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The Fellow As Consumer, Building Bridges and Other Wishes for a New Year

January 2008

When I started editing the web version of CareerTalk in 2002, my goal was simple: to begin building an on-line resource containing the maps and tools needed by the aspiring pulmonologist to achieve career success. For budding academicians, the need seemed particularly acute. Many trainees and junior faculty still believe that just because they work in an academic environment, this makes them an academician. The problem is, educating fellows and junior faculty is not enough. Most will not thrive in academics without mentors to help and inspire them.

Take grant writing, for instance. It doesn’t matter how many workshops one attends, or how many books and essays you read. A fellow or junior faculty person needs to find a seasoned, successful grantwriter, preferably one with study section experience, to review their applications and mercilessly edit them.  Senior investigators know the difference that grantsmanship can make between a great (and funded) versus a good (and unfunded) application.

Unfortunately, other than altruism, there are few incentives for being a good mentor and even fewer ways of holding faculty members with postdocs accountable for their mentoring (or lack thereof). This isn’t to say that a principal investigator may or should be good at anything other than his/her research. But postdocs are not cheap technicians. If a PI is going to have postdocs working for him/her, s/he needs to assume some responsibility for their career development and insure that they have access to quality guidance. In a recent ATS Forum post, I noted that the National Science Foundation has begun requiring researchers applying for NSF grants to document the mentoring that they provide their postdocs.

http://www.thoracic.org/forums/forum/messageview.cfm?catid=13&threadid=60&enterthread=y

It’s a start, to be sure. But, there is no mention of how mentoring is defined, nor how the NSF will actually insure that PI’s are doing what they say they are doing. Most telling, there is no required measurement of outcome.

The only real way that you, as a fellow or junior faculty person have to influence the situation is to vote with your feet by finding programs and mentors that best fit your needs and goals. Obtaining the objective data that will enable you to make informed choices is not straightforward as most published data is not well organized or hard to find. And as mentioned, measures of quality are almost non-existent. One place to start is the updated Best of the Web on Career Development that is coming out this month.

In particular, I mention the CRISP database.  http://crisp.cit.nih.gov
CRISP or Computer Retrieval of Information on Scientific Projects is as its name implies, a searchable database of federally funded biomedical research being conducted at universities and other research institutions. The search engine is rather cumbersome, but allows you to search by type of award, institution, geographic location, investigator, and other terms. For instance, let’s see how many NHLBI awarded K awards are active in the state of California in 2007. This gives us  83 “hits”, listing grant number, PI name and project title.  Clicking on the project title takes us to a page with the PI’s name and institution, the project start/end date as well as an abstract.

If we narrow the search to include only the University of California, San Francisco, we get 35 hits.

CRISP

In contrast, the much smaller state of Massachusetts has 91 NHLBI K awards. Type in Brigham% (for Brigham and Women’s) and we get 24 hits. Johns Hopkins-29, University of Colorado-20, University of Pennsylvania-23, University of Washington-19. Wow. Not all of these are individual awards and it would take more digging to figure out how many of these awards are to cardiology or hematology, but considering that these 6 schools currently hold about one-quarter of the roughly (619) currently active K awards  given out by the NHLBI gives you a sense of their power and size.

I am not, by any means, saying that you have to go to a big name school to be successful in academics. For instance, you cannot extrapolate success rate from these figures as this data does not provide the denominator (i.e., total number of applications received per institution). But it’s a start.

In addition, two important data sites document the declining funding success rates of K applications and NEW unsolicited RO1 applications.

            http://grants.nih.gov/grants/award/training/comrcp7006.htm

            http://www.epidemiologic.org/2006/12/precipitous-decline-of-nih-r01-success.html

This data is not sorted by institution or field of study. But, it does provide quantitative information that can provide the basis for important discussions and questions. Indeed, the attitude with which a program director or division chief addresses these numbers may be more informative to an applicant than the actual data itself. For instance, if both the K awards and  R01 are essential for the career success of independent investigators, then it is pretty obvious that in our current economic and political environment, most trainees accepted into academic training programs will not make it to their first R01, let alone survive through a renewal without some aggressive and creative thinking regarding alternative sources of support.

