In the falls of 2004 and 2009, all COMs in the United States were asked by AACOM to complete standardized reporting forms regarding all currently active internally and externally funded projects.¹⁰ Specifically, college administrators self-reported information about active awards including the award amount, funding agency (eg, NIH), academic degree and department of the principal investigator, activity (eg, research grant), and subject area (eg, biomedical). The only difference between the 2004 and 2009 forms was the format. The 2009 form could be completed electronically whereas the 2004 form could not. For this study, only data pertaining to research grants and contracts and the first principal investigator listed were used. Respondents could identify a second principal investigator if applicable; however, this information was not required and underreporting may have occurred (only 15% of active awards had a second principal investigator listed). Further, we examined data on OMM funding separately from clinical funding to better illustrate details regarding funding in the OMM subject area. Additional data about 2004 and 2009 research expenditures, number of full-time faculty, number of students, and school type (private or public) were also obtained from the AACOM survey. The response rates for the 2004 and 2009 surveys were 100%. The research protocol was reviewed and approved by the human subjects' research review board at the Kansas City University of Medicine and Biosciences. 

The Consumer Price Index represents changes in prices of all goods and services purchased for consumption by urban households.¹¹ Based on the inflation calculator on the US Bureau of Labor Web site (http://www.bls.gov/data/inflation_calculator.htm), we determined that the inflation rate between 2004 and 2009 was 13.57%. All 2004 dollar amounts were adjusted for this inflation rate to reflect 2009 dollar values. For example, the 2004 total award amount of $101.408 million would be equivalent to $115.169 million in 2009 dollars. 

Descriptive statistics were calculated as means (eg, average amount per award) or as summations (eg, total amount per award). Data and results from the analyses are given for the 20 COMs that completed the 2004 survey plus an additional 6 that did not exist in 2004, thus giving a sample size for 2009 of 26. Descriptive statistics for these schools are presented as mean (standard deviation) with variable ranges and summations, if applicable. The distributions of skewed 2009 variables were normalized by means of log or square root transformations. Bivariate relationships among continuous variables were examined using Pearson product moment correlation. Point biserial correlation was used for school type (a dichotomous variable) and the continuous variables of interest. To guard against an experimentwise error rate associated with the bivariate correlation procedures, a Bonferroni correction for multiple tests was made. Therefore, the level of statistical significance was set at .007 (0.05 ÷ 7 tests) for bivariate correlations. Two multiple linear regression models were constructed to explore predictors of the total amounts (model 1) and number (model 2) of awards active in 2009. The independent variables were school type (0=private, 1=public), the number of faculty, and research expenditures in dollars; these variables were found to be related to the total amounts and number of awards in the bivariate analysis. The level of statistical significance was set a priori at .05 for the multiple regression analyses, and all analyses were conducted using SPSS statistical software version 20.0 (SPSS for Windows, SPSS Inc, Chicago, Illinois). 

Provided in Table 1 are descriptive statistics for select characteristics of the 20 COMs completing the AACOM survey in 2004 and 2009. The workforce of full-time faculty grew (19.9% or 288 faculty) during the 5-year period, as did the amount of funds expended on research (41% increase or $17.0 million). Substantial increases were observed from 2004 to 2009 in the total amount of awards (88.1% or $101.5 million additional), the number of awards (47.8% or 215 awards), and the dollar amount of each award (28.8% or $60,000). In both years of the survey, there was a large spread of ranges for the measured variables. As an example, in 2009 one COM had more than $82.6 million in awards, while another had $0.1 million. Distributions of the total amount of awards were skewed; in 2004, 2 COMs received 51.2% of the awards, and in 2009, 2 COMs received 61.2% of the awards. Although the majority of COMs (13 [65%]) showed an increase in the total amount of awards from 2004 to 2009, their rank or position relative to other COMs was stable (7 COMs in the top half for total award amounts in 2004 were in the top half in 2009). 

