Special Topic Sources of Federal Funding in Plastic and Reconstructive Surgery Research Kelsey E. Larson, M.D. Brian Gastman, M.D. Cleveland, Ohio
Background: In the last several years, federal funding has become increasingly difficult to obtain. The purpose of this project was to define the level of federal funding among plastic surgeons in the modern era. Methods: The authors evaluated members of the Plastic Surgery Research Council because of their expected invested interested in research. The authors collected information from 1998 to 2012 on funding using curricula vitae and publically available online tools. Data on Plastic Surgery Foundation funding was also collected to determine its role in supporting federally funded investigators. Results: Of 256 individuals, the authors found 41 to be primary investigators on federally funded grants, with the majority receiving one to two awards. Common subtypes of awards included National Institutes of Health R01 (n = 15), K08 (n = 9), and R21 (n = 6). Limited funding from the National Science Foundation and the Department of Defense was identified. Despite a steady number of available National Institutes of Health awards, plastic surgery recipients have grown in number over the past 15 years. In a review of 20 years of Plastic Surgery Foundation awards, 113 Plastic Surgery Research Council members (44.1 percent) were awardees, averaging 1.8 awards per person. Twenty-nine Plastic Surgery Foundation awardees were also recipients of federal funding; 12 individuals received federal funding without prior Plastic Surgery Foundation funding. Conclusions: A search of plastic surgeons indicates a limited but increasing number of individuals receive federal funding. Plastic Surgery Foundation awards appear to be helpful in supporting investigators as they move to larger federal awards. (Plast. Reconstr. Surg. 133: 1289, 2014.)
U
pcoming generations of plastic surgeons have shown continued interest in research, as evidenced by the number of projects and publications on the curricula vitae.1,2 In general surgery, trends toward increased time in dedicated research years have also been noted over the last two decades.3 This indicates increasing interest in research among young surgical professionals. Despite the interest in research in plastic surgery, it is unclear whether federal funds are being used. Federal awards are typically larger and important for plastic surgery divisions as they vie to obtain department status. Prior studies of From the Department of General Surgery and the Dermatology and Plastic Surgery Institute, Departments of Plastic Surgery and Immunology, Cleveland Clinic. Received for publication July 19, 2013; accepted November 20, 2013. Copyright © 2014 by the American Society of Plastic Surgeons DOI: 10.1097/PRS.0000000000000083
National Institutes of Health funding for surgical research as a whole indicate that non–surgeon/ scientists have almost four times the average number of these awards compared with their counterparts in surgery.4 The difference in number of awards was mainly due to much a lower number of applications from surgeons. In looking at National Institutes of Health funding at medical schools nationwide, surgical subspecialties account for only 4.8 percent of National Institutes of Health awards, with general surgery contributing the largest to this pool.5 The purpose of this project was to understand more about federal funding in plastic surgical research by looking at plastic surgeon researchers who are members of the Plastic Surgery Research Council. In addition, Plastic Surgery Foundation
Disclosure: Neither author has any financial information to disclose.
www.PRSJournal.com
1289
Plastic and Reconstructive Surgery • May 2014 funding was reviewed as a significant source of nongovernment funding.
METHODS Members of the Plastic Surgery Research Council were taken as a sample of practicing U.S. plastic surgeons with an active and invested interested in research. All active, staff/senior members as listed on the Plastic Surgery Research Council Web site were included in this study. We excluded individuals with a Doctor of Philosophy (i.e., those without a Doctor of Medicine who are not practicing surgeons) or who were not plastic surgeons. Following identification of the focused sample of plastic surgeon researchers, e-mail and telephone correspondence was initiated in an effort to obtain curricula vitae for review of grant awards. Two rounds of e-mail and telephone campaigns were undertaken in an attempt to obtain a good response rate. After contacting individuals for curricula vitae, we turned our attention to online resources for review. Each individual in the group was entered into the NIH RePORTER and Veterans Affairs Research and Development online sources to determine grants awarded in the last 15 years. Additional government Web sites were used in an attempt to obtain information on National Science Foundation and Department of Defense funding, including the Army Research Office, the Defense Advanced Research Projects Agency, the Armed Forces Institute of Regenerative Medicine, and the Multidisciplinary Unit Research Initiative awards. We included any results that indicated that the surgeon was a primary investigator on a grant. All information on grant awards was obtained via available public records, and no additional requests for non–publically available awards were made. Finally, we contacted the Plastic Surgery Foundation to request information on awardees over the last 20 years, as part of the organization’s commitment is to foster research that can obtain eventual federal funding. Data from the last 5 years are available on the Plastic Surgery Foundation Web site, and data on additional years were provided by the organization.
