Exploring Match Space: How Medical School and Specialty Characteristics Affect Residency Match Geography in the United States

The COVID-19 pandemic has disrupted the residency match process by eliminating away rotations and changing from in-person to virtual interviews. In this study, we explore the impact of the COVID-19 pandemic on the geographic match distance of United States (US) senior medical students across all specialties. We collected publicly available student match data between 2018 and 2021 from US allopathic medical schools and calculated match distance between medical school and residency training using a novel metric - the "match space." Match space was codified by whether the student matched at their home institution, home state, adjacent state, same or adjacent US census division (non-adjacent state) or skipped at least one US census division. Adjusting for covariates, ordinal logistic regression correlated school and specialty characteristics with match distance pre- and post-pandemic for all specialties. We defined and ranked specialty competitiveness using predictive values from factor analysis. A total of 34,672 students representing 66 medical schools from 28 states matched into 26 specialties in 50 states and Canada. Fifty-nine percentof students were from public institutions, and 27% of schools ranked in the top 40 for research. The mean percentage of in-state students by school was 60.3% (range 3-100%). Match space was lower after the pandemic (adjusted odds ratio (OR) 0.94, 95% CI 0.90-0.98; p=0.006), from schools with higher in-state percentages (OR 0.74, 95% CI 0.72-0.76), from top National Institutes of Health-funded institutions (OR 0.88, 95% CI 0.85-0.92), from the Northeast (OR 0.71, 95% CI 0.67-0.75; Midwest reference), and the West (OR 0.67, 95% 0.60-0.74). Match space was higher for students graduating from private schools (OR 1.11, 95% CI 1.05-1.19), from the South (OR 1.62, 95% CI 1.2-1.33), and matching into more competitive specialties (OR 1.08, 95% CI 1.02-1.14). The top five most competitive specialties were Plastic Surgery, Neurosurgery, Dermatology, Orthopedic Surgery, and Otolaryngology. Internal Medicine ranked eighth. After the COVID-19 pandemic, students graduating from US allopathic schools matched closer to their home institution. Students attending public schools, schools with more in-state matriculants, and schools with higher research rankings also matched closer to their home institutions. Specialty competitiveness and US census region also impacted match distance. Our study adds insight into how geographic match patterns were influenced by school, specialty choice, and the pandemic.

How Important Is the Contribution of Surgical Specialties to a Medical School’s NIH Funding?

National Institutes of Health (NIH) funding of orthopaedic surgery departments has historically lagged behind that of other surgical disciplines. In this study, we present an updated analysis of NIH grants awarded to orthopaedic surgery departments at U.S. medical schools and an evaluation of the characteristics of NIH-funded principal investigators (PIs). The NIH Research Portfolio Online Reporting Tools Expenditures and Results (RePORTER) database was queried for grants awarded to orthopaedic surgery departments in the 2015 to 2021 fiscal years. Funding totals were calculated for 4 categories: award mechanism, awarding institute, recipient institute, and PI. Trends in funding from 2015 to 2021 were determined and compared with the annual NIH budget. Funding awarded to orthopaedic surgery departments was compared with awards received by other surgical specialties in 2021. The characteristics of NIH-funded PIs and co-PIs were evaluated. Funding awarded to orthopaedic surgery departments in 2021 was compared with funding in 2014 as reported in a previous study. In 2021, 287 grants were awarded to 187 PIs at 47 orthopaedic surgery departments for a total of $104,710,841, representing 0.4% of the overall NIH budget. The top 5 departments earned $41,750,321 (39.9%) of the total NIH funding for orthopaedic surgery. From 2015 to 2021, total funding increased by 79.7% (p < 0.001), but the rate of increase was not significantly different from that of the overall annual NIH budget (p = 0.469). In 2021, grants were most commonly awarded via the R01 mechanism (70.0% of total funding), with a median annual award of $397,144 (interquartile range [IQR], $335,017 to $491,248). The majority of grants (70.0%) supported basic science research, followed by translational (12.2%), clinical (9.4%), and educational (8.4%) research. NIH funding did not vary by the gender of the PI (p = 0.505), and the proportion of female PIs was significantly greater in 2021 than in 2014 (33.9% versus 20.5%, p = 0.009). Compared with other surgical departments, orthopaedic surgery departments ranked second-lowest in terms of the total NIH funding received in 2021. NIH funding to orthopaedic surgery departments continues to be limited and lags behind that of other surgical subspecialties, which may create challenges in addressing the rising burden of musculoskeletal disease in the U.S. These findings highlight the importance of efforts to identify barriers to grant procurement in orthopaedic surgery.

