Has your Doctor Been Trained to be Selfish, Not Selfless?

A lot has been said lately about the fact that many doctors are quitting medicine because it isn’t rewarding. With applications opening for entrance to the class of 2016 this week, it is a particularly important time to think about how our current system rewards seemingly selfish behaviors in the extremely long and harsh competition to rise through the ranks from premed to attending physician.

 

I am a patient, mentor, scientist, and health training innovator. Due to unique life circumstances I have trained and worked with hundreds of physicians in many different roles. They define “Rewards” in many ways. Clinical, research, financial and reputational success matter in varying degrees.

 

I agree with the Institute of Medicine’s July 29 report that says we aren’t using the $15 billion we spend each year on physician training to maximally benefit overall health. I am personally and professionally aware that our current system promotes physicians in training based on their capacity for selfishness, not selflessness. We therefore create health professionals neither experientially nor psychologically prepared to see the rewards in managing the 150 million Americans with chronic health concerns who need money, more than a $1 trillion a year in low-yield assistance more than brief, “interesting” interventions.

 

We therefore increase patient and family caregiver suffering, raise healthcare costs enormously and, almost certainly, add significantly to physician burn-out through poor selection and preparation.

 

Candidates for medical school admission are told a great “story” includes outstanding scores, grades, recommendations, extra-curriculars, and research. These demand lots of study time. Studying-while it can be done in groups-is usually done alone. Most pre-medical students say earning outstanding scores, grades, and recommendations rewards competitive behaviors, not teamwork skills.

 

Many pre-health advisors and most pre-medical students also say students are told admission to “dream” medical schools like Harvard, UCSF or Washington University requires lots of time doing laboratory research. This is supported by data from the American Association of Medical Colleges showing that “good” research is particularly attractive to these schools where students are prepared to be "academic" physicians even though most of their graduates will primarily work with patients.

 

Doing "good" research requires competition to get noticed by the "right" lab director. Once in lab, students often work with yeast, flies, mice or rats for at least fifteen hours a week during the year and fifty or sixty ours a week in summer. Students’ human co-workers in lab are socioeconomically similar to them; aka they are generally more educated, higher income, healthier, younger and less likely to be African American or Lattino than the typical patient will be. Lab work, therefore, doesn’t offer much interaction with patients whose life stresses and experience are very different than those of most medical students and young physicians.

 

Once in medical school, students keep competing. They need high grades in classes and clerkships along with high "board" scores to get into the "best" residencies. They learn and regurgitate 20,000 facts. They must put hundreds or thousands more hours into lab work in order to publish papers that are, again, necessary to get into competitive residencies and later, prestigious fellowships where strong pressure to publish still exists. Trainees may work outside the clinic, but there is relatively little time for this priceless, often voluntary, experience.

 

After fellowships often requiring trainees to spend 50% of their time in the lab, they become attending physicians. They have learned that behaviors leading to good grades, scores, research, and recommendations (often ignoring their interactions with co-workers or patients), will help them succeed in medicine.

 

At this point, Life suddenly changes. Self-focused behavior is still accepted, (after all, practicing physicians aren’t punished for refusing to take patients who can damage their outcome factors) but helping people very unlike themselves is now their full time job.

 

It therefore isn't surprising that our physicians are burning out when they must now focus on patients full time rather than on themselves. Too many aren't prepared to work with everyone in our healthcare environment. We now know this causes poor team and patient management leading to errors and suboptimal outcomes that cost hundreds of billions and kill many thousands annually.

 

How can this be changed? First, service is quantifiable just like scores and grades. The American Medical College Application Service which handles students’ applications currently classifieds service as "significant" or not. AMCAS members could demand a set number of direct patient care hours before applications are considered. Most physician assistant training programs require candidates to show 500 hours of direct patient contact before applying. MD applicants (who spend almost twice as much time in medical school), should have twice as many. Second, implementing the IOM report’s recommendations on putting training dollars into community medicine could be very beneficial. Medical school debt for community physicians can be fully waived or traded for service under any new rules. Further, Medicare—which funds most residencies-can choose to fund only residents with no more than 10% of their medical school time in research and require 90% time on direct patient care for Medicare funded residents and fellows .

 

Scores and grades will always reward selfishness, but these changes would quantify service time, reshape financial incentives for many specialties, add clinical service time and better prepare our future physicians  who will mostly focus on patients, not research in their careers.