RESULTS We identified 256 individuals as the sample group of Plastic Surgery Research Council members who are plastic surgeon-scientists. After two rounds of e-mail and telephone campaigns, 20.3
1290
percent of curricula vitae (from 52 individuals) were available for review. Of these, only seven individuals (2.7 percent of total, 12.5 percent of returned curricula vitae) listed government funding sources. After searching each individual’s name (256 total) in NIH RePORTER, we identified 36 who were primary investigators over the last 15 years. Most of the identified individuals (31 of 36; 86.1 percent) received one to two awards, three of 36 (8.3 percent) received three to four awards, and only two of 36 (5.5 percent) received five or more awards. We noted a variety of subtypes, the most common being R01 (15 individuals), K08 (10 individuals), and R21 (six individuals). With regard to R01 awards, 15 individuals had a total of 24 unique topics receiving awards, and of these 15, five received extensions of their R01 awards for additional years, for a total of 28 renewals on original awards. Most recipients received awards for basic science research (77.8 percent), followed by clinical research (16.7 percent), then translational research (8.3 percent). One individual received awards for both basic and clinical research (2.8 percent). The trend in number of new National Institutes of Health awards per year is demonstrated in Figure 1, above. In our review of other sources of government funding databases, we found limited funding by the National Science Foundation (one recipient), the Army Research Office (four recipients), the Defense Advanced Research Projects Agency (one recipient), and the Armed Forces Institute of Regenerative Medicine (six recipients). No individuals who had received Multidisciplinary Unit Research Initiative funding were identified. The trend in new awards of all subtypes per year is demonstrated in Figure 1, below. Many of these awards were a combination of subtypes and thus could not be categorized. Overall, we identified 41 recipients of funding from the National Institutes of Health, Veterans Affairs, the National Science Foundation, or the Department of Defense. A breakdown of the percentage of primary investigators with each subtype of award is demonstrated in Figure 2 and Table 1. After review of 20 years of Plastic Surgery Foundation awards, we identified 113 award recipients (44.1 percent), with an average of 1.8 awards per person. Federally funded individuals tended to have a history of funding by the Plastic Surgery Foundation. Twenty-nine of 41 individuals (70.7 percent) who had received Plastic Surgery Foundation awards were also recipients of federal funding, while 12 of 41 (29.2 percent) who received
Volume 133, Number 5 • Sources of Federal Funding
Fig. 1. (Above) Number of new National Institutes of Health–funded awards per year in the sample group of surgeons. (Below) Number of new federally funded awards per year in the sample group of surgeons (including Department of Defense and Veterans Affairs funding).
federal funding had no prior Plastic Surgery Foundation funding (Fig. 3).
DISCUSSION After using several avenues in an attempt to identify recipients of federal funding for research,
we identified only a limited number of primary investigators in plastic surgery in the sample group. To date, few studies have focused on government funding in subspecialty surgery areas overall, and none have been identified in plastic surgery. One subspecialty analysis in the field of cardiothoracic surgical research noted a low rate
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Plastic and Reconstructive Surgery • May 2014
Fig. 2. Breakdown or subtype of federally funded award types.
