Title: From Fellowship to Junior Faculty and the Health Status of the
1From Fellowship to Junior Facultyand the Health
Status of the Triple Threat Faculty Member
William J. Bremner, M.D., Ph.D. Professor and
Chair Department of Medicine July 15, 2010
2Goals and Rewards of a fellowship what to get
out of it?
- Area is interesting
- Patients
- Research questions
- Teaching opportunities
- Practice opportunities
- Life style
- Hours
- Geography
3Patients
- Learning from each one
- Numbers
- Increasing level of responsibility
- Clinician-Teachers / Mentors
- Learning to do research and teaching
4Research
- Mentorshipprimary, secondary
- Track record of mentees
- Lab facilities/environment
- Space, equip, staff
- Other trainees
- Rarely if evera specific research question first
5Teaching
- Mentorship
- Seek out excellent clinicians/teachers
- Not so well supported financially
- Very gratifying
6Practice opportunities
- Developing local/regional/national contacts
- Active demand for our graduates
- Shortages in most specialties throughout the
region - Excellent reputation for quality of UW training
7Biotech opportunities
- Both Ph.D.s M.D.s
- Increasing locally
- Tech Transfer/Intellectual Property (IP) issues
8Academics
- Clinical/Research/Teaching/Leadership
- Can determine individual balance
- Can vary over ones career
- Varied life/challenges/opportunities
- Travel
- Generally lower incomes than practice or
biotech/pharma
9Yearly Goals
- Year One
- Concentrate on clinical mastery.
- Identify and bond with mentor(s)
- Check track record of mentees and funding of
mentor - With mentor, identify ongoing studies that can be
joined and consider IRB submissions for studies
in second year - Consider writing a review paper in area targeted
for research
10- Year Two
- Conduct research studies
- Initiate new studies
- Submit abstract(s) for regional, national
meetings - Training in statistics, study design
- Write paper(s) as soon as data available
- Maybe middle author initially, then first author
- Consider NRSA application
11- Year Three
- Continue and initiate additional research
- Publish (first author) initial research
- Additional middle author papers
- Submit NRSA, K award, foundation applications
12- Year Four
- Additional first and middle author research
papers. Reviews and chapters usually not worth
the time spent - K award and foundation or pharma support for
salary - Looking to Acting Instructor or Assistant
Professor appointment
13- By end of year four (definition of success /
victory!) - 5-10 papers, most as first authors, in good
journals and K award
14Department of MedicineFellowship Programs
- ACGME Fellows 123
- M.D. Fellows not in ACGME 68
- Ph.D. Fellows 58
- Other 1
- Total 250
15Department of MedicineFellowship Programs
- ACGME Fellowship Programs
- Allergy and Infectious Diseases 16
- Cardiology 21
- Dermatology 1
- Endocrinology 8
- Gastroenterology 13
- Gerontology 0
- General Internal Medicine 0
- Hematology/Oncology 25
- Medical Genetics 1
- Nephrology 8
- Pulmonary and Critical Care 25
- Rheumatology 5
- Total 123
16Fellowship Salaries Sources
- ACGME Fellows
- Medical Center Stipends
- Training Grants
- Division Funds
- Non ACGME Fellows
- Research
17Institutional Research Training Grants
- T 32 Institutional National Research Service Award
18Individual Fellowships
- F 32 Postdoctoral Individual National Research
Service Award - F 33 National Research Service Awards for Senior
Fellows
19Department of MedicineFellowship Programs
- MD 151
- MD, MPH 8
- MD, PhD 32
- PhD 58
- Other 1
- Total number of fellows 250
20Agencies fund DOM Fellowships, Career Development
Training Awards (I)
- American Heart Association
- American Diabetes Association
- American Society of Hematology
- Arthritis Foundation
- American College of Cardiology
- American Federation of Aging Research
- American Lung Association
- American Assoc for the Study of Liver Diseases
- Association of Teachers of Preventive Medicine
21Agencies fund DOM Fellowships, Career Development
Training Awards (II)
- American Association for Cancer Research
- Cystic Fibrosis Foundation
- Doris Duke Charitable Foundation
- European Association for the Study of Diabetes
- The Firlands Foundation
- Juvenile Diabetes Foundation (and several of its
branches) - National Kidney Foundation
- Novartis Pharmaceuticals
- Pfizer, Inc.
