EditorialOriginal Research

Gender Differences in National Institutes of Health Funding for Family Medicine Faculty

Shurjeel Uddin Qazi, Jeanne Cawse-Lucas, Mehwish Hussain, Kiran Khurshid and Faisal Khosa
The Journal of the American Board of Family Medicine January 2026, 39 (1) 158310; DOI: https://doi.org/10.3122/jabfm.2025.250118R1

Abstract

Introduction The present study investigated the current trends of gender disparity in the National Institutes of Health (NIH) funding patterns for research within Family Medicine.

Methods Funding data was collected from the online NIH Research Portfolio Online Reporting Tools Expenditure and Results (RePORTER) system for fiscal years 2017-2020, and information regarding each Principal Investigator (PI) was retrieved from the Scopus database and departmental websites. Mann-Whitney U and Kruskal Wallis tests were performed on collected data for statistical comparison of continuous variables.

Results We analyzed 730 grants in our analysis. Amongst them, 398 (54.5%) were awarded to women PIs and 332 (45.5%) to men PIs. The mean NIH grant amount awarded to men PIs (Embedded Image490,793.32) was significantly higher than the mean grant amount awarded to women PIs (Embedded Image428,405.62) (p = 0.04). The strongest correlation between NIH funding and academic output was observed for the number of publications of men PIs. When the gender of PI and co-PI were analyzed together, there was no significant difference in the number of grants or mean grant amount. Stratification by academic degree revealed no significant difference between both genders for the mean NIH grant amount.

Conclusion Despite the increasing representation of women within the discipline of family medicine, men continue to receive higher average NIH grant amounts compared to women. The differences are multifactorial and may include differences in academic productivity or grant committees’ heuristics. Overall, the results were promising with little evidence of significant gender disequilibrium within NIH-funding for researchers in FM.

Introduction

Family Medicine (FM) is one of the most sought-after specialties in the United States and the primary source of national care. Although internal medicine and surgical fields are often perceived as the leading drivers of medical research, FM plays a critical role in producing influential evidence—ranging from global health policy and behavioral science to epidemiology and clinical outcomes research.1 Despite FM’s significance, research funding and attention have historically lagged: for example, FM accounts for just 0.2% of NIH funding, compared to more than 4.5 times that for other clinical specialties.2

The National Institutes of Health (NIH) is the leading public funding source for biomedical research worldwide.3 In the past, there have been significant gender imbalances reported concerning NIH funding among various medical specialties, including internal medicine, ophthalmology, radiology, and otolaryngology.4–8 It was observed that across all the studies, more than half of the grants were awarded to men PIs, where the amount of total grants received exceeded the amount awarded to their women counterparts. However, recent research examining NIH funding in FM concluded no evidence of significant gender disparity from 2008 to 2017.9

This underrepresentation of women extends to medical school faculties, leadership roles, editorial boards, professional societies, and authorships as well.10–15 Although there has reportedly been a significant increase in the representation of women authors in FM from 2008 to 2017 (8.9% in the first authorship and 13% in the last authorship), disequilibrium between men and women researchers still exists.16–21 Hart et al. found that across nine medical specialties, women authorship increased over time but still remained below 50% in all fields. Similarly, Mamtani et al. reported that women held only 17% of first author and 12% of last author positions.17,19 The amount of funding and support a researcher garners is closely related to the institution’s reputation and financial burdens, therefore affecting the professional progression and promotions faculty may receive.22,23 Prior studies suggest that research roles, expectations, and institutional advancement may differ based on academic degree, potentially contributing to variation in grant success and academic output across genders. These structural differences may interact with gender to shape access to funding, research output, and career advancement. This is evident by the fact that as of 2023, women comprised 45% of full-time faculty in U.S. medical schools, but only 25% of department chairs and 27% of medical school deans.24 Moreover, men are nearly twice as likely to hold full professorships with disparities even after adjusting for factors such as years of experience and publication record.25

The gender disparities in research productivity—measured through metrics such as publication count, citation frequency, and h-index—have been consistently documented across academic medicine.26,27 In FM specifically, women researchers have historically produced fewer publications and received fewer citations than their men counterparts, which can impact their ability to secure competitive grant funding and career advancement.28 These metrics are commonly used as criteria in academic promotion, compounding disparities in recognition and opportunity. Given these persistent differences in academic output and visibility, it is likely that such productivity gaps also contribute to the lower NIH funding observed among women researchers.

