Surgeon-scientists face challenges in obtaining sustained research funding, threatening surgical innovation and potentially affecting patient care, according to recent research. The study highlights that while early career surgeon-researchers receive initial funding, they struggle to maintain funding due to heavy clinical demands and the need to maintain surgical skills, which can hinder progress in various medical fields.
Surgeons who are also conducting important biomedical research are struggling to secure research funding. Experts at UVA Health warn that if nothing is done, this "broken pipeline" could lead to the demise of surgeon-scientists and slow innovation for patients.
Researchers led by Bruce Schirmer, M.D., UVA's Department of Surgery, found that while surgeon-scientists often receive research grants early in their careers, they are much less likely to convert them into ongoing research grants than their internal medicine counterparts.
The reasons for this are complex and include the heavy clinical demands faced by surgeons and the ongoing need to maintain and refine their skills, Schirmer and colleagues say in a new Scientific paper. This often leaves them little time to compete for research funding and conduct studies that ultimately benefit patients.
Schirmer and colleagues warn this could have dire consequences for the future.
"Surgeons have made many significant advances in the treatment of disease, particularly cardiovascular, digestive, neurological, endocrine, pulmonary and urinary tracts, and most types of cancer. A lack of sustained funding for surgical research may limit such contributions in the future," Schirmer said. "These data should serve as a wake-up call to the surgical community to reconsider when best to conduct research during surgical training and how best to secure the resources to subsequently support it."
Schirmer and his team looked at research grants received by surgical and internal medicine trainees. They found that trainees received F32 grants from the NIH to support specialized research at similar rates, but internal medicine trainees were almost six times more likely to later use them for R01 grants, the NIH's oldest and most competitive funding mechanism. Internal medicine researchers are also five times more likely to receive an NIH Career Development K Award.
The researchers called the difference an "alarming decline" and said it represented a "significant problem" for the surgical profession.
UVA Health's Bruce Schirmer, MD (left) and Adishesh K. Narahari, MD, warn that a "burst" funding pipeline for surgeon-scientists could harm innovation in patient care. Image Credit: Adishesh K. Narahari, MD
"Surgeons are struggling to find funding, and many of them cannot get it despite trying for 10 years. Surgeon-scientists are making many advances in biomedical research in areas such as transplantation, oncology and diabetes," said UVAHealth surgical intern Adishesh K. Narahari, MD, PhD, first author of the new Science paper. "Simply put, surgeons need to apply for funding early and become well-versed in the field of biomedical research. Otherwise, we may see reduced innovation and a lack of new solutions not just for surgical problems, but for many areas of biomedical research."
Narahari, Schirmer and their collaborators say swift action is needed and have developed recommendations to address the problem. These suggestions include:
Develop alternative grant mechanisms to support surgeon-scientists;
Establish programs at various institutions to support surgical residents who wish to pursue research;
Encourage surgeons to conduct research by evaluating surgeon-scientists using different job performance measures than surgeons who do not conduct research.
Researchers at the University of Virginia warn that surgical research will suffer if steps are not taken.
"We hope this paper will spark a movement to encourage the development of surgeon-scientists through curricula, programs and support mechanisms that will prepare those highly interested in such career paths for maximum productivity and success," Schirmer said. "We hope those overseeing surgical education and training will take these findings seriously."