Advice for approaching research as a late bloomer

[inthezone2]

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I wanted to reach out to this community for some advice in terms of integrating more research into my career.

 

[Fencer]

Sure... but then is the networking thing, credibility to lead trials (even w MSCI), etc. After your fellowship, you will likely need to do at least a couple of years of sub-specialty (organ-based) with substantial research at one of the Big Oncology 4 (Dana Faber, MD And., Fred Hutch., or Sloan Kett.) or at NIH. There is a reason to the observation that the age to first R01 is the same for MD and MD/PhD investigators. It takes time to learn how to write competitive grants.

 

[inthezone2]

Sure... but then is the networking thing, credibility to lead trials (even w MSCI), etc. After your fellowship, you will likely need to do at least a couple of years of sub-specialty (organ-based) with substantial research at one of the Big Oncology 4 (Dana Faber, MD And., Fred Hutch., or Sloan Kett.) or at NIH. There is a reason to the observation that the age to first R01 is the same for MD and MD/PhD investigators. It takes time to learn how to write competitive grants.

I really appreciate your input. It makes sense. The R01 is a benchmark grant right? I see the average age for MD's getting those would be 45.

In your opinion how far behind the curve am I? Is my goal more of a pipedream w/o a PhD or first author pubs in hand already?

 

[Fencer]

Age is a funny concept. You are not that behind. Would you be happy stuck in a rural practice not doing research? Have burnout for 20 to 30 years... Even if you do what I said, you will have 30+ years of professional life expectancy. Would you want to set yourself to be successful doing what you love?

 

[inthezone2]

I do at least want to take an honest stab at becoming a physician scientist. regardless of how difficult the global funding scene is right now.

However, at the same time, I appreciate brutal honesty about my chances. If the ship has sailed, I am willing to pursue other avenues in life. I just don't want to invest time in something that is like a lottery ticket. I don't want to be the IMG trying to match orthopedic surgery, which is admirable, but ultimately futile.

 

[SurfingDoctor]

I dabbled in research in undergrad, medical school and residency which only netted me 1 mid-author publication and didn't get seriously about science till fellowship because it was only then that I realized what I was missing. There's been plenty of ups and downs along the way, but currently I'm super-jazzed about my experiments and the data I'm getting.

You do need to invest extra time/training and there is a good bit of luck along the way, BUT you'll never get a grant and get funding if you don't try (with some repeated failures along the way). Kinda obvious, but sometimes it's better to try and fail than to guess about the "what if".

 

[inthezone2]

I dabbled in research in undergrad, medical school and residency which only netted me 1 mid-author publication and didn't get seriously about science till fellowship because it was only then that I realized what I was missing. There's been plenty of ups and downs along the way, but currently I'm super-jazzed about my experiments and the data I'm getting.

You do need to invest extra time/training and there is a good bit of luck along the way, BUT you'll never get a grant and get funding if you don't try (with some repeated failures along the way). Kinda obvious, but sometimes it's better to try and fail than to guess about the "what if".

Haha, that's fair. Nothing ventured, nothing gained. I have a plan in place, but wanted to get a semi-reality check. It's good to see that my goal is still realistic.

 

[dl2dp2]

The likelihood of you getting an R01 (or something comparable) eventually is relatively low, IMO. Thankfully, if you want to be part of a team that engages in clinical trial work in oncology, this is not difficult if you are a board-certified oncologist. This is not a yes/no question. There are many pathways to engage research, some of which might work better for you than others.

If you are saying I need to be a NIH-sponsored PI or else, then no, I think your chance of getting there right now is let's say ~ 10%. It improves if your institution has a track record of training NIH-sponsored PIs (i.e. you are doing your heme onc fellowship at a facility that sponsors a lot of PIs, and there are a half dozen of them), but even people who completed fellowship training at those places, the chance of them getting a K award is about 20-50%, then another 50% or so become R01 level PIs. So your overall chance would improve from 10% to about 25%.

If you are not training at such a facility, and the likelihood of you training at such a facility in the future is low, then your chance of becoming an NIH-sponsored PI is substantially lower (< 10%). This becomes this FMG going for ortho situation--except worse, because NIH study section doesn't give you an answer as to when you should stop filing grants, that sort of thing.

