Abstract
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.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 66-70 |
| Number of pages | 5 |
| Journal | Journal of Surgical Research |
| Volume | 184 |
| Issue number | 1 |
| DOIs | |
| State | Published - Jan 1 2013 |
Funding
The study population consisted of all current members of APSA (as listed in the directory in July 2012) who have held an NIH grant between 1988 and 2012. NIH grant holders were identified through a query of all current APSA members in the NIH Research Portfolio Online Reporting Tools (RePORT). This resource is an online database of reports, data, and analyses of NIH research activities. Regular (full) members and senior members (members over 65 y old, may or may not be practicing) were queried. No members were directly contacted. All query results were cross-verified with institutional affiliation and department as listed in the NIH RePORT database to ensure the results represented the intended physician in question. Research subject matter was not evaluated in this study. 2.2 Information regarding extramural funding provided by the NIH was queried in the NIH RePORT. The following factors were evaluated: type of funds, funding mechanism, date of award, previous grants awarded, allocation of funds per fiscal year, and funding institution or center. Type of funds and date of awards were available from fiscal years (FY) 1988–2012. Total funds awarded and funding institution or center were available from FY 2000–2012. A descriptive analysis was conducted, including the frequency distribution of different funding mechanisms/awards. K24 awards were excluded from the successful conversion of K- to R-awards, as the K24 is awarded for midcareer development (designed for senior faculty) and is beyond the scope of this study. 3 At the time of the query, we identified 37 current APSA members with active extramural funding from the NIH through 43 active grants. Since 1988, the NIH has funded 83 independent pediatric surgeon-investigators, representing 13% of current APSA members. 3.2 The 43 active grants were funded by the NIH through various funding mechanisms. Of these active grants, 21% (9/43) were mentor-based career development K08 grants and 40% (17/43) were R01 grants. Seven percent of the grants (3/43) were funded through the R03 small grant program, which provides shorter-term, limited funds for projects such as pilot or feasibility projects. Cooperative agreement–type grants (U-series) comprised 9% (4/43) and program project/center grants (P-series) comprised 7% (3/43) of active grants ( ). Fig. 1 Since 1988, there have been 171 NIH grants funded through a variety of different mechanisms. K08 grants comprised 16% (28/171), whereas 29% (50/171) were R01 grants and 14% (24/171) were awarded as small grant program (R03) or exploratory/developmental research grants (R21). Among the other grants, 5% (9/171) were awarded through the U-series and 4% (7/171) were awarded through the P-series mechanisms. 3.3 There have been 28 K08 grants awarded, with nine active at the time of the data query. Although the K series was initiated in 1972 by the NIH, the first K08 award was granted to a pediatric surgeon in 1995. Of the recipients of expired K08 grants, 39% recipients have been subsequently awarded an R01 grant ( ). A total of 63% of mentor-based K-awards transitioned to independent, non-mentor-based NIH award mechanisms, including R01 and U01 grants. Of the currently funded independent investigators, 44% of R01 awardees were previously funded through the K08 award. Fig. 3 4 This study identifies a population of pediatric surgeons with the ability to successfully compete for NIH funding, both historically and in the present, with awards exceeding $7.2 million in FY 2012 distributed through various funding mechanisms. Also, we found pediatric surgeon-scientists are capable of successful transition from the mentored K-series award to independent research grants. Pediatric surgeons have a rate of K-to-R-award conversion of 39%, compared with the overall NIH average of 32% [10] . When additional funding mechanisms, including U-series (cooperative agreements) and M-series (general clinical research center programs) funding, are included, the rate of transition from K-award to independent NIH funding climbs to 63%. Despite this encouraging K-to-R-award conversion rate, early-career investigators continue to face considerable challenges, as demonstrated by their overall success rate for R-awards, which is consistently lower than that of established investigators [2] . Early-career investigators are simultaneously challenged by the demands to build a clinical practice and to develop a research plan. Junior faculty members also often lack effective collaborators and consultants. The K-award addresses these challenges, supporting early development of investigators as researchers via a formal mentorship program and facilitating relationships with NIH program officers. Although the K08 varies between institutions, this grant mechanism provides salary support and funding for supplies and indirect costs. This category has seen a significant increase in funding by some institutes, with salary support in excess of $100,000 per year and $50,000 for supplies and fringe benefits, yielding 5-y awards that approach $1 million. Most importantly, the award also establishes ∼75% of full-time professional efforts as “protected research time.” This allows junior faculty the time to undertake their