Faculty development is a critical part of any surgical HSR program, but is often difficult. Surgeons seeking to become HSR experts face several challenges; including time constraints, monetary disincentives, limited fellowship training opportunities, and a paucity of senior faculty mentors.

Compared to other specialties in medicine, surgery has historically demanded greater time commitment to clinical activity, making it difficult for surgeons to find time for research. This challenge is compounded by the common misperception among many academic surgeons that HSR requires little time to perform. Surgical HSR program leaders must convince surgeons who want to pursue HSR (and their clinical leaders) to make the significant time investment required to build a successful surgical HSR portfolio.

Financial disincentives to focus on HSR are also particularly difficult for surgeons to overcome. The gap between research funding for salary support and what a surgeon typically earns with clinical activity is larger than for less generously remunerated specialties: the maximum NIH salary cap at the time of this writing is US$178,700 compared to a typical academic surgeon salary of approximately US$300,000. When 0.20 FTE salary support is awarded in an NIH grant, this would typically cover only about 12 % of a typical surgeon salary. In the current tight market for research funding, doing clinical work is by far the easiest way for a surgeon to achieve targets for income generation, whether determined institutionally or personally.

Compared to other specialties in medicine, surgery has fewer research fellowship opportunities in HSR, and the ones that do exist are highly competitive. Furthermore, the training paradigm in surgery is challenging for those pursuing a research career. Trainees in the medical specialties can enter research fellowships directly following residency training, which provides a smooth transition to an academic career. In contrast, surgeons typically complete HSR fellowships between years for residency, followed by 2–6 years of further surgical training, after which they remain on a steep clinical learning curve while building a surgical practice. This situation makes a strong start in surgical research difficult for young surgeons.

Surgical HSR is a relatively young field, but is growing rapidly. Many academic surgery departments aim to recruit surgeon researchers who can contribute to the increasingly active policy dialogue related to healthcare delivery. Because of this, surgical HSR experts are in high demand. While this environment provides many opportunities for faculty to assume positions of leadership and responsibility early in their careers, it also points to a paucity of senior mentors for the increasing number of trainees and junior faculty who want to pursue surgical HSR.

Given the above challenges, creating an effective “pipeline” for faculty is of utmost importance to a surgical HSR program. The essential components of a faculty development pipeline include initial protected research time, training programs and mentorship, access to active intellectual forums, and grants administration support.