of National Institutes of Health funding, with primary cause linked to low number of applicants compared with other specialties.6 From the information collected, we found that a select but growing group of plastic surgeons successfully obtained federal funding. This limited funding may be related to the number of applicants, reflecting a lack of training (either in grant applications or research experience overall) or a lack of support and time to perform the work. The novel finding that indeed many individuals were previously funded by the Plastic Surgery Foundation demonstrates how instrumental the
Plastic Surgery Foundation is in supporting plastic surgery–based research. Given that 44 percent of active Plastic Surgery Research Council members have a history of Plastic Surgery Foundation awards, there is clearly a larger group that could be applying for funding if circumstances were appropriate. It is clear that even with time and support, individuals need guidance on when, why, and how to apply for federal funding. Ultimately, fostering continued interest in research will take commitment not only from training programs but also from academic centers to provide and support staff positions for surgeon scientists.
Table 1. Number and Description of Federal Funding and Subtypes* Grant R01 R03 Exploratory grants R21 P20 Training grants R90 F32 T32 T90 K awards K07 K08 IO1 M01 NSF DOD AFIRM ARO DARPA
No. of Primary Investigators 15 4 8 6 2 6 1 2 2 1 11 1 10 1 2 1 11 6 4 1
Type of Award Research project grant—large award, usually spans several years Small grant program—short period of time Exploratory/developmental research—early stages Exploratory/developmental research—interdisciplinary Interdisciplinary research education (undergraduate, predoctoral or postdoctoral levels) Individual postdoctoral fellowship—up to 3-year award Institutional national research service award Interdisciplinary research training (undergraduate, predoctoral, or postdoctoral levels) Academic career award—for improving curricula in particular field Mentored clinical scientist development award—path to R01 principal investigator Veterans Affairs award General clinical research National Science Foundation Armed Forced Institute of Regenerative Medicine Army Research Office Defense Advanced Research Projects Agency
NSF, National Science Foundation; DOD, Department of Defense; AFIRM, Armed Forces Institute of Regenerative Medicine; ARO, Army Research Office; DARPA, Defense Advanced Research Projects Agency. *National Institutes of Health–funded awards include R-types, exploratory grants, training grants, K awards, and M01. Veterans Affairs awards include I01. Department of Defense awards are as listed.
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Volume 133, Number 5 • Sources of Federal Funding
Fig. 3. Rate of federal funding in individuals who have and have not received prior Plastic Surgery Foundation funding.
Several authors have thoroughly described the rigor required to appropriately train successful surgeon scientists.7,8 During residency, graduate medical education funding supports only clinical training. Individuals with an interest in research are left to pursue their research during limited nonworking hours. Alternatively, if residents or fellows wish to spend 1 to 2 years in research, they must align themselves with an already-established laboratory that can pay a stipend or apply for separate funding sources. However, given the trends in federal funding among plastic surgeons and the quality of plastic surgery trainees, there should be significant enthusiasm for the future of research in the field. This interest and enthusiasm are reflected in increasing conference attendance, including the May 2013 Plastic Surgery Research Council meeting, which had the highest attendance in the history of the organization. Several published studies note the link among National Institutes of Health awards, h-index (used to help define an individual’s publication activity and impact of publications), and advancement in career within academic medicine. More recent publications in otolaryngology and urology have found a strong relationship among h-index, National Institutes of Health funding, and promotion along career paths.9,10 Examination of various surgical subspecialties demonstrated similar trends.11 Analysis of National Institutes of Health funding for general surgery departments indicates those that are increasing their total funding had researchers with “high ratio of dollars/grant.”12 These studies illustrate the importance of government funding not only at the department level but at the individual level of career advancement as well. From an institutional
