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Assessment of the NIH Salary Cap Gap Reveals the Increasing Financial Burden of Training and Hiring Surgeon-Scientists
*
Juliet Emamaullee1, *Sarah Bangerth
1, *Krista Haines
2, *Shannon Jordan
1, David Linehan
3, Arden Morris
4, Anton Sidawy
5, Timothy Donahue
6, Ankush Gosain
8, Todd Rosengart
71Surgery, University of Southern California, Los Angeles, CA; 2Surgery, Duke University, Durham, NC; 3Surgery, University of Rochester, Rochester, NY; 4Surgery, Stanford University, Palo Alto, CA; 5Surgery, George Washington University, Washington, ; 6Surgery, UCLA, Los Angeles, CA; 7Surgery, Baylor University, Houston, TX; 8University of Virginia, Charlottesville, VA
Objectives: Surgeon-scientists are critical to advancing our understanding of surgical diseases and innovating care of surgical patients. However, demands for clinical productivity while securing extramural funding in the setting of increasingly competitive NIH funding paylines has limited growth of the surgeon-scientist workforce, which represents <1% of all federally funded principal investigators. The goal of this study was to evaluate trends in the cost share required by departments or institutions to support NIH funded surgeon trainees and faculty.
Methods: The federal Executive Level II salary cap and T32/F32 Postdoctoral Fellow stipends (0 years of experience) were obtained from the NIH website. The median total compensation for faculty at the Associate Professor level (PhD, Total Clinical Faculty, Total Surgeons, and within surgical subspecialties) and PGY3 level residents (incorporating 30% fringe benefits) were obtained from Association of American Medical College data. Data were analyzed for fiscal year 2010 to fiscal year 2023 based on 20% effort for faculty investigators and a non-modular budget of $500,000 direct costs. The impact of inflation was evaluated using the Biomedical Research and Development Price Index and Consumer Price Index. Changes in the salary cap gap over time (with a 95% confidence interval (CI)) were forecasted using an exponential smoothing algorithm.
Results: Over the study period, there was no cost share required for PhD scientists, while the cost share for a surgeon investigator increased from $34,260 to $68,660 per year (100% increase). For a single T32/F32 trainee, the cost share increased from $22,932 to $31,608 per year (38% increase). For a T32 training grant with a surgeon investigator at 10% effort with no salary budgeted and four positions, the total cost share increased from $128,828 to $181,971 per year. As of fiscal year 2023, the total cost share for a department to support one NIH-funded surgeon at 20% effort and one T32 training grant with four positions was estimated to be $250,631. The cost share for surgeon investigators is projected to expand by another 47% by 2035 versus 2023, further widening the salary cap gap (
Figure 1).
Conclusions: This analysis demonstrates that the NIH salary cap gap for surgeon trainees and investigators creates a financial burden on departments of surgery, which is projected to increase substantially over the next decade. It is likely that this will limit the capacity to train and hire the surgeon-scientist workforce. These data highlight the urgency to advocate for policy development to adequately compensate federally funded surgical investigators and should facilitate dialogue within institutions to develop alternative funding mechanisms to support surgeon scientists.
Figure 1: Projected NIH Salary Cap Gap per year for each surgeon investigator at the Associate Professor Level with 20% effort. By 2035, this is projected to expand 47% further from 2023 levels (projected gap in 2035 is -$101,125 [-108,182, -94,068].
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