- The Pfizer/AGS Foundation for Health in Aging
2209-10 Salary Levels
- RANK ANNUAL T or F (NIH)
- R-4 52,994 45,960
- R-5 55,032 47,940
- R-6 57,012 49,836
- R-7 59,676 52,068
- R-8 62,268 52,068
23How to Support Fellow to Academic Position
- Apply for
- K awards
- Foundations
- Request support on mentors grants
- Collaboration with other faculty
24Years Between Fellowship Academic Titles
- Avg
- Count Years Min Max
- Fellow to Acting Instructor 118 3.1 0 8.5
- Fellow to Acting Asst Prof. 41 4.6 0.9 7.7
- Fellows to Asst Prof. 80 5.4 2.2 9.0
25K-awards
- K08 Mentored Clinical Scientist Development Award
Development of independent clinical research
scientist. 3-5 yrs 75 effort. - KL2 Mentored Clinical Scientist Development
Program Award Support to institution for the
development of independent clinical scientists. 5
yrs 75 effort initiated by the educational
institution. - K23 Mentored Patient-Oriented Research Career
Development Award Development of the independent
research scientist in the clinical arena. 3-5
yrs, 75 commitment. - K99/R00 NIH Pathway to Independence (PI) Award
Facilitate receiving an R01 award earlier in a
research career and to assist investigators in
securing a stable research position during the
critical transition stage of their career. - K01 Mentored Research Scientist Development Award
New direction for PI. Development of the
independent research scientist. 3-5 yrs 75
effort.
26R0-1, etc
T32
27Landing Sites
- R-01 Classic benchmark
- P Program Project Grants Project PI
- U Interactive grants or PPGs - PI
- VA Merit Award PI
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29K Grant Outcomes
- Data are for NIDDK K08 recipients who completed
awards in 1990-1995, n140. - 74 remain in research (in 2006).
- 56 received R grants.
- 9.4 publications/investigator.
- 11 in private practice.
- 3.6 unknown.
30Conclusions
- Research Fellowships are a gateway to great
career opportunities - Especially academics
- But also practice, biotech, and others
- Pick successful mentors and pick important
questions - Enjoy the time
- Be challenged and be challenging
- K award Kiosk.
- http//grants.nih.gov/training/careerdevelopmentaw
ards.htm
31The Triple Threat Thriving or on Life Support?
- The day of the triple-threat academician who was
great in research, could take care of patients,
teach and do administration is over. - R.G. Petersdorf, Is the establishment
defensible? - NEJM 309 1053-57, 1983
32- it is time to reassess our fixed image of the
idealized physician-scientist as the much
lamented triple-threat academic. Indeed, was
there ever really a time when large numbers of
physicians actually moved effortlessly among the
bench, the clinic and the classroom on a typical
day? More realistically, I think the
prototypical triple-threats went through
transitions in their careers where during certain
periods they were immersed primarily in clinical
practice, then in protected time for research
then in more administrative responsibilitieswe
must be careful not to confine our definition of
a serious physician-scientist to this largely
mythical triple-threat model. - Andrew Schafer, The vanishing physician-scientist
- Translational Research 155 1-2, 2010
33Physician-Scientists
- Conduct medical research along entire continuum
- Devote majority of effort to research
- Vital and unique role in medical research
enterprise
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362006
1980
Sources IMPAC II Current and History Files and
AAMC Faculty Roster
September 2007, Age Distribution of NIH RPG
Investigators and Medical School Faculty
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38Summary of Changes in NIH PI and Medical School
Faculty Pools (1980-2006)
1980
1998
2006
Number and Average Age of NIH PI 14,887 39.1 17,761 42.7 25, 419 50.8
Number and Average Age of NIH New PI 1,843 37.2 1,355 39.0 1,346 42.4
Number of Medical School Faculty Positions 53,552 73,413 121,468
Average Age of Medical School Faculty 43.1 45.2 48.7
Average Age of First time Assistant Prof. 33.9 35.4 37.7
39Recipients of NIH RO1 Grants, 1964-2004
- Among first-time applicants, those with an MD
consistently had less success than those with a
PhD or MD/PhD
- Among investigators who obtained a first RO1
grant, those with an MD were consistently less
likely than those with a PhD or MD/PhD to obtain
a subsequent RO1 grant
40New Concerns About Future Viability of
M.D.-Scientist Workforce
- Dramatic changes in demographics of medical
school graduates
- Generational attitudes about work-life balance
and controllable lifestyles
- Increasing unpredictability of federal support
for research
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42Major Recommendations
- Attention and resources should be directed at
repairing the leaking physician-scientist
pipeline.
43Major Recommendations
- Major changes should be made to the contemporary
approach to mentoring physician-scientists.
44Major Recommendations
- Institutions should proactively promote the
advancement and minimize the attrition of women
in physician-scientist careers.
45Major Recommendations
- The physician-scientist workforce should be
strengthened by earlier and more coordinated
efforts to identify and prepare successful future
investigators who have a more enduring commitment
to research careers.
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47- Find what you enjoy doing and pursue it with
focus, discipline, and vigor. Be mindful of the
matrix organization in which you work (research
lab, department hospital, professional
organizations, etc.), network, and establish
constructive collaborations. Seek out mentors,
besides your research PI, who can provide
objective, supportive and mature advice about
your career development. Establish a positive,
respectful relationship with your boss.
Articulate career goals and on a yearly basis
review your goals and progress toward them with
your boss and mentors. Dont lose sight of your
family. And, importantly, have fun and enjoy the
ride! - Elizabeth G. Nabel
- Former Director of National Heart, Lung and Blood
Institute - Current President of Brigham and Womens Hospital
- The Journal of Clinical Investigation 120 2251,
2010