instituiton. If so, what is the point of making such artificial distinctions? Tom
Competing interests: None declared
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Competing Interests: None declared.
Published on: (10 October 2006)
Page navigation anchor for Family Medicine Research Funding
Family Medicine Research Funding
doug campos-outcalt, Phoenix, Az
Family medicine (FM) faculties conduct research funded by a variety of sources other than the National Institutes of Health (NIH). Even so, expanding our specialty’s proportion of the NIH pie is important for three reasons: 1. It will enhances our prestige among our academic colleagues; 2. The money brought in through indirect costs will strengthen our departments financially; and 3. It will bring more funds to research t...
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Family medicine (FM) faculties conduct research funded by a variety of sources other than the National Institutes of Health (NIH). Even so, expanding our specialty’s proportion of the NIH pie is important for three reasons: 1. It will enhances our prestige among our academic colleagues; 2. The money brought in through indirect costs will strengthen our departments financially; and 3. It will bring more funds to research that will, hopefully, assist our community-based colleagues to improve patient care. With that in mind, the data and analysis on NIH funding of Family Medicine researchers provided by Rabinowitz and colleagues (1) serves as a useful foundation for future comparisons and raises questions that need further exploration.
The picture provided has both good news and bad. The good is that family physicians can, and do, compete successfully for NIH funding. The bad is that we don’t do it very frequently and consequently we garner only a small proportion of total NIH funding.
To provide a useful comparison to other academic departments it would be helpful to know what FM faculty NIH grant success rate is compared to other disciplines, especially our primary care internal medicine and pediatric colleagues. To understand what an increased emphasis on research means for our traditional strengths of teaching and service we should explore how much of each is performed by successful FM researchers and departments, before and after NIH funding is obtained. Balancing the triple threat within a department should be possible but is more of a challenge for the individual faculty member.
It will also be critical to document the effects of increased FM academic research on the perceptions of students about family medicine and how it affects their specialty choices. Hopefully we will attract students who desire a research career as well as those who see the value of research in their future practices.
As we improve our discipline’s research capacity and output we should also insure that the product is improved patient care and improved practice by our non academic colleagues; in other words making our research relevant to the daily practice of family medicine. A main function of academic family medicine should be to provide the research that assists and improves the practices of our specialty’s front line.
1. Rabinowitz HK, Becker JA, Gregory ND, Wender RC. NIH funding in family medicine: an analysis of 2003 awards. Ann Fam Med 2006;4:437-442.
Competing interests: None declared
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Competing Interests: None declared.