Assessment of the NIH Salary Cap Gap Reveals the Increasing Financial Burden of Training and Hiring Surgeon-Scientists.

Abstract

OBJECTIVE The goal of this study was to evaluate trends in the cost-share required to support NIH funded surgeon trainees and faculty. SUMMARY OF BACKGROUND DATA Surgeon-scientists are critical to advancing our understanding of surgical diseases and innovating care of surgical patients. However, demands for clinical productivity while securing extramural funding in the setting of increasingly competitive National Institutes of Health (NIH) funding paylines has limited growth of the surgeon-scientist workforce. METHODS The NIH salary cap and postdoctoral fellow stipends were obtained from the NIH website. The median total compensation for faculty at the Associate Professor rank (Non-Clinical, Clinical Faculty, Surgeons, and Surgical Subspecialties) and PGY3 level residents were obtained from Association of American Medical College data. Data were analyzed for fiscal years 2001-2023 (faculty) and 2005-2003 (trainees). Changes in the salary cap gap over time were forecasted using an exponential smoothing algorithm. RESULTS Over the study period, no cost-share was required for non-clinical faculty, while the cost-share for a surgeon investigator increased from $18,360 to $68,660 per year. For a single postdoctoral fellow trainee, the cost-share increased from $22,932 to $31,608 annually. In 2023, the total cost-share to support the program director and four positions on a T32 training grant was estimated to be $250,631. The cost-share for surgeon investigators is projected to expand by another 47% by 2035. CONCLUSIONS This analysis demonstrates that the NIH salary cap gap creates a financial challenge for institutions and Departments of Surgery, which is projected to increase substantially over the next decade. These data highlight the urgency to advocate for policy development to adequately compensate federally funded surgical investigators and should facilitate dialogue within institutions to develop alternative funding mechanisms for surgeon-scientists.