Transforming the Future of Surgeon-Scientists.

OBJECTIVE: To create a blueprint for surgical department leaders, academic institutions, and funding agencies to optimally support surgeon-scientists.

SUMMARY BACKGROUND DATA: Scientific contributions by surgeons have been transformative across many medical disciplines. Surgeon-scientists provide a distinct approach and mindset toward key scientific questions. However, lack of institutional support, pressure for increased clinical productivity and growing administrative burden are major challenges for the surgeon-scientist, as is the time-consuming nature of surgical training and practice.

METHODS: An American Surgical Association (ASA) Research Sustainability Task Force was created to outline a blueprint for sustainable science in surgery. Leaders from top NIH-sponsored departments of surgery engaged in video and in-person meetings between January and April 2023. A SWOT analysis was performed, and workgroups focused on the roles of surgeons, the department and institutions, and funding agencies.

RESULTS: Taskforce recommendations: (1) SURGEONS: Growth mindset: identifying research focus, long-term planning, patience/tenacity, team science, collaborations with disparate experts; Skill set: align skills and research, fill critical skill gaps, develop team leadership skills; DEPARTMENT OF SURGERY (DOS): (2) MENTORSHIP: Chair: mentor - mentee matching / regular meetings / accountability, review of junior faculty progress, mentorship training requirement, recognition of mentorship (e.g., RVU equivalent, awards; Mentor: dedicated time, relevant scientific expertise, extramural funding, experience and/or trained as mentor, trusted advisor; Mentee: enthusiastic / eager, proactive, open to feedback, clear about goals; (3) FINANCIAL SUSTAINABILITY: diversification of research portfolio, identification of matching funding sources, departmental resource awards (e.g., T- / P-grants), leveraging of institutional resources, negotiation of formalized / formulaic funds flow investment from AMC towards science, philanthropy; (4) STRUCTURAL / STRATEGIC SUPPORT: Structural: grants administrative support, biostats / bioinformatics support, clinical trial and research support, regulatory support, shared departmental lab space / equipment; Strategic: hiring diverse surgeon-scientist/scientists faculty across DOS, strategic faculty retention / recruitment, philanthropy, career development support, progress tracking, grant writing support, DOS-wide research meetings, regular DOS strategic research planning; (5) COMMUNITY AND CULTURE: Community: right mix of faculty, connection surgeon with broad scientific community; Culture: building research infrastructure, financial support for research, projecting importance of research (awards, grand rounds, shoutouts); (6) THE ROLE OF INSTITUTIONS: Foundation: research space co-location, flexible start-up packages, courses / mock study section, awards, diverse institutional mentorship teams; Nurture: institutional infrastructure, funding (e.g., endowed chairs), promotion friendly towards surgeon-scientists, surgeon-scientists in institutional leadership positions; Expectations: RVU target relief, salary gap funding, competitive starting salaries, longitudinal salary strategy; (7) THE ROLE OF FUNDING AGENCIES: change surgeon research training paradigm, offer alternate awards to K-awards, increasing salary cap to reflect market reality, time extension for surgeon early-stage investigator (ESI) status, surgeon representation on study section, focused award strategies for professional societies/foundations.

CONCLUSIONS: Authentic recommitment from surgeon leaders with intentional and ambitious actions from institutions, corporations, funders, and society is essential in order to reap the essential benefits of surgeon-scientists towards advancements of science.