Rates of National Institutes of Health Funding for Surgeon-Scientists, 1995-2020

Abstract

ImportanceSurgeon-scientists are uniquely positioned to facilitate translation between the laboratory and clinical settings to drive innovation in patient care. However, surgeon-scientists face many challenges in pursuing research, such as increasing clinical demands that affect their competitiveness to apply for National Institutes of Health (NIH) funding compared with other scientists.ObjectiveTo examine how NIH funding has been awarded to surgeon-scientists over time.Design, Setting, and ParticipantsThis cross-sectional study used publicly available data from the NIH RePORTER (Research Portfolio Online Reporting Tools Expenditures and Results) database for research project grants awarded to departments of surgery between 1995 and 2020. Surgeon-scientists were defined as NIH-funded faculty holding an MD or MD-PhD degree with board certification in surgery; PhD scientists were NIH-funded faculty holding a PhD degree. Statistical analysis was performed from April 1 to August 31, 2022.Main OutcomeNational Institutes of Health funding to surgeon-scientists compared with PhD scientists, as well as NIH funding to surgeon-scientists across surgical subspecialties.ResultsBetween 1995 and 2020, the number of NIH-funded investigators in surgical departments increased 1.9-fold from 968 to 1874 investigators, corresponding to a 4.0-fold increase in total funding (1995, $214 million; 2020, $861 million). Although the total amount of NIH funding to both surgeon-scientists and PhD scientists increased, the funding gap between surgeon-scientists and PhD scientists increased 2.8-fold from a $73 million difference in 1995 to a $208 million difference in 2020, favoring PhD scientists. National Institutes of Health funding to female surgeon-scientists increased significantly at a rate of 0.53% (95% CI, 0.48%-0.57%) per year from 4.8% of grants awarded to female surgeon-scientists in 1995 to 18.8% in 2020 (P < .001). However, substantial disparity remained, with female surgeon-scientists receiving less than 20% of NIH grants and funding dollars in 2020. In addition, although there was increased NIH funding to neurosurgeons and otolaryngologists, funding to urologists decreased significantly from 14.9% of all grants in 1995 to 7.5% in 2020 (annual percent change, −0.39% [95% CI, −0.47% to −0.30%]; P < .001). Despite surgical diseases making up 30% of the global disease burden, representation of surgeon-scientists among NIH investigators remains less than 2%.Conclusion and RelevanceThis study suggests that research performed by surgeon-scientists continues to be underrepresented in the NIH funding portfolio, highlighting a fundamental need to support and fund more surgeon-scientists.

Increasing Funding for Surgeon-Scientists—Lowering the Bar Is Not the Answer

“…However, Nguyen et al also make recommendations that attempt to “lower the bar” for surgeons, which we do not agree with. These recommendations may have adverse effects on the perception of surgeon-scientists by other scientists.…”

“…In this issue of JAMA Surgery , Nguyen et al conducted a rigorous evaluation of National Institutes of Health (NIH) funding among surgical departments. They found that, from 1995 to 2000, the number of primary investigators in surgery departments increased 1.9-fold (from 968 to 1874), corresponding to an increase in the number of funding dollars by approximately 4.0-fold (from $214 million to $861 million).…”

“…The authors make several recommendations that we fully support . First, they advise that department leadership should consider lowering clinical demands on surgeon-scientists to allow for scientific growth.…”

A Comprehensive Analysis of Academic Attributes of the Presidents of the North American Skull Base Society

“…Indeed, many other surgical specialties report low NIH funding. 16 Despite the utility of clinical research, however, efforts should be taken to conduct more nonclinical translational and basic science research as the skull base field, and academic medicine as a whole, is moving toward a more biomechanistic-focused approach to treatment.…”