While recent research has examined NIH funding trends in FM—particularly focusing on R01 grants and gender distribution—key academic productivity metrics such as publication count, citation frequency, h-index, and years of active research were not evaluated.9 The present study aims to examine gender disparities in NIH funding patterns within FM from 2017 to 2020, focusing on potential changes over time. The primary outcomes include the proportion of men and women grant recipients, along with their academic achievements, measured by degree type, h-index, years of active research, publication count, and citation metrics.

Methods

The current study is exempted from Institutional Review Board approval as retrospective collection of publicly available data was assessed. Our study methodology has been validated in several recent publications.5,7,8

Database Search

Data on grants awarded to FM departments was retrieved using the NIH’s Research Portfolio Online Reporting Tools Expenditure and Results (RePORTER) website.29 The search was restricted to include awards dating fiscal year (FY) 2017 through 2020 (Note: NIH fiscal years begin on October 1 and end on September 30 of the following year). The specific data points of interest for collection included number of grants received, dollar amount of each grant, the name and terminal degree of the Principal Investigator (PI), as well as the academic institution associated with each PI, and the name of the Co-Investigator (Co-I), as found within the “Details” tab section on the NIH RePORTER website.

To assign gender categories to PIs and Co-Is, we used Gender API, a widely used name-based gender inference tool validated in prior research for high accuracy in large-scale bibliometric analyses.30–32 First names were uploaded, and cases with prediction confidence ≥70% were categorized as women or men accordingly. For names flagged as ambiguous or with lower confidence, we conducted a manual review using institutional faculty listings and publicly available professional profiles to assign the most likely gender category. Cases that remained unresolved after manual review were excluded from analysis.

The Scopus database was searched to collect further information about each PI, including the total number of publications, total number of citations, years of active research, and h-index.33 These productivity metrics were calculated at the individual PI level and then grouped by terminal degree (MD/DO, PhD, or Other). For example, the average number of publications reported for MDs reflects the mean publication count per PI with an MD degree. Grant totals and funding amounts were also stratified by gender and terminal degree to evaluate whether academic background modified observed gender disparities. Years of active research were defined as the period between a PI’s first indexed publication and the present (or most recent publication year). While this measure does not account for earlier training (e.g., doctoral or postdoctoral work) or interruptions in research activity, it is used here as a standard proxy for research career duration. If any authors had multiple research profiles, the profile with the highest h-index was used for this study.

Data Extraction

To observe the number of grants based on the gender of PI and Co-I, in the presence of multiple PIs, the gender of the Contact PI was only considered for analysis. Frequency and percentages were computed for the degree of PI and gender of PI and Co-I. Mean with standard deviation and median with interquartile range were computed for the number of publications, years of active research, total number of citations, h-index, number of grants, and grant amount of PI. The number of grants was calculated based on the project titles for each PI in the data.

As part of the overall grant recipient profile, we examined the distribution of grant numbers by degree type within each gender group. Education degrees of PIs were organized into three categories: MD, PhD, and Other degrees. The “Other” category contained degrees with less than 15 occurrences in the data, which includes (but, is not limited to): MD, PhD; MPH, PhD; Ph.D., MA; ScD; ScD, ScM.

Statistical Analysis

Data were analyzed using Statistical Package for the Social Sciences (SPSS) version 26(IBM Corp., Armonk, New York). Normality was assessed by the Shapiro-Wilk test. Descriptive statistics were used to report frequencies and proportions for the categorical data. Mann-Whitney U and Kruskal-Wallis tests were used for comparing the above-mentioned metrics between gender and degree of PI, respectively. Spearman’s correlation test was used to determine statistical significance in the bivariate correlation analysis between author metrics and mean NIH funding totals per PIs. P-value <0.05 was considered significant in all cases.

Results

NIH Funding Awardee Demographics

There was a total of 730 grants awarded during the study period. It is worth noting that each investigator may or may not have been awarded multiple grants (the mean number of grants awarded per PI was 2 for both men and women [IQR=2]). Out of 730 awards, 398 (54.5%) were awarded to women PIs and 332 (45.5%) to men PIs in FM (Table 1). Women comprised 35.9% of MDs and 66.7% of PhDs in this analysis. The total number of women PIs who received funding was 135 (57.0%) and the total number of men PIs receiving funding was 102 (43.0%). Of all the PIs, 50% held a PhD (n=120), and 27% held an MD (n=64). The median number of publications by the PIs was 64 (IQR=88) while the median number of years the PIs were active in research was 21 (IQR=14).

