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From Fellowship to Junior Faculty and the Health Status of the

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From Fellowship to Junior Faculty and the Health Status of the Triple Threat Faculty Member William J. Bremner, M.D., Ph.D. Professor and Chair – PowerPoint PPT presentation

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Title: From Fellowship to Junior Faculty and the Health Status of the


1
From 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
2
Goals 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

3
Patients
  • Learning from each one
  • Numbers
  • Increasing level of responsibility
  • Clinician-Teachers / Mentors
  • Learning to do research and teaching

4
Research
  • Mentorshipprimary, secondary
  • Track record of mentees
  • Lab facilities/environment
  • Space, equip, staff
  • Other trainees
  • Rarely if evera specific research question first

5
Teaching
  • Mentorship
  • Seek out excellent clinicians/teachers
  • Not so well supported financially
  • Very gratifying

6
Practice 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

7
Biotech opportunities
  • Both Ph.D.s M.D.s
  • Increasing locally
  • Tech Transfer/Intellectual Property (IP) issues

8
Academics
  • 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

9
Yearly 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

14
Department of MedicineFellowship Programs
  • ACGME Fellows 123
  • M.D. Fellows not in ACGME 68
  • Ph.D. Fellows 58
  • Other 1
  • Total 250

15
Department 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

16
Fellowship Salaries Sources
  • ACGME Fellows
  • Medical Center Stipends
  • Training Grants
  • Division Funds
  • Non ACGME Fellows
  • Research

17
Institutional Research Training Grants
  • T 32 Institutional National Research Service Award

18
Individual Fellowships
  • F 32 Postdoctoral Individual National Research
    Service Award
  • F 33 National Research Service Awards for Senior
    Fellows

19
Department of MedicineFellowship Programs
  • MD 151
  • MD, MPH 8
  • MD, PhD 32
  • PhD 58
  • Other 1
  • Total number of fellows 250

20
Agencies 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

21
Agencies 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

22
09-10 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

23
How to Support Fellow to Academic Position
  • Apply for
  • K awards
  • Foundations
  • Request support on mentors grants
  • Collaboration with other faculty

24
Years 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

25
K-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.

26
R0-1, etc
T32
27
Landing Sites
  • R-01 Classic benchmark
  • P Program Project Grants Project PI
  • U Interactive grants or PPGs - PI
  • VA Merit Award PI

28
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29
K 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.

30
Conclusions
  • 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

31
The 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

33
Physician-Scientists
  • Conduct medical research along entire continuum
  • Devote majority of effort to research
  • Vital and unique role in medical research
    enterprise

34
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35
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36
2006
1980
Sources IMPAC II Current and History Files and
AAMC Faculty Roster
September 2007, Age Distribution of NIH RPG
Investigators and Medical School Faculty
37
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38
Summary 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
39
Recipients 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

40
New 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

41
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42
Major Recommendations
  1. Attention and resources should be directed at
    repairing the leaking physician-scientist
    pipeline.

43
Major Recommendations
  1. Major changes should be made to the contemporary
    approach to mentoring physician-scientists.

44
Major Recommendations
  1. Institutions should proactively promote the
    advancement and minimize the attrition of women
    in physician-scientist careers.

45
Major Recommendations
  1. 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.

46
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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
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