The Modern Surgeon: the difficulties of striving to be a triple threat

Introduction

The triple threat, for a surgeon, is defined by these key points:

• Basic science: conducting bench-level, well-funded research.
• Clinical productiveness and surgical skills: maintaining a busy practice and mastering surgical techniques in their field.
• Academic achievements: authoring and co-authoring a significant number of publications leading to promotions and peer-recognition.

This concept now seems more and more difficult to achieve. There has been a steady decrease in surgeons’ participation in basic science, due to the pressure to be master clinicians and well-trained surgeons.

According to the National Institute of Health, funding for surgical departments decreased by 27% between 2007 and 2014. An online survey distributed to members of the Association for Academic Surgery and Society of University Surgeons shed light on the contributing factors, including:

• Pressure to be clinically productive.
• Excessive administrative responsibilities.
• Difficulty obtaining extramural funding.
• Desire for work-life balance.

These challenges seem impossible to overcome. In fact, most of the faculty interviewed believed that is not realistic for a surgeon to be successful in basic science in today’s environment. Also, non-surgical colleagues have been far more likely to apply for grants and also to receive them. Nevertheless, there might be a way to keep the surgeon-scientists alive, changing the current paradigms and adapting to achieve a solution.

Dr. Alverdy analyzes some of the problems identified and finds a compromise when the solution seems unattainable. One of the most promising ideas, based on Dr. Murray’s life work, is the concept of “team science”. Building a multidisciplinary team might alleviate the burden for surgeon-scientists to lead their own laboratories and still be involved in basic research.

Nevertheless, research derived from clinical care seems to be the focus of the majority of surgical publications nowadays. Young trainees build their curriculum on them, knowing that it is a valid strategy to climb the academic ladder. Promotion committees have shifted their criteria over time to adjust to the current market, further diminishing the interest in a career in basic science. This situation seems to be a shortcut to academic relevance and shows the lack of motivation of younger surgeons.

Rather than being a part-time scientist in a wet laboratory, a surgeon can shift their interest to other areas of research and still become a triple threat. Changing the perspective might motivate and engage young surgeons to grow in different fields (i.e. technology, ethics, healthcare data) and salvage their investigative spirit. The future is at best uncertain, but curiosity and a true “calling” will always fuel true surgeon-scientists.