 

Too Many Smart Americans are Turning Away from Careers in Science

People considering training in science face many barriers to personal and professional advancement. Four science policy leaders including a former Director of the National Institutes of Health and a recently retired President of Princeton University say so in a paper published in the Proceedings of the National Academy of Sciences on March 14, 2014. Having advised hundreds of students, I know low pay and unattractive working conditions lead many of our best and brightest people to seek careers in consulting or medicine likely to bring high achievement and income at little increase in labor time. By making science careers relatively unattractive to too many of America’s brightest and most creative, we are drying the well of creativity that has helped American science and technology lead the world.

 

Scientists, particularly in the biological sciences, let Charles Darwin’s theory of natural selection shape our thinking in ways justified by evidence of the world around us that we test in the laboratory and retest until it can be proven or disproven. We also apply “natural selection” to training and selecting future scientists. People who best combine dedication, creativity, intelligence, political savvy, luck and timing may become tenured scientists. Those without even one of these traits probably won’t.

 

Students we hope will become scientists know our system forces them to compete for jobs with long hours and relatively low pay. These smart people recognize biomedical science isn’t a secure path toward nice homes, good work life balance and significant opportunities for advancement and respect in their fields. This awareness is, unfortunately, ensuring that though competition to advance in the sciences is strong, too many of America’s best and brightest feel other careers are a safer and better paying bet.

 

Scientists usually spend long hours in the lab. Through the tenuring process, 70-90 hour weeks are common. Seventy to ninety hour weeks during which young researchers earn less than a first year associate on Wall street, where many of the same skills (intelligence, math, logic, creativity, observational skills, discipline), needed in the lab are also valued. In fact, per-hour lab salaries are probably sub-minimum wage at many universities once actual, not reported, hours are accounted for.

 

Furthermore, students know non-science jobs will be secure as opposed increasingly insecure in the lab. Even in tenured roles, hours are often long and incomes aren’t guaranteed at leading universities where faculty support themselves on “soft” (EG grant supported) money, not hard (I.E. guaranteed) funds from university budgets.

 

A partner at a consultancy earns between five and ten times as much as a tenured scientist and works barely more hours a week. Many full-time physicians (who generally have plenty of patients), make almost as much as those consultancy partners. An associate in an investment bank or one of the major consultancies is as likely to make partner as today’s graduate student is to get tenure and maintain stable career lab funding.

 

People are willing to do the work to get funded. There are too many people who will need funding. If current trends continue, the number of long term lab supporting project proposals funded by 2030 may be less than five percent when a college freshman reading this essay is ready to challenge for tenure; a figure that will drop even further as time passes.

 

Study in science’s only financially attractive feature is that graduate school and postdocs are usually funded by government grants whereas physicians in training usually finish medical school in debt. The hours and job satisfaction are at least comparable, and although young health professionals take debt their science peers aren’t forced to, physicians’ life time earnings will more than balance losses from medical school debt.

 

How can science careers become more financially and professionally secure? I agree with those who say the only way forward justified by reasonable projections of Federal science spending is a fifty percent cut in the number of our science trainees with increased salaries for those remaining. This option is risky because it depends on the hope that by taking this option we  will grow the quality of our young scientists to the point at which their increased confidence, intelligence and creativity overcome the lost person hours that a smaller, but better paid, brighter more creative and more financially and professionally secure workforce can give us.

 

We may not take this path because we may do less science per dollar spent. Given this likely outcome, we are near certain to continue using “cheap” graduate student and postdoc labor—much from people who are increasingly likely to return to their homes overseas after being trained here in America, due to relatively better job prospects. As a former scientist and science administrator, I believe improved lab productivity through use of optimal tools and technology can only do so much to help us loosen the jaws of this trap because lab tech is expensive and training people to use it takes time. Streamlining science administration and regulation (AKA cutting indirect costs”), are other short-term fixes with the potential to bring long-term gains, particularly where “indirect cost” savings are concerned.

 

Whatever we do, we must find a solution that speeds progress and gives financial and professional security to those discovering knowledge and creating technology for us. If we don’t, the lead in science and technology that let us become the leading power in the biomedical sciences, defense research, and many kinds of applied technology will be handed to countries willing and able either to spend more or pay less for similar work, many of which are not particularly friendly to the United States at this time.

Are Tax Payers' Precious Dollars Paying to Train Selfish, Not Selfless, Physicians?

