Abstract
Context: Colleges of osteopathic medicine (COMs) trying to stimulate research and develop research infrastructures must overcome the challenge of obtaining adequate funding to support growing research interests. The authors examine changes in research funding at COMs during the past 15 years.
Objectives: To track 1999-2004 data on COM research funding, COM faculty size, educational backgrounds of principal investigators receiving funding, and funding institutions. To compare these data with published results from 1989 to 1999.
Methods: Data on number of grants, funding amounts by extramural source, percent of total dollars by extramural source, percent of total dollars by COM, and total amount of extramural funding were obtained from the American Association of Colleges of Osteopathic Medicine databases. Data on the Osteopathic Research Center (ORC) were obtained from the ORC's databases.
Results: Research, both in terms of number of grants and funding amounts within the osteopathic medical profession, increased substantially from 1999 to 2004. The largest single source of funding remained the National Institutes of Health. The number of COMs whose research funding exceeded $1 million annually more than doubled, increasing from 5 in 1999 to 12 in 2004. The osteopathic medical profession's decision to direct research dollars into a national research center devoted to research specific to osteopathic manipulative medicine resulted in an almost eightfold return on initial investment in 4 years.
Conclusions: The amount of research productivity at a COM may be aligned with the size of the COM's full-time faculty, suggesting that once “critical mass” for teaching, service, and administration are achieved, a productive research program can be realized. Expanding the evidence base for those aspects of medicine unique to the osteopathic medical profession is dependent on the future growth of research.
Medical institutions increase in prestige and value to society when they participate in research that results in new discoveries that help prevent or manage disease and that promote advances in the basic and clinical sciences. Yet, health-related science centers and independent medical schools face the challenge of maintaining financial viability in the face of fluctuating income from traditional sources of revenue, such as state appropriations, medical practice plans, and student tuition. Because of these variables, medical schools may need to increase their reliance on alternative sources of revenue, such as research-related endowments and philanthropic gifts, to help maintain or enhance their financial viability.
1,2
Formal reports of federal and private-sector monies granted to colleges of osteopathic medicine (COMs) for research purposes are limited. The American Association of Colleges of Osteopathic Medicine (AACOM) publishes an annual report that tracks all grant and contract funding to COMs.
3 Guillory and Sharp
4 summarized AACOM data for research grants and research contracts during the 10-year period from 1989 to 1999. They reported that cumulative research funding in 1999 for all osteopathic medical institutions was 60% larger than it was in 1989.
4 Although substantial, this funding increase was still less than the National Institutes of Health's (NIH's) overall 100% increase in funding for the 5-year span starting in 1999.
5
The NIH Roadmap for Medical Research
6 is an integrated plan to deepen the clinical understanding of biology, stimulate interdisciplinary research teams, and reshape clinical research in the United States. In 1999, 77.8% of all grants awarded to COMs went to principal investigators (PIs) with PhD degrees, while 16.6% went to PIs with DO degrees.
4 With the new emphasis on translational research in medicine, there will be a greater demand for increasing the number of osteopathic physicians serving as PIs and collaborators on interdisciplinary teams.
Since 1999, there has been a greater impetus for COMs to increase research and garner additional research funding.
7 In December 2001, the osteopathic medical profession established the Osteopathic Research Center (ORC).
8,9 The main goal of establishing the ORC was to focus and enhance collaborative research on osteopathic manipulative medicine (OMM) at all osteopathic medical institutions through expansion of private and public funding opportunities.
8,9 Individual COMs have also launched independent programs aimed at increasing research and research funding at their home institutions.
10
Some of the objectives of the present study are to track research funding, funding sources, and the educational background of PIs at the COMs. In addition, we explore faculty size as a potential contributing factor to a productive research environment. Finally, the present study will examine data from 1999 to 2004, comparing it with previously published reports.
4
Each COM self-reported funding data to AACOM for its annual survey.
3 All COMs were sent standardized AACOM reporting forms that request data on all research grants and contracts, funding sources and amounts, and PIs. These forms also asked college administrators to attribute research funding received into one of several categories (
Figure).
Additional information requested from the COMs
3 includes the name of the department to which each research grant or research contract was awarded, the total amount of the award, the purpose of the award, and the academic degrees of the awardees. Grants were listed as cooperative agreements, demonstration projects, evaluation projects, fellowships, general institutional support, program projects, research career awards, research contracts, research grants, service/outreach, or teaching.