rather than an individual standpoint, research is an important factor in obtaining department status, in attracting top residency applicants, and in drawing top staff surgeons. A major advantage of federal grants is significant indirect funds critical for research. Indirect funds are typically used for laboratory space and equipment, with a portion of the money designated for the department or institution itself. In contrast, many (even large) society and foundation grants give little or no indirect funds; thus, the researcher needs to either add federal funding or obtain intrainstitutional support. Industry funding does not commonly give significant indirect funds and comes with the potential for conflict of interest. When looking at departmental income overall, relative value units are a standard for measuring an individual’s worth. Because federally funded researchers are required to split time between research and clinical responsibilities, their relative value units from clinical work are most certainly lower compared with nonfunded or industry-funded surgeons. Previous studies have confirmed lower relative value units, and thus lower clinical revenue generated, for federally funded (versus nonfunded or industry-funded) surgeons.13 However, such studies do not take into account indirect funding, which is a significant source of additional revenue awarded to the department and institution. Indirect funds do not go toward supplemental income for the primary investigator individually but rather go toward the department as a whole. Thus, the individual surgeon–scientist is contributing to departmental income from a research source rather than from a clinical source. While this article represents, to our knowledge, the most complete review of federal funding in plastic surgery research, there are some shortcomings. First, it was not possible to include all practicing plastic surgeons in the United States when we searched for grants. Some individuals who are not members of the Plastic Surgery Research Council may receive federal funding for their research and thus would not be included in this review. Second, because we elected to focus specifically on surgeon scientists for the purpose of this article, there is likely underreporting of the true overall level of federal funding as individuals who had a Doctor of Philosophy only (i.e., those without a Doctor of Medicine) or those with a Doctor of Medicine from other disciples who work in plastic surgery departments were excluded from the analysis.
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Plastic and Reconstructive Surgery • May 2014 Overall, it appears that individuals who choose to apply for federal funding for their research are successful in the application process. As demonstrated in Figure 1, the number of awards each year for the plastic surgeons in the sample group is increasing despite the decreasing applicant success rate overall.14 In recent years, the success rate for those applying for R01 awards has dropped, with 18 percent success in 2011 and 2012 (versus 22 percent in 2010, 25 to 32 percent throughout the 1990s, and up to 58 percent in the 1960s).15,16 In 2013 and beyond, it has been announced that these rates will decrease further, making the federal grant application process increasingly competitive.
CONCLUSIONS A limited but growing number of individuals appear to receive federal funding for their research. Other nongovernment sources, such as the Plastic Surgery Foundation, provide more opportunities for awards and appear to support those seeking federal-level funding. Overall, the trend toward increasing number of awards per year among plastic surgeons is a source of enthusiasm and indicates that the type and quality of projects being performed are in demand. Brian Gastman, M.D. Cleveland Clinic Foundation 9500 Euclid Avenue Cleveland, Ohio 44195 [email protected]
REFERENCES 1. Rogers CR, Gutowski KA, Munoz-del Rio A, et al. Integrated plastic surgery residency applicant survey: Characteristics of successful applications and feedback about the interview process. Plast Reconstr Surg. 2009;123:1607–1617. 2. Guo L, Friend J, Kim E, Lipsitz S, Orgill DP, Pribaz J. Comparison of quantitative educational metrics between
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integrated and independent plastic surgery residents. Plast Reconstr Surg. 2008;122:972–978; discussion 979. 3. Ellis MC, Dhungel B, Weerasinghe R, Vetto JT, Deveney K. Trends in research time, fellowship training, and practice patterns among general surgery graduates. J Surg Educ. 2011;68:309–312. 4. Mann M, Tendulkar A, Birger N, Howard C, Ratcliffe MB. National Institutes of Health funding for surgical research. Ann Surg. 2008;247:217–221. 5. Ozomaro U, Gutierrez JC, Byrne MM, Zimmers TA, Koniaris LG. How important is the contribution of surgical specialties to a medical school’s NIH funding? J Surg Res. 2007;141:16–21. 6. Ratcliffe MB, Howard C, Mann M, del Nido P. National Institutes of Health funding for cardiothoracic surgical research. J Thorac Cardiovasc Surg. 2008;136:392–397; discussion 398. 7. Suliburk JW, Kao LS, Kozar RA, Mercer DW. Training future surgical scientists: realities and recommendations. Ann Surg. 2008;247:741–749. 8. Brock MV, Bouvet M. Writing a successful NIH mentored career development grant (K award). Ann Surg. 2010;251:1013–1017. 