Jeanie Park, MD, Emory University School of Medicine, Atlanta, GA
For most physicians, the pathway to a career in science often appears ambiguous and uncertain. Although the trajectory to becoming a practicing clinician is clearly defined, with well-demarcated milestones such as passing the USMLE step exams and completing residency training, the path to becoming a physician-scientist is not clear-cut. In fact, most physicians are unaware of the steps involved in fashioning a career in scientific research or the rewards and challenges involved in such a pursuit. In addition, unless one has dual MD and PhD degrees, a physician without PhD training may feel like a “late bloomer” when pursuing a career in science and not adequately trained or prepared. We may feel that our PhD counterparts have been preparing for years throughout graduate school and postdoctoral fellowships for a research career, while we have been training for an entirely different type of career in clinical medicine and patient care. These and other obstacles have led to a relative dearth in the number of young physicians pursuing academic research careers. However, physicians may evolve into successful scientists with some planning and foresight, and enjoy fulfilling careers that combine scientific research with patient care and teaching.
What is a Physician-Scientist?
A physician-scientist is a practicing clinician who spends the bulk of his or her time doing research. Like their PhD counterparts, physician scientists conduct all types of biomedical research, including basic, translational, clinical, and population studies. Physician-scientists also engage in clinical activities, teaching, service, and administration. Unlike clinician-educators that usually spend a minority of their time pursuing scholarly activities, physician-scientists typically devote at least 50% or more of their time in research activities as a principal investigator funded by federal and foundation grants. Research activities include a variety of specific endeavors, with some variation depending on the type of research program. These include writing grants and papers, performing experiments, training students and research fellows, collaborating with other investigators, serving on study sections, and presenting at national meetings. Although physicians may have relatively less experience in these areas, such skills can be developed during fellowship and as a junior faculty member. In addition, physicians have unique perspectives and backgrounds, which include scientific and clinical expertise, both of which can be leveraged when competing for grants and establishing a research program. Physician-scientists identify clinically relevant questions at the bedside, study these questions in the laboratory, and then apply that knowledge back at the bedside.
Do You Have the Desire for an Academic Research Career?
Given our relatively late start as MDs, you may wonder whether you have what it takes to become a physician-scientist. Several resources list various qualities that are necessary to becoming a physician-scientist, including being hard-working, self-motivated with perseverance, capable of problem-solving and multi-tasking with the focus and ability to see things through to the end. I believe that, for the most part, physicians possess these intrinsic traits, since these are also the qualities necessary for surviving the rigors of medical school and clinical training. In my opinion, the essential ingredient necessary for success as a physician-scientist is the desire to pursue this career path, and the commitment to make it your goal. This commitment is crucial because it will ensure that you apply your skills and talents to establishing a scientific career with the same fervor that has made you successful thus far. This level of commitment is akin to the commitment made when completing medical school and residency; if one’s mindset was open to giving up and opting for an alternative career if things got rough, then many of us may have given up medicine during our internship when working long hours on call under sleep-deprived and stressful conditions. However, giving up was not an option. When this same level of commitment is applied to pursuing an academic research career, then you have an excellent chance of successfully establishing a fulfilling and rewarding career as a physician-scientist.
There are many advantages of a physician-scientist career that make it a very attractive career choice. I particularly value the variety of the work. On any given day, I may be treating outpatients in the clinic, conducting experiments in the lab, rounding on hospital patients with residents, discussing grant ideas with my postdoctoral fellow, attending a scientific meeting, etc. This type of variety allows me to use my creativity and exercise different parts of my brain in interesting and stimulating ways, as well as eliminate any threat of a mundane work life. Many physician-scientists also appreciate the constant learning and opportunity for advancement. After completing training and becoming an attending physician, some physicians are left with a sense of “what next,” which can lead to long-term job dissatisfaction. In academic medicine, there are constantly new goals to be met, and endless ways to grow and evolve. Flexibility and autonomy are also important factors that enhance job satisfaction. Not only are the work hours more flexible in general than in private practice, but the type of work, including the types of clinical activities and research endeavors, is also more flexible and under my control. These advantages lead to a deeply satisfying sense that I am contributing on multiple levels: directly to patients through clinical work, broadly to scientific knowledge through research, and to the education of future physicians and scientists through teaching.
There are also a number of disadvantages that should be considered when pursuing this pathway. The salary of a physician-scientist is lower than that of physicians in private practice, which can be worrisome for those with large amounts of student loans. However, programs such as the NIH loan repayment program help to decrease the burden by paying a substantial portion of medical school debt for physicians engaged in research. Second, a career as a physician-scientist requires a great deal of troubleshooting. Unlike the clinical training years, your career as a physician-scientist may not follow the trajectory and timetable that you have set in your mind. Technical problems will arise, experiments may not go as planned, grants may take multiple attempts to get funded, and papers will be rejected. This kind of uncertainty and rejection may be difficult to deal with given that physicians are accustomed to achieving each expected outcome within an expected timeframe. However, science does not tend to work this way. Troubleshooting and adaptability are part of the scientific process. In short, failure is an essential part of the journey toward success in this line of work.
