Year: 2024
Type: article
Abstract: Just in case you missed it, in September 2023, JAMA Network Open published an original article in the medical education section titled “National Institutes of Health Funding Gaps for Principal Investigators” (JAMA Netw Open 2023;6:e2331905). The objective of this article by Gillen et al., which focused on persons who receive R01 NIH funding, was to determine incidence rates of principal investigator-level funding gaps, the mean funding gap length, and whether these two metrics are associated with previous funding success (JAMA Netw Open 2023;6:e2331905). Utilizing the NIH RePORTER data from 2011-2021, it was found that 39,944 unique researchers were awarded 220,131 NIH awards, of which 103,753 were R01 awards (JAMA Netw Open 2023;6:e2331905). The authors determined, not surprisingly, that principal investigators with higher NIH funding were less likely to experience a funding gap. Additionally, when these principal investigators encountered a funding gap, this period without funding was shorter and typically lasted two to three years. For most of us, this is not a surprise: highly cited, highly funded NIH principal investigators are likely to receive more funding from the NIH. However, this article should not be ignored, because although their studies represent the NIH-funded, there is a larger issue. The authors, Gillen et al., conclude that “This analysis may be useful to principal investigators and academic institutions as they prepare, structure, and project research resource allocations, working with investigators to develop a strategy for offsetting the risks and consequences of encountering a funding gap” (JAMA Netw Open 2023;6:e2331905). In other words, academic institutions and departments make decisions regarding resource allocation for clinicians and investigators. Anesthesiologists must become part of this broader conversation in order to sustain the anesthesiologist scientist. This sustenance is critical to our survival, since the majority of anesthesiologists are trained in university settings. Embraced by Dr. Jeanine Wiener-Kronish, followed by Dr. Michael Avidan, then to Dr. Jeffrey Kirsch, and continuing with Dr. George Mashour and now me, the AUA has commenced a strategic vision to sustain the academic anesthesiologist. The Mission of the AUA has been updated: To promote excellence in academic anesthesiology through mentorship; promotion of diversity and inclusivity; and professional growth throughout the careers of educators, academic leaders, and researchers. The Vision has been fine-tuned: The advancement of academic anesthesiology as a dynamic specialty that makes substantive contributions to medicine, science, and society. Our Compelling Purpose has become laser focused: Developing scholars, educators, practitioners, and leaders at the forefront of academic anesthesiology. This was a timely strategic pivot from “honor, to honor and action”. By the time you read this article, we would have completed our first return to the university meeting in several years. The paper by Gillen et al. was accompanied by an invited commentary in which Drs. Jennifer Kwan and Cary Gross eloquently highlighted the crux of the issue: Although a record of uninterrupted R01 funding is a symbol of academic success, Gillen et al. have demonstrated that even in the most successful group, the idea of uninterrupted NIH funding as a singular symbol of academic success may not be attainable for the majority of academic physicians (JAMA Netw Open 2023;6:e2332982). Moreover, this symbol may have unintended consequences and could risk “driving away young scientists from the field. This is particularly worrisome for physician scientists – whose dual roles in research and patient care enable them to generate novel insights and strategies for disease prevention and treatment.” And in my opinion, this latter group reflects anesthesiologists. Thus, we are not alone in our challenges for academic space so that we too can develop our research scholars, educators, and practitioners. In 2019, we discovered that physician scientists constitute 1.5% of the biomedical workforce (N Engl J Med 2019;381:399-402). The contribution by anesthesiology physician scientists to the biomedical workforce is even smaller. Physician scientists in anesthesiology are a diverse group represented by MDs and MDs with advanced and doctoral degrees. Clinician anesthesiologists provide insight into disease processes as well as their acute and chronic management in the perioperative period. Clinician anesthesiology scientists provide novel insights for disease prevention and management. Thus, in addition to early career scientists, a funding gap could be detrimental to a clinician investigator, mid-level, or under-represented scientist who may not be part of the NIH-funded. There is a real potential for a lost generation of clinician-scientists, including women and scientists from underrepresented groups. This fact was highlighted in an article in the February 2023 ASA Monitor (ASA Monitor 2023;87:36). Multiple analyses suggest that career development at all stages would generate a stable and engaged workforce (Acad Med 2021;96:1383-8). Hence, the AUA has taken on this focus. Drs. Kwan and Gross make several recommendations in their commentary of the JAMA article: They suggest that lawmakers be encouraged to 1) guarantee increases in the NIH budget by a minimum of the annual inflation rate plus 5% (i.e., 5% increase in real funding), 2) allocate dedicated funds to support mid-career physician scientists, and 3) enhance funding to support early-career scientists (JAMA Netw Open 2023;6:e2332982). Fortunately, these recommendations are being addressed on an organizational level through advocacy by ASA. However, are there additional strategies that we can encourage as anesthesiologists to prevent a lost generation of anesthesiology physician scientists? Through organizations like the AUA and your home institutions, there are further actions we can take to help make a difference: The AUA will provide mentorship, promotion of diversity and inclusivity, and professional growth throughout the careers of educators, academic leaders, and researchers. We ask you to encourage seed funding partnerships between mission-similar academic institutions and nonprofit organizations. We ask that you support partnerships between specialty societies and foundations. Lastly, join the conversation regarding promotion and tenure metrics at your home institutions or alma mater in order to help ensure that clinical-based specialties, along with their physician scientists, are not left behind. Fortunately, the AUA is not alone in supporting professional growth of academic anesthesiologists. Many of our societies have embraced early-career and established academic anesthesiologists. Hence, we can choose to support our academic anesthesiologists at all stages of their careers.Dolores B. Njoku, MD, President, Association of University Anesthesiologists, The Rudolph L. and Mary Frances Wise Endowed Chair in Pediatric Anesthesiology, Professor of Anesthesiology and Pain Medicine, Pathology and Immunology, Chief, Pediatric Anesthesiology, and Vice Chair, Department of Anesthesiology, Washington University in Saint Louis, Saint Louis, Missouri.
Source: ASA Monitor
Author: Dolores B. Njoku
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W4393040260