The Future of Basic Science in Academic Surgery

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.

Rebranding “The Lab Years” as “Professional Development” in Order to Redefine the Modern Surgeon Scientist

“…This trend is compounded by steadily decreasing federal funding for surgeon scientists and shifts to productivity-based compensation models which result in increased pressure to produce work relative value units. 2–4 Furthermore, to expedite training and address a workforce shortage, new surgical training models including integrated vascular surgery, integrated thoracic surgery, integrated plastic surgery, and general surgery with early specialization options commonly eliminate dedicated and protected time for research. Expedited surgical training adds the temptation of increased income potential in the form of faster time to practice from medical school which is understandably pursued by medical students in the current climate of soaring costs for medical education.…”

Pediatric Surgical Research Output in Germany in the Last 30 Years – An Assessment and International Comparison of Three Dedicated Paediatric Surgical Journals

“…A postulated major factor for a reduced research output has been a decrease in external funding for surgical research (4,36), which has been identified as a highly relevant factor for a successful scientific career in academic surgery (37). An increasing competition and thus a low success rate for variable funding with decreasing fixed funding has been described for Germany and the Netherlands (38)(39)(40).…”

“…Likewise, the success rate for grants has also experienced a decline over time in Israel (41). Besides this financial factor, excessive burden of time due to clinical duties for junior doctors (4,28,36,42) and administrative tasks for their senior counterparts (4,34) were identified by others as barriers to successful research.…”

“…In addition, a lack of formal research training has repeatedly been stated to highly contribute toward unsuccessful and inefficient research experiences by surgical registrars in the United States (36), South Africa (43), Europe (44), and Germany (28) in particular. This might be a factor in the observation of almost halved number of basic science abstracts presented at the Academic Surgical Congress (4). An observation that has also been made at pediatric surgical meetings, although in a less pronounced manner, particularly at the expense of basic science abstracts (45).…”

“…More than twenty years ago, others noted that the share of formerly scientifically active countries in surgical journals decreased (3), despite the overall increase of journals and published research articles. This development has been accompanied by a steep reduction of surgical registrars that continue to participate in research activities after a temporary experience during training (4). We therefore aimed to assess whether the research output of German pediatric surgery within three dedicated pediatric surgical journals has also decreased and explored possible underlying factors that may have contributed to what some have called a "crisis of surgical research" (5).…”