Research while doing payback time

[Denny Crane]

Is it possible to do any significant research during HPSP payback time, probably after residency? I know it's probably more common at some locations than at others, but I heard once of people doing research and publishing (or at least preparing things to be published) while deployed to the Middle East. Any thoughts/comments?

As a side note, if one were to do lots of research during payback, would this make it easier to transition into an academic tenure-type position? Would one enter academia a few steps closer than the fresh residency grad to being a professor?

---

Members don't see this ad.

 

[DrMetal]

Is it possible to do any significant research during HPSP payback time, probably after residency? I know it's probably more common at some locations than at others, but I heard once of people doing research and publishing (or at least preparing things to be published) while deployed to the Middle East. Any thoughts/comments?

What kind of research are you trying to do? Case reports, perhaps small case series, retrospective studies, perhaps a small clinical trial . . .these things are doable in military medicine. If you're looking to do hard bench-top basic science, large clinical trials . . . not so much.

As a side note, if one were to do lots of research during payback, would this make it easier to transition into an academic tenure-type position? Would one enter academia a few steps closer than the fresh residency grad to being a professor?

Maybe, but I wouldn't bet on it. Most professors have an extensive research background, including 1 or 2 post-doc periods dedicated specifically to that task. Most military doctors don't have such experience. If it's academia that you really desire, best to go the civilian route (maybe consider joining the military as a reservist if you desire to serve).

 

[Perrotfish]

Is it possible to do any significant research during HPSP payback time, probably after residency? I know it's probably more common at some locations than at others, but I heard once of people doing research and publishing (or at least preparing things to be published) while deployed to the Middle East. Any thoughts/comments?

As a side note, if one were to do lots of research during payback, would this make it easier to transition into an academic tenure-type position? Would one enter academia a few steps closer than the fresh residency grad to being a professor?

My experience with military research has been somewhat more positive that the post above. The military, or at least the Navy, is surprisingly resource rich when it comes to research, all the more so because those resources are so underutilized. Those resources are also divided much more evenly across the ranks than you would expect at a civilian institution: as a senior attending our resources are standard to substandard, but for a junior attending your access to those resources is actually pretty impressive, and as a resident what I have the capibility to do is actually pretty unheard of. Resources I have access to right now:
1) A dedicated clinical research nurse who will do significant parts of my data mining, and who will do a significant part of the paperwork for my IRBs
2) An in house, responsive statistician who I do not need to find any funding for
3) A library research team able to do fairly extensive literature searches for me on short notice. Also an excellent library system with a great selection of journals.
4) For the ambitious: in house bench ID (bench) research facilities
5) A strong in house print shop able to generate poster presentations for me from a fairly limited word document
6) The corpsmen: in the projects I have worked with them on they are amazingly willing to do the legwork for research, especially the ones trying for either premedicine or a military career.
7) Most importantly: a very underutilized pool of command funding for both resident and faculty research. Most modest, in house prospective research projects can be funded without applying for any grants.
And I will have access to these resources (except the clinical research nurse) wherever I go in the world.

That being said, the military does also make things harder in other ways. For example
1) They will give you no time to do this research. None. Not one hour. Not one rotation in residency. They will fund your research, do most of the IRB, do most of the lit review, and the corpsmen will do some of the grunt work, but whatever your part of it is you will be doing on nights and weekends because you will not get a single clinic off for your project. If you do get the research done you need to focus on journal publications and in area weekend conferences. They will not only not fund a conference (in or out of town) for a poster presentation, they likely won't even give you time off to go unless you take it as vacation, so it has to be cheap and local if you want to do a poster at all.
2) Our EMR is very difficult to data mine. For retrospective reviews it can be very difficult to identify your target population.
3) You lack stability. If you want to do research you more or less need to pump out every IRB you're dreaming of in your first three months at a new command, because otherwise you will be moving on before you can finish your project.

