When Training Pipelines Break: What NIH F31 Terminations Mean for the Future of Public Health Research

Abstract

National Institutes of Health (NIH) predoctoral fellowships, including the Ruth L. Kirschstein National Research Service Award (NRSA) Individual Predoctoral Fellowship (general F31 and F31-Diversity awards), have long served as mechanisms to support trainees, including those who are historically underrepresented in the biomedical and behavioral sciences. In 2025, many of these awards were unjustly terminated. Since then, the status of many grants has changed among a funding landscape of partial reinstatements and continued uncertainty. In this article, we summarize historical evidence of the impact of NIH-predoctoral fellowships and explore the implications of these terminations on trainee well-being and public health more broadly. One illustrative case example of a termination (and subsequent reinstatement) of a diversity-promoting F31 grant highlights the multifaceted costs of these disruptions amid ongoing political and policy shifts.

In 2024, I (Jahn Jaramillo) was awarded the Ruth L. Kirschstein National Research Service Award (NIH F31 Diversity Fellowship) with a perfect score to support my dissertation on adapting an employment-focused HIV prevention intervention for immigrant Latinx gay, bisexual, and other men who have sex with men in Miami (mentored by Audrey Harkness) (Jaramillo, 2025). A year later, as I awaited renewal of my grant, I received news that the fellowship was terminated. My project was deemed “incompatible with agency priorities” under the NIH Grants Policy Statement (U.S. Department of Health and Human Services, 2025) and 2 C.F.R. §200.340, which allows termination if an award “no longer effectuates the program goals or agency priorities,” on the grounds that research tied to diversity, equity, and inclusion (DEI) is “antithetical to scientific inquiry” and “not cost-effective.” Thanks to the support of university leadership, institutional centers, mentors, and community partners, I was able to complete my project. However, the experience showed me how fragile the training pipeline is for students, especially those from underrepresented backgrounds. Overnight, words that had always made sense to me like “equity,” “Latinx men who have sex with men,” and “immigrants,” were no longer acceptable. This shift shattered my sense of self and the professional identity I was just beginning to claim with confidence. I was now living a new reality where what we can study, how we are supported, and whether underrepresented early-career researchers make it through the highly competitive path from trainee to early career faculty (Ramirez-Valles et al., 2023), to tenured senior faculty, were all being shaped by political decisions. Although my grant was fortunately reinstated nearly a year later, many awards remain terminated and the harms of funding interruptions persist despite partial and full reinstatements (Brain Research Institute, 2025; Grant Witness, 2025; Tham et al., 2024).

Predoctoral training opportunities for the next generation of health leaders can be traced back to the 1960s (Institute of Medicine; Committee on National Needs for Biomedical and Behavioral Research Personnel, 1984). Over time, these efforts evolved into structured mechanisms of support, including the National Institutes of Health Ruth L. Kirschstein National Research Service Award (NRSA) Individual Predoctoral Fellowship, which was designed to support the early research trajectories of doctoral trainees through protected time, funding, and mentorship (Pion, 2001). The F31 mechanism was composed of both the general F31 and F31-Diversity pathways and recognized the potential of trainees early in the research pipeline (National Institutes of Health, 2025a, 2025b). These awards were one of the few federally supported pathways available to students toward becoming independent researchers who go on to contribute to scientific innovation and inform policies that address the nation’s most pressing health challenges (Lutz, 2025; Pickett, 2019; Pilsbury & Nicole, 2025; Schaller, 2023).

The extant literature demonstrates that predoctoral and early career scientists face systematic barriers that limit access to NIH structured training support, especially among scholars from underrepresented backgrounds (Nguyen et al., 2022). These barriers include unequal access to research mentors, limited support for grant-writing, and hidden curricula, translating into higher attrition from research pathways among minoritized scholars (Alvero et al., 2024; Fitzsimonds et al., 2024). The F31 mechanism was designed, in part, to mitigate these barriers for trainees who face an uneven training trajectory and who aspire to enter faculty or leadership ranks—roles in which scholars from underrepresented racial and ethnic groups remain markedly underrepresented (Ramirez-Valles et al., 2023). Despite this resource, the pipeline remains narrow as only a small proportion of candidates receive an F31 each year, and of those awards, even fewer are awarded to underrepresented scholars (National Institutes of Health, 2021). This pipeline has become even more constrained due to the recent discontinuation of the F31-Diversity mechanism, based on Executive Order 14151 that ended federally supported Diversity, Equity, and Inclusion (DEI) initiatives (Executive Order 14151, 2025; McMurray, 2025; Temporary Pause of Agency Grant, Loan, and Other Financial Assistance Programs, 2025). In 2025, this Executive Order led to the termination of hundreds of previously awarded F31 grants, which disrupted an already competitive and fragile pathway and introduced instability among highly qualified, dedicated students who are at a critical transition point in their academic and professional careers (Association of American Medical Colleges, 2025; Grant Witness, 2025). In this article, we describe the importance and impact of NIH predoctoral fellowships to date, explore the implications of the terminations on student well-being and public health, and provide policy recommendations based on the first author’s experience of an F31 termination.

