A comparative analysis of National Institutes of Health research support for emergency medicine – 2008 to 2017

Abstract

Objectives

We sought to compare National Institutes of Health (NIH) funding received by Emergency Medicine (EM) to the specialties of Family Medicine, Neurology, Orthopedics, Pediatrics and Psychiatry over the 10-year period from 2008 to 2017.

Methods

The NIH database of both submitted and funded NIH applications were queried and crossed with the departmental affiliation of the principal investigator. Research Grants were defined by the following activity codes: R, P, M, S, K, U (excluding UC6), DP1, DP2, DP3, DP4, DP5, D42 and G12. Derived data were further analyzed using information from the Association of American Medical Colleges to determine the relationship between the number of awards and the size of respective teaching and research faculty.

Results

From 2008 to 2017, there were a total of 14,676 funded grants across included specialties with total monetary support of $6.002 billion. Of these funded grants, 250 (1.7%) were from EM principal investigators which corresponded to total support of $89,453,635 (1.5% of overall dollars). There was an increase in total support after 2012 in EM, however when compared to the other specialties, EM investigators submitted relatively fewer grants and awarded grants were funded by a wider distribution of NIH Institutes and Centers (ICs).

Conclusions

Compared to other select specialties, EM investigators accounted for a small proportion of grants submitted and funded over the past decade. Though findings illustrate promising trends, to foster success, more submitted grant applications are needed from within EM along with systematic approaches to support faculty members in their pursuit of NIH funding.

Introduction

In 2003, the National Academies of Science Engineering and Medicine (NASEM) convened to evaluate the state of emergency care systems [[1], [2], [3]], and a key recommendation was to “examine the gaps and opportunities in emergency and trauma care research…” One of the recognizable issues facing Emergency Medicine (EM) is the relative underfunding in research. When compared to many other specialties, Emergency Medicine received fewer total National Institutes of Health (NIH) awards and funding dollars overall and per active faculty [4]. In response to the NASEM reports, the NIH formed a NIH Task Force on Research in Emergency Medicine to address the challenges as a growing research specialty. There were 3 roundtable discussions to identify challenges facing emergency care research with strong recommendations to identify these barriers and develop potential solutions [[5], [6], [7]]. To better address these barriers and to also help improve health outcomes, a new Office of Emergency Care Research (OECR) was created in 2012 within NIH to serve as the focal point for emergency care research and training across NIH.

Some of the leading challenges facing emergency care research include the lack of EM-specific senior investigators with independent funding, the absence of a dedicated institute at the NIH and the lack of training mechanisms for EM trainees. A one-year cross-sectional study reported about 40 EM faculty with (R) or (U) funding where both the absolute and proportionally (grants per board certified physicians) number of grants were smaller when compared to other specialties such as internal medicine [4]. This may be related in part to the relatively small number of EM applicants who have successfully secured career development awards who often have mentors outside the specialty of EM [8].

Despite these recognized challenges, there have been changes over the past decade to promote emergency care research. In 2010, the NIH National Heart, Lung and Blood Institute (NHLBI) funded six institutional (K12) research career development programs specifically to address the lack of few federally-funded EM investigators, and this program was renewed in 2016. Other critical developments also include funding various ED based networks including the Neurological Emergency Treatment Trials (NETT) and The Strategies to Innovate Emergency Care Clinical Trials Network (SIREN).

To better understand how NIH funding for EM researchers was progressed over a ten-year period, we sought to describe NIH research grant funding amounts and success rates for principal investigators from EM and five comparator specialties over the past 10 years. We analyzed non-public NIH grant application data.