The Extinction of the Surgeon Scientist
In this issue of Annals of Surgery, Keswani et al present data demonstrating the decline in the number of surgeons pursuing careers in basic and translational research. The authors show that over an 8-year period (2006-2014) total NIH funding to surgical departments fell from $185M to $157M whereas at the same time total NIH funding increased from $6.2B to $6.9B. Because another indicator of the decline is the amount of basic and translational research being conducted by surgeons, the authors examined the number of basic science abstracts submitted to the Academic Surgical Congress, the joint annual scientific meeting of the Association for Academic Surgery (AAS) and the Society of University Surgeons (SUS). In 2011, 48% of all abstracts submitted were categorized as basic science (398 of 832), whereas in 2015, this number fell to only 27% (304 of 1128).
To understand the root of why we are seeing fewer surgeons interested in pursuing careers in basic and translational research, the authors conducted a survey of members of the AAS and SUS. Of the 2,504 members surveyed, 41% responded. After excluding trainees, 757 faculty members remained of which 227 were chairs or division chiefs. Of most concern, although 42% of the faculty cohort indicated that their primary research focus was basic science, only 32% of the faculty cohort believed that it was realistic for surgeons to be successful in basic science in today’s environment. Even more concerning was that this number was not much higher among the chair and chief cohort (35%), indicating that even leadership does not think it is realistic for surgeons to pursue basic science research. Obstacles identified by the junior faculty as to why surgeons are having a hard time securing extramural funding included: (1) excessive clinical demands and pressure to generate revenue; (2) challenging funding environment; (3) insufficient protected time; and (4) excessive administrative duties.
How should we, as a surgical community, react to these data? If the challenges and barriers are too great, should we give up pursuing basic science and translational research and instead focus on providing outstanding clinical care? We believe this would be a grave mistake to our profession. To provide outstanding clinical care, the surgical workforce must be at the forefront of innovating and performing discovery science. Surgeons are in a unique position because we are at the forefront of delivering care to patients with surgical disease. We know firsthand what works well and what does not. Thus, we are uniquely positioned to ask the right questions and be the ones to answer them.