On academic medicine: If your goal is definitely to work in an academic institution you should be aware that every physician who works with USUHS medical students, at any site, is eligible to become USUHS faculty. There's no extra pay for that, of course, but the title can allow you to move 'laterally' into academic medicine at the end of your obligation. If you show a real interest in medical student education at your site you can move up the ranks too: I have met multiple full professors at USUHS who have literally never worked on the school's campus in Bethesda. Its probably possible to move up from assistant to associate professor by the end of your first tour. You don't need to be at a major MTF for this either. Our FM residency sites, which are considered first tour locations for most specialties, have USUHS students rotating. If you really want to move into academic medicine work with your specialty leader to get assigned to a site with medical students, and fill out the paperwork to become USUHS faculty.

Maybe, but I wouldn't bet on it. Most professors have an extensive research background, including 1 or 2 post-doc periods dedicated specifically to that task. Most military doctors don't have such experience. If it's academia that you really desire, best to go the civilian route (maybe consider joining the military as a reservist if you desire to serve).

Most academic medicine attendings do not have extensive bench research experience or MD/PhDs, many have no real research background at all. Medicine might be the last field where you can easily be a full faculty member without ever publishing more than a few studies. I know senior faculty at top schools who have literally never published anything.

 

[DrMetal]

Resources I have access to right now:

Have you ever actually tried to use said resources? Done any quality research, lead to any publications, that have actully changed peoples' clinical practices? Likely not. We talk a lot about research in the military, often (as you just did) praising the resources that we have . . . but when we try to use said resources---in other words, when we try to make the rubber meet the road---things falter and you realize just how hard it is.

The fact of the matter is, with respect to most areas of research: nobody looks to the military to conduct large clinical trials (with N>20,000, several arms, etc etc) . . . we certainly don't do much basic science.

I'm an academic at heart, I love research . . .but I'll be the first to admit the military is not for those who want to dedicate their lives to academia, it's just not the right culture (nor should it be, that's not the main goal of military medicine).

That being said, the military does also make things harder in other ways. For example

This part of your post is more pain-fully accurate.

On academic medicine: If your goal is definitely to work in an academic institution you should be aware that every physician who works with USUHS medical students, at any site, is eligible to become USUHS faculty.

I'm not sure what you're involvment in the past has been with USUHS .....I was there as a student. It's not an ivory tower of research. There definitely is research going on there, but it's definitely not at the level you'd find say across the street, at NIH. It's a teaching institution, a good one at that. You can do research via USUHS, but it's limited.

Most academic medicine attendings do not have extensive bench research experience or MD/PhDs, many have no real research background at all. Medicine might be the last field where you can easily be a full faculty member without ever publishing more than a few studies. I know senior faculty at top schools who have literally never published anything.

What top schools and what senior faculty are you speaking of? You're gonna find me a medical school professor at UCSF, Mayo or Harvard, who hasn't published in his/her field? What on earth are you talking about???

 

[Denny Crane]

Thanks for the replies. Gosh I just cannot decide whether or not to go for HPSP. I mean, the money sounds good, and going 400k in debt (including interest and undergrad debt) is just pee your pants scary. I mean, how does anybody even function with that much debt hanging over their shoulders? But I certainly like my autonomy and living where I choose. The research thing could be the straw that breaks the camel's back. If they have good research opportunities, I'm still interested. If not, well I guess I would just have to take the debt haha and hate my life for a few years.

 

[Perrotfish]

Have you ever actually tried to use said resources? Done any quality research, lead to any publications, that have actully changed peoples' clinical practices? Likely not. We talk a lot about research in the military, often (as you just did) praising the resources that we have . . . but when we try to use said resources---in other words, when we try to make the rubber meet the road---things falter and you realize just how hard it is.

Short answer is yes. I have used almost all the resources listed above and have watched my classmates in Residency use the rest, and yes they have led to publications in first and second tier (mostly second tier) journals in our field. Not a ton and not anything that rocked the world of medicine (we are still residents) but yes the resources work and no they're not hard to utilize. As I said above they really did give me everything I needed to do research other than the time to do it.

The fact of the matter is, with respect to most areas of research: nobody looks to the military to conduct large clinical trials (with N>20,000, several arms, etc etc) . . . we certainly don't do much basic science.

If this is your standard for good research then you're right that the Military doesn't do a lot of good research. Of course by this standard the top journal in my field hasn't published any good research in at least the last year. Multi-arm prospective studies with an N>20,000? Are you f-ing kidding me?