The total amount of awards, the number of awards, and the amount of dollars received per award for each funding source were higher in 2009 than 2004 (Table 2). The total amount of awards obtained from foundations increased 335.7% ($26.4 million) from 2004 to 2009. This increase was due more to an increase in the dollar amounts of each award (144.6% increase or $227,000) than the number of awards (78% increase or 39 awards). Foundations provided by far the largest increase in awards from a particular funding source; however, fairly large gains were noted in funds from the NIH, the AOA, and other federal agencies. The percentages of total award amounts accounted for by other federal agencies, state or local agencies, the Centers for Disease Control and Prevention (CDC), the US Department of Defense (DOD), pharmaceutical companies, and other groups were lower in 2009 compared with 2004, while total amounts were similar for the NIH (60.1% in 2004 vs 62.3% in 2009) and higher for foundations (2.5-fold higher in 2009). While the total amount of awards from “other” federal agencies and the AOA increased, the dollar amount of each award decreased substantially (31.3% or $158,000 for other federal agencies and 50.0% or $53,000 for AOA). In 2009 there was an absence of funding from the CDC and the DOD, which provided $2.2 million in 2004. 

Most of the total dollars awarded were obtained by PhD principal investigators (82.8% or $95.3 million in 2004 and 78.4% or $169.9 million in 2009) followed by DOs (12.5% or $14.3 million in 2004 and 11.6% or $25.1 million in 2009) (Table 3). Although the total amount of awards grew for all degree types from 2004 to 2009, increases were most substantial for principal investigators holding PhD and DO degrees (909% or $1.3 million), MD degrees only (515.4% or $8.1 million), and PhD and MD degrees (267.5% or $4.4 million). Each degree type also obtained relatively higher dollar amounts for each award funded in 2009, with the largest increase being $38,000 per award for principal investigators with PhD and DO degrees (237.5% increase). 

Most of the total amount of awards in 2004 (78.5% or $90.4 million) and 2009 (63.3% or $137.2 million) went to biomedical research (Table 4). No clinical research awards were reported active in 2004, while $48.7 million in clinical research awards was identified in 2009. The largest rise from 2004 to 2009 in funding occurred in the area of drug research, with increases of 173.7% or $9.8 million in the total amount of awards and 181.6% or $89,000 in the amount per award. Increases in funding amounts for biomedical (51.7% or 81 additional awards in 2009), behavioral (65.7% or 10 additional awards in 2009), and OMM (60.2% or 6 additional awards in 2009) research were also noted with increases in award amounts for biomedical (15.5% or $54,000) and OMM (25.2% or $38,000) and a decrease for behavioral research (-21.5% or -$118,000). Fairly large decreases in the total amount of awards (-81.9% or -$9.1 million) and dollars per award (-72.5% or -$170,000) for other research areas were observed. 

Selected descriptive statistics for the 26 COMs completing the AACOM survey in 2009 are displayed in Table 5. Acceptable skewness statistics (values <2.0) were noted for skewed 2009 variables (total award amounts, total number of awards, number of faculty, and research expenditures) after normalizing their distributions. Total research expenditures, total award amounts, and the total number of awards were not much higher in 2009 than 2004 awards, even with the addition of 6 new COMs ($1300 for expenditures, $255,000 for award amounts, and 7 awards). Also notable in this table is the robustness of variance indicators (standard deviations and ranges) for all variables. For instance, 1 COM expended $0 on research while another expended more than $26 million on research in fiscal year 2009. Likewise, the total amount of awards ranged from $0 at 2 COMs to more than $82 million at 1 COM. The $82 million received for research by the COM that led in research funding was approximately $32 million higher than the COM with the second highest amount of research funding. There were 20 private (76.9%) and 6 public (23.1%) COMs. 

Correlation coefficients derived for the purpose of examining the bivariate relationships among school demographics and award data are presented in Table 6. The total amount of awards and number of awards were statistically significant for and positively correlated with research expenditures and the number of faculty. In addition, public COMs obtained more award dollars and awards, expended more on research, and had larger faculties than private COMs. 

The results of the multiple regression analyses are given in Table 7. The tolerance and variance inflation factors were within acceptable ranges, thus indicating colinearity, and did not compromise the models.¹² In model 1, faculty number and research expenditures were statistically significant predictors of the total amount of awards. These 2 variables plus school type explained 79.0% of the variance in the total amount of awards. Research dollars expended was the only statistically significant predictor of the number of awards (model 2). The variables contained in model 2 accounted for 81.0% of the variance in the number of awards. Although school type was not a statistically significant predictor of the total amount or number of awards, being a public COM was associated with having $4.9 million more in awards and 12.7 additional awards than that of being a private COM. 

The purpose of the present study was to examine research funding at COMs. Specifically, we used data from AACOM surveys of college administrators to compare active research awards in 2009 with active research awards in 2004. The total amount of awards, the number of awards, and the amount of dollars obtained per award increased from 2004 to 2009, which is consistent with findings of previous studies on COM research funding.^8,9 A unique aspect of this study was the examination of research expenditures, the number of faculty, and school type as predictors of research funding. In general, increasing numbers of faculty and expending more dollars on research enhanced research productivity as evidenced by funding procurement. 

