Article

Gender differences in funding among grant recipients in emergency medicine: A multicenter analysis

a b s t r a c t

Objective: To describe differences in funded grants between male and female faculty in two academic emergency departments.

Methods: This was a retrospective analysis of grant funding at two academic emergency departments from Jan- uary 2012-September 2018. We queried the grants department databases at each institution and obtained re- cords of all funded grants for emergency medicine (EM) faculty. We extracted the following information for each award: gender of the principal investigator (PI), PI Academic rank, grant mechanism (government, institu- tional, industry, organizational), and percent effort. Differences by gender were compared using Chi-square or Fisher’s exact test and Wilcoxon-rank sum.

Results: One-hundred and thirty grants were awarded to EM faculty at the two institutions during the study pe- riod. Of the funded grants, 35 (27%) of recipients were female. Among grant recipients, females held lower aca- demic ranking than males (p-value b 0.001): Instructor (49% vs 51%), Assistant Professor (36% vs 64%), Associate Professor (9% vs 91%), and Professor (0% vs 100%), respectively. Organizational grants were dispersed equally be- tween funded faculty, but females received a fewer government, industry, and institutional grants (p-value = 0.007). Female grant recipients were awarded a higher median percent of effort compared to males (14% [IQR: 3-51] vs 8% [IQR: 1-15], respectively, p-value = 0.023).

Conclusion: In this Multicenter analysis, gender discrepancies exist among funded grants of EM faculty. Male re- cipients had higher academic ranking than their female counterparts. Female recipients were less likely to have government, institutional, and industry grants but received a greater percent effort on funding that was awarded.

(C) 2019

Introduction

Gender discrepancies are a central issue in academic medicine across many medical specialties. In research within academic medicine, women submit less than one third of National Institutes of Health (NIH) grant applications and comprise less than one third of grant recip- ients even though there are no differences in success rate of first-time NIH awards compared to males [1-3]. Women in junior faculty posi- tions are paid less and have significantly smaller startup packages than men with similar qualifications [4] and female faculty at public medical schools have a significantly lower mean salary compared to men, even when adjusted for academic rank, age, experience, clinical revenue and research productivity [5]. In a 2008 multicenter analysis of Harvard Medical School faculty, women submitted fewer grant

* Corresponding author at: Department of Emergency Medicine, Beth Israel Deaconess Medical Center, One Deaconess Road, Rosenburg 2, Boston, MA 02115, USA.

E-mail addresses: [email protected] (N.M. Dubosh), [email protected] (K.L. Boyle), [email protected] (T. Yankama), [email protected] (A.M. Landry).

applications and requested less funding compared to men ($115,325 vs $150,000, respectively) [6]. It is unclear if this has changed in recent years.

In the specialty of emergency medicine (EM), gender discrepancies exist across the workforce, including leadership and salary. The American College of Emergency Physicians (ACEP) found that while fe- males comprise 50 percent of medical school classes, they make up only 25 percent of EM-trained physicians and an even smaller percentage hold leadership and chair positions [7]. According to the Association of American Medical Colleges, in 2015 there were only ten female chairs in academic emergency departments [8]. The 2015 Academy of Admin- istrators in Academic Emergency Medicine Salary Survey found the mean salary of women was $19,418 less than men even after adjusting for other factors including rank, years of experience, clinical hours, core faculty status, administrative roles, board certification, and Fellowship training [9].

While the gender discrepancies in the general EM workforce and leadership positions are apparent, it is unclear how this translates to dif- ferences in grant funding among academic EM faculty. The objective of this study was to determine if there were differences in funded grants

https://doi.org/10.1016/j.ajem.2019.11.006

0735-6757/(C) 2019

between male and female faculty members in two academic emergency departments. Specifically, we compared differences in gender by aca- demic rank of faculty recipient, grant funding mechanism, and percent effort awarded during the study period.

