First, there is a shrinking of clinical income resulting from the revolution of managed care. While the goals of managing costs of health care are laudable and probably essential, no commercial insurers have demonstrated interest or commitment to the other missions of academic medicine. Thus, the income from clinical activities that in the past helped to support the teaching and research activities of the Department is dwindling and will almost certainly decline further.

Second, the opportunities for research and the number of active biomedical scientists are at an all time high. The major source of medical research funding is the National Institutes of Health, and although it has received generous increases in funds from Congress at a time that many programs were cut or reduced, the increases have not matched the increase in scientists eager to carry out research. Thus, competition for research funding has been very keen for over a decade. This has been a source of frustration and discouragement for younger investigators in particular, and has seemed to have the effect of reducing the number of M.D. investigators choosing academic medicine as a career. The dilemma is that just as the Federal budget gets balanced and growth in the NIH funds can increase, academic medicine, and in particular Departments of Medicine, is under severe financial stresses that may well prevent us taking advantage of new research money. This is the result of less ability to provide startup money and salary support for these individuals. We have estimated that institutional support of research amounts to about 15% of the direct costs; to become a larger, better funded research center requires larger amounts of infrastructure support, which clinical departments are less able to fund.

The continued world leadership of American medical research will depend upon finding ways to finance the training and career development of young physician scientists. Despite the challenges outlined above, the Department is committed to reaching the top 10 Departments in NIH funding. If you would be interested in the sponsorship of research at Indiana, please see our Philanthropy page.