View this table:
Table 1. Demographic Information of All NIH Grant Recipients in Family Medicine from 2017-2020.

Among men PIs, the mean number of grants received by PhD holders (2.15 ± 1.46; IQR: 2.0; median: 2) and MD/DO holders (2.20 ± 1.21; IQR: 2.0; median: 2) were similar. The highest number of grants (2.52 ± 1.81, IQR: 3.0; median: 2) were awarded to men PIs with a degree designated as “other”. Similarly, for women PIs, the “other” degree holders had the highest number of mean grants (2.66 ± 1.72; IQR: 2; median: 2). This was followed by MD/DO holders (2.26 ±1.25: IQR; 3; median: 2) and the lowest number of mean grants among women PhD holders (2.21 ±1.33; IQR: 2; median: 2); (Figure 1).

Figure 1.
Figure 1. Difference in Number of NIH Grants.

This boxplot shows the difference in the number of NIH grants received by men and women principal investigators, stratified by their terminal academic degrees.

Abbreviation: National Institute of Health (NIH).

Overall Academic Productivity Stratified by Terminal Degree

On average, PIs with MD degrees had the highest number of publications (136.5 ± 179.2) and were active in research for 21.8 ± 8 years. PhD-holding PIs had 101.5 ± 112.2 publications and 18.9 ± 8 years of research activity, while PIs with Other degrees had 86.7 ± 65.7 publications and 20.7 ± 8.3 years of research activity.

MD/DO degree holders also had a higher total number of citations (5,511.7 ± 10,205.3) and h-index (27.2 ± 19.7) than their counterparts (PhD: 4,475.0 ± 8,608.7 years, h-index: 26.6 ± 20.7; other: 2,966.28 ± 3,733.80, h-index: 22.9 ± 12.8). However, a higher number of grants were awarded to the faculty members with other degrees (3.2 ± 1.9). Comparing these matrices, only years of active research produced significant differences among different degrees of the PIs (p = 0.04).

Gender Differences in NIH Grant Funding Amounts

The mean NIH grant amount awarded to men PIs ($518,862.73 ± $490,793.32) was significantly higher than the mean grant amount awarded to women PIs ($450,195.80 ± $428,405.62) (p = 0.04); (Figure 2a). One hundred seventy-three PIs (94 women and 79 men) were awarded more than one NIH award, hence the sums of all NIH awards per individual were calculated. While statistically insignificant, men PIs were awarded greater total NIH funding per individual ($1,705,568.56 ± $1,966,831.96) than women PIs ($1,346,488.17 ± $1,551,615.30) (p = 0.32) (Fig⁠ure 2b). Additionally, there was no difference in the mean number of grants awarded to women and men PIs (p = 0.6).

Figure 2a.
Figure 2a. Difference in Mean NIH Grant Amounts.

This figure shows the comparison between the mean NIH grant amounts awarded to men and women principal investigators.

Abbreviation: National Institute of Health (NIH).

A graph of a number of people Description automatically generated with medium confidence
Figure 2b. Difference in Mean NIH Funding per Individual.

The figure illustrates the difference in mean NIH funding per individual between men and women principal investigators.

Abbreviation: National Institute of Health (NIH).

Gender Differences in NIH Grant Funding Amounts Stratified by Terminal Degree

When stratified by terminal academic degree, no significant difference was observed between genders for the mean NIH grant amount across all degrees between men and women researchers. (Figure 3, Table 2). The number of NIH grants awarded to women increased steadily from 2017 to 2020, particularly among those with MD/DO and PhD degrees, who saw 91.7% and 39.2% increases, respectively, in total grant count over the 4 years (Table 3).

Figure 3.
Figure 3. Comparison of Mean Number of NIH Grants.

The figure presents a comparison of the mean number of NIH grants awarded to men and women principal investigators, stratified by their terminal academic degrees.

Abbreviation: National Institute of Health (NIH).

View this table:
Table 2. Mean NIH Grant Amount Awarded to Men and Women PIs Stratified by Terminal Academic Degree in Family Medicine.
View this table:
Table 3. Mean NIH Grant Amount Awarded to Men and Women PIs Stratified by Terminal Degree and Fiscal Year in Family Medicine.

