Name and Characteristics of National Institutes of Health R01-Funded Pediatric Physician-Scientists

Abstract

This study describes the number and characteristics of physician-scientists who are funded by National Institutes of Health independent investigator awards.

Physician-scientists in general, and pediatric physician-scientists in particular, are vanishing. Rates of National Institutes of Health (NIH) awards to pediatric departments have declined from 23.8% to 16.8% during the past 10 years. Being granted an NIH independent investigator award (R01) is not only a means to support a physician-scientist’s research but also is a commonly required milestone for promotion. Details of R01-funded pediatric physician-scientists, including the number of R01 awards granted, individuals who are awarded an R01, and their institutions, subspecialties, academic rank, leadership status, and sex, are unknown.

Methods

The NIH Reporter (https://projectreporter.nih.gov/reporter.cfm) was accessed on May 17, 2017, using the following search criteria: (1) department type (“Pediatrics”), (2) fiscal years 2012 to 2017, and (3) activity code “R01 Equivalents” (DP2, R01, R23, R29, R37, and RF1). Because some institutions with NIH-funded investigators may not identify with a “Department of Pediatrics,” we added an additional search using “Children’s Hospital” in the “organization” search field with “contains” as the qualifier. Duplications, administrative supplements, and yearly renewals for the same award were removed while competitive renewals were included. Individual awardees were identified (individuals with more than 1 award were represented only once) and their pediatric division, sex, terminal degree, current academic rank, and administrative status as division chief, department chair, or dean was determined using an internet search.

Results

We identified 6870 R01-equivalent awards (including yearly renewals for the same award; 2471 individual grants were awarded to 1593 investigators) during the fiscal years 2012 to 2017. One thousand eight hundred ninety-one of the individual 2471 R01-equivalents (76.53%) were new (<5 years of support). Fifteen institutions supported 1561 of all R01-equivalent awards (63%) (Table 1) and 6 NIH institutes (National Heart, Lung, and Blood Institute [n = 560, 20.5%]; National Institute of Diabetes and Digestive and Kidney Diseases [n = 345, 14%]; National Institute of Allergy and Infectious Diseases [n = 316, 13%]; National Cancer Institute [n = 257, 10.4%]; National Institute of Child Health and Human Development [n = 229, 9.3%]; and the National Institute of Neurological Disorders and Stroke [n = 209, 8.5%]) supported 75% of the awards. Among the 1593 investigators with R01-equivalent awards, 907 (57%) had an MD-equivalent degree or an MD with an additional graduate degree. Their pediatric divisions are represented in Table 2. Five hundred twenty-six of the 907 physician-scientists (58%) currently hold the rank of professor and 219 (24%) hold chief, chair, or dean positions. Program project grants and center grants (P01, M01, P20, P30, P50, and U54) over the same period were awarded to 268 individual scientists in pediatrics (who were not limited to physician-scientists), of whom 91 (34%) were already represented among the 1593 we identified. A query of NIH Reporter on October 8, 2017, using the same strategy that was used for R01s identified 644 R21 awards to 522 individuals, of whom 278 (53%) were already represented on the R01 or PPG list.

Table 1. Institutional Distribution of Pediatric R01-Equivalent Awards^a.

Institutions With R01-Equivalent Awards	No. of Awards
Boston Children’s Hospital	326
Cincinnati Children’s Hospital	289
Children’s Hospital of Philadelphia	184
Seattle Children’s Hospital	103
Baylor College of Medicine	78
Nationwide Children’s Hospital	73
Emory University	68
Indiana University-Purdue University at Indianapolis	65
University of California, San Diego	64
University of Colorado, Denver	61
Stanford University	58
University of Pittsburgh	57
Vanderbilt University	46
University of Minnesota	45
Johns Hopkins University	44

^aThe top 15 institutions that accounted for 1561 (63%) of the 2471 individual Pediatric R01 awards from January 2012 to May 17, 2017. The National Institutes of Health (NIH) Reporter (https://projectreporter.nih.gov/reporter.cfm) was accessed on May 17, 2017, using the following search criteria: (1) department type (“Pediatrics”), (2) fiscal years 2012 to 2017, and (3) activity code “R01 Equivalents” (DP2, R01, R23, R29, R37, and RF1). Because some institutions with NIH-funded investigators may not identify as “Department of Pediatrics,” we added an additional search using “Children’s Hospital” in the “organization” search field with “contains” as the qualifier. This list of R01-equivalent grant awards was exported from NIH Reporter and curated to remove duplications, administrative supplements, and yearly renewals of the same award to generate a list of individual awards. The number of individual awards to each institution (listed under “organization name” within the NIH Reporter output) was determined.

Table 2. Pediatric Division Representation Among the 907 R01-Equivalent Physician-Scientist Awardees^a.

Pediatric Specialty	R01-Equivalent Awardees, No. (%)
Hematology-oncology	146 (16.1)
Academic general	109 (12.02)
Infectious disease	93 (10.25)
Neonatology	82 (9.04)
Endocrinology	49 (5.40)
Neurology	46 (5.07)
Pulmonology	45 (4.96)
Gastroenterology	44 (4.85)
Genetics	39 (4.30)
Cardiology	36 (3.97)
Nephrology	32 (3.53)
Critical care	31 (3.42)
Allergy and immunology	31 (3.42)
Rheumatology	15 (1.65)
Adolescent	14 (1.54)
Behavioral and development	10 (1.10)
Emergency medicine	10 (1.10)
Nonpediatric primary training	75 (8.27)

^aNumber and percentage of R01-equivalent awardees per pediatric specialty from January 2012 to May 17, 2017. Among the 1593 pediatric investigators we identified who were awarded 2471 R01-equivalent awards during the fiscal years 2012 to 2017, 907 (57%) had an MD-equivalent degree or an MD with additional graduate degree. No R01–equivalent–funded pediatric investigator identified using this search strategy was removed from any list that was used to generate the data presented. The current division for each physician-scientist was determined using an internet search and is displayed in the table. Physician-scientists who were identified using our search criteria in NIH Reporter (“Department of Pediatrics” and “Children’s Hospital”) and received R01-equivalent awards, but had not completed a residency in pediatrics, were considered “nonpediatric primary training.”

Discussion

To our knowledge, this is the first data-supported pediatric-focused report to describe the number and characteristics of NIH R01–funded pediatric physician-scientists. That there were a limited number of awards made to investigators concentrated at a few institutions (Table 1) and that the awards were granted primarily to men (63.6%) in senior positions, many of whom had dual (academic/administrative) roles, raises concerns for our ability to motivate and develop young trainees to choose this path. While the number of awards does not predict the effect of the discoveries, that there were 2471 R01 awards over a 5.4-year period granted to all scientists in pediatrics nationwide (including established physician-scientists), and only 379 to nonprofessor physician-scientists (data not shown) is troubling.

The NIH recognizes the reduction in the physician-scientist workforce and has implemented several interventional programs. Increases in the number of mentored physician-scientist (K) awards and a priority for R01 funding for first-time applicants help to offset fewer new physician-scientists entering the work force, but K award applications have declined recently. We recognize that all physician-scientists might not be captured using our approach and many physician-scientists may have garnered support via other mechanisms outside the R01 (eg, foundation funding). However, our results are concerning because an R01 is a common requirement in academic centers for (1) promotion, (2) the opportunity to serve as a research mentor, and (3) junior scientists transitioning from career development awards.