Trends in National Institutes of Health Funding of Principal Investigators in Dermatology Research by Academic Degree and Sex

Importance  National Institutes of Health (NIH) grants are becoming increasingly competitive in the academic research arena. Identifying NIH funding disparities is an important step in improving academic diversity.

Objective  To examine recent NIH funding trends in dermatology.

Design, Setting, and Participants  Retrospective study with linear regression analysis and repeated-measures analysis of variance of all NIH grants awarded to departments of dermatology from fiscal year 2009 to 2014. Funding data were exported from the NIH Research Portfolio Online Reporting Tools Expenditures and Results. Publication data were drawn from Scopus. All NIH-funded principal investigators in dermatology were categorized by their academic degree and sex.

Main Outcomes and Measures  The NIH funding trends were compared by investigator degree (MD, PhD, or MD/PhD) and sex.

Results  A total of 1292 NIH-funded grants were awarded to dermatology research from fiscal year 2009 through 2014. Adjusted NIH funding for dermatologic research diminished by 4.6% from $67.3 million in 2009 to $64.2 million in 2014, with a nadir of $58.6 million in 2013. Funding for the NIH’s Research Project Grant Program (R01) decreased by 21.0% from $43.9 million to $34.7 million during this period. The dollar amount of NIH funding significantly trended down for investigators with an MD degree by $1.35 million per year from $23.6 million in 2009 to $18.4 million in 2014 (P = .02) while there was no significant change in NIH funding for MD/PhD (from $17.6 million in 2009 to $19.8 million in 2014; P = .44) and PhD investigators (from $26.1 million in 2009 to $25.9 million in 2014; P = .74). Similarly, the total dollar amount of R01 grants awarded to principal investigators with only an MD degree trended down by $1.4 million per year from $13.2 million in 2009 to $6.0 million in 2014 (P < .001). The number of female investigators with NIH grants in dermatology trended down significantly compared with the trend of their male counterparts (from 49 women in 2009 to 43 women in 2014 vs from 84 men in 2009 to 97 men in 2014; P = .04).

Conclusions and Relevance  There is a downward trend in NIH funding for female and MD-only dermatology investigators. Departmental support and junior faculty mentorship for women and MD investigators is crucial for maintaining their presence in NIH-funded dermatology research.

Medical research relies on continuous funding support. Although there are many sources of funding, National Institutes of Health (NIH) awards remain the benchmark. The NIH provides nearly $30 billion annually for medical research,¹ making it the largest public funding source. However, despite an increase in research costs and grant applications,² the total NIH budget in adjusted dollars has steadily decreased since 2003, a major concern to academic dermatologists who rely on the NIH for research support.

Given the increasingly competitive landscape for NIH dollars, we hypothesized that certain groups of dermatology researchers would be subjected to additional challenges in securing NIH awards. The goal was to assess NIH funding trends by investigators grouped by academic degree (MD vs PhD vs MD/PhD). The NIH’s Research Project Grant Program (R01) was highlighted in a subanalysis because the R01 is the original and most well-known NIH grant mechanism.

In addition, we were interested in the effect of sex on obtaining NIH grant awards. Historically, women are significantly less funded than their male counterparts.^3,4 Also, women hold less prestigious positions in academia despite their known proficiency in academic leadership positions.^5,6 Therefore, we also sought to examine how sex and seniority affect NIH funding.

Box Section Ref ID

Funding data were sourced from the NIH Research Portfolio Online Reporting Tools Expenditures and Results (NIH RePORTER).¹ We exported data on grants awarded to dermatology research from fiscal years (FY) 2009 to 2014. These grants were queried through the “Fiscal Year,” “Activity Code,” and “Department” search options on NIH RePORTER. Funding from non-NIH sources was excluded, such as from the Food and Drug Administration and Department of Veteran Affairs.

All project leaders, also known as principal investigators (PIs), were collected and their academic degrees and sexes were determined through an Internet search of academic institution websites and faculty directories. Sex categorization required photographic evidence or identification through institutional biographies. Degrees that were still in progress at the time of the award were not counted. All PIs were categorized successfully through this method. Because the NIH RePORTER organizes grants by their single project leader, grants with multiple PIs were categorized to their project leader for consistency. All data were extracted in August 2015, and costs were adjusted to 2009 equivalent dollars using the Consumer Price Index.

