The Future of Basic Science in Academic Surgery

Identifying Barriers to Success for Surgeon-Scientists

Sundeep G. Keswani, MD; Chad M. Moles, BSPH; Michael Morowitz, MD; Herbert Zeh, MD; John S. Kuo, MD, PhD; Matthew H. Levine, MD, PhD; Lily S. Cheng, MD; David J. Hackam, MD, PhD; Nita Ahuja, MD; Allan M. Goldstein, MD

Disclosures

Annals of Surgery. 2017;265(6):1053-1059. 

In This Article

Abstract and Introduction

Abstract

Objective: The aim of this study was to examine the challenges confronting surgeons performing basic science research in today's academic surgery environment.

Summary of Background Data: Multiple studies have identified challenges confronting surgeon-scientists and impacting their ability to be successful. Although these threats have been known for decades, the downward trend in the number of successful surgeon-scientists continues. Clinical demands, funding challenges, and other factors play important roles, but a rigorous analysis of academic surgeons and their experiences regarding these issues has not previously been performed.

Methods: An online survey was distributed to 2504 members of the Association for Academic Surgery and Society of University Surgeons to determine factors impacting success. Survey results were subjected to statistical analyses. We also reviewed publicly available data regarding funding from the National Institutes of Health (NIH).

Results: NIH data revealed a 27% decline in the proportion of NIH funding to surgical departments relative to total NIH funding from 2007 to 2014. A total of 1033 (41%) members responded to our survey, making this the largest survey of academic surgeons to date. Surgeons most often cited the following factors as major impediments to pursuing basic investigation: pressure to be clinically productive, excessive administrative responsibilities, difficulty obtaining extramural funding, and desire for work-life balance. Surprisingly, a majority (68%) did not believe surgeons can be successful basic scientists in today's environment, including departmental leadership.

Conclusions: We have identified important barriers that confront academic surgeons pursuing basic research and a perception that success in basic science may no longer be achievable. These barriers need to be addressed to ensure the continued development of future surgeon-scientists.

Introduction

Surgeons have a long legacy of important contributions in basic and translational research, and advancing the fundamental understanding of surgical diseases remains a priority in academic surgery.[1] However, despite the importance of basic investigation, academic surgeons are expected to participate in clinical care, administrative duties, education, and mentoring. Those who wish to develop a successful research career must also manage laboratory personnel, write manuscripts, obtain funding, and mentor students and fellows. When added to the importance of achieving work-life balance, the challenges facing surgeon-scientists are seemingly insurmountable. Recent pressures have compounded these challenges, including increased difficulty obtaining federal funding, mounting administrative burden, and ever-growing pressure for clinical productivity.[2] It is not surprising that evidence suggests that the continued existence and development of surgeon-scientists is threatened.

Several studies have noted that surgeon-scientists have been falling behind in basic research compared to other disciplines in medicine. Examining National Institutes of Health (NIH) funding from 1995 to 2001 to the 5 most active clinical departments at US medical schools, Rangel et al[3] found that success rates for surgical proposals were significantly lower than for the other departments for all years studied. A similar study of NIH funding from 1982 to 2004 showed that although total grant applications to NIH increased by 124% during that period, applications from surgical departments increased by only 67%.[4] Commensurate with this, total NIH awards went up by 71%, but surgical awards increased only by 41%. Looking specifically at the pipeline of surgeon-scientists, Rangel and Moss[5] compared funding success for career development K-awards between surgical and nonsurgical faculty. Nonsurgeons were 2.5 fold more likely to apply for a K-award, and significantly more likely to receive one. Departments of surgery also fare poorly compared to nonsurgical departments with respect to funding from other agencies, such as the American Cancer Society.[6]

Motivated by the uncertain future of basic science in surgery, this study was designed to identify challenges confronting surgeon-scientists to inform academic leaders and to define opportunities for improving the success of the future academic surgical workforce. With over 1000 academic surgeons and trainees responding, this study represents the largest survey to date addressing this important question regarding the future of academic surgery.

Comments

3090D553-9492-4563-8681-AD288FA52ACE

processing....