Landscape of Centralized Otolaryngology Research Efforts Grant Recipients Over the Past Decade

Abstract

Objective

To investigate the demographics of CORE grant recipients (Centralized Otolaryngology Research Efforts) over the last decade and evaluate disparity among recipients as compared with otolaryngology overall. To assess whether procurement of a grant predicts pursuit of an academic career.

Study Design

Analysis of grant recipients’ bibliometrics.

Setting

Academic medical center.

Methods

The list of recipients of grants from 2010 to 2019 was obtained from the website of the American Academy of Otolaryngology–Head and Neck Surgery. Demographics of recipients were collected through an internet search, including gender, race, residency program, and h-index. Recipients from 2010 were searched to determine current academic faculty rank. Univariate and multivariate analyses were used to compare these factors with otolaryngology overall.

Results

The distribution of gender among recipients over the last decade remained nearly constant, with no significant difference versus residents in otolaryngology (P > .05). However, there were significantly more female recipients when adjusted for gender differences in the field overall (P < .01). Asians were relatively overrepresented, while Black and Hispanic residents were underrepresented (P < .01). Many recipients (52.6%) trained at institutions recognized as the best training programs with reputations for quality research output. The h-index of recipients decreased over the last decade (P < .01). The h-index of duplicate winners was significantly higher than those of nonduplicate winners (P < .01). After adjusting for gender and rank, recipients were significantly more likely to hold academic positions (P < .01).

Conclusion

CORE grants are favorably distributed as related to gender and racial disparities, and recipients frequently go on to achieve high levels of academic success.

Keywords

gender disparities racial disparities CORE grant academic rank scholarly productivity CORE grant recipient academic productivity academic success NIH grant

In 1985, the Centralized Otolaryngology Research Efforts (CORE) grant program was established through the American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS).¹ The CORE program was developed to bolster support for research by streamlining the grant application process for training resident physicians by connecting applicants to otolaryngology associations offering funding.^1,2 Since its inception, CORE has provided >$12 million in funding.³ The CORE program has also been successful in preparing individuals for the US National Institutes of Health (NIH) peer review application process.⁴ Procurement of a CORE grant is associated with greater scholarly impact and pursuit of an academic position after residency graduation.^5,6

In medicine, gender, racial, and ethnic disparities exist, which propagate inequality and can negatively affect health care delivery.^7-10 Female medical students disproportionately enter primary care and are underrepresented in otolaryngology and other surgical subspecialties.¹¹ Furthermore, women are underrepresented in academic practice and positions of leadership.¹² In academic medicine, women and minority faculty are less likely to be promoted to higher ranks.¹³ Minority faculty are less likely to be retained in academic medicine and to secure industry grant funding as compared with their White counterparts.^14-16 This study aims to examine the evolution of the demographics of CORE recipients with regard to gender, race, residency program, and h-index. The disparity among CORE grant recipients is then compared with the demographics of otolaryngologists in the United States. In a secondary analysis, CORE grant winners in 2010 were evaluated to determine if they currently hold positions in academia.

Methods

A comprehensive list of the recipients of the CORE program from 2010 to 2019 was obtained from the AAO-HNS website.^17-22 The demographic characteristics of each recipient were collected through an internet search, which included gender, race, residency program, and h-index. Much of the data were extracted from Doximity, a company that provides an online networking service for US physicians.²³ The Doximity database includes all physicians entered in the National Plan and Provider Enumeration System and the National Provider Identifier registry. Physicians who lack active National Provider Identifiers may self-register with Doximity. Demographic data were also collected from websites of medical schools, hospitals, and private practices. Two authors (S.C.R. and D.W.W.) used several sources to ascertain the race of each recipient—including Doximity, medical school and residency program webpages, and general internet search. When a discrepancy was encountered, a best guess was made. The Scopus database (Elsevier) and Google scholar were utilized to determine the current h-index of each recipient. The h-index is an objective measure used to describe the quantity and quality of research produced by physicians in a single number. The h-index has been studied extensively within otolaryngology and has been shown to be a reliable predictor of academic advancement and leadership status.^5,24 Data were then compared with the demographic data of US resident otolaryngologists and working otolaryngologists as a whole from the Association of American Medical Colleges (AAMC) to determine significance. The most recent data were provided by the AAMC in 2018, reporting 2017 data.

