Report back from NINDS/AUPN conference (and some good news?)

[dl2dp2]

I don't know how many of you went to this conference. Just want to open a thread on this.

Summary: This is sponsored by NIH and NINDS with Association of University Professor of Neurology. Targeting MSTP students interested in clinical neuroscience, and more specifically in neurology. The roster and slides are posted on the web and if you look for it you'll find them.

And I just want to report a few of my impressions. Please don't flame me.

(1) Clinical departments in cognitive specialties (Neurology, Psychiatry, Pathology, etc.) are supportive (at least on paper) of a 80% research/20% clinical career. This means you can generally get hired after residency + fellowship.

(2) Clinical departments in procedural oriented specialties (Rad, anesthesia, rad onc, derm, etc.) are more interested in revenues brought in. But academic programs still want research oriented students.

(3) If you want a basic research career, you need to get a K-level grant during/after residency. This is ~1mil over 4-5 yrs. If you have a K-level grant you WILL get hired, and usually get multiple offers. There will be additional start-up funds at any reasonable institution.

(4) However, there is a catch: you'll be forced to do some clinical work, at least 1 day a week of clinics. Now if your research is related, then it's the perfect arrangement...but if not, it'll just be a waste of time. However, this is still far better than the deal from regular PhD->postdoc->fight for your faculty position route. You gradually transition into a full time research job once your R01 comes through.

(5) Women who are interested in this do exist and survive. The standard tenure clock delay is 6mth for a child. Negotiation is possible.

(6) If grants don't come through or your research stinks, you will be pushed into a full time clinical job. There may be a buffer for a few years via internal funding, but it won't last forever and you'll be marginalized meanwhile. This is important: pick a specialty you will enjoy because if not and you are faced with no grant funding, your life will be miserable.

(7) Salary information: at the level of fellowship: 70-80k a year, possibly higher once you get your K-level (i think this year it's 95k). Assistant Prof. 130-140k a year in cog specialties, ~180-200k for procedural oriented. This is good cause it's dramatically (well...) higher than a fresh postdoc. Just keep in mind your salary won't go lower just because you decided to do more research.

(8) Work hours: usually not bad, but variable. One female prof who is doing well @ a highly ranked private school: 8-5 M-F, one day a weekend at home. No call (big big plus).

Conclusion: overall it seems that the Clinician Scientist pathway is alive and well. The future is relatively bright. You can and will get jobs. Not enough MSTP students are going into it and many of these spots are being filled by regular MDs (loan forgiveness is very nice). This career pathway is a nice way to build a solid career in basic biomedical research. Hours are generally better than private practice (save a few specialties), but the income is definitely not there. The safety net exists. While much bitterness and uncertainty exist in science, this career path seems to still be one of the better paths in research, particularly research of a translational nature.

A few remaining questions are
(1) Why do neurology/psych/IM, if I can do anesthesia/rads and do unrelated research on the side?
Answer: It's much harder. These departments hand you lots of $$$$ to NOT do research, or do research of a much more applied nature. If this is your thing, go for it. (And, personally, I might go for it. )

(2) Why do MD/PhD if you can do MD with loan forgiveness?
Answer: Still not entirely clear to me. I think MD/PhD might have a more well-rounded training experience and less debt (even with loan forgiveness). Overall however I believe you can do everything with an MD only. In fact, this meeting confirmed my belief that if you want to do biomedical research related to diseases, do an MD, not a PhD. (unless you absloutely can't stand patients.)

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[RxnMan]

Very cool post. Thanks for the report. A couple of questions - When you're talking about "loan forgiveness," what exactly do you mean? The NIH LRP, or something else? And when you say Clinician Scientist pathway, that's referring to something like the ABIM Research Pathway, right?

As one of those, future-MDs-in-academia-who's-takin-your-research-job, I'd like to know.

 

[dl2dp2]

Very cool post. Thanks for the report. A couple of questions - When you're talking about "loan forgiveness," what exactly do you mean? The NIH LRP, or something else? And when you say Clinician Scientist pathway, that's referring to something like the ABIM Research Pathway, right?

As one of those, future-MDs-in-academia-who's-takin-your-research-job, I'd like to know.

NIH LRP is the main program, I think it's 30k/yr in research.
Clincian scientist pathway is a general umbrella term for people with MD and residency training to move into R01 supported research positions. This basically entails a research fellowship + K08/K23. ABIM is but one instantiation of a more organized program. Most clinician scientists did not go through any particular "named" pathway.

 

[Neuronix]

NIH LRP is the main program, I think it's 30k/yr in research.

I remember having a long and semi-detailed argument about LRP and I can't find it in the searches now. Anyhow, LRP is pretty much for clinical research, not basic science

 

[Doodledog]

(3) If you want a basic research career, you need to get a K-level grant during/after residency. This is ~1mil over 4-5 yrs. If you have a K-level grant you WILL get hired, and usually get multiple offers. There will be additional start-up funds at any reasonable institution.

