$10M/ year seems unusually high, even for med schools - are you sure those are annualized costs? Perhaps it's because I'm familiar with the more basic science (non clinical trial) parts of NIH, but a typical R01 is $250K-$500K/ year in direct costs so that would imply having to hold ~15 of them (with overheard) to reach $10M/year.

It seems like $10M in total value of active grants in a given year (~5 R01s) might be more typical (though the standard for tenure I've heard of in med schools is maybe ~2-3 R01s, so 5 would make you top tier and highly sought after).

For clarity, when I'm referring to $1M/year in annual funding, that's coming from ~6-7 active grants whose total value might be in the $5M range total.