Patterns of Recent National Institutes of Health Funding in Family Medicine: Analysis Using the NIH Research Portfolio Online Reporting Tools Expenditures and Results System

Common Paths in Medical Education: An Updated Look at the Training of Allopathic, Osteopathic, and Naturopathic Physicians

Context

Allopathic, osteopathic, and naturopathic medical education all prepare students to practice medicine yet diverge in certain respects. Despite the significant changes that have occurred in the education of each discipline, a more recent comparison and analysis of these three pathways hasn't been published.

Objective

The review intended to examine the five segments of the educational process common to all three pathways: admissions, preclinical education, clinical education, graduate medical education, and continuing medical education.

Design

The research team's evaluations and assessments of each pathway are based on publicly available data collected from each pathway's accrediting organizations and from accredited institutions, because these organizations and institutions accurately reflect the generally-accepted standards and practices within each pathway. The research team performed data collection for this study in 2019 to 2020, and the article reflects the changes in the literature up to that point.

Setting

The study took place at Rocky Vista University - Southern Utah in Ivins, Utah; the University of Texas at Austin Dell Medical School in Austin, Texas; the Albany Medical Center in Albany, New York; and the National University of Health Sciences in Lombard, Illinois.

Results

Naturopathic, allopathic, and osteopathic all undergo rigurous pre clinical training which highlights the basic sciences. Naturopathic schools generally have more in classroom hours and less in person clinical experience than osteopathic and allopathic training programs. All three professions have standardized board exams that cover the required curriculum. Many osteopathic students both take and pass the USMLE which highlights the similarities of their curriculum with the allopathic model. A similar comparison can not be made with naturopathic students as they do not take the USMLE. While all three education models have residency programs, naturopathic are more flexible and less standardized than ostopathic and allopathic residency programs.

Limitations

Some data points had to be drawn from conversations as they were not publicly avalable. Credit hours are not sufficient to compare the scope of the curriculum of each education pathway. The NPLEX needs to be compared to both COMLEX and USMLE.

Conclusions

Since 1997, the three major branches of educating physicians have continued to converge pedagogically. The currently most-notable similarity among the three pathways is the preclinical years and their basic-science curriculum. The combined match of allopathic and osteopathic residents, as well as increasing similarities and crossovers in curriculum and methods of practice, highlight this fact. Philosophy and methodologies of practice continue to distinguish these educational pathways, but their increasing similarities may lead to further convergence of practice and pedagogical models.

National Institutes of Health Funding in Internal Medicine: Analysis of Physicians Receiving an R01 Grant Between 2008 and 2017

Introduction As the world's largest funding source for biomedical research, the National Institutes of Health (NIH) supports physician-scientists with a discipline-specific R01 grant. Recently, scholarly activity disparities regarding investigator degree and gender have been highlighted in the medical literature among allopathic and osteopathic investigators of various medical backgrounds. We aimed to assess trends in internal medicine NIH R01 grants over the past decade. Methodology Internal medicine R01 funding was retrospectively obtained from a centralized online NIH database encompassing 2008 through 2017. Principal investigators (PIs) were then categorized by gender and academic degree(s). Two-way analysis of variance was used to analyze NIH grant funding trends over the time period studied. Results A total of 5,089 NIH R01s were awarded to internal medicine PIs, with an average value per grant of $469,270. Awardees were predominantly male (71.5%, 3,639/5,089). Most awards were issued to PIs with an MD degree (62.4%, 3,173/5,089), followed by PhD degree (36.3%, 1,845/5,089). DOs accounted for five awards over the time period studied (0.15%). MDs were awarded higher funding than PhDs ($466,494 and $421,576, p < 0.001), and females were awarded higher amounts than males ($462,771 and $444,868, p < 0.001). Investigators who held a second degree received more funding than PIs with a single degree ($476,693 and $439,693, p < 0.001). Conclusion In the decade under investigation, both gender and degree disparities existed within NIH R01 funding for PIs in the field of internal medicine, and osteopathic representation accounted for a paucity of R01 funding.

Medical Degree Disparity Among Authors of Original Research in Pediatric Journals: A Four-Year Follow-Up

Introduction and Objective: Scholarly activity is a major component of residency training and the accreditation process for graduate medical education. In 2014, Accreditation Council for Graduate Medical Education and the American Association of Colleges of Osteopathic Medicine announced a single accreditation system with the transition beginning July 1, 2015. Previous data before the transition had shown that osteopathic physicians rarely published original research in three high-impact pediatric journals. The objective of this study is to determine if there is a degree disparity between osteopathic and allopathic physicians among authors who publish original research manuscripts in three high-impact pediatric journals after the beginning of the transition to a single graduate medical education accreditation system. 

Methods: Degree designation for the first and senior authors of original research manuscripts was reviewed for the Journal of Pediatrics (J Pediatr), Pediatrics, and JAMA Pediatrics (JAMA Pediatr) for the years 2016, 2017, 2018, and 2019. Inter-rater reliability was calculated by the kappa coefficient, and data were analyzed with descriptive statistics and simple linear regression. 

