An uncertain future

Funding for medical research in South Australia is perilously low, with many talented researchers likely to move interstate or overseas or leave the profession, warn some of the state’s most eminent researchers.

Professor Michael Horowitz, Director of the Endocrine and Metabolic Unit at the Royal Adelaide Hospital, says research funding in South Australia – particularly for collaborative research between medical clinicians and scientists – is at a very low ebb.

With a career spent entirely in Adelaide as a researcher, educator and clinician, and recently made a Member of the Order of Australia (AO) for distinguished service to endocrinology, particularly diabetes, Professor Horowitz says the research funding landscape in South Australia is bleaker than it has been at any point in his long career.

‘Involvement of clinician-scientists (including nursing and allied health professionals) is pivotal to advancements in medical care, particularly because of their distinct perspective. Unfortunately, clinician-scientists can be regarded as an increasingly endangered species,’ he says.

‘Some medical researchers have the option of moving into more secure clinical work but many clinician-scientists do not, obliging them to look elsewhere or outside the research sector for job security.

‘The budget for National Health and Medical Research Council (NHMRC) grants for the whole of Australia is about $900 million a year. When considered in relation to the wealth of Australia that’s not a lot of money.

Professor Horowitz says that South Australia has tried to gain a larger share of research funding by consolidating research through the South Australian Health and Medical Research Institute (SAHMRI) and by encouraging collaborations. However, he says, the success of this strategy is uncertain.

‘Throughout the majority of my career, the success rate for NHMRC grants was 15 to 20% nationally, and often higher in South Australia – now it is often less than 10%,’ he says.

A 2020 SA Productivity Commission Health and Medical Research Inquiry reported that only 6.6% of NHMRC funding was awarded to South Australia in 2019, down from 10.9% in 2000. NHMRC summaries show this slipped further to 3.7% in 2020, 5.4% in 2021 and 4.5% in 2022. In contrast, research projects in states such as Victoria and Queensland are increasingly successful.

Risk to research standing

There are concerns that South Australia’s research standing will be further affected by the proposed merger of the University of Adelaide, ranked at 89 in the world, and the University of South Australia, ranked at 363.

Professor Horowitz and others ponder whether this will have an impact on South Australia’s capacity to recruit and retain the sharpest minds, including elite PhD students, as the new combined institution maydrop below the top 100.

‘Adelaide has a history of being very strong in multidisciplinary clinical research. In part, that’s why I embarked on a research career and probably why I am still working at age 69,’ Professor Horowitz says.

‘I have terrific colleagues in both my clinical and research groups and my research continues to be intellectually challenging and stimulating,.’

Despite the challenges, South Australian researchers continue to deliver world leading scientific advances, he says. The internationally recognised multidisciplinary group Professor Horowitz has led since 2007 – the Centre of Research Excellence (CRE) in Translating Nutritional Science to Good Health –integrates researchers with clinical expertise in gastroenterology, endocrinology, intensive care and nuclear medicine, with basic scientists, and is part of international research collaborations. Training future clinician-scientists is a major focus.

In 2007 it was the first group in South Australia to be awarded a five-year CRE grant by the NHMRC, and against the odds the group received a second five-year CRE grant in 2012.

‘Despite the demanding research environment, our research performance is arguably better than when we received our initial two CRE grants,’ Professor Horowitz says. ‘However, to my profound disappointment, additional and necessary infrastructure support provided by the university was withdrawn as a result of fiscal constraints about three years ago.

‘I would like to see options for talented younger people improved substantially. I believe this is feasible – the costs, when considered in perspective, are not major.

‘Providing appropriate structures to support the development of future clinician-scientists – not just doctors, but also those in complementary clinical disciplines –would represent a very sound investment in the future,’ he says.

Internationally regarded gastroenterologist Professor Chris Rayner, who chairs the Scholarships and Fellowships Committee at the Royal Adelaide Hospital (RAH) and has worked with Professor Horowitz for about 25 years, agrees research grants are increasingly difficult to win.

Professor Rayner says many hospital research grants of around $40,000 to $50,000 that early-career researchers once used to generate pilot data to attract major NHMRC grants no longer exist. The Central Adelaide Local Health Network (CALHN) offers some Clinical Rapid Implementation Project Scheme (CRIPS) grants of up to $200,000 over two years, but these focus exclusively on research that contributes to shorter hospital stays and other ‘service delivery’ outcomes.