 

[SurfingDoctor]

Just a caveat, many Hem/Onc clinical trials are not NIH funded and are instead industry or foundation funded. Of course, some of them are disease specific.

Funding Sources - Cancer Research | Resources for Cancer Researchers

www.umms.org

I don't know if that changes the calculus, but I still think you'll need an MSCI or something similar.

 

[inthezone2]

The likelihood of you getting an R01 (or something comparable) eventually is relatively low, IMO. Thankfully, if you want to be part of a team that engages in clinical trial work in oncology, this is not difficult if you are a board-certified oncologist. This is not a yes/no question. There are many pathways to engage research, some of which might work better for you than others.

If you are saying I need to be a NIH-sponsored PI or else, then no, I think your chance of getting there right now is let's say ~ 10%. It improves if your institution has a track record of training NIH-sponsored PIs (i.e. you are doing your heme onc fellowship at a facility that sponsors a lot of PIs, and there are a half dozen of them), but even people who completed fellowship training at those places, the chance of them getting a K award is about 20-50%, then another 50% or so become R01 level PIs. So your overall chance would improve from 10% to about 25%.

If you are not training at such a facility, and the likelihood of you training at such a facility in the future is low, then your chance of becoming an NIH-sponsored PI is substantially lower (< 10%). This becomes this FMG going for ortho situation--except worse, because NIH study section doesn't give you an answer as to when you should stop filing grants, that sort of thing.

Maybe this is a silly question, but what happens to those who get the K grant and don't make R01? I can't imagine you'd just stop doing research.

 

[SurfingDoctor]

I will be training at a facility that is in top 50 for NIH funding with even better distribution per PI.

Maybe this is a silly question, but what happens to those who get the K grant and don't make R01? I can't imagine you'd just stop doing research.

Yep, you kinda stop doing research and find something else. Usually they switch from a physician-scientist tenure track to a clinician-educator track. Maybe they do some research in other projects, but it’s not the same because the path to promotion is different for clinician-educators.

 

[inthezone2]

Yep, you kinda stop doing research and find something else. Usually they switch from a physician-scientist tenure track to a clinician-educator track. Maybe they do some research in other projects, but it’s not the same because the path to promotion is different for clinician-educators.

Ahh, thank you! It's great to see the academic advancement can still happen even if the research falls through.

 

[SurfingDoctor]

Ahh, thank you! It's great to see the academic advancement can still happen even if the research falls through.

I mean, this is by design. 1) The institution doesn't want to have faculty that are failures with no path forward as its a poor reflection of them and probably more importantly 2) it's a negative net cost to the institution to fire and hire someone for the exact same position at a junior faculty level.

 

[dl2dp2]

I will be training at a facility that is in top 50 for NIH funding with even better distribution per PI.

Maybe this is a silly question, but what happens to those who get the K grant and don't make R01? I can't imagine you'd just stop doing research.

You should ask around to see what their graduating fellows outcomes are. I suspect at a top 50 program, about 10-20% of heme/onc fellows eventually receive a K award and stay. Possibly lower. There's often a "research track", that people get on at these types of schools with an aim for a K award.

As of right now, your "chance" (i.e. totally number of people who have R01 who come from a spot like yours divided by total people who are someone like you) of eventually securing an R01 is somewhere between 5% and 15%, likely on the lower side.

This is not to say though that it's entirely the fault of the track itself. Research careers also pay a lot less. Out of the 10 fellows a year who graduate, perhaps 5 will end up in private practice making 500k. 4 will be in academic practice making 300k, 1 will end up in this research track starting at 150k. Is that really worth it? A lot of people say no to it and leave.

 

[inthezone2]

You should ask around to see what their graduating fellows outcomes are. I suspect at a top 50 program, about 10-20% of heme/onc fellows eventually receive a K award and stay. Possibly lower. There's often a "research track", that people get on at these types of schools with an aim for a K award.

As of right now, your "chance" (i.e. totally number of people who have R01 who come from a spot like yours divided by total people who are someone like you) of eventually securing an R01 is somewhere between 5% and 15%, likely on the lower side.