Early and Enduring Impact of NIH Predoctoral Fellowships

Historical evidence (see Table 1) and recent studies suggest that predoctoral opportunities like the F31 have increased research capacity, improved productivity, and generated innovative research (Institute of Medicine; Committee on National Needs for Biomedical and Behavioral Research Personnel, 1984). Even before the F31 mechanism existed, NIH supported the training and development of scientists at the predoctoral level through the F01 fellowship (which was later replaced by the F31) and other similar programs (Institute of Medicine; Committee on National Needs for Biomedical and Behavioral Research Personnel, 1984). A 1984 evaluation of these programs (F01, T01, T03, T05, T32) demonstrated a solid return on investment; fellows were more likely to enter research-focused careers, obtain faculty positions at influential institutions, and secure federal funding for research compared with peers who did not receive NIH predoctoral training support (Institute of Medicine; Committee on National Needs for Biomedical and Behavioral Research Personnel, 1984). More recent evaluations have shown similar outcomes among scholars from underrepresented backgrounds, including higher earnings, greater F32 award attainment (postdoctoral fellowship), and more representation in nonacademic sectors over time such as industry compared with underrepresented peers without predoctoral awards (Alvero et al., 2024; Moore, 2019; National Academies Press, 2005). Two particularly rigorous studies found that after accounting for factors such as years of experience and institutional prestige, NIH predoctoral support was linked to greater odds of completing postdoctoral training, applying for and receiving NIH/NSF grants, publishing more articles, earning more citations per paper, and receiving stronger NIH grant scores (Institute of Medicine; Committee on National Needs for Biomedical and Behavioral Research Personnel, 1984; National Research Council, 2006; Pion, 2001).

Table 1.

Impact of Predoctoral Fellowships on Student Outcomes.

