Hope and Challenges for the Vanishing Pediatric Physician-Scientists

Physician-scientists in general, and pediatric physician-scientists in particular, are vanishing.^1– 3 Rates of National Institutes of Health (NIH) awards to pediatric departments have declined from 23.8% to 16.8% during the past 10 years.⁴ Being granted an NIH independent investigator award (R01) is not only a means to support a physician-scientist’s research but also is a commonly required milestone for promotion. Details of R01-funded pediatric physician-scientists, including the number of R01 awards granted, individuals who are awarded an R01, and their institutions, subspecialties, academic rank, leadership status, and sex, are unknown.

The NIH Reporter (https://projectreporter.nih.gov/reporter.cfm) was accessed on May 17, 2017, using the following search criteria: (1) department type (“Pediatrics”), (2) fiscal years 2012 to 2017, and (3) activity code “R01 Equivalents” (DP2, R01, R23, R29, R37, and RF1). Because some institutions with NIH-funded investigators may not identify with a “Department of Pediatrics,” we added an additional search using “Children’s Hospital” in the “organization” search field with “contains” as the qualifier. Duplications, administrative supplements, and yearly renewals for the same award were removed while competitive renewals were included. Individual awardees were identified (individuals with more than 1 award were represented only once) and their pediatric division, sex, terminal degree, current academic rank, and administrative status as division chief, department chair, or dean was determined using an internet search.

We identified 6870 R01-equivalent awards (including yearly renewals for the same award; 2471 individual grants were awarded to 1593 investigators) during the fiscal years 2012 to 2017. One thousand eight hundred ninety-one of the individual 2471 R01-equivalents (76.53%) were new (<5 years of support). Fifteen institutions supported 1561 of all R01-equivalent awards (63%) (Table 1) and 6 NIH institutes (National Heart, Lung, and Blood Institute [n = 560, 20.5%]; National Institute of Diabetes and Digestive and Kidney Diseases [n = 345, 14%]; National Institute of Allergy and Infectious Diseases [n = 316, 13%]; National Cancer Institute [n = 257, 10.4%]; National Institute of Child Health and Human Development [n = 229, 9.3%]; and the National Institute of Neurological Disorders and Stroke [n = 209, 8.5%]) supported 75% of the awards. Among the 1593 investigators with R01-equivalent awards, 907 (57%) had an MD-equivalent degree or an MD with an additional graduate degree. Their pediatric divisions are represented in Table 2. Five hundred twenty-six of the 907 physician-scientists (58%) currently hold the rank of professor and 219 (24%) hold chief, chair, or dean positions. Program project grants and center grants (P01, M01, P20, P30, P50, and U54) over the same period were awarded to 268 individual scientists in pediatrics (who were not limited to physician-scientists), of whom 91 (34%) were already represented among the 1593 we identified. A query of NIH Reporter on October 8, 2017, using the same strategy that was used for R01s identified 644 R21 awards to 522 individuals, of whom 278 (53%) were already represented on the R01 or PPG list.

To our knowledge, this is the first data-supported pediatric-focused report to describe the number and characteristics of NIH R01–funded pediatric physician-scientists. That there were a limited number of awards made to investigators concentrated at a few institutions (Table 1) and that the awards were granted primarily to men (63.6%) in senior positions, many of whom had dual (academic/administrative) roles, raises concerns for our ability to motivate and develop young trainees to choose this path. While the number of awards does not predict the effect of the discoveries, that there were 2471 R01 awards over a 5.4-year period granted to all scientists in pediatrics nationwide (including established physician-scientists), and only 379 to nonprofessor physician-scientists (data not shown) is troubling.

The NIH recognizes the reduction in the physician-scientist workforce and has implemented several interventional programs.^5,6 Increases in the number of mentored physician-scientist (K) awards and a priority for R01 funding for first-time applicants help to offset fewer new physician-scientists entering the work force, but K award applications have declined recently.⁵ We recognize that all physician-scientists might not be captured using our approach and many physician-scientists may have garnered support via other mechanisms outside the R01 (eg, foundation funding). However, our results are concerning because an R01 is a common requirement in academic centers for (1) promotion, (2) the opportunity to serve as a research mentor, and (3) junior scientists transitioning from career development awards.

Corresponding Author: James L. Wynn, MD, Division of Neonatology, Department of Pediatrics, University of Florida, 1600 SW Archer Rd, PO Box 100296, Gainesville, FL 32610-0296 (james.wynn@peds.ufl.edu).

Published Online: January 16, 2018. doi:10.1001/jamapediatrics.2017.4947

Author Contributions: Dr Wynn had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Good, McElroy, Wynn.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Good, McElroy, Wynn.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Good, McElroy, Wynn.

Obtained funding: Good, Wynn.

Administrative, technical, or material support: Good, McElroy, Wynn.

Supervision: Good, McElroy, Wynn.

Conflict of Interest Disclosures: None reported.

Funding/Support: Dr Wynn receives support from grant K08GM106143 from the National Institutes of Health (NIH)/National Institutes of General Medical Science and from grant R01HD089939 from the NIH/Eunice Kennedy Shriver National Institute of Child Health and Human Development. Dr. Good is supported by grants K08DK101608 and R03DK111473 from the NIH, March of Dimes Foundation Grant 5-FY17-79, the Children’s Discovery Institute of Washington University and St Louis Children’s Hospital, and the Department of Pediatrics at Washington University School of Medicine, St Louis.

Role of the Funder/Sponsor: The funding organizations had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Reproducible Research Statement: The complete methodologic details and data are available at http://www.peds.ufl.edu/files/Wynn2017/.