Among numerous threats to the academic mission, diminishing funding for biomedical research attracts particular attention because it is so tangible and is likely to slow scientific progress in the near term. More dangerous still may be long-term adverse effects of reduced resources on the pipeline of physician-scientists. For pediatric departments, the impact may be accentuated by an already disproportionately low share of research funding and by well-recognized challenges in meeting parallel clinical demand for subspecialty services. In the absence of an imminent prospect of increased federal or foundational support, solutions to these workforce and economic issues will need to come from a reassessment of priorities within departments and institutions. Leaders in academic pediatrics must recognize the importance of all aspects of the academic mission but also recognize that within a single institution, investments must be tied to people and programs with a high likelihood of success. Proper alignment of investments and capabilities at both the individual and institutional levels will give academic health centers the chance to redefine themselves and succeed in a threatening environment.
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