National institutes of health funding for surgical research

OBJECTIVE: The objective was to compare National Institutes of Health (NIH) funding rates and application success rates among surgeon and nonsurgeon-scientists over the past 2 decades. SUMMARY BACKGROUND DATA: Surgeons may be capable of accelerating the translation of basic research into new clinical therapies. Nevertheless, most surgeon-scientists believe they are at a disadvantage in competing for peer-reviewed funding, despite a recent emphasis on "translational science" by organizations such as the NIH. METHODS: We accessed databases from the NIH and the American Association of Medical Colleges. RESULTS: Although total competing NIH awards rose 79.2% from 5608 to 10,052, the much smaller number of surgical awards increased only by 41.4% from 157 to 222. There was a small but statistically significant difference between total NIH and surgical application success rates (29% vs. 25%, P < 0.01). However, the persistently low percent of NIH funding going to surgical investigators was due primarily to the very small number of surgical applications, and to a much smaller increase in the absolute number of applications over time (464 vs. 23,847). As a result, the number of grants per 100 faculty members was more than 4 times higher among nonsurgical than surgical faculties at US medical schools. CONCLUSION: NIH funding to academic surgeons is declining relative to their nonsurgical colleagues. This trend will likely be reversed only by an increase in the number of grant applications submitted by surgeon-scientists. Structural changes in surgical training programs, and in the economics of academic surgery, may support a greater contribution of surgeon-scientists to the success of translational research.     

Trends in research support and productivity in the changing environment of academic surgery

BACKGROUND: We hypothesized that the changing environment of academic surgery has resulted in a decrease in surgical research funding and basic surgical research productivity of academic departments of surgery. MATERIALS AND METHODS: Trends in National Institutes of Health (NIH) grants to Departments of Medicine and Surgery were analyzed from 1992 to 1999. To assess trends in research productivity, selected basic science journals were screened from 1988 to 1999 for the number of basic research publications where authors cited affiliation with a Department of Medicine or Surgery. RESULTS: NIH funding to Schools of Medicine increased 5.9% per year from 1992 to 1999. Funding to Departments of Medicine increased 21.1% per year, whereas funding to Surgery increased 3.1% per year. As a percentage of total funding to medical schools, NIH funding to Departments of Surgery declined slightly and funding to Departments of Medicine increased 1% per year. The number of grants awarded to Schools of Medicine and Departments of Surgery and Medicine remained constant from 1992 to 1999. The number of publications in basic science journals trended up for both Departments of Surgery and Departments of Medicine. As a percentage of departmental totals, Departments of Surgery publications increased by 9.5% yearly and Departments of Medicine increased 1.5% per year. CONCLUSION: Support for basic surgical research has been static. Despite static grant support, basic research productivity has increased for Departments of Surgery. Basic surgical research remains an integral part of academic surgery department activity.     

Little science, big science: strategies for research portfolio selection in academic surgery departments

OBJECTIVE: To evaluate National Institutes of Health (NIH) funding for academic surgery departments and to determine whether optimal portfolio strategies exist to maximize this funding. SUMMARY BACKGROUND DATA: The NIH budget is expected to be relatively stable in the foreseeable future, with a modest 0.7% increase from 2005 to 2006. Funding for basic and clinical science research in surgery is also not expected to increase. METHODS: NIH funding award data for US surgery departments from 2002 to 2004 was collected using publicly available data abstracted from the NIH Information for Management, Planning, Analysis, and Coordination (IMPAC) II database. Additional information was collected from the Computer Retrieval of Information on Scientific Projects (CRISP) database regarding research area (basic vs. clinical, animal vs. human, classification of clinical and basic sciences). The primary outcome measures were total NIH award amount, number of awards, and type of grant. Statistical analysis was based on binomial proportional tests and multiple linear regression models. RESULTS: The smallest total NIH funding award in 2004 to an individual surgery department was a single $26,970 grant, whereas the largest was more than $35 million comprising 68 grants. From 2002 to 2004, one department experienced a 336% increase (greatest increase) in funding, whereas another experienced a 73% decrease (greatest decrease). No statistically significant differences were found between departments with decreasing or increasing funding and the subspecialty of basic science or clinical research funded. Departments (n = 5) experiencing the most drastic decrease (total dollars) in funding had a significantly higher proportion of type K (P = 0.03) grants compared with departments (n = 5) with the largest increases in total funding; the latter group had a significantly increased proportion of type U grants (P = 0.01). A linear association between amount of decrease/increase was found with the average amount of funding per grant and per investigator (P < 0.01), suggesting that departments that increased their total funding relied on investigators with large amounts of funding per grant. CONCLUSIONS: Although incentives to junior investigators and clinicians with secondary participation in research are important, our findings suggest that the best strategy for increasing NIH funding for surgery departments is to invest in individuals with focused research commitments and established track records of garnering large and multiple research grants.     