The full names of the COMs appear with their abbreviations in the Appendix on page 478.
The COMs sent their data to us without individual identifiers. Because the present study used secondary data that did not include personal health information, the institutional review board at KCUMB-COM granted review-exempt status to the current study.
The 1989-1999 data used for comparative analysis was published in 2003.
4 Research grants and research contracts discussed in the present study include all those awards reported as active during 2004. The one exception to this rule involves the description of the funds as a percentage of the NIH budget, which was calculated based on the year the grant was funded (ie, 1999 or 2004). Descriptive analysis and frequencies were obtained only for those awards listed as research grants or research contracts. Analysis was conducted using SAS/STAT software (version 9.1; SAS Institute, Cary, NC).
Although data on the number of full-time faculty members at MWU/AZCOM, MWU/CCOM, and UNECOM were obtained from the human resources departments at each of those schools, data on the remaining 17 COMs noted in the present analysis were published in
US News & World Report.11
Data on the ORC was obtained from the ORC databases.
12 The ORC tracks all awards resulting from initial funding on an ongoing basis.
In their annual reports to AACOM, the COMs disclosed a total of 673 grants and contracts in 2004. Of these, 449 (66.7%) were reported as research grants or research contracts.
The number of research grants and research contracts awarded to COMs increased by 135 between 1999 and 2004, from 314 to 449 (
Table 1). Research funding dollars won by researchers at COMs showed a net increase of $74.9 million during this time, from $26.8 million in 1999 to $101.7 million in 2004 (
Table 2). The average amount of funding per research grant from all sources during this time more than doubled, from $84,346 to $225,706 (
Table 3).
In 1999, pharmaceutical companies provided the largest number of individual research grants to COMs—95 grants (
Table 1) totaling $4.9 million in funding (
Table 2), which amounted to 18.4% of all funding dollars provided to COMs that year (
Table 4). By 2004, an additional 31 research grants were funded by pharmaceutical companies (
Table 1). The average size of research grants from these companies increased to $55,915 in 2004, from $51,579 in 1999 (
Table 3). This increase was accompanied by a net increase of $2.2 million in total pharmaceutical company dollars to all COMs (
Table 2).
The NIH provided the largest amount of research funds to COMs in 1999, at $14.7 million, and also in 2004, at $60.4 million (
Table 2). In addition, the NIH produced the second largest number of research grants by a single funder in 1999 (80 awards) and in 2004 (115 awards) (
Table 1). The average NIH research grant to COMs increased from $183,750 in 1999 to $525,046 in 2004 (
Table 3), while the percentage of NIH funding to COMs increased from 54.2% of all funding in 1999 to 59.6% of all funding in 2004 (
Table 4).
Grants from state and local sources (eg, state, county, and city government) accounted for another substantial increase in research funding to COMs. The total funding in this survey category rose from $600,000 in 1999 to $2.5 million in 2004 (
Table 2) with a total of seven research awards (
Table 1) and 2.2% of total research dollars in 1999 (
Table 4) to 10 research awards and 2.5% of total research dollars in 2004.
Foundation funding to researchers at COMs also showed a net increase of 15 research grants—from 35 in 1999 to 50 in 2004 (
Table 1). The average size of research grants from foundations increased from $43,333 in 1999 to $138,583 in 2004 (
Table 3). The total amount of research funding awarded to COMs from foundations demonstrated a net increase of $5.7 million, from $1.3 million in 1999 to $7 million in 2004 (
Table 2).
Although intramural support by COMs was not available in the 1999 data, 49 (10.9%) awards were school-supported research grants in 2004, for a total of $876,797. However, this funding source represented only 1% of total research funding to all COMs.
In 1989, only three COMs received research awards totaling more than $1 million (
Table 5). These schools were MSUCOM, UMDNJ-SOM, and UNTHSC/TCOM. By 1999, PCOM and UNECOM had also passed the cumulative total of $1 million for research funding (
Table 5). However, the number of COMs reporting more than $1 million of research funds increased to 12 (60%) by 2004 (
Table 5). The most successful of these was UNTHSC/TCOM with a total of $31.9 million received in research funding.
In 2004, the 20 COMs employed a total of 1445 full-time faculty members (
Table 6), for an average faculty size of 72 members per school. When staffing levels at the six state-supported COMs (MSUCOM, OSU-COM, OU-COM, UNTHSC/TCOM, UMDNJ-SOM, WVSOM) were analyzed separately, the average full-time faculty size at these six COMs was 114 (
Table 6). In 2004, the mean amount of research funding received by these six schools was $12.5 million per institution. By contrast, when privately supported COMs were analyzed as a group, the average faculty size decreased to 54, with a mean research income slightly short of $2 million per school (
Table 6).