Methods

Study design

This was a retrospective analysis across two academic emergency departments from January 2012 to September 2018. The Institutional Review Boards of Beth Israel Deaconess Medical Center (BIDMC) and University of Massachusetts Medical School (UMMS) approved this study.

Study population

Both departments are level one trauma centers and home to three- year EM residency programs. The study population included all EM fac- ulty members who received grant funding through the grants depart- ments during the study period.

Study protocol

To determine baseline demographic data of each department, we searched the institutional websites and identified all academic faculty. We then queried the grants department databases at each institution and obtained records of all grant funding for EM faculty. Grants awarded to residents, fellows, and medical students were excluded. The study au- thors based their protocol for this chart review and data abstraction on recommendations for high quality chart review in emergency medicine described by Gilbert et al. [10].

Data abstraction and measurements

The data was abstracted by two of the study authors: NMD at BIDMC and SC at UMMS who were not blinded to the objectives of the study. Both abstractors are academic physicians with extensive research expe- rience. They were trained in data abstraction prior to the onset of the study. At BIDMC, the grant database query was performed by the grants office administrator. At UMMS, the database was accessed directly by author SC. The reason for the variation in the database queries was due to differences in data storage and accessibility at each institution.

We extracted the following information for each award: gender of the principal investigator (PI) for the institution, PI academic rank at the onset of the funding period, grant funding mechanism, and percent effort awarded. Grant mechanism was classified as government (local, state or federal), industry, organizational/foundational, or institutional. For government funding, NIH mechanisms were recognized separately for a sub-analysis. Any question regarding funding mechanism based on the organization listed was discussed among the two data abstrac- tors as well as a third author (KLB) until consensus about the mecha- nism classification was reached. Percent effort was defined as the amount of time the faculty’s efforts for the grant activities will take, which translates to the percent of the salary that is funded by the grant [11].

To calculate percent effort for grants funded for a period of less than

rank

Male

Female

Male

Female

institutions, Male

institutions, Female

Fellow

5

3

3

4

8

7

Instructor

17

6

1

1

18

7

Assistant

11

8

26

11

37

19

Associate

6

1

8

3

14

4

Professor

2

0

6

2

8

2

Data analysis

Continuous variables were summarized using median (IQR), with the differences between genders tested using Wilcoxon rank-sum test. Categorical variables were summarized using counts and proportions, with the differences between genders tested using Chi-square or Fish- er’s exact test, as applicable. All analyses were two-sided with a signifi- cance level of 0.05 and performed using R version 3.51 (R Foundation for Statistical Computing, Vienna, Austria).

Results

The academic faculty at the two institutions was made up of 39 (31%) females and 85 (69%) males during the final year of the study pe- riod. The demographic data of the faculty at the two departments are displayed in Table 1. During the study period, a total of 135 grants were awarded among the participating institutions. Four were excluded because they were awarded to residents and one was excluded because it was awarded to a medical student. The remaining 130 grants were in- cluded in the analysis. Several of the included grants had missing data points as follows: rank (1), funding mechanism (1), percent effort (3), budget (3) but were still included in the analysis given the majority of the variables were available.

The main results are displayed in Table 2. Of the funded grants in the study period, 35 (27%) of recipients were female faculty. Among grant recipients, females held significantly lower academic ranking than males (p-value b 0.001): Instructor (49% vs 51%), Assistant Professor (36% vs 64%), Associate Professor (9% vs 91%), and Professor (0% vs 100%), respectively. The academic ranks of the faculty awarded grant funding during the study period are displayed in Fig. 1. The funding mechanisms are displayed in Fig. 2. Compared to females, male recipi- ents significantly (p-value = 0.007) received more funding from gov- ernment (78% vs 23%), industry (87% vs 13%), institutional sources (68% vs 32%), and NIH (91% vs 9%) while no gender difference was ob- served in organizational grants (50% vs 50%). Female recipients were awarded a median effort of 14% [IQR: 3-51] whereas male recipients re- ceived a median effort of 8% [IQR: 1-15] (p = 0.023). During the seven- year course of the study period, there was no significant difference in grant funding by gender over time (Fig. 3).