Duplicate winners, defined as recipients who received CORE grants in >1 year, were then evaluated in a secondary analysis. An internet search of the CORE grant recipients from 2010 was performed to determine their current academic ranks if applicable. Specific data collected included medical school faculty rank: assistant professor, associate professor, professor, and chair. These data were then stratified by gender and medical school by using Doximity and medical school websites.

The recipient count in the top 10 residency programs was also analyzed, as described by Doximity at the time of access (March 2020). To account for the different number of residents at different training programs, the number of grants at each program was divided by the number of residents per class. Statistical analysis was performed with Pearson’s chi-square analysis or t test through Microsoft Excel 2018 (version 16.18). Our analysis set the alpha level at 0.05, and variables with a P value <.05 were statistically significant. The utilized databases contain publicly available information. Therefore, institutional review board approval was not required per the standing policies at Rutgers New Jersey Medical School.

Results

Data from 310 CORE program grant recipients were analyzed. In 2010, the recipient group was 60.86% male and 39.13% female, as opposed to the 67.70% male and 32.30% female distribution of US resident physicians in otolaryngology (P > .05).²⁵ However, when compared with the gender differences of all active physicians in otolaryngology in the United States (87.30% male and 12.70% female), the gender makeup of recipients was statistically significant, with a greater percentage of female recipients (P < .01).²⁵ In 2019, the gender differences of recipients were nearly unchanged: 60.00% male and 40.00% female. This was still not significantly different than the gender distribution of US resident otolaryngologists: 63.80% male and 36.20% female (P > .05). However, this was significant when compared with the gender distribution of all US otolaryngologists (P < .01).²⁶ The distribution of gender among recipients over the last decade remained nearly constant but with significantly more female recipients in comparison with overall gender differences in otolaryngology ( Figure 1 ).^25,26 There were 63 duplicate winners (58.73% male, 41.27% female). Of these, there was no statistical difference in gender when compared with the residents in otolaryngology (P > .05).²⁶ There was also no significant difference in comparison with the grant recipients overall (61.57% male, 38.43% female). However, there was a significant difference versus the field of otolaryngology overall (P < .01; Table 1 ).²⁶

Figure 1.

Gender disparities of CORE grant recipients from 2010 to 2019.

Table 1.

Comparison of Demographics of CORE Grant Recipients and Otolaryngologists in the United States: 2010-2019. ^a

Demographic	Observed grant recipients, %	Expected working otolaryngologists, %	P value	Expected otolaryngology residents, %	P value
Gender
2010
Male	60.86	87.30	<.01	67.70	>.05
Female	39.13	12.70		32.30
2019
Male	60.00	82.90	<.01	63.80	>.05
Female	40.00	17.10		36.20
Race
2010
White	63.04	65.56	<.01
Black	2.17	0.97
Asian	32.61	17.70
Hispanic	2.17	5.70
2019
White	69.70	66.55
Black	3.03	2.30	<.01
Asian	27.27	13.79
Hispanic	0.00	3.50
Duplicate winners
Gender			<.01		>.05
Male	58.73	82.90		63.80
Female	41.27	17.10		36.20
Race			<.01
White	68.25	65.56
Black	3.17	0.97
Asian	15.00	17.70
Hispanic	0.00	5.70

Abbreviation: CORE, Centralized Otolaryngology Research Efforts.

Data from the Association of American Medical Colleges. Bold P values indicate statistical significance (P < .05).

In 2010, the racial breakdown of grant recipients was 63.04% White, 32.61% Asian, 2.17% Black, and 2.17% Hispanic. In 2019, it was 69.70% White, 27.27% Asian, 3.03% Black, and 0.00% Hispanic. Both these groups had statistically significantly more Asian recipients when compared with the proportion of US Asian otolaryngologists (17.70% Asians in 2010 and 13.79% Asians in 2017; Table 1 ). Black recipients represented 2.17% of CORE grant recipients, as compared with 0.97% of US otolaryngologists in 2010. In 2019, 3.03% of recipients were Black versus 2.30% of US otolaryngologists in 2017. Hispanic recipients were underrepresented: in 2010, 5.70% of US otolaryngologists were Hispanic, and only 2.17% of grant recipients were Hispanic. In 2017, 3.50% of US otolaryngologists were Hispanic, and no CORE grant recipients were Hispanic. Figure 2 displays the changes in racial disparities among grant recipients over the last decade. The analysis of duplicate winners displayed a similar pattern: 68.25% White, 23.81% Asian, 3.17% Black, and 0.00% Hispanic.