9. Svider PF, Mauro KM, Sanghvi S, Setzen M, Baredes S, Eloy JA. Is NIH funding predictive of greater research productivity and impact among academic otolaryngologists? Laryngoscope 2013;123:118–122. 10. Colaco M, Svider PF, Mauro KM, Eloy JA, Jackson-Rosario I. Is there a relationship between NIH funding and research impact in Academic Urology? J Urology 2013;190: 999–1003. 11. Svider PF, Pashkova AA, Choudhry Z, et al. Comparison of scholarly impact among surgical specialties: An examination of 2429 academic surgeons. Laryngoscope 2013;123:884–889. 12. Shah A, Pietrobon R, Cook C, et al. Little science, big science: Strategies for research portfolio selection in academic surgery departments. Ann Surg. 2007;246:1110–1115. 13. McKenney MM, Livingstone AS, Schulman C. The effect of federal funding on clinical productivity: The price of academics. J Trauma 2011;70:51–55. 14. NIH Data Book Reports. Research grants: Competing applications and awards. Available at: http://report.nih.gov/nihdatabook/index.aspx. Accessed April 24, 2013. 15. Hromas R, Abkowitz JL, Keating A. Facing the NIH funding crisis: How professional societies can help. JAMA 2012;308:2343–2344. 16. NIH Data Book Reports. Research Grants: Applications, awards, and success rates. Available at: http://report.nih. gov/nihdatabook/index.aspx. Accessed April 24, 2013.
Background: In the last several years, federal funding has become increasingly difficult to obtain. The purpose of this project was to define the level of federal funding among plastic surgeons in the modern era. Methods: The authors evaluated members of the Plastic Surgery Research Council because of their expected invested interested in research. The authors collected information from 1998 to 2012 on funding using curricula vitae and publically available online tools. Data on Plastic Surgery Foundation funding was also collected to determine its role in supporting federally funded investigators. Results: Of 256 individuals, the authors found 41 to be primary investigators on federally funded grants, with the majority receiving one to two awards. Common subtypes of awards included National Institutes of Health R01 (n = 15), K08 (n = 9), and R21 (n = 6). Limited funding from the National Science Foundation and the Department of Defense was identified. Despite a steady number of available National Institutes of Health awards, plastic surgery recipients have grown in number over the past 15 years. In a review of 20 years of Plastic Surgery Foundation awards, 113 Plastic Surgery Research Council members (44.1 percent) were awardees, averaging 1.8 awards per person. Twenty-nine Plastic Surgery Foundation awardees were also recipients of federal funding; 12 individuals received federal funding without prior Plastic Surgery Foundation funding. Conclusions: A search of plastic surgeons indicates a limited but increasing number of individuals receive federal funding. Plastic Surgery Foundation awards appear to be helpful in supporting investigators as they move to larger federal awards. (Plast. Reconstr. Surg. 133: 1289, 2014.)
U
pcoming generations of plastic surgeons have shown continued interest in research, as evidenced by the number of projects and publications on the curricula vitae.1,2 In general surgery, trends toward increased time in dedicated research years have also been noted over the last two decades.3 This indicates increasing interest in research among young surgical professionals. Despite the interest in research in plastic surgery, it is unclear whether federal funds are being used. Federal awards are typically larger and important for plastic surgery divisions as they vie to obtain department status. Prior studies of From the Department of General Surgery and the Dermatology and Plastic Surgery Institute, Departments of Plastic Surgery and Immunology, Cleveland Clinic. Received for publication July 19, 2013; accepted November 20, 2013. Copyright © 2014 by the American Society of Plastic Surgeons DOI: 10.1097/PRS.0000000000000083
National Institutes of Health funding for surgical research as a whole indicate that non–surgeon/ scientists have almost four times the average number of these awards compared with their counterparts in surgery.4 The difference in number of awards was mainly due to much a lower number of applications from surgeons. In looking at National Institutes of Health funding at medical schools nationwide, surgical subspecialties account for only 4.8 percent of National Institutes of Health awards, with general surgery contributing the largest to this pool.5 The purpose of this project was to understand more about federal funding in plastic surgical research by looking at plastic surgeon researchers who are members of the Plastic Surgery Research Council. In addition, Plastic Surgery Foundation
Disclosure: Neither author has any financial information to disclose.
www.PRSJournal.com
1289
Plastic and Reconstructive Surgery • May 2014 funding was reviewed as a significant source of nongovernment funding.
