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Orthopedic surgeon Adil S. Ahmed discusses his article, “Academic medical centers under threat: the impact of funding cuts.” He outlines the essential, multifaceted roles of academic institutions in educating future doctors, conducting vital biomedical research, and providing complex care, often for underserved populations—functions distinct from private equity-driven health care models. The conversation highlights the critical dependence of these centers on funding, grants, and donations, particularly from government sources like the NIH, HHS, and CDC, to sustain their tripartite mission. Adil argues that recent government funding cuts, driven by political shortsightedness and a potentially misleading focus on “efficiency,” pose a direct threat to medical training opportunities, scientific advancement, and the capacity to care for the most complex patients. Actionable takeaways focus on recognizing the long-term societal value of academic medical centers and the potential dangers of reducing their funding, urging support for policies that bolster science and education.

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Transcript

Kevin Pho: Hi, welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome Adil S. Ahmed; he’s an orthopedic surgeon, and today’s KevinMD article is “Academic medical centers under threat: The impact of funding cuts.” Adil, welcome to the show.

Adil S. Ahmed: Thank you, Kevin. Thanks for having me.

Kevin Pho: All right, so just briefly share your story and then tell us what led you to write your KevinMD article.

Adil S. Ahmed: So, a brief background: I was born and raised in Texas. I went to Baylor in Houston for medical school, and then I did my orthopedic surgery residency in Tampa, Florida. Then I did two fellowships: I did hand and microsurgery at Emory in Atlanta, and then I did a shoulder and elbow fellowship after that in Sydney, Australia.

My practice is pretty much full upper extremity; I almost exclusively do surgeries in the arm. I’m here at Baylor now in my third year of practice back in Houston. Obviously, being in academics, the recent changes with the regime that has been in office since the start of the year—obviously, a lot of that has been funding cuts, cuts at the NIH, CDC, and things like that. That directly affects academic medical centers for funding for research in particular, but also grants for other things for resident activity: travel, presentation, all that kind of stuff. So that is what spurred my interest in writing this article to bring attention to the issue.

Kevin Pho: All right, so talk more about the article itself and just let us know about how it’s affecting you as an academic orthopedic surgeon and as well as the academic center that you work in currently. So, what’s the article about?

Adil S. Ahmed: The article starts with, as any article attempts to, a little attention grabber to hyperbolize the fact that we get all these notifications and emails all the time, and this was like that. We got a notification that, hey, there have been some changes at the higher level, and that is directly affecting the funding that our institution is getting. These medical centers rely heavily on government funding—government funding through things like the NIH that fund research, but also indirectly help fund the organization as a whole.

Because so much of academic medicine focuses on tertiary coronary referrals and care for patients that may not have funding or have really complex problems, it’s not necessarily the most lucrative financial practice model. You can’t just bill for the clinic visits and expect the surgeon to cover it all. For that reason, a lot of this funding is critical. It allows us to train our residents, and that’s something I touch on in the article.

The medical training for students and residents is huge, and having opportunities for them to engage in direct cadaver labs and work with implants and things like that, if they’re interested in surgery, to get a little more exposure in the lab, have opportunity for projects, travel nationally and internationally to present for projects, build networking opportunities—and the same thing for the faculty. Continued development of your skill sets, learning a new ultrasound technique or a new surgical technique, something like that is important to stay on the cutting edge. Those kinds of things start diminishing when the funding diminishes because ultimately it’s all reliant on money.

Kevin Pho: Now, when you say that it’s diminishing, what exactly would that look like? Is it just the uncertainty, or have you experienced or did you have to supervise any cuts because of this funding?

Adil S. Ahmed: It’s a good question. A lot of it is a bit of uncertainty and expectation of what may happen, but there have been direct cuts already. The main areas where we see it affecting us—myself personally as an academic surgeon—our stipends, our individual stipends, are diminishing. Our ability to travel where the expenses are covered for conferences and meetings and things like that is diminishing, which is how we build the research collaboration. So many studies nowadays are multicenter, multifactorial studies because that’s really how you gather enough patients to have meaningful data. Your ability to go and present and discuss and engage in these conversations with your peers across the country and across the world is really what makes a lot of this research happen, a lot of the tangible aspects. So, those things have happened.

The same thing with the residents. For them even more so, building their CVs and their list of what they’ve done is very important to get into fellowships, to get jobs. If their ability to travel has decreased, that really hurts them. Those things are real; they’re happening not just here at Baylor. My colleagues all over the place—it’s happening with them too.

Kevin Pho: Now, for those who aren’t following the funding cuts through the NIH, what kind of dollar amounts are we talking about? Or tell us what kind of percentages, in terms of how much this comprises of your institution’s research funding. Just give us a sense of the scope.

Adil S. Ahmed: It’s a good question. It probably affects people in a variable manner. Me personally, I don’t have any direct NIH-funded studies, but some institutions have up to 60 percent of their funding coming from institutions like the NIH. The NIH gives billions. I think—again, maybe check me on the numbers—but I think around 30-35 billion dollars was the amount that the NIH gave to institutions in the U.S. in, I think, 2023 or 2024. So, it’s a sizable amount of money, naturally spread across a lot of institutions, but that’s huge.

