Abstract
Background & Purpose
Neurovascular research is underfunded, imposing substantial challenges on clinical researchers in the field of neurovascular diseases. We explored what physicians perceive to be the greatest challenges with regard to neurovascular research funding, and how they think the funding crisis in neurovascular research could be overcome.
Methods
We performed an international, multi-disciplinary survey among physicians involved in the medical care of patients with neurovascular diseases. After providing their demographic data, physicians were asked closed-ended questions on their personal opinion regarding challenges in neurovascular research funding, and how these challenges could be overcome. Physicians also described in their own words what they perceived to be the biggest challenges in obtaining funding. Data were analyzed using descriptive statistics and response clustering.
Results
Of 233 participating physicians (70.4% male,82.8% senior staff) from 48 countries, 217(97.4%) perceived the discrepancy between required and available funding to be a problem;172(73.8%) considered it a major problem. High competitiveness (61/118 available free text responses[51.7%]), time-consuming application processes (28/118[23.7%]) and administrative requirements (25/118[21.1%]) were identified as key obstacles. Traditional big funding agencies were perceived to be most capable of closing the neurovascular research funding gap, followed by specialty-specific organizations and industry, while philanthropy and crowdfunding were perceived to be less important.
Conclusion
The gap between required and available funding was perceived to be a major problem in neurovascular research, with high competitiveness, time-consuming funding processes and excessive administrative requirements being the key obstacles to obtaining funding. Traditional funding agencies were perceived to be most capable of closing this funding gap.
Keywords: Neurovascular research, research funding, clinician-scientist
Introduction
Neurovascular diseases are the second leading cause of death in the United States and the 4th leading cause of disability worldwide. 1 As such, their burden and impact is massive. 2 Conversely, the amount of funding available for research on neurovascular diseases is relatively low, comprising only a fraction of the money that is spent on research for cardiac diseases or cancer. 3 This discrepancy does not only apply to large established public funding agencies such as the National Institutes of Health (NIH), 4 but it persists even when it comes to industry funding, smaller private foundations and charitable organizations. 3 Moreover, the overall amount of funding from traditional agencies has begun to plateau, so that the demand for research funding in general is now by far exceeding NIH capacities. 5 At the same time, clinical researchers are facing increasing pressure from their academic institutions to raise funding – in many institutions, having received at least one major grant is even required to qualify for tenure and promotion – forcing them to commit a lot of time to grant applications over and beyond their busy clinical schedules. 6 As a consequence, clinical research is becoming disincentivized, which has already led to a decrease in the number of clinical researchers. 7 Unless these developments are at least partially reversed, they may result in a sudden collapse of the physician-scientist workforce once the older generation of researchers retires. 8 Neurovascular diseases, despite their prevalence, are no exception – if anything, the problem is aggravated due to the severe underfunding of neurovascular research compared to other medical research domains. 3
We conducted an international, web-based survey to explore the perception of this funding gap within the neurovascular physician community. We aimed to determine what physicians perceived to be the biggest challenges with regard to the neurovascular research funding landscape, and what they thought would be possible solutions to overcome these problems.
Methods
An international, web-based, anonymous survey was conducted to explore perceptions and thoughts on challenges and opportunities in neurovascular research funding among a broad, international audience of physicians who treat patients with neurovascular diseases in their daily practice. Approximately 600 physicians of various neurovascular specialties were invited to participate in the survey. An online survey tool (Qualtrics.com), was used for survey distribution, data collection, encryption and secure data storage. Access to the survey data was password-protected and granted to the study investigators only. Incomplete survey entries were excluded to avoid duplicate responses and incomplete data. Study raw data will be made available upon reasonable request to the corresponding author.
Survey design
The survey was divided into three parts: in part 1, physicians provided their demographic data, e.g., country of practice, age range, research experience and career stage. Part 2 consisted of closed-ended questions and focused on physicians’ interest in neurovascular research, the challenges they encountered in the process, and possible solutions to overcome these challenges using pre-specified answer options. Answer options in part 1 were either binary (yes/no), ranking questions (i.e. physicians had to rank response items in their order of importance) or Likert-scale type questions (i.e. physicians had to rate each answer option on a scale, for example from 0, indicating that this response item is not important at all, to 5, indicating that this particular response item is very important). Answering parts 1 and 2 of the survey was mandatory; physicians with incomplete responses in those two parts were excluded from the analysis. Part 3 was optional and consisted of open questions with free text responses. In this section, physicians were able to express in a few sentences what they personally perceive to be the biggest challenges related to funding of neurovascular research. A detailed list of the survey questions is provided in the Supplementary Material.