research proposal and accumulate preliminary data for an R-award application. The importance of funding and support from institutions and extramural funding from foundations outside of the NIH will only increase as we see changes in the health-care system. The success rate for all research grants funded by the NIH has dropped drastically, from 32% a decade ago to the current rate of 18%. The rate has decreased as the number of research grant proposals continues to increase, with an 8% rise between 2011 and 2012 alone. Although the K-award provides a mechanism to encourage research success in young physicians, there are clearly different routes to obtain research independence, as demonstrated by the 56% of pediatric surgeon-scientists who currently have R01 funding without a prior K-award. This finding suggests that there are support mechanisms independent of the NIH-funded career development award. This support may include internal funding from institutions or other extramural career development awards provided through foundations such as the March of Dimes, American Heart Association, Juvenile Diabetes Research Foundation, and the Robert Wood Johnson Foundation. These foundation programs may provide the same support and structure to the early-career physician-scientist as the K-award funding mechanism of the NIH. Further study of R01 awardees will provide a better understanding of the resources needed to become an independent researcher. Institutional support will continue to play an important role in the successful transition from early-career to established investigator. With or without the K-award, the structure of an investigator's clinical practice must permit time to conduct research with a faculty development plan that spans multiple years. The initial 3–5 y of physician-scientists' practice will be devoted to building their lab, acquiring collaborators, and assembling preliminary data to develop a grant proposal in their progression to independent investigator. The time devoted towards these research endeavors will be diverted from clinical practice and may translate to decreased operative volume and revenue. This potential loss of clinical revenue compounds the burden of personal debt and student loans following 9 y of postgraduate training as residents, research fellows, and pediatric surgery fellows. Financial considerations are undoubtedly a factor in the decision to pursue a career as a surgeon-scientist or as a full-time surgeon. Therefore, institutions must provide financial support to ensure that compensation of the surgeon-scientist is comparable to that of a full-time clinician in order to incentivize junior faculty to pursue a research career. The K-award support has recently increased, to almost $1 million over 5 y, between salary support, supplies, and fringe. The salary contribution of ∼$100,000 constitutes over 50% of an average nonsurgical physician salary (internal medicine, $350,000) [11,12] . This imbalance highlights why additional internal support is necessary to recruit surgeons to undertake investigative careers. Some institutions have proposed the use of an “educational value unit” as a means to align compensation of academic efforts and achievements with clinical practice [13] . One limitation of this study is the potential for lag between the expiration of the investigator's K-award and obtaining of an R-award. We report the K-to-R-award conversion based on the time of the query and may be underestimating the rate of successful conversion if investigators are in the process of review. Additionally, although the study includes members of APSA regardless of retirement, it is unable to capture pediatric surgeons who may have died or allowed their membership to lapse. Also, this study focuses on the ability of pediatric surgeons to successfully obtain NIH funding and represents only a small section of surgery as a whole. The training undertaken by pediatric surgeons often incorporates a component of research, which is not typical of general surgery as a whole. This willingness to engage in research endeavors for 2–3 y outside of residency likely skews the population towards an interest in further research pursuits when compared with other specialties. However, this study allows for a well-defined group of research-oriented academic surgeons, not limited to a single practice or institution, but spanning the nation. Additionally, an independent study of similarly research-oriented cardiothoracic surgeons has demonstrated similar success rates of K-to-R-award conversion (44%, n = 6) [14] . This study demonstrates that pediatric surgeons as a group continue to have a strong interest in pursuing research as surgeon-scientists with successful career development and competitive grants. Extramural funding is drawn from various institutes via multiple funding mechanisms and demonstrates the variety of surgical research interests. These data demonstrate that surgical independence can be fostered successfully through the mentor-based award mechanisms, but that such mechanisms are by no means the only path, as evidenced by the 56% of pediatric surgeon-scientists who currently hold R01 grants independent of the K-series funding mechanism. However, the value of the K-award cannot be underestimated, as demonstrated by the 63% of K08 awardees who have successfully transitioned to research independence.
Keywords
- Funding
- K-award
- NIH
- Pediatric surgery
- R-award
- Surgeon-scientist
ASJC Scopus subject areas
- Surgery