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as published in the American Journal of Surgery, August 2006, Volume 192, Number 2
Colleen M. Brophy, MD, FACS Clinician scientists are in a unique position to communicate and collaborate with PhD scientists as well as with clinical colleagues. Essentials to pursue a basic science career successfully as a surgeon are explored. Clinician scientists are rare and surgical clinician scientists even rarer. The number of MDs (compared to MD/PhDs, and PhDs) as first-time applicants for National Institutes of Health (NIH) research project grant support has plummeted. If this progression continues , there will be no first-time MD applicants.1 This trend is ongoing in the midst of a Biotech Revolution in which the bridge between bench and bedside needs to be strengthened. Clinician scientists are in a unique position to communicate and collaborate with PhD scientists, as well as with clinical colleagues. This potential extinction of clinician scientists also means a tremendous opportunity exists for young surgeons. There will be fewer persons seeking funding for their research in a time when research dollars are increasing. To be successful in this endeavor, you need to clearly decide if this is the track in which you are interested. It is not an easy route to follow and requires an organized, focused, and motivated person. Therefore, the first major question is, are you sure you want to do this? Secondly, success requires a supportive environment (Table 1). The support must first and foremost come from the Surgical Department. It must be clear that the Chairperson and Division Chief support you in becoming a clinician scientist. The support of your clinical colleagues is also necessary (Table 2). Without this internal support, it will be nearly impossible to succeed. Table 1 - What You Need
Table 2 - Satisfying Multiple Constituencies
Thirdly, success requires a rich research environment and mentor. Junior faculty with identified mentors tend to publish more articles, have better employment opportunities, feel more confident about their capabilities, and are more satisfied with their careers.2 The mentor should be a senior and respected person who can serve as counselor, cheerleader, and a source of wisdom and resources. Make sure your mentor has a “track record” of mentoring others. The mentor also should have sufficient grant support for their own research effort, and be sufficiently established to assist you in your efforts without using your efforts to advance their own careers. It is not imperative that your mentor is a surgeon, but it is important that they are committed to the development of your career. One of the largest challenges is to identify an area of research investigation in which you want to devote your career. This area of investigation needs to be well coordinated with your clinical efforts, contain obtainable goals, and “light your fire.” This is a unique opportunity for you to decide “what disease you want to cure” and set forth to accomplish this goal. This specific area requires a tremendous amount of time and thought (Table 3). Table 3 - Choosing Your Research
Theme
Negotiating your first position before you arrive is another crucial element. In studies that have examined women in academic positions, research has determined that despite equivalent preparation for the position, fewer women than men achieve full professorship.3 The factors that may contribute to this disparity is that the cohort of women began their careers with more clinical and teaching responsibilities and less laboratory space and protected time. Find and use a “coach” to help you define your initial appointment. Factors to consider carefully are your sources of salary support. If your entire salary support is to be derived from the clinical income you generate, the chances you will have any protected time for research are minimal. To achieve success, some salary support should be derived from departmental, state, or federal (VA) funds ("hard" money and not soft money). Make certain the duration of time you will be supported on non-clinical revenue (“hard funding”) is defined in advance. A memorandum of understanding that defines your specific responsibilities (what percentage of your effort will be spent doing what specific activities) is an optimal way to memorialize the relationship between you and the institution. There is no realistic way for a surgeon to fully “protect” their time. If a patient needs you during your laboratory day, the patient comes first. However, one way to get institutional support for your research time is to obtain a career development award. These are mentored awards that require the institution to provide a specific commitment of your time to research. They also require you have a specific training program that ensures your progression to independent investigator. The premier program is the NIH Mentored Clinical Scientist Development Award (KO8), which provides 5 years of funding and an average success rate of 50%.4 Information about the program is available at the following Web site: www.nih.gov. The major impediment of the KO8 awards is the relatively low salary support ($75,000) provided, compared to clinical practice, which requires the department to provide additional support. In addition, many of the surgical societies provide initial career development awards, such as the Association for Academic Surgery (www.aasurg.org), American College of Surgeons (www.facs.org), and Society of University Surgeons (www.susWeb.org). If you have a full- or part-time (5/8 minimum) VA position, you are eligible for VA career development proposals (Type II Meritsee http://www1.va.gov/resdev/funding/CDP.cfm). You also should explore available grant funding through the societies specific to your discipline in surgery. The best approach is to prepare an application for a KO8 and then tailor it for the other awards. You will not be able to accept more than one award, but your chances improve the more options you keep open. One opportunity available to help with grant-writing skills is the American College of Surgeons’ Young Surgical Investigators Conference, held every two years near the NIH, which provides an ideal opportunity to understand the grant-writing process (ACS Web site: www.facs.org). In addition, use your mentor and other persons in your institution who have had success with grant writing to assist you in the process. The key to success in grant writing is to write early and write often (Table 4). Writing a proposal at the last minute nearly ensures its demise under review. If you complete your proposal early, you will have an opportunity for those who have been funded previously, or have been on review panels, to provide you with a “pre-review.” One rule of thumb is to have the proposal done a full month before the due date. This rule also allows you the chance to give a fresh look at the proposal prior to submission. Table 4 - Managing Your Scientific Life
An essential element of career development is to attend and present the results of your research at regional and national meetings, such as the Association for Academic Surgery, Surgical Forum (at the American College of Surgeons), and Society for University Surgeons. Also, numerous meetings relevant to your specialty or disease, which allows you to meet peers with similar interests/career goals, learn new techniques and /models, and develop outside collaboration. The ultimate measure of your career is your Curriculum Vitae, largely dependent on the papers you publish. Establish authorship at the onset of a project, in writing, which will prevent problems later. Additionally, it is necessary to establish independence from your mentor as your research progresses. To be successful in this transition, you will need to publish papers with yourself as last author that do not include your mentor in the authorship. The best way to approach this is to maintain open and frequent communication with your mentor. Transition from the career development to the independent investigator phase is an additional challenge. It requires the clinician scientist become independent of the mentor and apply for independent investigator awards (NIH RO1). Work closely with your mentor to ensure their support as you progress through this phase. Anyone who has survived medical school and residency training is by nature goal-oriented, success-oriented, and tenacious. Use those traits to your benefit and clearly and continuously identify, outline, and share your goals with yourself, your mentor, and the leaders in your department (Tables 5 and 6). Table 5 - Advice
Table 6 - Summary Points
References 1. Rosenberg LE,
Physician-Scientists, endangered and essential. Science 283:331-332, 1999. |
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