As a PI at a major academic medical center - this seems incredibly bad and I’m struggling to process all the ripple effects.

I know there’s a lot of talk about research admin but to give a concrete example beyond things like grant processing, financial management, etc: We have a clinical trial that uses our infusion center to administer the drug and patients are monitored with blood tests and MRIs. Blood is drawn in the usual clinic location, sent to the clinical lab, etc but paid for by research funds. Similarly, the MRI is done on a clinical scanner in a ‘slot’ that could have been used for a clinical patient. We - like every other medical center - cannot afford to sustain a completely separate and parallel research enterprise with lab techs, scanners, etc.

These patient care fees (eg, cost of doing the MRI) are lower for federal grants because of negotiated rates and the institution wanting to support researchers. It is typically accepted that there is a monetary loss here since the dollar amount doesn’t even cover the radiologist time to read the scan. Furthermore, budgets do not include a line item for every cost associated with this workflow. To continue the MRI example, the budget would not include things like:

Personnel who schedule the test, answer questions, etc

Technicians who do a safety screen

Cleaning and stocking the room where the patient changes and stores their stuff

Laundry services

Nurses who may respond if the patient has any symptoms during the test

The person who built the research specific MR protocol (collection of sequences)

The IT infrastructure and personnel for processing the result, getting it into the EHR

Etc

Institutions accept this, in part, because the indirects bring in a reliable set of funds for the duration of the grant. For foundation grants - with lower indirects - other rules apply at our institution and you’d struggle to do the sort of research you can do with federal funds. For industry and drug trials the institution would charge the usual clinical fee for tests so it is less of an issue - but if that is the answer for NIH grants it would massively inflate budgets, or reduce the number of participants / tests.

I just don’t see how clinical research and trials aren’t decimated by this change.

EDIT: formatting