Surgeon-scientist representation in surgical research is declining, reshaping the landscape of surgical innovation.

• NIH surgery funding rose 53% from $352M to $539M, but the total number of grants remained stable.
• MD-only principal investigators dropped from 48.9% to 40.8%, while MD-PhD investigators increased from 15.2% to 24.9%.
• A growing disconnect is noted; 93.2% of MD principal investigators have credentials, yet only 66.6% are billing Medicare in 2024.

Academic departments must foster pathways for surgeons to stay clinically active while engaging in research.