Discussion

The results of our multicenter analysis highlight gender disparities among academic EM faculty grant recipients. To the best of our knowl- edge, this is the first study examining gender discrepancies in grant funding specifically in EM faculty. At the Instructor rank, the number of male and female grant recipients was the same, despite an overall dif- ference in gender makeup of all faculty members. Beyond the rank of In- structor, however, an increasing number of the grant recipients were male. Interestingly, female grant recipients in our population were awarded greater percent effort compared to their male counterparts.

Our findings are consistent with national data showing that while the number of women in academic EM is growing, the major of women are early in the pipeline and women account for only 15% of

Table 1

Emergency medicine faculty rank by gender at Beth Israel Deaconess Medical Center (BIDMC) and University of Massachusetts Medical School (UMMS), 2012-2018.

twelve months, the number of months of the grant period divided by twelve was used as a multiplier. For grants funded for a period of more than twelve months, the total amount was divided by each twelve-month period. During the data abstraction period, the study au- thors periodically discussed questions and discrepancies in data collec- tion. A standardized data collection form was used by the abstractors and is displayed in the supplementary material. All data was entered into a Microsoft Excel database for analysis.

Academic

BIDMC

BIDMC

UMMS

UMMS

Both

Both

Table 2

Grant funding at Beth Israel Deaconess Medical Center (BIDMC) and University of Massa- chusetts Medical School (UMMS), 2012-2018.

grants, sumitted fewer applications, were less successful in renewing grants compared to men [2].

Our findings our comparable to studies on grant funding published

Overall

(n = 130)

Female (n = 35)

Male

(n = 95)

P-value

in other academic specialities. In dermatology, there has been a down- trend in the number of female investigators receiving funding from

Institution, n (%) 0.537

BIDMC

87 (67)

25 (29)

62 (71)

UMMS

Rank, n (%)

43 (33)

10 (23)

33 (77)

b0.001

Instructor

35 (27)

17 (49)

18 (51)

the NIH compared to their male counterparts [13]. In an analysis of NIH grant funding in otolaryngology departments, men received higher levels of NIH funding compared to women at the assistant level and con- tinued despite the same number of years in practice [14]. In a study

Professor 20 (16) 0 (0) 20 (100)

Assistant professor

42 (33)

15 (36)

27 (64)

assessing NIH funding in diagnostic radiology, women received only

Associate professor

32 (24)

3 (9)

29 (91)

15.9% of awards and 13.3% of funding, with average funding per

Start year, n (%) 0.169

2012

11 (9)

4 (36)

7 (64)

2013

18 (14)

2 (11)

16 (89)

2014

17 (13)

5 (29)

12 (71)

2015

12 (9)

2 (17)

10 (83)

2016

24 (18)

10 (42)

14 (58)

2017

18 (14)

2 (11)

16 (89)

2018

30 (23)

10 (33)

20 (67)

Funding type, n (%) 0.007a

Government

40 (31)

9 (23)

31 (78)

Industry

15 (12)

2 (13)

13 (87)

Institutional

19 (15)

6 (32)

13 (68)

NIH

23 (18)

2 (9)

21 (91)

Organizational

32 (25)

16 (50)

16 (50)

Percentage of effort, % median (IQR) 15 (1-20) 14 (3-51) 8 (1-15) 0.023a

a Rank: 1 missing data, male. Funding type: 1 missing data, male. Percentage of effort: 3 missing data, all males. Budget: 3 missing data, all males.

all full professors in EM [12]. Women were also found to have less funding from government sources including NIH, as well as industrial and institutional funding. Although our particular study did not exam- ine accepatnce rate of grant applications, our findings are consistent with governmental data. Hechtman et al found through an analysis of NIH grant application records that women individually held fewer

award of $353,512 compared to $434,572 for men [15]. Further studies are needed to assess for such disparities in grant types outside of those funded by the NIH. Currently robust demographic data from industry, organizational, and institutional grant mechanisms are lacking.

