Status of Early-Career Academic Cardiology: A Global Perspective

Abstract

Early-career academic cardiologists, who many believe are an important component of the future of cardiovascular care, face myriad challenges. The Early Career Section Academic Working Group of the American College of Cardiology, with senior leadership support, assessed the progress of this cohort from 2013 to 2016 with a global perspective. Data consisted of accessing National Heart, Lung, and Blood Institute public information, data from the American Heart Association and international organizations, and a membership-wide survey. Although the National Heart, Lung, and Blood Institute increased funding of career development grants, only a small number of early-career American College of Cardiology members have benefited as funding of the entire cohort has decreased. Personal motivation, institutional support, and collaborators continued to be positive influential factors. Surprisingly, mentoring ceased to correlate positively with obtaining external grants. The totality of findings suggests that the status of early-career academic cardiologists remains challenging; therefore, the authors recommend a set of attainable solutions.

Keywords: cardiology profession; clinician-scientist; early-career academic cardiologist; mentoring; physician-scientist.

Figure 1. Early Career Academic Cardiologists’ Characteristics

(A) Sex and practice type distribution, (B) Motivation for pursuing academic cardiology, (C) Academic track and % research effort distribution, (D) Type of research.

Figure 2. Funding Environment

(A) National Institutes of Health/National Heart, Lung, and Blood Institute (NIH/NHLBI) funding of K-08 Mentored Clinical Scientist Development Award (Basic-Translation Research), (B) NIH/NHLBI funding of K-23 Mentored Patient-Oriented Research Career Development Award (Clinical Research), (C) American Heart Association (AHA) Fellow to Faculty transition award (three recipients declined the award in 2015 to depress the % for that year), (D) AHA Scientist Development Grant, (E) >$499K external funding for early career members with >40% research effort, (F) Funding distribution for all early career members for 2013 (only counted funding received as principal investigators (PIs)) and 2016 (counted funding received as PI, Co-PI, and Co-investigator).

Figure 3. K-Grant Awards for ACC Early Career Members

All fiscal year 2017 active NHLBI K-grants were extracted from NIH RePORTer. Principal investigators for these active K-grants were matched against ACC Membership database with ≤ 10 years from completing fellowship at the time of grant activation. The match showed number of ACC early career academic cardiologists successfully completing for K-grant by year. Of note, some of the K-grant recipients have aged out of the early career range at the time of 2016 survey.

Figure 4. Analyses by States of US

Fiscal year 2017 NIH research funding correlated with number of hospital beds (A) and number of teaching hospitals (B). Number of early career academic cardiologists (ECAC) correlated with number of hospital beds (C) and number of teaching hospitals (D). Average funding for ECACs with ≥ 40% research effort did not correlate with amount of NIH research funding received by state (E) and number of teaching hospitals by state (F). Data were extracted from NIH RePORTer,(16) Center for Medicare and Medicaid Services reporting of teaching hospitals,(17) and American Hospital Directory.(18)

Figure 5. Challenges and Resources

Respondents provided rating for their beliefs and experiences pertaining to academic pursuits. Comparisons were done on US vs. international members on summation of the top two agreement responses.

Figure 6. Focused Mentor Excellence to Grant Funding Analyses

Early career members’ reported onsite mentoring provides excellent guidance 1-strongly disagree to 5-strongly agree were plotted against external grant amount received. (A) 2013 Total NIH funding for US members reporting > 40% of research effort, (B) 2016 Total NIH funding for US members reporting > 40% of research effort, (C) 2013 Total external funding for all members, (D) 2016 Total external funding for all members. Pearson correlation analyses were performed between members’ rating of mentoring to achieved grant support (correlation coefficient r and p values are listed within the figures).

Figure 7. Penalties and Requested Help

(A) Members’ reported salary reductions for pursuing academic cardiology with respect to their peers, (B) Reported application of relative value units (RVU), (C) Likelihood of leaving academic cardiology in the next 12 months, (D) Top three areas where members believe ACC can best meet their research needs.

Central Illustration. Early Career Academic Cardiologist

Personal motivation and commitment sustains drives the progress. Institutional support and mentoring help to deliver the external funding to sustain life. Successful actions provide scientific discoveries and deliver outstanding patient care.