M.D. Researchers Often Hit an NIH Funding Wall

WASHINGTON, June 13 -- The odds of getting an NIH grant are a lot better for Ph.D.s and for M.D.s who also hold a Ph.D. than for physicians who have a medical degree alone, one study showed.

The average annual percentage of first-time M.D.-only applicants who were awarded grants was 28%, compared with a success rate of 31% for applicants with a Ph.D. and 34% for those with both degrees, said David Korn, M.D., of the Association of American Medical Colleges, and colleagues here.

Furthermore, they reported in the June 13 issue of the Journal of the American Medical Association, when investigators who had obtained a first grant applied for a second one, those with an M.D. were consistently less likely than those with a Ph.D. or those with double degrees to receive funding.

To determine the perseverance and comparative success of physician-scientists competing for NIH grants over the long term, the researchers undertook a longitudinal, comparative study of all first-time applicants and recipients from 1964 through 2004.

The scientists were stratified by the principal investigators' degrees -- M.D., Ph.D., or both -- and their proposed involvement in research on humans or human tissues.

The investigators also looked at the chances of getting a second research grant and found a similar pattern.

For M.D.-only applicants seeking a second grant, the mean annual percentage was 70%. For those with a Ph.D., that percentage was 73% (P=0.04 versus M.D. only). For those with an M.D. and a Ph.D., the percentage was 78%; P<0.001 versus M.D. only, and P=0.007 versus Ph.D. only).

The investigators also found differences in the nature of the grant requests. Just over two-thirds of the first-time M.D.-only applicants proposed to pursue clinical research.

The percentage was much lower for physicians who also had a Ph.D. (43%) and for Ph.D.-only applicants (39%). Those groups tended to submit applications for non-clinical studies, the researchers reported.

First-time M.D.-only applicants who proposed clinical research were also funded at lower rates than their counterparts who proposed nonclinical research (23% versus 29%, respectively; P<0.001), the researchers reported.

Among second-grant applicants, the difference in obtaining funding between clinical and nonclinical research was again substantial: 72% versus 80% for M.D.s only, and 76% versus 86% for those with an M.D. and a Ph.D.

When looking at the overall pool of researchers, the investigators found that the annual number of first-time NIH grant applicants who held only an M.D. remained remarkably stable over four decades (a 41-year mean of 707 applicants).

By contrast, the number of first-time applicants with dual degrees increased from 79 in 1964 to 511 in 2004, while first time applicants with a only a Ph.D. increased from 1,423 in 1964 to 2,869 in 2004, both increases well above the 41-year mean.

M.D.-only clinical researchers were more likely than nonclinical researchers to leave the research pool, the authors noted. One reason, they speculated, is that their clinical research applications did not fare as well as nonclinical applications.

The investigators also related abundant anecdotal evidence indicating that those who leave research careers do so because of insufficient institutional support, a perceived lack of mentors, and discouragement.

"We agree with others that physician-scientists bring unique skills, experience, motivation, and perspective to biomedical research," Dr. Korn and colleagues noted. "They play an indispensable role, especially in designing and conducting the translational and clinical research by which scientific advancements are brought into medical practice."

The recent report by a task force of the Association of American Medical Colleges calls on the leadership of academic medical centers to reaffirm translational and clinical research as a core mission, they said.

"For medical schools and teaching hospitals, the challenge is to create a more attractive and supportive academic culture that not only attracts and trains but also actively nurtures and sustains clinical and translational scientists," they concluded.