Recent trends in National Institutes of Health funding for surgery: 2003 to 2013

Background

The purpose of this study is to compare the compositions of federally funded surgical research between 2003 and 2013, and to assess differences in funding trends between surgery and other medical specialties.

Data Sources

The National Institutes of Health (NIH) Research Portfolio Online Reporting Tool database was queried for grants within core surgical disciplines during 2003 and 2013. Funding was categorized by award type, methodology, and discipline. Application success rates for surgery and 5 nonsurgical departments were trended over time.

Conclusions

Inflation-adjusted NIH funding for surgical research decreased 19% from $270M in 2003 to $219M in 2013, with a shift from R-awards to U-awards. Proportional funding to outcomes research almost tripled, while translational research diminished. Nonsurgical departments have increased NIH application volume over the last 10 years; however, surgery’s application volume has been stagnant. To preserve surgery’s role in innovative research, new efforts are needed to incentivize an increase in application volume.     

The pediatric surgeon's road to research independence: utility of mentor-based National Institutes of Health grants

Background

The current research environment for academic surgeons demands that extramural funding be obtained. Financial support from the National Institutes of Health (NIH) is historically the gold standard for funding in the biomedical research community, with the R01 funding mechanism viewed as indicator of research independence. The NIH also supports a mentor-based career development mechanism (K-series awards) in order to support early-stage investigators. The goal of this study was to investigate the grants successfully awarded to pediatric surgeon-scientists and then determine the success of the K-series award recipients at achieving research independence.

Methods

In July 2012, all current members of the American Pediatric Surgery Association (APSA) were queried in the NIH database from 1988–2012 through the NIH Research Portfolio Online Reporting Tools. The following factors were analyzed: type of grant, institution, amount of funding, and funding institute or center.

Results

Among current APSA members, there have been 83 independent investigators receiving grants, representing 13% of the current APSA membership, with 171 independent grants funded through various mechanisms. Six percent currently have active NIH funding, with $7.2 million distributed in 2012. There have been 28 K-series grants awarded. Of the recipients of expired K08 awards, 39% recipients were subsequently awarded an R01 grant. A total of 63% of these K-awarded investigators transitioned to an independent NIH award mechanism.

Conclusions

Pediatric surgeon-scientists successfully compete for NIH funding. Our data suggest that although the K-series funding mechanism is not the only path to research independence, over half of the pediatric surgeons who receive a K-award are successful in the transition to independent investigator.     

How important is the contribution of surgical specialties to a medical school's NIH funding?

