Recent trends in National Institutes of Health funding of surgical research

Abstract

Objective: To compare the amount of National Institutes of Health (NIH) funding provided to departments of surgery with that provided to other major clinical departments, to examine the relationship between peer-review activity and funding success, and to compare trends in participation in the peer-review process between surgeons and representatives from other clinical departments.

Summary background data: Surgical research has made enormous contributions to human health. This work is fundamentally dependent on fair and unbiased distribution of extramural research funds from the NIH. To date, no published report has examined the relative distribution of extramural support between departments of surgery and other major clinical departments.

Methods: Data regarding funding trends and peer-review activity were obtained from the NIH and compared between departments of surgery and four nonsurgical departments (medicine, psychiatry, pediatrics, neurology). Award data were examined during 1996 to 2001. Participation trends were examined during 1998 to 2000.

Results: Success rates of surgical proposals were significantly lower than nonsurgical proposals. Differentials in success rates were greatest for proposals assigned to the National Cancer Institute, although relative underfunding for surgical research spanned all major institutes. Awards for surgical grants averaged 5% to 27% less than nonsurgical grants). Surgeons exhibited 35% to 65% less peer-review activity relative to nonsurgeons when normalized to grant submission activity. Overall, surgeons participated on sections where they made up a relatively smaller proportion of total review members compared to nonsurgeons.

Conclusions: Surgical grant proposals are less likely to be funded and carry significantly smaller awards compared to nonsurgical proposals. Relatively fewer surgeons participate in the review process, and those who do are more likely to be in the minority within study sections. Multiple strategies are needed to address these trends and level the playing field for surgical research.

Figure 1. (A) Success rates for competitive research proposals submitted to the NIH by the five most active clinical departments at US medical schools during FY 1995–2001 (P = .017 or less vs. surgery for each nonsurgical department). (B) Success rates for surgical vs. combined nonsurgical clinical departments during the same period (mean ± SD for nonsurgery group, P = .0005 vs. nonsurgery group).

Figure 2. (A) NIH Institutes assigned the largest proportions of surgical grant proposals for potential funding consideration during FY 1995–1999 (mean annual percentage ± SD). (B) Success rates of surgical and nonsurgical grant proposals assigned to these institutes over the same period (mean of annual success rates for 5-year period ± SD).

Figure 3. (A) Mean awards for successfully funded proposals from surgical and nonsurgical departments during FY 1995–2000 (mean ± SD for nonsurgery group). (B) Award data after normalization to NIH extramural budget increases during same period (presented in 1995 constant dollars;P = .0045 vs. nonsurgery over 6-year period).

Figure 4. Relative peer-review activity of major clinical departments during FY 1998–2000 fall cycles. There was no difference in the relative increase (recruitment) of participants between surgical and nonsurgical departments during the 3-year period (surgery 50%, nonsurgery 46–317%;P = .27).

Figure 5. Relative concentration of study section participants to the number of annually submitted grants from surgical and nonsurgical departments (FY 1998–2000 fall cycles). Nonsurgeons exhibited 35 to 65% greater peer-review activity to nonsurgeons when normalized to grant submission activity (P = .015 for the 3-year period; annual mean ratio ± SD for nonsurgery group).

Figure 6. Scatterplot of individual study sections containing members from each clinical department. Each plot represents one section where at least one member from the relavent department was participating. Location of the y-axis represents the percentage of all members in that section. (B) Participants from the nonsurgical group were concentrated on sections with relatively greater proportions than surgeons for each year examined (FY 1998: P = .032; FY 1999: P = .004; FY 2000: P = .002).

Figure 7. Distribution of surgeons participating in the peer-review process during FY 1998–2000 (data reflect all review cycles – fall, winter, and spring; n = 36 for 1998, n=39 for 1999, and n = 54 for 2000). Forty-nine percent of all surgeons were concentrated in one of two dedicated surgery study sections (Surgery, Anesthesia and Trauma [SAT], or Surgery and Bioengineering [SB]).

Figure 8. (A–C) Relative peer-review activity of surgical specialties within the two major study sections dedicated to surgical research. Participation data reflects all nine review cycles during FY 1998–2000. A single surgeon may occupy multiple positions if they serve more than one cycle (CC = critical care, CT = cardiothoracic).