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UC Berkeley UC Medical Humanities Press Book Series Title Follow the Money: Funding Research in a Large Academic Health Center Permalink https://escholarship.org/uc/item/59p124ds ISBN 97809963324229 Authors Bourne, Henry Vermillion, Eric Publication Date 2016-05-16 License https://creativecommons.org/licenses/by-nc-nd/4.0/ 4.0 Peer reviewed eScholarship.org Powered by the California Digital Library University of California Follow the money Funding Research in a Large Academic Health Center Henry R. Bourne & Eric B.Vermillion Perspectives in Medical Humanities Perspectives in Medical Humanities publishes scholarship produced or reviewed under the auspices of the University of California Medical Humanities Consortium, a multi-campus collaborative of faculty, students and trainees in the humanities, medicine, and health sciences. Our series invites scholars from the humanities and health care professions to share narratives and analysis on health, healing, and the contexts of our beliefs and practices that impact biomedical inquiry. General Editor Brian Dolan, PhD, Professor of Social Medicine and Medical Humanities, University of California, San Francisco (UCSF) Recent Titles Health Citizenship: Essays in Social Medicine and Biomedical Politics Dorothy Porter (Winter 2012) Patient Poets: Illness from Inside Out Marilyn Chandler McEntyre (Fall 2012) (Pedagogy in Medical Humanities series) Bioethics and Medical Issues in Literature Mahala Yates Stripling (Fall 2013) (Pedagogy in Medical Humanities series) Heart Murmurs: What Patients Teach their Doctors Edited by Sharon Dobie, MD (Fall 2014) From Bench to Bedside, to Track & Field: The Context of Enhancement and its Ethical Relevance Silvia Camporesi (Fall 2014) Humanitas: Readings in the Development of the Medical Humanities Edited by Brian Dolan (Fall 2015) www.UCMedicalHumanitiesPress.com [email protected] This series is made possible by the generous support of the Dean of the School of Medicine at UCSF, the Center for Humanities and Health Sciences at UCSF, and a University of California Research Initiative, Grant ID 141374. Advance praise for Follow the Money: This important study explores effects on an outstanding research university of a national funding crisis that threatens basic research and senior and junior biomedical researchers alike, notwithstanding large and continuing federal funding. Anyone puzzled by the contradictions facing US scientific research should read this book —Michael Teitelbaum, analyst of the US scientific workforce, former Vice President of the Alfred P. Sloan Foundation, and now Senior Research Associate at Harvard’s Law School. This insightful book is a MUST read for those who serve in leadership positions in large academic health centers, or support these institutions with their strategic or financial planning. —Diana Carmichael, president of AMC Strategies, strategic planning consultant to leading US academic medical centers. All happy institutions are alike; each unhappy institution is unhappy in its own way. Money— too little or too much, here or there—can open many possible routes to institutional unhappiness, as shown in this compelling, authoritative analysis of the finances of a leading research medical center. —Joseph Goldstein, a leading investigator of cholesterol homeostasis who shared with his colleague, Michael Brown, a Lasker Award in Basic Biomedical Research, a Nobel Prize, and the National Medal of Science. This clear account of research financing at one academic health center highlights its challenges and possible coping strategies, and exposes research funding misconceptions. It helps us understand how university based research in the US can hope to remain the envy of the world. —Tony Decrappeo, President of the Council on Governmental Relations, a national association of leading research universities. Following the financial streams of a top health sciences research institution, this book questions long-term sustainability of its research funding. An important book for any reader interested in future support of health sciences research. —Martha Hooven, Vice Dean for Administration, Columbia University School of Medicine. About the Authors: Henry R. Bourne, an emeritus professor at UCSF and a member of the National Academy of Sciences, is also the author of Paths to Innovation: Discovering Recombinant DNA, Oncogenes, and Prions, in one Medical School, Over One Decade. Eric B. Vermillion retired as Vice Chancellor – Finance in 2013 after almost 35 years at UCSF with an Emeritus status. While at UCSF he also served as National Chair for the Associa- tion of American Medical Colleges Group on Institutional Planning and as a member of the national board of the Council on Governmental Relations. First published in 2016 by the University of California Medical Humanities Press UCMedicalHumanitiesPress.com © 2016 University of California Medical Humanities Consortium 3333 California Street, Suite 485 San Francisco, CA 94143-0850 Designed by Virtuoso Press Cover photo courtesy of Getty Images Library of Congress Control Number: 2016939149 ISBN: 978-0-99633242-2-9 