Receiving grant funding is considered one of the pillars of success in academic medicine. Many mechanisms exist to support faculty to pur- sue and continue careers in academic medicine. In a study looking at the impact of funding longevity, women who received major funding from NIH grants had continued success in funding and similar attrition rates in careers in research as men [2]. Closing gaps between men and women in terms of grant funding is important for a variety of reasons, including fostering career longevity and promotion. Choo et al also sug- gest that gender disparities in the area of grant funding, salary, and ac- ademic rank may contribute to more deeply rooted societal issuses that can also affect the well-being and career longevity of women. Dis- parities in salary and rank may lead to the notion that women are sys- tematically devalued which undermines their insitutional power and ability to report or defend themselves against ongoing forms of abuse in the workplace including sexual harassment [16].

The reasons for gender disparities are complex and multifactorial and therefore effective strategies for overcoming them remain unclear. Several EM organizations have taken initiatives to advance the scholar- ship of women. The Academy of Women in Academic Emergency

Fig. 1. Faculty academic ranks.

Fig. 2. Mechanism of funded grants.

Medicine (AWAEM) was founded in 2009 to promote the recruitment, retention, advancement and leadership of women and now offers grants that align with this mission [17]. Similarly, ACEP has established the American Association of Women Emergency Physicians (AAWEP) to promote the professional advancement and leadership skills of female physicians and serve as a resource for members on issues relating to

female emergency physicians [18]. More recently, FemInEM was cre- ated as an open access resource to address gender disparities in EM and has established a new gender equity in medicine research founda- tion [19]. A working group from the leadership of AWAEM and AAWEP developed recommendations for organizations to implement to create a workplace environment supportive of women in EM through

Fig. 3. Funding by gender, 2012-2018.

a consensus-building process of male and female stakeholders. The rec- ommendations encompass four domains: (1) global approaches to supporting the recruitment, retention, and advancement of women

(2) recruitment, hiring, and compensation (3) supporting development and advancement of women in EM and (4) physician health and well- ness [20]. Future studies are needed to determine the effect of such ini- tiatives on outcomes including grant funding.

Limitations

There are several limitations to this study. First, the sample size is relatively small and may not be generalizable. However, the data repre- sents two different institutions, which adds heterogeneity to our find- ings. Additionally, only funded grants were included based on the nature of the institutional grants databases. It is possible that there may be differences between funded and non-funded grant applications that are not captured in our findings. Due to the retrospective nature of the study, it is possible some funded grants were not captured, however, each institution requires that grants go through the respective grants of- fices so we believe our dataset thoroughly captures the majority of funded grants. Furthermore, it is important to note that these data do not distinguish between the roles of the individual in the project. Physi- cians were included if they were the PI at their institution, but we did not capture if they were the main PI or site PI in cases of multicenter awards. Additionally, academic rank and promotion requirements may vary by institution. Finally, the data abstractors were not blinded to the study objective which may have introduced bias into the results. However, given the fairly objective nature of the data we examined, lit- tle interpretation was needed and therefore any potential bias is likely minimal.

Conclusion

In this multicenter analysis, gender discrepancies exist among funded grants of EM faculty. Male recipients were found to have higher academic rankings than their female counterparts. Female recipients were less likely to have government, institutional, industry, and NIH grants compared to males, but were awarded a greater percent effort. Future research efforts should focus on examining trends on larger scale, investigating why these disparities exist and applying interven- tions to narrow the gender gap.

Declaration of Competing Interest

None.

Acknowledgements

The authors would like to thank Martha Cross for her help in gather- ing the data.

Funding

This research did not receive any specific grant from funding agen- cies in the public, commercial, or not-for-profit sectors.

Appendix A. Supplementary material

Supplementary data to this article can be found online at https://doi. org/10.1016/j.ajem.2019.11.006.

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