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Mission Impossible? Candid Words About Medical Research Grants

 
Advice on how to write and win research grants is plentiful. Applicants can talk to faculty mentors and program officers, pore over hundreds of websites, and even listen to YouTube tutorials and podcasts. For a fee, applicants can rub shoulders with NIH officers and over 800 of their eager peers during training seminars. While there’s no Kaplan for medical grant writing (yet), any applicant can spend hundreds of dollars on books, subscriptions, training workshops, or even hire writers, statisticians, and consultants. The how-to of grant writing has turned into a cottage industry, but there are few who will ask: Should you bother?
This article will describe the distinction between the difficult and the futile quest for research grant funding. This article culls from subjective and objective data from the NIH, candid advice of post-docs on blogs, and my career as a grant writer and advisor. Little of the following information and recommendations are new, but it is organized to serve as a platform for discussion. The major message is that grant hopefuls must be persistent and be prepared to do some planning and thinking before they begin to write.
An Example to Set the Stage
A new doctorate is in a panic to write her first NIH grant. The deadline is in only 3 weeks! She is hesitant to submit, but her advisor urged her to apply. She updates an unfinished grant application from two years ago. Upon reading the draft, she sees that the application had diffuse research aims backed by unrelated preliminary studies. Her faculty advisor makes a suggestion for a completely new study and shares an unpublished manuscript. The doctorate spends late nights to match her research to her advisor’s suggestions (and the literature of her field). The doctorate’s proposal squeaks in just ahead of deadline.
This is an adaptation of a true story of a Ph.D.’s first NIH grant proposal. Commonly, first attempts are driven by external factors such as deadlines and mentor preferences. This effort was doomed because the grant seeker was deprived of precious time to develop a coherent research concept. What’s worse is that the applicant did not revisit any of her concepts until the rejection arrived months later. She had held onto the vain hope that somehow she’d get “lucky” and the NIH would reward her hastily written proposal.
Fierce competition for academic jobs and grants
While research is a profession that provides great value to medicine, academic research is usually not a profitable venture. Therefore, government and industry grant funding provides an investment in research. The NIH is a prime investor in medical research with a current annual budget of $30.9 billion that is distributed to 2,500 institutions with a workforce of 300,000 researchers. (1)
While NIH funding is essential to conduct research in a university or medical center, the heyday of NIH grant funding is over. Appropriations for NIH funding doubled in the years from 1998 to 2003, but funding has since flattened, meaning reductions in real dollars. As a result, the competition for grant funding is ridiculously high and success rates have plummeted. Only 17.7% of the 80,000 NIH grant applications were funded in 2011. (2)
But that dismal figure paints too rosy a picture. A 3% payline may be needed to win the prized R01, which means a score that is better that 97% of other worthy applications. The NIH builds in a small handicap for early career investigators, who are within 10 years of their academic training. However, those changes have not made a substantial difference in rates of funding.
What that means is that casual grant seekers need not apply. The golden goal of independent research takes long years to achieve. An often-quoted statistic from the NIH is that the average age of the first R01 grant for a PhD is 42. This statistic has not changed in the past decade. The age of first R01 for MD-PhDs has climbed from age 42 in 2001 to age 44 in 2011. MDs are the oldest of the first-time R01 winners with an average age of 45. Data displayed by the NIH demonstrate that age of first R01 has been climbing for the past decade. (3)
Those who aspire to academic research careers already know the statistics and are willing to make the sacrifices. Grants are needed to conduct research, generate data, achieve tenure, and make beautiful science. Grants mean independence, even with the frequent reporting and bureaucratic requirements. Grants also raise the reputation of the researcher, ease publication, and are often publicized. While grants yield myriad rewards, there are years of uncertainty and struggle to win them.
Is innovation rewarded?
Innovation is a core review criteria for research grants. Grant advice states that funding preference is given to groundbreaking work. Therefore, applicants achieve the Herculean task of being innovative and approachable to peer review committees. Those who are most likely to be successful have already achieved success with grants, which seems like an impossible puzzle. What compounds the problem is that “risky” or exploratory research has declined in popularity among peer review committees in the face of shrinking budgets. Early career investigators may be well suited to innovative research due to having a fresh perspective and experience in the latest technologies and research modalities. However, those novel and innovative perspectives are not always well received on review panels.
Stories circulate among new researchers about a sympathetic review panelist plucking an application from the likely-to-reject pile. There are anonymous champions in peer review, who will discover the brilliance in a research concept. There are other stories about how an ultimately fruitful research endeavor was thwarted by the score of one peer reviewer. There is an element of chance is awards, but that’s not a strategy to build a career. It’s better to apply effort on what you can control, which is an application that can withstand the scrutiny of many eyes. A reality check is to run your work by veteran grant winners in your field. Can they see your work as a small, but critical building block in medical research?