Is There a Relationship between National Institutes of Health Funding and Research Impact on Academic Urology?

The Elephant in the Room: NIH Funding of Faculty-Initiated Award Proposals

To examine trends in National Institutes of Health (NIH) funding to U.S. medical schools and their academic departments and the amount of awards provided by each of the NIH institutes. All data on NIH awards to U.S. medical schools from 2000 to 2020 are publicly available and were obtained from the NIH Research Portfolio Online Reporting Tools and Blue Ridge Institute for Medical Research. These data include the value and number of awards to each medical school, medical school department, medical school location, principal investigator, and the NIH awarding institute. Trends in the inflation-adjusted awards from 2011 to 2020 were calculated and a comparison of the awards made in 2011 and 2020 was performed. The total NIH budget increased by 16.1% from 2011 to 2020. The allocation of NIH funds to medical schools increased 26.3% ($13.7 billion to $17.3 billion) during this interval. In 2020, 29.3% of all medical school NIH funds were allocated to departments of internal medicine/medicine. Psychiatry was the second ranking department, which was followed, in order, by pediatrics, neurology, and microbiology/immunology/virology. The National Cancer Institute, National Institute of Allergy and Infectious Diseases, and National Heart, Lung, and Blood Institute were the top medical school funding institutes in 2011 and 2020. Medical schools as a group continue to receive the greatest percentage of NIH funding. Funding to clinical science departments increased by a larger percentage than that to basic science departments (35.3% vs 10.9%, respectively) over the 2011-2020 interval. Funding for clinical science departments is increasing at a faster rate than that of basic science departments. However, that so much investigation in basic science and clinical science departments is performed by personnel with a PhD degree indicates the goals and methods of the basic and clinical sciences may not be so different.

Purpose To analyze trends in National Institutes of Health (NIH) funding in ophthalmology and characterize its distribution to departments and principal investigators (PIs) affiliated with U.S. medical schools. Design Longitudinal descriptive analysis. Methods We queried publically accessible data from the Blue Ridge Institute for Medical Research and NIH RePORTER to determine annual funding trends in ophthalmology from 2009 to 2020. To characterize the distribution of funding, we further ranked the top departments and principal investigators (PIs). Department websites (among other online resources) were utilized to extract characteristics of the latter cohort. Results After adjusting for inflation, we observed a modest 9% increase in median NIH funding to academic ophthalmology departments between 2009 and 2020. In the same time period, among individual PIs, this translated to a 9% decline in median funding. Our results among both departments and PIs indicated a persistent inequality in NIH funding. In 2020, 10 ophthalmology departments received 44% of total funding, which is consistent with findings from prior years. Our ranking of PIs by average annual NIH funding indicated a disproportionate representation of males (76%) and PhDs (58%) in the top 50. Conclusions Overall, the results of this investigation suggest NIH funding remains limited for individual investigators, reflecting the increasingly competitive nature of the grant application process. Systemic alterations will be required to reverse these trends. If not accomplished, nascent and established researchers alike will continue to endure challenges in obtaining and maintaining funding.

Analysis of National Institutes of Health Funding to Departments of Urology

The Authors’ Reply—The differences Ramachandran et al. note between our results1 and two other recent publications2,3 may be explained by both the analytic approaches used in our different studies and the outcomes we examined. In their important papers, both King et al. and Epstein et al. analyzed prescribing patterns for psychoactive drugs, using difference-in-differences models that dichotomized medical schools or residency training programs based on their conflict of interest policies alone, and found that those policies were important predictors of subsequent actual drug prescribing decisions. By contrast, we examined the relationship between students’ self-reported receipt of gifts and two characteristics of their medical schools—conflict of interest policies represented by the American Medical Student Association (AMSA) PharmFree Scorecard score and National Institutes of Health (NIH) funding. We found that students’ receipt of gifts correlates strongly with lower levels of NIH funding at their schools, but less so with the schools’ AMSA score after controlling for NIH funding level, suggesting that a higher AMSA score is closely correlated with a school’s receiving above-average NIH funding. As a result, the score may add little further power to account for this behavior beyond the research intensity of the institution. Our findings should not be interpreted to reduce the importance of institutional policies to control conflict of interest issues for trainees. This is still a young area of investigation, and more studies such as these are needed to clarify the best way to implement conflict of interest policies, and the effect of doing so on improving clinical decision-making. These policies emerged in the King et al. and Epstein et al. studies as valid predictors of subsequent rational prescribing behavior on the part of trainees. Despite these salutary downstream effects, our findings also suggest that the reported policies may not completely reflect the day-to-day reality of the medical learning environment that shape trainees. We agree with Ramachandran et al. that meaningful enforcement of conflict of interest policies is essential. Further research can identify better ways to measure implementation of these policies to ensure that resources are optimally directed to interventions that will change trainees’ attitudes and behaviors to benefit patients. Finally, we would like to direct readers’ attention to the revised Figure 1 in an accompanying Erratum. The original Figure contained clerical errors in the regression models.

