The purpose of this study was to characterize clinician-scientists in ophthalmology and identify factors associated with successful research funding, income, and career satisfaction.
A survey was conducted of clinician-scientists in ophthalmology at US academic institutions between April 17, 2019, and May 19, 2019. Collected information including 1) demographic data; 2) amount, type, and source of startup funding; first extramural grant; and first R01-equivalent independent grant; 3) starting and current salaries; and 4) Likert-scale measurements of career satisfaction were analyzed using multivariate regression.
Ninety-eight clinician-scientists in ophthalmology were surveyed across different ages (mean: 48 ± 11 years), research categories, institutional types, geographic regions, and academic ranks. Median startup funding ranged from $50-99k, and median starting salaries ranged from $150-199k. A majority of investigators (67%) received their first extramural award from the National Eye Institute, mainly through K-award mechanisms (82%). The median time to receiving their first independent grant was 8 years, mainly through an R01 award (70%). Greater institutional startup support ( P = .027) and earlier extramural grant success ( P = .022) were associated with earlier independent funding. Male investigators ( P = .001) and MD degreed participants ( P = .008) were associated with higher current salaries but not starting salaries. Overall career satisfaction increased with career duration ( P = .011) but not with earlier independent funding ( P = .746) or higher income ( P = .300).
Success in research funding by clinician-scientists in ophthalmology may be linked to institutional support and earlier acquisition of extramural grants but does not impact academic salaries. Nevertheless, career satisfaction among clinician-scientists improves with time, which is not necessarily influenced by research or financial success.
B ridging the gap between bench and bedside, clinician-scientists form the cornerstone of biomedical research. As medical providers, they are intimately aware of the unmet clinical needs of patients. As researchers, they are empowered to tackle these needs by engaging in basic, translational, and clinical research. However, the pathway to becoming a successful clinician-scientist is arduous, often requiring prolonged periods of training and multiple academic degrees that result in greater accumulation of debt from medical or other graduate education, start-up packages that are reduced compared to those for PhD scientists, as well as delayed entry into academic faculty positions. Many experts have commented on the shortage and endangerment of clinician-scientists, especially those in ophthalmology. The ongoing COVID-19 pandemic is exacerbating these issues, with models predicting a decrease in research output between 20% and 40%. Particularly scientists in earlier career stages, women, and underrepresented groups are most impacted, and the lasting consequences of this crisis have yet to be determined. ,
Prior reports have also underscored the critical roles of the US National Institutes of Health (NIH) and National Eye Institute (NEI) in maintaining the viability of the clinician-scientist career path. Undergraduate medical training can be supplemented with biomedical research through NIH-supported research immersion programs such as the Medical Research Scholars Program, or through dual MD-PhD degree programs such as the Medical Scientist Training Program. After graduation, NIH K-award mechanisms support early career clinician-scientists with research and salary support under mentorship from more established investigators. However, among the ophthalmologists who received K08 or K23 funding, only 48% of those individuals successfully secured an R01 grant, which is often considered an indicator of research funding success as an independent investigator. A recently published study showed that, of the ophthalmology or optometry clinician-scientists who obtain their first R01 grant, less than 4% will secure a second R01 grant (renewal of first R01 or new second R01) 5 years following initiation of funding of the first R01 grant. Beyond extramural funding, institutional or departmental support, startup funding, and salary all contribute to job satisfaction. This study conducted an anonymous survey of current clinician-scientists in ophthalmology to investigate factors that may be associated with research funding, income, and career satisfaction.
A 38-item survey was developed using Qualtrics survey software (Qualtrics, Provo, Utah, USA) and digitally administered to clinician-scientists in ophthalmology between April 17 and May 19, 2019 (Supplemental Figure). Invitations to complete the survey were sent by electronic mail to a list of approximately 300 self-identified clinician-scientists compiled from an Association for Research in Vision and Ophthalmology (ARVO) annual meeting mailing list, as well as clinician-scientists known by the authors to have obtained NIH funding through a search of NIH RePort/Reporter (projectreporter.nih.gov). Question responses were multiple choice with the option for free-text responses. Because the survey did not collect personal identifiable information, multiple responses from single internet protocol (IP) addresses were blocked to ensure that each entry was unique. Entries without complete research funding, income, or satisfaction data were excluded from the analysis. Subjects who had not yet received an academic appointment were also excluded. E-mail reminders were sent to encourage participation, but no additional incentives were provided. This survey study was not considered human subject research and was exempted by the Institutional Review Board at the University of California Davis. All study procedures adhered to the tenets set forth in the Declaration of Helsinki.
The survey collected demographic data including age and gender, as well as academic factors such as professional degree; primary research type (basic science, clinical science, or both); self-reported career stage (early, mid, or senior career); current academic rank (assistant, associate, or full professor); institution type (private or public); and US geographic region (Northeast, Midwest, South, or West). The year of the most recent academic degree, terminal training position, and first academic appointment were also requested. Career duration was defined as years from first academic appointment to present. Research funding information included institutional startup funding amount; source and year of first extramural grant (any non-institutional support) and first independent (R01-equivalent) grant; years of continuous extramural funding; and alternative support during funding lapse, if applicable. Income data included starting and current salary and, along with funding data, were recorded in category increments of $50,000. The US Bureau of Labor Statistics Consumer Price Index for all Urban Consumers (CPI-U) was used to calculate the annual rate of inflation to adjust institutional startup funding amount and starting salary. Career satisfaction was assessed using a series of 5-point Likert scale questions to address burnout, salary, research progress, clinical impact, work-life balance, grant support, university contribution, teaching, and overall satisfaction, which were summed to produce a composite satisfaction score with a maximum of 45 points. The survey form is included in Supplemental Materials.