Gender Disparities in Academic Metrics Among NIH Grant Recipients

Table 4 presents a bivariate correlation of author metrics (number of citations, publications, h-index, and active years of research) and mean NIH funding totals per PIs for FM faculty. A statistically significant correlation was observed between number of publications and NIH grant amount for men PIs (r = 0.211) (p = 0.03). Men PIs also had a significantly higher number of mean publications in comparison to women PIs (133.6 vs 87.6) (p<0.01). Years of active research for women PIs were significantly fewer than men PIs (Men: 22.1±8.2, Women: 18.5±7.8) (p <0.001). Additionally, men PIs had a significantly higher scholarly impact, as measured by h-index (29.8±21.4 vs 22.9±16.6) (p = 0.005) and were cited twice as many times on average (5825.3 vs 3379.4) (p = 0.005), as compared to their women counterparts.

View this table:
Table 4. Bivariate Correlation Coefficient Between Mean NIH Grants Awarded to Principal Investigators in Family Medicine for Fiscal Years 2017-2020, and Number of Publications, Number of Citations, Years of Active Research, and h-index.

Co-Principal Investigator Gender Analysis

The mean NIH grant amount for men PIs with men Co-I was $663,552.52 ± $622,074.45, while with a woman Co-I, the mean NIH grant amount was $453,331.88 ± $294,943.28 (p = 0.2). Women PIs with women Co-I received higher NIH grant amounts ($662,622.00 ± $378,963.56) as compared to when their Co-I were men ($519,999.40 ±$347,167.67) (p = 0.08); (Figure 4). The mean number of grants for a men PI with a man Co-I was 2.91 ± 1.16 (IQR: 2; median: 3) while with a woman Co-I, the mean number of grants was 2.45 ±1.00 (IQR: 1; median 3). When PI was a woman and Co-I was a man, the mean number of grants was 3.00 ± 1.62 (IQR: 2.0; median: 3); whereas, when PI and Co-I both were women, the mean number of grants was 3.25 ± 2.17 (IQR: 2.0; median 2.5). There was no significant difference in the number of grants when the gender of PI and Co-I were considered together.

Figure 4.
Figure 4. Difference in the Mean NIH Grant Amount.

This figure depicts the difference in the mean NIH grant amount awarded to men and women principal investigators, stratified by the gender of their co-principal investigator.

Abbreviations: National Institute of Health (NIH), Principal Investigator (PI).

Discussion

The present study found little evidence of significant gender disparity within mean NIH funding for FM from the years 2017-2020 (Table 2). While there was no significant difference between women and men PIs when it came to the number of grants awarded, men were awarded greater amounts of grants on average. The findings of our analysis are in contrast to the previous study of NIH funding within FM from years 2008-2017 which demonstrated greater, but not significantly so, grant amounts awarded to men compared to women.9

The significantly lower academic productivity observed among women PIs may contribute to the lower NIH funding amounts awarded to them in FM. In our analysis, men PIs had significantly more years of active research, higher citation counts, and greater h-indices compared to their women counterparts (all p < 0.01). Prior research has established a strong association between h-index and grant success, with investigators holding an h-index below 10 significantly less likely to receive NIH funding than those above this threshold.34 Moreover, the h-index is not only a reflection of past academic productivity but also a predictor of future research success and professional advancement.35 As demonstrated by Zhu et al., higher h-indices are associated with increased citations, successful promotions, and higher research output—creating a reinforcing cycle that further enhances a researcher’s scholarly profile.36

This cycle may partly explain the gender-based disparity in NIH funding: men, already more likely to receive NIH grants, may benefit from greater resources that allow them to publish more, garner more citations, and thus improve their academic metrics. In turn, stronger bibliometric indicators may position them more competitively for future funding. Interestingly, at least one study found that the disparity in h-index between men and women diminishes when controlling for self-citations, suggesting that structural and cultural factors may further amplify the observed gap.37 Another possible reason for the lower grant amounts could be that women may apply for lower funding totals, as was shown in prior studies.38 Unfortunately, data on unsuccessful grant applications is not currently available to the public on the NIH RePORTER website and was beyond the scope of this analysis.

The analysis of the influence of multiple principal investigator teams (MPI) yielded interesting findings. We observed that in women-led MPIs, with a woman Co-I, the mean amount of grants awarded was greater but not significant than with a man Co-I. Our findings align with the results of Kingsley et al. who investigated the gender disparity in grant awardees in Australia.39 Firstly, their research reinforced that women-led MPIs tend to consist of a majority of women Co-Is. Secondly, they reported that while historically, research teams composed primarily of women received less funding per grant than teams composed primarily of men, this disparity diminished over time, reaching equity by 2020 regardless of greater or lower representation of women in research teams. This shows that fostering women leadership of team grants as an avenue to increase the representation of women in the research pool could, in turn, bridge the cumulative funding gap over time.