(4) However, there is a catch: you'll be forced to do some clinical work, at least 1 day a week of clinics. Now if your research is related, then it's the perfect arrangement...but if not, it'll just be a waste of time.

A solid post but I'd like to make a few minor comments of a general nature (i.e. not related to neuroscience) in particular about these two point.

The 1 mil is a bit of a stretch and MOSTLY supports 80% of your salary with relatively little support for the actual research. That means you do have to be cautious about where you go and that THEY are willing to provide admin support and tech support. This may be provided "anywhere" but the level and type of support will be variable. So, be a good shopper here - you hold the power with the K-award. Look also at mentoring as the K-award is a mentored award. You won't get enough lab/tech/admin support with a K award to run an independent lab. It is true that you are highly marketable in any field - after all, you're coming with 80% of your salary, indirects and some other money. The real question, for any area, is what % of K awards lead to successful R01's?

The clinical work, even if unrelated to your research is not a waste of time. First, it is the reason you went MD/PhD or at least you SAID you wanted to do patient care when you interviewed with "me".. Second, depending on the type of work, it can be used to support additional salary or even moonlighting in some fields (this may be less true in neurology than other fields) and finally, as you noted, it is an important backup if you decide not to do a research career. Your first 5 years as an attending are key times to develop clinical skills and you don't want to lose this time as an MD/PhD.

Otherwise, I agree that the opportunities are there for MD/PhDs. The real future question is conversion to other grants after that first faculty grant.

 

[Doodledog]

I remember having a long and semi-detailed argument about LRP and I can't find it in the searches now. Anyhow, LRP is pretty much for clinical research, not basic science

I think we'd discussed before (I review applications for LRP) that the definition of "clinical" or "pediatric" research (the two main categories) is very broad and includes almost anything with any human component. I believe a large proportion if not most of the applications are lab based and many include cell biology and genetics. It may be true that they'd reject some cell/molecular work that is truly "basic" science, but no one should think that only clinical trials are acceptable here.

It is best to go to the LRP web page (I'd found it before) to review the criteria.

 

[Neuronix]

I think we'd discussed before (I review applications for LRP) that the definition of "clinical" or "pediatric" research (the two main categories).

Sigh, twas a good thread that now I can't find. I think the website is what makes me worry about clinical vs. basic science research. It's the insider info that makes you aware, oh yeah, you can do just about anything under the LRP. Hopefully that doesn't change. For me it's simply a matter of buyer beware. I wouldn't want someone to go in a certain direction assuming they will get a LRP only to get denied, as it is a competitive grant that claims to be oriented towards "clinical" research. I've heard several attendings citing the LRP at my institution but none seem to know the the details of actually getting one. This is why I'm cranky I will say with the year of hold up on my current grant, I'd sure hate to be forced to pay back my loans a year due to NIH mix-ups while I wait for my grant to go through... This whole situation has me very wary of ever applying for another NIH grant, but that's a conversation for somewhere else I guess.


Now that Tildy's around I can get the the insider's perspective *poke* *poke* My main gripe about that conference is that it seems to be Neurology only. I thought about going one year until I looked into it. The title is "Combining Clinical and Research Careers in Neuroscience" but to me that title is misleading. Was anything other than Neurology represented? Is Neurology the only career that can have clinical and research components of Neuroscience?

I dug up the flier for this year's conference and that bit kind of irks me.

Many of these individuals cite this course as playing a crucial role in their decision to pursue a clinician/scientist career in neuroscience, and we are excited to announce the sixth edition of this valuable course on "Combining Clinical and Research Careers in Neuroscience" to be held late June 6-7, 2008 at the JW Marriott Hotel in Washington, DC.

Alright!

We invite students who may be candidates for combined research and clinical careers in the neurosciences, i.e., future clinician-scientists, to apply to attend this meeting in Washington, DC.

Great! This sounds like it could be me...

An outstanding group of academic neurologists will discuss strategies for combining research and clinical activities from personal perspectives.

But I don't want to go into Neurology?

Our lab has had several NINDS grants and we're a Radiology lab. My training grant, which has been mired in paperwork for 10 months so I don't know if I'll ever see it, is even from the NINDS. So my gripe with that conference is calling it a clinical neuroscience conference but then having it be all about Neurology. There are many Neuroscience-oriented careers MD/PhDs are thinking about. To me it seems to be a better service to give MD/PhDs the viewpoint from many specialties.