A lot has been said lately about the fact that many doctors are quitting medicine because it isn’t rewarding. I am a patient, mentor, scientist, and health training innovator. I have trained and worked with hundreds of physicians in many different roles. They define “Rewards” in many ways. Clinical, research, financial and reputational success matter in varying degrees.

 

I agree with the Institute of Medicine’s July 29 report that says we aren’t using the $15 billion we spend each year on physician training to maximally benefit overall health. I am personally and professionally aware that our current system promotes physicians in training based on their capacity for selfishness, not selflessness. We therefore create health professionals neither experientially nor psychologically prepared to see the rewards in managing the  150 million Americans with chronic health concerns who need $ more than a $1 trillion a year in low-yield assistance more than brief, “interesting” interventions.

 

We therefore increase patient and family caregiver suffering, raise healthcare costs enormously and, almost certainly, add significantly to physician burn-out through poor selection and preparation.

 

Candidates for medical school admission are told a great “story” includes outstanding scores, grades, recommendations, extra-curriculars, and research. These demand lots of study time. Studying-while it can be done in groups-is usually done alone. Most premedical students say earning outstanding scores, grades and recommendations rewards competitive behaviors, not teamwork skills.

 

Many pre health advisors and most pre medical students also say students are told admission to “dream” medical schools like Harvard, UCSF or Washington University requires lots of time doing laboratory research. This is supported by published data showing “good” research is particularly attractive to these schools where students are prepared to be "academic" physicians even though most of their graduates will primarily work with patients.

 

Doing "good" research requires competition to get noticed by the "right" lab director. Once in lab, students often work at least fifteen hours a week during the year and fifty or sixty ours a week in summer. Students’ co-workers in lab are similar to them with respect to many socioeconomic factors. Lab work, therefore, doesn’t offer much interaction with patients whose life stresses and experience are very different than those of most medical students and young physicians.

 

Once in medical school, students keep competing. They need high grades in classes and clerkships along with high "board" scores to get into the "best" residencies. They learn and regurgitate 20,000 facts. They must put hundreds or thousands more hours into lab work in order to publish papers that are, again, necessary to get into competitive residencies and later, prestigious fellowships where strong pressure to publish still exists. Trainees may work outside the clinic, but there is relatively little time for this priceless, often voluntary, experience

 

After fellowships often requiring trainees to spend 50% of their time in the lab, they become attending physicians. They have learned behaviors leading to good grades, scores, research and recommendations (often ignoring their  interaction with co-workers or patients), help them succeed in medicine.

 

At this point, Life suddenly changes. Self-focused behavior is still accepted, (after all, practicing physicians aren’t punished for refusing patients who can damage their rankings) but helping people very unlike themselves is now their full time job.

 

It therefore isn't surprising that our physicians are burning out when they must now focus on patients full time rather than on themselves. Too many aren't prepared to work with everyone in our healthcare environment. We now know this causes poor team and patient management leading to errors and suboptimal outcomes that cost hundreds of billions and kill many thousands annually.

 

How can this be changed? First, service is quantifiable just like scores and grades. The American Medical College Application Service which handles students’ applications currently classifieds service as "significant" or not. AMCAS members could demand a set number of direct patient care hours before applications are considered. Most physician assistant training programs require candidates to show 500 hours of direct patient contact before applying. MD applicants (who spend almost twice as much time in medical school), should have twice as many. Second, implementing the IOM report’s recommendations on putting training dollars into community medicine could be very beneficial. Medical school debt for community physicians can be fully waved or traded for service under any new rules. Further, Medicare—which funds most residencies-can choose to fund only residents with no more than 10% of their medical school time in research and require 75% time on direct patient care for Medicare funded residents and fellows unless they are trained in pathology where  physicians often never se patients because they are dead or because they only see samples to determine the extant and progress of a patient’s disease.

 

Scores and grades will always reward selfishness, but these changes would quantify service time, reshape financial incentives for many specialties, add clinical service time and better prepare the 90% of physicians who will focus mostly on patients, not research, thereby improving healthcare and our selection and training of the people on whom your health will almost certainly depend

Today’s Science Funding Mechanisms Threaten Tomorrow’s Economy, Health and National Security

I am an experienced health educator, technology innovator, researcher, patient, and science administrator. My personal and professional experience of the importance of scientific research to America’s work, health and welfare, convince me that current policy forcing Federal agencies to ignore the cost of “Facilities and Administration (also called “indirect cost rates” or ICRs) (AKA the cost of services and other things that support research), in deciding where they will allocate the $40+ billion tax payers spend on academic researchers’ work is an unjustifiable form of welfare to centers that mostly don’t need it. This short-sighted policy decreases our ability to compete with nations learning to develop and market ideas more efficiently than we do today; weakens our national defense; and slows treatments or cures for everything from colds to cancer.