I'm not sure what you're involvment in the past has been with USUHS .....I was there as a student. It's not an ivory tower of research. There definitely is research going on there, but it's definitely not at the level you'd find say across the street, at NIH. It's a teaching institution, a good one at that. You can do research via USUHS, but it's limited.

I think you missed the point of that part of the post post. The OP said he wanted to move into academic medicine after the military. While research is an important component of that, saying 'I am an associate professor at *** medical school' is dramatically more important. USUHS gives you the opportunity to move up the ranks of academic medicine even if you're not billeted at USUHS. I have seen faculty in my program finish their obligation (at 8 years in) and move directly into a mid career academic medicine position at a civilian institution by virtue of being non-billeted faculty at USUHS. If you want to be a tenure track professor, the best thing that the military can do for you is to testify that you already are one.

 

[Denny Crane]

As a side note, @Perrotfish , when I read your responses and look at your avatar simultaneously I get really excited because some part of me really believes I'm talking to Barney Stinson. Which is, wait for it, LEGENDARY

 

[DrMetal]

Of course by this standard the top journal in my field hasn't published any good research in at least the last year.

Possibly quite true, as might be the case in many fields. You look at the plethora of literature that's come out say over the last 5 years, and ask yourself, "Which papers have really stood the test of time and changed clinical practice?", the answer is in the realm of few, not many.

Multi-arm prospective studies with an N>20,000? Are you f-ing kidding me?

No I'm not f-ing kidding you, yes this is the standard for good research. Well-powered, large N, multi-arms, randomized controlled studies. Hell even with such "good" studies, there can be a lot of controversy . . . and so anything sub-par is even more questionable. In the military, we're not used to being involved in such large studies (which can take a decade to execute and write up), and so we get used to thinking that smaller studies are just as important and valuable....but they really aren't.

Thanks for the replies. Gosh I just cannot decide whether or not to go for HPSP. I mean, the money sounds good, and going 400k in debt (including interest and undergrad debt) is just pee your pants scary. I mean, how does anybody even function with that much debt hanging over their shoulders? But I certainly like my autonomy and living where I choose. The research thing could be the straw that breaks the camel's back. If they have good research opportunities, I'm still interested. If not, well I guess I would just have to take the debt haha and hate my life for a few years.

You're saying all the wrong things my friend. Autonomy, choosing where you live? An avid interest in research? The mil life might not be right for you. Find yourself a nice civilian MD PhD program (most of which come with a stipend and pay for themselves) . . . you can certainly join the military later if you still desire to serve.

 

[notdeadyet]

As a side note, if one were to do lots of research during payback, would this make it easier to transition into an academic tenure-type position? Would one enter academia a few steps closer than the fresh residency grad to being a professor?

You can become an academic at a top program via the military. You can also match into Derm from a Caribbean med school. It doesn't mean that either one is a smart plan.

Academic medicine is incredibly competitive. If going to military route was some kind of shortcut like some are describing, you would have a lot more folks going into the military route to do just that. Academic job titles sound impressive only outside of academia. Having a professor title because you have residents around looks great on paper, but most civilian academic places, at least the decent ones, will understand that for what it's worth.

Again, I'm not saying that going the military route will sabotage an academic medicine career. But for folks with that goal, it is hard to describe going to military route as being advantageous. It is very limiting. Even the more optimistic on this thread are describing resources that are available, but admitting that you will be doing it ALL on your own time in addition to a full time load. Most people in the military do not lead research projects and publish good research in reputable journals.

In a decent civilian academic residency program, you will get funding and support for research. At my place, I could have done a research pathway, in which I would have protected time all four years of my residency for research. Including up to 30% of my third year and up to 80% of my fourth year. This is not that uncommon in a good civilian residency program. This is folks applying to academic gigs tend to skew from academic programs.

The military is not the ideal start to a career in academics. It can certainly be done, but painting military GME and service as a smart strategy for preparing for a career in academics is sweet lemons.