With cuts—the main cuts, the way that they have proposed them and are doing them—is that there’s direct funding and indirect funding, two different sides of funding. Indirect funding is basically anything and everything that doesn’t involve direct, for example, procurement of cells or something like that; like the time that a research assistant spends and, obviously, their salary in order to keep a database. Indirect costs are all of that stuff, factoring in publication fees, because those are a reality. If you do research, you have to put it out there; otherwise, no one’s going to know about it. So, all of that is a real cost, and those have very much been cut—the indirect funding—and that is huge for academic institutions to participate in research.

Kevin Pho: Now, there’s a narrative from supporters of the administration that a lot of these cuts are because of waste, because of fraud, because of abuse. So, from your perspective, is there a lot of abuse and fraud and waste happening, and are these cuts an effective way of addressing that?

Adil S. Ahmed: You’d probably get multiple answers if you asked multiple people. I’ll just preface it by saying this is my opinion; this is not Baylor’s stance or anything like that. I don’t represent all of the institution or even all of academic medicine. I think anytime human beings are involved with anything, you have human nature. There are people that are so-called good people, so-called bad, and the reality of life is people are usually in between. If there’s an opportunity to take advantage of things, I’m sure there will be some people that do that. It would be foolish to claim, no, all of this funding is going towards exactly what is written in your Excel sheet rows, that the funding for this goes to this.

I’m sure some of it does get lumped into that term—fraud, waste, abuse—that we’re all used to hearing. But the majority of it, I do not think is, because so much of our ability now to keep engaging in research and collaborating with other institutions and traveling, and then recruiting research fellows and students that want to participate, has diminished almost immediately because of these cuts. So, it is definitely happening, and it’s definitely stopping our pursuit of this research.

Kevin Pho: So, are you actually seeing investigational studies being shut down, principal investigators being laid off, or funding completely pulled? Are you seeing that either at Baylor or among your colleagues nationally?

Adil S. Ahmed: I haven’t personally seen any where people have been laid off because of it or they’ve had to stop a current study. I’m not aware—and maybe this is my naivety—I’m not aware of any study that’s already been funded and approved and ongoing that has had to halt because of it. I believe, Kevin, that this is for new grants and for new funding, and again, I might be wrong—I’m not positive on that—but I don’t think it’s retroactive.

Kevin Pho: How about in terms of patient care? We talked a lot about education; we talked a lot about research. What are the direct impacts on patients who may be listening to you and wondering about the impacts of these funding cuts on patient care?

Adil S. Ahmed: It’s more so in the sense of the continued pursuit of improvement and continued advancing of the field. If, for example, 50 years ago we had stopped pursuing research on diabetes and metabolic syndrome and that whole cascade, all the advances we’ve seen today with medications that can better control and better prevent all of that would’ve never occurred. It’s a long-term continued pursuit. Out of everything—you have a study, an idea, a project, and it goes down a pipeline—you have so many offshoots, these so-called spinoffs that happen. That is a real way that real science happens.

You have a question, you design a study and a project, and you pursue it. You may find something completely unrelated that you had no idea would come out of that. It leads to a real thing. So much of science has happened that way—a near accidental finding. But it’s just a general pursuit of improvement within science and the ability to ask questions and then execute a study, which naturally requires funding, in order to find the answer. You may end up finding a lot of corollaries that actually help patients a lot long-term.

So, that’s really the main issue in my mind: if you want to be on the precipice of excellence and keep pushing and remain national leaders for the global community, you’ve got to fund science. That’s where I think the real harm is going to be, not directly right now to us as much as for future generations.

Kevin Pho: What’s the morale like over at Baylor in terms of your colleagues, your fellow academic physicians, residents, fellows, medical students? My daughter is a pre-medical student, and last year she did the NIH Summer Internship Program, and they stopped that this year because of the funding cuts. So, what’s it like in terms of what you are seeing among the whole cohort of people who rely on funding? What’s the morale like?

Adil S. Ahmed: Initially, when you hear the news, when all of us first found out about this, there was a very sharp, knee-jerk negative reaction. It was, “Oh my gosh, it’s doom and gloom,” right? But that’s how human beings react to any news that’s negative. Then, it simmers down, and you see how it’s playing out. It’s not really something you can control. So, you can let it eat at you, but I think most people—we’re all very busy in our clinical practices. I don’t have a dedicated researcher or admin day. I work as an orthopedic surgeon five days a week, and then plus call, including weekends. And so, you still do that. I still am engaged in patient care, still teach residents and fellows and medical students every day, and I’m still doing my research. So, you keep at it, but it’s just a bit demoralizing when the support systems start eroding a bit.

Kevin Pho: So, what’s the response of Baylor itself? How are large academic medical centers like Baylor preparing themselves for the next few years of uncertainty?