‘Support from institutions and structures must be addressed,’ Professor Rayner says. ‘At the moment, getting people out of hospital efficiently seems to be the only priority – an extremely short-sighted perspective.

‘There are also numerous institutional silos, so people at the different organisations aren’t actively encouraged to talk to each other about what they’re doing and collaborate. It’s a real challenge.

‘South Australia has a history of outstanding, world-leading research in medicine and bioscience. It also has numerous advantages as a location for research and clinical trials. Australia is seen as a favourable regulatory environment with attractive tax concessions. We should be attracting much more.’

Professor Rayner also observes the accelerating decline in the number of doctors who combine research duties with an intense clinical workload , with fewer than 50 people employed as ‘clinical academics’ in CALHN.

This has inevitably contributed to the reduction in research in specific areas in South Australia – such as the work once led by Professor of Surgery Glyn Jamieson that established Adelaide as a world-leading centre in gastro-oesophageal reflux treatment.

‘In the health system, we are told that we are in a state of emergency all the time,’ he says. ‘That’s a daily message.

‘Everything is about immediate clinical demand. There’s apparently no time to address the big picture.

‘We have to invest in the future and think beyond the immediate needs of today. Otherwise, we will inevitably lose outstanding people – or fail to attract them in the first place.

‘Even small-scale budget changes to boost funding for fellowships to support early career researchers, and small grants that are accessible and don’t have to focus on service delivery –these would be very worthwhile.’

Recognising the value

Professor Guy Maddern, a hepatobiliary surgeon based at The Queen Elizabeth Hospital and for three decades the Adelaide Medical School’s Professor of Surgery, agrees research support needs rethinking. ‘Governments need to recognise the real value in having vibrant, questioning people doing great research in public hospitals,’ he says.

With a role including both clinical care and research, Professor Maddern has been involved in running the Basil Hetzel Institute for Translational Health Research at TQEH for about 20 years.

Ongoing discussion about ‘what or who pays’ clinical academics and salaried hospital clinicians who want to split their working hours between research, clinical and teaching roles remains a significant handbrake on clinical research.

Disagreements between employers about who pays for what time spent by the researcher on clinical or research roles damages output, morale and the reputation of the state as an incubator of ground-breaking, world-changing science.

More clarity around research roles would help, says Professor Maddern. ‘We need more positions that are substantial appointments – 0.7 and 0.8 FTE rather than 0.2 and 0.3 – and identify within those positions the amount of time that will be quarantined for research.

‘In exchange, they need to generate outcomes – publications and bringing in funding – that can be measured and support higher-degree students in their research endeavours.’

Professor Maddern supervises 10 higher-degree students who don’t need additional funding to draft work emanating from their clinical opportunities.

‘I’m able to get reasonably substantial grants to employ clever people to do really clever work but obtaining grants is an administrative nightmare. That lack of administrative support means I spend my time on work that would be cheaper and better done by writers and admin staff.’

World-renowned academic cardiologist Professor John Beltrame, who is the Michell Chair and Medicine Lead at the University of Adelaide and Director of Research for the Central

Adelaide Local Health Network (CALHN) and senior consultant at the Queen Elizabeth, Royal Adelaide and Lyell McEwin Hospitals, agrees the chase for grant funding is frustrating. He says an application for a NHMRC or Medical Research Future Fund (MRFF) grant typically takes 100-plus hours to complete and researchers usually come away empty-handed.

He agrees there is a focus on funding research that can be immediately translated into benefits for patients rather than having a longer-term horizon.

But he says there are positive signs.

Collaboration between the state’s researchers and with international and interstate partners is the key to greater funding success, Professor Beltrame says.

‘Forums for hospital, university and SAHMRI researchers to promote their research activities to other local researchers are important mechanisms to facilitate collaboration, particularly between clinical, basic and epidemiological research fields,’ he says.

‘This is especially important for translational research, where clinician researchers do not have the time or expertise for the basic laboratory research and the lab researchers benefit from an opinion as to the clinical relevance of their research studies.’

Professor Beltrame is confident that collaboration-based initiatives will start to make a difference to South Australia’s success rate over the next few years.

The new independent cancer-focused medical research institute, South Australian immunoGenomics Cancer Institute (SAIGENCI), is one of the ‘good news stories’. ‘There’s also the Genomics Centre – these are both excellent institutions that are developing and hopefully will drive an improvement in South Australia’s grants success rates,’ he says.

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