Report name	Years	Population	Outcomes explored	Main/significant findings
The Career Achievements of NIH Predoctoral Trainees and Fellows (Institute of Medicine (US); Committee on National Needs for Biomedical and Behavioral Research Personnel, 1984)	1967–1980	Predoctoral trainees/fellows who received ≥9 months of NIH support through Graduate Training Program (T01); Combined Undergraduate & Graduate Training Program (T03); Medical Scientist Training Program/Institutional NRSA (T05/T32); Predoctoral Individual Fellowship [F01] (phased out mid-1970s)	PhD completion and time-to-degree, postdoctoral training, employment in research or academia, NIH grant submissions and awards, research productivity (publications, citations), and time devoted to research & development activities.	NIH predoctoral fellows and trainees were more likely than their peers to complete PhDs (over two‑thirds vs. <50% overall), pursue postdoctoral training, apply for and receive NIH grants, obtain faculty roles at major research universities, engage in federally funded research, and publish more articles with higher citation rates. Regression models showed that NIH predoctoral support was independently associated with submitting more NIH grant applications, more published articles, more citations per article, and better (lower) NIH grant proposal priority scores (p < .01), even after controlling for years of experience and institutional prestige.
The Early Career Progress of NRSA Predoctoral Trainees and Fellows (Pion, 2001, National Institutes of Health & Vanderbilt University) Enhancing Philanthropy’s Support of Biomedical Scientists: Proceedings of a Workshop on Evaluation (National Research Council, 2006)	1981–1992	F31 & T32 NRSA Predoctoral Fellows/Trainees (≥9 months support) in biomedical and behavioral sciences were compared with 1) PhDs from the same departments/institutions with NIH training grants who were not directly funded as NRSA fellows or trainees, and 2) PhDs from departments or institutions that did not receive any NIH training grants	Time-to-degree, postdoctoral training, tenure-track or tenured faculty appointment, employment at top-ranked research institutions, research-related career position (academic and nonacademic), NIH/NSF grant submission rate, NIH/NSF grant success rate, number of publications, number of citations	Group comparisons (nonregression) showed NRSA predoctoral recipients were significantly more likely (all p < .05 or better) to: -complete their PhD sooner biomedical: 6.5 years vs. 6.9 [same dept]], 7 [non-NIH] behavioral: 7.3 years vs. 8.2 [same dept], 8.0 [non-NIH] -pursue postdoctoral training biomedical: 78% vs. 60% [same dept], 48% [non-NIH] behavioral: 37% vs. 26% [same dept], 19% [non-NIH] -apply for research grants biomedical: 46% vs. 35% [same dept], 26% [non-NIH] behavioral: 36% vs. 22% [same dept], 15% [non-NIH] -publish more peer-reviewed articles biomedical: 13 vs. 9 [same dept], 10 [non-NIH] behavioral: 6 vs. 4 [same dept], 3 [non-NIH] -receive more citations biomedical: 29 vs. 25 [same dept], 19 [non-NIH] -work in a research career position biomedical: 87% vs. 77% [same dept], 72% [non-NIH] behavioral: 57% vs. 54% [same dept], 49% [non-NIH] -be employed at top-ranked research institutions biomedical: 41% vs. 30% [same dept], 27% [non-NIH] behavioral: 23% vs. 14% [same dept], 10% [non-NIH] -hold tenure‑line academic positions biomedical: 39% vs. 29% [same dept], 32% [non-NIH] behavioral: 48% vs. 40% [same dept], 34% [non-NIH] Small but statistically significant independent regression effects were observed for shorter time to PhD completion (biomedical & behavioral; p < .001); greater likelihood of pursuing postdoctoral training (biomedical only; p < .001); higher NIH/NSF research future grant success (biomedical only; p < .01); greater likelihood of grant submission (behavioral vs. non-NIH only; p < .01)
Assessment of NIH Minority Research and Training Programs Phase 3 (National Academies Press, 2005)	1970–1999	F31 Minority Access to Research Careers predoctoral fellows	PhD completion, transition to postdocs or faculty roles, research productivity (e.g., publications), subsequent NIH grant submissions/awards	63% completed PhDs (mean time to degree: 7.3 years PhD; 7.7 years MD/PhD); 63% pursued postdocs; 17% applied for NIH grants (67% success rate); similar research output to other NIH trainees and fellows; majority employed in academia; increase in industry placements over time (up to 25% by 1991–93 cohort). Interviews with recipients revealed the fellowship was instrumental to their success in graduate school and beyond, allowing them to focus on research and dissertation completion without outside distractions. Most reported that their expectations were met and believed the award improved their chances of securing postdoctoral training, research or faculty positions, and future grants. Respondents who were F31 fellows and T32 trainees were especially likely to report that the program shaped their research careers. More than half were employed at U.S. universities, community colleges, or medical schools, and about half reported receiving one or more research grants after graduation.
Predoctoral MD-PhD grants as indicators of future NIH funding success (Ghosh-Choudhary et al., 2022, JCI Insight)	1990–2012	MD-PhD students who received F30 awards	Proportion of F30 awardees who received K awards, proportion of F30 awardees who received R awards, time from F30 to K award, Time from F30 to R award, K-to-R conversion rates, gender differences	F30 awardees had low overall rates of NIH K (15.7%) and R (18.5%) funding. K award receipt did not differ by gender, nor did time to K award. Men were significantly more likely to receive R funding than women (24.0% vs. 9.3%, p = .0001) and did so more quickly (13.6 vs. 14.9 years, p = .001). Among those who received K awards, men had a higher K-to-R conversion rate (56% vs. 29%; no p-value reported). A subanalysis showed F31 recipients had lower rates of K award attainment compared with F30 recipients, but a higher proportion of R award receipt overall.
F31 Diversity Fellowship Program Evaluation (Moore, 2019, National Institute of General Medical Sciences [NIGMS])	1991–2017	F31 Diversity Fellows, F31 Applicants, and T32 URM Trainees (NIGMS)	Impact of diversity fellowships on PhD completion, obtaining a postdoc, NIH grant outcomes, long-term career paths	F31 Fellows had significantly higher PhD completion than F31 applicants (74.5% vs. 49.7%, p < .001); higher 2014 earnings than F31 Applicants ($134K vs. $91K, p = .002) and T32 Trainees ($131K vs. $109K, p = .006); higher likelihood of securing an F32 postdoc (significance observed only in the last 3 cohorts: 8.3% vs. 2.6% for F31 applicants, p = .031; 8.1% vs. 4.8% for T32 Trainees, p = .037); slightly longer PhD duration than T32s (p < .001). No significant differences in NIH funding or research employment.
Time to Degree, Identity, and Grant Writing: Lessons Learned From a Mixed-Methods Longitudinal Case Study of Biosciences PhD Students (Alvero et al., 2024, Sage Open)	2008–2009 2018–2019 2022 (interviews)	Stanford biosciences PhD students	Time to degree, grant award status (i.e., NSF Graduate Research Fellowships, Ford Predoctoral Fellowships, and other grants recorded in Stanford’s Electronic Research Administration system), and students’ qualitative experiences with grant application processes, including advisor support & identity-related barriers	Underrepresented racial minority (URM) students with awards graduated significantly faster than URM students without awards (mean difference=0.74 years; p < .001), and also faster than non-URM students who won awards (p < .001); URM women grant winners graduated in an average of 5.15 years compared with 6.00 years for URM women who did not win awards (p < .001). Survey data revealed students with supportive advisors were more likely to apply for external funding (92%) vs. those without (40%); 100% of URM women reported gaps in mentorship compared with 14% of the rest of the sample who reported limited support. Qualitative findings suggested that those with accessible mentors/PIs who offered iterative feedback, structured guidance, and encouragement throughout the grant writing process described feeling more confident and motivated to pursue external funding opportunities. In contrast, those without this support, particularly URM women, often described not knowing where to start or having “psyched themselves out” of applying, citing feelings of isolation, intimidation, and lack of proactive mentorship.
Research productivity and training support for doctoral students in the biological and biomedical sciences (Schaller, 2023, FASEB BioAdvances)	2001 – 2021	All F31 awardees in the biological and biomedical sciences	Publication productivity (first-author and total publications), citation impact, and subsequent NIH funding awards (F32, K99, R15, R21, R01)	F31 awardees published more first-author papers (2.37 vs. 2.03; p < .0001) and more total publications (4.83 vs. 3.84; p < .0001) than their non-F31 peers; had higher citation counts for first-author papers (27.2 vs. 21.1; p < .0001); published earlier than peers (−1.56 years vs. −1.13 years relative to dissertation; p < .0001); about 9%–10% of F31 awardees received F32s; 6–7% secured R01s; 4% to 5% were awarded an R21; 2–3% received K99s; F31 awardees often stayed in the same type of institution for their R01.
Perspectives of an NCI T32 Training Program Designed to Train a Diverse Workforce in Cancer Health Equity Research (Ferguson et al., 2025, Journal of Cancer Education)	2013–2023	Predoctoral and postdoctoral fellows from the University of Illinois Chicago T32 Cancer Health Equity and Career Development Program	Predoctoral/Postdoctoral Fellow Outcomes (training status, post-training placement, grants submitted/awarded, underrepresented minority fellows, total publications)	32 fellows were trained (16 predoctoral, 16 postdoctoral) with high academic placement rates in postdoctoral, assistant professor or equivalent positions (87.5% and 68.75% respectively), strong grant submission and award success (e.g., 50% for F31s, 77% for K99s), and substantial scholarly output (405 publications, including 24% first-authored). Over 50% of both predoctoral and postdoctoral fellows were from underrepresented minority backgrounds.