Survey participants
Physicians involved in the medical care of patients with neurovascular diseases (neurologists, diagnostic and interventional neuroradiologists, neurosurgeons, and other physicians directly involved in neurovascular care) were invited to participate in the survey, without restrictions for personal caseload, hospital setting, geographical location, clinical and research experience, level of training or career stage.
Statistical analysis
Physicians’ baseline characteristics and responses to closed-ended questions (survey parts 1 and 2) were summarized using descriptive statistics, appropriate to the type of data. Free text responses from part 3 were analyzed qualitatively and thematically clustered. This format was deliberately chosen in addition to the closed-ended question format of part 2 in order to provide physicians the opportunity to address additional funding-related challenges not explicitly mentioned in the response options of the closed-ended questions. Some responses in part 3 contained more than one thematically distinct message. In such cases, the response was divided, and the respective parts were assigned to the most appropriate clusters (see Table 1 for a complete overview of the clusters that were used to classify the free text responses). Data analysis was performed using Stata 16.1 (Stata LLC, Corp). Figures were created with Microsoft Excel, version 16.4.
Table 1.
Exemplary free text responses for each cluster.
| Cluster | Exemplary free text responses |
|---|---|
| Competitiveness | “competitiveness with multiple other worthy causes” |
| “competitive funding calls with other major diseases with higher success rate [for example cancer]” | |
| Time-consuming funding application processes | “the application procedure is long - for one project, I will have to rewrite the project description, the budget, and change formats to match a rigid frame of a different fund - this is awfully time-consuming – and annoying” |
| “time is another constraint. In a busy department, to take time out to deal with administration for funds is stressful” | |
| “it requires more and more time and effort spent in writing grants rather than actually planning and doing research” | |
| Administrative tasks | “major bureaucracy from the funding organization after having received the grant; limited expertise with clinical trials at the European Union [Horizon 2020], resulting in unrealistic expectations and requirements” |
| Biased funding processes | “established researchers unfairly advantaged as past success is rewarded in an exclusionary feed-forward cycle” |
| “unfair judges or biased committees, old school ties” | |
| Disadvantage of clinical researchers compared to basic scientists | “many competing applications from groups who have more time to spend on applications than working neurovascular clinicians” |
| Insufficient diversity and patient involvement | “need for more diversity of both the investigators and patients” |
| Lack of good research questions | “there may be lack of good research ideas” |
| Lack of mentorship in grant writing | “lack of preparation to write and apply for grants” |
| “having very little experience with research funds” | |
| Problems in obtaining funding for long-term projects | “need for commitment to follow the entire duration of a trial” |
| Unclarity about the profile of funding agencies | “I do not know exactly who can support my research in most of the cases” |
Results
Of the 600 physicians who received a survey invitation, 233 (38.8%) completed parts 1 and 2 of the survey and were included in the analysis. Part 3, which was not mandatory, was completed by 118 physicians (50.6%).
Respondents’ demographics & research experience
Of the 233 physicians who completed at least parts 1 and 2 of the survey, 70.4% were male, 27.9% female, and 1.7% were of undisclosed sex. Responses were collected from 48 countries. Most physicians were between 40 and 60 years of age (64.0%), in advanced career stages (82.8% senior staff) and worked at academic hospitals (83.3%), see Supplemental Table 1.
Quantitative response analysis on perceived challenges in funding neurovascular research
Among 233 physicians, 217 (97.4%) perceived the discrepancy between funding that is required to advance neurovascular research and the actual amount available to be a problem; 172 (73.8%) perceived it to be a major problem, while only 6/233 (2.6%) considered it to be no problem at all (Figure 1A). Based on physicians’ personal experiences, problems related to lack of financial resources, lack of funding opportunities and unsuccessful funding applications were of intermediate importance when participating in and leading multi-center studies or trying to do so without success (median scores from 1.1–1.8 on a scale from 0 [not important at all] to 3 [very important], Figure 1B to D).
Figure 1.
Perceived funding gap (A) and personal experience with difficulties in obtaining research funding (B–D). (A) Percentage of physicians perceiving the funding gap in neurovascular research as a major problem (red), minor problem (yellow) or no problem (green). (B) Lack of financial resources as a problem when participating in and leading multi-center studies (0 = not important at all, 3 = very important). (C) Lack of funding opportunities as a reason for failure to participate and failure to lead multi-center studies (0 = not important at all, 3 = very important). (D) Unsuccessful funding applications as a problem for failure to participate and failure to lead multi-center studies (0 = not important at all, 3 = very important). Mean scores with respective standard deviations (SD) are shown.
