Commentary: Academic Surgery-A Soldier on the Front Line

Research output: Contribution to journalComment/debatepeer-review

Original languageEnglish (US)
Pages (from-to)288-289
Number of pages2
JournalJournal of surgical education
Issue number4
StatePublished - 2008

Bibliographical note

Funding Information:
Daniel A. Saltzman MD, PhD Division of Pediatric Surgery, University of Minnesto Medical School, Minneapolis, Minnesota Krajewski and Chandwalker tout a “use-inspired” approach to surgical research. These authors poignantly illustrate that many of the major discoveries in basic, clinical, and translational research have come from surgeons; however, changes in funding paradigms, edicts over surgical training from the accrediting bodies, and reimbursement from clinical practice collectively threaten surgical research as it stands. In short, academic surgery is being squeezed. Squeezed from Medicare, Medicaid, and insurance companies where reimbursement rates are at record low levels. Gone are the days when one could transfer funds from the practice plan to cover research interest. Squeezed from academic practice plans where academic fees are continuously rising and inefficiencies in billing and collecting mount. Academic surgery is being squeezed from funding agencies where competition for grants is at an all time high and funding levels are at an all time low. Furthermore, study sections at the National Institutes of Health (NIH) and awarded grants are dominated by the scientist rather than by the physician/scientist. Furthermore, NIH awards to physicians are at an all time low. Facing enormous challenges, academic surgery is at a crossroads and the “use-inspired” approach to surgical research can be the method that will return the surgeon scientist to the top of the research ladder. Our original laboratory has always been the operating room, a place where complex decisions are made and innovation is principal. Applying those operating room principles to a research program will allow us to think about clinical problems from a perspective that a pure research scientist or internists are simply not capable of. However, the traditional model of the isolated “do all” laboratory must be abandoned. Strategies must be sought to encourage mid-level surgical faculty to mentor surgical residents in ways that will not punish them for a lack of clinical productiveness. Furthermore, I believe that a successful surgical research program is based on collaborative efforts. Younger surgeons should align themselves with well-established surgeons who have a successful research program or scientist who do not have clinical responsibilities. Thus, I believe these authors correctly highlight strategies for success that mention collaborations with well-funded investigators, partnerships with industry, and institutional obligations for a successful academic department.

Cite this