Identifying Predictors of Successful Conversion from OREF Grants to Extramural Federal Funding Among Orthopaedic Surgeons

Abstract

Background: Musculoskeletal diseases are a major contributor to global human disability, but research in this area of medicine contends with chronic underfunding in the United States, receiving <2% of the National Institutes of Health (NIH) budget. The Orthopaedic Research and Education Foundation (OREF) serves as a vital nongovernmental organization, providing essential support for orthopaedic research. This study investigated the translation of various OREF grants into successful extramural federal funding discerning the clinician demographics and OREF award characteristics associated with increased chances of securing federal grants. Methods: We included OREF data from 1994 to 2020, and federal funding from the NIH, the U.S. Department of Defense (DoD), the National Science Foundation (NSF), and the Agency of Healthcare Research and Quality (AHRQ) was queried using publicly available databases: the NIH RePORTER, the DoD Defense Technical Information Center, the NSF search engine, and the AHRQ search engine. Clinician demographics and training were collected from the American Academy of Orthopaedic Surgeons roster and institution departmental websites. The successful translation of OREF grants into federal awards was assessed based on clinician gender, training, and specialty, as well as OREF grant mechanisms and characteristics; multivariable logistic regression was used to determine the likelihood of federal translation based on these predictor variables. Results: Three hundred and forty-eight OREF grants were awarded to 319 different clinicians, 23.5% of whom successfully translated their award into a federal grant. Notably, recipients of the OREF Career Development Grant (CDG) demonstrated a 48.4% translation rate to federal funding. The federal return on investment for all of the OREF grants averaged 503%, translating approximately $34 million in OREF awards into >$200 million in federal funding. Logistic regression revealed that recipients who received CDG funding, as well as orthopaedic oncologists, were more than 3 times as likely to secure federal funding than those who received grants with other mechanisms and those in other subspecialties. Conclusions: OREF fills a vital role in supporting budding orthopaedic research careers, ensuring the field’s competitiveness for federal awards on a national scale. The success rates, particularly for CDG recipients, highlight OREF’s effectiveness in identifying promising surgeon-scientists.