METHODS Members of the Plastic Surgery Research Council were taken as a sample of practicing U.S. plastic surgeons with an active and invested interested in research. All active, staff/senior members as listed on the Plastic Surgery Research Council Web site were included in this study. We excluded individuals with a Doctor of Philosophy (i.e., those without a Doctor of Medicine who are not practicing surgeons) or who were not plastic surgeons. Following identification of the focused sample of plastic surgeon researchers, e-mail and telephone correspondence was initiated in an effort to obtain curricula vitae for review of grant awards. Two rounds of e-mail and telephone campaigns were undertaken in an attempt to obtain a good response rate. After contacting individuals for curricula vitae, we turned our attention to online resources for review. Each individual in the group was entered into the NIH RePORTER and Veterans Affairs Research and Development online sources to determine grants awarded in the last 15 years. Additional government Web sites were used in an attempt to obtain information on National Science Foundation and Department of Defense funding, including the Army Research Office, the Defense Advanced Research Projects Agency, the Armed Forces Institute of Regenerative Medicine, and the Multidisciplinary Unit Research Initiative awards. We included any results that indicated that the surgeon was a primary investigator on a grant. All information on grant awards was obtained via available public records, and no additional requests for non–publically available awards were made. Finally, we contacted the Plastic Surgery Foundation to request information on awardees over the last 20 years, as part of the organization’s commitment is to foster research that can obtain eventual federal funding. Data from the last 5 years are available on the Plastic Surgery Foundation Web site, and data on additional years were provided by the organization.
RESULTS We identified 256 individuals as the sample group of Plastic Surgery Research Council members who are plastic surgeon-scientists. After two rounds of e-mail and telephone campaigns, 20.3
1290
percent of curricula vitae (from 52 individuals) were available for review. Of these, only seven individuals (2.7 percent of total, 12.5 percent of returned curricula vitae) listed government funding sources. After searching each individual’s name (256 total) in NIH RePORTER, we identified 36 who were primary investigators over the last 15 years. Most of the identified individuals (31 of 36; 86.1 percent) received one to two awards, three of 36 (8.3 percent) received three to four awards, and only two of 36 (5.5 percent) received five or more awards. We noted a variety of subtypes, the most common being R01 (15 individuals), K08 (10 individuals), and R21 (six individuals). With regard to R01 awards, 15 individuals had a total of 24 unique topics receiving awards, and of these 15, five received extensions of their R01 awards for additional years, for a total of 28 renewals on original awards. Most recipients received awards for basic science research (77.8 percent), followed by clinical research (16.7 percent), then translational research (8.3 percent). One individual received awards for both basic and clinical research (2.8 percent). The trend in number of new National Institutes of Health awards per year is demonstrated in Figure 1, above. In our review of other sources of government funding databases, we found limited funding by the National Science Foundation (one recipient), the Army Research Office (four recipients), the Defense Advanced Research Projects Agency (one recipient), and the Armed Forces Institute of Regenerative Medicine (six recipients). No individuals who had received Multidisciplinary Unit Research Initiative funding were identified. The trend in new awards of all subtypes per year is demonstrated in Figure 1, below. Many of these awards were a combination of subtypes and thus could not be categorized. Overall, we identified 41 recipients of funding from the National Institutes of Health, Veterans Affairs, the National Science Foundation, or the Department of Defense. A breakdown of the percentage of primary investigators with each subtype of award is demonstrated in Figure 2 and Table 1. After review of 20 years of Plastic Surgery Foundation awards, we identified 113 award recipients (44.1 percent), with an average of 1.8 awards per person. Federally funded individuals tended to have a history of funding by the Plastic Surgery Foundation. Twenty-nine of 41 individuals (70.7 percent) who had received Plastic Surgery Foundation awards were also recipients of federal funding, while 12 of 41 (29.2 percent) who received
Volume 133, Number 5 • Sources of Federal Funding
Fig. 1. (Above) Number of new National Institutes of Health–funded awards per year in the sample group of surgeons. (Below) Number of new federally funded awards per year in the sample group of surgeons (including Department of Defense and Veterans Affairs funding).
federal funding had no prior Plastic Surgery Foundation funding (Fig. 3).
