Increasing Funding for Surgeon-Scientists—Lowering the Bar Is Not the Answer

Abstract

In this issue of JAMA Surgery, Nguyen et al 1 conducted a rigorous evaluation of National Institutes of Health (NIH) funding among surgical departments. They found that, from 1995 to 2000, the number of primary investigators in surgery departments increased 1.9-fold (from 968 to 1874), corresponding to an increase in the number of funding dollars by approximately 4.0-fold (from $214 million to $861 million). However, the total percentage of NIH primary investigators who were surgeon-scientists decreased from 1.5% to 1.4%. Furthermore, among surgeon-scientist investigators, female surgeons were represented proportionally but received a lower percentage of the total NIH grants and garnered less NIH funding dollars. There were marked differences across specialties, with some surgical specialists, such as urologists, showing marked decreases in NIH funding, although the reasons for this decrease are unclear. The authors concluded that surgeon-scientists are underrepresented NIH investigators, and despite an increase in the number of NIH funding dollars to surgical departments, the amount is still grossly deficient, and many of these funds are going to nonclinician-scientists in the department. This finding is highly relevant for society, given that 30% of the disease burden is in the surgical domain but only 2% of funding accrues to surgical departments.The authors make several recommendations that we fully support. 1 First, they advise that department leadership should consider lowering clinical demands on surgeonscientists to allow for scientific growth. Of course, with narrow department and hospital margins, there is only so much protected time to go around. In this context, this opportunity is an advantage and should be offered in an equitable fashion. Fostering such a culture should acknowledge that historical patterns have allocated this time, mentorship, and sponsorship in nonequitable ways. 2 Second, we agree that surgeon-scientists and PhD scientists should work in dyads or teams, which often increases grant submissions and