1. 1 Census of NIH Support of Clinician Scientists Post-Graduate Years to First Major Research Project Grant A Report to the NIH Deputy Director for Extramural Research Rashada Alexander, Jennifer Sutton, Henry Khachaturian, Rod Ulane August 29, 2011

2. 2 Introduction Interest in NIH’s support and training of physician- researchers Used data on career development awards targeted to physicians to look at support and training Focused on major mentored awards targeted to physicians, both individual (K08, K23) and institutional (K12, KL2). o Awards serve different purposes, but all targeted to clinician scientists in the earlier stages of their careers Also used data on subsequent RPG applications and awards from K08 and K23 awardees to illuminate outcomes

3. Caveats During study period, NIH experienced: –Doubling of its budget (1999-2003) –Initiation of a new career award (K23) expressly for physicians intending careers in clinical research (1999) –Initiation of a new institutional career award (KL2) housed within CTSAs (2006) –Initiation of a new career ‘bridge award’ (K99/R00) (2007) –Severe economic downturn impacting faculty hiring and NIH budget 3

4. K08 Applications and Awards By Degree 4 K08 Awards: Initiated more than 3 decades ago Targets physicians interested in pursuing research careers From 1996-2010:  Number of applications from MDs decreased by 25% with the number of awards to MDs decreasing by almost 50%  Number of applications from MD/PhDs increased by 34%, although numbers of awards remained constant  Start of the K23 and KL2 awards coincides with a decrease in the number of applications from MDs  Decline in MD/PhD applications probably not related to initiation of KL2, but may be due to end of doubling of NIH budget

5. K08 Applications and Awards By Gender 5 K08 Awards:  Applications from women increased 13% from 1996, while applications from men decreased nearly 15%  Gap between awards to men versus women narrowed between 1996- 2010

6. K23 Applications and Awards By Degree 6 K23 Awards: Initiated in 1999 Targets physicians interested in clinical and/or patient-oriented research From 1996-2010:  For MDs, both the number of applications and awards more than doubled since 1999  Percentage of PhDs applying for this award increased from 8% to 23%  As of 2010, MDs submitted 68% of the applications for the K23 and received 75% of the awards

7. K23 Applications and Awards By Gender 7 K23 Awards:  Since 2004, somewhat more women than men have applied for and received K23s

8. Cumulative KL2 and K12 Appointments 8 KL2 Awards: Institutional award supported by NCRR Used as an ‘entry level’ career award for physicians who may have minimal research experience  Steady increase in total appointments across all degree types K12 Awards: Institutional award issued by ICs to recruit researchers into specific disciplines Average of 5 appointments per award used for estimation  Decrease in appointments/ awards after 2007 could stem from growth in the KL2 program

9. Cumulative F32 Awards By Degree and Gender 9 F32 Awards: Individual post-doctoral fellowships  Majority of these awards go to PhDs, with nearly equal gender representation  Relatively low numbers of MDs and MD/PhDs supported by these awards

10. Subsequent RPGs to Career Awardees Focused on K08 and K23 awardees from 1999 to 2010 From the accumulated data studied, most awardees who applied for an RPG did so by the 7 th or 8 th year after receiving their career award, with a significant number doing so in a shorter time frame 10

11. RPG Awards To K08 Awardees 11

12. RPGs Awards To K23 Awardees 12

13. Summary-RPG Award Outcomes for K08 and K23 Awardees Nearly 70% of MDs and MD/PhDs who received career awards in 2003 subsequently have been awarded an RPG Over 50% of MDs and MD/PhDs who received a career award as recently as 2005 have been awarded an RPG 13

14. 2010 Selected RPG Awards Made to ESIs, By Degree AwardMDMD/PhDPhDOther DP2110341 R0113111364737 R21241523416 R03241518414 Data from QVR

15. Breakdown of NIH Career Support to ESI MD R01 Recipients in 2010 Of the 131 ESI MD R01 recipients, 20 earned their MD in other countries Of the remaining 111, 90% received prior NIH formal training or career support (K, F, or T) The majority of this group (84 out of 111)received prior NIH Career (K) support 15

16. Breakdown of NIH Career Support to ESI MD R01 Recipients in 2010 Of the ESI MD R01 recipients with prior NIH K support: –2% received K01s –6% received K07s –42% received K08s –1% received K11s –37% received K23s –10.8% received KL2/K12 support 16

17. Breakdown of NIH Career Support to ESI MD/PhD R01 Recipients in 2010 Of the 113 ESI MD/PhD R01 recipients, 43 earned one or both their degrees in other countries Of the remaining 70, 91% received prior NIH formal training or career support (K, F, or T) The majority of this group (51 out of 70) received prior NIH Career (K) support 17

18. Breakdown of NIH Career Support to ESI MD/PhD R01 Recipients in 2010 Of the ESI MD/PhD R01 recipients with prior NIH K support: –2% received K07s –84% received K08s –12% received K23s –2% received K99/R00 support 18

19. Summary K08 application and award rates for MDs have decreased since 1996 The introduction of the K23 and KL2 awards may have contributed to the decrease in K08 applications and awards Applications and awards from women for the K23 have increased since 1996, while those from men have decreased KL2 appointments have steadily increased since its introduction in 2006 19

20. Historical Perspective on NIH R01 Recipients by Degrees From the early 1970s to 2004 the number of 1 st time MD R01 applicants fluctuated from about 500 per year to about 800 per year, with no downward or upward trend. During that same period, however, the number PhD 1 st time applicants nearly doubled to about 2,800 in 2004, while the number of MD/PhD applicants nearly quadrupled reaching just under 500 in 2004. ( Korn, et al. 2007:JAMA 297 #22, p.2496) By 2010 the number of 1 st time MD applicants was about 1000, the number of 1 st time MD/PhD applicants was about 600, while the number of PhD 1 st time applicants was over 5000. The share of MD 1 st time applications for R01s fell from about 25% in the early 1970s to about 15% in 2010, while the share of MD/PhD applicants increased from less than 5% to about 10% during the same period. 20