Adil S. Ahmed: It’s a good question. I’m not in the higher-ups or admin; I don’t really know. The one thing is just openness. Baylor’s very open and honest with the faculty: “Hey, this is happening.” And that’s the case everywhere. As soon as we started finding out about this, I was texting my friends that are academic surgeons in other programs, asking, “Hey, is this affecting you guys?” Absolutely, it’s affecting everybody.

The institutions are also in a bit of a wait-and-see mode. If you can’t get funding that you used to get from the main sources—or, I should probably say it’s diminished; it’s not that institutions aren’t getting it anymore—you have to look for other avenues, right? You have to get creative. So that’s the impasse we’re at. Is this actually going to happen as proposed, and if it does, OK, what do we do? Or is it a little bit of bravado in the news to make a sweeping statement, and then it won’t pan out? We’re all eagerly awaiting to see.

Kevin Pho: So, one of the things that you touched upon in your article was the partisanship of science and education. I think during the pandemic, there was a certain level of distrust in public health and expert institutions, like medicine. So, in terms of fostering nonpartisan political public support regarding these funding cuts, and better support for research and these academic medical centers, what kind of paths forward do you see in terms of making this whole issue less partisan?

Adil S. Ahmed: I think it’s a bit sad that we even have to push to make it nonpartisan. I don’t think it should have ever become a partisan issue because the side of the political coin that you sit on, I don’t think that should influence at all someone’s desire to know more, learn more, advance society more. I think that logically is a very collective goal. It’s the collective goal that allowed civilization to happen; it’s how we transitioned from nomads into city-dwelling individuals over thousands of years. It’s the collective pursuit of improvement. That collective pursuit doesn’t happen when only half the population wants to do it. And so, it’s almost, I think, foolish for people to be so-called anti-science.

It’s not that science is a thing; it’s just the advancement of knowledge. So, I think really, framing is everything. Honestly, everything’s marketing and advertising these days in little snippets and sound bites across the social media apps. It’s become somehow painted in a negative light that it’s these scientists that are pushing some left- or right-wing agenda and that’s harming us, or they’re being wasteful. I don’t think that’s the case, and I think that’s the wrong way to look at the issue. It’s almost creating an issue that doesn’t really exist, just so for whatever end is desired, funding can be pulled or cut or repurposed.

I really think reframing and having scientists—as an example, a scientist who’s very much in the public eye is Neil deGrasse Tyson. He’s an astrophysicist who’s very active on social media; he goes on news channels, and he’s just one example. But I think he’s a very good speaker, and I think he’s very active in trying to dispel this myth as if science is something to be against; it’s just part of our lives. Everything we do and use day to day comes from that.

Kevin Pho: Now, does this issue ever come up whenever you interact with patients? And if not, just tell us the message that you want patients to know about the impact of these funding cuts.

Adil S. Ahmed: Honestly, it doesn’t really come up directly with patients. What I would just love patients to know is that despite whatever happens at these institutional or political levels—the levels that really are not participating in patient care—we, as the doctors that are treating the patients, are still going to do our best because that’s why we do what we do. It’s not going to stop me from caring for my patients. If someone comes in with a broken bone or needs a joint replacement for arthritis or something, I’m going to do it, right; that doesn’t really matter.

But it makes it more challenging to stay on that cutting edge. It makes it more challenging to educate our trainees with fewer resources. The fear is, if this goes on or potentially worsens, this entire generation—the current generation of trainees, students, and residents—collectively may have subpar training. That whole generation is who is going to take care of the future generation of Americans. I really hope that that is grasped: that the investment that we put in now in terms of time, energy, enthusiasm, and funding for the current generation of trainees is going to affect all of us—me and you, Kevin, our parents, all of us. We’re going to be taken care of one day by someone who’s currently training. It’s critical that we remember that and we don’t repurpose funding just for the short term: “Oh, look, the deficit is cut. Yay.”

Kevin Pho: We’re talking with Adil S. Ahmed; he’s an orthopedic surgeon. Today’s KevinMD article is “Academic medical centers under threat: The impact of funding cuts.” Adil, let’s end with some of your take-home messages that you want to leave with the KevinMD audience.

Adil S. Ahmed: Just stay enthusiastic about your practice. I personally don’t let things like this really get in the way of how I interact with patients or my view on treating my patients, because that’s disastrous for why we do this. So, that’s one take-away message. The other one is, and this may be completely separate, Kevin, from this topic, but I think it’s critical that we as physicians, surgeons—whether you’re in academics, private practice, whatever you do—you have to take care of yourself too. I’m a huge advocate of that.

Especially getting into so-called middle age, focusing a lot more on exercise and appropriate exercise and diet, I think that’s huge. A lot of times we let ourselves go by the wayside and sacrifice a lot. It’s taught to us in training to sacrifice: you can take it, you can do another night shift, you can be sleep deprived, but it wears on you. If you don’t take care of yourself, it’s hard to take care of others. So, I think that’s critical.

Kevin Pho: Adil, thank you so much for sharing your perspective and insight, and thanks again for coming on the show.

Adil S. Ahmed: Kevin, thanks for having me. You have a great day. Take care.