 

Office of Management and Budget circular A-21 allows each research center to negotiate a figure for “indirect costs” on federally funded research done there with a “cognizant Federal Agency”. According to the website of the National Science Foundation, academic institutions usually set ICRS with the Dept. of Health and Human Services. Indirect costs cover grants administration, building maintenance, utilities, and other things needed to support research as well as libraries and student services that, inevitably, are used by people whether their work is tax payer funded or not.

 

To determine the potential of proposed projects, many agencies funding research ask outside experts knowledgeable about the relevant science to assign scores to proposals to state their estimated potential. Scores express potential, they don’t guarantee outcomes.

 

The National Institutes of Health’s website says the estimated potential of a proposed project is scored from one (exceptional) to nine (low). Most agencies use conceptually similar ways to have outside experts rate the potential of proposed projects, but the details do differ significantly.

 

The University of Wisconsin-Madison’s website says its “indirect cost rate” is 53% for federally funded research. The universities of Alabama, (47%) South Carolina (46.5%), and other centers charge less for research. Harvard University sets indirects at 61%. Comparing Medical Schools, Harvard Med’s ICR is 69.5%; the University of South Carolina Med School’s ICR is 33%.

 

The real cost of a fully funded million dollar research project to the taxpayer therefore becomes 1.53 million at UW Madison and, in most cases, between 1.61 and 1.695 million at Harvard. Projects at the University of Alabama would cost $1.47 million, and at the University of South Carolina 1.33 million at the medical school, 1.465 million on the main campus in Columbia. Partly funded projects still receive the center’s ICR in an amount aligned to the smaller budget.

 

Many centers and campuses set comparable fees. Some, like the Scripps Research Institute (90%) ask even more, sometimes justified by unique infrastructure and capabilities. Almost all research centers post “facilities and administration” rates. They can be found with internet search tools.

 

Because extra funding isn’t authorized when an agency funds research on a campus with high ICRs, the finite resource pool available to support American research takes an outsized hit every time a grant goes to a center with relatively high ICR charges.

 

Funding projects without attending to the cost of research at one institution as opposed others

  • Doesn’t incentivize centers with high indirects to do research economically while encouraging centers with low non-research costs to seek more money if they can get it;

  • Limits America’s ability to create knowledge and technology now and later;

  • And further inflates the long-term cost of research—which already rises far faster than consumer prices—because centers with high indirects can use future funding to justify the cost of building space where more relatively expensive research will be done later.

 

Circular A-21 justifies current policy by saying that “Each institution, possessing its own unique combination of staff, facilities, and experience, should be encouraged to conduct research and educational activities in a manner consonant with its own academic philosophies and institutional objectives.”   This phraseology frees many research centers to inefficiently do research we all want and need done while efficiently fleecing taxpayers of billions of dollars a year under the rubric of “unique academic philosophies and institutional objectives”.

 

This wasteful policy can be curbed quickly by funding highly scored proposals from centers with relatively low “indirect costs” first; those at centers with high non-research costs if money is available. Proposals with lower scores can be prioritized similarly if there is money for them.

 

This policy change won’t affect peer reviewers freedom to rank proposals in ways that illustrate their seeming potential. It would significantly increase the number of projects funded here at no added taxpayer cost. It would also

  • incentivize efficient use of funds;

  • reduce wasteful welfare to centers whose often-vast endowments show it isn’t needed;

  • continue paying for needed research supports;

  • Grow our effectiveness in areas from DoD funded academic work to humanities studies;

  • create many good jobs;

  • and speed treatments or cures for millions. 

Mommas Don’t Let Your Babies Grow Up to Be Scientists

People considering training in science face many barriers to personal and professional advancement. Four science policy leaders including a former Director of the National Institutes of Health and a recently retired President of Princeton University say so in a paper published in the Proceedings of the National Academy of Sciences on March 14, 2014. Having advised hundreds of students, I know low pay and unattractive working conditions lead many of our best and brightest people away from careers in the laboratory and toward careers in consulting or medicine likely to bring higher achievement and income at little increase in labor time. By making science careers relatively unattractive to too many of America’s brightest and most creative, we are drying the well of creativity that has helped American science and technology lead the world.