Previous reports^8,9 indicated the total amount of awards at COMs increased $9.9 million between 1989 and 1999 and $74.9 million between 1999 and 2004. We also noted substantial increases in funding ($101.5 million) and investments in research (41%) between 2004 and 2009 even after adjusting for the effects of inflation, which was not done in the previous studies. Similar patterns of funding were evident among the 3 studies such as major contributions from the NIH (54.9% in 1999, 59.6% in 2004, and 62.3% in 2009), the skewed distribution of research funding toward 2 to 3 COMs, and virtually nonexistent support from the CDC, the DOD, and the Health Resources and Services Administration. A primary difference between studies involved the contributions of foundations to COM research. Foundation funding was relatively low in 1999 and 2004 (5% to 7% of total funding) but increased substantially (336%) between 2004 and 2009, thus promoting foundations to the status of “major supporter” of COM research (15.8% of total funds, second only to the NIH). Also of relevance was the nonexistence of funding for clinical studies in 2004. It is not clear if this finding represents an actual absence of clinically funded research in 2004 or a reporting error on the 2004 survey. 

Consistent with the 2 previous studies^8,9 on COM research funding, principal investigators with PhD degrees garnered the most research dollars and the highest number of awards. They averaged approximately $0.4 million per award, which is consistent with findings on principal investigators with PhD degrees employed by allopathic medical schools.¹³ In contrast with previous reports on COM research funding, the greatest increase in funding activity was not for PhDs but for individuals with dual degrees or MD degrees. For instance, the total amount of awards for PhD-DO principal investigators increased 909% between 2004 and 2009. This may reflect more involvement with research (and success) from an existing COM “pool” of dual-degree faculty, the addition of COM faculty having dual degrees along with their capacities to obtain research funding, or the attainment of additional terminal degrees by existing DO or MD COM faculty and consequently an enhanced ability to obtain research funds. Zinner and Campbell¹³ found that increasing the involvement of faculty with medical degrees in research is a potential method of securing additional extramural research funding. This achievement may require COMs to allot faculty with medical degrees more time for research by reducing their hours allocated to patient care. It has been shown that faculty at medical schools without funding devote substantially more hours to patient care than do faculty at schools with funding (22.3 hours vs 9.8 hours).¹³ Allied with this concept would be the provision of incentives (eg, tuition remission, sabbaticals) that encourage current medical faculty to hone their research skills. For example, there are several academic programs that build research skills that are often not addressed during medical training. Determining ways to involve more faculty with DO degrees in research is particularly relevant given that they received only 3 additional research awards in 2009 compared with 2004. 

The present study is the first to our knowledge to present detailed funding data for OMM research conducted at COMs. Although OMM research in 2009 amounted to only 2.4% of the total amount of awards received, there was a substantial increase in funding for OMM research (60%) between 2004 and 2009 (albeit only an increase of 6 total awards for a total of 27 awards or 1.4 awards per COM). This is indirect evidence that efforts to promote OMM research (eg, AOA research grants and development program) are making an impact at COMs similar to that observed at The Osteopathic Research Center and congruent with the suggestion that osteopathic physicians have an obligation to generate scientific evidence establishing the safety, efficacy, and effectiveness of alternative treatments for musculoskeletal conditions and spinal manipulation.^1,3,8 Moreover, an increase in OMM research may help to address the growing use of complementary and alternative therapies.¹⁴ For OMM research to continue to expand, it will be necessary for COMs to secure more federal funding to build research infrastructure and programs to a level proportionate to the number of practicing osteopathic physicians.² 

