From bench to bedside: trends in National Institutes of Health funding for neurosurgeons from 1991 to 2015

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OBJECTIVE

Neurosurgeons play an important role in advancing medicine through research, the funding of which is historically linked to the National Institutes of Health (NIH). The authors defined variables associated with neurosurgical NIH funding, prevalence of funded topics by neurosurgical subspecialty, and temporal trends in NIH neurosurgical funding.

METHODS

The authors conducted a retrospective review of NIH-funded American Association of Neurological Surgeons members using NIH RePORTER (http://report.nih.gov/) for the years 1991–2015.

RESULTS

The authors followed 6515 neurosurgeons from 1991 to 2015, including 6107 (94%) non–MD-PhD physicians and 408 (6%) MD-PhDs. NIH grants were awarded to 393 (6%) neurosurgeons, with 23.2% of all first-time grants awarded to the top 5 funded institutions. The average total funded grant-years per funded neurosurgeon was 12.5 (range 1–85 grant-years). A higher percentage of MD-PhDs were NIH funded than MDs (22% [n = 91] vs 5% [n = 297], p < 0.0001). The most common grants awarded were R01 (128, 33%), K08 (69, 18%), F32 (60, 15%), M01 (50, 13%), and R21 (39, 10%). F32 and K08 recipients were 9-fold (18% vs 2%, p < 0.001) and 19-fold (38% vs 2%, p < 0.001) more likely to procure an R01 and procured R01 funding earlier in their careers (F32: 7 vs 12 years after residency, p = 0.03; K08: 9 vs 12 years, p = 0.01). Each year, the number of neurosurgeons with active grants linearly increased by 2.2 (R2 = 0.81, p < 0.001), whereas the number of total active grants run by neurosurgeons increased at nearly twice the rate (4.0 grants/year) (R2 = 0.91, p < 0.001). Of NIH-funded neurosurgical grants, 33 (9%) transitioned to funded clinical trial(s). Funded neurosurgical subspecialties included neuro-oncology (33%), functional/epilepsy (32%), cerebrovascular (17%), trauma (10%), and spine (6%). Finally, the authors modeled trends in the number of active training grants and found a linear increase in active R01s (R2 = 0.95, p < 0.001); however, both F32 (R2 = 0.36, p = 0.01) and K08 (R2 = 0.67, p < 0.001) funding had a significant parabolic rise and fall centered around 2003.

CONCLUSIONS

The authors observed an upward trend in R01s awarded to neurosurgeons during the last quarter century. However, their findings of decreased K08 and F32 training grant funding to neurosurgeons and the impact of these training grants on the ultimate success and time to success for neurosurgeons seeking R01 funding suggests that this upward trend in R01 funding for neurosurgeons will be difficult to maintain. The authors’ work underscores the importance of continued selection and mentorship of neurosurgeons capable of impacting patient care through research, including the MD-PhDs, who are noted to be more represented among NIH-funded neurosurgeons.

ABBREVIATIONS AANS = American Association of Neurological Surgeons; MGH = Massachusetts General Hospital; NIH = National Institutes of Health; PI = principal investigator; SPORE = Specialized Programs of Research Excellence; UCLA = University of California, Los Angeles; UCSF = University of California, San Francisco.

Article Information

Correspondence Manish K. Aghi: University of California, San Francisco, CA. manish.aghi@ucsf.edu.

INCLUDE WHEN CITING Published online August 30, 2019; DOI: 10.3171/2019.1.JNS181531.

A. Jahangiri, P. M. Flanigan, M. Arnush, and A. Chandra contributed equally to this work.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Impact of degrees, subspecialty, and training grants on neurosurgical NIH funding. A: A higher percentage of MD-PhDs were awarded NIH funding than neurosurgeons with MDs (p < 0.0001). B: Neuro-oncology and functional neurosurgical research received the highest percentage of funding at 33% and 32%, respectively, while the remaining grants were distributed to cerebrovascular at 17% and trauma at 10%, with spine research accounting for only 6% of the funded grants. C: Nearly 30% of F32 recipients transitioned to K08s (18%) and/or R01s (12%), and 38% of K08 recipients transitioned to R01s.

  • View in gallery

    Impact of training grants on time to first R01 procurement. Left: R01 recipients with any prior training grant had a shorter time to R01 procurement than those who had no prior training grants. The mean time to R01 procurement was 32% shorter for those who had prior F32s compared with R01 recipients who did not (7 vs 12 years postresidency; p = 0.03). Right: Prior K08 recipients had a mean time to R01 procurement that was shorter by 19% compared with those without a prior K08 (9 vs 12 years; p = 0.01).

  • View in gallery

    Temporal trends in active grants to neurosurgeons over the 25-year period. A: Assessment of the number of neurosurgeons with active grants over the 25-year study revealed that there has been an increase of 2.2 neurosurgeons with active grants per year (R2 = 0.81, p < 0.001) with a similar trend in males (R2 = 0.79, p < 0.001) and females (R2 = 0.63, p < 0.001). B: Assessment of the total number of active grants run by neurosurgeons over 25 years revealed a linear increase of 4.0 grants/year (R2 = 0.91, p < 0.001) with a similar tendency seen among funded male (R2 = 0.91, p < 0.001) and female (R2 = 0.68, p < 0.001) neurosurgeons. C: Assessment of number of active grants per funded neurosurgeon revealed an upward trend during our study (R2 = 0.8, p < 0.001) with an increase of 0.14 active grants per funded neurosurgeon each decade. D: The number of active R01s and training grants (K08s and F32s) were analyzed for temporal trends across the 25-year study, which revealed a linear increase in active R01s (R2 = 0.95, p < 0.001) while active K08s and F32s both showed parabolic rise and fall (R2 = 0.67, p < 0.001 and R2 = 0.36, p = 0.012, respectively) with a vertex centered at 2003. E: While there was no temporal trend in the number of newly funded neurosurgeons during the 25-year study (R2 = 0.12, p = 0.08), including among males (R2 = 0.14, p = 0.06) and females (R2 = 0.0001, p = 0.95), the number of newly funded neurosurgeons decreased by 34% between the first 5 (1991–1995) and last 5 (2011–2015) years of our study (p = 0.03).

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