Which brings us to the issue of job security. I remember one particular career discussion during which someone said that it was not reasonable for fellows to think that everyone is going to make it in academics. True, there is no profession with 100%  job security or guaranteed job success, but most physician-fellows do not go into a training program with the same mindset as someone joining a start-up company or a competitive law firm. Nor are most internal medicine-trained residents as familiar with pyramid-type programs as their surgical peers. Furthermore, it is daunting to think that even if you get your first RO1 (at the average age of 43) that it could all come crashing down if you are unable to renew it, or obtain a second RO1, a key marker of having “made it.” These concerns are very real. Single RO1 supported endeavors are flimsy. There are no contingencies built into the current model, no way for individual laboratories to save for a “rainy day” in case a lapse in funding occurs. 
 
Pouring more money into the system isn’t necessarily the entire answer. Program and division directors need to learn not only how to properly select the trainees/junior faculty who are going to apply for training awards but also how to provide long term career development. This means that the system, from the NIH down, needs to insure that the limited resources available are used wisely to provide adequate security for those in the pipeline. Junior faculty with K awards need more, not less support than fellows. At the very least, career development funding should provide enough salary to buy sufficient protected time for the nascent faculty member. And protected time should be strictly defined to account for all time involved in clinical and administrative duties. Too many institutions use the standard of a 60-hour work week to squeeze extra non-research time out of their K awardees. Being up all night covering a busy ICU is not conducive to creative thinking the next day or even the next 48 hours. And since most applicants will not get their K award or RO1 the first time around, the system needs to openly deal with the economic uncertainties surrounding these transition periods and plan for the “what if’s”? Ignoring these issues only heightens the existential angst faced by young investigators, many with families to support. Without hope, of course they will drop out.

Luckily, pulmonary, critical care and sleep medicine is a subspecialty made rich by its diversity and opportunities. Even when everyone does what they are supposed to do, success in academics depends on a bit of luck and timing. And, like any career, academics has its quirks and personality requirements. It isn’t and shouldn’t be for everyone.  There is a wonderful resource guide for medical faculty (trainees should read this also) entitled “Taking Root in a Forest Clearing.”  You can download the pdf file just by googling the title or going to http://www.bumc.bu.edu/Dept/Content.aspx?DepartmentID=42&PageID=8849.

In the introduction, one characteristic of a successful academic environment is described as “purposeful...where the classroom is seen as a place where community begins.”  Scientific training is never wasted. Trainees need to feel that if they do leave academics that they are not going to be doing something less worthy and that the door to the professional home in which they were raised is not being shut. Training programs should be the bridge between clinical and academic medicine, not the gap that separates them.

To address these issues, CareerTalk is expanding in 2008 by going live as a postgraduate course in Toronto this May. My co-chairs: Lynn Schnapp, David Au, Lynn Gerald and I have worked hard to assemble a diverse, dynamic faculty to cover professional skills and knowledge from a trainee or junior faculty point of view. For instance, we won’t be talking about mentoring but “mentee-ing.” Similarly, we’ll talk about people management in terms of how to deal with your boss or division chief.

Among the key features of this course are 10 workshops that focus on specific topics in academic and clinical pulmonary medicine including Timelines and Transitions, Managing the Gauntlet to Associate Professor to Life in Industry,  PhD considerations in an MD world, Pediatric/Neonatology, Family/Career and others. These workshops are being kept small in order to facilitate interaction among participants. This is your chance to get to know people who are passionate about mentoring, medicine and science. They know what it takes to succeed and understand the struggle that meeting these challenges entails. Earlier in this article, I talked about altruism. Nearly all of the faculty are donating their time in order to help keep costs down and permit a reduced registration fee of $100 for ATS trainee members.

The advance program goes online later this month, so stay tuned! And please, help spread the word, tell your friends, colleagues, program and division directors!