The present study also presents novel information regarding predictors of research funding at COMs. The variables used in the regression models explain a substantial portion of the variance in total award amounts (79%) and number of awards (81%) and provide guidance to COMs on how to increase research funding. First, research expenditures were found to be statistically significant predictors of the total amount and number of awards. This association was linear, thus indicating that similar, incremental increases in funding or awards can be achieved by COMs regardless of their current dollar investments in research. In other words, COMs with limited monetary resources or with philosophies favoring medical education could still increase research productivity by providing money for research. Similarly, The Osteopathic Research Center, the AOA's Council on Research, and the University of Rochester School of Medicine and Dentistry all reported substantial gains in research dollars relative to initial, smaller outlays of dollars for research support.^3,8,15 Simply speaking, investing dollars in research is important for obtaining funds to conduct research; however, the importance most likely resides with how the funds are used to support research and how efficient the process is for securing research funds. It has been suggested that providing coverage for basic university functions (eg, administrative tasks) and having a well-developed infrastructure for submitting and managing grants is essential for advancing research.^8,16 The importance of infrastructure was examined by Klein and colleagues,¹⁷ who demonstrated that adding infrastructure raised grant applications 153% and total funds requested from $11.9 million to $41.8 million. It will be important to determine if there is an optimal and broadly applicable method for investing in research at COMs that produces the greatest effect on funding. 

The regression analysis also showed that larger faculty sizes were significantly associated with more dollars in research funding independent of whether the COM was public or private. This finding supports the contention made by previous researchers that increasing faculty numbers beyond a certain critical mass needed for student education would allow faculty with greater research responsibilities to be more successful in securing extramural funding.^8,9 Moreover, this approach enhances research productivity without compromising educational objectives. It should be noted that faculty numbers used in this study did not include part-time or adjunct faculty. Use of such human resources has economic advantages and may represent an undocumented resource for promoting research. 

Prozialeck¹⁸ argued in a letter that COMs characterized as valuing and rewarding research create an institutional culture conducive to pursuing and obtaining research funds. Further, he states the research culture, not the number of faculty, is the primary factor influencing grant procurement by faculty. In contrast, this study found faculty size to be a statistically significant predictor of research funding even after considering COM type (private or public). Possibly different analytic approaches or the use of different data (ie, 2004 vs 2009) are reasons for these contradictory results. Nevertheless, the outcomes of the present study could be interpreted as supporting the contention that the research culture is an important factor to consider. More specifically, greater investments in research and reducing non–research-related workloads for researchers by hiring teaching faculty could substantially improve the research culture at COMs. Incentives for securing grants, a well-developed intramural funding program, protected time for research, and adequate start-up packages would enhance research-related morale, motivation, and culture. It may also be important to consider the dynamic interrelationships between research expenditures and monetary investments for additional teaching faculty. For example, a COM that employs more faculty members to cover teaching responsibilities may be in a better position to recruit and retain productive researchers who value reduced teaching workloads. Similarly, gains through research (eg, lab equipment) could improve teaching efficiency, thereby reducing teaching workloads. Therefore, we propose that expenditures for both research and teaching are associated with the research culture at COMs and thus the grant-seeking motivation of faculty. 

The results of the present study should also be interpreted in the context of its limitations. First, the information presented was obtained using self-report surveys without published evidence regarding the surveys' reliability and validity. Therefore, certain biases and measurement error could cause erroneous reporting of data. Second, the data describe only dollar-supported research projects. It is possible that the full body of research occurring at COMs was not captured, as some faculty may be involved in research endeavors not requiring dollars. Third, because analyses were limited to data collected without the guidance of a theory-driven research hypothesis, certain key predictors of funding may have been overlooked. It will be important to examine individual, institutional (eg, philosophical views on research and teaching), and external (eg, culture of area where the COM is located) factors potentially related to funding.¹⁹ Finally, the surveys were not designed to obtain information on all unique researchers associated with a funded research project. This will be necessary in the future if we want to construct a more comprehensive picture about COM research funding, such as the percentage of funding representing new, mid-career, and mature investigators and how this status relates to research productivity (eg, larger awards, multiple awards) in a COM environment. 

Taken in the context of previous studies on COM research funding, the overall trend since AACOM began formally collecting funding data is a substantial rise in total research award amounts, from $16.6 million in 1989 to $216.6 million in 2009 (concurrent with research expenditure increases of $17 million). Further, the rate of increase has been exponential in some areas (eg, foundations, drug studies, faculty with dual PhD-DO degrees). Although this finding is encouraging, funding at COMs remains below what is typically observed at allopathic medical schools.^20,21 The possibility exists that COMs could branch out to other areas (eg, life sciences) that are experiencing rapid growth.¹³ The American Recovery and Reinvestment Act of 2009 allocated new money for health services research to prioritize the study of health care practices in order to determine the best treatments, devices, and procedures for almost any ailment or disease. Further, academic-industry relationships may provide an important benefit in terms of funding and open new lines of research.¹³ Although COMs have made great strides in the area of research funding, there is still room for growth.