Counting the cost of an NRSA Primary Care Research Fellowship Program

Concerns are often raised about the potential financial and logistical burdens that fellows (even those who receive federal funding) add to departmental budgets.

We collected data on patient care income, financial values of teaching, on-call and attending duties, and departmental costs for patient care overhead, administration, and supervision over a 1-year period for six fellows in the National Research Service Award (NRSA) Primary Care Research Fellowship Program at the University of North Carolina at Chapel Hill.

Net receipts for clinical services ranged from $4,023 to $15,742, which, when adjusted for overhead costs, led to financial loss. However, assuming an academic dollar value of $15/hour, teaching, precepting, and on-call coverage were worth from $3,330 to $9,780 to a department, depending on level and specialty of the fellow. Overall, NRSA fellows imposed a financial burden consisting of practice-related costs and uncompensated faculty supervision and administration. Three factors can modify the estimate of this burden, including the calculation of patient care overhead, the estimated value of academic work, and whether fellows provide "replacement" or "additive" clinical functions to their departments.

The NRSA Fellowship Training Program can be a cost-neutral but valuable resource for developing highly trained primary care researchers and new faculty. Increased administrative funding for these programs would be a low-cost strategy to compensate faculty time and program management in generalist departments.