The sad and bleak future for urology funding at the National Institutes of Health.

The bulk of federal funding for medical research is delivered through the National Institutes of Health (NIH). Because federal funding is coordinated through the annual discretionary budget review process, the budget for NIH varies from year to year. Small changes in the rate of funding growth lead to significant problems for individual researchers and their supporting institutions. There is no single metric that serves as a surrogate to predict the appropriations process. This article begins with a history and physical examination of NIH. Next, the authors review the internal NIH priorities that continue to drive the funding process. Finally, the authors give a brief review of the impact congressionally mandated medical research programs have had on disease-specific funding.