Abstract
This cohort study examines associations between National Institutes of Health funding for surgeon-scientists and sex and race/ethnicity.
Broad disparities in receipt of National Institutes of Health (NIH) grant funding1 are increasingly recognized within academic surgery. The field has fewer women and underrepresented minority (URM) group members than men and White individuals,2 potentially increasing disparities. This study sought to examine the associations of sex, race, and ethnicity with receiving NIH funding by surgeons.
Methods
The University of Tennessee Health Science Center institutional review board exempted retrospective analysis of public data sources. This study was considered secondary research for which informed consent is not required under federal regulation 45 CFR 46.104(d)(4). The Blue Ridge Medical Institute for Medical Research in Horse Shoe, North Carolina, identified NIH-funded investigators from departments of surgery (surgery, neurosurgery, ophthalmology, orthopedics, otolaryngology, and urology). The NIH Research Portfolio Online Reporting Tool (RePORTER) provided grant details, and web searches were used to ascertain investigator details. Data were compared with a faculty distribution from the Association of American Medical Colleges (AAMC).2
Statistical analysis was performed in R version 3.6.1 (R Foundation for Statistical Computing). Data collection included the period from January 2019 to December 2019. All P values less than .05 were considered significant.
Results
In 2019, 1788 members of surgical departments (522 women [29.2%]; 1263 men [70.6%]), representing less than 7% of 25 642 total faculty members in those departments,2 received 2917 NIH awards. Excluding nonphysicians, 773 surgeons received 1235 awards (165 women [21.3%] and 607 men [78.7%] vs the AAMC faculty distribution of 7071 women [27.6%] and 18 571 men [72.4%]; P < .001). Surgeons (n = 477; 91 women [19.1%] and 385 men [80.7%]) received 671 R01-equivalent grants (under DP1, DP2, DP5, R01, R37, R56, RF1, RL1, U01, and R35 code numbers). Female vs male surgeon-scientists differed in demographics of rank (eg, professor; 59 of 165 women [35.8%] vs 330 of 607 men [54.4%]; P < .001), race (eg, White individuals: 98 of 165 women [59.4%] vs 429 of 607 men [70.7%]; P = .02), and department (eg, surgery: 80 of 165 women [48.5%] vs 248 of 607 men [40.9%]; P = .003) (Table 1).
Table 1. Demographics of Female vs Male Surgeons Receiving National Institutes of Health Grants.
| Feature | All awardsa | R01-equivalent awardsb | ||||
|---|---|---|---|---|---|---|
| Surgeons, No. (%) | P valuec | Surgeons, No. (%) | P valuec | |||
| Women (n = 165) | Men (n = 607) | Women (n = 91) | Men (n = 385) | |||
| Degree | ||||||
| MD | 85 (53) | 346 (57) | .16 | 50 (55) | 212 (55) | .58 |
| MD and another degree | 24 (14.6) | 57 (9) | 10 (11) | 30 (8) | ||
| MD, PhD | 53 (32.1) | 204 (34) | 31 (34) | 143 (37) | ||
| Academic rank | ||||||
| Emeritus professor | 1 (1) | 0 | <.001 | 1 (1) | 0 (0) | .008 |
| Professor | 59 (36) | 330 (54) | 45 (50) | 256 (67) | ||
| Associate professor | 36 (22) | 147 (24) | 28 (31) | 93 (24) | ||
| Assistant professor | 58 (35) | 108 (18) | 14 (15) | 28 (7) | ||
| Adjunct faculty | 1 (1) | 2 (0) | 1 (1) | 1 (0) | ||
| Others | 2 (1) | 12 (2) | 2 (2) | 7 (2) | ||
| Residents | 8 (5) | 8 (1) | 0 (0) | 0 (0) | ||
| Race | ||||||
| White | 98 (59) | 429 (71) | .02 | 53 (58) | 268 (70) | .03 |
| Black | 7 (4) | 12 (2) | 0 (0) | 7 (2) | ||
| Asian | 60 (36) | 163 (27) | 38 (42) | 109 (28) | ||
| Other/unknown | 0 | 2 (0) | 0 (0) | 1 (0) | ||
| Ethnicity | ||||||
| Hispanic | 1 (1) | 19 (3) | .13 | 0 (0) | 13 (3) | .16 |
| Non-Hispanic | 164 (99) | 588 (97) | 91 (100) | 372 (97) | ||
| Department | ||||||
| Neurosurgery | 16 (10) | 101 (17) | .003 | 6 (7) | 70 (18) | .007 |
| Ophthalmology | 45 (27) | 112 (19) | 25 (28) | 75 (20) | ||
| Orthopedics | 3 (2) | 36 (6) | 0 (0) | 20 (5) | ||
| Otolaryngology | 14 (9) | 67 (11) | 9 (10) | 44 (11) | ||
| Surgery | 80 (49) | 248 (41) | 46 (51) | 150 (39) | ||
| Urology | 7 (4) | 43 (7) | 5 (6) | 26 (7) | ||
| Total budget, $d | ||||||
| Grant, mean (SD) | 428 109 (467 131) | 499 631 (493 182) | .04 | 535 269 (440 457) | 515 055 (322 356) | .64 |
| No. | 233 | 965 | 117 | 553 | ||
| Individual, mean (SD) | 520 070 (573 446) | 689 141 (836 693) | .003 | 659 343 (551 420) | 840 037 (873 651) | .01 |
A total of 1235 awards were made.