Advice for Early Career Clinical Stroke Researchers Applying for National Institutes of Health Funding.

Surgeon-scientists are uniquely positioned to facilitate translation between the laboratory and clinical settings to drive innovation in patient care. However, surgeon-scientists face many challenges in pursuing research, such as increasing clinical demands that affect their competitiveness to apply for National Institutes of Health (NIH) funding compared with other scientists. To examine how NIH funding has been awarded to surgeon-scientists over time. This cross-sectional study used publicly available data from the NIH RePORTER (Research Portfolio Online Reporting Tools Expenditures and Results) database for research project grants awarded to departments of surgery between 1995 and 2020. Surgeon-scientists were defined as NIH-funded faculty holding an MD or MD-PhD degree with board certification in surgery; PhD scientists were NIH-funded faculty holding a PhD degree. Statistical analysis was performed from April 1 to August 31, 2022. National Institutes of Health funding to surgeon-scientists compared with PhD scientists, as well as NIH funding to surgeon-scientists across surgical subspecialties. Between 1995 and 2020, the number of NIH-funded investigators in surgical departments increased 1.9-fold from 968 to 1874 investigators, corresponding to a 4.0-fold increase in total funding (1995, $214 million; 2020, $861 million). Although the total amount of NIH funding to both surgeon-scientists and PhD scientists increased, the funding gap between surgeon-scientists and PhD scientists increased 2.8-fold from a $73 million difference in 1995 to a $208 million difference in 2020, favoring PhD scientists. National Institutes of Health funding to female surgeon-scientists increased significantly at a rate of 0.53% (95% CI, 0.48%-0.57%) per year from 4.8% of grants awarded to female surgeon-scientists in 1995 to 18.8% in 2020 (P < .001). However, substantial disparity remained, with female surgeon-scientists receiving less than 20% of NIH grants and funding dollars in 2020. In addition, although there was increased NIH funding to neurosurgeons and otolaryngologists, funding to urologists decreased significantly from 14.9% of all grants in 1995 to 7.5% in 2020 (annual percent change, -0.39% [95% CI, -0.47% to -0.30%]; P < .001). Despite surgical diseases making up 30% of the global disease burden, representation of surgeon-scientists among NIH investigators remains less than 2%. This study suggests that research performed by surgeon-scientists continues to be underrepresented in the NIH funding portfolio, highlighting a fundamental need to support and fund more surgeon-scientists.

Introduction Existing literature reports a general trend of increasing National Institutes of Health (NIH) funding for surgeon-scientists in America and shows that urology has not benefited from this trend. NIH funding for urologists continues to lag behind that of our peers in other surgical specialties. Between 2010-2019 urology departments received the second-lowest amount of NIH funding of all surgical specialties, only above plastic surgery. The literature also shows that NIH awards significantly less money to male cancer research (i.e., prostate cancer) than female cancer research (i.e., breast cancer). We sought to explore further gender-specific grant variation within NIH urologic funding by exploring dollars awarded to benign gender-specific non-cancer topics of urologic research. We hypothesized that an NIH funding disparity would exist between men’s health urologic research and research devoted to women’s health urologic issues. Objective To explore NIH funding trends for men's and women's urologic health conditions via the NIH Reporter database Methods We used the publicly available NIH Research Portfolio Online Reporting Tools Expenditures and Results (NIH RePORTER) to perform our data collection. NIH RePORTER is an online search tool of the repository of NIH-funded research projects and is linked to publications, patents and clinical trials resulting from NIH funding. Data was queried for a ten-year period between 2012-2021. We used uniform search parameters including “Department Type: urology” to filter for publications from departments of urology, “Funding Mechanism: research project grant” to eliminate R&amp;D, and “Award Type: new” to capture only first-time awards in our search period. All authors were included in our search, which encompassed both trainees and non-trainees independent of Activity Code. We selected four women’s urological health issues and four men’s urological health issues to guide a keyword search. Our women’s urological health issues included overactive bladder, incontinence, and pelvic organ prolapse. In addition, we queried the NIH Spending Category of “Women’s Health”. Our men’s urological health issues include erectile dysfunction, Peyronie's disease, hypogonadism and male stress incontinence. Search terms related to these health conditions were used to query project title, projects terms and project abstracts in the NIH RePORTER. Results Results of our research findings are summarized in Table 1. Of the 12 projects identified that exclusively investigate either a men’s health condition or a women’s health condition, 7 focused on men’s health and 5 on women’s health. NIH spending on women’s health issues exceeded that for men's health conditions by $833,964, a 51% difference, even though fewer projects were identified related to women’s health conditions. Overall, fewer gender-exclusive projects were found than expected. For example, incontinence projects frequently included both male and female-bodied participants. Conclusions NIH appears to devote substantially less funding for investigating benign urologic men’s health issues than benign urologic women’s health issues. Further examination of this funding gap is warranted, and if confirmed it would be prudent to improve NIH urologic funding in general and men’s health research funding specifically. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast.

