Do you think that for younger faculty, the pres-
sure to generate clinical revenue compromises
their ability to do research?
Margins from clinical revenue are smaller and are what
we use to offset the cost of research. There is an increasing emphasis on a division’s profitability. It means that
you can only support a certain number of people in
research positions and still have a financially solvent
division. If everybody was a funded researcher, maintenance of a positive profit margin would be nearly
impossible, unless it has other significant sources of revenue, such as endowments. We use the clinical margin
to supplement our researchers, so many of our faculty
will generate the margin to support the academic mission. The challenge for leadership is to create a culture
where everyone values each other’s contributions to
the overall academic mission.
What do you think are the greatest challenges fac-
ing surgeon-scientists today?
I think the greatest challenge is keeping support for
surgeon-scientists as a foremost mission in academic
surgery departments. Surgeons need to be leaders in
the field of scientific discovery and investigation. It is
really important because surgeons bring a different
perspective and have different interactions and understanding of the diseases we treat. Having that approach
and mindset fundamentally changes the way you might
think about a solution to a problem. The challenges to
achieve this are, quite simply, talent, time, and money.
It is increasingly competitive to do basic science
research. PhD-trained scientists do not have the time
commitments of training residents and taking care of
patients competing with their research; to compete
with them head-to-head for funding is a challenge.
The National Institutes of Health (NIH) funding
rates have been flat. We need to keep surgeons on
study sections that are advocating for grants from
surgeons; otherwise, the sentiment might be that a
surgeon-scientist cannot be as effective in either role
as a colleague who only does science or only does sur-
gery. We need to continue to advocate that surgeons
can be effective at both of those disciplines, and that it
is really important to have them do both.
What do you think the surgical community can do
to support surgeon-scientists?
We can advocate for surgeon-scientists, we can
celebrate their successes, and we can encourage
surgeon-scientists to be on grant review committees
and NIH study sections to provide their perspective
and support during grant competitions. We need to
value research in our training programs and find dedicated time to support surgeons who want to become
scientists. However, we have to demonstrate that our
scientific training process is as rigorous as that of our
colleagues in the basic sciences.
You said that you have six siblings, and you are
the first physician in your family. You come from
a small town in Michigan. What do they think of
all of your success, including your appointment
to chair of surgery at Stanford?
My brothers and sisters might say, “Well, they didn’t ask
us about her!” People in my hometown are really proud
of me. I received many nice notes from my former high
school teachers after an announcement in the local
paper about my appointment at Stanford. I would not be
where I am today without the support I have received
from my family. We were competitive as kids, but now
we’re each other’s biggest supporters. ♦