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Postdoctoral National Institutes of Health F32 Grants: Broken Pipeline in the Development of Surgeon Scientists
Adishesh K. Narahari*1, Anirudha S. Chandrabhatla1, Emily Fronk1, Simon White1, Shreya Mandava1, Hannah Jacobs-El1, J H. Mehaffey2, Curtis G. Tribble1, Mark Roeser1, John Kern1, Irving Kron1, Bruce Schirmer1
1Department of Surgery, University of Virginia, Charlottesville, VA; 2Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WV

Objective(s): National Institutes of Health (NIH) F32 National Research Service Awards (NRSA) are individual grants awarded to medical/surgical residents pursuing dedicated research time. We sought to evaluate the impact of this funding mechanism as well as the short and long-term productivity of medical compared to surgical trainees receiving these grants.

Methods: NIH Research Portfolio Online Report Expenditures and Results (RePORTER) was queried for F32 grants awarded to surgery and internal medicine departments from 1991 to 2021. Subsequent grants for each F32 recipient (K-award, R01 etc.) were investigated. Total funding, publications, and citations for manuscripts from each grant were collected. A previously published grant impact metric was calculated for each grant using the following: sum of citations from manuscripts / funding for grant (per $100,000). Demographic information such as fellowship training, professorship level, leadership positions (division chief, chairman, or program director) for each F32 principal investigator was collected from institutional webpages. Chi-square tests and non-parametric t-tests were used to analyze categorical variables.

Results: A total of 1003 F32 grants were analyzed: 268 to surgeons and 735 to internal medicine physicians. In 2021, general surgery had 1337 residents and internal medicine had 7839 residents. Comparing the size of each specialty, surgery has proportionately more F32s compared to internal medicine (P < 0.0001). Surgery trainees published 1485 manuscripts with F32 funding (5.5 manuscripts/trainee) whereas internal medicine trainees published 1617 (2.2 manuscripts/trainee, P < 0.0001). Median grant impact metric was not significantly different between the two groups (46.1 for surgery compared to 57.6 for internal medicine; P = 0.127). Surgeons converted 48 F32 grants into all types of future NIH grants (48/268; 18%) and internists converted 338 F32 grants (338/736; 46%) (P < 0.0001). Subsequent grants total $1.5 billion for internal medicine trainees and $176 million for surgery trainees. A total of 22/268 (9.0 %) surgery trainees and 144/735 (19.6%) internal medicine trainees converted F32 grants into R01 funding (P < 0.0001). Surgery R01 grants totaled $131 million (n = 50) and internal medicine R01 grants totaled $624 million (n = 293).

Surgery trainees are effective at applying for and receiving F32 funding and are extremely productive during their research years. However, compared to internal medicine trainees, surgery residents have less success in converting this funding into future NIH funding even though they are equally productive in terms of citations per dollar. While the clinical demands on surgeons and medical doctors differ, this analysis highlights that our specialty must capitalize on the talent developed during the F32 support to foster research in early career surgeons as they apply for additional NIH funding.

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