This is not to say though that it's entirely the fault of the track itself. Research careers also pay a lot less. Out of the 10 fellows a year who graduate, perhaps 5 will end up in private practice making 500k. 4 will be in academic practice making 300k, 1 will end up in this research track starting at 150k. Is that really worth it? A lot of people say no to it and leave.

Got it. Looks like it still boils down to putting in the effort and taking it one step at a time. I appreciate you taking the time to break it down for me.

 

[tortuga87]

You should ask around to see what their graduating fellows outcomes are. I suspect at a top 50 program, about 10-20% of heme/onc fellows eventually receive a K award and stay. Possibly lower. There's often a "research track", that people get on at these types of schools with an aim for a K award.

As of right now, your "chance" (i.e. totally number of people who have R01 who come from a spot like yours divided by total people who are someone like you) of eventually securing an R01 is somewhere between 5% and 15%, likely on the lower side.

This is not to say though that it's entirely the fault of the track itself. Research careers also pay a lot less. Out of the 10 fellows a year who graduate, perhaps 5 will end up in private practice making 500k. 4 will be in academic practice making 300k, 1 will end up in this research track starting at 150k. Is that really worth it? A lot of people say no to it and leave.

Actually curious -

How do you deal with the stress caused by rejected grants that you think actually contain great ideas?

How do you deal with the stress of spending so much more time writing grants than actually doing research?

What percent of time do you spend actually doing research versus writing grants, doing administrative duties and teaching?

What is your intrinsic motivation? Are you motivated more by making discoveries themselves so that the grants and prestige are just a means to make the discoveries? Or are you motived by the prestige and money that come as a consequence of making discoveries and getting grants? Honest question and do not mean to offend. If the latter, what would you advise someone who is motivated more by the former?

 

[dl2dp2]

Actually curious -

How do you deal with the stress caused by rejected grants that you think actually contain great ideas?

How do you deal with the stress of spending so much more time writing grants than actually doing research?

What percent of time do you spend actually doing research versus writing grants, doing administrative duties and teaching?

What is your intrinsic motivation? Are you motivated more by making discoveries themselves so that the grants and prestige are just a means to make the discoveries? Or are you motived by the prestige and money that come as a consequence of making discoveries and getting grants? Honest question and do not mean to offend. If the latter, what would you advise someone who is motivated more by the former?

Most grants get rejected. I don't feel particularly stressed because nobody cares if it has good ideas or not.

Writing grants IS doing research. There is no sharp boundary between admin and teaching and mentorship and collaborative work supervision etc, all of which is research broadly defined. I don't consider day-to-day lab work to be "research" to the extent that I don't consider tiling a brick to be real estate development.

Academic research makes very little money, and outside of say top 5 there's little prestige to the public eye, even with R01s. Also, on a personal level, I'm already wealthy and my practice is quite prestigious. So the answer to your question is that your assumptions about me or the academic career are not valid.

As to my advice to you--if you really care so much about some part of your job, then it seems very strange that you wouldn't just do something you don't like so you can get to do something you like.

 

[SurfingDoctor]

I think most people do research because they like findings out new things, dreaming up new ideas and enjoy when their ideas come to fruition (realizing that happens about 5% of the time). I don’t think there is really much more to that.

Clinical medicine is very protocolized and the “art” of it is slowly fading to be replaced by clinical practice guidelines. I mean, if it leads to better outcomes, that’s great, but it doesn’t really require the thought it used to. That’s kinda of the reason you’ve seen so much outsourcing of clinical jobs to people with less training. I use the lab and research as a place where I still get to be creative.

 

[StilgarMD]

That’s kinda of the reason you’ve seen so much outsourcing of clinical jobs to people with less training. I use the lab and research as a place where I still get to be creative.

I really wish we were made aware of more opportunities to do this outside of grant funded research. I know biotech and start ups exist, but I don't have any idea how to use the skills gained during medical training and a PhD to find work where I can be creative and involved in building something interesting which solves some problem for people.

 

[SurfingDoctor]

I really wish we were made aware of more opportunities to do this outside of grant funded research. I know biotech and start ups exist, but I don't have any idea how to use the skills gained during medical training and a PhD to find work where I can be creative and involved in building something interesting which solves some problem for people.

I mean, I’m not very privy to that world but there are opportunities for physician-scientists in industry. I know a very well funded physician-scientist who left NIH funding and academia to go work for private industry.