OBJECTIVE: To determine the relative contribution and importance of five surgical specialties (general surgery, urology, otolaryngology, neurosurgery, and orthopedics) to the total National Institutes of Health (NIH) funding at medical schools. METHODS: Publicly available NIH funding data from 1996 to 2004 were analyzed. RESULTS: From 1998 through 2003 the NIH budget increased from 11.2 billion to 21.9 billion dollars. Overall, NIH funding to departments of medicine was the greatest contributor to any individual medical school's total NIH funding, comprising 28.4% of total NIH awards on average, with a correlation coefficient highly predictive of medical school's ranking for NIH awards (cc = 0.93). Total NIH funding by different surgical specialties varied greatly, both within and between institutions. Together all of the surgical subspecialties combined accounted for 4.8% of medical school NIH awards on average from the years 1996 to 2004. Among the surgical specialties, general surgery received the largest fraction of NIH dollars followed by otolaryngology, neurosurgery, urology, and orthopedics. Although general surgery had the highest overall correlation coefficient of the surgical departments during the early years of the study period (r = 0.71 in 1996), its correlation significantly decreased during the period of study (as low as r = 0.54 in 2002). CONCLUSIONS: Surgical departments as an aggregate have continued to receive a stable overall fraction of NIH awards. The total funding to the different surgical departments varies considerably between institutions and does not correlate well with total institutional funding. The downward trend in the correlation of general surgery funding to total institutional funding suggests a decline in support for surgical research in this specialty nationwide.     

Recent trends in the funding and utilization of NIH career development awards by surgical faculty

INTRODUCTION: Career development awards (K-awards) from the National Institutes of Health comprise the most significant mechanism of research funding for junior faculty. This study compared the funding success rates and utilization of these awards between faculty from surgical departments and those from nonsurgical departments. METHODS: Success rates for major career development awards were obtained from the National Institutes of Health and compared between departments of surgery and four other clinical departments during 1992 to 2002. The number of faculty associated with these departments was obtained from the American Association of Medical Colleges and used to compare K-award utilization between groups during 1998 to 2002. RESULTS: Success rates for award proposals designed for clinical scientists were consistently lower when originating from departments of surgery compared with other clinical departments (combined K08, K23, and K24 pool: Surgery 41.3%; range of nonsurgery 46.7-57.5%, P = .009 vs nonsurgical group). Nonsurgeons were 2.5 times (range 2.0-7.8) more likely to apply for any type of career development award compared with surgeons (P < .01 for all awards). CONCLUSIONS: Surgeons are less likely to apply for career development awards, and those who do are less likely to be successful compared with their nonsurgical peers. Innovative strategies are needed to increase the number and success of career development proposals submitted by surgical faculty.     

Long-term outcomes of performing a postdoctoral research fellowship during general surgery residency

OBJECTIVE: To determine whether dedicated research time during surgical residency leads to funding following postgraduate training. SUMMARY BACKGROUND DATA: Unlike other medical specialties, a significant number of general surgery residents spend 1 to 3 years in dedicated laboratory research during their training. The impact this has on obtaining peer reviewed research funding after residency is unknown. METHODS: Survey of all graduates of an academic general surgery resident program from 1990 to 2005 (n = 105). RESULTS: Seventy-five (71%) of survey recipients responded, of which 66 performed protected research during residency. Fifty-one currently perform research (mean effort, 26%; range, 2%-75%). Twenty-three respondents who performed research during residency (35%) subsequently received independent faculty funding. Thirteen respondents (20%) obtained NIH grants following residency training. The number of papers authored during resident research was associated with obtaining subsequent faculty grant support (9.3 vs. 5.2, P = 0.02). Faculty funding was associated with obtaining independent research support during residency (42% vs. 17%, P = 0.04). NIH-funded respondents spent more combined years in research before and during residency (3.7 vs. 2.8, P = 0.02). Academic surgeons rated research fellowships more relevant to their current job than private practitioners (4.3 vs. 3.4 by Likert scale, P < 0.05). Both groups considered research a worthwhile use of their time during residency (4.5 vs. 4.1, P = not significant). CONCLUSIONS: A large number of surgical trainees who perform a research fellowship in the middle of residency subsequently become funded investigators in this single-center survey. The likelihood of obtaining funding after residency is related to productivity and obtaining grant support during residency as well as cumulative years of research prior to obtaining a faculty position.     

