Table 1.

Common Challenges

Traditional sources of funding have declined
Federal	National Institutes of Health/National Heart and Lung and Blood Institute (NIH/NHLBI) ❖Funds vast majority of cardiovascular research ❖Budget plateaued in 2010 and then declined (Figure 1)(22, 23) ❖Grant funding success rates have steadily decreased by >50% from 2003 to 2012 (Figure 1)(22, 23) ❖Using 1995-constant US dollars, NIH 2013 budget was 22% lower than 2003(24)
	General Medical Education (GME) ❖Medicare support of GME has been frozen at 1996 levels(25) ❖Frozen cap led to 12% decrease in cardiology fellowship slots in 1995–2001(11) ❖Presidential budgets proposed to reduce indirect Medicare support of GME by 10%(25–27)
Industry	❖Research spending for new cardiovascular therapies has been declining (28, 29) ❖Cardiovascular drug development has decreased(30)
Increasing number of PhDs competing for smaller available funding pool ❖Life-science/medical PhDs awarded per year grew from <2000 in 1993 to >8000 in 2007(31) ❖Biological sciences PhDs awarded per year grew from <5000 in 1993 to 8052 in 2010(31, 32) ❖PhD growth likely contributed to steadily increasing number of grant applications (Figure 1)
Over-reliance on relative value units (RVU) discourages academic pursuits ❖Medicare pays by [current procedure terminology code (CPT)) X (RVU) X (conversion factor)) ❖Medicare formula does not reimburse academic pursuits ❖Consequently, healthcare systems do not award RVU “credit” to academic pursuits ❖Academicians are forced to add RVU tasks in lieu of academic pursuits
Trends in medicine and academia reduce available time for investigator-initiated academic pursuits ❖Progressive limitations on house-staff increasingly shift work to cardiology faculty ❖Explosive growth of complex regulatory compliance requirements add increasing administrative burdens (e.g., Institutional Review Boards, Institutional Biological Safety Committee, Institutional Animal Use and Care Committee, and Environmental Health Safety) ❖More time is required to maintain expert competency ➢Increasing number of studies and guidelines for each subspecialty ➢Increasing requirement for formal demonstration of competency (e.g. yearly maintenance of certification exercises and more frequent board certification exams)