This growing body of quantitative evidence (Ghosh-Choudhary et al., 2022; Schaller, 2023) is complemented by qualitative research with program administrators at academic institutions and fellows (Alvero et al., 2024; National Academies Press, 2005). In one study, fellows described that their fellowship provided them with protected time to focus on their research, shaped their confidence, motivated them to apply for future grants, and fomented their long-term research careers (National Academies Press, 2005). Collectively, these prior evaluations reinforce the impact of predoctoral fellowships in supporting economic mobility, diversifying and transforming the US biomedical and behavioral workforce, supporting trajectories from early-stage trainees to scientific leaders, and creating scientific contributions in the short and long-term.

Worsened Student Well-Being

Policy volatility (Mora, 2025) and the misclassification (Oza, 2025) of grants that has led to predoctoral fellowship terminations also shapes student well-being (Basilio, 2025; Mastej et al., 2025). Underrepresented students have expressed uncertainty and feeling demoralized during review of their applications (e.g., pulled from study section, applications withdrawn by NIH), while others with active grants reported being abruptly terminated mid-year, rather than being allowed a phase out period (Lutz, 2025). Even among those now possibly reinstated, trainees report lost time that cannot be replaced due to degree timelines, paused work, and some awards are still caught in administrative delays, which prolong uncertainty and continue to come at a psychological and reputational cost for students (Feldscher, 2025). Underrepresented scholars describe feeling punished for choosing the F31-Diversity mechanism (rather than the general F31) and exposing their identities or equity-focused work (Lutz, 2025; Russo, 2025). What was designed to be a lifeline for predoctoral students who historically have not had a seat at the research table became a mechanism that made students vulnerable to termination. Beyond the harm of systematic defunding of student work, talented scholars—many of whom may have been role models or mentors—are increasingly leaving the United States to continue their research overseas, representing a “brain drain” from a country known for scientific innovation and leadership (Offord, 2025). Students who remain face difficult choices: leave for other industries where stability may be possible (Mastej et al., 2025), stay in academia with continued fear of funding losses, or “pivoting” to new areas of research that may not fully reflect trainees’ research agendas and be experienced as erasure of personal identity when one’s research program is inconsistent with their own identity (Brain Research Institute, 2025; Nuwer, 2025; Russo, 2025). None of these choices are just, and all of them come with a mental health cost.