Young Transplant Surgeons and NIH Funding

Transplant surgeons have historically been instrumental in advancing the science of transplantation. However, research in the current environment inevitably requires external funding, and the classic career development pathway for a junior investigator is the NIH K award. We matched transplant surgeons who completed fellowships between 1998 and 2004 with the NIH funding database, and also queried them regarding research effort and attitudes. Of 373 surgeons who completed a fellowship, only 6 (1.8%) received a K award; of these, 3 subsequently obtained R‐level funding. An additional 5 individuals received an R‐level grant within their first 5 years as faculty without a K award, 3 of whom had received a prior ASTS‐sponsored award. Survey respondents reported extensive research experience during their training (78.8% spent median 24 months), a high proportion of graduate research degrees (36%), and a strong desire for more research time (78%). However, they reported clinical burdens and lack of mentorship as their primary perceived barriers to successful research careers. The very low rate of NIH funding for young transplant surgeons, combined with survey results that indicate their desire to participate in research, suggest institutional barriers to access that may warrant attention by the ASTS and the transplant surgery community.     

Surgical work output: is there room for increase? An analysis of surgical work effort from 1999 to 2003

OBJECTIVE: To analyze physician work production over a 5-year period to discover trends in productivity. SUMMARY BACKGROUND DATA: Surgical workforce calculations over the past 25 years have projected major oversupply as well as looming shortages. Recent studies indicate that demand for surgical services will increase over the next two decades as the population ages and develops age related chronic diseases. This study examines actual physician productivity to determine whether there is capacity for increased work output in response to projected increases in demand. METHODS: Physician productivity data as measured by relative value units were obtained from the Medical Group Management Association Physician Compensation Reports for a 5-year period. Surgeons were compared with nonsurgeons and across subspecialties. RESULTS: Surgeon and nonsurgeon productivity in terms of relative value units remained relatively stable over the study period; surgical:nonsurgical productivity per provider was 1.30-1.46:1. CONCLUSIONS: Surgeons produce a significant amount of the total work in multi-specialty medical groups. These results may indicate that the surgical and general surgical workforce has reached a plateau with respect to clinical productivity. Predicted increases in demand for procedure-based work to care for the aging population are likely to be difficult to meet with the available workforce.     

Pediatric surgical workload during the past decade: impact on clinical activity and hospital finance at a children's hospital

PURPOSE: The authors hypothesized that there are significant differences in clinical effort among the faculty of the various departments at an academic Children's Hospital, and that the clinical workload of surgeons has increased over the past decade. METHODS: A retrospective analysis of clinical practice and financial performance of the five departments (anesthesiology/critical care medicine, pathology, pediatrics, radiology, and surgery) at the Children's Hospital of Philadelphia from 1987 to 1997 was performed including clinical activity parameters (admissions, discharges, clinic visits), departmental faculty rosters, number of operations for the department of surgery as a whole and for individual surgeons in each pediatric surgical specialty, and professional and hospital financial data. RESULTS: Pediatric surgical specialists represented 15% of the total full-time physicians throughout the decade. In 1997, surgeons were responsible for 29% of hospital admissions, 28% of total outpatient visits at all clinical care sites, 37% of total professional fee revenue, 39% of hospital-based revenue, and a substantial portion of the hospital margin. Compared with 1987, the department of surgery in 1997 had a 60% increase in outpatient visits and a 58% increase in total operative case load (10,265 to 16,266). In terms of individual surgeon's workload during the decade, the outpatient visits per surgeon increased 45% and the operations per surgeon increased 27%, yet total reimbursement per surgeon slipped 16%. CONCLUSIONS: For the Children's Hospital that was studied, pediatric surgical specialists are doing more clinical work compared with 10 years ago, which may impact teaching, research, and administrative responsibilities. Surgeons have a greater responsibility than nonsurgeons for the hospital's clinical activity and financial health.     

