Academic Careers in Colon and Rectal Surgery

A career in academic colon and rectal surgery can be tremendously stimulating due to its variety and ability to combine a busy clinical practice with teaching and training of medical students, general surgery residents and colon and rectal surgery fellows. Front line research aimed at solving many clinical problems and bench laboratory work are also appealing to many.

While some surgeons in academic medicine have a hard time juggling all three responsibilities, most academic surgeons would never trade this for another practice style. Today, many academic medical centers are seeking colon and rectal surgeons for their faculty. Our specialty has done well in demonstrating the value of a surgeon with a specialized interest and training in colon and rectal surgery, especially in the treatment of low rectal cancers, inflammatory bowel disease and anorectal and pelvic floor problems.

While there are many positions at the instructor and assistant professor level, career advancement, like any surgical procedure, is the result of several different steps taken in the correct order. This is by no means meant to provide the "only" path of beginning and pursuing an academic career, but presents the most common route taken by surgical residents, colon and rectal surgery fellows and young faculty in both general and colon and rectal surgery.

Table of Contents

• American College of Surgeons
• American Society of Colon & Rectal Surgeons
• Association for Academic Surgeons
• Society of American Gastrointestinal
• Endoscopic Surgeons
• Society of Surgical Oncology
• Society for Surgery of the Alimentary Tract
• Surgical Infection Society
• Society of University Surgeons
• American Surgical Association

• Central Surgical Association
• North Pacific Surgical Association
• Pacific Coast Surgical Association
• Southeastern Surgical Congress
• Southern Surgical Association
• Southwestern Surgical Congress
• Western Surgical Association
• Table I: Regional Organizations

• American Society of Gastrointestinal Endoscopists
• American Gastroenterological Association
• Obtaining Funding
• Table II: Curriculum Vitae

• Obtaining Funding
• Table II: Curriculum Vitae

Curriculum Vitae

Having an up-to-date and accurate curriculum vitae is essential. This should be updated regularly, whenever there is something new to add, so that it is always ready whenever needed. This is also essential for ultimate tenure and promotion.

CVs should be orderly, easy to read and not contain "fluff." Trying to "stretch" your CV to make it look better is always readily apparent. "Padding" your CV creates a bad impression and is more likely to be counted against you than be beneficial. The outline provided in Table I may serve as an example.

Memberships in associations can be ordered chronologically according to the date of membership, alphabetically, or alternatively can be ordered from increasing to decreasing importance. Peer reviewed publications should be separated from non-peer reviewed publications such as "throw away journals" and other non-refereed materials. Abstracts should be listed separately and include only published abstracts. Scientific Presentations should not include local or community talks but only significant national, regional or local meetings or invited presentations. As you get along into your career, there should be separate categories for Invited Lectures, Visiting Professorships, Books, and Grants, even small ones.

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Getting a Mentor

Depending on your institution, getting a mentor may or may not be easy. You may be the only colon and rectal surgeon there or not have colleagues with whom you can discuss such matters. Attending national meetings is a great way to get a mentor, colorectal or general surgical. Find someone who you think has a well-established career and ask him or her for advice and follow it. Most people are flattered by such inquiries and requests for advice. Few people refuse this. Another alternative way is to request your department chairperson or other senior faculty members' CVs. See what steps they have taken in their career advancement. What organizations have they joined? In what journals have they published? What committees do they serve on, etc?

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Department Activities

You should be sure that you meet with your department chairman at least once a year to go over with him or her your progress during the previous year. Is he/she happy with your performance? Do they have suggestions on how you can become more effective or more productive in your work? If such meetings are not a normal part of your department's activity, schedule them yourself. It is a lot better to know if you are doing something unsatisfactorily ahead of time, so that you can change this, rather than waiting until tenure time to find out the hard way when it is too late to address problems. Get a copy of your university, school and department's tenure policies and work toward these. Make sure that, when the time for tenure comes, you are in a strong position and can stand well in the review process. Many institutions require that all documentation for tenure be submitted during the candidate's fifth year at an institution, even though tenure only takes effect in the seventh year. Don't be lulled into thinking that you still have time to work toward this! Remember that manuscripts that you want to publish generally take three to five months after submission to determine whether they will be accepted and then, depending on the journal, from three to eighteen months until publication. Find out which types of publication your department, school and university values most. Peer review publications are usually respected most highly. Book chapters are usually valued to a lesser extent and non-peer reviewed articles to a much lesser degree.

Become an integral part of teaching general surgery residents and medical students. This will help you become a full participant in department activities, especially if you are a member of a surgery department. It is, however, important to remember that teaching is not everything. In many departments young faculty have significant teaching loads. This is always assumed to be part of the job. People rarely get tenure for being a good teacher, without having additional publications, grants, etc.

