Dermatology: Practical and Conceptual Letter to the Editor | Dermatol Pract Concept. 2023;13(3):e2023162 1 Dermatology Receives Fewer Grants Versus Other Specialties but Excels in Citation Impact in a Cross-sectional Analysis of R01 Grants 2000-2022 Jade Conway1, Jose W. Ricardo2, Shari R. Lipner2 1 New York Medical College, Valhalla, New York, USA 2 Department of Dermatology, Weill Cornell Medicine, New York, New York, USA Citation: Conway J, Ricardo JW, Lipner SR. Dermatology receives fewer grants vs. other specialties but excels in citation impact in a cross- sectional analysis of R01 grants 2000-2022. Dermatol Pract Concept. 2023;13(3):e2023162. DOI: https://doi.org/10.5826/dpc.1303a162 Accepted: January 21, 2023; Published: July 2023 Copyright: ©2023 Conway et al. This is an open-access article distributed under the terms of the Creative Commons Attribution- NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original authors and source are credited. Funding: None. Competing Interests: Ms. Conway and Dr. Ricardo have no conflicts of interest. Dr. Lipner has served a consultant for Orth-Dermatologics, Hoth Therapeutics, and Belle Torus Corporation Authorship: All authors have contributed significantly to this publication. Corresponding Author: Shari R. Lipner, MD PhD, Department of Dermatology, Weill Cornell Medicine, 1305 York Avenue, 9th floor, New York, NY 10021 Phone: 646-962-3376 E-mail: shl9032@med.cornell.edu To the Editor, Grant funding is essential for conducting high-impact bio- medical research, and the National Institutes of Health (NIH) Research Project Grant R01 remains the benchmark non-industry funding mechanism. We aimed to characterize number and citation impact of R01 grants awarded to der- matology compared to other fields. The NIH Research Portfolio Online Reporting Tools database was retrospectively reviewed for new R01 grants issued to dermatology and other specialties, 2000-2022. Primary investigators with MD or MD-PhD were defined as “physician-scientists,” and those with PhD or equiv- alent as “research-scientists.” NIH iCite database was searched for Relative Citation Ratio (RCR), measuring field- and time-independent citation rate for each publica- tion per grant.1 Reviews and articles without RCR were excluded. Weighted RCR for each grant, defined as sum of grant-associated manuscript RCRs, represented the overall grant impact, and mean RCR represented the average RCR of grant-associated publications. There were 396 new R01 dermatology grants (total grant money: $153,057,895), resulting in 3,975 publica- tions and 10.04 articles/grant 2000-2022. Number of der- matology grants/year was stable (m of best fit line 0.087, variance 16.72, Supplemental Table 1). Average number of grants/physician was 0.032 for dermatology and 0.052 for all specialties (Table 1). Most primary investigators were physician-scientists (220 grants, 55.5%). Mean weighted RCR for physician-scientist grants (27.49, 95% confi- dence interval [CI], 20.95-34.03) was greater than for research-scientist grants (15.05, 95% CI, 12.17-17.93) (0 = .0017) (Figure 1). Mean RCR for physician-scientist publications (1.81, 95% CI, 1.57-2.04) was greater (P = 0.02) than for research-scientist publications (1.44, 95% CI, 1.24- 1.63) (Supplemental Figure 1). 2 Letter to the Editor | Dermatol Pract Concept. 2023;13(3):e2023162 Our study demonstrated that NIH-funded dermatology research is highly impactful, considering the high mean RCR value versus a field-normalized RCR standard value of 1.0 for NIH-funded research. While dermatology performed above average for number of articles/grant (10.4 versus 7.36) [2], average grants/physician was lower compared to other specialties, suggesting limited allocation of NIH funds to dermatology or dermatology investigators applying for few grants. Despite numerous challenges, physician-scientists produced significantly more impactful research than research-scientists. In a retrospective study of all NIH grants Table 1. Number of new National Institute of Health R01 grants and associated publications by specialty, 2000-2022 Specialty # Grants #Publications Average # Grants/Physician* Internal Medicine 12,168 192,553 0.101 Psychiatry 3,742 55,754 0.096 Pediatrics 2,722 38,114 0.045 Radiology 2,150 36,192 0.077 Neurology 1,973 33,818 0.139 General Surgery 1,572 26,169 0.061 Ophthalmology 1,065 17,307 0.055 Obstetrics and Gynecology 693 8,108 0.016 Dermatology 396 3,975 0.032 Family Medicine 315 3,221 0.003 Urology 277 3,525 0.027 Physical Medicine and Rehabilitation 166 2,291 0.017 Emergency Medicine 144 1,280 0.003 All Specialties 27,383 422,307 0.052 *Number of grants/physician was calculated with the number of active physicians per specialty, obtained from the Association of American Medical College (AAMC) Physician Specialty Data Report, as the denominator. Figure 1. Mean Weighted Relative Citation Ratio for R01 Grants Issued to Department of Dermatology Investigators from 2000-2022, calculated using GraphPad unpaired 2-tailed t test. The lines inside both blue bars represent the confidence intervals for the t test. RCR = Relative Citation Rate Letter to the Editor | Dermatol Pract Concept. 2023;13(3):e2023162 3 awarded to dermatology departments, 2009-2014, R01 grants for MD investigators decreased by $1.4 million/year (P<0.001), and was stable for MD/PhDs ($0.34 million/year, P=.25), and PhDs ($0.20 million/year, P = 0.53) [3]. Further- more, in a retrospective study of 106,368 R01 grant applica- tions, 2000-2006, inclusion of human subjects significantly decreased likelihood of receiving NIH funding (P < 0.001), suggesting NIH inclination for basic over translational science [4]. Physician-scientists must balance patient care and research responsibilities, with only 28% of MD-PhD dermatologists spending >50% of their time on research, in a survey-based study of 6,786 MD-PhD graduates, 1975- 2014 [5]. Dermatology physician-scientists have excelled in research output and deserve to be equally supported by funding agencies. Institutional, philanthropic and industry-based funding mechanisms were not assessed, and RCRs might not fully capture influence of R01 grants, limiting our analysis. In sum, dermatology performs above average for cita- tion impact of R01-funded research, but receives fewer grants, on average, than other specialties. In addition, der- matology physician-scientists demonstrate higher citation impact than research-scientists. We encourage dermatology investigators to apply for NIH funding and persuade fund- ing agencies to allocate resources supporting dermatology physician-scientists. References 1. Janssens ACJW, Goodman M, Powell KR, Gwinn M. 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