I have spent my entire academic career as a clinical investigator and have grown to recognize the importance of a strong and vibrant rheumatology workforce. However, I am deeply concerned about our ability as a subspecialty to sustain our research enterprise and take advantage of the modern breakthroughs in science. The reduction in federal funding is among the many uncertainties scientists must face throughout their research careers.
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Explore This IssueJuly 2015
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The shrinkage of the NIH budget is real and threatening. In constant dollars, the FY2015 NIH budget remains more than 22% behind the FY2003 level, leading to a hypercompetitive environment for grant funding. Although the proposed FY2016 budget of $31.311 billion represents a 3.3% increase over the current FY2015 funding level, it will not be enough to correct the imbalance between the available research dollars and the demands of the growing scientific community. As investigators must devote more time to writing grant applications, less time is available for reading and thinking. The competition for too few NIH dollars has increased the career pressures on young investigators and pushed back the average age of research independence into the mid-40s.
The biggest slice of my academic career has been spent as a clinical investigator. Few things can match the excitement of a new discovery, the thrill of sharing your results with your peers or the lasting friendships built through scientific collaborations. The opportunities in science are truly extraordinary. Although we cannot escape the realities of the funding environment, young investigators must be encouraged to follow their dreams and be perpetually nurtured along the way to ensure their success. We must also cherish established scientists because it is they who provide the scientific leadership and mentor our young people.
The ACR and the Rheumatology Research Foundation take this challenge seriously. As part of its mission to Advance Rheumatology! the ACR seeks to increase research into rheumatic diseases while fostering the careers of young investigators. Last year, the Foundation awarded more than $13 million in grants for the support of research and training—a sterling and noteworthy achievement. The ACR also works to increase federal funding for research into rheumatic diseases and serves as an advocate in the formulation of public policy relating to the care of people with arthritis and other rheumatic diseases.
Keeping a Finger on the Pulse
To address the current crisis in funding for rheumatic disease research and training in the U.S., the ACR Committee on Research (COR) collaborated with the Foundation to gather and analyze comprehensive data about the state of public and private rheumatology research funding for the past five years. This information was used to identify members of the rheumatology community receiving research funding from the NIH and other foundations. These funding data will be updated and analyzed annually to track trends and develop solutions to improve funding for rheumatology research and training.
The 2015 analysis produced many insights into the current state of funding for rheumatology research. Over the past five years, the rheumatology community received 8,037 awards, representing 1.99% of total funds distributed by the NIH. Between 2010 and 2014, 12 private foundations awarded 744 grants to 642 rheumatology investigators totaling $143,743,757. For the first time, we have direct knowledge about the funding landscape in rheumatology.
The comprehensive report, titled, Funding for Academic Rheumatology Research and Training FY 2010–2014, may be accessed on the Foundation website.
Working with Stakeholders
Through the ACR COR and Foundation, the ACR builds and maintains working relationships with various stakeholders in the rheumatology research community.
NIH Relations: You may not know that the NIH has a seat at the table of the ACR COR. This committee includes a staff member from both the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) and the National Institute of Allergy and Infectious Diseases (NIAID), who serve as invited guests at all COR meetings. NIAMS and NIAID are the major sources of funding for rheumatology researchers. Representatives from these NIH institutes periodically provide updates to the ACR Board of Directors. Members of COR, in turn, meet regularly with leadership of NIH institutes to identify new funding opportunities, exchange ideas and discuss ways to better meet the research needs of the rheumatology community.
‘The Committee on Research is focusing on ways to improve funding to support innovative clinical, basic and translational research. Although times are challenging, we are making efforts to attract the best and brightest young researchers into rheumatology & help them have productive careers.’ —S. Louis Bridges Jr., MD, PhD, Chair of the ACR Committee on Research
Most recently, on May 13, S. Louis Bridges Jr., MD, PhD, ACR COR chair; Susan Boackle, MD, ACR COR member; and ACR staff met with representatives from NIAID and NIAMS. During the meeting with NIAID, Daniel Rotrosen, MD, director of the Division of Allergy, Immunology, and Transplantation (DAIT), provided valuable insights on funding trends and offered recommendations for rheumatology researchers. He told us about the decline in R01 applications and funded proposals and explained that the decrease in awarded R01s is partly due to increasing average direct costs of awarded R01s (increasing from approximately $310,000–410,000 per year). He dispelled the oft-held belief that grant applications exceeding the limit for modular budgets ($250,000/year) receive less favorable scores than those within this limit and recommended that investigators submit grants that support high-quality research with well-justified, nonmodular budgets. In addition, NIAID is funding a large number of R21 grants and is also interested in receiving grant applications for clinical trials (R01 and U01), with accompanying mechanistic studies. NIAID encourages investigators applying for grants to contact program officers for more details and advice.
During the meeting with NIAMS, Stephen I. Katz, MD, PhD, NIAMS director, affirmed NIAMS’ commitment to basic science research and career development and emphasized the importance of continued dialogue between NIAMS and the ACR. While discussing the COR’s efforts to increase visibility of rheumatology among MD/PhD students, Dr. Katz suggested the ACR seek MD/PhD students working in labs to discuss potential research opportunities available in rheumatology and begin recruiting prospective MD/PhD students as early as high school.