Figure 2.

Racial disparities of CORE grant recipients from 2010 to 2019.

The top 10 residency programs for CORE grant recipients and their number of awards are listed in Table 2 . Of the 310 recipients, 182 trained at 1 of these programs (58.71%). The top residency programs, as ranked by Doximity at time of access, and their number of CORE grant recipients in the past 10 years are listed in Table 3 . Of the 310 recipients, 163 trained at 1 of these top-ranked residency programs (52.58%).

Table 2.

Residency Programs of CORE Grant Recipients: 2010-2019.

Residency programs of grant recipients	No.	No. / residency class size
1. Washington University	35	7
2. University of Michigan	27	5.4
3. Johns Hopkins University	22	5.5
4. Massachusetts Eye and Ear Infirmary / Harvard Medical School	20	4
5. University of Pennsylvania	17	3.4
6. Stanford University	14	2.8
7. University of Iowa	13	2.6
8. Oregon Health and Science University	12	4
9. University of California Los Angeles	12	2.4
10. Medical University of South Carolina	10	2.5
11. Other	128	—

Abbreviation: CORE, Centralized Otolaryngology Research Efforts.

Table 3.

Top Residency Programs as Ranked by Doximity and Corresponding CORE Grant Recipients: 2010-2019.

Residency programs as ranked by Doximity	No.	No. / residency class size
1. Massachusetts Eye and Ear Infirmary / Harvard Medical School	20	4
2. Johns Hopkins University	22	5.5
3. The Ohio State University	2	0.4
4. Stanford University	14	2.8
5. University of Iowa	13	2.6
6. University of Michigan	27	5.4
7. University of Pennsylvania	17	3.4
8. University of Pittsburgh	8	1.6
9. Vanderbilt University Medical Center	5	1
10. Washington University	35	7

Abbreviation: CORE, Centralized Otolaryngology Research Efforts.

The h-index of CORE grant recipients decreased over the last decade ( Figure 3 ). In 2010, the average h-index was 15.0. In 2019, it was significantly lower at 8.32 (P < .01). Analysis of duplicate winners revealed that the h-index of duplicate winners was 13.13, as compared with 10.68 for nonduplicate winners (P < .01).

Figure 3.

Average h-index of CORE grant recipients from 2010 to 2019.

Of the 47 recipients in 2010, 68.06% are currently working in academic medicine, with 62.50% being male and 37.50% female. Again, this is statistically significant when adjusted for the gender distribution of otolaryngologists today (P < .01). Of the cohort of CORE grant recipients in 2010, currently 15.62% are female professors, 12.50% female associate professors, and 6.25% female assistant professors ( Figure 4 ). This is statistically significant in comparison with the AAMC report on otolaryngology faculty, which breaks down at 3.80% female professors, 6.49% female associate professors, and 15.35% female assistant professors (P < .01).²⁷ Of the 2010 CORE grant recipients, 15.62% are male professors, 12.50% male associate professors, and 21.85% male assistant professors. This is statistically significant when compared with the AAMC report of all otolaryngology faculty in 2010: 19.97% male professors, 16.43% male associate professor, and 25.29% male assistant professors.²⁷ Overall, CORE grant recipients were more likely to enter academia as compared with the proportion of US otolaryngologists in academia per the most recent AAMC report (68.06% vs 23.45%, P < .01).

Figure 4.

Current academic rank of the 2010 CORE grant recipients.