It’s not really the PhD (there’s lots of those), but the science coupled with the MD that is quite desirable.

 

[tortuga87]

Most grants get rejected. I don't feel particularly stressed because nobody cares if it has good ideas or not.

Writing grants IS doing research. There is no sharp boundary between admin and teaching and mentorship and collaborative work supervision etc, all of which is research broadly defined. I don't consider day-to-day lab work to be "research" to the extent that I don't consider tiling a brick to be real estate development.

Academic research makes very little money, and outside of say top 5 there's little prestige to the public eye, even with R01s. Also, on a personal level, I'm already wealthy and my practice is quite prestigious. So the answer to your question is that your assumptions about me or the academic career are not valid.

As to my advice to you--if you really care so much about some part of your job, then it seems very strange that you wouldn't just do something you don't like so you can get to do something you like.

After teaching a class, reviewing papers, meeting about a new department policy, writing the 3rd grant this year, teaching residents, presenting the same research findings for the 20th time, seeing my patients... maybe then finally scratch together a few hours to do research while being very tired... wait, the post doc will do it if I can just get this next grant funded

This is the ultimate goal? So much for wanting to go in the submarine yourself to discover the new species or having that moment of insight to come up with the special relativity equations... too busy with other things...

I guess im just too quixotic. It’s all good though... I graduated from mgh and I make a lot of money from rich patients in my exclusive practice... the guy who gets the grants also gets the credit nowadays, so I sleep well at night...

What are we doing???

 

[dl2dp2]

After teaching a class, reviewing papers, meeting about a new department policy, writing the 3rd grant this year, teaching residents, presenting the same research findings for the 20th time, seeing my patients... maybe then finally scratch together a few hours to do research while being very tired... wait, the post doc will do it if I can just get this next grant funded

This is the ultimate goal? So much for wanting to go in the submarine yourself to discover the new species or having that moment of insight to come up with the special relativity equations... too busy with other things...

I guess im just too quixotic. It’s all good though... I graduated from mgh and I make a lot of money from rich patients in my exclusive practice... the guy who gets the grants also gets the credit nowadays, so I sleep well at night...

What are we doing???

You need therapy and Lexapro ;-) This is not a career issue. This is a "you" issue. I'm focusing on #winning right now and don't have time for deep existential self-talk.

 

[inthezone2]

Even I know as a pre-residency scrub that the path to winning isn't through academics anymore. Medicine is slipping through the grasps of traditional academic institutions and into the hands of large healthcare organizations. If you want to win, it's being QIPS obsessed and becoming an admin + making good investments.

Unfortunately, I'm just too stupid to give up on a dream of being a stuffy professor in the academic tower.

 

[dl2dp2]

Even I know as a pre-residency scrub that the path to winning isn't through academics anymore. Medicine is slipping through the grasps of traditional academic institutions and into the hands of large healthcare organizations. If you want to win, it's being QIPS obsessed and becoming an admin + making good investments.

Unfortunately, I'm just too stupid to give up on a dream of being a stuffy professor in the academic tower.

I wouldn't say this. Many professors I know are highly #winning.

I actually can't think off the top of my head a single successful physician-scientist who's not also wealthy. This is not to say much of their income derives from what R01s are budgeting into their salary. In general this block of work is high value-add expertise that can be monetized if you know what you are doing.

You need to stop dichotomize incorrect assumptions and start thinking creatively. Focus on #valueadd. Focus on #relationships and less on protocols and pathways. There are many pathways to get to where you want to go if the right people can help you along the way. Ask the right people the right questions. I know this sounds really vague but the way to success is idiosyncratic. In my experience, if people like you, they *create* pathways for you when there isn't one. Another very common situation is where you don't even know what you don't know until you met the right people to tell you. It's quite amazing, actually.

 

[psychacad]

You need therapy and Lexapro ;-) This is not a career issue. This is a "you" issue. I'm focusing on #winning right now and don't have time for deep existential self-talk.

What is #winning? Does it vary with the audience? Didn't you say you worked 20 hours a week in South Florida and made 700k+ on the pysch board? Are you also a scientist? If so, you're def not working "20 hours".

Just saying, something is not adding up.