Data regarding the PI’s publication history were compiled using Scopus (http://www.scopus.com). Principal investigators were searched using the author’s first and last name, and/or through their university affiliation. The seniority of an investigator was measured by the number of years since first publication. Because this study did not involve human participants, institutional review board approval was not required.

Statistical analysis was performed using SAS statistical software, version 9.4 (SAS Institute). The underlying assumptions of normality and homoscedasticity of statistical inferential tests were checked prior to statistical analysis. Linear regression analyses were used to assess the relationship between 2 variables, and the goodness of fit (R²) was determined for each linear model. Analysis of covariance was used to compare slopes of regression lines. For multiple pairwise group comparisons, P < .017 was considered to determine significance when comparing a pair from 3 groups based on the Bonferroni method. For all other analyses, P < .05 was considered significant.

Longitudinal trends of 6-year change in funding were estimated by a repeated-measures analysis of variance (ANOVA) via linear random-effects models. Funding amount was entered as the dependent variable (Y). Degree (or sex), time (year), and degree × time interaction terms were entered as independent variables with seniority (or publications) included as a covariate in the model. To account for between-subject heterogeneity in the changes of funding amounts, intercept and time were modeled as random effects.

There were a total of 1292 NIH-funded grants awarded to dermatology research from FY 2009 through 2014. Adjusted NIH funding for dermatologic research diminished by 4.6% from $67.3 million in 2009 to $64.2 million in 2014, with a nadir of $58.6 million in 2013. Comparatively, funding for R01 awards in dermatology underwent a larger decrease of 21.0% from $43.9 million to $34.7 million during the same period (Table 1).

The total amount of dermatology NIH grants awarded to PIs with MD degrees trended down significantly by $1.35 million per year (P = .02). Comparatively, funding has trended up by $0.25 million per year (P = .44) for PIs with MD/PhD degrees and trended down by $0.23 million (P = .74) for non-MD PIs with PhD degrees (Figure 1A). Repeated-measures ANOVA revealed that these trend lines were statistically different from one another (P = .016) (Table 2). Pairwise comparisons between the following groups: MD vs PhD, MD vs MD/PhD, and PhD vs MD/PhD revealed that there was a significant difference between MD and PhD dermatology investigators (P = .008). The significance of this comparison remained true after adjustment for publications (P = .001) and seniority (P = .013) (Table 2).

Subanalysis of these data revealed that the dollar amount of R01 grants awarded to PIs with only an MD degree trended significantly down almost linearly by $1.4 million per year (P < .001). Meanwhile, MD/PhD and PhD R01 funding trended down by $0.34 million per year (P = .25) and up by $0.20 million per year (P = .53), respectively (Figure 1B). Also, the slope of the trend line for R01 MD funding is significantly more negative than the slopes of the trend lines for R01 MD/PhD funding and total PhD funding (P = .001).

Between 2009 and 2014, the majority of NIH-funded investigators in dermatology were men and the number of male PIs trended up by approximately 1.5 PIs per year (P = .21) (Figure 2). The number of female PIs was 49 in FY 2009 and trended significantly down by approximately 1 PI per year (P = .04). The difference between these 2 trends was statistically significant (P = .04) (Figure 2A).

To further examine the gender gap, we focused on the investigators who retained funding throughout our study timeline. Of these investigators, the funding awarded to men was statistically greater than the funding awarded to women (P = .02). However, after adjustment for publications and seniority, the funding gap between the sexes was no longer significant (P = .08 and P = .16, respectively), suggesting that seniority and publications play an important role in award size.

There was no significant trend in the number of male and female PIs with R01s from FY 2009 to 2014 (P = .78 and P = .90, respectively) (Figure 2B).

This study demonstrates that total adjusted NIH funding for dermatology research from 2009 to 2014 decreased, with awards to PIs with only an MD degree decreasing by more than $1 million per year. In addition, the decreasing trend in the number of NIH-funded women in dermatology was statistically different than the increasing trend seen in their male counterparts. Although the funding awarded to men was statistically greater than the funding awarded to women, this gap disappears when adjusted for publications and seniority. This suggests that seniority and publication track record trumps sex disparity.