Of the grant recipients, 68.12% were still in training at the time of grant receipt as medical students, residents, and fellows. The h-index of these trainees was significantly lower than that of faculty receiving a grant (7.33 vs 17.32, P < .01). An analysis of this group of trainees at time of grant receipt found that 22.58% are still currently in training. However, of those who completed training, 65.63% proceeded to secure an academic faculty position. This proportion is significantly higher than the current workforce of otolaryngology, in which only 23.69% are working in academia (P < .01).^27,28 This group now in academic faculty positions comprises 71.90% assistant professors, 23.14% associate professors, 4.13% professors, and 0.83% chairs. This is statistically significant when compared with the AAMC report of US medical school faculty in 2019: 41.10% assistant professors, 23.10% associate professors, 23.36% professors, and 3.84% chairs.²⁷

Discussion

In 2010 and 2019, males received the majority of CORE grant awards, with percentages virtually unchanged over the past decade. There was no statistical difference in the gender distribution of recipients as compared with that of US resident physicians in otolaryngology.^25,26 As the majority of CORE grants are awarded to trainees, this shows that awards are appropriately distributed with no bias to gender within the applicant pool. While women still receive a lower percentage of grants than men, they receive proportionately more based on their lower representation in the field of otolaryngology as a whole.^25,26 This is an encouraging statistic, as gender disparity has been documented in biomedical research grants awarded in the United States and internationally.^29,30 Manuscripts written by a female principal investigators were more likely to be accepted when reviewers were unaware of authors’ identities, suggesting systemic bias favoring male principal investigators.^31,32 Women in medicine often face obstacles that their male colleagues do not, and there is a significant subset of women in otolaryngology who believe that their gender has limited their careers.^33-35 Gender disparity has been identified in NIH and industry funding in otolaryngology, irrespective of length of career and, in some cases, despite men having lower research output than women at senior academic levels in otolaryngology in the United States.^36,37 Given that the CORE grant-funding mechanism has been shown to be a positive predictor for future academic output and NIH grant-funding success,^4,6 the high percentage of female CORE grant recipients could ultimately reduce the gender gap in NIH otolaryngologic research funding. Interestingly, previous work has shown that women are less productive from a research perspective earlier in their careers, but at senior levels, they equal or exceed the research productivity of men.³⁸ Several reasons have been postulated to account for lower productivity rates in the early careers of women, including reduced mentoring opportunities and greater involvement in family responsibilities.^12,33,39-43 Following the careers of the women who received CORE grants and remained in academic medicine may reveal how receipt of a CORE grant may alter the research production curve described. It is possible that this will improve early career research productivity. There was no significance in gender disparity among those who were awarded multiple grants.

When broken down by race, the majority of grant recipients were White in 2010 and 2019. Asian and Black otolaryngologists received a higher proportion of CORE grants than what their absolute representation within the field would predict. Generally speaking, minority physicians are underrepresented within academic medicine and surgery.^13,44,45 Non-White physicians are less likely to be retained in academic medicine and face lower rates of promotion than White physicians.^14,46,47 Minorities are also less successful than their White counterparts in securing grant funding.^15,16 Thus, the number of CORE grants awarded to Asian and Black otolaryngologists is a positive statistic. Given the correlation between CORE grant funding and future academic output and NIH grant application success,^4,6 the possibility that this could have a positive effect on racial disparity in academic medicine should be considered. Yet, Hispanic otolaryngologists were underrepresented among CORE grant recipients in 2010 (2.27%) and 2019 (0.00%) when compared with the proportion of all US otolaryngologists (5.70% and 3.50%, respectively).^25,26 None of the 63 duplicate winners were Hispanic. Furthermore, throughout the past decade, there were multiple years where there were no Black or Hispanic grant recipients ( Figure 2 ).

When the 10 residency programs with the most CORE grant recipients were examined, 7 of the programs were within the top 10 residency programs as ranked by Doximity. A 2012 study investigating the biographical information of otolaryngologists at academic programs via an Internet-based search identified the top 4 US otolaryngology programs as Massachusetts Eye and Ear Infirmary/Harvard, Johns Hopkins University, University of California–Los Angeles, and Washington University. These 4 programs train a disproportionate 11.20% of all academic otolaryngologists.⁴⁸ Of these 4 programs, 3 are in the top 10 at present, as outlined by Doximity ( Table 2 ), and are top 10 programs for CORE grant recipients. With CORE grants being a predictor of future academic endeavors in otolaryngology,⁴⁹ it is unsurprising that residency programs that receive a large number of CORE grants also account for high numbers of future academic otolaryngologists. This correlation between residency program ranking and CORE grant acquisition may be due to an academic environment that emphasizes research training and provides strong infrastructure and support for resident research projects. More in-depth analysis to understand the nature of this relationship is needed.