DISCUSSION After using several avenues in an attempt to identify recipients of federal funding for research,
we identified only a limited number of primary investigators in plastic surgery in the sample group. To date, few studies have focused on government funding in subspecialty surgery areas overall, and none have been identified in plastic surgery. One subspecialty analysis in the field of cardiothoracic surgical research noted a low rate
1291
Plastic and Reconstructive Surgery • May 2014
Fig. 2. Breakdown or subtype of federally funded award types.
of National Institutes of Health funding, with primary cause linked to low number of applicants compared with other specialties.6 From the information collected, we found that a select but growing group of plastic surgeons successfully obtained federal funding. This limited funding may be related to the number of applicants, reflecting a lack of training (either in grant applications or research experience overall) or a lack of support and time to perform the work. The novel finding that indeed many individuals were previously funded by the Plastic Surgery Foundation demonstrates how instrumental the
Plastic Surgery Foundation is in supporting plastic surgery–based research. Given that 44 percent of active Plastic Surgery Research Council members have a history of Plastic Surgery Foundation awards, there is clearly a larger group that could be applying for funding if circumstances were appropriate. It is clear that even with time and support, individuals need guidance on when, why, and how to apply for federal funding. Ultimately, fostering continued interest in research will take commitment not only from training programs but also from academic centers to provide and support staff positions for surgeon scientists.
Table 1. Number and Description of Federal Funding and Subtypes* Grant R01 R03 Exploratory grants R21 P20 Training grants R90 F32 T32 T90 K awards K07 K08 IO1 M01 NSF DOD AFIRM ARO DARPA
No. of Primary Investigators 15 4 8 6 2 6 1 2 2 1 11 1 10 1 2 1 11 6 4 1
Type of Award Research project grant—large award, usually spans several years Small grant program—short period of time Exploratory/developmental research—early stages Exploratory/developmental research—interdisciplinary Interdisciplinary research education (undergraduate, predoctoral or postdoctoral levels) Individual postdoctoral fellowship—up to 3-year award Institutional national research service award Interdisciplinary research training (undergraduate, predoctoral, or postdoctoral levels) Academic career award—for improving curricula in particular field Mentored clinical scientist development award—path to R01 principal investigator Veterans Affairs award General clinical research National Science Foundation Armed Forced Institute of Regenerative Medicine Army Research Office Defense Advanced Research Projects Agency
NSF, National Science Foundation; DOD, Department of Defense; AFIRM, Armed Forces Institute of Regenerative Medicine; ARO, Army Research Office; DARPA, Defense Advanced Research Projects Agency. *National Institutes of Health–funded awards include R-types, exploratory grants, training grants, K awards, and M01. Veterans Affairs awards include I01. Department of Defense awards are as listed.
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Volume 133, Number 5 • Sources of Federal Funding
Fig. 3. Rate of federal funding in individuals who have and have not received prior Plastic Surgery Foundation funding.
