Current trends toward increased cost sharing in health insurance are affecting patients with rheumatic diseases disproportionately, Dr. Yelin said. There is increasing prevalence of uninsured and underinsured people across the nation, and the way the U.S. healthcare system is organized has direct effects on people who have RA or systemic lupus erythematosus (SLE). Because RA and SLE are not “mortal” diseases, patients are more likely to go without care because of the costs.
Other trends indicate that Medicaid patients travel more than twice as far to get care for SLE, patients who live in areas of poverty or who have lower levels of education see their physicians 20% less, and uninsured patients have a substantially lower pass rate for quality indicators. Poverty variables are correlated to a higher incidence of clinical depression in patients with SLE. Those with lower education levels, who are immigrants, or who are Asian or Hispanic are more likely to report communication issues with their physicians, which is correlated with worse outcomes in RA.
The Truth about Study Sections
Many grant applicants may envision the study section panel as an angry mob, replete with torches and pitchforks. This is not actually the case, Dr. Cronstein said. Rather, the panels are composed of members who make “a very honest effort to get to the essence of what you’re trying to do … and decide whether it makes any sense.”
When the study section convenes, discussions include an overview of the proposal and rationale, the potential impact on the field, and the researchers’ approach and qualifications. “As junior investigators, we give you a lot of slack because there is an appreciation that we need another generation of people doing this,” Dr. Cronstein said.
Although the process is primarily fair overall, there are some nonfinancial conflicts of interest in grant evaluation. Some examples include disciplinary conflicts (i.e., bias against other disciplines), as well as personal rivalries and cronyism, which are fairly uncommon.
When the reviewers reach their consensus, the group votes to assign a score. Those who disagree can voice their dissent, but they have to do so publicly and with explanation. When the applicant gets the review back—online access to scores is available within about a week of when the study section meets and the “pink sheets” are sent about six to eight weeks later—the discussion characterizes the main points that ultimately came out in the review.
Launching an Academic Career
The ability to obtain grant funding is an important part of landing a faculty position. Institutions are more likely to provide matching funds for researchers who already have grants, said S. Louis Bridges, Jr., MD, PhD, Harbert-Ball Professor of Medicine and director of the division of clinical immunology and rheumatology at the University of Alabama at Birmingham. Although the dollar amounts of salary or start-up funds are important, he said, other factors weigh heavily.
