Distribution of research awards from the National Institutes of Health among medical schools

Background: Previous studies have demonstrated that a small number of the 1 25 medical schools in the United States receive a disproportionately large share of the research awards granted by the National Institutes of Health ( NIH). We assessed whether the distribution of NIH research awards to medica l schools changed between 1986 and 1997. Methods: We used NIH data to rank medical schools in each year from 1986 to 1997 according to the number of awards each school received (as a measure of each school's activity in research, also referred to as research intensi ty). The proportion of awards received by schools ranked 1 to 10, 11 to 30, 31 to 50, and 51 or lower in research activity was then calculated, and ch anges over time were examined. We also examined changes in the distribution of awards and changes in award amounts according to the type of department , the type of academic degree held by the principal investigator, and the a warding institute. Results: Between 1986 and 1997, the proportion of research awards granted b y the NIH to the 10 most research-intensive medical schools increased sligh tly (from 24.6 percent of all awards to 27.1 percent), whereas the 75 least research-intensive medical schools (those ranked 51 or lower) received pro portionately fewer awards (declining from 24.3 percent to 21.8 percent). Th e increased proportion of awards to top-10 schools consisted primarily of i ncreases in awards to clinical departments, awards to physicians, and award s from highly competitive NIH institutes. Basic-science departments receive d a smaller proportion of awards than clinical departments, both in 1986 an d in 1997. Conclusions: Research funded by the NIH is becoming more concentrated in th e medical schools that are most active in research. (N Engl J Med 2000;342: 250-5.) (C)2000, Massachusetts Medical Society.