The Challenge for the Physician-Scientist
What about the future of the MD-PhD prepared researcher, who translates research from the laboratory to the bedside? Is it possible to do both research and clinical practice? The obstacles for a busy physician to conduct clinical research are formidable. One challenge is that research is highly specialized and technology has grown increasingly sophisticated. Clinical medicine is driven to address immediate problems, to extend the life of a patient.
In the book, The Vanishing Physician-Scientist, editor Andrew Shafer, MD argues that several structural issues have made it difficult for a physician to move from laboratory to bedside. (4) The pathways of scientist and clinical physician have separated, in part because research and clinical practice have become sophisticated, specialized fields. The clinician is unable to keep up with understanding in molecular biology and genetics and the scientist is unfamiliar with technological and therapeutic advances at the bedside.
There are also practical issues that bar clinicians from practicing research. A clinician requires protected time to conduct research apart from clinical, teaching, and administrative activities. Institutional culture has a large impact on the career choices of the physician. Universities with nationally reputed academic medical centers receive the greatest number of federal grants. They also receive substantial industry and private foundation money. However, more clinically oriented physicians affiliated with these medical centers may be marginalized from the rapidly moving grant submission pipeline. Breaking into your institutions network requires an investment of time. A good start is to talk with faculty and research administrators and possibly attending meetings, seminars, and training sessions. There is a plethora of discussion in institutions, from heady policy and intellectual discussions to the mundane training on writing a modular budget. Familiarity with the language and culture of research and funding may give you the confidence to develop a research concept.
Despite the impracticality of balancing research and clinical responsibilities, there is high demand for physician scientists. National priorities on translational and comparative effectiveness research have opened up new funding streams. Francis Collins, Director of the NIH has stated that translational research is a top priority. In interviews, he has frequently discussed breakthroughs in sequencing an individual’s genome and how that may benefit clinical practice. The National Institutes of Health opened its newest Institute – the National Center for Advancing Translational Sciences (NCATS). The Center is focused on accelerating the study and release of diagnostics, therapeutics, and discovery technologies for the treatment and cure of disease.
The Clinical Physician’s Role in Research
The NIH notes that MD-level researchers have more difficulty with achieving funding and are less likely to resubmit a rejected R01. Many physicians would like to conduct medical research, but they don’t know how to break into the work. Nor do they know how to find the time and funding.
Some physicians may take a “Waiting for Godot” approach and will not commence research until the grant is awarded. However, those who are persistent will do the research anyway and cobble together small grants from their institution, industry, professional associations, and foundations. Ingenuity is an important quality among successful researchers.
There is a continued interest in clinical research, especially because that research is tangible to patients and their families. One movement in clinical research is comparative effectiveness research, which is focused on assessing the relative benefits of treatments. Legislation that passed the Affordable Care and Patient Protection Act launched a non-profit devoted to patient-centered outcomes research. The Patient Care Outcomes Research Institute will be giving over $100 million in grants over the next several years. While clinical research funding is small compared to laboratory and translational research, it answers some important questions that inform evidence-based medicine.
Recommendations
1. Most who persist succeed. Anyone capable of conducting research and becoming published should be able to win a grant, eventually. The NIH’s success rates increase considerably for revised and resubmitted applications.
2. Buy yourself time to build value into your application. There’s no better motivator than an absolute deadline. But listen to your common sense that you can’t remedy defects in your application on a short timeline. An application with all of the requirements in place still takes 3-4 months to write. The point of the delay is to use that time to do valuable things such as having that CV building article published, talking with an NIH Program Officer, or collaborating with others.
3. Apply for smaller grants, if you aren’t yet competitive for an R01. The only way to prove you are able is to demonstrate research skill and collect preliminary data. Small grant funding is available from your institution, professional associations, foundations, and the NIH R03. You can also investigate other funding mechanisms such as mentored research awards (K series) or fellowships (F series).
4. Collaborate for stronger research. Medicine, especially at the frontiers, is increasingly complex. Research is not work that can be done by a lone investigator. Talk with your colleagues, mentors, technical specialists, and members of your specialty field.
5. Pay attention to the entire application. Strong biographical sketches will augment your application. Contradictory elements, poor writing, and errors will significantly hurt your chances.
6. Budgets don’t affect your score, but will affect your performance. While review committees don’t consider your budget in scoring, your budget will set the limits for your research. Be meticulous in creating a real world budget. However, be prepared to have a revised research plan in mind, if you are funded at a lesser amount.
Caroline Leopold has been a professional grant writer since 1999 for non-profits, health programs, and medical research. She also writes on topics of public health, medical science, and the intersection of money and medical progress. You may follow her at her twitter account: caroline815.
References:
(1) National Institutes of Health. NIH Budget. Available from: http://www.nih.gov/about/budget.htm
(2) National Institutes of Health. Research Portfolio Online Tools (RePORT). Available from: http://report.nih.gov/success_rates/Success_ByIC.cfm
(3) NIH Office of Extramural Research. Our commitment to supporting the next generation. Available from http://nexus.od.nih.gov/all/2012/02/…xt-generation/
(4) Schafer AI, ed. The Vanishing Physician-Scientist. Cornell University Press: 2009.