Scientific Losses for Public Health in the United States

Recent findings show that terminations have disproportionately impacted the careers of underrepresented minority researchers (Fielding-Miller et al., 2025). Students whose work centers racial/ethnic, immigrant, and sexual and gender minority communities bring unique strengths to public health research, including lived experience, bilingual and bicultural skills, and the ability to build trust that ensures findings translate into action (Nuwer, 2025; Zubizarreta & Beccia, 2026). These strengths are assets that expand the impact of HIV, mental health, and equity research that ultimately benefit the broader U.S. population. Thus, these grant terminations result in losses of scientific knowledge that negatively impact all Americans. Many of today’s public health advances first emerged from LGBTQ+ research and advocacy. For example, pre-exposure prophylaxis (PrEP), was pioneered through studies with gay and bisexual men (Grant et al., 2010) and is now recommended for any sexually active adult (U.S. Preventive Services Task Force, 2023). Inclusive school policies to prevent bullying began with protecting LGBTQ+ students but ultimately improved safety for the entire student populations (Russell et al., 2021). Mental health frameworks first designed to address sexual minority stress now guide approaches that address the distress experienced by autistic individuals, leading to more effective, neuroaffirming care (Botha & Frost, 2020). Disinvestment in health equity-focused science means less innovation, weaker science, and poorer health outcomes for everyone.

Policy Recommendations

From conversations with faculty across the country who have persevered across shifting funding priorities linked to political shifts over the past decades, I have reconnected to the HIV movement and its legacy of resilience in the face of political pushback. Building on that legacy and spirit, and informed by the emerging literature, I propose several recommendations to better protect predoctoral trainees moving forward. First, the NIH could strengthen the existing general F31 mechanism to ensure continuation of predoctoral training support. For example, the NIH could incorporate provisions modeled on federal procurement frameworks (General Services Administration, 2025) that establish standardized termination and closeout procedures (e.g., compensation mechanisms, settlement processes, and where appropriate, bridge funding) to manage future funding disruptions in a more predictable and consistent manner. Second, the NIH could systematically collect trainee impact statements as part of the termination/closeout reporting stage to document impact on well-being and career progression. Third, university departments are well positioned to provide trainees with legal counsel and access to advocacy networks that provide options for ligation as soon as funding disruptions occur. In my experience, I was not aware that I needed to be an American Public Health Association member (American Civil Liberties Union, 2025) to be included in their recent lawsuit. Membership comes with fees that impact already financially-strained students; universities could establish dedicated funds to help students pay for legal access costs. Fourth, university programs could provide trainees with guidance on applying to nongovernmental funding mechanisms and establish individualized grant-writing training, which has shown to increase funding success rates (Kulage et al., 2022), to develop competitive applications for foundation-based funding opportunities.

But additional training alone is not enough. What happens when students are detained by Immigration and Customs Enforcement, or experience housing instability because of abrupt funding cuts? In a precarious legal and political landscape, universities must also show up beyond financial aid, by safeguarding students’ physical safety and basic well-being, while recognizing that those engaged in community-based research are showing up for their communities, and simultaneously are shouldering immense emotional labor at a time when more support is needed but funding is shrinking.

Conclusion

This article combines a personal reflection with a historical perspective of the impact of F31 grants on science to illustrate how these disruptions affect trainees and the nation’s overall health and proposes policy safeguards. History shows that predoctoral fellowships are early turning points in training future leaders who make major scientific discoveries that benefit all; these fellowships are not just a temporary funding resource. Setting aside the scientific accomplishments directly attributable to F31 projects, the fact that these predoctoral fellowships retain talented scholars who go on to complete larger scale NIH-funded projects underscores the eventual public health impact of the F31 awards. My path, going from doctoral training, to obtaining federal funding is no different than the pathway of thousands of scholars shaped through these fellowships over generations. Looking back, we can noticeably see the transformative effects of early investment; looking ahead, we must ensure such pathways remain open for the sake of science, equity, and the next generation of those who dare to dream and discover.