Research and research funding in vascular surgery

The presentation summarized the current status of funding available for vascular surgeons. In spite of the shrinking support for research by the federal government, there are opportunities for young investigators to pursue an academic career. Success of a grant application depends on preparation, design, and hypothesis. Potential applicants are encouraged to pay special attention to the many publications on how to prepare a research grant. Although there is an increase in participation by vascular surgeons in NIH-supported research, the funding support and focus on vascular surgery remains unsatisfactory. Despite the high ranking of death from aortic aneurysm, there is virtually no funded project on aortic aneurysm in either basic or clinical study. New technology such as laser has received some support, but clinical trial comparing this modality with standard treatment is lacking and not forthcoming. The participation by vascular surgeons in the American Heart Association-funded research activities remains unknown, even though the American Heart Association claims to have spent millions on research in heart and vascular diseases. To promote the study of and research in vascular disease, the members of this distinguished Society need to guide young vascular surgeons to submit grant proposals to various organizations.     

Canadian Network for International Surgery: development activities and strategies.

The Canadian Network for International Surgery (CNIS) is a surgical development and research organization, whose objective is to reduce death and disability from surgical disorders in low income countries. The organization has 4 main activities: (1) the Essential Surgical Skills (ESS) program teaches surgery to general practitioners and is predicated on the assumption that there will not be enough surgeons in Africa in the foreseeable future and therefore nonsurgeons must do surgery; (2) the injury control program, which is predicated on the conclusion that the incidence of injury in Africa is unacceptably high, therefore injury prevention is an imperative surgical strategy; (3) the library project, which sends new and recent books and journals to the surgical libraries of our African partners; and (4) the members' projects, which encourage individual or organization members to use their own creativity in meeting CNIS objectives. The CNIS has direct activity in 4 African countries and presents its project check list as a means to help others succeed. Canadian surgical and allied specialists can help in the reduction of needless suffering by supporting the CNIS.     

Research at US colleges of osteopathic medicine: a decade of growth

Although research is a critical component of academic medicine, it has not been a significant component of osteopathic medicine. For years, leaders in the osteopathic medical profession have called for increased research in osteopathic medical schools. The need for cost-effective clinical practice leading to improved clinical outcomes creates a necessity for conducting well-designed clinical outcomes research related to osteopathic practice. The authors assess the growth in research at osteopathic academic medical centers from 1989-1999. The amounts of extramural funding at each school, sources of funding, types of research funded, departments funded, and investigators' degree types are also assessed. During the 10 years analyzed, total research funding increased 37%. Twenty-five percent of the grants and 55% of the funding to colleges of osteopathic medicine were from the National Institutes of Health. Most (63%) grants were awarded to PhD faculty. Most research was conducted in the basic biomedical sciences. Clinical research related to osteopathic practices appears to be a relatively minor component of research at osteopathic medical centers.     

Research funding at colleges of osteopathic medicine: 15 years of growth

CONTEXT: Colleges of osteopathic medicine (COMs) trying to stimulate research and develop research infrastructures must overcome the challenge of obtaining adequate funding to support growing research interests. The authors examine changes in research funding at COMs during the past 15 years. OBJECTIVES: To track 1999-2004 data on COM research funding, COM faculty size, educational backgrounds of principal investigators receiving funding, and funding institutions. To compare these data with published results from 1989 to 1999. METHODS: Data on number of grants, funding amounts by extramural source, percent of total dollars by extramural source, percent of total dollars by COM, and total amount of extramural funding were obtained from the American Association of Colleges of Osteopathic Medicine databases. Data on the Osteopathic Research Center (ORC) were obtained from the ORC's databases. Results: Research, both in terms of number of grants and funding amounts within the osteopathic medical profession, increased substantially from 1999 to 2004. The largest single source of funding remained the National Institutes of Health. The number of COMs whose research funding exceeded $1 million annually more than doubled, increasing from 5 in 1999 to 12 in 2004. The osteopathic medical profession's decision to direct research dollars into a national research center devoted to research specific to osteopathic manipulative medicine resulted in an almost eightfold return on initial investment in 4 years. CONCLUSIONS: The amount of research productivity at a COM may be aligned with the size of the COM's full-time faculty, suggesting that once "critical mass" for teaching, service, and administration are achieved, a productive research program can be realized. Expanding the evidence base for those aspects of medicine unique to the osteopathic medical profession is dependent on the future growth of research.     

