Where You Train Matters: Surgeon-Scientists Disproportionately Trained at Highly Funded Institutions

To assess the distribution of National Institutes of Health (NIH)-funded surgeon-scientists by residency training institution and to examine whether training at institutions with higher NIH funding is associated with greater individual NIH funding.

Surgeon-scientists face challenges securing NIH funding, with surgical research funding lagging behind other fields. Training in resource-rich environments may enhance research engagement and funding success.

Blue Ridge Institute for Medical Research (BRIMR) rankings were used to identify NIH-funded principal investigators (NIH-PIs) among surgeons in Departments of Surgery from 2013-2023. Residency program NIH-funding quartiles, and top-ten programs, were determined by averaging institutional funding from BRIMR spreadsheets. Chi-square or Fisher's exact tests, nonparametric tests, Z-tests, and linear regression were performed.

Among 559 NIH-funded surgeon-scientists, 394 (70.5%) trained at first-quartile institutions, representing 75-82% of NIH-PIs annually and receiving 79-85% of total funding each year. Total annual funding was significantly higher among first-quartile trained NIH-PIs ($117.9 vs. $24.8 million; P <0.0001), though median funding per NIH-PI did not differ ($354,544 vs. $328,179; P =0.358). In subgroup analysis, top-ten trained NIH-PIs had higher median funding per PI ($379,407 vs. $322,666; P =0.013) and experienced faster annual growth in funding per PI ($61,920/year vs. $38,666/year, P =0.009) even when adjusted for current affiliated institution funding quartile. Additionally, top-ten trained PIs exhibited greater scientific influence measured by the NIH iCite tool's weighted relative citation ratio (119 vs. 100; P =0.034).

Surgeon-scientists who trained at first-quartile institutions represent the majority of NIH-funded investigators, highlighting the potential influence of training in well-funded environments.