Qualitative response analysis on perceived challenges in funding neurovascular research
When clustering free text responses of participants to the question “What, in your own words, are the biggest challenges in funding neurovascular research?” (n = 118 responses), the majority of responses (61/118, 51.7%) referred to the cluster “competitiveness”, i.e., physicians felt that the degree of competition is simply too high. This was not only described to be a problem within the pool of neurovascular researchers, but also between disciplines, i.e., other medical specialties for which stronger lobbies exist
The second largest cluster (28/118 responses, 23.7%) was “time-consuming processes”, i.e., the fact that both the time needed to prepare a grant, and the time that elapses until the money is received, is too long. Administrative tasks and biased funding processes that put early career researchers at a disadvantage were the third (21.2%) and fourth (18.6%) most common clusters, respectively, followed by lack of mentorship in grant writing (6.8%) and systematic disadvantage of clinical researchers compared to basic scientists (5.9%). Other themes were mentioned in <5% of responses (Figure 2). Table 1 provides an overview of the clusters and corresponding exemplary free text responses.
Figure 2.
Tree chart showing the frequency of clusters as they occurred in participants’ free text responses to the question, “what, in your own words, are the biggest challenges in funding neurovascular research?”, (n = 118 responses). Responses were thematically clustered based on the topics they addressed. In case one response contained more than one thematically distinct message, the response was divided, and each part assigned to its respective cluster. Percentage of responses addressing a certain theme are represented by the size of the colored areas and are also shown in brackets below the cluster titles.
Perceived potential solutions for closing the funding Gap in neurovascular research
Participants were asked to rank the importance of different funding sources (traditional, big national funding agencies such as the NIH or the Canadian Institutes of Health Research [CIHR], specialty-specific funding organizations such as the American Heart Association and the American Stroke Association [AHA/ASA], industry, philanthropy and crowdfunding) with regard to the role they could play in closing the funding gap in neurovascular research. Ranking options ranged from 0 (not important at all) to 5 (very important). Traditional funding agencies received the highest mean score (3.4, SD 1.1), followed by specialty-specific organizations, industry, philanthropy, and crowdfunding, which ranked the lowest with a mean score of 0.6 (SD 0.9), Figure 3A. When using the concrete example of funding a collaborative research platform for rare neurovascular diseases and assuming an ideal scenario, physicians thought that traditional government funding agencies should play the most important role in funding such a platform (mean score 3.4 out of a maximum of 5.0, SD 1.0), followed by specialty-specific organizations, philanthropy, industry and crowdfunding, which ranked lowest (mean 0.6, SD 1.0). When asked the same question, but assuming a “real-world” scenario (i.e. taking into account the constraints of the current funding landscape in neurovascular research), the rank order of importance was preserved with the exception that funding from industry was perceived to be a slightly more important funding source (mean score 1.9, SD 1.2) than philanthropy (mean score 1.8, SD 1.1), Figure 3B.
Figure 3.
Perceived importance of the role of different funding sources in bridging the funding gap in neurovascular research in general (A) and when funding an exemplary project (collaborative research platform for rare neurovascular diseases) (B). (A) Participants were asked to rank the importance of different funding sources with regard to the role they can play in bridging the current funding gap in neurovascular research on a scale from 0 (not important at all) to 5 (very important). (B) Participants were then asked to rank the importance of different funding sources with regard to the role they could play in bridging the funding gap using the concrete example of a collaborative research platform for rare neurovascular diseases on a scale from 0 (not important at all) to 5 (very important). Participants hereby ranked the importance of the funding sources under assumed ideal conditions (i.e. “which funding sources should play the most important role in an ideal world?”, shown in light green on the right), and under current circumstances (i.e. “which funding can play an important role in a real-life scenario given the current funding landscape in neurovascular research?”, shown in dark green on the left). Mean scores with respective standard deviations (SD) are shown.
Discussion
In this survey-based study, the vast majority of physicians perceived the “funding gap”, i.e., the discrepancy between funds available and those required to conduct necessary research in the field of neurovascular sciences to be a problem. More than two thirds perceived it to be a major problem. Traditional government funding agencies, such as the NIH, were thought to be most capable of closing the funding gap, while alternative resources such as crowdfunding and philanthropy were thought to play only a minor role.
