Dr. Keswani said that research evolves rapidly. “By the time a resident opens their own laboratory or practice, the work they were doing earlier in their career has already changed,” he said. “We have to come up with a way to make training more amenable to developing surgical scientists.”
Michael S. Benninger, MD, chairman of the Head and Neck Institute at the Cleveland Clinic in Ohio, believes that another reason surgeons are performing less research is because fewer institutions are paying for the expenses involved in attending educational meetings. “It makes it more difficult for researchers to break the intellectual thought process of performing research if fewer healthcare providers are exposed to ideas,” he said, adding that he gets many ideas for research endeavors at conferences.
In addition, the Physician Payments Sunshine Act of 2010 requires increased transparency of financial relationships between healthcare providers and pharmaceutical manufacturers—which can be significant funders of mid-level grants [see also “What Physicians Need to Know About the Physician Payment Sunshine Act” on enttoday.org]. “As a result, it’s difficult to have a relationship with a drug company and still get federal research funding,” Dr. Benninger said. “Some academic medical centers frown upon clinical, device, and drug trials if they are performed within an industry relationship.”
Another deterrent, Dr. Goldstein and colleagues noted, is that younger surgeons prioritize work/life balance more than those a generation ago. “Doing both surgery and research is more time consuming than it used to be,” he added. “Some younger surgeons aren’t willing to sacrifice that balance in order to pursue their academic goals.”
More administrative duties and clinical demands also play roles. “The amount of paperwork, whether it’s for documenting patient visits, billing, or educating residents, has risen substantially,” Dr. Keswani added.
In addition, Deepak Mehta, MD, director of the Pediatric Aerodigestive Center and a pediatric otolaryngologist at Texas Children’s Hospital in Houston, noted that a greater emphasis on multi-disciplinary teams and coordinating care requires much more time compared to 20 years ago.
According to Dr. Amsler, reimbursement is primarily based on the number of procedures performed. “Therefore, the more surgeries that are done, the greater the hospital’s income,” he said. “This increases the incentive to focus on performing surgeries over other possible pursuits, including research.”
With fewer surgeons performing research, Dr. Keswani said that more non-surgeons will make decisions about what happens to surgeons’ patients, which is problematic. “We see things in the operating room that give us insight into knowing how to better treat our patients,” he said. “But our medical colleagues or PhD researchers may not have the same interests that we have in our surgical disease processes. If someone doesn’t tackle our surgical issues, it will be a detriment to the care of our surgical patients.”