For COMs that received more than $1 million in total research funding in 2004, the average faculty size was 94, with average research awards of $8.2 million per institution. For the remaining COMs, there was an average of 40 full-time faculty, with average research awards of $320,792 (
Table 6). Finally, of the five COMs in the top quartile of funding in 2004, only one, UNECOM, was a private institution. Among the five state-supported schools in the top quartile of funding for 2004, the average number of faculty members was 133, and the average amount of funds awarded was $16 million.
Principal investigators with PhD degrees received the largest number of awards at COMs in 1999 (197 awards) and in 2004 (263 awards) (
Table 7). Investigators with PhD degrees also received the largest percentage of total dollars awarded in both years: 77.8% in 1999, 82.8% in 2004 (
Table 7). Principal investigators with DO degrees at COMs received 84 (26.7%) awards in 1999 and 134 (29.8%) awards in 2004 (
Table 7).
Principal investigators with PhD degrees at COMs received the largest total amount of funding in 1999 ($20.6 million) and in 2004 ($83.9 million) (
Table 8). The average dollar amount awarded to PhD-holding PIs was $104,625 in 1999 and $319,050 in 2004 (
Table 8).
For PIs with DO degrees at COMs, the total dollar amount awarded in 1999 was $4.4 million. That amount increased to $12.6 million by 2004 (
Table 8). The average dollar amount awarded to DO-holding PIs was $52,195 in 1999 and $93,802 in 2004 (
Table 8).
The ORC was established in December 2001 with a 4-year initial investment of $1.1 million. This amount was granted jointly by the AOA, the American Osteopathic Foundation (AOF), and AACOM, and was directed toward infrastructure development to support uniquely osteopathic medical research.
8,9
By the end of 2005, the ORC had generated a total of $8.6 million of research funding, representing nearly an eight-fold return on the osteopathic medical profession's initial investment.
9
Results from the present analysis demonstrate how research funding to COMs increased substantially between 1999 and 2004. Compared with 1999 data, a net increase in research funding of $74.9 million, resulting from 135 additional awards, was reported in 2004 for all COMs.
Trends reveal increased amounts of funding from all source categories, with the two exceptions of the AOA and the US Department of Health and Human Services' Health Resources and Services Administration (HRSA) (
Table 2). Funding sources exhibiting the largest increase in the number of awards to COMs were pharmaceutical companies and the NIH, while the largest increase in the monetary amount for individual awards was from the NIH and other federal funding sources. These findings highlight the value of federal funding to osteopathic medical research.
The NIH provided the largest amount of funding to COMs in 1999 and in 2004. Although the NIH budget doubled from 1999 to 2004,
13 there was a threefold increase in the actual dollars awarded by the NIH to COMs. Still, the percentage of NIH funding provided to COMs remains small.
13 In 1999, $6.3 million, representing only 0.04% of the total NIH budget of $15.6 billion, was awarded to COMs.
13,14 In 2004, NIH awards to COMs increased to $19.9 million, or 0.07% of the total NIH budget of $28 billion for that year.
14
In 2004, the combined NIH funding to all COMs ranked 163rd among the funding totals provided by the NIH to the top 500 research institutions.
13-15 In 1999, the combined NIH funding awarded to the COMs ranked 202nd among all NIH-funded institutions, revealing that there was a modest improvement for COMs in funding rank between 1999 and 2004.
2,13-15
From the increase in the average amount of awards made by the NIH to COMs between 1999 and 2004 (
Table 3), one may surmise that the research grants were deemed of greater scientific merit in 2004 than in 1999. Both the number of research grants (
Table 1) and the funding amounts for individual grants (
Table 2) from the NIH increased more than those from any other single funding source between 1999 and 2004—and these increases happened as the diversity of funding sources increased in nearly every other category (
Table 2). The increase in funding diversity might bode well for COMs in the future because the broader base of options allows for COMs to enhance their competitive edge across the full spectrum of funding sources.
No funds specifically earmarked for research were provided by the HRSA to COMs in 2004. However, COMs reported that they received a total of $12.2 million in other funding categories from the HRSA during 2004. The absence of 2004 COM research funding from the HRSA may reflect a shift in funding priorities toward other disciplines, such as nursing.