Printed in USA To L.H. “Holly” Smith, Jr. Who envisioned research as the life-blood of a health sciences university, and made it so Contents Acknowledgments ix Introduction 1 1 Today’s enterprise reflects decades of change 7 2 Revenue generates and constrains opportunity 21 3 Moiling for gold: The indirect cost mystery 33 4 Money is a good soldier: Buildings, equity, gifts, and debt 54 5 Sweet uses of adversity: Planning for change 69 6 Researchers’ salaries: Soft dollars, thorny issues 83 7 Put money in thy (research) purse: Funds, administration, and goals 99 8 Basic science departments: The future ain’t what it used to be 114 9 Science in clinical departments: Ambition vaults to success 137 10 Skies uncertain as a child’s bottom: Proposals for change 164 Late-breaking news 182 References 183 Index 210 Acknowledgments s beginners, we suspected this book would the first of its kind, but didn’t Aknow why. The answers were soon obvious. First, nobody else was fool- hardy enough to tackle the bewildering complexities of an academic health science center. Second, people who know enough to write such a book are too busy following actual dollars in such a center to dream of writing about it. Third, such centers are rarely willing to reveal nitty-gritty details of their financial accounts, decisions, and mistakes. So, without our initial ignorance, our recent retirements from jobs at a health science center, and the generous access to key information granted by two UCSF Chancelllors, this book would not exist. We are deeply grateful to many people who helped to repair that igno- rance and make this task possible. Busy tending irons in many fires (mostly at UCSF), they gave abundant time and expertise to help us find key documents and to understand myriad rules, contradictions, policies, mistakes, and hard- won achievements. In short, they enabled us to tell a true story—despite the fact that pure and simple truth (as Oscar Wilde put it) is rarely pure and never simple. We begin with those people who helped us understand the “big picture” at UCSF. At the outset of this project, UCSF Chancellor Susan Desmond- Hellmann gave it her blessing and correctly suggested that the two authors together could do a better job than either alone. Her successor, Chancellor Sam Hawgood, maintained his office’s invaluable support and furnished use- ful advice and insights throughout. In addition, we are especially grateful to Dan Lowenstein, Executive Vice-Chancellor and Provost, whose thoughtful approach to problems and frank appraisals of policies, opportunities, and challenges have proved invaluable. Theresa Costantinidis, the Interim Senior Vice Chancellor – Finance & Administration, who allowed us to work closely with her staff to gather the lion’s share of the data we present and discuss. Keith Yamamoto, Vice Chancellor for Policy and Strategy and Vice Dean for Research in the School of Medicine, gave us his perspective on research in basic and clinical departments. Most UCSF staff who worked with us are long time professionals who viii Follow the Money intimately understand the institution’s woof and warp. We could not have as- sembled the data we presented without the tireless help of Jerome Sak, Fred- erick Parsons and Trent Spradling, members of the UCSF Budget Office se- nior staff who put up with our endless questions and insatiable need to look at every tree, branch and twig in the forest. In the Budget Office, we also relied on Ann Rodriguez, Kathleen Dykhuizen-Hill, Debra Fry, Mike Clune, Bob Rhine, David Hathaway, Andrew Joseph, Chau Tu, Nilo Mia, Risa Gleichen- haus, Denis Nepveu, Taylor Mayfield, and Angie Marinello. Other UCSF ad- ministrators, analysts, and data miners who helped us in ways large and small, include John Ellis, Tammy Wallace, Shannon Turner, Lori Yamauchi, Gary Forman, Cynthia Leathers, Terri O’Brien, Jennifer O’Brien, Bob Pizzi, Steve Downs, Mike Baldelli and Mickey Zeif. We also thank Martha Hooven, cur- rently Vice Dean of Administration at Columbia University Medical School and formerly at UCSF. Without their support this book would largely be a work of fiction. We devoted a large fraction of our effort to exploring research and its funding in UCSF’s School of Medicine. Sam Hawgood, Dean of Medicine when we began writing this book, helped to orient us before he became Chan- cellor. We also received excellent advice and insight from Bruce Wintroub, Chair of the Department of Dermatology, when he served as interim Dean of Medicine after Hawgood became Chancellor. We are much indebted to Talmadge King, Hawgood’s successor as Dean of Medicine, for help he pro- vided in two important roles. In his previous position, as Chair of the Depart- ment of Medicine, he had already given us invaluable information and advice. As Dean of Medicine also, we found Talmadge a fount of detailed, carefully thought-out knowledge and analysis, who communicated his comprehensive understanding in a refreshingly direct, no-nonsense way, entirely different from the friendly but sometimes blandly uninformative style affected by some high-level administrators.

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