With regard to ongoing multi-center studies, lack of financial resources was perceived as a major obstacle. The lack of funding opportunities as well as the high rate of unsuccessful funding applications (when opportunities are available) were considered moderately important reasons for failing to participate in or lead multi-center studies. These results are in line with previous data from administrative sources, which clearly show an increasing discrepancy between the number of funding requests in medical research and the number of studies receiving funding. 6
For neurovascular diseases, this discrepancy is even more pronounced compared to other fields of medical research such as cancer or cardiovascular diseases, which have a stronger research lobby. 3
Physicians in this survey believed that traditional government funding agencies would be the most capable of closing this funding gap. However, the research funding capacity of NIH has declined by >20% in the past two decades and, despite federal attempts to increase the budget, this trend has not yet been successfully reversed.9,10 The increasing difficulty to obtain funding from NIH and similar agencies, together with the debt burden of medical school graduates, the greater time commitment and prolonged postdoctoral training that is required to become a successful clinical researcher compared to pursuing a purely clinical career, has resulted in a concerning decrease in the number of clinical researchers that has led to serious concern about the future of the physician-scientist community. 11 In the long run, the decreasing physician-scientist workforce may slow down scientific progress, and thereby ultimately negatively affect patient care. 11
As reflected by the participants’ responses, the severe shortage of funding disproportionately affects early career investigators (i.e. those without a “track record”), because established traditional funding agencies heavily rely on the number of their applicants’ publications, citations and previous successful funding applications as criteria for allocation of funding. This reinforces a feed-forward cycle that puts junior researchers that enter the field at a clear disadvantage.6,9
One potential solution to this dilemma could be to “change the medical research ecosystem” by taking advantage of private sector opportunities and incorporating currently untapped alternative funding sources, such as crowdfunding. 9 Although in this survey, crowdfunding was consistently considered to be the least important of all funding sources for neurovascular research compared to other funding sources, physicians’ free text responses highlighted the high competitiveness when applying for traditional funds and the slow funding processes with long waiting times and high administrative workloads; all of which could be overcome by leveraging philanthropy and crowdfunding sources. Indeed, crowdfunding has already found its way into other areas of medical research12–14: Projects such as PathoMap (whose goal it was to promote awareness of microorganisms on common surfaces), Genome Liberty (for personalized DNA sequencing), and BiRA (a literature search tool that links articles based on commonality) have been funded by crowdfunding platforms such as Indiegogo and Rockethub. 13 XPrize (www.xprize.org) is another innovative funding platform that hosts public competitions to solve a particular technological problem, and has funded research projects at the interface between medicine and technology, such as the $2.25 million Nokia Sensing XChallenge, which led to the development of a nanofluidic lab-on-a-chip system for fast and uncomplicated analysis of blood and other body fluids without the need for specialized lab equipment.
However, all of the aforementioned crowdfunding platforms have a rather broad profile and are not specifically tailored towards medical, let alone neurovascular, research. Thus, they may be largely unknown to medical researchers, which could be the reason why only few physicians thought of crowdfunding as a valid alternative funding option for neurovascular research. Furthermore, successful funding applications are often required for tenure and promotion, 6 and it is not clear whether academic institutions will consider crowdfunding equivalent to raised funds from traditional funding agencies. This may prevent physician-scientists from leveraging these alternative funding sources, thereby delaying the integration of crowdfunding into the medical research landscape. Clear policy statements from academic institutions with regard to crowdfunding are desirable and necessary to address this uncertainty.
In light of the stagnating capacities of traditional funding agencies, incorporating alternative funding concepts for neurovascular research, such as philanthropy and crowdfunding, may not only help to mitigate the disadvantage of early career researchers, but they may also be the only solution to sustaining neurovascular research progress in the long run. As such, we as a neurovascular research community should actively work towards incorporating these alternative funding concepts into our funding landscape. Important steps in this direction include raising awareness for crowdfunding platforms and philanthropy funding opportunities among physician-scientists and encourage them to apply for these funds. This could be achieved through, for example, dedicated sessions during professional meetings, especially those targeted at early career professionals, or establishing dedicated medical and neurovascular research crowdfunding platforms. Another important step towards incorporating crowdfunding and philanthropy into the funding landscape would be to raise stroke awareness among potential donors, for example through public outreach initiatives and advocacy work, in order to ensure a sufficient donor base.
Limitations
This study has limitations. First, physicians were invited to this survey based on institutional networks and collaborations, and some geographic regions and particularly early career stage researchers were under-represented. Furthermore, we did not collect any data on the number and characteristics of invited physicians that did not complete the survey and the results may therefore not be representative of the neurovascular research community in general. Second, survey data are cross-sectional and thus do not reflect developments in the funding landscape over time. Third, since the goal of our study was not focussed on hypothesis testing but rather aimed to explore perceived challenges and opportunities in the current neurovascular research funding landscape, we deliberately refrained from using statistical tests and p-values. As a result, we are unable to draw any conclusions on the statistical significance of our findings. Finally, part of the survey participants as well as the survey investigators were physicians-scientists involved in research. Participants may have been susceptible to giving answers that they perceived as socially desirable.