Tips for Preparing for a Physician-Scientist Career
1) Choose Your Scientific Niche
For physicians, research training often begins late in the game during residency or clinical fellowship. Therefore, it is crucial to think long-term when choosing a research area. Choose an area that you are passionate about, while leveraging the resources and expertise at your given institution, as well as your own strengths and talents. Given our late start in scientific training, you want to avoid switching fields during or after fellowship, and establish a foundation for a continuous line of research. For example, I became interested in autonomic regulation and its role in the pathogenesis of high blood pressure and kidney disease during my Nephrology fellowship. I became passionate about human physiology research and felt that there was a critical gap in our understanding and approach to treatment in this area to which I could devote my career long-term while continuing to treat patients.
2) Seek Mentorship
There is a consensus that good mentorship is a critical component of research training that can determine success or failure. However, mentorship is not a passive process on the part of the mentee. The mentee is not a receptacle into which a mentor pours his or her wisdom and guides each step of the way. Rather, the mentee will gain more by being an active player in the mentor-mentee relationship. It is best to understand your training needs and then actively seek out mentors who can fulfill those deficits. To that end, it is difficult to find a single person who can fulfill all of your training needs; therefore, you may have separate mentors for your science, career development, work-life balance, etc. Therefore, your mentors may be outside of your division, department, or even institution. However, one common characteristic of your mentors should be an interest in seeing you succeed, and the ability to offer honest advice with your best interests at the forefront.
3) Write a Fellowship Grant
Having the experience of writing a grant during your fellowship training will be an invaluable asset during your first faculty position. Even if you are fortunate enough to be supported on an institutional training grant or have other guaranteed sources of funding, I would still highly recommend writing a fellowship grant. Why? The process of writing a grant allows you to formulate your short-term as well as your long-term objectives, and will serve as a useful springboard for your career development award application as a junior faculty member. Writing a fellowship grant will provide experience with formulating research aims and approach, grantsmanship and scientific writing, organization and submission process as the principal investigator, and responses to a summary statement. Submitting the first grant application is an arduous process with a steep learning curve; therefore, you do not want your first grant-writing experience to occur as a faculty member. Writing a fellowship grant will set you up for writing a much stronger career development award application as a faculty member.
4) Practice Independence
Practicing self-reliance during your training period will increase your likelihood of success when you are indeed independent. Although it may be easiest to go to your mentor with each problem or unexpected result, try your best to solve the issue initially as much as possible on your own. Doing so will improve your technical proficiency and troubleshooting abilities. Understand the nuts and bolts of every aspect of performing research, including IACUC or IRB process, data management, and safety monitoring. If possible, set up a lab or a new experimental protocol on your own. This experience will be invaluable when you start your first faculty job and need to set up your own lab. And importantly, don’t rush it. This training period is a golden opportunity to gain as much proficiency as possible before embarking on your own. As such, it is in your best interest to continue training until you feel sufficiently prepared to develop your own program.
5) Find the Right First Faculty Position
The criteria for determining the right first faculty position will depend on many factors, both professional and personal. For instance, you may be restricted to a certain city or state due to family reasons, or institutions with a specific patient population that you need for enrollment into your studies. There is not one single type of institution that will guarantee success, but rather many different institutions at which one has the potential to start a successful research career. What these institutions have in common is that the goals of the department align with your long-term career goals. For example, if the department’s goal is to recruit a clinician-educator but your goal is to establish an independent research career, then this is likely not a good fit, even if the institution is a top-tier research institution or promises you some degree of protected research time. If the department’s goal is to see you succeed in research, then it will be more open to providing resources and, importantly, protected time to develop your research program. At the same time, be sure to have a clear understanding of what you will need to be successful (lab space, clinical coordinator support, protected time, start-up funds, etc), and communicate those needs before you start the job. It is much more difficult to ask for these things after you have been hired.
Navigating the first faculty job and all of the new responsibilities will take time. Early on, invest your time into establishing your research career. You can always increase your clinical time later, but it is difficult to do the reverse. If possible, relate your clinical work and teaching to your research endeavors. In this way, your clinical work will inform your research, and your research will inform your clinical work. Moreover, you will further develop your scientific niche and your reputation as a leader (both clinically and scientifically) in your field. Be flexible and don’t give up. Remember that troubleshooting is part of the process. And lastly, don’t forget to enjoy your successes. They are well-deserved.