Grants 101: Helping You Decode the NIH Labyrinth
After receiving my PhD in 2019, I was off to begin a T32 Postdoctoral Fellowship in Behavioral Geriatrics and Palliative Medicine. Sounds cool, right? Let’s just ignore the fact that I didn’t know what “T32” stood for or what it meant. On the first day of my new cool-sounding post-doc, I had a meeting with three mentors who asked me “…so what are you proposing to submit for your K?” to which I responded with an internal freak out – “Huh? More letters? What is this?” At the time, I had a very rudimentary understanding of the grants world and a vague idea that grants would be the backbone of my new work environment, whatever that meant. Turns out, grants are fundamental for the survival of us non-clinical folks pursuing careers in research. The NIH, and the process of applying for federal funding, is an overwhelming labyrinth to decode with strict rules and many random letters, numbers, and acronyms, and everyone (except me) seemed to know what it all meant. Hearing or seeing these cryptic-like terms - T32, K99, R21, R01 - would activate my stress-response. Almost three years later, I compare navigating the NIH to learning a new language – one in which I have spent my entire post-doc trying to become fluent in. Spoiler alert: I’m still not fluent, but the good news is that I went through some of the process so you don’t have to. Here, I’ll provide some tips and tricks on helping you begin to navigate and decode the labyrinth that is the NIH.
What is the NIH?
NIH stands for the National Institutes of Health, a federal agency part of the U.S. Department of Health and Human Services. The NIH is the largest private funder of biomedical and public health research for investigators at both the pre- and post-doctoral levels. There are 27 Institutes with varying research priorities that operate under the NIH, including the National Institute on Aging (NIA) and the National Cancer Institute (NCI).
What is “funding”?
Funding = research support. It’s a grant obtained through a competitive process to fund scientific research. I don’t think I fully grasped the costs associated with conducting research until my post-doc. From your own salary, personnel, recruitment, to equipment, software, and beyond – everything costs money. Sure, we can do research without funding, but to pull off a major study like a Randomized Controlled Trial - we need major resources to do so. The funds you are provided as a study team member account for a specified amount of time (usually in calendar months) that you will devote to the project.
Why would I need funding?
A fun fact (or harsh reality) is that for many, grants are the very thing responsible for paying your salary. Yup, if you’re not in a traditional tenure-track academic position where teaching and service provide hard funds for salary, researchers rely on grants (aka ‘soft money’) to sustain their positions and paycheck. Many of us end up in post-doctoral positions because those tenure-track positions are both limited and highly competitive (the odds of securing a tenure-track position are estimated to be between 10-25%). Each grant allocates funds to pay a specific percentage of your salary based on the maximum allowable by the NIH and your respective institution. That means researchers need multiple grants to cover their salary. It’s a cyclical process – all grants have timelines, so researchers often need to submit multiple grants even if they’re currently funded. Those of us with non-clinical degrees can’t bill for services and patients the way clinicians and doctors would, and most institutions don’t have internal funding to allocate to research positions. For many researchers, the NIH is our only lifeline – especially in the world of academic medicine. But, for those who don’t want to rely on NIH funding for the rest of their careers, just know that securing any kind of funding provides you with a track record and competitive edge on the job-market. By showing that the NIH is willing to invest in you, as a researcher, and the work you propose, you have leverage when exploring your career options.
What are all those letters?
It took me a few, but I eventually figured out what a T32 was (T=Trainee)! NIH uses activity codes to classify the various programs of research they support. Here’s a simple breakdown:
T & F Series: Grants that begin with the letters T or F represent the NIH’s Research Training and Fellowship programs. These grants are awarded to institutions to provide training to pre-doctoral or postdoctoral candidates. As a T32 trainee, in addition to covering my salary, I was provided with a certain amount funds annually for coursework tuition, conference travel, and any other activities that would bolster my professional development. I was provided with this support specifically to build a compelling research program -- through publications, leadership roles, and gaining grant-writing experience -- that would strengthen my candidacy to obtain independent NIH funding. The end-goal of our T32 postdoctoral fellowship is the successful submission and funding of a K-level award.