Surgeon scientists remain underrepresented among recipients of National Institutes of Health (NIH) grants despite their unique ability to perform translational research. This study elucidates the portfolio of NIH grants awarded for degenerative spine diseases and the role of spine surgeons in this portfolio. The most common diagnoses and surgical procedures for degenerative spine diseases were queried on the NIH Research Portfolio Online Reporting Tools Expenditures and Results (RePORTER) database (2011-2021). Total NIH funding was extracted for 20 additional clinical areas and compound annual growth rates (CAGRs) were calculated. A retrospective cohort study of principal investigators (PIs) was conducted. NIH grants and funding totals were extracted and compared to those from other clinical areas. The total NIH research budget increased from $31 to $43 billion over the 10-year period (CAGR 3.4%). A total of 273 unique grants equaling $91 million (CAGR 0%) were awarded for degenerative spine diseases. Diabetes ($11.8 billion, CAGR 0%), obesity ($10.6 billion, CAGR 3%), and chronic pain ($5.6 billion, CAGR 7%) received the most funding. Most NIH funding for degenerative spine disease research was awarded through the R01 (66%) and R44 (8%) grant mechanisms. The National Institute of Arthritis and Musculoskeletal and Skin Diseases awarded the most NIH funding (64%). Departments of orthopedic surgery were awarded the most funding (32%). NIH funding supported clinical (28%), translational (37%), and basic science (35%) research. Disease mechanisms (58%), imaging modalities (20%), and emerging technologies (16%) received the most funding. Nineteen spine surgeons were identified as PIs (16%). There were no significant differences in NIH funding totals by PI demographic and academic characteristics (p > 0.05)-except for full professors, who had the most NIH funding (p = 0.007) and highest h-index values (p < 0.001). Few spine surgeons receive NIH grants for degenerative spine disease research. Future opportunities may exist for spine surgeons to collaborate in identified areas of clinical interest. Additional strategies are needed to increase NIH funding in spine surgery.

Prior research suggests an association between burden of disease and National Institutes of Health (NIH) funding. The allocation of NIH funding should reflect, to some extent, the health needs of the population, along with other factors. To examine the factors associated with NIH funding in 2019 for 46 diseases. This cohort study used disability-adjusted life-years to measure the 2008 and 2019 US burden of disease and compared them with NIH categoric funding for 46 diseases. Disability-adjusted life-years to measure the 2008 and 2019 US burden of disease, 2016 health spending, and 2008 NIH funding levels for 46 diseases. 2019 NIH funding levels for 46 diseases. The 46 diseases accounted for 62 392 713 of 94 399 784 disability-adjusted life-years (66.1%) in 2008 and 75 706 718 of 111 074 472 disability-adjusted life-years (68.2%) in 2019, representing more than 66% of all disability-adjusted life-years in both years. By dollar volume, Alzheimer and dementia increased the most, with approximately $1.8 billion more funding in 2019 than 2008 (from $530 million in 2008 to $2398 million in 2019, a 352% increase), whereas interpersonal violence had the greatest decrease, $95 million, in 2019 NIH funding (from $236 million in 2008 to $141 million in 2019, a 40% decrease). For the 46 diseases in this study, the variable with the greatest association with NIH funding in 2019 was the level of NIH funding in 2008, with a simple correlation of 0.88. Burden of disease and changes in burden of disease were not statistically significantly associated with NIH funding levels once the prior level of funding was included in the model. The models suggested that a 1% higher level of NIH funding in 2008 was associated with a 0.91% higher level of NIH funding in 2019. In this study, NIH spending for most diseases seemed to be based primarily on the level of NIH spending more than 10 years earlier, despite changes in burden of disease. Congress and the NIH should examine the allocation process to ensure NIH investments are responsive to changes in the health of the population.

The American Gastroenterological Association Supports a 6.7% Funding Increase for the National Institutes of Health in Fiscal 2008