Productivity outcomes for recent grants and fellowships awarded by the American Osteopathic Association Bureau of Research

The objective of the present study was to evaluate productivity outcome measures for recent research grants and fellowships awarded through the American Osteopathic Association (AOA) Bureau of Research. Recipients of grants and fellowships that were awarded between 1995 and 2001 were contacted by mail, e-mail, or telephone and asked to provide information about publications, resulting grant awards, advances in clinical care, or other notable products that were generated from their projects. For grants funded between 1995 and 1998, 76% of principal investigators reported a notable product from their study. By contrast, for grants funded between 1999 and 2001, only 31% reported a notable outcome. This difference most likely can be attributed to the lag time between the awarding of a grant and actual completion of the project, the processing of the data, and the publication of the results. Several recipients of 1999-2001 grants were optimistic about eventually generating a notable product. Most (79%) of the 1995-2001 fellows met the requirements for successful completion of their project. Many fellows exceeded the minimal requirement by publishing their results, continuing research activity, attracting extramural grant monies, or entering an academic position. It appeared that a much larger proportion of osteopathic fellows went on to academic careers than their counterparts who did not have fellowship training. From 1995 to 2001, the AOA Bureau of Research awarded dollars 3,072,140 in research grants and fellowships. To date, these awards have helped the recipients bring an additional dollars 5,659,329 of extramural funds for research at osteopathic institutions. The Bureau of Research grant and fellowship programs have been successful both scientifically and in terms of financial outcomes.     

The Society of Black Academic Surgeons CV benchmarking initiative: Early career trends of academic surgical leaders

BackgroundSurgeons from under-represented backgrounds are less likely to receive academic tenure and obtain leadership positions. Our objective was to query the curriculum vitaes (CVs) of SBAS leadership to develop a benchmarking tool to promote and guide careers in academic surgery.MethodsCVs from academic leaders were reviewed for academic productivity at early career stages—the first 5-and 10-years. Variables queried: peer-reviewed publications, grant funding, surgical societal involvement, invited lectureships and visiting professorships.ResultsOf 20 CVs, 41 leadership positions including 13 SBAS Presidents were identified. At 5- and 10-years, respectively, the academic productivity increased: 20.6 and 52.3 publications; 4.7 and 9.7 grants; 18 and 42.6 lectures/professorships.ConclusionThe CV benchmarking tool may be a useful framework for aspiring academic surgeons to track their progress relative to successful SBAS members. Creative strategies like these, paired with faculty mentorship and sponsorship are necessary to improve the ethnic diversity in academic surgery.     

The role of chairman and research director in influencing scholarly productivity and research funding in academic orthopaedic surgery

The purpose of this study was to determine what orthopaedic surgery department leadership characteristics are most closely correlated with securing NIH funding and increasing scholarly productivity. Scopus database was used to identify number of publications/h‐index for 4,328 faculty, department chairs (DC), and research directors (RD), listed on departmental websites from 138 academic orthopaedic departments in the United States. NIH funding data was obtained for the 2013 fiscal year. While all programs had a DC, only 46% had a RD. Of $54,925,833 in NIH funding allocated to orthopaedic surgery faculty in 2013, 3% of faculty and 31% of departments were funded. 16% of funded institutions had a funded DC whereas 65% had a funded RD. Department productivity and funding were highly correlated to leadership productivity and funding(p< 0.05). Mean funding was $1,700,000 for departments with a NIH‐funded RD, $104,000 for departments with an unfunded RD, and $72,000 for departments with no RD. These findings suggest that orthopaedic department academic success is directly associated with scholarly productivity and funding of both DC and RD. The findings further highlight the correlation between a funded RD and a well‐funded department. This does not hold for an unfunded RD. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 33:1407–1411, 2015.