Will the clinicians support the researchers and teachers? Results of a salary satisfaction survey of 947 academic surgeons

Rates of National Institutes of Health Funding for Surgeon-Scientists, 1995-2020

Importance

Surgeon-scientists are uniquely positioned to facilitate translation between the laboratory and clinical settings to drive innovation in patient care. However, surgeon-scientists face many challenges in pursuing research, such as increasing clinical demands that affect their competitiveness to apply for National Institutes of Health (NIH) funding compared with other scientists.

Objective

To examine how NIH funding has been awarded to surgeon-scientists over time.

Design, Setting, and Participants

This cross-sectional study used publicly available data from the NIH RePORTER (Research Portfolio Online Reporting Tools Expenditures and Results) database for research project grants awarded to departments of surgery between 1995 and 2020. Surgeon-scientists were defined as NIH-funded faculty holding an MD or MD-PhD degree with board certification in surgery; PhD scientists were NIH-funded faculty holding a PhD degree. Statistical analysis was performed from April 1 to August 31, 2022.

Main Outcome

National Institutes of Health funding to surgeon-scientists compared with PhD scientists, as well as NIH funding to surgeon-scientists across surgical subspecialties.

Results

Between 1995 and 2020, the number of NIH-funded investigators in surgical departments increased 1.9-fold from 968 to 1874 investigators, corresponding to a 4.0-fold increase in total funding (1995, $214 million; 2020, $861 million). Although the total amount of NIH funding to both surgeon-scientists and PhD scientists increased, the funding gap between surgeon-scientists and PhD scientists increased 2.8-fold from a $73 million difference in 1995 to a $208 million difference in 2020, favoring PhD scientists. National Institutes of Health funding to female surgeon-scientists increased significantly at a rate of 0.53% (95% CI, 0.48%-0.57%) per year from 4.8% of grants awarded to female surgeon-scientists in 1995 to 18.8% in 2020 (P < .001). However, substantial disparity remained, with female surgeon-scientists receiving less than 20% of NIH grants and funding dollars in 2020. In addition, although there was increased NIH funding to neurosurgeons and otolaryngologists, funding to urologists decreased significantly from 14.9% of all grants in 1995 to 7.5% in 2020 (annual percent change, -0.39% [95% CI, -0.47% to -0.30%]; P < .001). Despite surgical diseases making up 30% of the global disease burden, representation of surgeon-scientists among NIH investigators remains less than 2%.

Conclusion and Relevance

This study suggests that research performed by surgeon-scientists continues to be underrepresented in the NIH funding portfolio, highlighting a fundamental need to support and fund more surgeon-scientists.

Best practices for enhancing surgical research: a perspective from the Canadian Association of Chairs of Surgical Research

Summary

The Canadian Association of Chairs of Surgical Research was created in 2014, with representation from every departmental surgical research committee across Canada, to establish Canadian surgical research as a beacon for health care innovation and to propose solutions for the daily challenges facing surgeon-researchers. Our key mandate has been to identify challenges for surgeons and scientists performing research to prevent further erosion of this vital area of activity that benefits patients, health care service providers and Canadian society. This article outlines the findings of a nationwide survey sent to all members of departments of surgery across Canada, seeking input on current threats and potential solutions. The results suggest that surgical research in Canada is experiencing a decline in funding and an increase in challenges affecting research productivity of academic surgeons, such as pressures to be clinically active, unpredictable surgical schedules, growing administrative demands, and increasing complexity of patient populations. Although surgeons are productive in their research endeavours, institutional changes and sharing of best practices are needed to ensure sustainable growth of research programs.

National prospective cohort study describing how financial stresses are associated with attrition from surgical residency

BACKGROUND

Attrition from general surgery residency is high with a national rate of 20%. We evaluated potential associations between financial considerations and attrition.

METHODS

National prospective cohort study of categorical general surgery trainees.

RESULTS

Of the 1048 interns who started training in 2007, 681 (65%) had complete survey and follow-up data. In logistic regression, those with higher starting attending salary expectations (>$300K) were more likely to leave training (OR 2.9, 95% CI 1.2-6.9). Women with a partner who earned more (>$50K/year) were more likely to leave training (OR 4.1, 95% CI 1.6-10.5). In a subgroup of interns undecided about their future practice setting (academic, community, private practice, industry), those with less debt (≤$100K) were more likely to leave training (OR 2.4, 95% CI 1.1-5.2).

CONCLUSIONS

Several financial matters were associated with attrition. Addressing these financial concerns may help decrease attrition in surgical training and improve surgical training.

The Economics of Private Practice versus Academia in Surgery

OBJECTIVE

Residents often make career decisions regarding future practice without adequate knowledge to the realities of professional life. Currently there is a paucity of data regarding economic differences between practice models. This study seeks to illuminate the financial differences of surgical subspecialties between academic and private practice.

DESIGN

Data were collected from the Association of American Medical College (AAMC) and the Medical Group Management Association's (MGMA) 2015 reports of average annual salaries. Salaries were analyzed for general surgery and 7 subspecialties. Fixed time of practice was set at 30 years. Assumptions included 5 years as assistant professor, 10 years as associate professor, and 15 years as full professor. Formula used: (average yearly salary) × [years of practice (30 yrs - fellowship/research yrs)] + ($50,000 × yrs of fellowship/research) = total adjusted lifetime revenue.

