The Surgeon Investigator: Balancing Research and Clinical Practice


Figure 38.1 presents the Impact Factor for some of the journals I have published in over the past 5 years. Several things are notable; first, the highest ranked surgical journal, Annals of Surgery (Impact Factor 7.492), does not have a particularly high Impact Factor when compared to other journals. The journals with the highest Impact Factor tend to be general medical journals such as the New England Journal of Medicine (53.298) and JAMA (30.026). These are journals with a wide readership and are highly influential. However, even among medical specialties, the Impact Factor for Annals of Surgery is not particularly high. For example, if I have surgical research of broad interest to the surgical and oncology community, I would at least consider sending my manuscript for consideration to the Journal of Clinical Oncology (Impact Factor 18.372) before sending it to Annals of Surgery.


Fig. 38.1
2011 Impact Factor for select journals publishing my work within the past 5 years

When selecting a journal, I have three considerations:


Who will want to publish my work? Is the work novel or likely to have general interest and impact? If the answer to these questions is yes, then I will submit my work to a journal with a broad readership and a high Impact Factor. If my research is of importance to a narrow group of readers or is more confirmatory or exploratory in nature, I will select a journal accordingly. I generally decide where my work will be a long shot, where my work will have a reasonable chance of being accepted, and where my work will be likely to be accepted. If there is no urgency to publish, in particular there is no chance another research will publish something very similar, I will begin by submitting to the highest impact journal that might possibly be interested. In general, the editors of high impact journals reject a large number of publications without sending for review—often, a rejection comes within a week or two and does not delay time to publication substantively. Once rejected, I will send my manuscript to the journal that where I think the work has a reasonable chance of being accepted, and so on. If my manuscript is accepted with minor or no revisions, I consider this a signal that perhaps I underestimated the potential impact and importance of my work.



Who needs to read and be aware of my work? If it is particularly important that surgeons in my subspecialty are aware of my findings, I may consider publishing in a lower impact journal to reach a specific audience. Subspecialty journals may have a tremendous impact within the scope of practice of readers of the journal. For example, important research on the surgical management of complex perianal fistula due to Crohn’s disease is likely to have more impact on practice if published in a subspecialty journal that is highly read by the target audience (such as Diseases of the Colon and Rectum, Impact Factor 3.132) than in a higher impact journal such as Gastroenterology (Impact Factor 11.675), which is not routinely read by the target audience.



Have I been happy with service at the journal in the past? The important factors I consider include the ease of the submission process and the timeliness of rejection notices, reviews, and notification of acceptance. Also, it is very important that accepted manuscripts do not wait for many months prior to publication. There are thousands of indexed journals to choose from and I will think twice about sending to a journal that has provided poor service in the past.


There are of course other measures of research significance, and I do not propose to value the Impact Factor of a journal as the only or best metric. While the Impact Factor is an important measure, it is flawed. Journals with a large number of review articles tend to have a comparatively high Impact Factor as this type of article is frequently cited. For example, the journal CA: A Cancer Journal for Clinicians, a publication of the American Cancer Society, publishes annual cancer statistics for the United States and solicited review articles. Because these annual cancer statistics are frequently cited, the Impact Factor of this journal is 101.78, nearly twice that of New England Journal of Medicine. Clearly, the impact of publication articles published in this journal is not twice that of articles published in the New England Journal of Medicine. Additionally, subspecialty journals will never achieve the Impact Factor of journals of broad interest to the medical community despite the fact that articles published in subspecialty journals may change the care of a large number of patients.

Finally, it is much more common to publish in a journal with a high Impact Factor than to publish an article that has high impact. The Impact Factor for a given journal is often driven by a relatively small number of articles published in that year; many articles will have a low number of citations, while a few articles will have a very high number. Because institutions are aware of the limitations of the Impact Factor, academic promotion committees may ask for other measures of research success. Currently, one of the more common measures is the h-index [5]. The h-measure is an evaluation of research impact and productivity for an individual researcher as a measure of research impact. To calculate the h-index, all articles written by an individual author are ordered according to the number of citations to that article. The h-index is based on the distribution of these ordered articles. A scientist with an h-index of x has x articles published that have been cited at least x times. For example, according to Google Scholar, my h-index is 33, meaning that I am an author on 33 articles that have been cited at least 33 times. Note that this measure attempts to balance both quantity and quality. While Hirsh suggested some h-index benchmarks for promotion, for promotion to associate professor, it is likely more important to have a good understanding of the benchmarks at your institution. Calculate the h-factor for faculty that have recently been promoted—this will give some indication of where you stand in comparison to your peers.

Of note, there are limitations to the h-index. The measure does not consider the number of authors on a paper or the order of authorship. Additionally, as it takes time for citations to occur, the h-index will naturally increase as the time actively publishing increases. Finally, some noble laureates actually have a relatively poor h-index as they have produced a small number of publications, although they were of seminal importance. Despite the limitations, it is important to be aware of your h-factor particularly when you are considering promotion as many schools at least consider this metric with the goal of applying more objective criteria to decision-making. While it is quite possible that the specific metric of academic success will change over time, it is almost certain that academic institutions will continue to use measures that enable benchmarking; being aware of what metrics are in use at your institutions is key.

Obtaining Funding

Key Concept: Funding not only is a metric of success, it allows you to continue your role long term as a surgical investigator. Plan ahead, as obtaining funding is often a long process, and set realistic and achievable goals.

Obtaining peer-reviewed funding is essential to maintain your research team and to continue your salary support for research once your 3–5 years of institutional salary support is over. Additionally, obtaining funding for your research is an important measure of academic success, and at many institutions, it is the most important measure. Obtaining funding has always been highly competitive; however, in the current era of fiscal restraint, there are even more challenges.

The first step to success in obtaining funding for your research is to develop your strategic plan for funding. As part of your plan, consider the two major types of funding: salary support awards and research funding awards. Set feasible goals; if you have been given 20 % protected time, it is not possible for you to obtain a major mentored career award and unlikely that you will be successful as a principal investigator on an R01. Obtaining institutional funds or specialty society grants for projects and becoming active in cooperative groups conducting research in your area would be very feasible. In contrast, if you have been given 50 % or more protected time for research, you will be expected to obtain funding for salary and research support, and obtaining NIH support may be an important benchmark for consideration of promotion at your institution—expect to spend considerable time applying for funding!

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Mar 23, 2017 | Posted by in GASTROENTEROLOGY | Comments Off on The Surgeon Investigator: Balancing Research and Clinical Practice
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