Supporting Research in Departments of Internal Medicine: Recommendations for NIH T he last 5 years have witnessed tremendous growth in information available about disease and treatment options. In the United States, this increase in knowledge is partially due to the ever-in- creasing support of the public and the federal govern- ment for the US medical research enterprise. The com- mitment to double the National Institutes of Health (NIH) budget by fiscal year (FY) 2002 has been a result of broad-based bipartisan support in Congress. In FY 1999, Congress approved a $15.7 billion budget for NIH, an unprecedented 15.4% increase from the pre- vious year (1). In FY 2000, Congress budgeted $17.9 billion for NIH, remaining on track for the 5-year dou- bling (2). Nearly 83% of NIH’s annual budget is ex- pended in extramural grants to laboratories, founda- tions, and academic health centers (3). In 1999, approximately 28.9% of all NIH extramural grant funding was awarded to departments of internal medicine at US medical schools (4). The largest depart- ment in most schools, internal medicine accounts for nearly 23.3% of all full-time faculty (5). At most institu- tions, internal medicine includes 11 subspecialties (aller- gy and immunology, cardiology, endocrinology and me- tabolism, gastroenterology and hepatology, geriatrics and geronotology, hematology, infectious diseases, nephrol- ogy, oncology, pulmonary and critical care medicine, and rheumatology) as well as general internal medicine. As a result, internists treat several of the nation’s most preva- lent diseases (6). Departments of internal medicine are important supporters of NIH, its mission, and its fund- ing. Through its coalition efforts, the Association of Pro- fessors of Medicine (APM)—the national organization of departments of internal medicine at the US medical schools and numerous affiliated teaching hospitals as represented by chairs and appointed leaders— has served as a voice for internal medicine before the federal govern- ment. In the wake of this national support, NIH has a respon- sibility to ensure that US institutions are prepared to support research now and in the future. To optimize sup- port of research in departments of internal medicine, APM recommends that NIH (1) fortify institutional re- search infrastructure; (2) encourage and fund the new technologies of medical research; (3) focus on the physi- cian-investigator shortage; and (4) emphasize transla- tional research. NIH SHOULD FORTIFY INSTITUTIONAL RESEARCH INFRASTRUCTURE Recent declines in overall institutional funds have re- sulted in less available money for research infrastructures. However, recent advances in technology create a need for more space as well as renovation of existing facilities. Lab- oratories must be capable of powering and accommodat- ing the new technology; administrative space must be built to monitor and maintain federal rules, regulations, and guidelines for research. Construction funds have not been generally available from NIH since the late 1960s (7); reactivating NIH construction authority would sta- bilize the national investment in medical research while restructuring institutional facility costs. Such a change has the added benefit of reallocating facilities costs away from indirect cost pools. A large portion of the support for clinical research has been traditionally derived from clinical practice. How- ever, as health care changes cause department and insti- tutional resources to decrease, decisions about clinical research are made by strategic planning efforts of affili- ated hospitals and health care systems. NIH must con- tinue to support multinstitutional and multidepartmen- tal efforts—such as the General Clinical Research Cen- ters—as well as support endeavors to develop shared research infrastructure within an institution to overcome fiscal and spatial restraints of individual departments. Moreover, the emphasis on genetic and molecular re- search in the new millennium will lead to a need for much more complicated and costly equipment. Although the NIH Shared Instrumentation Grant program can provide up to $500,000 toward the cost of new instrumentation for at least three NIH-supported scientists, cost sharing by institutions is required for grants in excess of that amount. Increased NIH funding for often prohibitively expensive research equipment, such as gene sequencers, supercomputers, and protein analyzers, will allow more institutions to conduct groundbreaking research. 178 2000 by Excerpta Medica, Inc. 0002-9343/00/$–see front matter All rights reserved. PII S0002-9343(00)00462-9 APM Association of Professors of Medicine