LETTER TO THE EDITOR

MICROSURGERY 28:387–389 2008

OUTSOURCING BENCH RESEARCH TO REDUCE ATTRITIONOF JUNIOR SURGERY FACULTY

Dear Editor,

Pressure on junior clinical faculty’s work time has

never been greater. First, changes in Medicare and Med-

icaid rules have shifted direct care responsibility to fac-

ulty supported by university monies or residuals from

NIH research grants.1 Second, an increase in the demand

for physicians has led to higher student enrollment in

medical schools that, in turn, has resulted in rebudgeting

of faculty time to attend more to student teaching and

pay less attention to research.1 Third, the research ques-

tions that dominate medical queries today are more

highly specialized and expensive than in times past.2–4

Advances in molecular and genetic sciences are now cen-

tral to most medical investigations and command a con-

siderable investment in time, learning, and capital. As

Bromely contends, contemporary research has ‘‘widened

the gap between doctor and scientist.’’2

The evolution of research in surgery departments has

resulted in a classic example of the basic sociological

concept known as role strain, which occurs when a per-

son holds contradictory or incompatible roles. Role strain

takes place when the performing of one role makes prop-

erly executing another expected task difficult or even

impossible and creates tension within the conflicted indi-

viduals. If widespread, role strain can hinder a social sys-

tem from reaching its overall goals.

Of concern for the present discussion is that the

increased demands on junior clinical faculty for treating

patients and mentoring students and the technological

specialization of most current research streams has made

research expectations difficult to fulfill. Consequently

many junior faculty vacate clinical/research positions;

while those who remain on faculty spend increasingly

less time conducting original investigations.

Given these conditions, previous paradigms are inad-

equate in today’s clinical department research milieu. The

early model of first-hand learning in personal laboratories

became outdated as work conditions and research ques-

tions changed. Later, many research functions were

replaced by premade kits and automated instrumentation

that allowed researchers to conduct experiments outside

their area of expertise. Today, in the age of molecular

biology, multidisciplinary research is the norm, and the

lone laboratory investigator is very rare. The complexity

of molecular techniques has led to the development of

highly sophisticated equipment requiring specialized per-

sonnel to operate and maintain. These factors have driven

the cost of research to the point where it is unaffordable

for junior clinical faculty to establish personal laborato-

ries. Even if another laboratory were available, clinical

faculty would better spend their time doing clinical work

than learning and performing complicated laboratory

techniques. Furthermore, if departments provide Research

Fellows or Interns to assist clinical faculty with technical

support, these temporary trainees are usually inexper-

ienced in molecular techniques, and the completion of

projects may be jeopardized because of time constraints

due to long learning curves. Typically, trainees have a

1-year appointment, in which 3–6 months are spent

receiving training, and the remaining months are spent

attaining data and writing papers. The cost of training fel-

lows in research is prohibitive when considering the time

needed to become productive in the laboratory combined

with the amount of costly supplies that are consumed in

*Correspondence to: Claudio Maldonado, Ph.D., 511 South Floyd Street,MDR 332, Louisville, KY 40292. E-mail: cjmald01@louisville.edu

Received 12 February 2008; Accepted 21 February 2008

Published online 16 June 2008 in Wiley InterScience (www.interscience.wiley.com). DOI 10.1002/micr.20506

VVC 2008 Wiley-Liss, Inc.

the training process without generating usable or reliable

data. Junior clinical faculty seldom have equipped labora-

tories or funds to cover these expenses and are forced to

leave academia due to a lack of productivity in research-

based scholarly activity.

To assuage these problems, we are proposing a new

paradigm in the organization of basic research in Sur-

gery and other clinical departments of medical schools.