 

Scientists, particularly in the biological sciences, let Charles Darwin’s theory of natural selection shape our thinking in ways justified by evidence of the world around us that we test in the laboratory and retest until it can be proven or disproven. We also apply “natural selection” to training and selecting future scientists. People who best combine dedication, creativity, intelligence, political savvy, luck and timing may become tenured scientists. Those without even one of these traits probably won’t.

 

Students we want to become scientists know our system forces them to compete for jobs with long hours and relatively low pay. They are learning that biomedical science isn’t a secure path toward nice homes, good work life balance, and significant opportunities for advancement anymore. Unfortunately, poor mentoring on the part of advisors not trained to help students gain the skills they need to succeed outside of academia is ensuring that though competition to advance in the sciences is strong, too many of America’s best and brightest are seeing for themselves that other careers will be a safer and better paying bet.

 

Scientists usually spend long hours in the lab. Through the tenuring process, 70-90 hour weeks are common. Seventy to ninety hour weeks during which young researchers earn less than a first year associate on Wall street, where many of the same skills (intelligence, math, logic, creativity, observational skills, discipline), needed in the lab are also valued.

 

A partner at a consultancy earns between five and ten times as much as a tenured scientist and works barely more hours a week. Many full-time physicians (who generally have lots of patients), make almost as much as those consultancy partners. Even a primary care physician is likely to earn at least half again what a tenured research faculty member makes with fewer work hours, less required travel, and far more job security.

 

It is also easily arguable that high-salary non-science jobs are now as, or more, secure than jobs in academic research are today. If NIH’s estimates of current trends in funding for research projects continue, the number of long term lab supporting project proposals funded by 2030 may be less than five percent when a college freshman reading this essay is ready to challenge for tenure; a figure that will drop even further as time passes.

 

The only financially attractive feature of study in science is that graduate school and postdocs are usually funded by government grants whereas physicians in training usually finish medical school in debt. The hours and job satisfaction are at least comparable, and although young health professionals take debt their science peers aren’t forced to, physicians’ life time earnings will more than balance losses from medical school debt.

 

The only way to make careers in science more secure that is justified by reasonable projections of Federal science spending is a fifty percent cut in the number of our science trainees with increased salaries for those remaining. This option is risky because it depends on the hope that by taking this option we will grow the quality of our young scientists to the point at which their increased confidence, intelligence and creativity overcome the lost person hours that a smaller, but better paid, brighter more creative and more financially and professionally secure workforce can give us.

 

We may not take this path because we may do less science per dollar spent. Given this likely outcome, we are near certain to continue using “cheap” graduate student and postdoc labor—much from people who are increasingly likely to return to their homes overseas after being trained here in America, due to relatively better job prospects. One can’t blame foreign nationals for coming to our shores, learning what they can and then bringing it—and often some of their American friends—back to countries where the science infrastructure may be less well developed, but there is a reasonable hope of stable long-term employment in academic research.

 

I have often heard how increasing lab productivity may solve this problem. Unfortunately, improved lab productivity through use of optimal tools and technology can only do so much to help us loosen the jaws of the opportunity trap because lab tools are expensive and training people to use them takes time. Other short-term fixes such as streamlining science administration and regulation (AKA cutting indirect costs), have the potential to bring some gains, but these savings won’t be enough to employ all of the young scientists we are training today.

 

Whatever we do, we must find a solution that speeds progress and gives financial and professional security to those discovering knowledge and creating technology for us. If we don’t, America will lose its lead in biomedical science, defense research, and many kinds of applied technology. Instead, opportunities for advancement in science and technology will be handed to countries like China, India, Japan, and the UK where there are funds to support science and national attitudes toward the United States aren’t always friendly.

 

Long-Standing Policy on "indirect Costs" is Academic Welfare That Threatens America's Competitiveness, National Security, and the Health of Millions

NIH Director Francis Collins is quoted in the Huffington Post as saying that if the NIH budget hadn’t “been cut”, Ibola would already be cured. Dr. Collins and others on both sides of the aisle in Washington want us to forget they support an insidious form of academic welfare to wealthy universities that rewards inefficiency in the library and laboratory; has delayed cures for diseases from cancer to ibola; decreases America’s ability to compete with nations learning to develop and market ideas more efficiently than we do today; and weakens our national security in other ways.

