How do you create a doctor with both the surgical skills and scientific expertise to unravel the complex mechanisms of disease on a molecular level?
Current Stanford ophthalmology resident Gabriel Velez M.D., Ph.D. and his mentor Vinit Mahajan M.D., Ph.D., professor and vice chair for research, along with colleagues at the University of Iowa, examined this important question in a recent manuscript, “Trends in Specialty Training and National Institutes of Health Funding Among Surgeon-Scientists.”
It takes roughly double the years of dedication and training to develop surgeon-scientists with all the clinical, surgical, and scientific expertise needed to address disease. One path to becoming a surgeon-scientist includes the postgraduate training programs that offer a combined M.D., Ph.D. degree.
Mahajan said, “We need to actively recruit, train, and mentor early career surgeon-scientists. Career development and institutional resources, along with NIH support for research training during surgical residency, is crucial to keeping people on this challenging career path.”
He added, “Without surgeon-scientists, basic science technologies get stalled in the lab and don’t reach patients.”
Velez knows the value of translational research. He has been instrumental in the success of pivotal research projects in Mahajan’s lab that draw on basic science across disciplines, clinical data, and surgical specimens.
Velez explained, “The idea for my manuscript came to me as I was considering my career path and how I was going to balance my time between clinical practice, laboratory research, and surgery.”
“There was this notion among my classmates that pursuing a surgical subspecialty as an M.D., Ph.D. graduate would put one at a disadvantage for advancing their scientific career because this balance would be more difficult. Rather than take this misconception at face value, I wanted to get data on the surgeon-scientists who were making this career pathway work and see if I could learn anything from them,” he continued.
Gabe’s current study asked the question of whether an M.D., Ph.D. degree predicts success among early career surgeon scientists.
He said, “The choice of subspecialty and where you practice seems to make a big difference. A lot of the NIH-funded surgeon-scientists who were receiving R01 grants were in fact ophthalmologists and there seemed to be varying levels of departmental support depending on where the surgeon-scientist was starting their career.”
Using the National MD/PhD Program Outcomes Study and the Association of American Medical Colleges Graduate Medical Education Track database, Velez found that the number of people pursuing M.D., Ph.D.s increased over the years but not those seeking a surgical specialty and that surgeon-scientists are concentrated at a small number of institutions.
An online search of the NIH databases by Velez revealed a cohort of academic surgeon-scientists receiving the early-career K-awards from 2011 to 2021.
Roughly 27% of K-awards going to surgeon-scientists from 2011 to 2021 were coming from the University of Michigan, Johns Hopkins, UCSF, and Duke. Stanford came in 5th place during this period, although this trend may have changed in the last few years as Stanford’s ophthalmology department now ranks #4 in overall NIH funding. And among specialties, ophthalmology was a top performer for developing surgeon-scientists.
Velez said, “I think this concentration points to several environmental factors that contribute to success as an early-career surgeon-scientist, including available mentorship, protected research time, and financial support.”
Over the past decade, Velez developed a close relationship with faculty surgeon-scientist Mahajan, learning how to balance the demands of surgical patient care while running a lab.
Velez said, “During my Ph.D. training with Dr. Mahajan, it was helpful to have access to surgical specimens to run experiments and think about how we would translate our findings in the lab into treatments for patients. In my final years of medical school, I was exposed to the clinical side of being a surgeon-scientist. I got to meet patients and scrub into their surgeries where we would obtain the samples we studied in the lab. Seeing that patient care connection really had an impact for me and solidified my desire to pursue this career.”
With the mentors for surgeon-scientists at a very small number of schools, only a fortunate few like Velez have access to a successful surgeon-scientist. That coupled with an underrepresentation of surgical specialties in medical school curricula and a perceived lack of research opportunities in the surgical sciences could account for the small number of M.D., Ph.D. trainees pursuing surgical specialties.
Velez emphasized, “Investing in surgeon-scientists amid the current siege on funding for scientific research is important for our patients.”
Mahajan said, “Gabe’s study gives us clear data on what is happening and what we need to do going forward. Investing in surgeon-scientist training will lead to better prevention, diagnosis, and treatment of human disease. Surgeon-scientists can solve patient health problems other doctors can't. And instead of cutting NIH funding, we should be increasing funding. The return on investment is at least 100-X. It will save lives, it will prevent blindness, and it will cure diseases no one thought was possible.”