16 However, it may also be reflective of changed reporting methods among the COMs. This latter concept was suggested in a September 2003 letter to the editor published in
JAOA—The Journal of the American Osteopathic Association. The writer questioned whether grants funded by the HRSA were in fact research grants.
17 By way of example, this commentator
17 noted that neither MWU/AZCOM nor MWU/CCOM reported training grants as research funds in their 1999 submissions to AACOM.
Because individual schools were asked to categorize their awards when self-reporting data to AACOM, the possibility exists that one school might have considered a training grant with a small research component as a research grant, while another school might have considered a similar grant as a training grant—not reporting it as research dollars. These problems may be inherent to the AACOM reporting system.
17 Nevertheless, such reporting errors would be expected to remain relatively consistent during the 15-year study period, because all changes for data acquisition and reporting were uniform among the COMs. Thus, such errors should be accounted for in the cumulative totals of each reporting category.
In 1999, award dollars were concentrated at three COMs, with 75.4% of total award dollars reported by UNTHSC/TCOM, MSUCOM, and UMDNJ-SOM (
Table 5). By 2004, the five COMs with the most award dollars (UNTHSC/TCOM, UMDNJ-SOM, OU-COM, MSUCOM, and UNECOM) received approximately 79% of all research awards (
Table 5). Four of these five schools are state-supported institutions. Faculty numbers tend to be higher at state-supported schools, allowing for a larger percentage of faculty time devoted to research. In addition, state-supported institutions in the osteopathic medical profession tend to have a more established and extensive infrastructure to support scholarly activities than do private institutions.
Allopathic medical schools command the vast majority of the NIH research grant budget and also have much larger faculty numbers than do COMs. In 1996, it was reported that, with an average number of 73 full-time faculty members, COMs were staffed at levels approximately 10% that of their allopathic counterparts who were able to maintain average full-time staffing levels of 716.
18-20 This disparity worsened by 2004, when the number of full-time faculty members at COMs was only 8.6% that of allopathic medical schools.
19,20 Part of this apparent trend may be the result of the initial small faculty numbers at the new, privately funded COMs that have opened since 1995 (
Table 6).
Even taking the new schools into consideration, however, the data suggest that a “critical mass” of faculty is necessary to meet the basic educational, administrative, and service needs of a COM before funding is allocated to substantial osteopathic research efforts. As noted previously, in the six state-supported COMs, the average faculty size was 114 in 2004, with a range of 36 members at WVSOM, which reported no research funding in 2004, to 190 members at UNTHSC/TCOM, where $31.9 million in research funding was reported for 2004 (
Table 6). By comparison, privately funded COMs averaged 54 faculty members (47% of the average size of state-supported COMs) and $1.9 million in research funding (19% of the funding of the state schools) (
Table 6). Thus, though the private institutions cumulatively employed about half the profession's full-time faculty, they produced only about 19% of the profession's research.
Those COMs with the largest faculty sizes receive the most research funds, suggesting that once the critical mass is met for education, administration, and service, the institution's research productivity can increase at a faster pace. All but one (VCOM) of the seven privately supported schools with research funding exceeding $1 million in 2004 were either established more than 90 years ago (ATSU-KCOM, KCUMB-COM, MWU/CCOM, PCOM) or had more than 85 full-time faculty members (NSU-COM, UNECOM).
It may be that a critical mass of 75 to 90 full-time faculty members—or an institution that has had many decades to establish an infrastructure—are necessary to garner even a modest amount of research funding. However, even after this critical mass is achieved, it is understandable that an institution with access to more financial and internal resources, usually as a result of state support, can attract research faculty members more easily than an institution whose support, space, and infrastructure are more limited.
Between 1999 and 2004, PhD-holding faculty members at COMs conducted the majority of funded research in the osteopathic medical profession. However, during that same period, more osteopathic physicians also began receiving research funding (
Table 7). The percentage of osteopathic physicians receiving research grants and research contracts increased from 26.7% of awards in 1999 to 29.8% of awards in 2004, and both the total number and average amount of these awards increased for DOs (
Table 8). However, when comparing data from 1999 to that of 2004, the percentage of total funding for research conducted by osteopathic physicians actually decreased from 16.6% to 12.4% (
Table 7). These data indicate that there was a larger incremental increase per grant for basic scientists, underscoring the need for increasing the translational and clinical research conducted by physician-scientists within the osteopathic medical profession.
