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Lewit RA, Black CM, Camp L, et al. Association of Sex and Race/Ethnicity With National Institutes of Health Funding of Surgeon-Scientists. JAMA Surg. 2021;156(2):195–197. doi:10.1001/jamasurg.2020.5016
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.
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.
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).
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).
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 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.
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.
Accepted for Publication: August 27, 2020.
Published Online: December 9, 2020. doi:10.1001/jamasurg.2020.5016
Corresponding Author: Ankush Gosain, MD, PhD, Children’s Foundation Research Institute, 50 N Dunlap St, Room 320, Memphis, TN 38105 (firstname.lastname@example.org).
Author Contributions: Drs Lewit and Gosain had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: Lewit, Black, Matthews, Emamaullee, Gosain.
Acquisition, analysis, or interpretation of data: Lewit, Black, Camp, Goldstein, Emamaullee, Gosain.
Drafting of the manuscript: Lewit, Black, Gosain.
Critical revision of the manuscript for important intellectual content: Camp, Goldstein, Matthews, Emamaullee, Gosain.
Statistical analysis: Lewit, Black, Gosain.
Administrative, technical, or material support: Camp, Gosain.
Supervision: Goldstein, Gosain.
Conflict of Interest Disclosures: None reported.