Several authors have thoroughly described the rigor required to appropriately train successful surgeon scientists.7,8 During residency, graduate medical education funding supports only clinical training. Individuals with an interest in research are left to pursue their research during limited nonworking hours. Alternatively, if residents or fellows wish to spend 1 to 2 years in research, they must align themselves with an already-established laboratory that can pay a stipend or apply for separate funding sources. However, given the trends in federal funding among plastic surgeons and the quality of plastic surgery trainees, there should be significant enthusiasm for the future of research in the field. This interest and enthusiasm are reflected in increasing conference attendance, including the May 2013 Plastic Surgery Research Council meeting, which had the highest attendance in the history of the organization. Several published studies note the link among National Institutes of Health awards, h-index (used to help define an individual’s publication activity and impact of publications), and advancement in career within academic medicine. More recent publications in otolaryngology and urology have found a strong relationship among h-index, National Institutes of Health funding, and promotion along career paths.9,10 Examination of various surgical subspecialties demonstrated similar trends.11 Analysis of National Institutes of Health funding for general surgery departments indicates those that are increasing their total funding had researchers with “high ratio of dollars/grant.”12 These studies illustrate the importance of government funding not only at the department level but at the individual level of career advancement as well. From an institutional
rather than an individual standpoint, research is an important factor in obtaining department status, in attracting top residency applicants, and in drawing top staff surgeons. A major advantage of federal grants is significant indirect funds critical for research. Indirect funds are typically used for laboratory space and equipment, with a portion of the money designated for the department or institution itself. In contrast, many (even large) society and foundation grants give little or no indirect funds; thus, the researcher needs to either add federal funding or obtain intrainstitutional support. Industry funding does not commonly give significant indirect funds and comes with the potential for conflict of interest. When looking at departmental income overall, relative value units are a standard for measuring an individual’s worth. Because federally funded researchers are required to split time between research and clinical responsibilities, their relative value units from clinical work are most certainly lower compared with nonfunded or industry-funded surgeons. Previous studies have confirmed lower relative value units, and thus lower clinical revenue generated, for federally funded (versus nonfunded or industry-funded) surgeons.13 However, such studies do not take into account indirect funding, which is a significant source of additional revenue awarded to the department and institution. Indirect funds do not go toward supplemental income for the primary investigator individually but rather go toward the department as a whole. Thus, the individual surgeon–scientist is contributing to departmental income from a research source rather than from a clinical source. While this article represents, to our knowledge, the most complete review of federal funding in plastic surgery research, there are some shortcomings. First, it was not possible to include all practicing plastic surgeons in the United States when we searched for grants. Some individuals who are not members of the Plastic Surgery Research Council may receive federal funding for their research and thus would not be included in this review. Second, because we elected to focus specifically on surgeon scientists for the purpose of this article, there is likely underreporting of the true overall level of federal funding as individuals who had a Doctor of Philosophy only (i.e., those without a Doctor of Medicine) or those with a Doctor of Medicine from other disciples who work in plastic surgery departments were excluded from the analysis.
1293
Plastic and Reconstructive Surgery • May 2014 Overall, it appears that individuals who choose to apply for federal funding for their research are successful in the application process. As demonstrated in Figure 1, the number of awards each year for the plastic surgeons in the sample group is increasing despite the decreasing applicant success rate overall.14 In recent years, the success rate for those applying for R01 awards has dropped, with 18 percent success in 2011 and 2012 (versus 22 percent in 2010, 25 to 32 percent throughout the 1990s, and up to 58 percent in the 1960s).15,16 In 2013 and beyond, it has been announced that these rates will decrease further, making the federal grant application process increasingly competitive.
CONCLUSIONS A limited but growing number of individuals appear to receive federal funding for their research. Other nongovernment sources, such as the Plastic Surgery Foundation, provide more opportunities for awards and appear to support those seeking federal-level funding. Overall, the trend toward increasing number of awards per year among plastic surgeons is a source of enthusiasm and indicates that the type and quality of projects being performed are in demand. Brian Gastman, M.D. Cleveland Clinic Foundation 9500 Euclid Avenue Cleveland, Ohio 44195 [email protected]
REFERENCES 1. Rogers CR, Gutowski KA, Munoz-del Rio A, et al. Integrated plastic surgery residency applicant survey: Characteristics of successful applications and feedback about the interview process. Plast Reconstr Surg. 2009;123:1607–1617. 2. Guo L, Friend J, Kim E, Lipsitz S, Orgill DP, Pribaz J. Comparison of quantitative educational metrics between
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