The Association for Academic Surgery is home to some of the best and brightest surgical investigators in the world. One only need to look back on the past and current leaders of this organization to see the profound impact that these individuals have had on the field of surgery. As scientific knowledge advances, so too does our capacity to improve the care of patients. While it is undeniable that the field is driven forward by the talents, vision, and drive surgical investigators, it is also true that much of this progress is funded by federal research dollars.
Like many in the AAS, I hope to stand on the shoulders of the giants who came before me. And like many in the AAS, the pathway to a successful career in surgical research seems to lead through the National Institutes of Health (NIH). Thus it was that in late May I was distraught to learn that the new presidential budget proposal included cutting research spending by 18%, dropping the NIH’s total annual budget from $31.7 billion to $25.9, including $1.2 billion in cuts for the current fiscal year. Additionally, the president also proposed that the Agency for Healthcare Research and Quality (AHRQ) be rolled into the NIH without specifically preserving its $334 million budget, which could functionally eliminate this institution. Given that AHRQ is one of the primary funders of surgical outcomes research and there are no Institutional Centers within the NIH devoted specifically to surgery, this move would likely have a strongly negative impact on academic surgery. In considering the impact of this proposal on colleagues who are funded or who hope to be funded through AHRQ, I can only imagine the frustration that comes with knowing a part of your life’s work is on the chopping block because of changing political winds. Of course, these proposed changes occurred in the setting of an already-tough funding environment for surgical investigators. A recent study by Moses et al reported that the NIH budget has declined 13% in real value since 20041 and worse still for academic surgeons, awards to surgical investigators decreased by nearly 20% over approximately the same time period 2.
So, what should we, the members of the AAS do? It’s easy to be discouraged by such headlines, and easier still to find in them a reason not to write that grant. But take heart: federal funding agencies always have and always will fund great science. If you let the voices of pessimism talk you out of submitting a proposal, there is no earthly way it can be funded. To quote hockey great Wayne Gretzky, you miss 100% of the shots you don’t take. And, as the winds of politics change, they can change again. Fortunately for the research community, in early April congress rejected the proposed cuts and replaced them by a $2 billion increase in funding for the NIH. Time for fist bumps and champagne? Well, maybe not yet. The approved budget will increase NIH funding levels through October, but there is no telling what the budget for fiscal year 2018 will look like or what the downstream implications of this budget will be. The only certainty for the near future is continuing uncertainty, but in that uncertainty one thing remains quite clear: whether the NIH budget is slashed or increased in the fall, grant review sections will be meeting in Bethesda. It’s up you to make sure your work is on the table.
- Moses H, Iii, Matheson DM, et al. The anatomy of medical research: Us and international comparisons. JAMA. 2015;313(2):174-189.
- Hu Y, Edwards BL, Brooks KD, Newhook T, Slingluff CL. Recent trends in National Institutes of Health Funding for Surgery: 2003 to 2013. Am J Surg. 2015;209(6):1083-1089.