Study: Impact and Productivity Associated with NIH-funded Grants to Study Cardiac Transplantation

Results from a long-term analysis presented at the 65^th Annual Meeting & Exhibition of the Southern Thoracic Surgical Association shed light on the productivity related to National Institutes of Health (NIH) funding for heart transplant research.

“We had two objectives: to evaluate the history of NIH-funded cardiac transplantation research here in the United States, and to compare surgeon-scientists to all other researchers studying heart transplantation,” study author Adishesh Narahari, a medical student at the University of Virginia, said during his presentation.

Nahari said that total NIH funding has significantly increased over the past 10 years, pegging the number at about $33 billion.

“Funding for surgery departments, however, has actually decreased over the last 10 years and is at about $300 million,” he said. “Surgeons’ rate of funding is lower than all other researchers,” Narahari said.

In their study, researchers utilized the NIH Research Portfolio Online Reporting Tools Expenditures and Results (RePORTER) to collect principal investigator, total grant funding amount, number of publications, and journal impact factors. The same Grant Impact Metric was applied to each grant, which was the sum of impact factors of each manuscript’s journal normalized by the funding of the respective grant (per $100K).

“If you had five papers that were published in a journal that had an impact of 10, your total grant impact would be 50, and if the grant had received $500,000 in funding, the Grant Impact Metric would be 10,” he explained.

Final analyses included 331 cardiac transplantation R01s to 261 investigators, which amounted to 6,529 publications in more than 800 journals. According to the abstract, surgeons received 79 grants, the most among clinician-scientists, totaling $155 million, followed closely by medicine (76 grants, totaling $185 million; then pathology with 10 grants at $28 million; then radiology/radiation oncology with 4 grants at $9 million).

“Surgery departments publish the most papers related to cardiac transplantations,” he added.

The study authors also noticed a correlation between the amount of funding in a grant and the amount of papers resulting from the grant, and also observed that the amount of papers did not translate to productivity.

“When we are looking at Grant Impact per $100,000, […] surgeons are on par with everyone else, except internal medicine,” Nahari said.  “We wondered, if surgery is getting so much money and they are  publishing so many papers, why is the productivity not there?”

According to their results, the researchers reported that physician scientists were significantly more productive than basic science researchers, and internists were better than basic science researchers and surgeons. One reason for this could be that the impact factors of internal medicine journals are much higher than those for surgeon journals.

“For example, the Annals of Surgery has an impact factor of 9.2, whereas the number sixth-ranked internal medicine journal, the Annals of Internal Medicine, has an impact factor of 19.4,” Narahari said.

One of the study’s limitations was that researchers only used certain search terms pertaining to cardiac transplantation. Researchers also only included a specific type of grant (NIH-R01) in their analyses. Additionally, they were unable to evaluate the investigators’ clinical productivity.

“Surgery departments receive the most NIH funding and publish the most papers to study cardiac transplantation, and although surgeons do not publish in high-impact journals, they still publish at the same rate as other researchers,” Narahari said. “And overall, physician scientists are significantly better than all other researchers at obtaining NIH funding and being productive with that funding.”

During discussion, Todd Rosengart, MD, FACS, of Baylor College of Medicine in Houston, Texas, said, “I think what you’re giving to us is a good-news story […] “surgeons are effective at garnering grants. One piece of data that would be interesting to know, although difficult to obtain would be what the denominator is. I am also concerned that the bad news on this is potentially that we, in trying to support our surgery journals and in particular cardiac surgery journals, are undermining our impact.”

Narahari agreed that the denominator will likely never be available and presented a twofold explanation for submitting research to different journals.

“We have to start submitting to some of these journals that have better impact factors, and one way to do that is by increasing the depth of analysis in some of these papers, possibly by collaborating with basic science researchers,” he said. “Otherwise, I think the target audience for some of the research being done is the people who read these journals, so is there a reason to publish in basic science journals when people who want to be reading this research are going to be people that subscribing to the Annals of Surgery or Annals of Thoracic Surgery?”