The Neurosurgeon Research Career Development Program (NRCDP) and the Impact of the NINDS/CNSF Getch K12 Scholar Award
Authors: Russell Lonser, MD, PhD
Stephen J. Korn, MD
Neurosurgeons have an important role to play in research towards understanding and treating neurological diseases and disorders. They have a unique ability to directly access the brain, use technologies in their clinical specialty that are unique to their specialty, and have clinical insight derived from patients and diseases for whom they are responsible. Although by no means the only source of research funding, the NIH R01 represents the fundamental, peer-reviewed grant mechanism by which clinicians in the U.S. conduct hypothesis-driven, cutting-edge research into brain function and dysfunction.
For a variety of reasons, including the evolution of neurosurgeon training paradigms and financial issues, the last 20 years has seen a dearth of neurosurgeon-led R01s. In 2009, just 34 neurosurgeons held NIH R01s, and the number appeared to be headed lower. In consultation with Department Chairs and research leaders in neurosurgery, The National Institute on Neurological Disorders and Stroke (NINDS) launched a new program, the . Neurosurgeon Research Career Development Award (NRCDP)(K12) as part of a comprehensive approach to increasing the number of neurosurgeons conducting hypothesis-driven research supported by the NIH.
The NRCDP is focused on the transition point from residency to faculty, a critical point of vulnerability for the development of neurosurgeon-researchers. Most neurosurgery residents accept a faculty position at an institution other than their residency institution. Even with significant research experience, and a desire for a dual career as clinician and scientist, newly transitioned neurosurgeons face large obstacles to successfully launching a scientific program. Most importantly, neurosurgeons have generally been away from research for three or more years prior to starting their faculty position, and upon moving to a new institution, must quickly get up and running with a new research project, in a new environment and with new scientific mentors (of which there are few in neurosurgery departments with which to make immediate contact). This daunting task coincides with the need to start a new clinical practice from scratch in a new environment, and the pressure to fit into a department that is almost entirely composed of purely clinical physicians.
Consequently, the premise of the NRCDP was three-fold: 1) to provide initial research support to outstanding neurosurgeons who had great promise for conducting important, high-quality research, 2) to incentivize the Chairs of their faculty departments to provide real protected time for research for a prolonged period of time, and 3) to create a nationwide community of neurosurgeon-scientists in which the small cohort of neurosurgeon-researchers could grow, mentor and support each other towards success.
The immediate goal of the NRCDP was simple: get supported researchers to individual NIH-level funding with which they could pursue their research. The NRCDP was set up as a national program, headed by a principal investigator and a national advisory committee, which would both run the program and be held accountable for its success. Neurosurgeons in their first faculty year who are practicing at an institution other than their residency institution are eligible to apply for support from the program. Candidates present a plan, both written and through interviews, by which they would launch an independent research program to investigate a problem of outstanding clinical importance for patients typically of relevance to neurosurgeons.
Candidates, in addition to being guided by one or more mentors, must have strong support from their Chairs. As part of the eligibility criteria, Chairs must commit to providing the candidate with 60 months of support for 50% of full-time professional effort towards research. Community building among all participants in the program, as well as oversight, occurs through an annual retreat that all attend for five or more years, as well as site visits to the home institutions of the awardees. Initially, the program was designed to support two new neurosurgeons each year for a total of two years each. The expectation was that those supported would obtain major individual funding by the third year or shortly thereafter.
The NRCDP program has funded 19 outstanding scholars since 2012. Remarkably, 50 neurosurgery departments have submitted applications to support new faculty, notwithstanding the requirement that Chairs must commit to 50% protected time for research for five years with just two years of support provided by the NRCDP.
Table 1 illustrates the results for the 13 scholars who have completed their two years of program support. Thus far, 85% have obtained major individual research awards. Ten of the first 13 scholars supported have received an individual Career Development Award (K), R01 or Cooperative Agreement award (UH3). One additional scholar received a major, R01-iike grant.
In light of the early, great success of the program, the Congress of Neurological Surgeons (CNS) and the CNS Foundation in 2015 initiated a yearly contribution to the Foundation for the National Institutes of Health (FNIH), which, with matching NINDS funding, provides two years of support biennially for an additional scholar – called the NINDS/CNSF Getch K12 Scholar Award. This CNS contribution to the program plays an important, unique role. Along with supporting an additional, outstanding junior neurosurgeon researcher, the Getch Scholar award can be used to support an individual who stays at his/her residency institution as well as one who leaves for a different institution. Indeed, the first two scholars chosen for the Getch Scholar award have been individuals who obtained faculty positions at their home institutions.
To date, six individuals from the NRCDP program have obtained NIH R01 or equivalent awards. However, this cooperative endeavor between NINDS and much of the neurosurgeon community may be having an even broader influence on the future of neurosurgeon-driven research.
Figure 1 illustrates the change in the number of neurosurgeons holding a major, individual NIH research grant since the inception of the NRCDP program. The number of unique neurosurgeons holding a major individual NIH award (R01 or DPseries research grant) increased by 90% between 2012 and May 2019.
The NRCDP, through collaboration with academic departments and the broad neurosurgical community, has successfully led to the development of early-career neurosurgeon-scientists into independent investigators. Moreover, the number of independent neurosurgeon-investigators has grown significantly since the inception of the program. The growth in neurosurgeon-led research will undoubtedly contribute to a better understanding of neurological function and dysfunction and ultimately to a better understanding and treatment of patients with neurological disease.