Is this a common assumption at the NINDS--that to be a clinician/scientist in Neuroscience you must do Neurology? The first summary statement I got back on my training grant asked where my Neurology advising was, such as: do I have a Neurologist on my thesis committee. In my training goals section I stated plainly that I planned to go into Neuroradiology

 

[dl2dp2]

The real question, for any area, is what % of K awards lead to successful R01's?

I have this written down in my notes

According to Dennis Landis (Chair of Neurology @ Baylor) and husband of Story Landis (Director of NINDS), 40% of new K08s are funded. 75% of K08 cohorts eventually go on to get R01s. However, 43% of K08s failed to file for R01 during K08 support period, resulting in an unpleasant vacuum of tenure clock with only internal start-up money.

This is certainly encouraging in light of the recent <10% NIH-wide funding rate.

 

[RxnMan]

The MD/PhD forum has just erupted with interesting posts...

NIH LRP is the main program, I think it's 30k/yr in research...

Thanks for the clarification.

As an aside, depending on what speciality you choose, you can qualify for state-supported LRPs, without going the Northern Exposure route. I know of a few folks who have recieved $ based practicing medicine (IM, Peds, EM) in an urban underserved area. It's not much (5-10k/yr) but it helps. I have yet to see if these awards can stack with other LRPs.

...So, be a good shopper here - you hold the power with the K-award. Look also at mentoring as the K-award is a mentored award...

So you apply for a K without stating a specific mentor? I always assumed that you had to have a specific lab and PI support your application.

...Second, depending on the type of work, it can be used to support additional salary or even moonlighting in some fields (this may be less true in neurology than other fields) and finally, as you noted, it is an important backup if you decide not to do a research career. Your first 5 years as an attending are key times to develop clinical skills and you don't want to lose this time as an MD/PhD...

Every MD/PhD or MD researcher I've met has said the same thing. There are guys who go 100% into research, and I know of a few who have done well, but everyone reccomends keeping and refining your clinical skills (becoming board-certified) - it gives you just so many options.

...I review applications for LRP...

I'll have to remember this come residency. Do you take your bribes canned or in doggie treats?

...Hopefully that doesn't change...I've heard several attendings citing the LRP at my institution but none seem to know the the details of actually getting one. This is why I'm cranky ..

I've done some poking around on this subject too. The PD I know (in charge of a major basic-science oriented department) said that his fellows regularly get NIH LRPs and nearly wipe out their debt. I expect that a part of it is getting in with a department that has a history of successfully obtaining these (just like anything else...).

 

[Doodledog]

So you apply for a K without stating a specific mentor? I always assumed that you had to have a specific lab and PI support your application.

I'll have to remember this come residency. Do you take your bribes canned or in doggie treats?

I've done some poking around on this subject too. The PD I know (in charge of a major basic-science oriented department) said that his fellows regularly get NIH LRPs and nearly wipe out their debt. I expect that a part of it is getting in with a department that has a history of successfully obtaining these (just like anything else...).

No, for the K award you do have to have a mentor. However, it's not unheard of to move with an award. Also, it is common to finish fellowship without the K award and then move to a place with the "right" mentor to apply. But, you are correct that you do have to identify a mentor for both LRP and K award applications.

Tildy is very fond of bread - especially challah. However, I don't exactly get to choose which grants I review and of course, there's that pesky little conflict of interest thing....

As far as fellows "routinely" getting LRPs, I don't have the data in front of me but I do know that like all grants they are getting more competitive each year. Lots more folks applying and some are very strong. However, from a grant reviewer perspective, some really do stand out based on the proposed research, the applicant and the institution/mentor.

 

[Doodledog]

I have this written down in my notes

According to Dennis Landis (Chair of Neurology @ Baylor) and husband of Story Landis (Director of NINDS), 40% of new K08s are funded. 75% of K08 cohorts eventually go on to get R01s. However, 43% of K08s failed to file for R01 during K08 support period, resulting in an unpleasant vacuum of tenure clock with only internal start-up money.

This is certainly encouraging in light of the recent <10% NIH-wide funding rate.

Although I'm certain he is being honest with these numbers, they undoubtedly primarily reflect applications over the 1995-2005 time period when R01 funding was closer to 20% than the current about 10%. The 40% of K08s may still be close to true, but I bet that for those starting now, unless NIH funding really improves, will be fortunate to have 30-40% conversion instead of 75%. If we assume however, 50% conversion, that would still give 40% times 50% = 20% of K applicants ultimately getting an R01 (personally I think this is a high estimate, but at least a start). This isn't necessarily horrible, but I think is a bit fairer way of looking at it. Now, additionally, some will be able to get R01s without ever getting K (or similar training) awards, but this will probably also be harder 10 years from now.

The problem for current applicants to MD/PhD and similar programs is they won't be applying for these awards for 8-12 years or even longer so looking at any dataset from the 1995-2005 era is nearly useless in terms of predicting successful application.