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Looking for Protected Research Time

If you find a department that gives you protected research time, you are incredibly lucky. In most departments this is wishful thinking. With the responsibilities of earning clinical income, teaching and university and hospital committees, it is difficult to set aside time. Most busy clinical surgeons will quickly lose referrals and clinical business if they are frequently unavailable to referring physicians because they are "in the laboratory" or "it is their research day." This is a very difficult problem to solve and time juggling can be quite challenging.

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Organizations and Memberships

University and Medical School Organizations

Many young faculty do not like serving on committees or taking part in this type of activity because of its time-consuming nature. A more balanced view of this, however, should be that, if you serve on committees, you will be asked to serve on more committees and get to know more people. More people will get to know you and consider you for both clinical and other administrative activities. The person who says "No" frequently will not be asked again when other opportunities arise. Consider carefully before declining.

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National Associations

Participation in national surgical associations is vital to your career. Only by being seen and participating at a national level will you become known among your peers and advance your career.

American College of Surgeons (ACS)

Residents and fellows should become candidate members of the American College of Surgeons. This level of membership produces free access to Clinical Congresses and simplifies applying for fellowships to the College later. In order to become a full fledged fellow of the College, you must practice in the same location for three years; i.e., job relocation delays initiation. The application process gets started when you have been in the same location for two years and do not anticipate moving the next year. The application requires filling out an operative log of your previous year's cases, as well as an interview by local College members. Many of the specialty and regional societies have as a pre-requisite fellowship in the ACS. The college journal formerly known as Surgery, Gynecology and Obstetrics and now renamed Journal of the American College of Surgeons is edited by Dr. Timothy Eberlein.

American Society of Colon & Rectal Surgeons (ASCRS)

The American Society of Colon & Rectal Surgeons is an inclusive society open to both colon and rectal and general surgeons. This organization of individuals with similar interests provides a unique opportunity for surgeons interested in a career in academic colon and rectal surgery to work together toward common goals. The organization's journal is Diseases of the Colon and Rectum of which, Dr. Susan Galandiuk is the editor.

Association for Academic Surgeons (AAS)

This is a great inclusive organization for young people in academic medicine and actually "retires" its members after they have belonged to the organization for ten years. You can join when you are not yet finished with training and can easily become involved and learn about how societies function, etc. Many people in academic medicine have gotten their early experience with committees, participating on councils, etc. from this association. The organization publishes its articles in the Journal of Surgical Research. The current editor is Dr. Scott LeMaire.

Society of American Gastrointestinal Endoscopic Surgeons (SAGES)

The Society of American Gastrointestinal Endoscopic Surgeons was founded by a colorectal surgeon, Dr. Gerald Marks. This is one of the busiest and largest surgical societies with a membership that currently is very active in both endoscopy and laparoscopic surgery issues. Membership requirements are not stringent. The society is involved in credentialing and guideline development and has become politically influential. SAGES was the first organization to create credentialing guidelines for laparoscopic surgery. They produce good publications devoted to similar topics and also sponsor numerous workshops. The society journal is Surgical Endoscopy (Editors: Dr. G. B. Hanna, UK and Dr. M. A. Talamini, USA (Coordinating).

Society of Surgical Oncology (SSO)

The Society of Surgical Oncology was formerly an exclusive society which was not flourishing ten years ago. Several years ago the requirements for membership were made much less stringent, allowing many types of surgeons with an interest in oncology to become members. The organization is now a large one with an excellent meeting whose proceedings are published in Annals of Surgical Oncology (Dr. Charles Balch is editor). This Society has been active in establishing algorithms and guidelines for diagnosis and treatment of many different types of cancer and seeks to be active legislatively as well.

Society for Surgery of the Alimentary Tract (SSAT)

The Society for Surgery of the Alimentary Tract's meeting is held in conjunction with Digestive Diseases Week during which three other organizations also meet: The Association for the Study of Liver Disease, The American Society of Gastrointestinal Endoscopists, and the American Gastroenterological Association. This week-long meeting of specialists with an interest in digestive disease is a wonderful experience and an unparalleled chance to interact with internists and endoscopists. Basic scientists and clinicians give presentations on every facet of gastrointestinal disease. The Society for Surgery of the Alimentary Tract formerly was an exclusive society. It has, however, greatly changed membership requirements and it is now much more simple to become a member. The new journal for the society, the Journal of Gastrointestinal Surgery, has just recently been published. (Editors: Drs. Richard Hodin and Timothy Pawlik).

Surgical Infection Society (SIS)

The Surgical Infection Society is among the more exclusive and esoteric general surgery organizations which may be of interest to the colon and rectal surgeon. As the name says, it largely concerns itself with sepsis, shock, infection and is now particularly cytokine oriented. This has great applicability to infection in colon and rectal surgery as well as cytokines involved in inflammatory bowel disease. Some of its papers are accepted by the Archives of Surgery.

