“Once I get on a puzzle, I can’t get off.”
Richard P. Feynman
As a PhD, I may have a little different view of research than many of my practicing colleagues. My pathway to an MD, PhD differed from many of my colleagues in that I completed my course work, research, and most of my dissertation prior to matriculating into medical school. I also graduated with my PhD and MD from two different and nonrelated institutions. While in medical school, I continued to perform research but ceased during residency due to time constraints, but also due to a lack of vision as to how my research interests and skills could be reconciled with my clinical interests and chosen career path. After graduating and starting practice, I did assist with several projects run by other primary investigators/authors but did not accept the baton until about 12 years ago.
I eventually concluded/realized that my disparate interests did not need to be reconciled and that intellectual pursuits are an end to themselves, knowledge for knowledge’s sake. I also found that many of the skills I had learned during my PhD training easily crossed over into clinical research and were easily augmented from readily accessible resources. Although setting up a lab may seem financially daunting and the thought of filing grant requests may fill you with fear, neither of these is necessary to make an active and significant contribution to science in general and medical science in particular. The barrier to entry is much lower. The advent of large patient outcome databases such as NSQIP-PUF combined with the low cost of computational resources means that many clinical questions can be asked and subsequently answered with low financial outlay, limited only by the creativity of the investigator. Other areas of interest to clinical medicine that are easy to access from a research standpoint are process improvement and patient safety. If these do not interest you, entertain projects outside of medicine. There are professors and students at local institutions who are looking for research partners. Share your time and energy with them.
There are four reasons that you should consider active participation in research projects. I will address them in order of importance.
First, for your own edification, career advancement, and knowledge base. For those of you who point out that I did not put the patient first, in the absence of a healthy, educated, and engaged physician, there is no health care. As physicians, we have seen too many of our colleagues who have burned themselves out “putting the patient first,” ignoring their own mental and physical health, allowing their skill set to atrophy, and, in the end, providing suboptimal care. Research projects are certainly not for everyone. If you enjoy solving problems, answering complex questions, expanding your understanding of a subject, and adding new skill sets, this may be an excellent intellectual outlet for you to pursue. I guarantee that if you do the reading and work, you will become the subject matter expert to your colleagues.
Second, for your colleagues. As medical science progresses, it becomes increasingly difficult for physicians to be informed about every condition and therapy their field/specialty addresses. This is one of the reasons for subspecialization within medicine. Becoming a subject matter expert for your colleagues does not mean taking patients away from them or cannibalizing their practices to advance your own, but rather a way to elevate the level of care they provide and be an educational resource they can utilize. I have found this particularly true in surgery, and I can give two examples. One of my academic interests is decreasing the rate of surgical site infections and other perioperative complications. It is not possible or even necessary for my practice partners to read as much of the surgery literature pertaining to this topic as I have. They have, however, benefitted from my subject matter expertise by allowing me to optimize the preoperative and postoperative order sets and update OR procedures that have resulted in a departmental risk of surgical site infection that is lower than the national standards for neurosurgery. I likewise have a strong interest in osteoporosis and fragility fractures since our hospital system serves an aging population. It is not possible for me to treat every fracture, nor do I desire to do so. I have, therefore, trained my partners to provide the same services that I do and function as a consultant for more complicated cases.
Third, for the patient. This is why all of us practice medicine, and they should be the ultimate beneficiary of our expertise and efforts. Medical science is not static and neither should your knowledge base be. Without research, even small projects, there is no improvement in patient care and no patient care at all. Even small projects to decrease perioperative complications, improve medication compliance, assess and decrease risk of fall, etc., have large financial impacts for both patients and society.
Fourth, for your group practice/institution. In an evermore competitive health care economy, research can improve care by improving quality of care by improving outcomes and decreasing the costs. Well done research will also increase the reputation of your institution, increase patient referrals, and improve the business model.
For those who are interested, here are some words of advice and caution.
First, IRBs, patient safety, confidentiality, data integrity, and research ethics matter. Before you start asking a research question or setting up resources, be sure to complete a course on research ethics and compliance. The Collaborative Institutional Training Initiative has a variety of courses that most likely will fulfill your institutional requirements. Most have CME credits assigned to them. If you are doing patient research, even database research that is potentially exempt from IRB review/controls, it is vital that the IRB is made aware of your work and that you are explicit with your plans for maintaining patient confidentiality and data integrity. Even an exempt project should have a letter from the IRB stating that the project is exempt and they have signed off on the compliance and data integrity aspects of the project. The consequences for violating patient confidentiality or having a data breach are severe and may include termination, legal action, and large fines.
Second, do your literature search and background research first. Has anyone else asked/solved this question? Was their methodology sound? Is it worth another look to confirm or refute the results? These things need to be considered before you move forward. Have an open mind and do not be afraid to play the devil’s advocate for your own preconceived notions. This is all part of solving the problem, and the intellectual reward.
Third, avail yourself of some statistical training. There are a variety of classes offered online and in person at extremely reputable medical training centers that are an excellent resource. I am not asking you to become statistician, but I am asking you to be aware of how and why certain tests are utilized and to understand the concepts of hypothesis training and how to interpret the results. Most projects would benefit from a professional statistician’s input and although such input is not cheap, it is not out of reach for most individuals and institutions to pay for this support.
Fourth, be honest, do what you say, and be forthright with your results and conclusions. Verify everything. We are already suffering from an epidemic of research fraud and abuse. Don’t add to the problem.
Last, be extremely cautious with artificial intelligence. This is an extremely complicated issue. Do not use it to write up your results. It is a useful tool for crafting language and looking for complex relationships; however, just like your hypothesis testing, everything needs to be verified. AI has problems with both data leaks and hallucinations (lying) that need to be understood prior to utilization.
If you have finished your project, what do you do with the results? Although not all research is worthy of peer-reviewed publication, it is worthy of presentation and discussion. Multiple local medical societies and professional associations have local, regional, and national meetings looking for research presentations. Find a meeting, prepare either a poster or podium presentation, and engage your colleagues. This is where the rubber meets the road. Seek out constructive criticism and potential collaborators. Also, take the time to look at other people’s work and see what is being done. Exercise your intellectual curiosity. If you are interested in advancing a project, these are the interactions and connections that make things happen. If the project goes no further than the meeting that is OK. If, on the other hand, you are interested in publication and grant support, use these interactions to advance your project and move it forward.
What’s stopping you from considering research? Share in the comments.
Dr. Charles Watts is a neurosurgeon practicing in St. Louis Park, MN. He is the department head of neurosurgery within the Health Partners system. His practice interests are minimally invasive spine surgery, pituitary tumors, and brain tumors. He also has research interests in quality, particularly the reduction of surgical site infections and other peri-operative complications as well as biophysical chemistry having completed a PhD in this field of study. He is married with four children, and likes to stay physically active with a variety of hobbies/interests outside of medicine. Dr. Watts is a 2025–2026 Doximity Op-Med Fellow.
Image by DrAfter123 / GettyImages
