future of surgical leadership lies with the surgeon-scientist
or the surgeon-advocate is incomplete without an understanding of the present regulatory, legislative, and political
Despite the significant contributions surgeons have
made to the advancement of the medical field and science
in general, we have traditionally not fared well when it
comes to funding. In 2016, the combined surgical specialties
received the fifth highest total dollars in National Institutes
of Health (NIH) awards, behind all of the other major medical disciplines, including internal medicine, pediatrics, and
psychiatry, as well as microbiology/immunology.
federal funding for biomedical research in the U.S. comes
through the NIH, and after a steady rise in NIH appropriations in the 1990s, during the last decade, the NIH budget
has suffered significant reductions. In fact, the NIH budget,
adjusted for inflation, has decreased by more than 19 percent
since 1995. Since the NIH budget directly correlates with
the department’s ability to fund investigators, the grant
application success rate has fallen by more than 33 percent
in that same period,
34 with the brunt of that decline falling
on new investigators,
35 leading to a reduced ability for young
surgeons to pursue careers as surgeon-scientists.
However, federal funding of biomedical research has
continued to garner bipartisan support, as evidenced by
the nearly unanimous passage of the 21st Century Cures
Act in 2016.36 This legislative measure provided an extra
$4.8 billion in funding for the NIH, $1.8 billion of which was
dedicated to cancer research. Although the political landscape at present is uncertain, the call to increase funding for
biomedical research is widely supported by scientists, professional organizations such as the ACS, and the lay public.
This consensus exemplifies how the work of surgeon-scientists and surgeon-advocates often intersect.
Interestingly, a recent study of the members of the Association for Academic Surgery and Society of University
Surgeons revealed that funding constraints are not the biggest perceived barrier to surgeon participation in research.
While 22 percent of more than 1,000 surveyed surgeons
indicated that the NIH pay line is too restrictive, most surgeons suggested that clinical and administrative duties and
a desire to maintain a work-life balance were the biggest
deterrents to their participation. Surgeons cite these same
RAS-ACS SYMPOSIUM: REFRAMING SURGICAL LEADERSHIP
continued on next page
27. Goldberg RF, Kaafarani HMA, Smith J, Winfield RD.
Surgical leadership and political advocacy. Bull Am
Coll Surg. 2012; 97( 8): 14-18.
28. Masiakos PT. Advocating for state injury
prevention laws. Bull Am Coll Surg. 2011; 96( 2): 31-35.
Available at: facs.org/~/media/files/publications/
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29. Masiakos PT, Warshaw AL. Advocating for a sensible
firearm injury prevention plan. Ann Surg. April 19,
2017 [Epub ahead of print].
30. Cochran A. We can’t wait. Blog: Life in the Wild
West: Thoughts from an academic burn surgeon/
surgeon educator. April 11, 2016. Available at: www.
amaliacochranmd.com/we-cant-wait/. Accessed May
31. Maa J, Sutton J. The defeat of Proposition 46 in
California: A case study of successful surgeon
advocacy. Bull Am Coll Surg. 2016: 101( 1): 61-63.
Available at: bulletin.facs.org/2016/01/the-defeat-
successful-surgeon-advocacy/. Accessed May 31, 2017.
32. American College of Surgeons. Leadership and
Advocacy Summit 2017. Available at: facs.org/
advocacy/participate/summit. Accessed May 31, 2017.
33. Blue Ridge Institute for Medical Research—Ranking
tables of NIH funding to U.S. medical schools in 2016.
Available at: www.brimr.org/NIH_Awards/2016/
NIH_Awards_2016.htm. Accessed May 31, 2017.
34. Federation of American Societies for Experimental
Biology (FASEB)–NIH Research Funding Trends.
Available at: http://faseb.org/Science-Policy-and-Advocacy/Federal-Funding-Data/NIH-Research-
Funding-Trends.aspx. Accessed May 31, 2017.
35. Rockey S. National Institutes of Health. Office of
Extramural Research. More data on age and the
workforce. Available at: https://nexus.od.nih.gov/
all/2015/03/25/age-of-investigator/. Accessed May 31,
36. DeBonis M. Congress passes 21st Century Cures
Act, boosting research and easing drug approvals.
The Washington Post. December 6, 2016. Available
Accessed June 1, 2017.