 

This policy forces Federal agencies to ignore the cost of “Facilities and Administration (also called “indirect costs”) (AKA the cost of services and other things that support research), in deciding where most of the $40+ billion in tax payer funds used on academic research will go.

 

Office of Management and Budget circular A-21 allows centers to negotiate a figure for “indirect costs” on federally funded research done there with a “cognizant Federal Agency”. Indirect costs cover grants administration, building maintenance, utilities, and other things that support research along with communal services used by people whether their work is tax payer supported or not.

 

To determine the potential of proposed projects, agencies funding research ask outside experts knowledgeable in these areas to form “study groups” of “peer reviewers”. These groups use scores they assign to projects supposedly proposed and received anonymously, to state their estimated potential. Scores express potential, they don’t guarantee outcomes.

 

The National Institutes of Health’s website says the estimated potential of a proposed project is scored from one (exceptional) to nine (low). Most agencies use conceptually similar ways to have outside experts rate the potential of proposed projects.

 

The NIH’s budget is about $30 billion a year, some of which is used for research and other activities on its campus. The vast majority of NIH’s money goes for “extramural” research. As you’ll see below, the amount of science done is no-where close to the amount of money the NIH budget makes it seem scientists at research centers outside of the NIH receive.

 

I am a researcher, innovator and former science administrator who thinks the flaws in this policy are easy to see if one does a little comparative shopping. The University of Wisconsin-Madison’s website says its “indirect cost rate” is 53% for federally funded research. The universities of Alabama, (47%) South Carolina (46.5%), and other centers charge less for research. Harvard University sets indirects at 61%. Comparing Medical Schools, Harvard me’d’s ICR is 69.5%; the University of South Carolina Med School’s ICR is 33%.

 

The real cost of a fully funded million dollar research project to the taxpayer therefore becomes 1.53 million at UW Madison and, in most cases, between 1.61 and 1.695 million at Harvard. Projects would cost $1.47 million at the University of Alabama. At  the University of South Carolina  research would cost 1.33 million at the medical school, 1.465 million on the Columbia campus.  If projects are partially funded, they receive the center’s ICR in an amount aligned to the smaller budget.

 

Many centers and campuses set comparable fees. Some, like the Salk Institute (90%) ask even more, sometimes justified by unique infrastructure and capabilities. Centers may or may not get lower ICRS from charities and the private sector than they do the tax payer. Where lower ICRS are negotiated, they happen because  non-governmental sources expect to use their funds as efficiently as possible. Almost all research centers post “facilities and administration” rates. They can be found with internet search tools.

 

Congress doesn’t authorize extra money because research gets funded on campuses with high indirect cost charges. So, every time a grant goes to a center with relatively high indirects, America’s finite research funding pool takes an outsized hit.

 

Making funding choices without attending to the cost of supporting research at one institution as opposed others has serious consequences. First, it doesn’t incentivize centers with high indirects to do research economically while encouraging places with low indirects to seek more money. Second, it limits America’s ability to create knowledge and technology that could cure many diseases. Finally, ignoring today’s indirects further inflates tomorrow’s cost of doing research—which already increases far faster than consumer prices do—because centers with high indirects can plan to use some of the money they will get to depreciate the cost of not-yet-built space where more , even higher cost, research will be done in the future.

 

Circular A-21 justifies current policy by saying that “Each institution, possessing its own unique combination of staff, facilities, and experience, should be encouraged to conduct research and educational activities in a manner consonant with its own academic philosophies and institutional objectives.”   This phraseology frees many wealthy research centers to inefficiently do research we all want and need accomplished while letting them efficiently fleece taxpayers of billions of dollars a year under the rubric of “unique academic philosophies and institutional objectives”.

 

Either Congress or the President can quickly curb this wasteful policy by directing proposals with high study group scores get funded at places with relatively low “indirect costs” first; those from centers with high non-research costs if money is available. Proposals with lower scores can be prioritized similarly if there are funds for them.

 

This policy change won’t affect peer reviewers freedom to rank proposals in ways that illustrate their potential. It would significantly increase the number of projects we fund at no added taxpayer cost. It would also incentivize efficient use of funds; reduce wasteful welfare to institutions whose multi-billion dollar endowments show they don’t need handouts; continue paying for needed research supports; grow our ability to compete in everything from defense science to study of the humanities; create many good jobs; and speed treatments or cures for the diseases we fear most.

Please reload

© 2023 by ROGER FORBES. Proudly created with Wix.com