A total of 671 R01-equivalent awards were made.
All P values represent the χ2 comparing women vs men. All P < .05 were considered significant.
Total budget by grant was the amount allocated for each individual grant. Total budget by individual was the cumulative sum of all grants received by that individual in 2019.
Female surgeon-scientists received less money per grant than men when considering all award types (mean [SD], $428 109 [$467 131] vs $499 631 [$493 182]; P = .04) but received comparable amounts for R01-equivalent grants. For surgeons with multiple awards, female surgeons with an R01-equivalent grant received substantially less total funding than men (mean [SD], $659 343 [$551 420] vs $840 037 [$873 651]; P = .01). By linear regression, male surgeons were more likely to receive increased funding for R01-equivalent grants (R2, 0.013; P = .003) and total grant funding (R2, 0.003; P = .045). Stratifying surgeon-scientists by degree or rank did not provide a significant difference explaining the sex disparities (comparing all faculty and all R01-equivalent grant recipients).
Further differences were noted when data were stratified by race, ethnicity, and department (Table 2). No Black women, Hispanic women, or female orthopedists received R01-equivalent grants. Within departments of surgery, women received less funding for R01-equivalent grants than men (median, $429 000 [interquartile range, $356 625-$613 368] vs $475 196 [interquartile range, $364 196-$613 390]; P = .02).
Table 2. Median Grant Award for R01-Equivalent Grants of Female vs Male Surgeons.
| Characteristic | Surgeons | P valuea | |||
|---|---|---|---|---|---|
| Women | Men | ||||
| Median (IQR), $ | No. | Median (IQR), $ | No. | ||
| Race | |||||
| White | 343 128 (38 360-636 571) | 62 | 349 780 (370 336-606 717) | 382 | .26 |
| Black | 0 | 0 | 593 908 (383 536-695 897) | 11 | <.001 |
| Asian | 436 723 (374 806-558 428) | 55 | 409 375 (352 130-560 978) | 158 | .26 |
| Ethnicity | |||||
| Hispanic | 0 | 0 | 432 529 (275 969-799 989) | 17 | <.001 |
| Non-Hispanic | 435 130 (149 129-3 869 686) | 117 | 429 879 (15 371-3 950 956) | 536 | .65 |
| Department | |||||
| Otolaryngology | 465 245 (412 423-629 398) | 14 | 463 405 (382 469-603 968) | 60 | .81 |
| Ophthalmology | 412 500 (394 364-546 513) | 27 | 396 250 (373 750-528 837) | 101 | .23 |
| Orthopedics | 0 | 0 | 375 607 (342 160-482 768) | 27 | <.001 |
| Neurosurgery | 467 502 (351 691-733 051) | 9 | 424 580 (354 597-592 658) | 100 | .37 |
| Surgery | 429 000 (356 625-613 368) | 61 | 475 196 (364 196-613 390) | 232 | .02 |
| Urology | 434 352 (391 936-521 775) | 6 | 522 044 (376 098-666 966) | 33 | .13 |
Abbreviation: IQR, interquartile range.
All P values less than .05 were considered significant.
Discussion
The present study is the first to consider demographic variables that may account for funding disparities among surgeons. Female surgeons received fewer and smaller grants compared with male surgeons, disproportionate to the sex distribution in AAMC departmental faculty rosters. No Black women, Hispanic women, or female orthopedic surgeons received R01-equivalent grants in 2019. These findings suggest that disparities may exist for female surgeons who apply for NIH funding, especially those who are from URM groups or specialties with few women.
Prior studies have reported that female medical school faculty members who received NIH grants had lower dollar amounts.1 This was attributed to academic rank, which was not observed in this study. Other studies looking specifically at surgery have found no sex differences in funding per R01-equivalent grant.3 Black researchers have been shown to have lower success rates with NIH funding,4 a finding that is echoed in this study. Potential opportunities for improvement include addressing barriers to publication productivity of female academic surgeons,5 addressing barriers to promotion among surgeons in URM groups, and ensuring appropriate mentorship of aspiring surgeon-scientists.6 Efforts by the NIH are under way to address potential disparities, including funding opportunities directed at women and members of URM groups and blinded grant review to mitigate unconscious bias.
Limitations
Limitations to this study exist. Demographic information was collected from public sources; some grant recipients may be missing, and race/ethnicity and sex determinations may not align with individual self-identifications. Information regarding academic rank and degrees may be outdated on webpages. A department of surgery, as the term is used in this article, may indicate general surgery or a larger department including other surgical specialties. This study was a snapshot in time and is not representative of trends. We did not have access to unsuccessful NIH grant applicant demographics, which may provide useful information about success rates.
Conclusions
Disparities appear to exist for female surgeon-scientists receiving for NIH funding, in that they receive fewer and smaller NIH grants compared with male surgeons. Targeted efforts to address sex and racial/ethnic disparities specific to surgeon-scientists are needed.
References
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