A focused investment in research has been shown to increase the productivity of research dollars, as evidenced by the formation and success of the ORC.
9 During the first 4 years of its existence, researchers at the ORC were awarded three NIH research grants totaling more than $3.2 million, including a U19 grant (Research Program [Cooperative Agreement]) for a developmental center for research on OMM, a K24 grant (Midcareer Investigator Award in Patient-Oriented Research) to study the efficacy of OMM on low back pain, and an R-21 award (Exploratory/Developmental Grant) to study the efficacy of osteopathic manipulative treatment (OMT) in patients with carpal tunnel syndrome.
12 Of equal, if not greater, importance is the fact that these NIH research grants were the first ever awarded to the osteopathic medical profession for research related to OMM. In addition to attracting this NIH funding, the ORC has coordinated the largest OMT trial ever—a 2-year, five-site, prospective, randomized, controlled, and blinded study named the Multi-Center Osteopathic Pneumonia Study in the Elderly.
21
The success of the ORC can be measured not only by the profession's return on its investment, but also by the increase in scholarly activity the Center has generated since 2002—as evidenced by 32 full-length research publications and 22 poster abstracts on OMM clinical trials and practice outcomes.
9 Another benefit accrued to the profession via the ORC is the creation of new training programs for clinical researchers that will further expand the osteopathic medical profession's ability to produce substantive research.
In contrast to the ORC's previously noted return on investment, 2003 AOA data reported a 1.69-fold return on initial investment for research grants and fellowships awarded by the AOA Bureau of Research.
22 However, the lower investment return on research dollars invested by the AOA should be expected because these funds are used primarily as seed dollars and to support fellowship programs. From a fiscal perspective, the return on investment associated with a fellowship or a seed grant is expected to be far less than that awarded to a seasoned PI. Further, it should be remembered that smaller fellowship and pilot grants are a major source of funding for new investigators in the osteopathic medical profession. Such funding frequently results in providing the impetus for a student or recent graduate to pursue a career in research. Therefore, to be fair, the impact of these funds should be assessed over time to determine whether the investment will result in the future development of larger research grants and more committed researchers within the profession.
There are several limitations to the present study. One of these is related to data collection and analysis. As noted, data were self-reported. The inherent issues associated with self-reporting of research grants have been previously discussed in this article.
A second limitation is that our analysis is based on 1-year comparison data from AACOM at 5-year intervals. This is the format used in the original study by Guillory and Sharp
4 and, therefore, it is consistent with the methods used in that study. However, funding can vary significantly from one year to the next, especially in any given research category. Our analysis does not include a cumulative total of all research funding at COMs. Rather, it represents 5-year trends in research at the schools. Thus, our data should be construed as representative—but not definitive—of research efforts at osteopathic medical institutions.
In addition, the present analysis is limited to the COMs rather than the entire osteopathic medical profession. Although, to our knowledge, there are no data on research conducted by osteopathic physicians in allopathic hospital systems, in other allopathic institutions, or in other academic centers not directly affiliated with osteopathic medical schools, one would assume that there is considerable research in these areas that is not included in the current study.
Finally, it would be useful to determine how much of the research conducted at COMs is related to osteopathic principles and practice. Recent funding trends within the profession have increased spending for uniquely osteopathic research, and tracking the progression of this funding would prove valuable over time.
Growth in research at COMs improved substantially during the 15 years between 1989 and 2004, with the largest increases noted during the most recent 5-year period. Funding increased in most source categories, especially from the NIH and state and local sources. By 2004, 60% of all COMs reported receiving more than $1 million in research funding per year.
The success of the ORC has demonstrated that focused research funding initiatives can provide a tremendous return on investment for OMM-related research. The initial investments in the ORC of $2 million over 8 years were more modest than the typical start-up budget for a new research institution, where up to $40 million is expected.
23 This profession's return on investment is even more impressive when one considers the success of the ORC in its first 4 years. Leadership within the osteopathic medical profession has determined that it would be best to focus limited OMM research dollars at a small number of institutions. This strategy appears to be solid as it has resulted in research growth within the profession.
In an editorial in the May 2005 edition of the
JAOA, Osborn
19 found one major point of connection among three articles that addressed the history and philosophy of osteopathic medicine:
As a profession, we continue to develop our research efforts in many areas. However, strategic financial support within the profession for research related to osteopathic principles and practice must continue to be a high priority—further enhancing research funding and scholarly activity—but also the profession's ability to develop its own distinctive clinical researchers.
9