Future Research and Policy

While our study found no significant difference in the number of NIH grants awarded to men and women in FM from 2017–2020, disparities in funding amounts, citation metrics, and academic productivity persist. These findings suggest that gender equity in research support may go beyond grant counts alone. To address these more nuanced disparities, future efforts might consider policies and institutional practices that promote equity in research visibility, mentorship, and career advancement. For example, enhancing data collection on gender and authorship, implementing interventions to address implicit bias, and expanding access to flexible training and promotion pathways may support a more inclusive academic environment. Future research should consider a more detailed stratification of NIH funding patterns based on PI and Co-I gender combinations. Analyzing all possible gender pairings (e.g., men-to-men, men-to-women, women-to-women, women-to-men) using interaction models may offer deeper insights into how gender dynamics within research teams influence funding outcomes. Although these recommendations extend beyond the scope of our current analysis, they are consistent with broader efforts to foster sustained gender equity in academic medicine, including NIH grant funding.

Limitations

There are several notable limitations to our study. Firstly, in the context of gender disparity, this research design does not account for non-binary gender identities. This potential limitation may be overcome if future researchers conduct a survey that can allow for self-reported gender instead of using publicly available data. This would open numerous other doors and widen the scope of data collection to include variables such as sexual identity, marital status, and whether or not the individual has children. This is especially relevant as we may continue to explore traditionally underrepresented groups in academic medicine by studying potential disparities for physicians in the LGBTQ community. Another limitation is that researchers could have publications under different names, as people change names for many reasons including changes in marital status or gender identification. Name changes may falsely underestimate the number of publications and other research metrics particularly affecting women researchers. As a result, their productivity may be systematically underrepresented in databases, leading to potential misclassification of research output and underestimation of academic impact. In the context of our study, this could mean that the apparent disparities in publication volume or citations between men and women PIs are partially inflated due to data matching errors, rather than true differences in productivity. Additionally, we did not analyze gender disparities by NIH funding mechanism (e.g., R-series vs. K-series grants), which may influence observed trends. Future studies should explore how career development awards and institutional mentoring programs contribute to differences in funding patterns by gender.

Some limitations exist that are inherent to the use of the Scopus database, which does not include citations before 1970. Consequently, data collected on PIs’ h-indices may not be accurate, especially for more senior faculty members. In addition, an author’s first publication as indexed by Scopus is the starting point for the “years of active research” parameter. Furthermore, this does not account for continuous productivity and may lead to an overestimation of an individual PI’s active research years.

An additional limitation of this analysis is that it was restricted to NIH-funded grants and did not include funding from other major sources such as the Agency for Healthcare Research and Quality. This decision was based on the availability of standardized, publicly accessible data from the NIH RePORTER system, which enables consistent extraction of grant-related information. However, we acknowledge that excluding other funding agencies may limit the generalizability of our findings and a future study inclusive of all the major funding sources is advisable.

Conclusion

In summary, as women representation in FM continues to grow, the gender gap among funding awardees continues to narrow, albeit at a slower-than-ideal rate. The reasons for these differences between women and men are multifaceted. This research analysis underscores the need for future research and policy review/implementation to ensure continued progress in achieving gender parity and progressing the careers of women researchers.

Conflicts of Interest

None.

Ethics Statement

This study utilized publicly available data from the National Institutes of Health (NIH) and did not involve human participants, patient information, or animal subjects.

Author Contributions

Study Conceptualization: Faisal Khosa and Mehwish Hussain; Methodology: Jeanne Cawse-Lucas; Formal Analysis and Investigation: Shurjeel Uddin Qazi; Writing- original draft preparation: Shurjeel Uddin Qazi, Kiran Khurshid; Writing- review and editing: Faisal Khosa and Jeanne Cawse-Lucas; Supervision: Faisal Khosa.

Corresponding Author

Faisal Khosa, MD, MBA, TI, FFRRCSI, FRCPC, FACR, Department of Radiology, Vancouver General Hospital, fkhosa{at}gmail.com

This article was externally peer reviewed.

Acknowledgements

Dr. Faisal Khosa is the recipient of the Michael Smith Health Research BC Health Professional-Investigator award (2023-2028).

  • Received for publication March 26, 2025.
  • Accepted for publication September 8, 2025.

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