As I was plotting my career path during residency – should I do research, what specialty to go into, etc. – one of my mentors suggested that I think about the day-to-day ennui and challenges that a field offers rather than focusing only on spectacular events that are far and few between. For example, it would be amazing if I found a new therapy for cancer (or even just published a paper), but if I don’t want to re-re-re-submit the grant application that keeps getting rejected or re-re-re-run gels to get to such a discovery, I shouldn’t go into research.
I think this would be a similarly useful exercise for residents and medical students who are considering incorporating basic science research as part of a surgical career. You should think about what it would be like to be a surgeon-scientist on a day-to-day or week-to-week level and not just when you put out a major publication or receive a large grant. To facilitate that, I thought it may be helpful to share the daily challenges of being a practicing surgeon who also works in a wet lab, focusing especially on the mental side.
As I complete my fourth year as a faculty member, I have found that there is a constant need to balance two separate worlds, that of the surgeon and the scientist, each with its unique rewards and challenges. Being a surgeon-scientist means trying to master two disparate domains while still having just 168 hours a week. Sometimes, working to be a surgeon-scientist feels like opening up yourself to two streams of pain and frustration rather than partaking in two sources of professional fulfillment.
I spend about 80% of my time working on research, which is comprised of a combination of wet bench work, reading papers, and writing. While that schedule averages one day a week of clinical work, the reality is that my clinical responsibility is clustered in a way where I may be completely off from patient care for multiple weeks in a row. This setup allows for long blocks of protected time that are highly conducive for research activities, which is essential since even simple techniques like immunohistochemistry and western blots are two-day affairs. In addition, I make the most progress on grant proposals and manuscripts when I devote consecutive days and weeks to writing. Thus, having significant protected time has been instrumental to my progress in the lab.
However, being a surgeon as well as a scientist means research time is a double-edged sword. As I was completing my general surgery residency and then surgical oncology fellowship, I felt like I was in control of the clinical sphere. For better or worse, time in the lab is inversely proportional to time in the operating room and wards. As a result of my research commitment, my technical skills and clinical acumen improve in only fits and starts with occasional periods of atrophy. I am missing out on the steep learning curves that my peers had as they began their clinical careers. But taking on more clinical responsibility equates to less time to make progress in research, so it is an open question whether I will ever become the technical master that I aspired to be during my training. My mentors have told me that they love the operating room because it is their sanctuary away from the administrative rabble that awaits them in their office. However, I have found it hard to enjoy the operating room experience when a grant deadline is approaching. Not wanting to be in the operating room is a discomforting feeling as it undermines my professional identity as a surgeon.
Despite the amount of protected time I can devote to research, it is still not enough. I often miss out on talks by important investigators visiting my institution because the lectures overlap with tumor board meetings. I still find it a slog to read and digest basic science papers because I need to think really hard to understand the background or techniques of which I have only a passing familiarity. It is an irony that even though basic science research progresses so slowly, potentially paradigm-shifting results are published daily. Keeping up with reports published even just in Cell, Nature, and Science is a Sisyphean task.
Even the distinct environs of the hospital and the lab can be challenging. Events in the operating room and on the wards change in minutes to hours, which leads to a constant level of stress and frenzy. While exhausting, the pace is exhilarating, and it is one of the reasons that drew many of us to surgery. In complete contrast, experiments take days, if not months, to complete. The rhythm of the lab is measured and tranquil, yet it can be frustrating. For me, leaving the operating room and sitting down at the bench is the mental equivalent of going from a sauna to an ice bath. I find it difficult to transition from one to the other. And as a result, at every transition, I lose time trying to re-engage my brain to go from dissection to grantsmanship.
I’ve yet to accomplish the spectacular – I have neither a Cell publication nor an R01 grant. Instead, there is the smaller daily satisfaction of taking good care of patients and doing interesting research projects. So far, these rewards have outweighed the constant challenge of trying to be comfortable with discomfort. But the struggle is ongoing, and I suspect not likely to end soon.