The Problem with Funding at University Hospitals isn't the Government

I have talked about funding a couple of times (here and here), and I get the impression from the comments about those posts that my views are at the minimum somewhat iconoclastic. Basically, while I would prefer the government to give more to research, at the moment I don't think that the primary issue is that the government isn't giving enough.

In this area, The Health Care Renewal Blog has a great post on the funding problems facing researchers in medical schools. Here's a clue -- they don't have to do with the government's but rather the medical school's priorities:

[Dr Goldman was asked to talk about academic careers....] I'd add something about the cold, hard facts of Academic Economics 101. There are four categories of faculty: 1) 'Taxpayers' who generate more than they cost and help fuel the academic mission; 2) 'Hired workers' who get paid to do a job that many people might like to do; 3) 'Loss leaders' who get short-term investments in the expectation that they will become successful 'taxpayers;' and 4) 'Welfare recipients' - faculty with more tenuous status.

Bottom line, you should strive to be a 'taxpayer.' If you're a 'hired worker,' you should strive to be better than the others who would like your job.

Dr Goldman reveals that in the typical medical school, the most important criterion for faculty success if generation of external funding, that is, generation of fees for clinical work, or of grants from external sponsors. Whether a faculty member is good at patient care, teaching, or research, or whether he or she upholds the highest professional standards, is secondary. (Emphasis in the original.)

Orac had this interesting comment in a long post I recommend reading in its entirety:

The bottom line, for universities, the system is a gravy train based on, in essence, the indentured servitude of young researchers, and it is not surprising that the doubling of the NIH budget from FY 1998 to 2003 resulted in an orgy of new construction and recruitment of new faculty to fill this new lab space. Indeed, the Director of the NIH, Dr. John Neiderhuber, in a speech that I attended yesterday at the Annual Meeting of the American Association of Cancer Research, stated that the NIH estimated that there was around $14-16 billion worth of new lab construction started in that period...When the NIH budget flattened out from FY 2004 to 2008, resulting in a 12% drop in purchasing power in real dollar terms over the most recent period, all this new construction and new recruiting of researchers, many of whom were chasing the now constrained NIH dollars, led to the current crisis in NIH grant funding...Woe indeed to the researcher who loses his grants in the current bleak climate. If not yet tenured, he'll be out on his tail. If tenured and without other funding, he'll lose his lab and be relegated to an uncomfortable position of being a "welfare case."

My read on these comments -- and the authors may feel free to disagree if they believe I am misrepresenting them -- is that while the relative scarcity of government funding is a problem for all of us at the moment, government funding isn't the biggest problem. The biggest problem is how university hospitals are structured as institutions. The biggest problem is how institutionally we have chosen to allocate these funds and how institutionally we place researchers between a rock and a hard place with respect to how they have to run their labs.

We had this retreat a couple weeks ago where there was a panel of alumni came to talk to us who have decided on different careers paths. One guy had decided to go the "big lab" route and said that he had to generate some 1.5 million dollars in new grants every year to keep things going. Another woman had decided to teach at a small liberal arts college. She still does research, but it is on the side and is primarily conducted by undergraduates. Mostly she gets paid to teach. Under the circumstances, I certainly understand why many people would prefer to choose a job at a small liberal arts college where the pressure is much lower.

The question for me is whether the institutions of large university hospitals change be modified to make it possible for people to do adequate research without fearing for their academic souls, selling their personal lives down the river, or completely ignoring the benefits of good teaching and competent clinical work. Maybe these are things are all antithetical...

Anyway, I am pleased that other people are talking about the things that are wrong with the way the system is set up.

Hat-tip: Abel.