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Building a top-notch research and medical training program takes enormous amounts of time, talent, creativity – and money.
“It’s one thing for an institution to say it has a philosophical commitment to training,” says Arnold Strauss, MD, who directs the Cincinnati Children’s Research Foundation. “Putting people and dollars behind that commitment is what has made the difference for Cincinnati Children’s.”
The institution is being called on to put more and more of its own dollars into training. As external funding for graduate medical education is squeezed by government belt-tightening, more of the cost of resident and fellowship training falls to teaching hospitals.
This past year that cost totaled $72 million, says Scott Hamlin, executive vice president and chief operating officer of Cincinnati Children’s. That includes direct costs of faculty salaries and indirect costs, such as facilities and shared services that support training.
Of that $72 million, less than one-fourth came from external sources, says Hamlin. The two sources that subsidize the training of pediatric residents are the Children’s Hospitals Graduate Medical Education Payment Program and Medicaid. Both face potential serious cuts due to state and federal deficits.
Strauss believes academic medical centers must lobby loud and long for federal funding of medical training to continue. And although the financial burden is substantial, he is quick to add that Cincinnati Children’s will find a way to continue training “because it is the right thing to do.”
“We provide training because it is critical for us to grow talent — for our own needs and for those of the rest of the world,” says Strauss.
Growing pediatric talent has been a big part of Strauss’s career. Before coming to Cincinnati Children’s in 2007, he spent much of his time as a pediatric cardiologist and scientist training others. Over the course of his career, he has trained more than 50 graduate students, post-docs and clinical fellows — many of whom are now national leaders in pediatric research and clinical practice.
Strauss says environment is “absolutely critical” for a training program — and its graduates — to be successful. “You need a strong faculty, an organization that fosters intellectual curiosity and collaboration, and the ability to take risks.”
Cincinnati Children’s scores high on all three.
“Here, the institutional culture is to work together,” Strauss says. “It’s a long history that comes from the leadership of people like Bill Schubert (see A Life Well Lived). We select people for it - people who are really smart but who work well with others.”
This level of collaboration is unusual in the scientific world, he adds, and has resulted in a robust exchange of ideas, vitally important discoveries and findings that move more quickly toward clinical applications.
“The integration of clinical and research activities makes us truly unique,” he says. “Our basic scientists sit in the same environment with our clinicians, attuned to what the clinical issues are. Why does a child have a heart defect? Well, it means the heart developed the wrong way. So the PhD looking at heart development can find out why that happened, then work with clinicians to study their patients and find mutations.”
Linking research to clinical relevance has been one of the big drivers behind our impressive record of external funding, says Strauss. Cincinnati Children’s ranks second in the nation in NIH funding of pediatric research. Our total research funding from external sources was $154 million this past fiscal year.
But Hamlin says our overall financial commitment to research and training puts us in the number one slot. He compares notes regularly with his counterparts at the six leading pediatric medical centers around the country.
“I believe the totality of our research effort is the most substantial,” he says. “We are willing to fund more research that’s in development by our young scientists.”
Hamlin says Cincinnati Children’s is able to fund more research and training because of an endowment that began with a $2.5 million donation by William Cooper Procter in 1927. Thanks to careful tending by the hospital and its board, that endowment today generates $50 million of support each year, most of which goes toward research and education.
“It’s reliable, it’s dependable, and it’s the investment our donors and the board are ensuring continues to make our research strong. It makes us who we are,” says Hamlin.
Additionally, the hospital reinvests 3 percent of its annual revenues into research and academic pursuits. This commitment enables Cincinnati Children’s to pursue promising new ideas, even when external forces might not be working in their favor.
“We can start programs and take a few gambles on faculty and not go under,” Strauss says.
There are solid business reasons for these investments as well, Hamlin says.
“Academic leadership makes us stand out from the crowd. We have to rely on people coming great distances and bypassing alternatives on the way to us. There’s one of three reasons they will do that: They believe the outcome will be better, the experience will be better, or the value we can deliver will be better.”
And training the pediatricians and pediatric researchers of the future creates lasting relationships.
“Those doctors and researchers know the quality of our scientific and clinical training,” Hamlin says. “So there is a halo effect. Whether it’s a scientist or a clinician who asks, ‘Who do I need to collaborate with?,’ I am confident it will be us.”
Dr. Arnold Strauss, MD.
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