Multivariate Cox semi-parametric regression and linear regression analyses with time adjustments were used to identify factors associated with time from first academic appointment to first independent grant, and duration of lapse in funding. Multivariate regression analyses with time and inflation adjustments were used to evaluate factors associated with the amount of startup research funding, starting salary, and current salary. Multivariate linear regressions were used to determine factors associated with composite career satisfaction score. Predetermined sets of factors were included as covariates in each multivariate regression model, with each analysis adjusting for all other covariates. Statistical analyses were performed using SPSS version 27.0 software (IBM Corp., Armonk, New York, USA).
Demographics and Academic Factors
Ninety-eight clinician-scientist respondents were included in the analysis (33% response rate). Median respondent age was 44 years old (range: 31-78 years old) ( Figure 1 , A), and consisted of more males than females (68% vs. 32%, respectively) ( Figure 1 , B). Most of the individuals held dual MD-PhD (52%) or MD (43%) degrees ( Figure 1 , C), with a median time of 14 years since their last academic degree at the time of this survey. Most respondents identified as engaging in both clinical and basic science research (46%), followed by basic science (34%) and clinical research (20%) ( Figure 1 , D); and were roughly evenly employed by public and private institutions ( Figure 1 , E), which included slightly more individuals from Western states ( Figure 1 , F). The median time since first academic appointment was 4 years for Assistant Professors, 8.5 years for Associate Professors, and 25 years for Full Professors, whereas a small subset of individuals held other academic positions such as “Instructor” ( Figure 1 , G). Most respondents considered themselves to be in an early career stage (46%) versus mid-career (29%) or senior career (25%), with median time since first academic appointment of 4 years for early career, 12 years for mid-career, and 26 years for senior clinician-scientists ( Figure 1 , H).
Most clinician-scientists surveyed in the present study reported <$50k of institutional startup funding, with a median ranging from $50-$99k, which is equivalent to $100-149k when adjusted for inflation ( Figure 2 , A). Higher startup funding was given to males but was not impacted by age, year of first appointment, degree, research type, institution type, or geographic location on multivariate regression (Supplemental Table).
Of the 84 respondents who received extramural funding, the majority (67%) received their first extramural grant from the NEI, with the most common mechanism being the K08 award (35%), followed by the K12 (29%), K23 (9%), and other K mechanisms such as K11 and KL2 (9%). Other funding sources included other NIH institutes (n = 3), the Department of Defense (n = 1), and various nonprofit foundations or commercial entities including Fight for Sight (n = 9), Research to Prevent Blindness (n = 3), Foundation Fighting Blindness (n = 3), Knights Templar (n = 2), International Retinal Research Foundation (n = 1), BrightFocus Foundation (n = 1), American Diabetes Association (n = 1), American Glaucoma Society (n = 1), Burroughs Wellcome Fund (n = 1), Lowry Medical Research Institute (n = 1), and Bayer (n = 1), or other local medical foundations (n = 1) ( Figure 2 , B).
Among 50 of these individuals (63%) who received their first major independent grant (R01 equivalent) at the time of the survey, most were awarded by the NEI (80%) and consisted primarily of R01 grants (70%), followed by other R- (11%) or U- (6%) mechanisms ( Figure 2 , C). Other independent grants (R01 equivalent) were awarded by the Department of Defense (n = 5), other NIH institutes (n = 2), Veterans Affairs (n = 1), or other unidentified sources (n = 2). Kaplan-Meier survival analysis showed that the median time from first academic appointment to first independent grant was 8 years (range: 0-26) among respondents ( Figure 2 , D), which remained generally stable over the past 40 years, albeit with less variability in the past decade ( Figure 2 , E). Earlier independent research funding was associated with earlier time to first extramural career award (estimate: 0.842; P = .022) and inflation-adjusted startup funding amount (estimate: 1.017; P = .027), whereas age and year of first appointment, gender, academic degree, research type, and first extramural grant source and type showed no significant association on multivariate analyses ( Table 1 ).
|Time to First Independent Grant||Current Salary||Career Satisfaction Composite Score|
|Category or Increment||Hazard Ratio||P-Value a||Estimate||P-Value b||Estimate||P-Value b|
|Age at First Academic Appointment||1 Year||.927||.410||−.909||.185||.205||.475|
|Year of First Academic Appointment||1 Year||1.009||.087||.294||.091||.245||.011 *|
|Female||.960||.935||− 9.108||.001 *||−.372||.788|
|MD/PhD||.515||.156||− 8.540||.008 *||−.249||.858|
|Current Academic Rank||Professor||−||−||Reference||−||Reference||−|
|Inflation-Adjusted Startup Funding||$10,000||1.017||.027 *||−||−||−||−|
|Time to First Extramural Grant||1 Year||.842||.022 *||−||−||−||−|
|Extramural Grant Type||K-Award||Reference||−||−||−||−||−|
|Time to First Independent Grant||1 Year||−||−||1.997||.541||.036||.746|
|Inflation-Adjusted Starting Salary||$10,000||−||−||.059||.596||−||−|