Society of University Surgeons (SUS)

Society of University Surgeons is an exclusive surgical organization. It consists of academic surgeons and its papers and election to membership are quite competitive. Its meetings are of excellent quality and are published in Surgery. There are currently few members of the American Society of Colon and Rectal Surgeons that are members of this organization; however, this number increases every year. Membership in this Society is also complex and must proceed through a society member and a formal nomination process.

American Surgical Association

American Surgical Association is one of the most prestigious surgical organizations in the world although its membership requirements have somewhat relaxed recently. This organization generally consists of more senior surgeons, most of which have an extensive CV with numerous publications and many other recognitions and leadership roles. Membership nomination must proceed through a member. Manuscripts are published in Annals of Surgery.

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Leading Regional Organizations

Some of the more prominent regional societies are listed in Table II. Of these organizations, the Southern Surgical is perhaps the most prestigious and it is consequently difficult to attain membership. These interesting societies consist of members in academic medicine as well as those in private practice. Entry qualifications for these two disparate types of surgeons are different. Membership applications need to proceed through a society member. Many regional groups require fellowship in the American College of Surgeons and/or endorsement by current members of the respective society.

TABLE I: Regional Organizations

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Non-Surgical Organizations

The two major non-surgical organizations which might be of interest to colon and rectal surgeons are the American Society of Gastrointestinal Endoscopists, a very large national organization with a lot of lobbying clout, and the American Gastroenterological Association which is the most respected gastroenterological association in this country.

A current list of colon and rectal surgeons who are members in these different societies is available on request. This may facilitate membership in these societies, particularly if sponsors or letters of recommendation are required.

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Funding

The young faculty member who arrives at an institution without a contact and without money, should find established investigators with which to collaborate. Starting out this way is the easiest way to get involved in research projects. Collaborators do not necessarily have to be surgeons, but can be basic scientists, biochemists, immunologists and faculty in other fields who may share common interests; i.e., cancer, growth factors, cytokines, hormone receptors, physiology, etc. If you have no one in your institution with whom you can collaborate, look for people with similar interests who might be willing to work with you at national meetings. If this is not an option, a second method of getting funding is through university grants. Many institutions have small start-up grants to help young investigators. These grants do not cover the entire costs of a project, but may defray some of the expenses and allow the young investigator to obtain preliminary data.

The third option is time tested and has funded a significant amount of research over the last thirty years: Money obtained through clinical trials to support basic science research. Many pharmaceutical companies making everything from antibiotics to motility drugs to cancer imaging agents will pay several thousand dollars per patient enrolled into a clinical trial evaluating new products. Many institutions or departments will have study coordinators that do this work; however, a beginning investigator who does not have access to a study coordinator may have to do much of this work himself. Money obtained in such a manner does not have tight restrictions as to its spending and can often be used for salaries, equipment, travel and other expenses that the young faculty member might incur. The most respected way of obtaining funding is through private and government grants. Competition for many of these grants is quite stiff.

In addition to the obvious benefits of having money with which to pursue research, your institution will value you for this because of the money that they get through indirect costs which are subtracted from the money you receive and given to the institution to cover "administrative expenses."

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TABLE II: Curriculum Vitae

1. PERSONAL INFORMATION (Include date and place of birth, marital status, address, telephone numbers, Social Security Number, languages spoken, etc.
2. EDUCATION (Include Degrees, School, City, Year)
3. SURGICAL TRAINING
   Internship (Include institution, city, state, years)
   Residency (Include institution, city, state, years)
   Fellowships (Include institution, city, state, years)
4. FACULTY APPOINTMENTS (Include institution, city, state, year; include present position)
5. BOARD CERTIFICATIONS (Include dates & certificate numbers)
6. LICENSES (Include states, numbers and dates)
7. SOCIETY MEMBERSHIPS (Include year of election)
8. EDITORIAL ACTIVITY (Include years and journals)
9. COMMITTEES (Include sections for Society, University, Hospital, State, Public Service and Corporate, if applicable)
10. OFFICES HELD (Include years)
11. HONORS AND AWARDS
12. BIOGRAPHICAL EDITIONS
13. PUBLICATIONS (Separate sections for peer-reviewed, non-peer-reviewed, and letters, comments and reviews, etc.)
14. ABSTRACTS
15. BOOK CHAPTERS
16. BOOKS
17. GRANTS/FUNDING (Include source of funding, dollar amount, project title, dates and principal investigator)
18. SCIENTIFIC PRESENTATIONS
19. ENDOWED LECTURESHIPS/VISITING PROFESSORSHIPS