Sex Differences in Attainment of Independent Funding by Career Development Awardees

Although women are now entering the medical profession at rates that mirror their representation in the general population, they remain in the minority in the senior echelons of academic medicine. In 2007, women constituted 49% of the medical student body but only 33% of medical faculty, 17% of full professors, and 12% of department chairs at U.S. medical schools (1). To some extent, the low proportion of women in the senior ranks of academic medicine is the outcome of a metaphoric slow pipeline. Given the long interval from medical school graduation to achievement of senior faculty positions, persons in these senior positions attended medical school at a time when women were underrepresented. By this reasoning, it will take more time before parity can reasonably be expected. However, a slow pipeline alone seems insufficient to explain the current numbers, considering that 24% of medical school enrollees in 1975more than 30 years agowere women, and leakage from the pipeline becomes an additional concern. Previous studies that sought to investigate this leakage problem (24) have been stymied by the possibility that women may be more likely to prefer teaching or clinical activity over research (5). Consequently, these studies could not address definitively whether women with a demonstrated commitment to research succeed at the same rate as their male colleagues. The highly select cadre of physician-scientists who receive career development awards from the National Institutes of Health (NIH) are a particularly informative group for understanding the career trajectory of female faculty. In particular, it is useful to consider recipients of the NIH K08 and K23 awards, which are intended to support the career development of researchers who hold clinical doctorates. These awards are highly competitive grants made to young physicians with a strong interest in and demonstrated aptitude for building research careers. The awards are designed to support protected time for awardees to participate in an intensive, supervised, research career development experience under the guidance of an experienced mentor (6). Recipients of these awards are generally expected to progress to independent research careers. A key indicator of such independence is subsequent attainment of an R01 award from the NIH. We sought to examine the rates at which men and women with K08 and K23 awards have gone on to achieve R01 grants, to offer specific evidence to inform the debate over the nature of the pipeline problem in academic medicine. Methods Study Population and Determination of R01 Award Attainment We identified recipients of new K08, K23, and R01 awards by using the NIH's online database, Computer Retrieval of Information on Scientific Projects (CRISP) (7, 8), for 1997 to 2003 (K08 awards), 1999 to 2003 (K23 awards; the K23 program did not begin until 1999), and 1997 to 2007 (R01 awards). Using Microsoft Excel 2002 (Microsoft, Redmond, Washington), we developed an automated algorithm to search for the full (first and last) name of each K08 and K23 recipient among a list of first and last names of R01 award recipients and the years in which a match appeared. We verified matches on the basis of other information in the CRISP database, including e-mail address, middle name or initial, institution, and department or subject area (as determined from the grant abstracts). If the data for these attributes were missing, we searched the Internet for institutional Web pages and curriculum vitae to provide additional information about recipient identities. Determination of Recipient Characteristics Two independent reviewers attributed sex for the K08 and K23 recipients on the basis of commonly accepted sex identity for first names (and middle names where available). In no cases did one reviewer believe a name to be female and the other believe the name to be male. For all recipients with first names for which either reviewer deemed sex to be potentially ambiguous, we determined sex by checking the project abstracts provided in CRISP for use of sex-specific pronouns or by searching the Internet to locate institutional Web pages with pictures of the recipient, use of sex-specific pronouns, or an explicit statement of sex. We extracted information on each recipient's institution and department at the time of K award from CRISP. For the purposes of analysis, we grouped institutions listed in CRISP so that all hospitals affiliated with a single university were considered to be a single institution. We then grouped institutions into 4 tiers, which contained approximately equal numbers of K awardees, on the basis of total NIH funding received by each institution in 2000 as listed in the NIH's Research Portfolio Online Reporting Tool (9). We also reviewed recipients' departmental names and grouped them into 6 specialty categories: medical specialties (internal medicine and its subspecialties, as well as neurology); surgical specialties (general surgery and surgical subspecialties); clinical specialties for women, children, and families (family medicine, obstetrics and gynecology, pediatrics, and their subspecialties); hospital-based specialties (such as radiology, anesthesiology, and pathology); basic sciences; and missing (no department listed in CRISP). We also used CRISP to determine the NIH funding institute that granted the K award. For analysis, we grouped funding institutes into 3 tiers of funding activity, on the basis of total dollar amount of R01 awards granted in 2000 (10). Female Surname Change To account for female surname change due to marriage or divorce, we further scrutinized all female K08 and K23 recipients whose names did not appear on the lists of R01 award recipients. We considered all female K08 and K23 recipients who had a first name that matched 1 or more R01 award recipients' first names and did not appear as having received an R01 award. We first searched for each woman's name in the online directory of the institution listed in her grant application or by navigating from the institution's main Web page to a departmental personnel listing. If her name appeared in either the directory or departmental listing with the same e-mail address, we considered this to be sufficient confirmation that she continued to use the surname listed on her K award. If her full name did not appear, we used Google and PubMed to search the Internet for evidence of a new institutional affiliation or name change. The Appendix and Appendix Figures 1 and 2 contain detailed information regarding our search criteria and methods. In all cases in which we found evidence for a name change, we searched the CRISP database for R01 awards under this new name and all potential last name combinations. Appendix Figure 1. Flow diagram of method of searching for new institutional affiliation or surname change among female recipients of K awards, part 1. CRISP = Computer Retrieval of Information on Scientific Projects. Appendix Figure 2. Flow diagram of method of searching for new institutional affiliation or surname change among female recipients of K awards, part 2. CRISP = Computer Retrieval of Information on Scientific Projects. When we could confirm neither continued use of the same name nor a name change with these approaches, we identified all R01 award recipients with the same first name in the last year of the person's K award or later and, where feasible, confirmed that each of these persons were not the same person as the K award recipient. We considered the following to be sufficient confirmation of separate identities: a CRISP record that showed the R01 award recipient had received an NIH grant under that full name before the date when the K awardee with the same first name had received her K award or its continuation, a PubMed record that showed the R01 award recipient had published under that name before or during the years that the K awardee had received her K award, evidence that the R01 and K awardees were engaged in entirely unrelated areas of research, an institutional Web page for the R01 award recipient that detailed training and employment history which precluded previous affiliation with the K awardee's institution, or evidence that the R01 award recipient did not hold a known degree of the K awardee. As an additional check, we identified all R01 award recipients with hyphenated surnames and searched the K award recipient lists for both surnames. Using the described methods, we confirmed that 17.4% of the women who did not receive R01 awards under the names listed on their K awards could not have received an R01 award because their first names did not appear on the list of R01 award recipients from 1997 to 2007, and that 74.7% of those women were still using the same name. We confirmed that an additional 5.2% had not received R01 awards after checking all R01 award recipients with the same first name in the years 1997 to 2007. We found that 13 women (1.8% of women not receiving R01 awards) had changed their names; this represents 2.3% of the women confirmed either to be still using the same names or to have changed their names (of note, none of these had received an R01 award under the new name). Given the low rate of name changes observed, we assumed that the remaining 1.0% whose current name we could not identify had not received an R01 award under a new name. Statistical Analysis We analyzed the tabulated data by using SAS statistical software, version 9.1 (SAS Institute, Cary, North Carolina). We used the KaplanMeier product-limit method to construct estimates of the probability of the receipt of R01 awards for the period after K award receipt, by sex and K award type. We considered recipients to be at risk for receiving an R01 award through the 2007 award cycle. We made no attempt to adjust for rare competing events, such as death of the K award recipient. For K08 or K23 award recipients who received multiple R01 awards, we used the year in whic