K Series: K awards are Research Career Development Awards. There are many funding mechanisms under a K-level award (i.e., K99/R00, K01, K03, etc.), all of which slightly differ in their submission requirements and level of competitiveness. These differ from T & F-level grants because they are awarded to individual candidates and not institutions. With K’s, the NIH is not only investing in one’s research idea, but also the overall professional development of the awardee. The K01 Mentored Research Scientist Career Development Award and K99/R00 Pathway to Independence Award are the most common submissions I’ve come across. These are mentored awards that allocate support for an interdisciplinary mentorship team, training, and skill building in relevant areas to establish expertise that will enable a trainee’s transition to independent researcher. The K99/R00 award, for example, is a five-year award, structured as two-years in the post-doctoral phase (K99) for training and three-years as an independent researcher (R00). Stipulations of the R00 phase include a promotion and/or title-change for the awardee (i.e., from postdoctoral fellow to assistant professor). Recipients of K-level career development awards work to submit their first R01 by the end of their 5-year project period.
R Series: R-level grants are your typical research projects, with varying levels of maximum dollar amounts, duration, and submission requirements. An R21, for example, provides two-years of support of up to $275,000 for exploratory research projects to support preliminary data collection in preparation for future, larger funding. Then you have R01s, which are the big leagues – these provide up to 5 years of support with a no-limit budget (although, special permission is needed for grants requesting >$500,000 per year). So, R01s by far are the most competitive. To qualify for an R01, a principal investigator needs to demonstrate significant expertise and a strong track record of funding in the area they propose to study as well as compelling preliminary data to support their proposal.
What is the application process?
This could be its own blog post! There are many parts to the NIH submission process. You have your Specific Aims page – the most important part of the entire application (and the hardest to write!), a one-page summary of your entire application. Then, you have six pages to make your case about the significance, innovation, and strategy of your proposed research and why specifically you are the researcher who should carry out the work. Grant writing is really an art – with such limited space, every single word matters. In addition, submissions require budgets and cost justifications, forms that must meticulously outline all aspects related to the protection of humans subjects, letters of support, and even your CV/resume in an NIH-specified format.
How are applications reviewed?
Application scoring procedures might be the least intuitive part of the grants process. New grant applications are typically submitted in October, February, and June of each year, but your application isn’t reviewed until the scientific review meeting, which usually takes place 3-4 months after your submission deadline. The review process is quite lengthy and takes place in steps.
Before the scientific review meeting (which consists of a panel of NIH-funded scientists), three reviewers are assigned to read and score your application using a 1-9 scale assessing five criteria: significance of the project, investigative team, innovation, research strategy, and institutional environment. In the NIH-world, a score of 1=Exceptional and 9=Poor, so lower scores are better. The scores of the three reviewers are then calculated to form a preliminary impact score. At the scientific review meeting, the study section will only discuss the applications with a score in the top 50%. Instead of receiving a score, the lower 50% of applications receive a designation of ND, or Not Discussed.
If your application scores in the top 50%, the three experts assigned to your submission will present your proposal to the review panel, discussing both strengths and weaknesses of the application. Based on the discussion, the entire council then votes to form an overall impact score. Following the meeting, applicants are notified of their scores and percentiles. Discussed applicants receive a summary of the council discussion and feedback from their three reviewers, (also called “summary statements”) roughly six weeks later.
The confusing thing is: there is absolutely no concrete threshold/score for funding. In fact, funding depends on a lot of things including NIH’s budget for the fiscal year – which changes on an annual basis but determines the score an application needs to meet for funding. The funding line also differs based on the NIH institute you apply to, your status as an investigator (e.g., junior versus senior), as well as your topic area. For example, the NIA has shifted their budget to devote increased funding for projects focused on Alzheimer’s disease and related dementias, and thus studies in this area have a higher funding line (i.e., a better chance of getting funded). Scores under the ‘funding line’ are likely to be funded pending one final Advisory Council meeting that takes place 3-4 months later. The whole process from submission to funding takes about a year. Overall, though, it is rare for a grant to be funded on the first try and typically requires a resubmission.
Some of you may be thinking, “this has no relevance to me,” but the truth is, if you’re considering a career in research – this is a harsh reality of the job that one needs to consider. There’s also a bright side too. Working as an NIH-funded researcher means conducting research that is clinically impactful, providing us with the opportunity and resources to work on developing innovative solutions to enhance health and well-being. We conduct research to identify actionable mechanisms of change and test interventions with potential for real-world impact. It’s grueling at times, but the purpose and impact of the work we do is the driving force that advances us forward.
As for me, I swore I’d never be a post-doc or a researcher working in a world fueled by the grant-funding machine… yet here I am! I completed my T32 fellowship and was awarded an NIA-funded K99/R00 Pathway to Independence Award, which will support my research and professional development for the next five years as I both transition to independent investigator and continue my pursuit of figuring out how to decode the NIH.