Conclusion
The discrepancy between required and available funding was perceived as a major problem for neurovascular research. High competitiveness and time-consuming funding processes with excessive administrative requirements were identified as key obstacles. Despite their limited financial capacities, traditional funding agencies such as the NIH, were perceived to be most capable of closing this funding gap, while crowdfunding and philanthropy funds are currently not perceived to contribute substantially to neurovascular research funding. However, in light of the increasing gap between the supply and demand of traditional funds, these alternative funding sources could soon play a major role in the neurovascular funding landscape. Neurovascular researchers should embrace this opportunity and actively work towards integrating alternative funding sources into the current funding landscape to fully leverage their potential.
Supplemental Material
Supplemental material, sj-pdf-1-ine-10.1177_15910199221084801 for Challenges and opportunities in research funding for neurovascular diseases from a clinical researcher's perspective by Johanna Maria Ospel, Rosalie McDonough, Aravind Ganesh, Arshia Sehgal, Manon Kappelhof, Nima Kashani, Catharina JM Klijn, Michael Hill, Jeffrey Saver and Mayank Goyal in Interventional Neuroradiology
Footnotes
The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Xxxxxxx.Michael Hill: Grants to the University of Calgary from Boehringer-Ingelheim for the TEMPO-2 trial, grants to the University of Calgary from Biogen Inc., grants to the University of Calgary from CIHR and NoNO Inc. for the ESCAPE-NA1 trial, Grants to the University of Calgary from Alberta Innovates to the University of Calgary for QuICR Alberta Stroke Programd and the ESCAPE-NA1 trial, US Patients 62/086,077 and 10,916,346 licensed to Circle NVI, DSMC Chari for the RACECAT, Oncovir Hiltonel, DUMAS, ARTESIA and BRAIN-AF trials, president of the Canadian Neurological Sciences Federation, board member of the Canadian Stroke Consortium, board member, founder and part ownership Circle NVI. Mayank Goyal: Unrestricted grants to the University of Calgary from Medtronic, grants to the University of Calgary from Cerenovus, NoNO Inc., royalties from GE Healthcare and Microvention, consulting fees from Medtronic, Stryker, Microvention, Mentice, Philips, stock options from Circle NVI. Jeffrey Saver: Stock options from Rapid Medical. Aravind Ganesh: grants to the University of Calgary from CIHR, Canadian Cardiovascular Society, Alberta Innovates, Campus Alberta Neuroscience, Sunnybrook Research Institute INOVAIT Program, consulting fees from MD Analytics, MyMedicalPanel, Figrue 1, CTC Communications Group, Atheneum, DeepBench, Research on Mind, Creative Research Designs, honoraria for lectures, Alexion, travel support from American Academy of Neurology, Association of Indian Neurologists in America, American Heart Association, University of Calgary, US patent 17/317,771 filed, editorial board member Neurology:Clinical Practice, Neurology, Stroke, stock options from SnapDX, Advanced Health Analytics (AHA Health Ltd.), TheRounds.com. Karin Klijn: grants from the Dutch HeartFoundation (grant 2012T077); The Netherlands Organization for Health Research and Development, ZonMw (grant 015008048); support of the Netherlands Cardiovascular Research Initiative, which is supported by the Dutch Heart Foundation, CVON2015–01: CONTRAST, and the support of the Brain Foundation Netherlands (HA2015·01·06). The remaining authors have nothing to disclose.
Funding: The author(s) received no financial support for the research, authorship, and/or publication of this article.
ORCID iDs: Johanna Maria Ospel https://orcid.org/0000-0003-0029-6764
Mayank Goyal https://orcid.org/0000-0001-9060-2109
Supplemental material: Supplemental material for this article is available online.
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Associated Data
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Supplementary Materials
Supplemental material, sj-pdf-1-ine-10.1177_15910199221084801 for Challenges and opportunities in research funding for neurovascular diseases from a clinical researcher's perspective by Johanna Maria Ospel, Rosalie McDonough, Aravind Ganesh, Arshia Sehgal, Manon Kappelhof, Nima Kashani, Catharina JM Klijn, Michael Hill, Jeffrey Saver and Mayank Goyal in Interventional Neuroradiology