The h-index, an objective and calculable measure of relevance and quantity of academic output, has been shown to be reliable when comparing academic productivity among researchers within fields of academic medicine, including otolaryngology.^24,50-52 Between 2010 and 2019, the average h-index of CORE grant recipients decreased from 15 to 8.32. This is an expected finding. These values represent h-indices at present, and the grant recipients from 2010 have likely continued to publish since they received their grants, thereby increasing their h-index score. This also likely explains why the h-index of those who were trainees at time of grant receipt is significantly lower than that of faculty members. The average h-index of 8.32 for 2019 grant recipients still indicates a high level of research output. In comparison, in 2012 the average h-index was 4.62 for assistant professors in otolaryngology and 8.13 for associate professors.²⁴ Duplicate winners had a significantly higher average h-index (13.13) than the remaining CORE grant recipients (10.68). This may be in part due to the increased publications and citations as a result of the achievement of their first CORE grant.

Of the 47 CORE grant recipients in 2010, nearly two-thirds remain in academia. Of these, 37.50% are women, representing a significantly higher proportion of female academic faculty when compared with the total number of women within academic otolaryngology as a whole (17.10%).²⁶ Female CORE grant recipients from 2010 also hold higher academic ranks than would be expected. Historically, women are underrepresented in leadership positions within otolaryngology and other fields.^5,53,54 That female CORE grant recipients compose a higher percentage of professors and associate professors than what would be predicted is encouraging.

A significantly greater proportion of otolaryngology trainees who received a CORE grant pursued an academic position than that predicted by the current otolaryngology workforce.²⁸ The trajectory of this group shows significantly more assistant professors and fewer professors or chairs than expected.²⁷ These trainees are recently out of training; therefore, it follows that they should still be appointed at the lowest academic rank. As time elapses, further study should be performed to determine whether receipt of a CORE grant is an independent predictor of academic advancement.

This examination of CORE grant recipients is not without its limitations. A main limitation was the data available for comparison. The latest demographic data for otolaryngology from the AAMC are from 2017, and there is the possibility that proportions of race and gender within otolaryngology have changed since then. While it is unlikely that the field has changed dramatically enough in the past 3 years to alter these results significantly, the degree of differences found among genders and races may be larger or less impactful than reported. Gender differences were compared with US resident otolaryngologists and active US otolaryngologists. However, racial differences were compared with US otolaryngologists only, as there are no available race data for US otolaryngology residents. In addition, since race is complex and considered a self-designation, it is possible there are inaccuracies in our assignments. This study was also limited by examining 2 snapshots in time, a decade apart, due to availability of data and ease of analysis. While this method is likely to capture overall trends in the past decade, it does not account for year-to-year variance. In addition, as data detailing grant applications are not publicly available, it is unclear whether these disparities are from fewer applications from specific demographic groups or from unsuccessful grants. The AAO-HNS reports that it does not blind applicants’ information to the reviewers or partner societies that are funding the awards. However, race and gender information is not captured in the application.

Conclusions

The majority of CORE grant recipients over the past 10 years are male and White. However, female, Black, and Asian otolaryngologists have received a larger percentage of grants than their absolute proportions within otolaryngology. Most grant recipients train at the top training programs in the country, which have reputations for output of quality research and production of academic otolaryngologists. These recipients often choose to continue within academia. Overall, CORE grant awards seem to be distributed in ways that decrease the gender and racial disparities within otolaryngology and recipients tend to go on to achieve academic success.

Footnotes

Authorship Contributions

Savannah C. Roy, design, conduct, analysis, manuscript writing; David W. Wassef, design, conduct, analysis, manuscript writing; Wissam A. Nasser, design, conduct, analysis, manuscript writing; Nicole I. Farber, design, conduct, analysis, manuscript writing; Christina H. Fang, design, conduct, analysis, manuscript writing, revision; Soly Baredes, design, conduct, analysis, revision; Stacey T. Gray, design, conduct, analysis, revision; Jean Anderson Eloy, design, conduct, analysis, revision

Disclosures

Competing interests: None.

Sponsorships: None.

Funding source: None.

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