Results: A total of 3,252 manuscripts and 4,068 authors were reviewed with 0.98% of all authors being osteopathic physicians. A total of 1.65% of first authors and 0.41% of senior authors were osteopathic physicians. For those with a dual degree, a total of 1.03% of first, and 0.41% of senior authors were osteopathic physicians. No statistical trend could be established for increased first, senior, dual-degree first, or dual-degree senior osteopathic physician authorship.

Conclusion: Osteopathic physicians continue to be underrepresented as first and senior authors in original publications in the three high-impact pediatric journals as compared to their allopathic counterparts. 

Comprehensive National Institutes of Health funding analysis of academic cardiac surgeons

OBJECTIVE

To determine trends in National Institutes of Health (NIH) funding for cardiac surgeons, hypothesizing they are at a disadvantage in obtaining funding owing to intensive clinical demands.

METHODS

Cardiac surgeons (adult/congenital) currently at the top 141 NIH-funded institutions were identified using institutional websites. The NIH funding history for each cardiac surgeon was queried using the NIH Research Portfolio Online Reporting Tools Expenditures and Results (RePORTER). Total grant funding, publications, and type was collected. Academic rank, secondary degrees, and fellowship information was collected from faculty pages. Grant productivity was calculated using a validated grant impact metric.

RESULTS

A total of 818 academic cardiac surgeons were identified, of whom 144 obtained 293 NIH grants totaling $458 million and resulting in 6694 publications. We identified strong associations between an institution's overall NIH funding rank and the number of cardiac surgeons, NIH grants to cardiac surgeons, and amount of NIH funding to cardiac surgeons (P < .0001 for all). The majority of NIH funding to cardiac surgeons is concentrated in the top quartile of institutions. Cardiac surgeons had a high conversion rates from K awards (mentored development awards) to R01s (6 of 14; 42.9%). Finally, we demonstrate that the rate of all NIH grants awarded to cardiac surgeons has increased, driven primarily by P and U (collaborative project) grants.

CONCLUSIONS

NIH-funded cardiac surgical research has had a significant impact over the last 3 decades. Aspiring cardiac surgeon-scientists may be more successful at top quartile institutions owing to better infrastructure and mentorship.

National Institutes of Health Funding in Obstetrics and Gynecology: Analysis of R01 Grants by Degree and Gender

INTRODUCTION

Limited data currently exist regarding the demographics of principal investigators (PIs) in obstetrics and gynecology (OBGYN), who have received an R01 grant from the National Institutes of Health (NIH).

OBJECTIVE

This study investigated funding differences among gender and advanced degree for PIs in the disciplines of OBGYN.

METHODS

Retrospective data were collected from the NIH Research Portfolio Online Reporting Tools Expenditures and Results (RePORTER) tool to identify OBGYN PIs who received an R01 grant between 2008 and 2017.  Results: Between 2008 and 2017, the NIH awarded 263 R01 grants totaling $113,326,883 in funding to investigators in OBGYN. Male PIs and PIs holding a non-medical degree were awarded the majority of R01 grants (52.47% and 55.51%, respectively). Zero osteopathic (Doctor of Osteopathic Medicine [DO]) physicians were awarded an R01 grant in OBGYN during this time period. Females were awarded larger dollar amounts than males ($449,556 vs $414,003, p=0.04). Allopathic (Doctor of Medicine [MD]) physicians were awarded larger grants than scientists holding a non-medical degree ($467,849 vs $401,291, p<0.01). Both male and female MD physicians were awarded more dollars per grant as compared with PIs holding a non-medical degree (p=0.01 and p<0.01, respectively).

CONCLUSIONS

Between 2008 and 2017, a degree disparity was found to exist for investigators who received an NIH R01 grant in OBGYN. Females and investigators holding an MD degree were awarded larger total grants than their male and non-physician counterparts. Further research needs to be undertaken to understand the degree disparity and recent funding trends by the NIH.

From advocacy to austerity: The new role of the U.S. public sector in HIV drug development and access

Whereas advocacy was once the driving force for U.S. public support for HIV drug development and access, the nation's response to the global epidemic is now shaped by austerity. Extending past scholarship about the role of advocates and governments in support of drug development and access around the world, in this article I identify key shifts in U.S. public sector support over the past 40 years. During the early years of the AIDS epidemic, the U.S. government and civil society expedited drug development for antiretroviral therapy (ART). After the turn of the century, a new wave of advocacy expanded access for ART, including to low- and middle-income countries through the U.S. President's Emergency Plan for AIDS Relief (PEPFAR). On the heels of these accomplishments, advocates and governments set an ambitious agenda to 'End AIDS' by 2030. However, progress toward this goal has been limited by a new era of austerity, as demonstrated by U.S. government spending on HIV.