Invited Commentary
May 17, 2023
Increasing Funding for Surgeon-Scientists—Lowering the Bar Is Not the Answer
Katherine A. Gallagher, Justin B. Dimick
JAMA Surg. 2023;158(7):765. doi:10.1001/jamasurg.2023.1580
In this issue of JAMA Surgery, Nguyen et al1 conducted a rigorous evaluation of National Institutes of Health (NIH) funding among surgical departments. They found that, from 1995 to 2000, the number of primary investigators in surgery departments increased 1.9-fold (from 968 to 1874), corresponding to an increase in the number of funding dollars by approximately 4.0-fold (from $214 million to $861 million). However, the total percentage of NIH primary investigators who were surgeon-scientists decreased from 1.5% to 1.4%. Furthermore, among surgeon-scientist investigators, female surgeons were represented proportionally but received a lower percentage of the total NIH grants and garnered less NIH funding dollars. There were marked differences across specialties, with some surgical specialists, such as urologists, showing marked decreases in NIH funding, although the reasons for this decrease are unclear. The authors concluded that surgeon-scientists are underrepresented NIH investigators, and despite an increase in the number of NIH funding dollars to surgical departments, the amount is still grossly deficient, and many of these funds are going to nonclinician-scientists in the department. This finding is highly relevant for society, given that 30% of the disease burden is in the surgical domain but only 2% of funding accrues to surgical departments.
The authors make several recommendations that we fully support.1 First, they advise that department leadership should consider lowering clinical demands on surgeon-scientists to allow for scientific growth. Of course, with narrow department and hospital margins, there is only so much protected time to go around. In this context, this opportunity is an advantage and should be offered in an equitable fashion. Fostering such a culture should acknowledge that historical patterns have allocated this time, mentorship, and sponsorship in nonequitable ways.2Second, we agree that surgeon-scientists and PhD scientists should work in dyads or teams, which often increases grant submissions and thereby funding. However, this should not relegate surgeon-scientists to the role of coinvestigators, but rather these partnerships should be used to elevate surgeon-scientists to being partners or co–principal investigators on these grants. Finally, we agree that major surgical professional societies should increasingly support matching funds for NIH career development awards, much like the Society of Vascular Surgery Foundation, which provides supplemental funds for NIH K grant awardees.3,4
However, Nguyen et al1 also make recommendations that attempt to “lower the bar” for surgeons, which we do not agree with. These recommendations may have adverse effects on the perception of surgeon-scientists by other scientists. First, we do not believe a surgical institute at the NIH is an ideal solution. Surgeons take care of diseases that are well represented in the current structure and run across many institutes. Despite this, surgeons are not well represented on the institutional councils and study sections through the Center for Scientific Review. We believe broader inclusion of surgeons in these roles would help to address bias against surgeons in that context and build capacity within our profession for writing more competitive grants.5 To that end, surgeons interested in serving should email scientific review officers of their study sections to offer to serve as reviewers and take advantage of early reviewer programs for K grant awardees. Finally, we do not agree that lowering the bar for surgeon-scientists is an appropriate policy solution. The authors recommend increasing the pay line for surgeon-scientists. Rather than funding less rigorous science, we believe the answer is to ensure that surgeons’ work is of the highest quality and is reviewed fairly.
The path to that goal relies on doubling our efforts at protecting time for the most dedicated emerging surgeon-scientists, encouraging team science or collaboration with PhD scientists in the department (and beyond) where equal partnerships can be built, and building surgical department cultures that promote equity by ensuring equal access to protected time, mentorship, and sponsorship.