Sent from my iPhone using Tapatalk

 

[Perrotfish]

No I'm not f-ing kidding you, yes this is the standard for good research. Well-powered, large N, multi-arms, randomized controlled studies. Hell even with such "good" studies, there can be a lot of controversy . . . and so anything sub-par is even more questionable. In the military, we're not used to seeing such large studies (which can take a decade to execute and write up), and so we get used to thinking that smaller studies are just as important and valuable....but they really aren't.
.

Virtually all of medicine is based on smaller trials than the kind you are proposing. This isn't a military thing, you just have a really warped idea of what qualifies as adequate research. Your definition of what's valuable also shows a very poor understanding of how you statistically power a study. A study that it significant at the 95% confidence interval is, by definition, a significant study. If the effect you're studying has a reasonable NNT then a large study isn't necessary to achieve significance at the 95 or even 99.9% confidence interval.

Large studies are only necessary if you're attempt to look effects so subtle that you need to examine very large populations to see a difference. Usually that means looking for rare side effects of a common intervention with very mild benefits that wouldn't outweigh a rare major side effect. Multiple arms are only necessary if you have some good reason to need to compare more than two interventions. The standard for good research is not that its a huge pain to do, its that you have a statistically significant result at the end of the research that advances science.

Possibly quite true, as might be the case in many fields. You look at the plethora of literature that's come out say over the last 5 years, and ask yourself, "Which papers have really stood the test of time and changed clinical practice?", the answer is in the realm of few, not many.

Again, WTF are you talking about? A huge chunk of the research that's been published in my field's top journal (Pediatrics) in the last 5 years has changed clinical practice. By 'changed clinical practice' do you mean 'revolutionized the way we understand the human body'? Medical research doesn't work like that. Our understanding of the body isn't so bad that it needs a revolution. Studies generally change clinical practice in one little tiny part of medicine. The study on UTI prophylaxis changes the way we order VCUGs on pediatric patients with a second culture positive UTI. A study on topical timolol changes the way we treat small hemangioms in toddlers. A study on early administration of Insulin in the NICU changes the way we approach glycemic control. Lots of small groups of scientists take little bites of research, and science advances.

 

[j4pac]

I've done far more research while on my fleet tour than in med school. You see issues, and you do what you can do address them. In med school you typically have a curriculum and that doesn't allow for as much creativity. You have more opportunities to piggyback in med school...but self-directed research does happen in the military very often. All the residency programs I interviewed at were very impressed that I had the initiative and dedication to see a self-directed research project through.

 

[Denny Crane]

Thanks for the replies. Yeah I don't want to do an MD/PhD. Not my thing. I definitely want to be a practicing physician first, and researcher second. My main draw to academics is teaching. But research would be cool, too. But I don't think I would be too happy having to take an entire year off of practicing for research. I want to have lots of patient care/resident responsibility and churn out a paper every now and then. As for taking a "shortcut," I don't think it would really be a shortcut as I would be putting in the same amount of years, just in the military and not in academics. I'm asking if it would be possible to transition into an academic position with the same amount of seniority as I would have if I started at the institution.

 

[Denny Crane]

This guy seems to dabble in research. He said he has co-authored 35 publications. I don't think I know enough about research to know how significant this is. I don't know how much more significant it is to be "head author" or whatever or if these are the types of studies MD's at academic institutions do that contribute to their advancement up the academic ladder.

 

[Denny Crane]

Perhaps another good question to ask is what are the chances of being stationed as an attending at a major medical center with residents so I can help train them?

 

[Perrotfish]

Perhaps another good question to ask is what are the chances of being stationed as an attending at a major medical center with residents so I can help train them?

Depends what you mean by major. The chance of being stationed at a major MTF (one of the 'big 3' hospitals in the Navy) where they train residents in your specialty, during your first three years after residency, is basically zero. They expect you to do at least one tour (3 years) at a small MTF, and preferably two (6 years) before they let you come back to a major MTF to work.

Your chances of being stationed at a mid sized MTF that trains family practice doctors and USUHS medical students, though, are actually pretty good. Not great, definitely not guaranteed, but if you make it clear that you have a strong desire to be involved in academic medicine and therefore desperately want to go to Camp Lejeune or Jacksonville your specialty leader might be able to accommodate you. You almost certainly could get to one of those sites after a chief year or a first tour at a small MTF without an FP residency.