(157) THE ROLE OF THE SURGEON-SCIENTIST IN MODERN UROLOGY: DO MD/PHD GRADUATES CONTINUE TO CONTRIBUTE TO SEXUAL MEDICINE AND UROLOGICAL RESEARCH?
Authors: Puhalla L , Ljubetic BM , Khooblall P , Lundy SD 
Published: December 2024

Abstract

Introduction
Surgeon-scientists have historically been pivotal in advancing basic and translational scientific knowledge in urology. As modern medicine shifts towards prolonged clinical training and additional fellowships, increasing emphasis on clinical productivity, and persistent challenges in obtaining research funding, it remains unclear whether dedicating 3 decades to train an MD/PhD surgeon-scientists will yield an academically productive clinician.

Objective
Characterize the research contributions, practice patterns, and scientific productivity of MD/PhD urologists to assess the academic retention of this highly-trained cohort to the urologic literature.

Methods
Alumni from 144 US accredited urology residency programs were manually queried for graduates holding both MD (or DO) and PhD degrees between 2010-2022. Demographic information, fellowship training and practice type were recorded. Web of Science was accessed to capture data on total and post-graduate publications, citations, and ongoing research involvement. Data was analyzed in Rstudio. Multiple linear and negative binomial regression models were used to identify predictors of total publications since residency.

Results
We identified 46 US urology residency graduates (31 male, 15 female) with MD/PhD degrees from a total of 27 programs. Most (93.5%) pursued their PhD in the US, with 91% completing formal combined MD/PhD programs. Post-residency, 36/46 (78.3%) pursued clinical fellowship training, 7/46 (15.2%) immediately became staff urologists at academic centers, 2/46 (4.3%) went into private practice, and 1/46 (2%) could not be located. Clinical fellowship breakdown was as follows (n = 36): 7 (19.4%) in sexual medicine, 6 (16.7%) in endourology, 7 (19.4%) in pediatrics, 14 (38.9%) in urologic oncology, and 2 (5.6%) in female pelvic medicine and reconstructive surgery. Remarkably, 93.4% continued to publish within 2 years of graduating residency, with a median of 20 and a mean of 59.5 publications (range: 0-442, SD: 94.8). After a median follow-up of 7 years, 78% of the subjects remained engaged in academic research, as evidenced by their publication activity in the past year. Multiple linear and negative binomial regression models were then used to predict publication quantity. Significant predictors included fellowship-trained in sexual medicine (β = 0.964, p &lt; 0.01), increased follow-up time after training (β = 0.201, p &lt; 0.001), current research involvement (β = 3.264, p &lt; 0.001), and number of citations (β = 0.000152, p &lt; 0.01). Gender academic status were not significant predictors.

Conclusions
To our knowledge, this study represents the first assessment of MD/PhD urologists to date. Formally trained urology surgeon scientists still represent a very small (0.35%) fraction of the active urology physician workforce. Despite the additional duration of training, these graduates continue to publish and contribute to the scientific literature for many years following completion of residency and fellowship. These findings suggest an ongoing role for surgeon-scientists with the interest and skillset to conduct basic science and clinical research in sexual medicine and in the field of urology as a whole.

Disclosure
No.