Empowering the Physicians that Bridge Patient Care and Biomedical Research

Sajid Khan: Physician-scientists are vital to society because they bridge patient care and biomedical research. Procedural physician-scientists, who are a subset of physician-scientists, have a particularly unique role as they directly observe and physically intervene in disease pathology with their own hands, whether it’s a surgical oncologist removing a tumour, a dermatologist excising skin cancer, or a gastroenterologist removing a polyp. Their dual expertise facilitates true bench-to-bedside research to address meaningful clinical issues and drive measurable improvements in patient outcomes.

They get a rare perspective that most other people don't. Observing physiology in real time provides proceduralists with insights that can enrich collaborative, cross-disciplinary research. So, you can imagine how and why, historically, procedural physician scientists have made significant contributions to biomedical sciences and society.

Khan: Along with the universal challenges that all physician-scientists and scientists face, like declining funding, procedural physician-scientists face particular hurdles. The structure of surgical training and heavy clinical and administrative duties limit their time for research. These factors make it less likely for procedural physician-scientists to successfully transition to independent research careers compared to their non-procedural counterparts.

It's a challenging time, but with challenging times come opportunities to find ways to improve workflows and productivity. Instead of feeling frustrated, it's better to focus on finding solutions and looking for opportunities for new methods to excel in research. Leaders from medical schools, hospitals, and the NIH need to find ways to safeguard researchers' time so they can conduct valuable biomedical research.

Ultimately, caring about answering research questions drives progress. And I believe passion should motivate persistence. If you're passionate about biomedical research, you should be able to continue despite these hurdles.

Khan: The team science model unites experts from various fields, with each contributing unique insights to tackle complex medical research. Adopting a team-based approach is crucial for procedural physician-scientists, as it fosters cross-disciplinary collaboration, which is key to developing innovative research perspectives and increasing the likelihood of securing intramural and extramural funding.

This approach allows for a more balanced allocation of responsibilities. Some team members can focus primarily on basic science research, while others can handle the clinical demands that coincide with the clinical translational aspect of a research project. This collaborative dynamic allows all members to contribute to a shared goal, creating a synergistic environment.

To facilitate this, institutions should try to establish shared laboratory spaces and centralized equipment resources. Structured team science programs can vitalize the careers of and help procedural physician-scientists manage competing demands on their time, enabling them to pursue rigorous scientific inquiry while maintaining their clinical commitments.

The NIH recognized the value of this approach by introducing the “multiple principal investigators” option in 2006, which allows research teams to have more than one principal investigator. This structure ensures that all team members, whether focused on clinical care or basic science, can collectively contribute to a shared research objective, thereby strengthening the quality of the research and helping these doctors achieve a better work-life balance.

Khan: I lead interdisciplinary research that combines my surgical expertise with the knowledge of experts in other biomedical disciplines. For instance, my collaborations with Caroline Johnson, PhD, a superb analytical chemist at Yale School of Public Health, and Jun Lu, PhD, a brilliant geneticist at Yale School of Medicine, on studies of colorectal cancer and liver metastasis, have led to significant findings that couldn't have been achieved by a single discipline.

This interdisciplinary approach allows for a comprehensive understanding of complex gastrointestinal cancers by integrating diverse perspectives and skillsets, from molecular biology to clinical practice. By working together, our team can translate discoveries from the lab to patient care more effectively, ultimately advancing the field of cancer research and treatment.

Khan: First, leadership should identify people who are passionate about research. If an individual has passion, that will drive and motivate them to do what they need to do to complete research projects and ultimately succeed.

Second, it's critical to identify people at an early stage of their career who are passionate about being a procedural physician-scientist. For example, Kurt Schultz, MD—a surgery resident at Yale New Haven Hospital and a co-author of the paper I wrote with Nita Ahuja, MD, MBA—we invited him on this paper because we could tell he was passionate about research and is early in his career as a surgeon-scientist.

I think this work will be a long-term benefit to his career and to biomedical research, since he will likely develop the foundation to come up with great research ideas in the future which will benefit society.

I also think it's important to reach out to people at the trainee level, as early as medical school and graduate school, to provide longitudinal mentorship. Medical students, residents, and non-surgeon research fellows who I have been fortunate to mentor at Yale have done exceptional work. As I see their careers progress, some are evolving into surgeon-scientists and basic scientists who apply a team science approach. It's very rewarding to see. They’re starting to make real contributions. I believe that will only continue.