Sunday, May 20, 2018

Dear Future Independent Investigator in Nephrology ...

As part of an effort to organize some materials relevant to career development for budding physician-scientists in my division, I wrote the following letter and deposited it on a shared drive. Since it might be helpful to other renal fellows thinking about starting a research career, I wanted to also leave it here on RFN. I hope someone finds it helpful!

Dear Future Independent Investigator in Nephrology,

If you are reading this letter, congratulations! You either have chosen or are seriously considering a challenging but rewarding career path as a Physician-Scientist in one of the most complex fields in medicine. Your efforts will contribute much needed work in improving the lives and longevity of patients with kidney disease. You are a rare bird: during a time when the American nephrology work force hasn't been at its peak, you have proven yourself to be an excellent clinician and are poised to ask the most pressing and relevant scientific questions that will actually make a difference in clinic.

The purpose of this letter is to arm you with as much information as possible for you to land your academic dream job. In a perfect world, we wouldn’t have to worry about grants and papers – we could just do the science we love. And yes, you should absolutely work on the questions that keep you up at night. But to make that dream goal a reality, there are a few milestones to hit, which will be addressed here. During the fellowship / instructor years, you will need to work towards obtaining a career development award (CDA) - this is your golden ticket to getting a job as an independent PI. Someone high up the political ranks at a prestigious institution once told me that really the CDA, especially a non-institutional NIH K, is a "hunting license" to go land a job. It's a nod from the NIH that yes you can successfully obtain extramural funding and is a good stepping stone towards developing your own research program and obtaining future R-level funding. But let's get back to where you are right now, as a fellow.

The Science. Your first task at hand is to pick a feasible primary project that truly fascinates you. Don't pick one that you think will just lead to a convenient paper; if you're not interested in what you're studying, your motivation levels will be down, and on top of that you won't sell the strongest pitch to grant and paper reviewers. Your curiosity about your project will be a strong motivating factor to keep pushing it along. Do pick one that will lead to 2-3 solid first-author papers over the course of your training period. Be sure to have one primary project and at least one smaller low-risk side project, in case the primary project does not quite work out. With a good research mentor, this task shouldn't be too difficult; if there are problems with the project and you feel at odds with your mentor, you should seek advice from your other mentors, which brings me to my next point.

Mentors: It Takes a Village to Raise a Physician-Scientist. Having good mentoring is a key ingredient to success. It doesn't matter how smart you are; if you don't have solid mentoring, you may not be able to find your way. But here's the rub: there is no such thing as one great mentor who would be everything to you. Your primary research mentor may be absolutely fantastic, but he or she cannot be or provide everything you need. You'll have your primary research mentor, a separate career mentor who may or may not be directly in your field, a life mentor who is not your parent, and your peer mentors who have their boots on the ground and can provide directly helpful tips but also empathize with the day to day frustrations. And don't forget to be a good mentee - be organized, be receptive to feedback, take ownership of your projects/career/mistakes/successes, and make the most of your time with your mentors. To succeed, you'll be building your own village of mentors who can provide complementary perspectives and also keep you sane. Doing so takes effort, which brings me to ...

Persistence. The path you have chosen is certainly not the one of least resistance. Some people get lucky, but you can succeed even if you don't come across a scientific windfall. To succeed, you must persist. You must never give up. You will have good days, and you will have bad days, but through the bad days your resilience and drive will keep you moving forward. And yes, you will see on social media that your med school and residency classmates are enjoying expensive cars and vacations while you are still on a fellow / instructor salary, but you just have to refocus on the task at hand, even if it's a bad day. One of my friends and colleagues said to me, "You know, we are in this either because we love it so much that we won't give up, or because we are so bull-headed and stubborn that we keep hanging on because we don't want to admit ourselves that we made a crazy choice, or both." Some things might be out of your control, but how you respond to the unexpected in terms of bouncing back with resolve and determination will allow you to get the final outcome you want. 

Planning. Being organized and hitting the milestones outlined by your division and mentors will be key to making sure you are moving towards your goals in a timely manner. Plan out your projects, grants you may be expected to obtain, manuscripts to write – having a concrete timeline for these things will keep you on track career-development-wise so that you can continue to do the science you love.

Productivity. You can have all the most brilliant ideas in the world, but no papers means no street cred for funding. For the F32, you don't necessarily HAVE to have a first author paper to be funded, but it would certainly help as those awards also go to competing PhD candidates. For the K, you will definitely need more than one first author original research manuscript to be competitive, so this is a factor that needs to be planned - the papers can be small, so get what you can into print. Don't hold on to everything for the one Nature paper you're hoping to put out; publish and present as often as you can in the beginning because the feedback is part of your training too and because no one expects you to have a Nature paper as an MD fellow. Review papers don't count as much, but they are good to have in your Biosketch and can provide the background / significance of your grants.

Creating an Emerging National Profile. Part of the benefit of presenting at meetings is to get your name out there. It is also good to network when you can - sometimes good ideas and collaborations spring up from these interactions. Also, it is good to have that national profile building for the job search and to have it as a foundation for the more distant future when you are being considered for promotion. Yes, Twitter can help a little, but you want your reputation to be built on concrete achievements such as data presentation at meetings or engaging in concrete roles in national societies.

Taking Ownership. So physicians who haven't taken time off from school to go work in a non-academic job have a special phenotype of living an extended adolescence during training. This is good and bad, but now that you are emerging from the training phase of your life, it is important to understand that the next phase of your career development will require you to take control and ownership of how you want to shape your career. I sound like I am stating the obvious, but having such structured GME curricula and sometimes micromanagement during clinical service can leave you in the habit of passively going through the motions of completing requirements. Outside the GME umbrella, you are in control of your own destiny and chasing opportunities. I quite like that aspect of graduating from GME and actually found it empowering.

 *** When all of these elements are cooking together, you will get what you need in terms of funding to start your career. It is an exciting time to join the Physician-Scientist workforce in nephrology - there is much work to be done, and your success will benefit the lives of your patients. You've got this!

Jennie Lin, MD MTR
May 17, 2018

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