Novel creative solutions that facilitate basic research for

clinical faculty are needed to optimize human and finan-

cial resources. We envision a new approach where the

technical research work will no longer be carried out by

investigators in personal laboratories but will be out-

sourced to specialized laboratories. The driving force

behind this concept is the high cost of research, which

has encouraged the notion of sharing instrumentation and

operational costs in ‘‘university’’ core laboratories (CLs),

and the emergence of ‘‘commercial’’ CLs in biotech

companies that offer research technical services for a fee

to capitalize on instrument investment and their exper-

tise. In general, these commercial CLs provide fast serv-

ice, guaranteed quality of product, and use expert scien-

tists who not only do the work but also serve as consul-

tants in projects. Both university and commercial CLs

are a low cost alternative to in-house research in per-

sonal laboratories and provide considerable time savings

in attaining research data for research productivity. An

example of efficiency and time savings can be seen in

constructing a gene for recombinant protein expression

to make a new drug. A number of commercial CLs can

deliver perfectly sequenced gene constructs in appropri-

ate vectors within 2–3 weeks, compared to an inexper-

ienced research trainee who will take months, perhaps

years, to accomplish the same task. In a personal labora-

tory, the minimum costs required to make a 1,800 base

pair construct would include salary for a technician or

Research Fellow (�$3,000 per month), oligos for cloning

and sequencing (�$2,100), enzymes (�$500), a vector

kit ($500), and a thermal cycler for polymerase chain

reaction ($6,000–$15,000). In contrast, the cost for the

same construct from a commercial CL is �$2,880 ($1.60

per base pair) an affordable sum that is attainable from

departmental or intramural seed funds. Using CLs does

not preclude the hiring or the use of Research Fellows.

On the contrary, this will make Fellows more productive

by freeing them from performing tedious laboratory tech-

niques and allowing them more time for the intellectual

components of their research. An additional scientific ben-

efit of using CLs is that experimental data avoid internal

bias, because they are generated objectively by a third

party, particularly if test samples are blinded.

A mentoring program will be essential for the suc-

cess of a CL-based research program. The absence of

formal mentoring programs for research socialization of

Table

1.ListofCustom

ResearchServicesProvidedbyCommercial‘‘C

ore

Laboratories’’

Companyname

Services

Peptide

synthesis

Flow

cytometry

Gene

synthesis

Human

froze

n

tissue

sets

Protein

expression

Antibody

productio

nProteonomics

Human

tissue

microarray

Gene

microarray

Microarray

analysis

RNA

interference

synthesis

Western

and/or

northern

blots

Fluorescent

insitu

hybridization

Assay

deve

lopment

Arvys

ProteinsInc.

XX

BlueHeron

Biotechnology

X

BocaScientific

X

Creative

Bioloabs

Corp

XX

XX

XX

Chemicon

XX

X

Cybrdi

XX

X

GeneScript

Corporation

XX

XX

X

ImgenexCorporatio

nX

X

MiltenyiBiotecInc.

XX

XX

New

England

Biogroup

XX

XX

388 Letter to the Editor

Microsurgery DOI 10.1002/micr

junior clinical faculty is partly responsible for deficien-

cies in research productivity. In the ‘‘traditional’’ mentor

model, it is assumed that junior faculty work in the

mentor’s laboratory. However, this situation is not plau-

sible in many clinical departments as evidenced by the

recent publications describing mentoring models to

empower faculty for their academic success,5,6 and

reports from the Association of American Medical Col-

leges showing an 8.4% annual attrition rate for clinical

faculty. In our model, we propose to use single mentors,

preferably from basic science departments, who will

educate clinical faculty on the basics of experimental

design but will not necessarily provide laboratory facili-

ties. The mentor’s emphasis will be on the intellectual

component of the research rather than where the

research will be conducted. The innovative component

of our model is to make bench research more accessible

and less costly to junior clinical faculty by outsourcing

the work to CLs. Companies providing a spectrum of

custom research services are listed in alphabetical order

in Table 1.

In conclusion, the social and technical demands on

faculty surgeons have evolved into a set of contradictions

in which both retention of faculty and research productiv-

ity have suffered. The solution proposed here expects

to lessen these problems and improve clinician-based

research productivity in the United States.

CLAUDIO MALDONADO, Ph.D.*

Department of Physiology and Biophysics,

and Department of Surgery

University of Louisville

Louisville, KY

ALLEN FURR, Ph.D.

Department of Sociology

University of Louisville

Louisville, KY

REFERENCES

1. Beaty HN, Babbott D, Higgins EJ, Jolly P, Levey GS. Research activ-ities of faculty in academic departments of medicine. Ann Intern Med1986;104:90–97.

2. Bromley E. The evolving relationship between the physician and thescientist in the 20th century. JAMA 1999;281:95–99.

3. Mallon WT. The financial management of research centers and insti-tutes at U.S. medical schools: Findings from six institutions. AcadMed 2006;81:513–519.

4. Mallon WT. The benefits and challenges of research centers and insti-tutes in academic medicine: Findings from six universities and theirmedical schools. Acad Med 2006;81:502–512.

5. Bussey-Jones J, Bernstein L, Higgins S, Malebranche D, Paranjape A,Genao I, Lee B, Branch W. Repaving the road to academic success:The IMeRGE approach to peermentoring. AcadMed 2006;81:674–679.

6. Thorndyke LE, Gusic ME, George JH, Quillen DA, Milner RJ.Empowering junior faculty: Penn State’s faculty development andmentoring program. Acad Med 2006;81:668–673.

Letter to the Editor 389

Microsurgery DOI 10.1002/micr