ENTtoday

The Decline of the Surgeon Scientist

by Karen Appold •

The lack of research in surgery means that the practice of surgery could become relatively stagnant. “This, coupled with research advances in non-surgery areas, could potentially lead to a decline in the position of surgery in the future healthcare landscape,” Dr. Amsler concluded.

Karen Appold is a freelance medical writer based in Pennsylvania.

Key Points

  • Fewer surgeons perform research today than several decades ago.
  • Funding to surgeons has been steadily decreasing, and rejection rates for grants are higher.
  • Many surgeons lack the necessary mentorship to help secure funding.
  • The lack of research in surgery means that the practice of surgery could become relatively stagnant.

Five Ways to Improve Surgeon Participation in Research

It’s imperative that more surgeons perform research. Experts provide some suggestions on how to improve rates of participation.

  • Provide training early. Poor continuity of the handoff among medical students, residents, and early-stage practitioners and expected competencies is occurring, said Arlen Meyers, MD, MBA, president and CEO of the Society of Physician Entrepreneurs, CMO of Bridge Health, CMO of Cliexa, and an emeritus professor of otolaryngology, dentistry, and engineering at the University of Colorado School of Medicine and the Colorado School of Public Health. Therefore, it’s important to engage medical students early on and have them understand the importance of doing research to forward the agenda. Deepak Mehta, MD, director of the Pediatric Aerodigestive Center and a pediatric otolaryngologist at Texas Children’s Hospital in Houston, concurred, adding that trainees should have more involvement in research. “They should receive more preparation, so they are capable of performing research in different areas—which might trigger some students to make it their career,” he said.
  • Set the numbers straight. Research needs to be listed as a line item on healthcare system budgets. Also, reestablish expectations for salaries for providers who desire to be clinical scientists, said Michael S. Benninger, MD, chairman of the Head and Neck Institute at the Cleveland Clinic in Ohio.
  • Seek out funding streams. Organizations’ development officers should look for donors whose primary objective is to fund research—which currently doesn’t have its own ready revenue stream. “How we direct donors is important,” Dr. Benninger said. Along these lines, Dr. Mehta said that having a separate funding agency committed to surgical and translational research would be helpful. “This would support surgeons and push them to do more research,” he said. Furthermore, Allan M. Goldstein, MD, professor of surgery at Harvard Medical School, chief of pediatric surgery at Massachusetts General Hospital, and surgeon-in-chief at MassGeneral Hospital for Children in Boston, said that funding agencies like The National Institutes of Health need to value surgeon scientists and formulate strategies to encourage them to participate more in research.
  • Shift attitudes. Dr. Goldstein said an attitude shift to value the surgeon as a scientist needs to occur at the leadership level. “The most staggering finding from our study, published in Annals of Surgery, is that 65% of division leaders across surgical specialties believe it is unrealistic for a surgeon to be a successful basic science researcher,” said Sundeep Keswani, MD, surgical director of basic science research at Texas Children’s Hospital in Houston. “There seems to be a sense of pessimism among surgical leaders when it comes to surgeon scientists.” In addition, surgeons need to understand that pursuing research will be a challenge. “They need to be able to commit the effort required to submit grants and work hard to remain at the forefront of their field in order to contribute,” Dr. Goldstein said. “Making mentorship a greater part of the profession could help to accomplish this.”
  • Contribute to aggregate research projects. Although fewer surgeons are formally conducting research, if you’re a practicing surgeon, Dr. Meyers said there are plenty of opportunities to contribute to aggregate projects. For example, for a surgical quality outcomes study you could contribute data to a bigger project to see if a certain procedure or intervention has value. “More specialty societies are engaging members to contribute their clinical data,” he said. “In a sense, you are participating in large aggregate databases that are used to generate outcomes.”