From Bedside to Bench Without Return: The Surgeon-to-Researcher Transformation (2009-2024)

Background: Surgeon-scientists translate laboratory discoveries into clinical practice. As NIH funding becomes increasingly competitive, concerns have emerged about physician representation in surgical research leadership. This study examines 15 years of NIH surgery funding to characterize trends in surgeon-scientist leadership and clinical engagement. Methods: NIH RePORTER data from 2009, 2014, 2019, and 2024 were analyzed (N=4, 511 unique principal investigators; 4, 011 grants; 1. 77 billion). PI credentials including degree type (MD-Only, MD-PhD, Non-MD), National Provider Identifier registration, board certification, and Medicare billing activity were obtained through web-scraping from national registries. VA and pediatric surgeons were excluded. Two-way ANOVA examined Time × PI Type interactions, and gap analysis assessed the relationship between clinical credentialing and active practice. Results: NIH surgery funding increased 53% (352M to 539M), though grant numbers remained stable. Two-way ANOVA revealed significant Time × PI Type interaction (p<0. 001). MD-Only PIs declined from 48. 9% to 40. 8% of grants, while MD-PhD PIs increased from 15. 2% to 24. 9% (64% relative growth). Non-MD investigators remained stable (~35%). Among MD PIs, clinical credentialing remained stable (93-96%), but gap analysis revealed growing disconnect between credentialing and practice. The credentialing-billing gap increased from 22. 6% (2014) to 26. 6% (2024) (β=0. 40%/year, p<0. 05). In 2024, while 93. 2% of MD PIs maintained credentials, only 66. 6% received Medicare payments. Conclusion: Traditional MD-only surgical research leadership has declined while MD-PhD investigators have increased. One-quarter of MD PIs now maintain credentials without recent Medicare billing. This disconnect may impact bidirectional translation; academic departments should develop pathways supporting clinically-active surgeon-scientists.