Building a Career as a Physician-Scientist in Academic Medicine in 2016

The journey to establish a career as a cardiologist in academic medicine is a long one and for many start prior to fellowship. I will share some of my experiences and try to provide some tips that I learned along the way either from my personal experience or that was shared by my peers. The commitment to the path of a physician-scientist is a serious one fraught with difficult obstacles and time pressures, but sprinkled with dozens of memorable moments. As challenging as it is, pursuing your own original questions that will add to our knowledge of diseases that have the potential to transform future treatment options is immensely gratifying.

Here I will discuss the formative years between fellow and junior faculty and offer some key points to consider. I try to dispense some general "advice" that is applicable whether you are a basic scientist dissecting cardiomyocyte biology, computational biologist assessing the genomics and proteomics of myocardial infarction or a clinical translational researcher directing clinical trials and collecting proof of concept data in humans. In this letter, I would like to focus on five important factors that are critical in making a successful transition to an independent junior faculty position:

  1. Finding Mentors
    We all know the importance of finding a good primary mentor who can help develop your science, maturity and prepare you for some of the "non-scientific" aspects of directing a research program. The primary mentor is the main person you go to for advice about your science who you do not need to schedule an appointment with weeks in advance. Often times, you are working in the mentor's lab or on a project with significant interest and synergy with your mentor. He will be invested in your success and take on the additional steps necessary to ensure your prompt arrival to your goals. The mentor need not be a senior faculty member but someone who can aid the mentee in rising to the next stage. The importance of having a great primary mentor cannot be overemphasized.

    That being said, it is essential to have multiple mentors. The main mentor is of paramount importance but it is often difficult for one person to cover all aspects of your mentoring needs. For example, you may be developing a new area of research in which a secondary mentor possesses expertise. Or one may have a clinical mentor and a separate scientific mentor. Your peers just a few years ahead of you can also serve as excellent mentors since they recently went through many of the same issues you are encountering.

  2. Choosing a Research Problem
    You need to find an important question that will provide ample motivation for you to answer it. Research takes time, energy and can be frustrating. So when you ask yourself, "Why am I doing this?" the answer should be readily apparent and refuel your desire to tackle the question. You will spend many, many hours and sometimes your whole career pursuing these questions!

    Identify a question that is worth asking rather than just taking the next step in a series of safe experiments. Design the experiment(s) that will yield decisive answers. One must be able to answer the problem in the current environment. If the tools, databases or technology are not available, then it would be wise to file the question away until a future time when you can drill down on the problem in a meaningful way. Or be prepared to construct the necessary experimental platform required to achieve your aim.

  3. Obtaining Funding
    This is one of the eye-opening moments as one segues from a fellow in training to a principle investigator. A carefully thought out plan to generate preliminary data, publish manuscripts and secure funding for longer term projects is the next big challenge that most trainees do not realize until later in their training. During fellowship training, this is a good opportunity to apply for your own independent funding. Although National Institutes of Health/National Heart, Lung and Blood Institute and the American Heart Association are traditional sources one thinks about in cardiology, there are other funding bodies out there. These other funding agencies may be very receptive to novel concepts and approaches from cardiovascular medicine and are likely to see fewer applications from cardiovascular researchers.

    Get a good scientist from outside your field to read your application! This is crucial because most of the reviewers will not be experts in your field. It is not inherently obvious to the reviewer how important your question is and how innovative your approach is. Your job is to guide the reviewer through the application in a simple and clear way. Complex experiments with a myriad of interpretations should be used cautiously if at all.

    Constructing and submitting a proposal is a valuable learning experience. However, do not submit if you are not ready. I do not follow the widely circulating belief that most grants now take at least one revision to get funded so it is okay to submit an ill-prepared grant application to get reviews. This usually results in either no comments (triaged grant) or short general comments that the grant needs a lot of work. In the end, this ends up to be an enormous waste of time.

  4. Clinical Role
    It is vital to coordinate your clinical training and activity during your research training years. At times you may need to focus more on research to complete the project. There are also scenarios where one devotes the majority of a one to two year stretch to subspecialty training such as interventional or electrophysiology fellowship leaving little to no time for research. Clearly, this decision is on a case by case situation and general recommendations do not apply here. Whatever choices you make, be sure that they permit you to reach your overall goals and discuss them with your chief in advance.

    After your training is complete and you are ready to establish a research program, the choices here are no less difficult. The clinical activity may be the cardiovascular care unit service or a highly specialized cardiovascular genetics clinic that is intimately connected to the investigator's research on finding genetic variants linked to dysrhythmias. As important as it is to hit the ground running and gain clinical experience as an attending, it is equally imperative to have the time and resources to build your research program.

  5. Transitioning to Academic Job and Timing
    Clinical fellowship training is near completion and you are now ready to take on your first faculty position. Clinical readiness and readiness to be an independent scientist do not necessarily follow the same time frame. Research training and publishing papers are time consuming and are not structured in the same way as medical school and postgraduate medical education. The advice here is to take any additional time necessary to learn the techniques, develop the expertise and scientific mind to make yourself a top candidate. Once you are independent, you are responsible for mentoring your trainees, managing research budgets and establishing research directions. Embrace the excitement ahead!

This article was authored by James C. Lo, MD, PhD, a cardiologist at the Metabolic Health Center at Weill Cornell Medicine in New York, NY.