Surgeon-Scientists: The Bridge Between Bench and Bedside

Arguably, no one advances their specialty more than physician-scientists. As a bridge between practitioners and researchers, physician-scientists help translate research into practical care. However, the number of physician-scientists has steadily declined since the trend was first noted in the late 1970s.1

As of 2014, physician-scientists were estimated to account for just 1.5% of the nation’s total physician workforce.2 Simultaneously, the age of physician-scientists has trended upwards, as new, younger physicians entering medicine choose to focus on clinical work or becoming clinician-educators rather than physician-scientists.3 Together, these trends raise concern — the number of physician-scientists continues to shrink, and the numbers are not being replenished by new doctors coming into the workforce.

Colorectal surgery is no exception

Aware of these trends and the importance of having a surgeon-scientist on staff, Cleveland Clinic Digestive Disease & Surgery Institute brought Jonathan Mitchem, MD on board earlier this year. Dr. Mitchem’s primary focus is understanding immune resistance mechanisms in colon and rectal cancer to enhance anti-tumor immunity. In addition to his work at Cleveland Clinic, he was also awarded a Veterans Affairs (VA) grant to explore how to alter macrophages and try to turn them from a cell that supports the tumor into a cell that tries to help reject the tumor.

“From the perspective of being a colorectal surgeon, there are very few places in the world that offer the breadth and depth of complexity that Cleveland Clinic has,” says Dr. Mitchem. “The research opportunities are fantastic because you have this massive volume of complex and interesting cases. So, bringing the intricacies and takeaways from the clinical cases into the lab and using that to inform the research we do in the lab, and using those findings to help patients is something I’m thrilled about.”

Current and future projects

“My main interest is in the immune response to cancer and why the immune cells in the tumor that should theoretically kill those cancer cells don’t actually do that,” explains Dr. Mitchem. “Then, I’m also looking at why using therapeutic applications to try and augment or improve the immune response to cancer as a therapeutic means doesn’t work in most colorectal cancer cases. PD-1 antibody therapy in colorectal cancer has been in the news recently, and some of the findings from studies on the topic are exciting.”

But Dr. Mitchem notes that while they have seen impressive results using this kind of antibody therapy in a particular subtype of colorectal cancer, it’s not applicable to most patients — only about 15% of the patients overall in colorectal cancer and an even smaller group in rectal cancer. Dr. Mitchem’s VA grant is centered around how to alter those other immune cells to help the T-cells, the main cell of target for antibody therapy, function better.

He explains, “One of the other main focuses I have is figuring out why this doesn’t work for most colorectal cancer patients and what can be done to overcome this resistance to the treatment in most patients. Simultaneously, I’m also looking at how we can improve therapies that we already know do work, like chemotherapy, and what their role is alongside these novel therapies.”

The role of surgeon-scientists

Dr. Mitchem explains that, in his view, surgeon-scientists help improve patient outcomes — both in regard to patients being treated today and those treated tomorrow. Surgeon-scientists treat and operate on patients, but they also take the lessons they’ve learned in their research and apply them in ways that can improve outcomes for future patients.

“No one knows our patients like surgeon-scientists know their patients,” says Dr. Mitchem. “We know the problems that they face because we see them in clinic. We take care of them before surgery in the operating room and after surgery. We see their recurrences. We see all the problems. But because we have this unique perspective on patients and patient care, it’s important that we bring that perspective to the research side too.”

In terms of research, Dr. Mitchem points out that surgical departments that have robust research infrastructure or large volumes of research funding are generally financially healthier. “Those kinds of departments are usually looking for ways to provide services that go beyond the standard of care. That’s really where the surgeon-scientist comes in. Because of our unique perspective, we can help push the envelope in terms of helping identify ways for patients to do better with or without surgery. That ability to think both critically and outside the box is really what separates the top-quality institutions from everyone else, and it’s the surgeon-scientists who help establish this way of thinking.”

The future of surgeon-scientists

Although other specialties have been able to foster a more robust pipeline of surgeon-scientists that the colorectal field, the cadre of surgeon-scientists in colorectal surgery has been able to develop a collaborative community. Dr. Mitchem leads a bimonthly meeting where surgeon-scientists from all over the country discuss projects, review grants, provide feedback and develop connections.4

“Because there are so few of us, I think it can be challenging for younger physicians to recognize that you can be a busy surgeon and participate in research,” says Dr. Mitchem. “I think as a result, mentorship becomes that much more important among the surgeon-scientists who are in colorectal surgery. I had mentors who really showed me that there are people doing this and this is what it looks like.”

One of the biggest selling points for Dr. Mitchem in becoming a surgeon-scientist is the immense impact he can have on patients.

“I think as surgeons, we all recognize that there are only so many patients you can operate on in your lifetime,” he explains. “But if you progress in your understanding of a disease or a treatment, from the research side, then you get the chance to impact everybody’s patients. I think that’s the amazing part of being a physician-scientist.”

References

1. Wyngaarden JB. The clinical investigator as an endangered species. N Engl J Med. 1979;301(23):1254-9.
2. National Institutes of Health. [Accessed August 20, 2023];Physician-Scientist Workforce (PSW) Report 2014: Executive Summary. https://acd.od.nih.gov/documents/reports/PSW_Report_ACD_06042014.pdf
3. Salata RA, Geraci MW, Rockey DC, et al. U.S. Physician-Scientist Workforce in the 21st Century: Recommendations to Attract and Sustain the Pipeline. Acad Med. 2018 Apr;93(4): 565–573.
4. Maguire LH, Mitchem JB, Smith JJ. CREATEing Community for Colorectal Surgeon-Scientists. Dis Colon Rectum. 2023;66(4):491-492.