As the U.S. government brandishes funding cuts, hospital and health system leaders have voiced concerns about the future of academic and clinical innovation workforce pipelines.
In an April 16 email obtained by Science, HHS instructed the National Institutes of Health to freeze research grants and contract payments to five universities. Hundreds of university and college professors, including those affiliated with academic health systems, signed an April 22 letter condemning the federal government’s pause in billions of grant funding.
Uncertainty around NIH’s proposed reimbursements cap of 15% for indirect research costs is also complicating research funding. A federal judge issued a permanent injunction to block it on April 4, which the Trump administration plans to appeal.
David Blumenthal, MD, professor of public health and health policy at Harvard T.H. Chan School of Public Health in Boston, told Becker’s these cuts will curtail some of the most productive research conducted in the U.S.
“Not many people outside of academic health systems really understand this set of institutions that have evolved since World War II that serve all of humanity,” Dr. Blumenthal said. “It’s really a shame to take a bulldozer to it.”
Dr. Blumenthal and Elena Fuentes-Afflick, MD, chief scientific officer for the Association of American Medical Colleges, said the funding cuts could affect workforce pipelines. Careers in pharmaceutical and biotechnology industries might seem more stable than academic research positions, potentially motivating research-track or PhD candidates to increasingly pursue industry roles over academic ones.
However, it is unclear whether those roles will offer greater stability, Dr. Blumenthal said. Funding cuts to the university research enterprise are likely to affect not only academic health system roles but the broader innovation ecosystem.
“New generations of researchers may seek jobs in those other places, but I’m not sure the jobs will be there,” he said. “I think the net effect is going to be fewer researchers, less research, less innovation, fewer drugs, fewer treatments.”
There is already a concern in the pharmaceutical industry that cutting drug prices could limit the research they use for innovation, Dr. Blumenthal said.
“That argument is doubly or triply true of cutting the funding to the universities of the United States,” he said. “I see this as a huge downsizing of our research commitment that will have implications for the health of the world, of the human race, for decades or generations to come. The supply of personnel, young researchers is just a symptom of that larger shift in investment.”
Rocky path for academic health systems
Academic health systems, including Northwestern Medicine in Chicago and Weill Cornell Medicine in New York City, have reported losses of millions in federal research funding, affecting their abilities to recruit physicians on the cutting edge of medicine.
Dr. Fuentes-Afflick said it is too early to speculate on the future of academic health systems, but she said they will “almost certainly” be affected. Already, apprehension is causing medical schools to scale back.
“For graduate students or postdocs, we are hearing that offer letters are being rescinded. That’s very concerning,” she said. “We are hearing of universities that have reduced the number of graduate students they are recruiting or postdoctoral positions they are offering.”
Academic health centers and universities rely on predictability, according to Dr. Fuentes-Afflick. Volatility surrounding federal funding is splintering this bedrock and making it difficult for leaders to make accurate projections and plans, she said. Faculty members are also uncertain about their career paths if they have fewer research opportunities.
“The one thing that is certain with this administration is disruption,” said Peter Pronovost, MD, PhD, chief quality and clinical transformation officer of Cleveland-based University Hospitals. “What’s uncertain is the destination.”
Potential steps toward stability
The more recent research grant funding freeze followed an earlier White House directive to halt more than $2.2 billion in federal grants to Cambridge, Mass.-based Harvard University.
The university, which is affiliated with Somerville, Mass.-based Mass General Brigham, filed a lawsuit against the Trump administration April 21. The university is seeking an injunction to block the freeze, arguing that the federal government is violating constitutional protections by using funding threats to control university governance and curriculum.
There is no easy or short-term solution to address the financial pressures health systems are facing as a result of federal funding cuts, Dr. Blumenthal said.
“One thing you can do about it, though, is join universities, join forces in testing the legality of these cuts in court,” he said. “I think many other organizations could join in those suits and make Harvard less of a target. That’s going to end up being the short-term opportunity for these institutions. Everyone wants to keep their head down, but that may not be the best strategy for their success.”
One policy measure that could help academic medicine remain competitive for research-track talent is to increase the research and development tax credit, Dr. Blumenthal added. This would reduce the cost for pharmaceutical companies to support university research — essentially making each research dollar go further.
Another opportunity lies in venture philanthropy. For example, the Veale Foundation donated $10 million to University Hospitals in 2023 to not only drive healthcare innovation but to prove its viability.
The system promised the foundation $156 million in five years in cost takeout or revenue increase, according to Dr. Pronovost, who became the inaugural Veale distinguished chair in leadership and clinical transformation from the $10 million gift.
About a year and a half later, the health system was supposed to be at $18 million in value. It achieved $44 million, he said.
“My own view is that we need the private sector’s philanthropic dollars, which are large, to start to replace some of the public funds that will likely go away or be reduced,” Dr. Pronovost said.
Despite the academic industry’s anxiety and feelings of vulnerability, Dr. Fuentes-Afflick said she is energized by this defining moment.
“This moment has allowed us to more clearly state the impact of research and science on the health of Americans and all around the world,” she said, as well as “the impact of the research and training that we offer people that prepares them to answer the questions of today and the questions of tomorrow.”