Partners in Rheumatology: Leadership Summit: To develop a cohesive community of stakeholders in rheumatology research funding, the Foundation held the first Partners in Rheumatology: Leadership Summit in June 2015. The goal of the two-day meeting was to provide a forum for high-level stakeholders from private foundations and the NIH to meet, thus fostering and strengthening the U.S. rheumatology research community. The Summit, which was moderated by the ACR, included presentations from different organizations and interactive breakout sessions. The high-level objectives of the meeting were to identify overlap and gaps in organizational missions and funding priorities, areas for collaboration and partnerships and best practices that may be replicable across organizations.
The ACR also had the opportunity to describe its progress on the newest version of the ACR National Research Agenda and to receive feedback about its priority scientific areas. First developed in 2005, and revised in 2011, the COR has been responsible for developing a National Research Agenda that comprehensively addresses important areas for research in rheumatic diseases. The current iteration can be accessed on the ACR website. The COR is currently updating the agenda to reflect the ACR’s research priorities for the period of 2016–2020. During this process, the COR has sought input from the rheumatology community at large, including investigators, academic clinicians, community rheumatologists, health professionals, and patients. The final ACR National Research Agenda will be available to the public through the ACR website in December 2015.
‘Early career investigators (ECIs) remain concerned about their future, given the difficulties obtaining funding. The Foundation is a tremendous resource for ECIs, supporting the earliest phases of their career with career development awards. The ACR also supports ECIs through training & mentorship, such as that provided annually at the Rheumatology Research Workshop.’ —Alexis R. Ogdie, MD, Chair of the ACR’s Early Career Investigators Subcommittee
Advocating for Rheumatology Research
In May, I was fortunate to join my colleagues on Capitol Hill for the ACR’s Advocacy Leadership Conference. During our meetings with senators, member of Congress and legislative staff, we had the opportunity to move forward several of the ACR’s issues on behalf of the subspecialty and our patients. Among these issues, we made strong asks for investing in U.S. medical research—$32 billion for the NIH in the FY2016 Labor, Health and Human Services Appropriations Bill, passage of the 21st Century Cures legislation, and $13 million for the Centers for Disease Control and Prevention’s Arthritis Program in the FY2016 Labor-HHS Appropriations Bill, as well as advocating for a $20 million fund to support a dedicated arthritis research program at the DOD that will serve veterans living with rheumatic diseases.
Addressing Issues for Early Career Investigators
The Early Career Investigator (ECI) Subcommittee of the ACR COR has identified barriers and facilitators to a career in research among rheumatologists in the U.S. in an effort to develop individualized support for early career investigators. The resulting paper titled, “Barriers to and Facilitators of a Career as a Physician-Scientist Among Rheumatologists in the US,” was published online in Arthritis Care & Research in February 2015. The paper describes the perceptions of young and established active investigators, those who have left a career in research, and fellows and clinicians about a career in rheumatology research. Not surprisingly, obtaining funding was the biggest barrier to a productive early career, and good mentoring was among the biggest facilitators of success.
The ACR provides support to early career investigators in a number of ways, including live educational conferences and online resources.
The ACR Rheumatology Research Workshop (RRW), held in conjunction with the Foundation’s Investigators’ Meeting in June 2015, offered outstanding opportunities for young investigators from undergraduate students up to physicians who are six years past their fellowship training. The two-day workshop included lectures, oral abstract presentations, poster sessions and time for interactions with senior investigators. The ACR offered a travel scholarship for this meeting to those investigators whose abstract was accepted for presentation. The application for the 2016 meeting will open in December and an announcement will be sent to all ACR/ARHP members.
In 2014, the ACR COR developed a grantsmanship webinar series to guide rheumatology investigators through the grant submission process. Topics in the eight webinar series, which can be accessed on the ACR website, include identifying available grant opportunities for investigators, crafting a planning timeline for grant submission and lessons to be gleaned from NIH grant summary statements.
Recruiting the Next Generation
Sustaining the ACR’s mission and enhancing the lives of patients with rheumatic diseases requires a deep understanding of the pathogenesis of the rheumatic diseases and an ability to translate these findings into novel and improved treatments. Physician-scientists’ unique combination of clinical expertise and scientific perspective is essential for the advancement of rheumatology. The ACR COR strives to attract and maintain a strong pipeline of basic and translational physician scientists who will serve as future thought leaders and pioneers in our field. This initiative is in its early stages, but progress to date includes liaising with the American Physician Scientists Association (APSA) (an organization for MD/PhD students) to increase the visibility of rheumatology, inviting MD/PhD, MD and DO students to attend the ACR RRW, and identifying physician scientists in rheumatology to become microvolunteers for the COR.
The ACR is committed to sustaining the pipeline of outstanding basic scientists in rheumatology by exposing prospective physician scientists to the field and to potential mentors early on in their careers.
E. William St.Clair, MD, is president of the ACR and chief of the Duke Division of Rheumatology and Immunology. Dr. St.Clair, a rheumatologist, has 25 years of experience as a clinical investigator. Contact him at [email protected].