To help alleviate the shortage of surgeon-scientists in the United States, MD–PhD training programmes funded by the National Institutes of Health (NIH) need reforming to encourage more clinician-scientist trainees to consider this career path (see Nature 544, 393–394; 2017).

Many surgical-residency programmes offer research tracks. I suggest that these research opportunities be introduced after residency, during the training for sub-speciality fellowships — as is more commonly done in subfields of internal medicine. That would allow surgeon-scientists to collect preliminary data to help them win research grants once they are junior faculty members.

Although the NIH provides funding for early-career clinician-scientists, most research institutes require a 75% time commitment — an unrealistic demand for many junior surgical faculty members. The National Institute of Arthritis and Musculoskeletal and Skin Diseases and the National Institute of Neurological Disorders and Stroke recognize this and require their orthopaedic surgeons and neurosurgeons, respectively, to spend only half of their time on research. Other institutes should consider following their example to spur research work in other surgical disciplines.

Hospital administrators and department chairs of academic medical centres can also help by providing surgeon-scientists with protected research time.