Supporting the early career orthopedic surgeon-scientist.

Abstract

The recent editorial by von Kaeppler et al.1 is a timely piece that highlights the lack of MD/PhD graduates pursuing a career in orthopedic surgery. A particularly striking finding of this study was that the trend of MD/PhD graduates increasingly choosing nontraditional residencies (i.e., non-internal medicine ones) did not result in an increased proportion of graduates training in orthopedic surgery. The authors highlight a number of potentially important factors contributing to the underrepresentation of MD/PhD graduates in practice and training in orthopedic surgery, ranging from perpetuation of stereotypes about orthopedic surgeons during medical school training to perceived lack of financial and institutional support for surgeon-scientists. A key question related to institutional support that must be asked is how many academic orthopedic departments are willing to hire a surgeon-scientist. The authors rightfully point out that many of the big data, “dry-lab,” research questions can more easily be investigated by surgeons without a major financial commitment from departments, but orthopedic surgeon-scientists should not abandon the “wet-lab” altogether. A prime example of a “wet-lab” field where clinical expertise could provide added value beyond PhD training is the field of tissue engineering, which aims to develop therapies that would be directly administered by a clinician. Academic departments must be willing to financially support the start-up costs of such labs. However, they do not have to go it alone. The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) provides the K08 funding mechanism for early career clinician-scientists. Insightfully, although 75% dedicated research time is required of most investigators, orthopedic surgeons are only required to have 50% dedicated research time, in recognition of the greater clinical demands on orthopedic surgeons than on other clinicians. However, a search on NIH RePORTER2 reveals that only 6 out of 41 total K08 grants awarded by NIAMS are to investigators in orthopedics departments. While some of these awards from NIAMS fund the skin diseases components of their mission, a greater emphasis on funding orthopedic surgeon-scientists could greatly alleviate the underrepresentation of MD/PhD graduates within the field. If the shortage of MD/PhDs entering academic orthopedics is to be rectified, it will likely take a combined effort from academic departments choosing to hire and support new surgeon-scientists as well as funding institutions making supporting these researchers a priority.