There are many possible explanations for the MD investigators’ funding decline. First, the NIH’s peer review system may be favoring basic science over translational research. This would be consistent with the study of Ginther et al,⁷ which demonstrated that R01 grants involving the study of human subjects were significantly less likely to be approved. Another possibility is that MD investigators, who often divide their time between clinic, teaching, mentoring, and research responsibilities, are at an inherent disadvantage compared with their PhD counterparts, who focus primarily on research. Even after controlling for seniority and productivity, MD investigator funding is decreasing compared with PhD investigator funding, suggesting that these are not major factors responsible for the decline. Another possibility is that dermatology physician-scientists may be choosing to obtain their funding from non-NIH sources. For example, competition for NIH dollars may be shifting clinical research funding away from government sources and toward industry-sponsored investigations. In support of this possibility, Ehrhardt et al⁸ have demonstrated that NIH-funded clinical trials decreased from 2006 to 2014, whereas industry-funded trials increased.

In regards to funding differences by sex, the majority of NIH-funded dermatology investigators were men. From FY 2009 to 2014, the downward trend in NIH-funded women in dermatology was statistically different than the upward trend seen in the their male counterparts. Similar to our findings, the RAND Corporation identified that women were underrepresented among the top NIH award winners.⁹ Additionally, female scientists were found to be less likely to progress to R01 grants compared with male scientists, suggesting a leakage of female investigators in the academic pipeline.^10,11 Because the significant difference in funding between the sexes disappears after adjustment for seniority and publications, our data highlight how the experience and productivity of the investigator translates to more NIH funding. Therefore, encouraging and retaining women in academic positions is essential to overcome the male-saturated NIH landscape. After reviewing several large-scale analyses, Ceci and Williams¹² found no concrete evidence of sex discrimination in NIH grant funding. Interestingly, they summarized that the lower publication rate seen in women is not the result of discrimination during the journal review process but is related to women occupying positions with fewer resources (eg, teaching vs research-intensive positions).¹² Thus, it seems that women’s less prominent role in the NIH funding arena stems from disparities at the academic institution level. The downward trend of NIH-funded women is especially concerning because NIH awards play a role in career advancement. If women in dermatology continue to lose their NIH-funded research, the current gender gap in leadership in academic dermatology¹³ is not likely to improve.

One limitation of this study is regarding the data source. Although all funding data were exported directly from NIH RePORTER, information about seniority and publication rates were compounded from Scopus, which may lead to inaccuracies. Also, without access to NIH grant application success rates, our study cannot fully assess whether the cause of these funding differences was related to NIH review and award policies. Last, we limited our timeline to dermatology grants awarded from FY 2009 to 2014. Therefore, longer studies are needed to fully assess these disparities.

Although further research is needed to better elucidate the funding disparities reported herein, our results demonstrate that there is a growing inequality of opportunity for women and MD physician-scientists in dermatology research. Promoting equality in the new generation of physician scientists requires a multifaceted approach. Thus, a concerted effort using evidence-based practices for achieving equal opportunity in dermatology departments is imperative for female and MD physician-scientists to improve their future presence in NIH-funded dermatology research. Otherwise, if the current trends continue, the gender and degree gap in dermatology funding will likely increase.

Accepted for Publication: January 30, 2016.

Corresponding Author: Emanual Maverakis, MD, Department of Medical Microbiology and Immunology, University of California–Davis School of Medicine, 3301 C St, Ste 1400, Sacramento, CA 95816 (emaverakis@ucdavis.edu).

Published Online: May 18, 2016. doi:10.1001/jamadermatol.2016.0271.

Author Contributions: Dr Maverakis had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Study concept and design: Cheng, Sultani, Maverakis.

Acquisition, analysis, or interpretation of data: Cheng, Sukhov, Kim, Maverakis.

Drafting of the manuscript: All authors.

Critical revision of the manuscript for important intellectual content: Sukhov, Kim, Maverakis.

Statistical analysis: Cheng, Kim, Maverakis.

Obtained funding: Sultani, Maverakis.

Administrative, technical, or material support: Cheng, Sukhov, Sultani, Maverakis.

Study supervision: Kim, Maverakis.

Conflict of Interest Disclosures: Dr Maverakis receives grant support from the NIH. Drs Cheng and Kim receive NIH funding through Dr Maverakis. No other disclosures are reported.

Funding/Support: Dr Maverakis is supported by career awards from the Burroughs Wellcome Fund, the Howard Hughes Medical Institute, and the NIH (No. 1DP2OD008752-01).

Role of the Funder/Sponsor: The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.