RESULTS

As a full professor, academic surgeons in all subspecialties make significantly less than their private practice counterparts. The largest discrepancy is in vascular and cardiothoracic surgery, with full professors earning 16% and 14% less than private practitioners. Plastic surgery and general surgery are the only 2 disciplines that have similar lifetime revenues to private practitioners, earning 2% and 6% less than their counterparts' lifetime revenue.

CONCLUSIONS

Academic surgeons in all surgical subspecialties examined earn less lifetime revenue compared to those in private practice. This difference in earnings decreases but remains substantial as an academic surgeon advances. With limited exposure to the diversity of professional arenas, residents must be aware of this discrepancy.

Integration of academic and clinical performance-based faculty compensation plans: a system and its impact on an anaesthesiology department

BACKGROUND

The current economic environment makes it difficult for academic institutions to maintain academic activities with necessary clinical coverage. Productivity-based faculty compensation is reported to improve clinical work output; however, the impact on academic productivity has not been fully described.

METHODS

An academic anaesthesiology department has used a comprehensive clinical and academic performance-based faculty compensation programme as fiscal year (FY) 2004. Faculty choosing to pursue an academic track can devote up to 80% of their time to non-clinical activities. Payment for this time is 'salary at risk', which is earned through a merit matrix system, which was newly developed to award points for various academic activities. Unclaimed portions of the salary at risk are absorbed into the department budget at the conclusion of the FY. Clinical activities are measured chiefly based on total hours of anaesthetic care.

RESULTS

Academic full-time equivalents (FTEs) decreased by 12.0% in FY2005 (FTE of 16.0-14.1) but recovered to the baseline level in FY2006 and remained stable. Clinical FTE also decreased by 6.6% in FY2005 (FTE of 109.1-101.9), then increased in FY2006-FY2010. Increased clinical work output was observed among the clinical and academic faculty members. Each academic faculty member successfully earned their salary at risk in each FY. The annual number of peer-reviewed publications per academic FTE in original research increased from 0.31 (0.18) (FY2001-FY2003) to 0.73 (0.14) (FY2006-FY2011), P=0.024.

CONCLUSIONS

Integration of clinical and academic performance-based faculty compensation systems is feasible and can be efficacious in a large academic anaesthesiology department.

Time-trends in publication productivity of young transplant surgeons in the United States

To further clarify whether the transplant surgical research workforce is adequately poised to further scientific achievement, we have investigated the publication productivity of young transplant surgeons. Our hypothesis is that recent young transplant surgeons write fewer academic manuscripts than their senior colleagues did when they were young surgeons. We compared the number of first and senior author publications in the first 5 years after completion of fellowship among recent transplant surgeons (completed fellowship 2000-2004) and former young surgeons (completed fellowship 1990-1994). Recent young surgeons wrote fewer overall manuscripts (0.94 vs. 1.67, p < 0.05), as well as basic science manuscripts (0.21 vs. 0.54, p < 0.05) and clinical manuscripts (0.73 vs. 1.14, p < 0.05). Adjusting for the number of trainees, we note that recent young surgeons published 59% fewer basic science publications (IRR 0.41, 95% CI 0.29-0.57, p < 0.001) and 33% fewer clinical publications (IRR 0.67, 95% CI 0.56-0.82, p < 0.001). Among fellows in the 2000-2004 cohort, there was a 32% lower chance of publishing at least one paper compared with fellows in the 1990-1994 cohort (IRR 0.68, 95% CI 0.51-0.89, p = 0.006). These findings raise concerns about the future place of transplant surgeons within the science that shapes our own field.

Surgical mentors' and mentees' productivity from 1993 to 2006

BACKGROUND

Mentorship in academic surgery is reflected in part by senior surgeon support of younger individuals with their scholarly contributions to the literature. Scholarship is also reflected in the procurement of extramural funding. This study sought to quantify this process in recent years.

STUDY DESIGN

All active American Surgical Association and Society of University Surgeons members in the following 2 eras were defined as being mentors (N = 559): 1993 to 1999 (I) and 2000 to 2006 (II). Mentees (N = 7,037) were defined as a primary author associated with the mentor. MEDLINE-cited papers of mentors and mentees were abstracted. Randomly selected mentees from era I and II were examined for academic productivity. The National Institutes of Health (NIH) Computer Retrieval of Information on Scientific Projects database was queried for federal research funding for the mentors and mentees. Continuous categoric and logistical regression was used as appropriate.

RESULTS

Combining both eras, mentors published a total of 23,558 articles, of which 3,854 were primary and 9,881 were senior authored. Mentor primary-authored papers were more common in era I than era II (mean = 8 vs 6 articles, P < .01), whereas the number of senior-authored papers was similar in both eras (mean = 18 vs 17 papers, P = .09). Fewer mentors had federal funding in era I compared with era II (42% vs 51%, P = .04). More mentees per mentor existed in era I compared with era II (15 ± 5 vs 9 ± 4, P < .001). Era I mentees examined in era II (n = 187) were primary and senior author of a mean of 2.5 and 5 articles, respectively. Of this group, 14 (7.5%) had federal funding. The number of primary- and senior-authored articles from the mentee but not their prior mentor correlated with federal funding (P < .05).

CONCLUSIONS

The number of mentees per mentor has decreased in recent years as has primary-authored authors, whereas federal funding has increased for mentors. Overall NIH funding for mentees was low but is related to their productivity with the mentor.