Physicians Issue Grave Alert: Impending Peril as Vital Surgeon-Scientist Pipeline Faces Imminent Disruption

Surgeon-scientists, who play a crucial role in both surgery and biomedical research, are facing significant challenges in securing the necessary funding for their research endeavors. Experts from UVA Health have expressed concern that this troubling trend, often referred to as a “broken pipeline,” may jeopardize the future of surgeon-scientists and hinder medical innovations for patients unless proactive measures are taken.

Dr. Bruce Schirmer, leading a team of researchers from UVA’s Department of Surgery, uncovered a concerning pattern. While surgeon-scientists tend to secure research funding early in their careers, they are far less likely than their counterparts in internal medicine to sustain this funding over time. This disparity arises from a multitude of complex factors, including the demanding clinical responsibilities that surgeons face and their continual need to enhance their surgical skills. Consequently, they find themselves with limited time to compete for research funding and conduct research projects that could ultimately benefit patients.

Schirmer and his colleagues warn that this situation could have dire consequences for the future of medical advancements. Surgeons have historically played a pivotal role in developing treatments for various diseases, spanning cardiovascular, digestive, neurologic, endocrine, pulmonary, urologic systems, and numerous cancer types. The absence of consistent funding for surgical research threatens to curtail these invaluable contributions.

Dr. Schirmer emphasized, “These findings should serve as a wake-up call to the surgical community, urging us to reconsider the optimal timing for research during surgical training and explore more effective means of securing the necessary resources to support it.”

Schirmer’s research team examined the acquisition of research grants by trainees in both surgery and internal medicine. They discovered that trainees from both fields obtained F32 grants from the National Institutes of Health at similar rates. However, internal medicine trainees were nearly six times more likely to subsequently secure R01 grants, the NIH’s most prestigious and competitive funding mechanism. Internal medicine researchers were also five times more likely to obtain career development K-awards from the NIH. This substantial gap in funding attainment is described as a “shocking drop-off” and poses a major challenge to the field of surgery.

Dr. Adishesh K. Narahari, a surgery intern at UVA Health and the lead author of the study, emphasized, “Surgeons are grappling with funding issues, with many struggling for a decade or more without success. Surgeon-scientists have made significant strides in biomedical research areas such as transplantation, oncology, and diabetes. In short, surgeons need to proactively seek funding opportunities early in their careers and become adept at navigating the complex landscape of biomedical research. Failure to do so may lead to decreased innovation and a lack of new solutions not only in surgical practice but across various biomedical research domains.”

Recognizing the urgency of the situation, Narahari, Schirmer, and their collaborators have put forth a series of recommendations to address this critical problem. These recommendations include the development of alternative grant-funding mechanisms tailored to support surgeon-scientists, the establishment of institution-specific programs to assist surgical residents pursuing research, and the evaluation of surgeon-scientists using distinct job-performance metrics compared to surgeons who do not engage in research activities.

Without swift action, the UVA researchers caution that surgical research may experience a significant setback. Dr. Schirmer concluded, “We hope this study serves as a catalyst for initiatives aimed at nurturing surgeon-scientists through educational, programmatic, and supportive measures to facilitate their productivity and success. We call upon those responsible for surgical education and training to seriously consider these findings and take appropriate action.”

[Reference: “Postdoctoral National Institutes of Health F32 Grants – Broken Pipeline in the Development of Surgeon-Scientists” by  Adishesh K. Narahari, Anirudha S. Chandrabhatla, Emily Fronk, Simon White, Shreya Mandava, Hannah Jacobs-El, J. Hunter Mehaffey, Curtis G. Tribble, Mark Roeser, John Kern, Irving L. Kron, Bruce Schirmer, September 2023, Annals of Surgery. DOI: 10.1097/SLA.0000000000005956. The study received funding from the National Institutes of Health.]

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