Therefore, I think that it is helpful to see what any program has done in getting career researchers from their MD/PhD training, but guessing at the % likely to be fully funded independent investigators based on past data is questionable in terms of accuracy.

 

[Doctor&Geek]

So MD/PhDs are/aren't encouraged to get the Pathways to Independence award? Also I've heard that getting a prestigious postdoctoral fellowship i.e. Damon Runyan is highly useful for obtaining faculty positions.

 

[dl2dp2]

Although I'm certain he is being honest with these numbers, they undoubtedly primarily reflect applications over the 1995-2005 time period when R01 funding was closer to 20% than the current about 10%. The 40% of K08s may still be close to true, but I bet that for those starting now, unless NIH funding really improves, will be fortunate to have 30-40% conversion instead of 75%. If we assume however, 50% conversion, that would still give 40% times 50% = 20% of K applicants ultimately getting an R01 (personally I think this is a high estimate, but at least a start). This isn't necessarily horrible, but I think is a bit fairer way of looking at it. Now, additionally, some will be able to get R01s without ever getting K (or similar training) awards, but this will probably also be harder 10 years from now.

The problem for current applicants to MD/PhD and similar programs is they won't be applying for these awards for 8-12 years or even longer so looking at any dataset from the 1995-2005 era is nearly useless in terms of predicting successful application.

Therefore, I think that it is helpful to see what any program has done in getting career researchers from their MD/PhD training, but guessing at the % likely to be fully funded independent investigators based on past data is questionable in terms of accuracy.

Sigh...I was just trying to be positive...why oh why doth thou haveth to kill that glimmer of hope
I feel like i should just go into rad onc. or rads. or dermpath. and forget about research. Even just Private practice neuro/psych makes 200k with fellowship. When should we sell out? when that k doesn't pan out? the r01? tenure?

 

[Doodledog]

Sigh...I was just trying to be positive...why oh why doth thou haveth to kill that glimmer of hope
I feel like i should just go into rad onc. or rads. or dermpath. and forget about research. Even just Private practice neuro/psych makes 200k with fellowship. When should we sell out? when that k doesn't pan out? the r01? tenure?

Sorry...just trying to keep the numbers honest. Those who are committed to research should move forward - the opportunities are there. I just think that we have to recognize that the "gold standard" of R01s (and getting them renewed ) may not be the only measure of research success and is a very high academic bar.

K-Awards are good ones as they get a career started and take a lot of pressure off the starting block. But, they are not a pot of gold and I've unfortunately seen many folks with K awards end up in private practice within 5-8 years.

 

[RxnMan]

No, for the K award you do have to have a mentor. However, it's not unheard of to move with an award. Also, it is common to finish fellowship without the K award and then move to a place with the "right" mentor to apply. But, you are correct that you do have to identify a mentor for both LRP and K award applications...

OK, that makes sense. Just another few questions: At what time in their training do most applicants get their LRP award? Can you apply during your last year in residency, to have it awarded in-time with fellowship?

...As far as fellows "routinely" getting LRPs, I don't have the data in front of me but I do know that like all grants they are getting more competitive each year...

Going through the MD application process (and I guess grad school too...), I realized that some people will play up aspects of their program just to get someone interested, or purely for another warm body. Your skepticism is noted!

I remember the posted award rate for 1st-time NIH LRPs is in the neighborhood of 40%. Re-ups are ~60%.

 

[Doodledog]

OK, that makes sense. Just another few questions: At what time in their training do most applicants get their LRP award? Can you apply during your last year in residency, to have it awarded in-time with fellowship?

I remember the posted award rate for 1st-time NIH LRPs is in the neighborhood of 40%. Re-ups are ~60%.

It's amazing the range I've seen in application timing. What I expected was mostly PhD's at the end of their post-doc and MD/PhD's and MD's only at the end of fellowships. What I've seen is everything from surgical residents applying during their research years to faculty with several years experience applying. It can be difficult to put these in the "same" category as far as evaluating the potential for a research career. For MD and MD/PhD holders, I think that applications towards the end of fellowship (timed about the same as the K or other similar award applications) or after a year or so of faculty might be the most common.

I think the award rates you have sound about right. Re-ups are always going to do a bit better because they are, by definition, from folks who've impressed the reviewers once. I would like to see these categories separated out in grant review and funding decisions, but I do not think they are, certainly for review they are not.

 

[litmus]

FYI, information about the NIH Loan Repayment Programs (LRPs) can be found here: www.lrp.nih.gov.

The application cycle for the five extramural LRPs (Clinical Research, Pediatric Research, Health Disparities Research, Contraception and Infertility Research, and Clinical Research for Individuals from Disadvantaged Backgrounds) will be open September 1 through December 1, 2008, with awards announced in summer 2009.