The Future of Basic Science in Academic Surgery: Identifying Barriers to Success for Surgeon-scientists

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.

FIGURE 1

Steady decline in National Institutes of Health (NIH) funding of surgical research and in the prevalence of basic science in academic surgery. NIH award data for fiscal years 2006 to 2014 were obtained from the Blue Ridge Institute for Medical Research. Values include direct and indirect costs, but exclude research and development contracts. Values represent the top 25 US medical schools that receive the most NIH funding. Departments of Surgery funding relative to total institutional funding (A) and to Departments of Medicine (B) are shown. The number of basic science abstracts submitted to the ASC from 2011 to 2015 is shown (C), as well as the proportion of accepted basic science abstracts relative to all abstracts presented each year (D). Values are presented as percentages for (A), (B), and (D), as well as the number of abstracts in (C).

FIGURE 2

Demographic characteristics of respondents. The career stage of respondents was classified as trainee, junior faculty (5 years or less out of training), senior faculty, or division/department chiefs (A). Values reflect absolute numbers for 1018 participants that answered the question “What is your current academic position?” Of note, 1033 respondents participated in this survey, but 15 individuals elected to skip this question. Faculty participants were classified based on their surgical specialty (B) and type of research performed (C). (B and C) Data shown represent reporting percentages of the 757 faculty members that participated in the survey.

FIGURE 3

Perceptions and pressures reflect a negative outlook on the ability of surgeons to succeed in basic research. Survey participants were asked: “Do you believe it is realistic to expect surgeons to be successful basic scientists in today’s hospital environment?” Responses were tabulated for all faculty (A), those doing basic vs. clinical research (B), and those with and without funding (C). A total of 53 editorial comments were provided by the 130 basic researchers with extramural funding who answered “no” to this question, and their primary reasons are shown graphically in (D). Focusing on this specific subgroup, data were analyzed from the following 3 questions: “Do considerations around work-life balance impact your desire/commitment to pursue research?”, “Do excessive hospital administrative duties have an impact on your ability to do research?”, and “Do you feel pressure to be clinically productive and generate revenue, so much so that it impacts your ability to do research?” Values represent the percentage of that subgroup responding “yes” (E).

FIGURE 4

Extramural funding among academic surgeons. Faculty were asked “Do you currently have research funding awarded from outside your institution?” and the results are shown for all faculty and for the clinical and basic research subgroups (A). Sources of funding for basic researchers are shown in (B). Faculty with funding are stratified by basic vs. clinical research and by career stage, showing lower funding rates among younger faculty and consistently among clinical researchers (C). Respondents were asked “Approximately how many applications have you submitted for National Institutes of Health/federal funding in the last 3 years?” The response is shown by the dark bars, with the number of submissions along the x axis, and represents the percentage of respondents who submitted the specified number of grants. Submission number was correlated with a respondent’s funding status, shown by the light bars, which represent the proportion of individuals who are actively funded for each of the groups of grant submission numbers. The results are shown for both basic science (D) and clinical research (E).

FIGURE 5

External pressures impact academic surgeons’ desire and ability to pursue research in today’s environment. Faculty respondents were asked the following questions: “Do considerations around work-life balance impact your desire/commitment to pursue research?” (A); “Do excessive hospital administrative duties have an impact on your ability to do research?” (B); and “Do you feel pressure to be clinically productive and generate revenue, so much so that it impacts your ability to do research?” (C). In (C), responses include “Yes, ALL the time”, “Yes, but only SOMEtimes”, and “NO”, as shown in x axis. Values represent percentages responding affirmatively. Respondents were also asked whether the current National Institutes of Health (NIH) payline affects their interest in pursuing basic research (D). Options included “Yes, funding levels are so restrictive it is not worth submitting;” “Yes, but NIH funding has always been competitive and so you just have to try harder”; and “No, NIH paylines do not influence my decision to submit grants or do research.” The graph shows basic science faculty only. (E) To determine the relationship between mentoring and research funding, participants were asked to report activities of their primary research mentor, as shown in the figure. The responses are stratified by funding status and include trainees.