Clinicians have largely avoided layoffs tied to federal research funding disruptions, but staffing cuts and federal funding uncertainty could exacerbate physician shortages.
Academic health systems across the country have paused the hiring of researchers, furloughed faculty and laid off administrators in response to the National Institutes of Health’s attempts to reduce payments for overhead linked to research. Most of these workforce reductions have spared clinicians, as academic systems are also battling capacity constraints, but the layoffs — combined with a crackdown on federal spending — may limit physician training and lead to fewer doctors in the long term, university executives said.
Related: Federal funding disruptions roil health system-led research
Some academic health systems are restructuring their workforces after the NIH said it planned to cap payment rates for maintaining labs, hiring support staff and other research-related overhead. Hospitals negotiate individual rates for those costs, averaging roughly 30% of a total grant. The NIH announced it would cap those payments at 15% in February, which would cut billions of dollars in annual health system grant revenue. However, the reimbursement change prompted several lawsuits, leading to a permanent injunction and an NIH appeal on April 8.
Payments were restored as deliberation continues, but health systems are still cutting costs to gird against potential funding cuts.
In addition to potential reimbursement reductions, the NIH has delayed ongoing grant funding, crimping provider budgets and stunting research, healthcare researchers said.
“Research on conditions like diabetes, Alzheimer's and heart disease needs to follow patients over many years,” said Shelly Sakiyama-Elbert, vice dean for research and graduate education at the University of Washington School of Medicine. “If you can’t enroll enough patients to finish a trial or test a new therapy, that is going to hurt patients.”
Some of the faculty members affected by recent layoffs or hiring freezes also train aspiring physician-scientists, experts said. Academic health systems like Johns Hopkins Medicine use NIH grant funding to help train clinicians, technicians and researchers, said Sridevi Sarma, an associate professor of biomedical engineering and vice dean for graduate education at Johns Hopkins Whiting School of Engineering.
NIH cuts may deter clinicians and researchers from entering the field or continuing their work, said Dr. Dan Cooper, a pediatric pulmonologist and a pediatrics professor at University of California, Irvine.
“These unreasonable cuts could put the next generation of researchers and clinicians in a place of great doubt regarding whether this is what they want to do,” he said.
Faculty members who face research disruptions may also be compelled to leave academia, reducing mentorship opportunities for students.
The National Center for Health Workforce Analysis in November predicted that by 2037, 31 of 35 physician specialties will experience shortages, including primary care, cardiology, obstetrics and anesthesiology. Hiring freezes and workforce reductions could exacerbate physician shortages, especially in specialties that focus on chronic disease, Sakiyama-Elbert said.
“Training a physician is a decades-long process, so any workforce changes are definitely going to have some downstream impacts there,” she said.
The University of Washington is one of many institutions that implemented a hiring freeze. A university-wide temporary hiring freeze for nonessential staff went into effect in March, following Seattle-based UW Medicine’s February pause on hiring nonclinical academic personnel, faculty and staff and student employees.
Most health systems are trying to insulate their clinical operations from staffing reductions as many academic systems treat an increasing number of patients. For instance, Nashville-based Vanderbilt University Medical Center in March paused hiring for most research positions in response to research funding cuts but has continued to hire frontline staff for its health system to accommodate ongoing growth in patient care, a spokesperson said.
“Hiring freezes in the setting of proposed NIH cuts, in addition to other financial threats and overall uncertainty in the field, threaten all aspects of academic medicine, including the teaching mission of our members,” Dr. Jonathan Jaffery, chief healthcare officer at the Association of American Medical Colleges, said in a statement.
The UMass Chan Medical School in Worcester, Massachusetts, paused all hiring, including for faculty, grant-funded positions and summer internships, and laid off or furloughed about 200 employees over the last two months, a spokesperson said.
University leadership said in a March 11 memo thousands of research organizations across the country are facing an unavoidable period of uncertainty even beyond NIH’s proposed rate cut, including fewer new grant awards and potential Medicaid funding cuts.
“Taken together, these proposed policy changes require us to reduce spending immediately to address the very real and immediate impacts created,” the memo said.
